bluuebunny/crossref_metadata_2025 huggingface dataset:
The study on bending performance of aluminum alloy honeycomb panel-beam composite grid structure
Authors: Wang Gang , Zhao Caiqi , Gu Ye , Ma Jun
Published: July 2020

Long-span space structures are particularly sensitive to their self-weight. In this paper, a honeycomb plate with a high strength and light weight is reliably connected to a single-layer aluminium alloy lattice shell to form a new type of combined lattice shell structure, which substantially improves the overall stiffness and stability of the lattice shell without a plate. The bending performance of the aluminium alloy honeycomb panel-beam combined grid structure (AAH combined grid structure) plays a key role in the stability of the combined lattice shell structure. Therefore, the bending performance of the AAH combined grid structure was studied through six groups of tests and refined finite element models. Then, the calculation formula for the equivalent bending stiffness of the AAH combined grid structure was obtained through a theoretical analysis. The results show that the contribution of the honeycomb structure to the stiffness of the structure is very obvious, and the proposed formula provides the theoretical basis and a practical method for the engineering design of new aluminium alloy combined lattice shell structures in the future.
Application of change-point analysis to the selection of representative data in creep experiments
Authors: Zomorodpoosh Setareh , Volz Nicklas , Neumeier Steffen , Roslyakova Irina
Published: July 2020

The high volume of data resulting from a rapidly increasing number of experiments in materials science necessitates an efficient preparing of the data before any analysis. In addition, due to the large datasets in some experiments, it is essential to reduce the data sample to a small number of representative data points. In this study, three statistical methods for the change-point analysis are tested for the automated selection of representative creep data which provides large possibilities to speed up the data preparation for their further analysis. Moreover, this approach aids the practitioner to produce consistent and unique representative data for each experiment more efficiently.
Machine learning in physics: the pitfalls of poisoned training sets
Authors: Fang Chao , Barzeger Amin , Katzgraber Helmut G
Published: July 2020

Known for their ability to identify hidden patterns in data, artificial neural networks are among the most powerful machine learning tools. Most notably, neural networks have played a central role in identifying states of matter and phase transitions across condensed matter physics. To date, most studies have focused on systems where different phases of matter and their phase transitions are known, and thus the performance of neural networks is well controlled. While neural networks present an exciting new tool to detect new phases of matter, here we demonstrate that when the training sets are poisoned (i.e. poor training data or mislabeled data) it is easy for neural networks to make misleading predictions.
Correlating nuclear morphology and external force with combined atomic force microscopy and light sheet imaging separates roles of chromatin and lamin A/C in nuclear mechanics
Authors: Hobson Chad M. , Kern Megan , O’Brien E. Timothy , Stephens Andrew D. , Falvo Michael R. , Superfine Richard
Published: July 2020

Chromatin and lamin A/C separately resist strain in nuclear volume and surface area, respectively, during compression as studied with combined atomic force microscopy and light sheet imaging. Chromatin decompaction further alters curvature dynamics during indentation.
Characterization of FFPE-induced bacterial DNA damage and development of a repair method
Authors: Flores Bueso Yensi , Walker Sidney P , Tangney Mark
Published: July 2020

Formalin-fixed, paraffin-embedded (FFPE) specimens have huge potential as source material in the field of human microbiome research. However, the effects of FFPE processing on bacterial DNA remain uncharacterized. Any effects are relevant for microbiome studies, where DNA template is often minimal and sequences studied are not limited to one genome. As such, we aimed to both characterize this FFPE-induced bacterial DNA damage and develop strategies to reduce and repair this damage. Our analyses indicate that bacterial FFPE DNA is highly fragmented, a poor template for PCR, crosslinked and bears sequence artefacts derived predominantly from oxidative DNA damage. Two strategies to reduce this damage were devised – an optimized decrosslinking procedure reducing sequence artefacts generated by high-temperature incubation, and secondly, an in vitro reconstitution of the base excision repair pathway. As evidenced by whole genome sequencing, treatment with these strategies significantly increased fragment length, reduced the appearance of sequence artefacts and improved the sequencing readability of bacterial and mammalian FFPE DNA. This study provides a new understanding of the condition of bacterial DNA in FFPE specimens and how this impacts downstream analyses, in addition to a strategy to improve the sequencing quality of bacterial and possibly mammalian FFPE DNA.
Hypertension and Alzheimer’s disease: indirect effects through circle of Willis atherosclerosis
Authors: Eglit Graham M L , Weigand Alexandra J , Nation Daniel A , Bondi Mark W , Bangen Katherine J
Published: July 2020

Hypertension is common among older adults and is believed to increase susceptibility to Alzheimer’s disease, but mechanisms underlying this relationship are unclear. Hypertension also promotes circle of Willis atherosclerosis, which contributes to cerebral hypoperfusion and arterial wall stiffening, two potential mechanisms linking hypertension to Alzheimer’s disease. To examine the role of circle of Willis atherosclerosis in the association between hypertension and Alzheimer’s disease neuropathology, we analysed post-mortem neuropathological data on 2198 decedents from the National Alzheimer’s Coordinating Center database [mean (standard deviation) age at last visit 80.51 (1.95) and 47.1% female] using joint simultaneous (i.e. mediation) modelling. Within the overall sample and among Alzheimer’s dementia decedents, hypertension was indirectly associated with increased neuritic plaques and neurofibrillary tangles through its association with circle of Willis atherosclerosis. Similar indirect effects were observed for continuous measures of systolic and diastolic blood pressure. These results suggest that hypertension may promote Alzheimer’s disease pathology indirectly through intracranial atherosclerosis by limiting cerebral blood flow and/or dampening perivascular clearance. Circle of Willis atherosclerosis may be an important point of convergence between vascular risk factors, cerebrovascular changes and Alzheimer’s disease neuropathology.
China’s Belt and Road Initiative: Patron-Client and Capture in Cambodia
Authors: Young Sokphea
Published: July 2020

The launch of China’s Belt and Road Initiative (BRI) has sparked scholarly interest in understanding how global Chinese capital has entered and faced the unique challenges often associated with the business and regulatory environments of developing economies. Drawing on the case of Cambodia, this article seeks to understand: (i) how the new generation of overseas Chinese investors and companies, in the era of BRI, acquire licences and secure business operation in developing economies and (ii) how these investments cope with the host country’s regulatory institutions, including grassroots communities and civil society organizations. The article argues that, while the BRI’s Chinese investors have played a crucial role in the Cambodian economy, this injection of capital has co-opted and exacerbated the ambiguity of Cambodia’s regulatory environment. These Chinese investors have perpetuated the host country’s socio-political culture of patron-client networks, partly entrenched by the Sino-Cambodian elites. These networks are necessary to tap into secure investment operations, and they duly capture (and influence) regulatory institutions at the expense of marginalized communities and civil society organizations. Drawing on Cambodia’s case, the article contributes to the understanding of patron-client relations and regulatory capture in the context of socio-legal studies and the political economy of China’s global capitalism.
Acquired aortopulmonary fistula: a case report
Authors: Mahmoud Osama , Elias Hadi , Rafiq Arsalan , Alsaid Amro
Published: July 2020

Background

Aortopulmonary fistula is a rare complication of ascending aorta pathology. Presentation is most commonly dramatic with acute onset chest pain or heart failure secondary to left to right shunting. We describe a patient with acquired aortopulmonary fistula who had an insidious onset of heart failure as his presenting complaint. We also highlight the utility of multimodality cardiac imaging in establishing the diagnosis.

Case summary

A 79-year-old male patient with a history of coronary artery bypass graft surgery and mechanical aortic valve replacement, 23 years prior, presented with exertional dyspnoea of 7 months duration. An initial workup that included transthoracic and transoesophageal echocardiography as well as coronary and bypass graft angiography failed to diagnose an acquired aortopulmonary fistula complicating an ascending aortic pseudoaneurysm. Upon referral to our institution, the correct diagnosis was suspected on off-axis transthoracic echocardiography. The fistula was subsequently confirmed, and the extent of ascending aorta pathology defined via a multimodality imaging approach that consisted of transoesophageal echocardiography and cardiac computed tomography. The patient underwent successful surgical repair and was discharged in a stable condition.

Discussion

Acquired aortopulmonary fistula is a rare clinical entity. We describe a patient who had an insidious presentation of heart failure and found to have a large ascending aortic aneurysm that eroded into the main pulmonary artery creating a fistulous communication. The diagnosis was delayed and required a high index of suspicion and multimodality cardiac imaging.
A case report of myocardial infarction with non-obstructive coronary artery disease: Graves’ disease-induced coronary artery vasospasm
Authors: Klomp Margo , Siegelaar Sarah E , van de Hoef Tim P , Beijk Marcel A M
Published: July 2020

Background

Coronary artery spasm can occur either in response to drugs or toxins. This response may result in hyper-reactivity of vascular smooth muscles or may occur spontaneously as a result of disorders in the coronary vasomotor tone. Hyperthyroidism is associated with coronary artery spasm.

Case summary

A 49-year-old female patient with a 2-day history of intermittent chest pain and electrocardiographic evidence of myocardial ischaemia was referred for emergency coronary angiography. This revealed severe right coronary artery (RCA) and left main (LM) coronary artery ostial vasospasm, both subsequently relieved with administration of multiple doses intracoronary nitroglycerine. Intravascular optical coherence tomography showed absence of atherosclerosis and no evidence of thrombus or dissection confirming the diagnosis of coronary artery vasospasm. Laboratory tests of the thyroid function were performed immediately after coronary angiography revealing Graves’ disease as the cause of vasospasm.

Discussion

Our case represents a rare presentation of Graves’ disease-induced RCA and LM coronary artery ostial vasospasm. In patients with coronary artery vasospasm thyroid function study should be mandatory, especially in young female patients.
Endovascular iliac vein recanalization for permanent pacemaker implantation in a patient who has long-term haemodialysis: a case report
Authors: Stoyanov Nikolay , Goranovska Valya , Gegouskov Vassil , Velchev Vasil
Published: July 2020

Background

In chronic haemodialysis patients central veins occlusion occur very often. In such patients, permanent pacemaker placement implantation can be challenging and alternative approaches should be used.

Case summary

This is a case of 66-year-old male patient with complete atrioventricular block after a mitral valve (MV) surgery for endocarditis. The patient has a permanent surgically inserted haemodialysis catheter in right heart atrium after several unsuccessful attempts of endovascular recanalization of superior vena cava. A lead was implanted in the right ventricle after successful endovascular revascularization of the right iliac vein. The pacemaker was placed in a pouch on the right lower abdominal wall.

Discussion

To our knowledge, this is the first reported case where a permanent single-chamber pacemaker was implanted through the right iliac vein after successful endovascular recanalization in chronic haemodialysis patient post-MV replacement.
“Monuments of Folly”: Frederick Douglass, Charlottesville, and the National Religions of America
Authors: Lê David
Published: July 2020

Heather Heyer’s murder at a 2017 white supremacist rally in Charlottesville, which was organized to defend a monument to Robert E. Lee, offers an occasion to reflect on Robert Bellah’s notion of “American civil religion.” Here I seek to reconstruct that concept in terms of “American national religion” to train scholarly attention on the privileged roles of nation and race in organizing the religion of Americans, as Americans. By looking at the material forms of this religion through the lens of Frederick Douglass’s writings about American national memorialization, I argue that we can better assess the actual as opposed to the ideal content of this religion. We can, further, avoid the Pollyannaish race-blindness endemic to the scholarly discourse on American civil religion. My reconstruction foregrounds a model of “hegemonic articulation” in which violence, power, and exclusion are taken to be the rule, rather than the exception, in defining America’s national religion.
Shared Liability and Excessive Care
Authors: Guttel Ehud , Procaccia Yuval , Winter Eyal
Published: July 2020

Extensive literature has shown that assignment of liability for a single harm to multiple injurers undermines incentives for optimal care. As each potential injurer anticipates bearing only a fraction of the harm, incentives to take precautions are often diluted. The dilution-of-liability concern has led theorists to propose sophisticated apportionment rules to restore optimal incentives. This article demonstrates, however, that shared liability also gives rise to the converse risk, namely, it induces injurers—whether subject to negligence or strict liability—to invest excessively in care. Furthermore, unlike its extensively analyzed counterpart, the risk of excessive care arises under any apportionment regime. While apportionment rules cannot eliminate the problem of excessive care, we suggest other means by which the problem can be addressed (JEL D62, D86, K13).
Gain-of-function mutant p53 in cancer progression and therapy
Authors: Zhang Cen , Liu Juan , Xu Dandan , Zhang Tianliang , Hu Wenwei , Feng Zhaohui
Published: July 2020

p53 is a key tumor suppressor, and loss of p53 function is frequently a prerequisite for cancer development. The p53 gene is the most frequently mutated gene in human cancers; p53 mutations occur in >50% of all human cancers and in almost every type of human cancers. Most of p53 mutations in cancers are missense mutations, which produce the full-length mutant p53 (mutp53) protein with only one amino acid difference from wild-type p53 protein. In addition to loss of the tumor-suppressive function of wild-type p53, many mutp53 proteins acquire new oncogenic activities independently of wild-type p53 to promote cancer progression, termed gain-of-function (GOF). Mutp53 protein often accumulates to very high levels in cancer cells, which is critical for its GOF. Given the high mutation frequency of the p53 gene and the GOF activities of mutp53 in cancer, therapies targeting mutp53 have attracted great interest. Further understanding the mechanisms underlying mutp53 protein accumulation and GOF will help develop effective therapies treating human cancers containing mutp53. In this review, we summarize the recent advances in the studies on mutp53 regulation and GOF as well as therapies targeting mutp53 in human cancers.
Lucilia bufonivora, Not Lucilia silvarum (Diptera: Calliphoridae), Causes Myiasis in Anurans in North America With Notes About Lucilia elongata and Lucilia thatuna
Authors: Whitworth T L , Bolek Matthew G , Arias-Robledo G
Published: July 2020

In North America, until recently, all cases of anuran myiasis were attributed to Lucilia silvarum (Meigen) or Lucilia elongata Shannon. The latter species is exceedingly rare and its life history is unknown, but L. silvarum is common and was thought to be capable of being either parasitic or saprophytic in North America. Until recently, the anuran parasite Lucilia bufonivora Moniez was thought to be strictly Palearctic, but a study in 2014 has determined this species is established throughout southern Canada. In 2019, a study demonstrated, with molecular and morphological evidence, that two adult flies formerly identified as L. silvarum and reared from amphibian myiasis cases from Canada, are actually L. bufonivora. Although the mentioned study detected relatively high genetic distances with European L. bufonivora, the lack of evident morphological differentiation suggest that they are the same species. The current study examined 12 adult males and eleven adult females morphologically from three additional North American studies. Specimens were examined which had been identified as L. silvarum or L. elongata, and they all proved to be L. bufonivora. We now suspect L. silvarum is strictly saprophagous in North America like they are in the Palearctic Region. We also provide evidence that the pattern of myiasis differs between European and North American specimens.
Host/genetic factors associated with COVID-19 call for precision medicine
Authors: Thierry Alain R
Published: July 2020

If the current rate of infection are to be better managed, and future waves of infection kept at bay, it is absolutely necessary that the conditions and mechanisms of exposure to Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) be better understood, as well as the downstream severe or lethal clinical complications. While the identification of notable comorbidities has now helped to define broad risk groups, the idiosyncratic responses of individual patients can generate unexpected clinical deterioration that is difficult to predict from initial clinical features. Thus, physicians caring for patients with COVID-19 face clinical dilemmas on a daily basis. The ability to decipher individual predispositions to SARS-CoV-2 infection or severe illness, in light of variations in host immunological and inflammatory responses, in particular as a result of genetic variations, would be of great benefit in infection management. To this end, this work associates the description of COVID-19 clinical complications, comorbidities, sequelae, and environmental and genetic factors. We also give examples of underlying genomic susceptibility to COVID-19, especially with regard to the newly reported link between the disease and the unbalanced formation of neutrophil extracellular traps. As a consequence, we propose that the host/genetic factors associated with COVID-19 call for precision medicine in its treatment. This is to our knowledge the first article describing elements towards precision medicine for patients with COVID-19.
Use of precision-fed cecectomized rooster assay and digestible indispensable amino acid scores to characterize plant- and yeast-concentrated proteins for inclusion in canine and feline diets1,2
Authors: Reilly Lauren M , von Schaumburg Patrick C , Hoke Jolene M , Davenport Gary M , Utterback Pamela L , Parsons Carl M , de Godoy Maria R C
Published: July 2020

Increased consumer interest in high-quality and novel protein sources has driven the demand for the inclusion of protein-rich ingredients in companion animal diets. Novel protein concentrates, with protein contents of at least 50%, have been used to satisfy these consumer demands. However, minimal information is available regarding the macronutrient composition and protein quality of these ingredients that is needed for proper formulation of pet foods. Therefore, the objectives of this study were to determine the macronutrient and amino acid compositions, standardized amino acid digestibility according to the precision-fed rooster assay, and protein quality using digestible indispensable amino acid score (DIAAS like) of pea protein (PP), potato protein (POP), faba bean protein (FBP), soy protein concentrate (SPC), and dried yeast (DY). Precision-fed rooster assays were conducted using cecectomized roosters to calculate standardized amino acid digestibility and true metabolizable energy corrected for nitrogen (TMEn). For all five protein concentrates, all essential amino acids were highly digestible (88.0% to 96.3%, dry matter basis) with differences (P < 0.05) in only lysine, methionine, and tryptophan digestibilities. The TMEn values were highest for POP (4.22 kcal/g) and DY (3.61 kcal/g). The DIAAS-like values for adult dogs indicated that methionine was the first-limiting amino acid in all protein concentrates except POP, where the first-limiting amino acid was tryptophan. Using Association of American Feed Control Officials (AAFCO)-recommended values for adult cats, DIAAS-like values for methionine were lowest (P < 0.05) for FBP at 81.5%, with all other amino acids for all protein concentrates over 100%. The National Research Council (NRC)-recommended allowances for adult cats indicated that DIAAS-like methionine values for PP (92.7%) and FBP (73.8%) were significantly lower (P < 0.05) with these being the first-limiting amino acids, with the remaining amino acids above 100% for the other protein concentrates. The protein quality and high essential amino acid digestibility of these protein concentrates indicate that they would be viable protein sources in canine and feline diets. However, additional complementary protein sources should be included to meet the requirements of all essential amino acids.
Bacillus amyloliquefaciens Strain PMB05 Intensifies Plant Immune Responses to Confer Resistance Against Bacterial Wilt of Tomato
Authors: Ho Ting-Hsin , Chuang Chiao-Yu , Zheng Jing-Lin , Chen Hong-Hua , Liang Yu-Shen , Huang Tzu-Pi , Lin Yi-Hsien
Published: July 2020

Tomato is an economic crop worldwide. Many limiting factors reduce the production of tomato, with bacterial wilt caused by Ralstonia solanacearum being the most destructive disease. Our previous study showed that the disease resistance to bacterial soft rot is enhanced by Bacillus amyloliquefaciens strain PMB05. This enhanced resistance is associated with the intensification of pathogen-associated molecular patterns (PAMP)-triggered immunity (PTI). To determine whether the PTI-intensifying Bacillus spp. strains are able to confer disease resistance to bacterial wilt, their effects on PTI signals triggered by PAMP from R. solanacearum and on the occurrence of bacterial wilt were assayed. Before assay, a gene that encodes harpin from R. solanacearum, PopW, was applied as a PAMP. Results revealed that the B. amyloliquefaciens strain PMB05 was the one strain among 9 Bacillus rhizobacterial strains which could significantly intensify the PopW-induced hypersensitive response (HR) on Arabidopsis leaves. Moreover, we observed that the signals of PopW-induced reactive oxygen species generation and callose deposition were increased, confirming that the PTI was intensified by PMB05. The intensification of the PopW-triggered HR by PMB05 in Arabidopsis was reduced upon treatment with inhibitors in PTI pathways. Furthermore, the application of Bacillus spp. strains on tomato plants showed that only the use of PMB05 resulted in significantly increased resistance to bacterial wilt. Moreover, the PTI signals were also intensified in the tomato leaves. Taken together, we demonstrated that PMB05 is a PTI-intensifying bacterium that confers resistance to tomato bacterial wilt. Screening of plant immunity intensifying rhizobacteria is a possible strategy to control tomato bacterial wilt.

[Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
New options for managing fecal incontinence in women
Authors: Stanton Amanda P. , Chen Anita H.
Published: July 2020

Fecal incontinence often is underreported and can be associated with both social embarrassment and isolation. As patients often do not proactively discuss their symptoms, healthcare providers should screen for this distressing condition. The cause of fecal incontinence often is multifactorial, so no single therapy can guarantee perfect, risk-free outcomes. This article reviews the limited therapies for managing fecal incontinence, including a minimally invasive vaginal control device that may offer hope for managing fecal incontinence in women.
Eliminating horizontal violence from the workplace
Authors: Tedone Deborah A.
Published: July 2020

The term horizontal violence (HV) is synonymous with nurse-to-peer incivility or bullying. This article examines why HV continues to plague the nursing profession and discusses tools and strategies for eliminating this toxic behavior from the workplace.
Mechanisms of Mindfulness Meditation, Cognitive Therapy, and Mindfulness-based Cognitive Therapy for Chronic Low Back Pain
Authors: Day Melissa A. , Ward L. Charles , Thorn Beverly E. , Burns John , Ehde Dawn M. , Barnier Amanda J. , Mattingley Jason B. , Jensen Mark P.
Published: July 2020

Objectives:

This study evaluated theoretically derived mechanisms and common therapeutic factors to test their role in accounting for pain-related outcome change during group-delivered cognitive therapy, mindfulness meditation, and mindfulness-based cognitive therapy for chronic low back pain.

Methods:

A secondary analysis of a pilot randomized controlled trial was used to explore the primary mechanisms of pretreatment to posttreatment changes in pain control beliefs, mindful observing, and pain catastrophizing, and the secondary common factor mechanisms of therapeutic alliance, group cohesion, and amount of at-home skill practice during treatment. The primary outcome was pain interference; pain intensity was a secondary outcome.

Results:

Large effect size changes in the 3 primary mechanisms and the outcome variables were found across the conditions. Across all 3 treatment conditions, change in pain control beliefs and pain catastrophizing were significantly associated with improved pain interference, but not pain intensity. Therapeutic alliance was significantly associated with pain intensity improvement and change in the therapy-specific mechanisms across the 3 conditions. Mindful observing, group cohesion, and amount of at-home practice were not significantly associated with changes in the outcomes.

Discussion:

Cognitive therapy, mindfulness meditation, and mindfulness-based cognitive therapy for chronic low back pain were all associated with significant changes in the primary mechanisms to a similar degree. Change in perceived pain control and pain catastrophizing emerged as potential “meta-mechanisms” that might be a shared pathway that contributes to improved pain-related outcomes across treatments. Further, strong working alliance may represent a critical therapeutic process that both promotes and interacts with therapeutic techniques to influence outcome.
Prolonged Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA in an Obstetric Patient With Antibody Seroconversion
Authors: Molina Loren P. , Chow Siu-Kei , Nickel Adam , Love Jason E.
Published: July 2020

BACKGROUND:

There is a growing understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19) in the general population. The unique immunology of pregnancy may result in variations from the reported course of disease.

CASE:

A 27-year-old primigravid woman presented with mild COVID-19 symptoms at 28 2/7 weeks of gestation, testing positive for SARS-CoV-2 infection by nasopharyngeal swab reverse transcription-polymerase chain reaction (RT-PCR). Antibody seroconversion was detected at 36 6/7 weeks of gestation. She presented for delivery at 38 1/7 weeks of gestation, and her SARS-CoV-2 RT-PCR test result was positive. Severe acute respiratory syndrome coronavirus 2 RNA remained detectable 34 days postpartum and 104 days from her initial positive test.

CONCLUSION:

Prolonged viral shedding of SARS-CoV RNA may occur in the pregnant patient. If prevalent, this complicates the interpretation of a positive SARS-CoV-2 RT-PCR test result in the asymptomatic gravid patient.
Do women experience microaggressions in orthopaedic surgery? Current state and future directions from a survey of women orthopaedists
Authors: Samora Julie Balch , Denning Jaime , Haralabatos Susan , Luong Marilan , Poon Selina
Published: July 2020

Background:

Microaggressions are verbal, nonverbal, or environmental slights or insults that convey hostile, derogatory, or otherwise negative messages. Repeated, long-term exposure to microaggressions can have damaging consequences. We sought to determine the prevalence of microaggressions in the field of orthopaedic surgery, as perceived among women.

Methods:

An anonymous 32-item survey was distributed to members of Women in Orthopaedics (N=1123), a private online group exclusive to female orthopaedic surgeons in practice or training. Demographic information was collected including information on orthopaedic subspecialty and location of residency, fellowship, and current practice. Respondents were asked a series of questions detailing instances of microagressions based on four categories: microinsults, microassaults, microinvalidations, and physical barriers. Respondents were asked to detail instances of microaggressions during each professional stage of their medical career.

Results:

A total of 264 (24%) surveys were collected. Among respondents, 74% had experienced some form of microaggression in their training, with 13% having been a perpetrator of a microaggression against someone else. Only 7.6% of respondents had not experienced a microaggression. Residents were more likely to experience microaggressions than fellows or attending surgeons. The most common perpetrators identified were patients and their families, male surgeons, and female support staff. There was no association between race, age, demographic region, or specialty and the likelihood of experiencing microaggressions.

Conclusions:

Microaggressions are commonly experienced by women in orthopaedics. The most common perpetrators of microaggressions are patients and their families, but other medical and support staff contribute to the environment. Awareness is crucial to address the issue.

Level of Evidence:

Level IV.
Instructional Video did not reduce anxiety during pediatric cast removal: a prospective cohort study
Authors: Barnes Brandon J. , Abdou Cherry , Wendling Kyle , Aarons Chad E.
Published: July 2020

The aim of the study was to determine if the use of an Instructional Video will decrease anxiety during cast removal. We enrolled 60 healthy children undergoing their first cast removal following conservative fracture treatment. Patients were divided into one of three groups (1) No Video (control group), (2) watching a video of a well-tolerated pediatric cast removal (Instructional Video), or (3) watching a nonmedical Children’s Video during cast removal. We assessed anxiety to the cast saw by recording heart rate in the waiting room, during the procedure, and 1–2 min after the procedure. There were no significant differences in waiting room, procedure, and post-procedure heart rates between the two interventions and the control group. The mean change in heart rate from baseline to the procedure room for the Instructional Video cohort exhibited a similar increase (25.8 beats/min) in heart rate during cast removal as the No Video group (26.3 beats/min), while the Children’s Video had the smallest change in heart rate (17.7 beats/min) with a trend towards significance (P = 0.12). The results were not statistically significant for the full linear mixed-effect model on the three measurements. When we use age to control for variability in the data, we have a moderate effect size between Children’s Video and control (η
2
P = 0.0592), revealing that certain ages likely benefited from the Children’s Video intervention. Distraction using a Children’s Video may help reduce anxiety during cast removal whereas the Instructional Video did not reduce anxiety as hypothesized.
Characterizing the Surgeon Learning Curve in Instrumented Minimally Invasive Spinal Surgery
Authors: Ferry Chris
Published: July 2020

Study Design:

This was a systematic literature review.

Objective:

The purpose of this systematic literature review was to aggregate all evidence characterizing the learning curve of instrumented minimally invasive surgery (MIS) techniques in spinal surgery and summarize what, if any, consideration has been given to surgeon training and experience.

Summary of Background Data:

MIS techniques have become prevalent in spine surgery given the ability to diminish the intraoperative footprint, translating to quicker patient recovery, and improved long-term outcomes. However, technical demand on the surgeon can be significant, particularly during the procedural adoption (learning curve) phase. Many studies have sought to quantify the duration and severity of these learning curve phases, with the intent to characterize MIS procedural appropriateness and safety. However, while these studies are robust regarding outcome metrics, it is not well understood whether they adequately characterize surgeon training and experience.

Methods:

A systematic literature review was performed in the PubMed and MEDLINE databases in accordance with the PRISMA guidelines. All inclusion articles were screened for statements regarding surgeon experience/training. Statements were further classified by the types of metrics/variables utilized to establish a contextual history of experience/training. Descriptive statistics were reported.

Results:

Initial search criteria yielded 458 articles, 12 met final inclusion. Seven articles (58.3%) attempted a summary statement of experience which acknowledged at least one of the following metrics: total years in practice (41.7%), years/number of cases performed using the traditional/gold-standard technique (16.7%), specification of residency/fellowship training (16.7%), use/nonuse of cadaveric or course/lab training (16.7%), and/or design of operating team (8.3%). No articles considered experience as a quantitative variable in their study analyses.

Conclusions:

Spine MIS learning curve studies for instrumented fusion procedures provide inadequate context/characterization of surgeon experience and training. Future efforts leveraging learning curve methodology utilized in other surgical specialties would be beneficial.
Comparison of Postoperative Opioid Utilization in an ACDF Cohort
Authors: Davison Mark A. , Lilly Daniel T. , Eldridge Cody M. , Singh Ravinderjit , Bagley Carlos , Adogwa Owoicho
Published: July 2020

Study Design:

A retrospective cohort study.

Objective:

To compare the postoperative opioid utilization rates and costs after anterior cervical discectomy and fusion (ACDF) procedures between groups of patients who were preoperative opioid users versus opioid naive.

Summary of Background Data:

Opioid medications are frequently prescribed after ACDF procedures. Given the current opioid epidemic, there is increased emphasis on early identification of patients at risk for prolonged postoperative opioid use.

Methods:

Records from patients diagnosed with cervical stenosis who underwent a ≤3-level index ACDF surgery between 2007 and 2017 were collected from a large insurance database. International Classification of Diseases diagnosis/procedure codes, Current Procedural Terminology codes, and generic drug codes were used to search clinical records. Two cohorts were established: a group of patients who utilized opioids preoperatively and a group of patients who were opioid naive at the time of surgery. The 1-year utilization and costs of postoperative therapies were documented for each group.

Results:

The preoperative opioid use cohort contained 4485 patients (61.6%), whereas the opioid-naive cohort included 2799 patients (38.4%). Postoperatively, 86.6% of the preoperative opioid use group continued to use opioids, whereas 59.0% of the opioid-naive group began using opioids. Patients who utilized opioids preoperatively were 4.48 times more likely (95% confidence interval, 3.99–5.02, P<0.001) to use opioids postoperatively and 4.30 times more likely (95% confidence interval, 3.10–5.94, P<0.001) to become opioid dependent compared with opioid-naive patients. In addition, after normalization, patients in the preoperative opioid use group utilized 3.7 times more opioid units/patient and billed for 5.3 times more dollars/patient than opioid-naive patients.

Conclusions:

In patients with cervical stenosis who undergo an ACDF procedure, the postoperative utilization and costs of opioids seem to be substantially higher in patients with preoperative opioid use compared with opioid-naive patients. Efforts should be made to avoid opioid use as a component of conservative management before surgery.

Level of Evidence:

Level III.
Advantages and Design of PROMIS Questionnaires
Authors: Gibbons Denys , Welch-Phillips Adanna , Ahern Daniel P. , Butler Joseph S.
Published: July 2020

The Patient-Reported Outcomes Measurement Information System (PROMIS) is a National Institute of Health initiative to improve the measurement of clinically important symptoms and outcomes. Patient-Reported Outcomes capture health outcomes that are relevant to the daily functioning of the patient and include the monitoring of physical, mental, and social health. PROMIS offers a standardized tool to measure Patient-Reported Outcomes for use in both the clinical and research setting. It is a flexible and dynamic tool for both patient and clinician, and its use is continuing to grow internationally. This article discusses the rationale and design of this tool, as well as its advantages to both research and clinical practice.
Aldophosphamide-thiazolidine (NSC-613060) an oxazaphosphorine cytostatic that crosses the blood brain barrier
Authors: Voelcker Georg
Published: July 2020

The pharmacologically active metabolite of cyclophosphamide is aldophosphamide. With cysteine, aldophosphamide forms stable aldophosphamide-thiazolidine which under physiological pH and temperature conditions hydrolyzes to aldophosphamide and cysteine. Aldophosphamide-thiazolidine was synthesized and tested for its ability as a cytostatic. The LD50 after a single intraperitoneal injection in mice was determined to be 2162 mg/kg, but after intravenous bolus administration of 500 mg/kg or in chronic toxicity tests with daily intraperitoneal injections, neurological side effects were observed. Antitumor activity was determined in therapy experiments in CD2F1 mice bearing subcutaneously transplanted P388 mouse leukemia cells. Administration of 100 mg/kg (less than 5% LD50) days 1–5 after tumor transplantation yielded an ILS of 100%. Organ distribution studies showed that aldophosphamide-thiazolidine is evenly distributed in all tissues examined, including brain tissue. The possibilities to increase the antitumor activity of aldophosphamide-thiazolidine by modulating the alkylating function are discussed.
Nurses' Attitudes Toward Internet-Based Home Care
Authors: Sheng Zhiren , Wang Jingting , Sun Kaili , Xu Qian , Zhou Hongdi , Liu Chunbo , Hu Jianli , Song Xiaoping , Dong Lingna , Yuan Changrong
Published: July 2020

Internet-based home care has emerged as a way to relieve the burden of hospitals and meet patients' need for home care. This study aims to explore nurses' attitudes toward Internet-based home care. A cross-sectional online survey was conducted in Ningbo City in China. A self-designed Internet-based home care attitudes questionnaire for nurses (23 items) was used. There were 2039 nurses from 13 hospitals who participated in this online survey. Results reveal that, 1369 nurses (67.1%) were willing to provide Internet-based home care. However, there were significant differences in the attitudes of nurses with different ages (H = 11.86, P = .001), years of work experience (H = 24.257, P = .000), positions (H = 8.850, P = .031), and types of phones (H = 13.096, P = .001). More than 80% of nurses were willing to provide hypodermic and intramuscular injection. But there was a significant difference in the attitudes toward hypodermic injection, intramuscular injection, and pressure ulcer care in nurses with different ages (H = 13.039, P = .005; H = 9.178, P = .027; H = 10.997, P = .012) and a significant difference in the attitudes toward pressure ulcer care in nurses with different years of work experience (H = 15.259, P = .002). Results also indicated that most nurses were worried about their own safety and personal rights protection during Internet-based home care.
Nationwide Patterns of Pathologic Fractures Among Patients Hospitalized With Bone Metastases
Authors: Jairam Vikram , Lee Victor , Yu James B. , Park Henry S.
Published: July 2020

Objectives:

Pathologic fractures from bone metastases can significantly affect quality-of-life, although it is unclear which patients may be at high risk of this outcome. We aim to determine risk factors for pathologic fracture among patients admitted with bone metastases and to evaluate the association of pathologic fracture with clinical and economic outcomes.

Methods:

The Healthcare Cost and Utilization Project National Inpatient Sample was queried for all patients hospitalized with bone metastases in 2016. Baseline differences between patients with and without pathologic fractures were assessed by χ2 and analysis of variance testing. Multivariable logistic regression was used to identify factors associated with fractures.

Results:

In 2016, 272,275 hospital admissions were associated with a diagnosis of bone metastases, of which 11,960 (4.4%) had a primary diagnosis of pathologic fracture. Patients with pathologic fractures had a longer length-of-hospital-stay (mean 7.5 vs. 6.4 d; P<0.001) and higher cost-of-hospital-stay (mean $23,611 vs. $15,942; P<0.001) compared to patients without pathologic fractures. Primary cancers associated with increased likelihood of pathologic fracture included liver and intrahepatic bile duct (odds ratio [OR] 2.34; 95% confidence interval [CI], 1.65-3.32), multiple myeloma (OR 1.94; 95% CI, 1.31-2.86), and kidney and renal pelvis cancer (OR 1.89; 95% CI, 1.50-2.37).

Conclusions:

Nearly 5% of hospitalizations with bone metastases presented with a concomitant pathologic fracture, which was associated with longer inpatient stay and higher cost. Patients with hepatobiliary, renal cell carcinoma, or multiple myeloma, had a higher likelihood of pathologic fracture. These groups may benefit from increased outpatient monitoring, prophylactic stabilization, or early irradiation.
The association of depressive symptoms to sleep-related symptoms during menopausal transition: racial/ethnic differences
Authors: Im Eun-Ok , Yang You Lee , Liu Jianghong , Chee Wonshik
Published: July 2020

Objectives:

Despite an increasing number of studies reporting significant associations of depression to sleep problems in general, few studies have been conducted on racial/ethnic variations in the associations among midlife women in their menopausal transition. The purpose of this study was to determine the associations between depressive symptoms and sleep-related symptoms in a multiethnic group of midlife women while considering the women's race/ethnicity and menopausal status.

Methods:

This was a secondary analysis of the data from 1,054 midlife women in two larger studies. The depression index for midlife women and the sleep index for midlife women were used to measure sleep-related symptoms and depressive symptoms. Descriptive and inferential statistics including hierarchical multiple regression analyses were used for data analyses.

Results:

In the regression models by race/ethnicity, the total numbers (0.294 in non-Hispanic [NH] African Americans ≤ β ≤ 0.410 in NH Asians), and total severity scores (0.141 in Hispanic ≤ β ≤ 0.365 in NH Whites) of depressive symptoms were positively associated with the total severity of sleep-related symptoms (all P < 0.01). In the regression models by menopausal status, the total numbers (β = 0.106 in premenopausal and 0.443 in postmenopausal) and total severity scores (0.272 ≤ β ≤ 0.561) of depressive symptoms were positively associated with the total severity scores of sleep-related symptoms (all P < 0.05).

Conclusions:

Further studies with diverse groups of midlife women using objective measurements and biomarkers are warranted to confirm the findings.
Cognitive complaints are associated with smaller right medial temporal gray-matter volume in younger postmenopausal women
Authors: Conley Alexander C. , Albert Kimberly M. , Boyd Brian D. , Kim Shin-Gyeom , Shokouhi Sepideh , McDonald Brenna C. , Saykin Andrew J. , Dumas Julie A. , Newhouse Paul A.
Published: July 2020

Objective:

Menopause is associated with increasing cognitive complaints and older women are at increased risk of developing Alzheimer disease compared to men. However, there is difficulty in early markers of risk using objective performance measures. We investigated the impact of subjective cognitive complaints on the cortical structure in a sample of younger postmenopausal women.

Methods:

Data for this cross-sectional study were drawn from the baseline visit of a longer double-blind study examining estrogen-cholinergic interactions in normal postmenopausal women. Structural Magnetic Resonance Imaging was acquired on 44 women, aged 50-60 years and gray-matter volume was defined by voxel-based morphometry. Subjective measures of cognitive complaints and postmenopausal symptoms were obtained as well as tests of verbal episodic and working memory performance.

Results:

Increased levels of cognitive complaints were associated with lower gray-matter volume in the right medial temporal lobe (r = −0.445, P < 0.002, R

2
 = 0.2). Increased depressive symptoms and somatic complaints were also related to increased cognitive complaints and smaller medial temporal volumes but did not mediate the effect of cognitive complaints. In contrast, there was no association between performance on the memory tasks and subjective cognitive ratings, or medial temporal lobe volume.

Conclusions:

The findings of the present study indicate that the level of reported cognitive complaints in postmenopausal women may be associated with reduced gray-matter volume which may be associated with cortical changes that may increase risk of future cognitive decline.

Video Summary:
http://links.lww.com/MENO/A626.