bluuebunny/crossref_metadata_2025 huggingface dataset:
The Reliability of Patient-Performed Fecal Calprotectin Testing in Inflammatory Bowel Disease
Authors: Dijkhuis Lies E J L , Crouwel Femke , Duijvestein Marjolijn , Buiter Hans J C , de Boer Nanne K , Hamer Henrike M
Published: December 2022

Background

Home use of a buffer-containing extraction device for fecal calprotectin determination can bypass the labor-intensive extraction procedure and potentially prevent degradation at room temperature.

Methods

In this prospective cross-sectional observational study, 2 CALiaGold tubes (extraction device) and one native tube were filled from the same bowel movement by patients with inflammatory bowel disease. Afterwards patients completed a questionnaire including whether they preferred the extraction device or the normal sampling method. All tubes were sent to the laboratory and when they arrived, 2 more CALiaGold tubes were filled at the laboratory from the native sample. The fecal calprotectin concentrations in all tubes were measured by a particle-enhanced turbidimetric immunoassay.

Results

Fifty-three patients were included in the study. Fecal calprotectin levels were significantly higher in samples extracted by the patient compared to the analyst-performed extractions. When patients were divided into 3 groups (i.e., fecal calprotectin levels <50 ug/g, 50 to 200 µg/g, and >200 µg/g) a substantial concordance was found (Cohen kappa 0.654). Patients sampling imprecision was higher (P < 0.018, median CV 16%) compared to the analyst. Most patients preferred this extraction device.

Conclusions

Patient-performed fecal calprotectin extraction seems a realistic alternative sampling method and is preferred by most patients.
Understanding Forest Landowner Attitudes, Perceived Risk, and Response to Emerald Ash Borer in Kentucky
Authors: Adhikari Ram K , Poudyal Neelam C , Ochuodho Thomas O , Parajuli Rajan , Joshi Omkar , Mehmood Sayeed R , Munsell John F , Dhungel Gaurav , Thomas William , Crocker Ellen , Zhou Mo
Published: December 2022

Emerald ash borer (EAB) (Agrilus planipennis), an invasive nonnative beetle, is responsible for the mortality of ash trees in the eastern and midwestern United States. Despite efforts to contain this beetle through various control options, human-induced spread of EAB has caused damage to ash forests in many states. Because most ash trees are under private ownership, it is important to understand how landowners evaluate the risk of EAB and perceive the effectiveness of various control options. A mail survey of private forest landowners was conducted in Kentucky in 2020 to assess their awareness and perception of various control options of EAB infestation. Results from this survey suggest that landowners are concerned about EAB and the associated increased risks, reduced quality of scenic views, and increased cleanup costs. Landowners experiencing EAB infestation believed that EAB management needs collective actions and that current efforts by government agencies are not sufficient. However, few landowners are taking actions themselves to manage EAB on their property. These findings shed light on the extent to which landowners are concerned about EAB impact and emphasize the need for development of effective control options and outreach programs to increase landowner engagement and actions in EAB control and management.
Environmental impacts on barley grain composition and longevity
Authors: Dufková Hana , Berka Miroslav , Psota Vratislav , Brzobohatý Břetislav , Černý Martin
Published: December 2022

To counter projected reductions in yields of the major crop barley, it is essential to elucidate the mechanisms of its resilience. To assist such efforts, we collected grains from plants grown in fields at 12 testing stations, with suitable temperature and precipitation gradients for identifying environmentally induced changes in their protein and metabolite contents. We then subjected the grains to detailed molecular analysis. The results showed that numerous metabolites and at least a quarter of the grain protein content was modulated by the environment, and provided insights into barley seed production under abiotic stress, including alterations in ribosomal proteins, heatshock protein 70 family proteins, inhibitors, storage proteins, and lipid droplet formation. Potential positive and negative markers of yield were also identified, including the phenolic compound catechin and storage protein levels, respectively. Complementary analyses of barley seedlings and Arabidopsis seeds, respectively, confirmed the role of the identified proteins in abiotic stress responses and highlighted evolutionarily conserved mechanisms. In addition, accelerated ageing experiments revealed that variations in the environment had stronger effects on seed longevity than the genotype. Finally, seeds with the highest longevity differed from the others in gibberellin contents, H2O2 metabolism, and levels of >250 proteins, providing novel targets for improving resilience.
Accuracy and precision of triaxial orbit models I: SMBH mass, stellar mass, and dark-matter halo
Authors: Neureiter B , de Nicola S , Thomas J , Saglia R , Bender R , Rantala A
Published: December 2022

We investigate the accuracy and precision of triaxial dynamical orbit models by fitting 2D mock observations of a realistic N-body merger simulation resembling a massive early-type galaxy with a supermassive black hole. We show that we can reproduce the triaxial N-body merger remnant’s correct black hole mass, stellar mass-to-light ratio and total enclosed mass (inside the half-light radius) for several different tested orientations with an unprecedented accuracy of 5–10 per cent. Our dynamical models use the entire non-parametric line-of-sight velocity distribution (LOSVD) rather than parametric LOSVDs or velocity moments as constraints. Our results strongly suggest that state-of-the-art integral-field projected kinematic data contain only minor degeneracies with respect to the mass and anisotropy recovery. Moreover, this also demonstrates the strength of the Schwarzschild method in general. We achieve the proven high recovery accuracy and precision with our newly developed modelling machinery by combining several advancements: (i) our new semiparametric deprojection code probes degeneracies and allows us to constrain the viewing angles of a triaxial galaxy; (ii) our new orbit modelling code SMART uses a 5-dim orbital starting space to representatively sample in particular near-Keplerian orbits in galaxy centres; (iii) we use a generalized information criterion AICp to optimize the smoothing and to compare different mass models to avoid biases that occur in χ2-based models with varying model flexibilities.
Evaluation of Methods to Detect Shifts in Directional Selection at the Genome Scale
Authors: Duchemin Louis , Lanore Vincent , Veber Philippe , Boussau Bastien
Published: December 2022

Identifying the footprints of selection in coding sequences can inform about the importance and function of individual sites. Analyses of the ratio of nonsynonymous to synonymous substitutions (dN/dS) have been widely used to pinpoint changes in the intensity of selection, but cannot distinguish them from changes in the direction of selection, that is, changes in the fitness of specific amino acids at a given position. A few methods that rely on amino-acid profiles to detect changes in directional selection have been designed, but their performances have not been well characterized. In this paper, we investigate the performance of six of these methods. We evaluate them on simulations along empirical phylogenies in which transition events have been annotated and compare their ability to detect sites that have undergone changes in the direction or intensity of selection to that of a widely used dN/dS approach, codeml’s branch-site model A. We show that all methods have reduced performance in the presence of biased gene conversion but not CpG hypermutability. The best profile method, Pelican, a new implementation of Tamuri AU, Hay AJ, Goldstein RA. (2009. Identifying changes in selective constraints: host shifts in influenza. PLoS Comput Biol. 5(11):e1000564), performs as well as codeml in a range of conditions except for detecting relaxations of selection, and performs better when tree length increases, or in the presence of persistent positive selection. It is fast, enabling genome-scale searches for site-wise changes in the direction of selection associated with phenotypic changes.
Five-year survivors from brain metastases treated with stereotactic radiosurgery: Biology, improving treatments, or just plain luck?
Authors: Pearce Jane B , Hsu Fang-Chi , Lanier Claire M , Cramer Christina K , Ruiz Jimmy , Lo Hui-Wen , Xing Fei , Smith Margaret , Li Wencheng , Whitlow Christopher , White Jaclyn J , Tatter Stephen B , Laxton Adrian W , Chan Michael D
Published: December 2022

Background

Improvements in therapies have led to an increasing number of long-term survivors of brain metastases. The present series compares a population of 5-year survivors of brain metastases to a generalized brain metastases population to assess for factors attributable to long-term survival.

Methods

A single institution retrospective review was performed to identify 5-year survivors of brain metastases who received stereotactic radiosurgery (SRS). A historical control population of 737 patients with brain metastases was used to assess similarities and differences between the long-term survivor population and the general population treated with SRS.

Results

A total of 98 patients with brain metastases were found to have survived over 60 months. No differences between long-term survivors and controls were identified with regards to the age at first SRS (P = .19), primary cancer distribution (P = .80), and the number of metastases at first SRS (P = .90). Cumulative incidence of neurologic death at 6, 8 and 10 years for the long-term survivor cohort was 4.8%, 16%, and 16% respectively. In the historical controls, cumulative incidence of neurologic death reached a plateau at 40% after 4.9 years. A significant difference in the distribution of burden of disease at the time of the first SRS was found between the 5-year survivors and the control (P = .0049). 58% of 5-year survivors showed no evidence of clinical disease at the last follow-up.

Conclusion

Five-year survivors of brain metastases represent a diverse histologic population, suggesting a small population of oligometastatic and indolent cancers exist for each cancer type.
Extensive gene flow in secondary sympatry after allopatric speciation
Authors: Wang Xinfeng , He Ziwen , Guo Zixiao , Yang Ming , Xu Shaohua , Chen Qipian , Shao Shao , Li Sen , Zhong Cairong , Duke Norman C , Shi Suhua
Published: December 2022

In the conventional view, species are separate gene pools delineated by reproductive isolation (RI). In an alternative view, species may also be delineated by a small set of ‘speciation genes’ without full RI, a view that has gained broad acceptance. A recent survey, however, suggested that the extensive literature on ‘speciation with gene flow’ is mostly (if not all) about exchanges in the early stages of speciation. There is no definitive evidence that the observed gene flow actually happened after speciation is completed. Here, we wish to know whether ‘good species’ (defined by the ‘secondary sympatry’ test) do continue to exchange genes and, importantly, under what conditions such exchanges can be observed. De novo whole-genome assembly and re-sequencing of individuals across the range of two closely related mangrove species (Rhizophora mucronata and R. stylosa) reveal the genomes to be well delineated in allopatry. They became sympatric in northeastern Australia but remain distinct species. Nevertheless, their genomes harbor ∼4000–10 000 introgression blocks averaging only about 3–4 Kb. These fine-grained introgressions indicate continual gene flow long after speciation as non-introgressable ‘genomic islets,’ ∼1.4 Kb in size, often harbor diverging genes of flower or gamete development. The fine-grained introgression in secondary sympatry may help settle the debate about sympatric vs. micro-allopatric speciation. In conclusion, true ‘good species’ may often continue to exchange genes but the opportunity for detection is highly constrained.
Increased All-cause Mortality in People With HIV and Comorbidities: Hepatitis B and C Virus Seropositivity and Hyperglycemia in Myanmar, 2005–2017
Authors: Kyaw Nang Thu Thu , Satyanarayana Srinath , Harries Anthony D , Kumar Ajay M V , Kyaw Khine Wut Yee , Phyo Khaing Hnin , Hayat Matthew J , Castro Kenneth G , Magee Matthew J
Published: December 2022

Background

Hepatitis C virus (HCV) and hepatitis B virus (HBV) coinfection are associated with increased mortality in people with HIV (PWH), and hyperglycemia is a common comorbidity in PWH. In this study, we used routinely collected clinical data to assess the associations between HBV and HCV seropositivity with all-cause mortality and whether this relationship differs by hyperglycemia status.

Methods

Eligible participants included adult PWH (≥15 years) who initiated antiretroviral therapy between May 2005 and June 2016 in Myanmar. HBV and HCV serostatus and hyperglycemia were measured at enrollment to HIV care using HBV surface antigen, HCV antibody tests, and random blood glucose (≥140 mg/dL), respectively.

Results

Among 27 722 PWH, 2260 (8%) were HBV seropositive, 2265 (9%) were HCV seropositive, 178 (0.6%) were HBV-HCV seropositive, and 1425 (5%) had hyperglycemia. During the median follow-up (interquartile range) of 3.1 (1.5–5.1) years, 3655 (13%) PWH died, and the overall mortality rate was 3.8 (95% CI, 3.7–3.9) per 100-person-years (PY). The mortality rate (per 100 PY) among PWH who were HBV seropositive was 4.6, among PWH who were HCV seropositive it was 5.1, and among PWH who were HBV-HCV seropositive it was 7.1. When stratified by glycemic status, the mortality rate was higher among patients with hyperglycemia compared with those with euglycemia (5.4 vs 4.0 per 100 PY), and the difference in mortality rate between patients with hyperglycemia and euglycemia was highest among those with HCV seropositivity (9.8 vs 5.0 per 100 PY).

Conclusions

Increased mortality rates associated with HBV and HCV seropositivity in PWH differed by their glycemic status. PWH with HCV seropositivity and hyperglycemia had the highest mortality rates.
Cyanobacterial photosystem II reaction center design in tobacco chloroplasts increases biomass in low light
Authors: Zhang Yuan , Ananyev Gennady , Matsuoka Aki , Dismukes G Charles , Maliga Pal
Published: December 2022

The D1 polypeptide of the photosystem II (PSII) reaction center complex contains domains that regulate primary photochemical yield and charge recombination rate. Many prokaryotic oxygenic phototrophs express two or more D1 isoforms differentially in response to environmental light needs, a capability absent in flowering plants and algae. We report that tobacco (Nicotiana tabacum) plants carrying the Synechococcus (Synechococcus elongatus PCC 7942) low-light mutation (LL-E130Q) in the D1 polypeptide (NtLL) acquire the cyanobacterial photochemical phenotype: faster photodamage in high light and significantly more charge separations in productive linear electron flow in low light. This flux increase produces 16.5% more (dry) biomass under continuous low-light illumination (100 μE m−2 s−1, 24 h). This gain is offset by the predicted lower photoprotection at high light. By contrast, the introduction of the Synechococcus high-light mutation (HL-A152S) into tobacco D1 (NtHL) has slightly increased photoprotection, achieved by photochemical quenching, but no apparent impact on biomass yield compared to wild type under the tested conditions. The universal design principle of all PSII reaction centers trades off energy conversion for photoprotection in different proportions across all phototrophs and provides a useful guidance for testing in crop plants. The observed biomass advantage under continuous low light can be transferred between evolutionarily isolated lineages to benefit growth under artificial lighting conditions. However, removal of the selective marker gene was essential to observe the growth phenotype, indicating growth penalty imposed by use of the particular spectinomycin-resistance gene.
NIR-II live imaging study on the degradation pattern of collagen in the mouse model
Authors: Li Huizhu , Meng Xinxian , Sheng Huaixuan , Feng Sijia , Chen Yuzhou , Sheng Dandan , Sai Liman , Wang Yueming , Chen Mo , Wo Yan , Feng Shaoqing , Baharvand Hossein , Gao Yanglai , Li Yunxia , Chen Jun
Published: December 2022

The degradation of collagen in different body parts is a critical point for designing collagen-based biomedical products. Here, three kinds of collagens labeled by second near-infrared (NIR-II) quantum dots (QDs), including collagen with low crosslinking degree (LC), middle crosslinking degree (MC) and high crosslinking degree (HC), were injected into the subcutaneous tissue, muscle and joints of the mouse model, respectively, in order to investigate the in vivo degradation pattern of collagen by NIR-II live imaging. The results of NIR-II imaging indicated that all tested collagens could be fully degraded after 35 days in the subcutaneous tissue, muscle and joints of the mouse model. However, the average degradation rate of subcutaneous tissue (k = 0.13) and muscle (k = 0.23) was slower than that of the joints (shoulder: k = 0.42, knee: k = 0.55). Specifically, the degradation rate of HC (k = 0.13) was slower than LC (k = 0.30) in muscle, while HC showed the fastest degradation rate in the shoulder and knee joints. In summary, NIR-II imaging could precisely identify the in vivo degradation rate of collagen. Moreover, the degradation rate of collagen was more closely related to the implanted body parts rather than the crosslinking degree of collagen, which was slower in the subcutaneous tissue and muscle compared to the joints in the mouse model.
Finding Fortune: How Do Institutional Investors Pick Asset Managers?
Authors: Brown Gregory W , Gredil Oleg R , Kantak Preetesh
Published: December 2022

We propose and test a framework of private information acquisition and decision timing for asset allocators hiring outside investment managers. Using unique data on due diligence interactions between an institutional allocator and 860 hedge fund managers, we find that the production of private information complements public information. The allocator strategically chooses how much proprietary information to collect, reducing due diligence time by 18 months and improving outcomes. Funds selected by the manager outperform those not selected by 9$\%$ over 20 months. The outperformance relates to the allocator learning about fund return-to-scale constraints and manager skill before other investors.
Patients’ and parents’ satisfaction to improve patient care in JIA: factors determining acceptable symptom state measured with JAMAR
Authors: Del Giudice Emanuela , de Roock Sytze , Vastert Sebastiaan J , Wulffraat Nico M , Swart Joost F , van Dijkhuizen Evert H P
Published: December 2022

Objectives

The aim of this study was to identify factors associated with patients’ and parents’ reported satisfaction with JIA care, measured with the juvenile arthritis child and parent acceptable symptom state (JA-CASS and JA-PASS, respectively).

Methods

A prospective cohort of 239 JIA patients and 238 parents in a tertiary centre who completed the juvenile arthritis multidimensional assessment report (JAMAR) was analysed cross-sectionally. The primary outcomes were positive JA-CASS and JA-PASS, respectively. Items in the JAMAR, as well as JIA subtype, demographics, and disease activity parameters, were analysed in univariate analysis. A multivariable logistic regression analysis was used to build models explaining the variance of the primary outcome as a dependent variable.

Results

According to the JAMAR, 141 (59.0%) of 239 patients and 149 (62.6%) of 238 parents were satisfied with their or their child’s current condition. For patients, the determinants in the final model were a shorter duration of morning stiffness (P = 0.001), a lower age at disease onset (P = 0.044), a longer disease duration (P = 0.009) and a higher rating of the patient’s well-being measured on a visual analogue scale (VAS) (P = 0.004). For parents, the determinants were the current state of disease activity (current state of persistent activity P = 0.002, relapse P < 0.005), problems at school (P = 0.002) and the items regarding quality of life (QoL) (P = 0.005).

Conclusion

Our data highlight the importance of patients’ and parents’ opinions in the evaluation of disease activity, and support their integration into the shared decision-making in daily clinical practice to improve the quality of medical care.
How politics constrain the public’s understanding of terrorism
Authors: Haner Murat , Sloan Melissa M , Pickett Justin T , Cullen Francis T , O’Neill Victoria
Published: December 2022

Far-right domestic terrorism is a major threat to US national security. Despite this reality, conservative policymakers have downplayed the threat of right-wing violence while arguing that far-left violence (from groups like Antifa) is a more pressing concern. Drawing on attribution theory and research on politically motivated reasoning, we suggest that politics constrain the American public’s understanding of terrorism by shaping casual attributions for it. Using data from an experiment within a national survey (n = 700), we examine how political views moderate attributions made for the actions of far-right, far-left, and Islamist terrorism. We find that causal attributions for terrorism depend on the type of terrorist considered, with external attributions (motivated by injustice or oppression) endorsed most strongly for Islamist terrorists and internal attributions (motivated by hate or evil) endorsed most strongly for far-right terrorists. Furthermore, political views moderate this effect such that people believe terrorism committed by politically aligned groups is motivated less by the internal characteristics of the terrorists and more by external factors. Taken together, these findings may help to explain partisan differences in moral outrage over politically motivated terrorism.
Automated acquisition of top-view dairy cow depth image data using an RGB-D sensor camera
Authors: Kadlec Robert , Indest Sam , Castro Kayla , Waqar Shayan , Campos Leticia M , Amorim Sabrina T , Bi Ye , Hanigan Mark D , Morota Gota
Published: December 2022

Animal dimensions are essential indicators for monitoring their growth rate, diet efficiency, and health status. A computer vision system is a recently emerging precision livestock farming technology that overcomes the previously unresolved challenges pertaining to labor and cost. Depth sensor cameras can be used to estimate the depth or height of an animal, in addition to two-dimensional information. Collecting top-view depth images is common in evaluating body mass or conformational traits in livestock species. However, in the depth image data acquisition process, manual interventions are involved in controlling a camera from a laptop or where detailed steps for automated data collection are not documented. Furthermore, open-source image data acquisition implementations are rarely available. The objective of this study was to 1) investigate the utility of automated top-view dairy cow depth data collection methods using picture- and video-based methods, 2) evaluate the performance of an infrared cut lens, 3) and make the source code available. Both methods can automatically perform animal detection, trigger recording, capture depth data, and terminate recording for individual animals. The picture-based method takes only a predetermined number of images whereas the video-based method uses a sequence of frames as a video. For the picture-based method, we evaluated 3- and 10-picture approaches. The depth sensor camera was mounted 2.75 m above-the-ground over a walk-through scale between the milking parlor and the free-stall barn. A total of 150 Holstein and 100 Jersey cows were evaluated. A pixel location where the depth was monitored was set up as a point of interest. More than 89% of cows were successfully captured using both picture- and video-based methods. The success rates of the picture- and video-based methods further improved to 92% and 98%, respectively, when combined with an infrared cut lens. Although both the picture-based method with 10 pictures and the video-based method yielded accurate results for collecting depth data on cows, the former was more efficient in terms of data storage. The current study demonstrates automated depth data collection frameworks and a Python implementation available to the community, which can help facilitate the deployment of computer vision systems for dairy cows.
Effects of increasing soybean meal in corn-based diets on the growth performance of late finishing pigs
Authors: Holen Julia P , Goodband Robert D , Tokach Mike D , Woodworth Jason C , DeRouchey Joel M , Gebhardt Jordan T
Published: December 2022

Three experiments were conducted to determine the effects of increasing soybean meal (SBM) levels by replacing feed-grade amino acids (AA) in corn, corn dried distillers grains with solubles (DDGS), and corn-wheat midds-based diets on growth performance of late finishing pigs (n = 4,406) raised in commercial facilities. Across all experiments, pens of pigs were blocked by initial bodyweight (BW) and randomly assigned to 1 of 5 dietary treatments. All diets were formulated to contain 0.70% standardized ileal digestible (SID) Lys and varying amounts of feed-grade AA. All diets were formulated to meet or exceed minimum essential AA requirement estimates as a ratio to Lys. In Exp. 1, 1,793 pigs (initially 104.9 ± 4.9 kg) were fed corn-based diets and pens of pigs were assigned treatments with increasing SBM from 5% to 20%. Overall, average daily gain (ADG) and feed efficiency (G:F) improved (linear and cubic, P ≤ 0.02) as dietary SBM increased, with the greatest improvement observed as SBM increased from 5% to 8.75% and little improvement thereafter. In Exp. 2, 1,827 pigs (initially 97.9 ± 4.3 kg) were fed diets containing 25% DDGS with SBM levels increasing from 0% to 16%. Overall, feed efficiency marginally improved (linear, P ≤ 0.10) as SBM increased, with the greatest performance observed when diets contained 8% SBM and similar performance thereafter with 12 or 16% dietary SBM. In Exp. 3, 786 pigs (initially 96.7 ± 3.2 kg) were fed diets that contained 30% wheat midds and dietary SBM from 0% to 16%. Final BW of pigs increased (linear, P < 0.05) and overall ADG and G:F improved (linear and cubic, P < 0.05) as SBM increased. The combined results of the three experiments suggest that inclusion of at least 4% to 8% dietary SBM at the expense of feed-grade amino acids in corn-based diets with or without grain coproducts can improve growth performance of late-finishing (greater than 100 kg) pigs.
Strategies to manage barn feed supply to prolong and hold late finishing pigs during a supply chain disruption
Authors: Miller Kayla A , Johnson Erika M , Matchan Stacie A , Goehring Devin , Ross Jason W , Gabler Nicholas K
Published: December 2022

The U.S. pork production system is sensitive to supply chain disruptions, including those that can create challenges of feed delivery and feed management during the event of a foreign animal disease outbreak. Therefore, the objective was to evaluate feeding strategies during a prolonged feed availability shortage in group-housed finishing pigs and assess the impacts on pig performance. A total of 1,407 mixed-sex pigs (92 ± 11 kg BW) were randomly allocated to one of five treatments across 60 pens (N = 12 pens per treatment, 22 pigs per pen) and were blocked by initial body weight (BW) within the replicate, over a 21-d test period. Treatments were fed for 14 d (P1), and thereafter all pens returned to ad libitum access to a standard commercial diet for 7 d (P2). Treatments included: 1) Pens fed ad libitum (CON); 2) Pens fed at 1.45X ME maintenance requirement daily of CON diet (1.45X); 3) Pens fed 2X ME maintenance requirement daily of CON diet (2X); 4) Tightened feeders to the lowest setting, fed ad libitum of CON diet (CF); and 5) whole corn kernels, fed ad libitum (WC). P1 and P2 BW and feed disappearance were recorded to calculate ADG, ADFI, and G:F. Data were analyzed with pen as the experimental unit and least-squares means values reported by treatment. Compared to CON, pens fed 1.45X, 2X, CF, and WC treatments had significantly reduced P1 ADG (1.09 vs. 0.02, 0.34, 0.72, 0.41 kg/d, respectively), ADFI (3.21 vs. 1.42, 1.90, 2.49, 2.40 kg/d, respectively) and G:F (P < 0.05). During P2, ADG and G:F were increased (P < 0.05) compared to CON across all treatments. However, ADFI increased only in the 2X, CF, and WC diet from the CON (P < 0.05). Overall (days 0 to 21), all strategies attenuated BW, ADG, and ADFI (P < 0.01) compared to CON. However, G:F was only reduced (P < 0.01) in 1.45X and WC, but not 2X and CF (P > 0.05) compared to CON. In conclusion, all strategies explored could extend feed budgets. Even though these strategies were successful, increased BW variability was reported with more restrictive strategies. Further, adverse pig behaviors and welfare implications needs to be considered in adopting any restrictive feeding strategy.
Progress in high-resolution isotope-ratio analysis of tree rings using laser ablation
Authors: Saurer Matthias , Sahlstedt Elina , Rinne-Garmston Katja T , Lehmann Marco M , Oettli Manuela , Gessler Arthur , Treydte Kerstin
Published: December 2022

Stable isotope ratio analysis of tree rings has been widely and successfully applied in recent decades for climatic and environmental reconstructions. These studies were mostly conducted at an annual resolution, considering one measurement per tree ring, often focusing on latewood. However, much more information could be retrieved with high-resolution intra-annual isotope studies, based on the fact that the wood cells and the corresponding organic matter are continuously laid down during the growing season. Such studies are still relatively rare, but have a unique potential for reconstructing seasonal climate variations or short-term changes in physiological plant properties, like water-use efficiency. The reason for this research gap is mostly technical, as on the one hand sub-annual, manual splitting of rings is very tedious, while on the other hand automated laser ablation for high-resolution analyses is not yet well established and available. Here, we give an update on the current status of laser ablation research for analysis of the carbon isotope ratio (δ13C) of wood, describe an easy-to-use laser ablation system, its operation and discuss practical issues related to tree core preparation, including cellulose extraction. The results show that routine analysis with up to 100 laser shot-derived δ13C-values daily and good precision and accuracy (ca. 0.1‰) comparable to conventional combustion in an elemental analyzer are possible. Measurements on resin-extracted wood is recommended as most efficient, but laser ablation is also possible on cellulose extracted wood pieces. Considering the straightforward sample preparation, the technique is therefore ripe for wide-spread application. With this work, we hope to stimulate future progress in the promising field of high-resolution environmental reconstruction using laser ablation.
Fitting In While Standing Out: Professional Identity Formation, Imposter Syndrome, and Burnout in Early-Career Faculty Physicians
Authors: Vaa Stelling Brianna E. , Andersen Carl A. , Suarez Diego A. , Nordhues Hannah C. , Hafferty Frederic W. , Beckman Thomas J. , Sawatsky Adam P.
Published: December 2022

Purpose

Professional identity formation (PIF) is a dynamic process by which an individual internalizes the core values and beliefs of a specific profession. Within medical education, PIF begins in medical school and continues throughout training and practice. Transitions affect PIF, with a critical transition occurring between medical training and unsupervised practice. This study aims to characterize PIF during the transition from resident to early-career faculty physician and explores the relationship between PIF and burnout during this transition.

Method

The authors conducted a qualitative study using constructivist grounded theory. They conducted semistructured interviews with early-career faculty physicians (defined as practicing for ≤ 5 years) from the Department of Medicine, Mayo Clinic. Deidentified interview transcripts were processed through open and axial coding. The authors organized themes and identified relationships between themes that were refined through discussion and constant comparison with newly collected data. During data analysis, the authors identified self-determination theory, with the concepts of autonomy, competence, and relatedness, as a framework to support the organization and analysis of the data.

Results

Eleven early-career faculty physicians participated in the interviews. Their PIF was characterized by the dual desires to fit in and stand out. Striving for these desires was characterized by imposter syndrome, driving physicians to question their decision making and overall competence. Participants associated imposter syndrome and academic pressures with burnout. Autonomy support by the institution to pursue opportunities important for career development helped mitigate burnout and support PIF.

Conclusions

Early-career faculty physicians face identity challenges when transitioning from training to unsupervised practice, including striving to fit in and stand out. They link this tension to imposter syndrome, which they associated with burnout. Institutional awareness and support, including addressing structural and cultural contributors to imposter syndrome, are paramount as new faculty explore their identities and navigate new challenges.
Carnegie and Rockefeller’s Philanthropic Legacy: Exclusion of African Americans From Medicine
Authors: Morsy Leila
Published: December 2022

In the first 3 decades of the 20th century, John D. Rockefeller Sr. and Andrew Carnegie used their philanthropy to support 2 main mechanisms that functioned to exclude African American doctors from medical education and the medical profession. First, Carnegie funded the Flexner report, recommending reforms to medical education including the closure of most Black medical schools. Next, Rockefeller’s General Education Board (GEB) funded restructures to medical education without equal support to ensure Black medical schools could keep up with changing standards. For every dollar the GEB donated to Black medical schools between 1902 and 1919, it donated $123 to White schools. During that period, for every dollar the GEB donated to White medical schools per White resident, it donated about $0.07 to Black schools per African American resident. Next, Rockefeller’s philanthropy supported a system of school education that underprepared African American candidates to meet the requirements needed to enter medicine. For African American children, the GEB supported a kind of schooling termed industrial education, which emphasized manual training (e.g., skills related to agricultural science and efficiency). In 1933, industrial education schools were located in 57% of all Southern counties, and two-thirds of African Americans who attended primary and secondary school received an education that followed the industrial education curriculum. Industrial education underprepared candidates for applying to medical school, completing a medical school curriculum, and passing a medical board examination. This article examines how these 2 mechanisms had lasting and harmful effects on the underrepresentation of African American doctors in the medical workforce. These insights provide a broad and collective understanding of the early role of philanthropy in excluding African Americans from the medical profession, which is a crucial first step toward developing interventions to help redress racial discrepancies in the medical profession that persist today.
Academic Health Centers and Humanitarian Crises: One Health System’s Response to Unaccompanied Children at the Border
Authors: Devaskar Sherin U. , Cunningham Coleen K. , Steinhorn Robin H. , Haq Cynthia , Spisso Johnese , Dunne William , Gutierrez Juan Raul , Kivlahan Coleen , Bholat Michelle , Barakat Suzanne , de Leon Siantz Mary Lou , Romero Stephanie , Lefteris Chad T. , Gaffney Samantha , Deville Jaime , Lerner Carlos , Liu Jasen , Kuelbs Cynthia L. , Kukreja Sudeep , Golden Charles , Nelson Zoanne , Elton Kristie , Byington Carrie L.
Published: December 2022

University of California Health (UCH) provided a system-wide, rapid response to the humanitarian crisis of unaccompanied children crossing the southern U.S. border in the midst of the COVID-19 pandemic in 2021. In collaboration with multiple federal, state, and local agencies, UCH mobilized a multidisciplinary team to deliver acute general and specialty pediatric care to unaccompanied children at 2 Californian emergency intake sites (EISs). The response, which did not disrupt normal UCH operations, mobilized the capacities of the system and resulted in a safe and developmentally appropriate environment that supported the physical and mental health of migrant children during this traumatic period. The capacities of UCH’s 6 academic health centers ensured access to trauma-informed medical care and culturally sensitive psychological and social support. Child life professionals provided access to exercise, play, and entertainment. Overall, 260 physicians, 42 residents and fellows, 4 nurse practitioners participated as treating clinicians and were supported by hundreds of staff across the 2 EISs. Over 5 months and across both EISs, a total of 4,911 children aged 3 to 17 years were cared for. A total of 782 children had COVID-19, most infected before arrival. Most children (3,931) were reunified with family or sponsors. Continuity of care after reunification or placement in a long-term shelter was enhanced by use of an electronic health record. The effort provided an educational experience for residents and fellows with instruction in immigrant health and trauma-informed care. The effort benefitted from UCH’s recent experience of providing a system-wide response to the COVID-19 pandemic. Lessons learned are reported to encourage the alignment and integration of academic health centers’ capacities with federal, state, and local plans to better prepare for and respond to the accelerating need to care for those in the wake of disasters and humanitarian crises.
Lumbar Plexus Nerve Blocks for Perioperative Pain Management in Cerebral Palsy Patients Undergoing Hip Reconstruction: More Effective Than General Anesthesia and Epidurals
Authors: Trionfo Arianna , Zimmerman Remy , Gillock Kelly , Budziszewski Ross , Hasan Aysha
Published: December 2022

Background:

Hip reconstruction in patients with cerebral palsy (CP) is associated with. significant postoperative pain. However, adequate analgesia can be difficult to achieve. in this population due to spasticity, communication barriers, and postoperative. spasticity. Recently, multimodal pain management techniques such as epidurals and. regional nerve blocks have been described for postoperative pain control, but it is unclear if 1 technique is more beneficial. The purpose of this study was to compare the outcomes of different perioperative pain management techniques.

Methods:

This study is a retrospective review of a consecutive series of children with CP over a 5-year period at a single pediatric tertiary-care hospital who underwent hip reconstruction (proximal femoral osteotomy with or without a pelvic osteotomy). Patients were subdivided based on their anesthetic protocol into the following groups: general anesthesia alone (G), general anesthesia with an epidural (E), and general anesthesia with lumbar plexus block (LPB). Our primary outcome was cumulative postoperative narcotic consumption (converted to morphine equivalents). Secondary outcomes included length of stay (LOS), average postoperative heart rate, and pain scores. analysis of variance testing was utilized to compare differences between the groups.

Results:

Fifty-four patients who underwent hip reconstruction were included: 19 in the G group, 18 in the E group, and 17 in the LPB group. LOS was significantly higher in the E group compared with the G and LPB groups: F(2,51)=3.58, P=0.04. The average pain score was significantly lower in the LPB group compared with the others: F(2,51)=4.26, P=0.02. The average postoperative heart rate was significantly lower in the LPB group: F(2,51)=7.08, P<0.01. Postoperative narcotic consumption was significantly lower in the LPB group: F(2,51)=11.57, P<0.01.

Conclusion:

The LPB patients required the least amount of narcotics compared with the other groups. This, combined with a lower perioperative heart rate and shorter LOS would suggest these patients experienced less pain over the time of their in-patient stay. In comparison to general anesthesia alone and epidural anesthesia, lumbar plexus nerve blocks are an effective pathway for postoperative pain control after hip reconstruction in a CP population.

Level of Evidence:

Level III—Case control or retrospective comparative study.
Guided Growth Improves Coxa Valga and Hip Subluxation in Children With Hereditary Multiple Exostoses
Authors: Hung Tun-Yu , Wu Kuan-Wen , Lee Chia-Che , Lin Sheng-Chieh , Kuo Ken N. , Wang Ting-Ming
Published: December 2022

Background:

In children with severe hereditary multiple exostoses (HME), coxa valga, and hip subluxation are common deformities. The literatures related to surgical management and prevention of hip joint subluxation in HME are scarce. In this study, we aimed to investigate the efficacy of guided growth procedure to correct coxa valga and hip subluxation in HME patients.

Methods:

We retrospectively retrieved 12 patients who received guided growth procedures for coxa valga and hip subluxation in HME patients with proximal femur exostoses with a minimum follow-up time of 2 years between 2012 and 2019. Radiographic parameters include head-shaft angle, Hilgenreiner-epiphyseal angle, acetabular index, Reimer migration percentage, center-edged angle, articulo-trochanteric distance, and femoral neck length for comparison between preoperative and latest follow-up results. It was conducted statistically by paired t test and Wilcoxon signed rank test.

Results:

In this study, the mean difference between preoperative and latest follow-up was significant in head-shaft angle (12±5 degrees; CI, 10-14; P<0.001), Hilgenreiner-epiphyseal angle (12±5 degrees; CI, 10-15; P<0.001), and MP (7%±8%; CI, 3-11; P=0.001). There was a low revision rate (4 of 21, 19%) and no complication in our study. Compared with previous studies on guided growth in children with cerebral palsy and developmental dysplasia of the hip, our study showed good comparable outcomes.

Conclusion:

The results indicated that guided growth improves the hip radiographic parameters of children with HME and may prevent coxa valga and hip subluxations. It is a safe procedure and provides predictable results.

Level of Evidence:

Level IV; therapeutic, case series.
Reconstruction of a Near-total Scalp Avulsion with NovoSorb Biodegradable Temporizing Matrix: Pediatric Case Report
Authors: Patel Niki K. , Tipps John A. , Graham Emily M. , Taylor Jesse A. , Mendenhall Shaun D.
Published: December 2022

Traumatic dog bites of the face and head are common among the pediatric population, although injuries resulting in total or subtotal scalp avulsions are rare and life-threatening. Standard treatment in these cases includes attempts at replantation or free tissue transfer; however, these procedures may not always be possible. An alternative treatment option involves the use of dermal substitutes, such as Integra (Integra LifeScience Corporation), with subsequent skin grafting. More recently, an alternative skin substitute called NovoSorb Biodegradable Temporizing Matrix (BTM) (PolyNovo North America LLC) has displayed favorable reconstructive outcomes in recent burn literature. NovoSorb BTM is a novel, fully synthetic bilayer scaffold made of biodegradable polyurethane matrix covered with a sealing membrane. In this report, the authors describe a 3-year-old boy who presented emergently with a severe dog bite avulsion to the subpericranial level of approximately 80% of his scalp, which was not replantable. The surgical plan involved a staged reconstruction using Integra and later skin grafting. Purulent infection ensued and required removal of Integra less than 2 weeks from application. Upon clearing of the infection, the wound was successfully closed with BTM and subsequent skin grafting. With proper wound management and over 6 months of follow-up, the patient experienced excellent healing of the graft with stable calvarial coverage and an acceptable aesthetic outcome. He will undergo tissue expansion of the remaining hair-bearing scalp in the future.
Assent in Pediatric Critical Care Research: A Cross-Sectional Stakeholder Survey of Canadian Research Ethics Boards, Research Coordinators, Pediatric Critical Care Researchers, and Nurses*
Authors: O’Hearn Katie , Cayouette Florence , Cameron Saoirse , Martin Dori-Ann , Tsampalieros Anne , Menon Kusum ,   the Canadian Critical Care Trials Group
Published: December 2022

OBJECTIVES:

Survey of four stakeholder groups involved in defining and obtaining assent for research in Canadian PICUs to better understand their perspectives and perceived barriers to assent.

DESIGN:

Cross-sectional survey.

SETTING:

Fourteen tertiary-care pediatric hospitals in Canada.

PARTICIPANTS:

Research Ethics Board Chairs, pediatric critical care nurses, research coordinators, and researchers.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A total of 193 participants responded. Thirty-seven percent (59/159) thought it was “Never/Almost Never” (59/159, 37%) feasible to obtain assent during the first 48 hours of PICU admission, and 112 of 170 (66%) indicated there are unique barriers to assent at the time of enrollment in PICU studies. Asking children for assent was most frequently rated as Important/Very Important for interviews/focus groups with the child (138/180, 77%), blood sample collection with a needle poke for research (137/178, 77%), and studies involving genetic testing with results communicated to the child/legal guardian (134/180, 74%). In two scenarios where a child and legal guardian disagreed about study participation, most respondents indicated that whether the child should still be enrolled would depend on the patient’s age (34-36%), and/or the risk of the study (24-28%). There was a lack of consensus over how the assent process should be operationalized, and when and for how long children should be followed to seek assent for ongoing study participation. Most stakeholders (117/158, 74%) thought that children should have the opportunity to decide if their samples could stay in a biobank once they are old enough to do so.

CONCLUSIONS:

There was an overall lack of consensus on the feasibility of, and challenges associated with, obtaining assent at the time of study enrollment and on how key aspects of the assent process should be operationalized in the PICU. This highlights the need for guidelines to clarify the assent process in pediatric critical care research.