bluuebunny/crossref_metadata_2025 huggingface dataset:
Revision of the relationship between anther morphology and pollen sterility by cold stress at the booting stage in rice
Authors: Yamamori Koichi , Ogasawara Kei , Ishiguro Seiya , Koide Yohei , Takamure Itsuro , Fujino Kaien , Sato Yutaka , Kishima Yuji
Published: July 2021

Background and Aims

Cold stress in rice (Oryza sativa) plants at the reproductive stage prevents normal anther development and causes pollen sterility. Tapetum hypertrophy in anthers has been associated with pollen sterility in response to cold at the booting stage. Here, we re-examined whether the relationships between anther abnormality and pollen sterility caused by cold stress at the booting stage in rice can be explained by a monovalent factor such as tapetum hypertrophy.

Methods

After exposing plants to a 4-d cold treatment at the booting stage, we collected and processed anthers for transverse sectioning immediately and at the flowering stage. We anatomically evaluated the effect of cold treatment on anther internal morphologies, pollen fertilities and pollen numbers in the 13 cultivars with various cold sensitivities.

Key Results

We observed four types of morphological anther abnormalities at each stage. Pollen sterility was positively correlated with the frequency of undeveloped locules, but not with tapetum hypertrophy as commonly believed. In cold-sensitive cultivars grown at low temperatures, pollen sterility was more frequent than anther morphological abnormalities, and some lines showed remarkably high pollen sterility without any anther morphological alterations. Most morphological anomalies occurred only in specific areas within large and small locules. Anther length tended to shorten in response to cold treatment and was positively correlated with pollen number. One cultivar showed a considerably reduced pollen number, but fertile pollen grains under cold stress. We propose three possible relationships to explain anther structure and pollen sterility and reduction due to cold stress.

Conclusions

The pollen sterility caused by cold stress at the booting stage was correlated with the frequency of entire locule-related abnormalities, which might represent a phenotypic consequence, but not a direct cause of pollen abortion. Multivalent factors might underlie the complicated relationships between anther abnormality and pollen sterility in rice.
Quantitative Determination of Anti-Migraine Quaternary Mixture in Presence of p-Aminophenol and 4-Chloroacetanilide
Authors: Farid Nehal F , Abdelhamid Nessreen S , Naguib Ibrahim A , Anwar Basma H , Magdy Maimana A
Published: July 2021

A validated RP-HPLC method was developed for the estimation of paracetamol, caffeine, metoclopramide and ergotamine simultaneously in bulk and pharmaceutical formulation. The method was extended for the determination of two paracetamol genotoxic and nephrotoxic impurities and degradation products namely p-aminophenol and 4-chloroacetanilide. Separation was done on octadecyl column (15 cm × 2.1 mm, 5 μm). Gradient elution was performed using mobile phase consisting of acetonitrile and water (pH 3) in ratio of (20: 80, v/v) for the first 3 min, (50: 50, v/v) for the next 4.5 min, then (20: 80, v/v) for the final 2.5 min. The flow rate was 0.7 mL/min throughout the run which took 10 min. UV detection was done at 230 nm. The proposed method agreed with ICH guidelines of method validation. The suggested method was applied for the estimation of the proposed drugs in their dosage form. Statistical comparison was done between the results obtained from the suggested method and those obtained from reported HPLC method. The proposed method is more beneficial than the published one because of having higher sensitivity and selectivity as it allows the detection of the proposed drugs in lower concentrations in the presence of paracetamol toxic impurities, p-aminophenol and 4-chloroacetanilide.
Characteristics of patients with atrial high rate episodes detected by implanted defibrillator and resynchronization devices
Authors: Miyazawa Kazuo , Pastori Daniele , Martin David T , Choucair Wassim K , Halperin Jonathan L , Lip Gregory Y H ,   the IMPACT Study Investigators
Published: July 2021

Aims

Atrial high rate episodes (AHREs) are associated with increased risks of thromboembolism and cardiovascular mortality. However, the clinical characteristics of patients developing AHRE of various durations are not well studied.

Methods and results

This was an ancillary analysis of the multicentre, randomized IMPACT trial. In the present analysis, we classified patients according to the duration of AHRE ≤6 min, >6 min to ≤6 h, >6 to ≤24 h and >24 h, and investigated the association between clinical factors and the development of each duration of AHRE. Of 2718 patients included in the trial, 945 (34.8%) developed AHRE. The incidence rates of each AHRE duration category were 5.4/100, 12.0/100, 6.8/100, and 3.3/100 patient-years, respectively. The incidence rates of AHRE >6 h were significantly higher in patients at high risk of thromboembolism (CHADS2 score ≥3) compared to those at low risk (CHADS2 score 1 or 2). Using Cox regression analysis, age ≥65 years and history of atrial fibrillation (AF) and/or atrial flutter (AFL) were risk factors for AHRE >6 min. In addition, hypertension was associated with AHRE >24 h (hazard ratio 2.13, 95% confidence interval 1.24–3.65, P = 0.006).

Conclusion

Atrial high rate episode >6 min to ≤6 h were most prevalent among all AHRE duration categories. Longer AHREs were more common in patients at risk of thromboembolism. Age and history of AF/AFL were risk factors for AHRE >6 min. Furthermore, hypertension showed a strong impact on the development of AHRE >24 h rather than age.
Legal Violence and (In)Visible Families: How Law Shapes and Erases Family Life in SOGI Asylum in Europe
Authors: Danisi Carmelo , Ferreira Nuno
Published: July 2021

Studies on the Refugee Convention have paid very limited attention to the notion of family and family rights of asylum claimants in connection with asylum claims based on sexual orientation and gender identity (SOGI). Drawing on the notion of ‘legal violence’, this article demonstrates the injurious cumulative effect that a heteronormative, homonormative and Western-centered formulation and implementation of asylum and refugee law has on SOGI claimants when it comes to intimate and family relationships. By relying on a solid body of primary and secondary data, it explores the invisibility of SOGI claimants and refugees’ families and how that invisibility is normalized by European legal frameworks, such as the Dublin (III) Regulation and Family Reunification Directive. To end this ‘legal violence’ and reconnect asylum systems with the lived experiences of SOGI claimants, a principled approach based on human rights and specifically the right to respect for family life is suggested.
Optimising sampling frequency for monitoring heterotrophic protists in a marine ecosystem
Authors: Lehtiniemi Maiju , Fileman Elaine , Hällfors Heidi , Kuosa Harri , Lehtinen Sirpa , Lips Inga , Setälä Outi , Suikkanen Sanna , Tuimala Jarno , Widdicombe Claire
Published: July 2021

Heterotrophic protists are essential components of the marine ecosystem, yet they are often excluded from monitoring programmes. With limited resources, monitoring strategies need to be optimised considering both scientific knowledge and available resources. In doing so, it is crucial to understand how sampling frequency affects the value of the data. We analysed 11 years of weekly heterotrophic protist time-series data from Station L4 in the Western English Channel to explore how different sampling intervals impact data quality. In the L4 dataset, comprising 55 protist taxa, the reduction of sampling frequency from weekly to four times a year at specific seasons decreased the number of taxa encountered by 38% for ciliates and 29% for heterotrophic dinoflagellates while the mean annual biomass or its mean variation were not affected. Furthermore, when samples were taken only four times a year, biomass peaks of the ten most important taxa were often missed. The primary motivator for this study was furthering the development of the heterotrophic protist monitoring in temperate and subarctic marine areas, e.g. the Baltic Sea. Based on our findings, we give recommendations on sampling frequency to optimise the value of heterotrophic protist monitoring.
Genotype-specific P-spline response surfaces assist interpretation of regional wheat adaptation to climate change
Authors: Bustos-Korts Daniela , Boer Martin P , Chenu Karine , Zheng Bangyou , Chapman Scott , van Eeuwijk Fred A
Published: July 2021

Yield is a function of environmental quality and the sensitivity with which genotypes react to that. Environmental quality is characterized by meteorological data, soil and agronomic management, whereas genotypic sensitivity is embodied by combinations of physiological traits that determine the crop capture and partitioning of environmental resources over time. This paper illustrates how environmental quality and genotype responses can be studied by a combination of crop simulation and statistical modelling. We characterized the genotype by environment interaction for grain yield of a wheat population segregating for flowering time by simulating it using the the Agricultural Production Systems sIMulator (APSIM) cropping systems model. For sites in the NE Australian wheat-belt, we used meteorological information as integrated by APSIM to classify years according to water, heat and frost stress. Results highlight that the frequency of years with more severe water and temperature stress has largely increased in recent years. Consequently, it is likely that future varieties will need to cope with more stressful conditions than in the past, making it important to select for flowering habits contributing to temperature and water-stress adaptation. Conditional on year types, we fitted yield response surfaces as functions of genotype, latitude and longitude to virtual multi-environment trials. Response surfaces were fitted by two-dimensional P-splines in a mixed-model framework to predict yield at high spatial resolution. Predicted yields demonstrated how relative genotype performance changed with location and year type and how genotype by environment interactions can be dissected. Predicted response surfaces for yield can be used for performance recommendations, quantification of yield stability and environmental characterization.
The Impact of Thermal Stress on Cognition and the Use of Cooling Wear for Alleviation—An Explorative Study
Authors: Luze Hanna , Nischwitz Sebastian Philipp , Fink Julia , Hecker Andrzej , Holzer Judith Christine Julie , Schellnegger Marlies , Kamolz Lars Peter
Published: July 2021

Increased ambient temperatures during the care of severely burned patients are essential for mitigating hypothermia and minimizing the impact of consecutive hypermetabolism. For involved medical staff, those conditions may lead to impaired concentration, possibly negatively affecting optimal patient care. Yet, alleviation strategies are lacking. As a novel coping strategy, cooling wear may be an effective means. This explorative study aimed to investigate the effect of high ambient temperatures on the concentration capacity and cooling wear to alleviate thermal stress. The effects of high ambient temperatures and the additional use of cooling wear on the concentration capacity of medical staff were investigated in six subjects during two simulated burn surgeries. Each individual served as his/her own control undergoing one simulation with and one without cooling wear. Concentration capacity was measured before and after each simulation with a standardized test. The results suggested that high ambient temperatures, as used in burn medicine, negatively affect human concentration capacity. The initial assessment of concentration capacity yielded homogenous values. After heat exposure, subjects wearing cooling wear showed a higher concentration capacity and a lower error rate compared to subjects without cooling wear. Summing up, temperature-related decrements in vigilance and performance among medical personnel may impair the patients’ outcome. As an opportunity to withstand thermal stress and improve medical care and safety, cooling wear showed promising results and may be used as a heat alleviator. Burn medicine may particularly benefit from further development and rigorous investigation of cooling strategies.
Incorporating Peer Learning Into Your Breast Imaging Practice
Authors: Schafer Leah E , Perry Hannah , Fishman Michael DC , Jakomin Bernadette V , Slanetz Priscilla J
Published: July 2021

Traditional score-based peer review has come under scrutiny in recent years, as studies have demonstrated it to be generally ineffective at improving quality. Many practices and programs are transitioning to a peer learning model to replace or supplement traditional peer review. Peer learning differs from traditional score-based peer review in that the emphasis is on sharing learning opportunities and creating an environment that fosters discussion of errors in a nonpunitive forum with the goal of improved patient care. Creating a just culture is central to fostering successful peer learning. In a just culture, mistakes can be discussed without shame or fear of retribution and the focus is on systems improvement rather than individual blame. Peer learning, as it pertains to breast imaging, can occur in many forms and venues. Examples of the various formats in which peer learning can occur include through individual colleague interaction, as well as divisional, multidisciplinary, department-wide, and virtual conferences, and with the assistance of artificial intelligence. Incorporating peer learning into the practice of breast imaging aims to reduce delayed diagnoses of breast cancer and optimize patient care.
A positive feedback regulatory loop involving the lncRNA PVT1 and HIF-1α in pancreatic cancer
Authors: Zhu Yiping , Wu Fang , Gui Weiwei , Zhang Nan , Matro Erik , Zhu Linghua , Eserberg Daniel Turunen , Lin Xihua
Published: July 2021

Extreme hypoxia is among the most prominent pathogenic features of pancreatic cancer (PC). Both the long non-coding RNA (lncRNA) plasmacytoma variant translocation 1 (PVT1) and hypoxic inducible factor-1α (HIF-1α) are highly expressed in PC patients and play a crucial role in disease progression. Reciprocal regulation involving PVT1 and HIF-1α in PC, however, is poorly understood. Here, we report that PVT1 binds to the HIF-1α promoter and activates its transcription. In addition, we found that PVT1 could bind to HIF-1α and increases HIF-1α post-translationally. Our findings suggest that the PVT1‒HIF-1α positive feedback loop is a potential therapeutic target in the treatment of PC.
A multidisciplinary neuro-oncological triage panel reduces the time to referral and treatment for patients with a brain tumor
Authors: de Swart Merijn E , Kouwenhoven Mathilde C M , Hellingman Tessa , Kuiper Babette I , Gorter de Vries Cathelijne , Leembruggen-Vellinga Machteld , Maliepaard Niels K , Wouda Ernest J , Moraal Bastiaan , Noske David P , Postma Tjeerd J , Sanchez Aliaga Esther , Uitdehaag Bernard M J , Vandertop William P , Zonderhuis Barbara M , Kazemier Geert , de Witt Hamer Philip C , Schuur Maaike
Published: July 2021

Background

Regional collaboration and appropriate referral management are crucial in neuro-oncological care. Lack of electronic access to medical records across health care organizations impedes interhospital consultation and may lead to incomplete and delayed referrals. To improve referral management, we have established a multidisciplinary neuro-oncological triage panel (NOTP) with digital image exchange and determined the effects on lead times, costs, and time investment.

Methods

A prospective cohort study was conducted from February 2019 to March 2020. All newly diagnosed patients referred to Brain Tumor Center Amsterdam were analyzed according to referral pathway: (1) standard referral (SR), (2) NOTP. The primary outcome was lead time, defined as time-to-referral, time-to-treatment, and total time (median days [interquartile range]). Secondary outcomes were costs and time investment.

Results

In total, 225 patients were included, of whom 153 had SR and 72 NOTP referral. Patients discussed in the NOTP were referred more frequently for first neurosurgical consultation (44.7% vs 28.8%) or combined neurological and neurosurgical consultation (12.8% vs 2.5%, P = .002). Time-to-referral was reduced for NOTP referral compared to SR (1 [0.25-4] vs 6 [1.5-10] days, P < .001). Total time decreased from 27 [14-48] days for the standard group to 15 [12-38.25] days for the NOTP group (P = .040). Costs and time investment were comparable for both groups.

Conclusion

Implementation of digital referral to a multidisciplinary NOTP is feasible and leads to more swift patient-tailored referrals at comparable costs and time investment as SR. This quality improvement initiative has the potential to improve collaboration and coordination of multidisciplinary care in the field of neuro-oncology.
Identification of characteristics that determine behavioral and personality changes in adult glioma patients
Authors: Zwinkels Hanneke , Dirven Linda , Bulbeck Helen J , Grant Robin , Habets Esther J J , Koekkoek Johan A F , Oberg Ingela , Oliver Kathy , Pace Andrea , Rooney Alasdair G , Vos Maaike J , Taphoorn Martin J B
Published: July 2021

Background

Glioma patients may experience behavioral and personality changes (BPC), negatively impacting their lives and that of their relatives. However, there is no clear definition of BPC for adult glioma patients, and here we aimed to determine which characteristics of BPC are relevant to include in this definition.

Methods

Possible characteristics of BPC were identified in the literature and presented to patients and (former) caregivers in an online survey launched via the International Brain Tumour Alliance. Participants had to rate the relevance of each presented characteristic of BPC, the three characteristics with the most impact on their lives, and possible missing characteristics. A cluster analysis and discussions with experts provided input to categorize characteristics and propose a definition for BPC.

Results

Completed surveys were obtained from 140 respondents; 35% patients, 50% caregivers, and 15% unknown. Of 49 proposed characteristics, 35 were reported as relevant by at least 25% (range: 7%-44%) of respondents. Patients and caregivers rated different characteristics as most important. Common characteristics included in the top 10 of both patients and caregivers were lack of motivation, change in being socially active, not able to finish things, and change in the level of irritation. No characteristics were reported missing by ≥5 respondents. Three categories of BPC were identified: (1) emotions, needs, and impulses (2) personality traits, and (3) poor judgement abilities.

Conclusion

The work resulted in a proposed definition for BPC in glioma patients, for which endorsement from the neuro-oncological community will be sought. A next step is to identify or develop an instrument to evaluate BPC in glioma patients.
Bartonella quintana Infection Manifesting as Leucocytoclastic Vasculitis Rash
Authors: Hopkins Brian J , Prokesch Bonnie C
Published: July 2021

We present the first case described in the literature of leucocytoclastic vasculitis due to Bartonella quintana infection. A 73-year-old woman presented to the hospital with persistent fevers, retro-orbital headache, generalized weakness, and left lower thigh pain for 1 week. She was found to have truncal and proximal lower extremity papules and small plaques. Serology revealed Bartonella quintana immunoglobulin M (IgM) titer of 1:256 with undetectable Bartonella quintana immunoglobulin G (IgG) and undetectable Bartonella henselae IgG and IgM. Skin biopsy of an abdominal lesion revealed fibrinoid necrosis of vessel walls in the superficial and mid-dermis consistent with leucocytoclastic vasculitis. Doxycycline 100 mg orally twice daily was initiated, after which she had defervescence within 36 hours and rapid improvement of other presenting symptoms.
Retracted: Meta-analysis of Randomized Trials of Ivermectin to Treat SARS-CoV-2 Infection
Authors: Hill Andrew , Garratt Anna , Levi Jacob , Falconer Jonathan , Ellis Leah , McCann Kaitlyn , Pilkington Victoria , Qavi Ambar , Wang Junzheng , Wentzel Hannah
Published: July 2021

Ivermectin is an antiparasitic drug being investigated for repurposing against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Ivermectin showed in vitro activity against SARS-COV-2, but only at high concentrations. This meta-analysis investigated ivermectin in 23 randomized clinical trials (3349 patients) identified through systematic searches of PUBMED, EMBASE, MedRxiv, and trial registries. The primary meta-analysis was carried out by excluding studies at a high risk of bias. Ivermectin did not show a statistically significant effect on survival (risk ratio [RR], 0.90; 95% CI, 0.57 to 1.42; P = .66) or hospitalizations (RR, 0.63; 95% CI, 0.36 to 1.11; P = .11). Ivermectin displayed a borderline significant effect on duration of hospitalization in comparison with standard of care (mean difference, –1.14 days; 95% CI, –2.27 to –0.00; P = .05). There was no significant effect of ivermectin on time to clinical recovery (mean difference, –0.57 days; 95% CI, –1.31 to 0.17; P = .13) or binary clinical recovery (RR, 1.19; 95% CI, 0.94 to 1.50; P = .15). Currently, the World Health Organization recommends the use of ivermectin only inside clinical trials. A network of large clinical trials is in progress to validate the results seen to date.
Properties of Skyrme force as a residual interaction in beyond-mean-field theories
Authors: Tohyama Mitsuru
Published: July 2021

In an effort to find an effective interaction that can consistently be used for both the mean-field part and the residual part in beyond-mean-field theories, the properties of the Skyrme interactions as a residual interaction are investigated. The time-dependent density-matrix theory (TDDM) is used as a beyond-mean-field theory and the ground states of $^{16}$O and $^{40}$Ca are calculated using the five standard parametrizations of the Skyrme interaction, which differ in density and momentum dependence. It is found that the Skyrme interaction, which has strong density dependence and weak momentum dependence, induces substantial ground-state correlations comparable to the results of other theoretical calculations.
A Chivalric Show of Civic Virtue: The Society of Prince Arthur’s Archers
Authors: Brown Felicity
Published: July 2021

This article explores civic pageantry’s role in detaching King Arthur and aspects of the Arthurian world from the narratives of the medieval tradition by examining the Society of Prince Arthur’s show, a popular event hosted by an archery fraternity in late sixteenth-century London. The processional nature of the Society’s annual show, the account of the Society provided by Richard Mulcaster, and readers’ annotations in copies of Richard Robinson’s The Ancient Order, Societie, and Unitie Laudable of Prince Arthure and his knightly armory of the Round Table (1583) reveal the importance of performance in the early modern reimagining of Arthur and his knights as symbols of civic virtue. The Society’s adaptations of Arthurian characters and the chivalry of the Round Table thus influence both satirical responses to chivalric literature in the period and Edmund Spenser’s presentation of the Arthurian legend in The Faerie Queene (1590).
Phylogeny, species delimitation and biogeography of the endemic Palaearctic tribe Tomarini (Lepidoptera: Lycaenidae)
Authors: Krupitsky Anatoly V , Shapoval Nazar A , Schepetov Dmitry M , Ekimova Irina A , Lukhtanov Vladimir A
Published: July 2021

The tribe Tomarini is represented by the sole genus Tomares, comprising about eight species distributed from the western Mediterranean to Central Asia. We carried out a multilocus phylogenetic and a biogeographical analysis to test the taxonomy of the genus by several molecular species delimitation methods and reveal patterns shaping the current distribution of Tomares. The phylogenetic analysis based on four molecular markers recovered the monophyly of the genus and recovered two deep-branching lineages: an African clade and an Asian clade. Species delimitation analyses suggested six or ten putative species depending on the method applied. The haplotype network analysis of the Tomares nogelii clade revealed no phylogeographical and taxonomic structure. We consider the taxon Tomares nesimachus (syn. nov.) a synonym of T. nogelii and reinstate Tomares callimachus dentata stat. rev. for populations from south-eastern Turkey. Tomares originated between the early Oligocene and the early Miocene, most probably in south-west Asia. The split of the most recent common ancestor of Tomares occurred between the middle-late Miocene and middle-late Pliocene, probably as a response to increasing aridification and habitat fragmentation. Differentiation of the Asian clade took place in south-west Asia during the Pliocene and Pleistocene and coincided temporally with the evolution of Tomares host plants of the genus Astragalus (Fabaceae).
Analysis and Evaluation of the Theory of Planned Behavior
Authors: Lee Sueyeon , Vincent Catherine
Published: July 2021

The Theory of Planned Behavior was developed to explain human behaviors. The theory has been broadly applied to health-related behaviors in nursing science but has not been examined in depth based on a critical nursing framework. This article systematically analyzes and evaluates the theory based on Fawcett and DeSanto-Madeya's 2013 framework. The theory reflects nursing metaparadigm concepts and has both social and theoretical significance as well as pragmatic adequacy, and its testability is supported by abundant empirical evidence. However, the theory's internal consistency and clarity could be improved with use of consistent terms for its concepts and relationships.
Heart-Focused Anxiety
Authors: Barthle Pamela
Published: July 2021

Although heart-focused anxiety is a common experience of patients following a myocardial infarction, it is one rarely addressed in nursing research. I used Rodger's evolutionary method of concept analysis to review uses of heart-focused anxiety in literature from several disciplines including nursing and synthesized a definition to guide future research. Heart-focused anxiety is an experience of avoidance, fear, and heart-focused attention that follows from cardiac diagnoses, somatic symptoms, and familial factors and results in adverse health outcomes, reassurance seeking, disruption of life, and recurrent chest pain. Although heart-focused anxiety is an evolving concept, the updated definition should help provide a foundation for future research. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A32.
Patterns of Knowing and Being in the COVIDicene
Authors: Blaine Brown Brandon , Dillard-Wright Jessica , Hopkins-Walsh Jane , Littzen Chloe O. R. , Vo Timothea
Published: July 2021

The crucible of the COVIDicene distills critical issues for nursing knowledge as we navigate our dystopian present while unpacking our oppressive past and reimagining a radical future. Using Barbara Carper's patterns of knowing as a jumping-off point, the authors instigate provocations around traditional disciplinary theorizing for how to value, ground, develop, and position knowledge as nurses. The pandemic has presented nurses with opportunities to shift toward creating a more inclusive and just epistemology. Moving forward, we propose an unfettering of the patterns of knowing, centering emancipatory knowing, ultimately resulting in liberating the patterns from siloization, cocreating justice for praxis.
Medial Submuscular Plating of the Distal Femur
Authors: Neiman Rafael , Finkemeier Christopher G.
Published: July 2021

Distal femur fractures are often treated with laterally based plate constructs. The use of medial plates is less common because of the concern for the proximity to vascular structures. With a solid understanding of the anatomy, the technique can be used more frequently to optimize fixation in medial distal femur fractures and osteoporotic, comminuted, bone loss, and periprosthetic fractures. This video demonstrates a safe technique for the medial submuscular plating of a distal femur fracture. The video covers indications for surgery and provides detailed anatomy of the structures at risk, especially the superficial femoral artery system.
Subtalar Distraction Arthrodesis
Authors: Probe Robert , Brown Jaycen C.
Published: July 2021

Subtalar distraction arthrodesis is a hindfoot reconstructive procedure designed to treat posttraumatic sequelae of certain calcaneal fractures. This video demonstrates one method of performing this procedure which resulted in dramatic pain improvement and functional restoration.
Staged Reconstruction of a Moore Type 4 Fracture Dislocation, Parts 1 and 2
Authors: Schultz Blake J. , Lowe Dylan T. , Pean Christian A. , Alaia Michael J. , Egol Kenneth A.
Published: July 2021

High-energy tibial plateau fractures are associated with knee fracture dislocations and concomitant ligamentous injury. Both bony and ligamentous injuries can require surgical fixation, often requiring a multidisciplinary team and staged treatment. This article and accompanying video describe the workup and treatment of a Moore type 4 tibial plateau rim compression fracture with posterolateral corner and anterior cruciate ligament rupture that underwent open reduction internal fixation of the tibial plateau with posterolateral corner reconstruction and then staged anterior cruciate ligament reconstruction with quad tendon autograft.
Triceps-Sparing Approach for Distal Humerus Fixation
Authors: Lee Christopher , Brodke Dane J.
Published: July 2021

The triceps-sparing approach to the posterior humerus affords broad exposure for fracture fixation with a minor risk of radial nerve palsy. By using a muscle-sparing interval, the approach facilitates reduction and fixation of humeral shaft and extra-articular distal humerus fractures without injury to the triceps. This video demonstrates the triceps-sparing approach used in the surgical treatment of a 23-year-old man with an extra-articular distal humerus fracture.
Evidence-Based Clinical Practice Guideline: Reconstruction after Skin Cancer Resection
Authors: Chen Andrew , Albertini John G. , Bordeaux Jeremy S. , Chen Michael W. , Cook Jonathan L. , Davidson Caryn , Donnelly Katelyn C. , Galaria Irfan I. , Hannan Catherine M. , Kantor Jonathan , Kapp Daniel L. , Lawrence Naomi , Lober Clifford W. , Loeding Lauren D. , Miller Alexander , Ness Daniel T. , Neves Rogerio I. , Revenaugh Peter C. , Setabutr Peter , Tholpady Sunil S. , Tollefson Travis T. , Van Beek Marta J. , Weiss Paul R. , Alam Murad
Published: July 2021

A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructive techniques and clinical scenarios, investigation centered around common elements in the process. In some cases, a distinction was made between treatment options in the office-based setting as opposed to those in the facility setting. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology). Final recommendations are related to concepts concerning the timing of reconstruction, management of anticoagulation, use of antibiotics, methods of pain control, and follow-up assessment. At times, there was insufficient evidence to make high-level recommendations. The literature analysis highlights the need for additional methodologically robust studies in this area, to help guide clinical practice.
Early clinical exposure improves medical students’ recognition of the need for professionalism and interprofessional collaboration
Authors: Chang Ching-Chih , Huang Hui-Chun , Lee Wen-Shin , Chuang Chiao-Lin , Huang Ling-Ju , Lu Dai-Yin , Yang Ying-Ying , Hsu Hui-Chi
Published: July 2021

Background:

Medical students in Taiwan start their clerkship in their fifth year. A lack of early clinical exposure can mean they have a lack of medical professionalism and collaborative practice. This study investigates whether early engagement in hospital-based clinical practice could improve their understanding of these requirements.

Methods:

From 2017 to 2019, a total of 59 medical students at the end of their third year joined a 2-week summer camp at the hospital. Every participant was assigned to work with one patient and they accompanied this patient throughout their hospital course. The students were also asked to interview other medical professionals within the hospital and to write up interview reports. In addition, they had to complete pre- and postcamp questionnaires which included 10 questions to evaluate their recognition of professionalism, doctor–patient relationships, and interprofessional collaboration. Answers to the questions were all rated using a 5-score Likert scale.

Results:

The total postcamp Likert scores were significantly increased after the 2-week training camp compared with the precourse scores (pre- vs postcourse: 44.08 ± 0.45 vs 46.66 ± 0.33, p < 0.001). In addition, the students’ recognition of medical professionalism, the importance of communication with patients, and their respect for other medical professionals were significantly improved after the 2-week training.

Conclusion:

Our data showed that early clinical exposure through a preclerkship summer camp can help medical students improve their recognition of medical professionalism and interprofessional collaboration.
Advanced Trauma Care for Nurses (ATCN): A Single-Center Analysis of Trauma Nurses Knowledge Gaps
Authors: Kaur Shivpreet , Rattan Amulya , Kumar Hemant , Rao Shalinee , Kant Ravi , Misra Mahesh C.
Published: July 2021

Background:

Trauma is a global cause of death and disability, and trauma systems are not well developed in low- and middle-income countries. Training of nurses in trauma care is of utmost importance to improve the organization and delivery of trauma care.

Objective:

This study aimed to identify common knowledge gaps and develop study aids to improve nurses' performance taking the Advanced Trauma Care for Nurses (ATCN) course.

Methods:

This is a descriptive, single-center study of the multiple-choice final examinations of the ATCN course conducted over 1 year in the All India Institute of Medical Sciences, Rishikesh, Level I trauma center. The questions missed by candidates were compiled, and the wrong options were tabulated. The most commonly missed questions were identified, and the most commonly marked wrong option was analyzed vis-a-vis the correct answer. Each error was classified into either a theoretical error or a practice-based error.

Results:

Ninety-six nurses attended 6 courses from June 2019 to June 2020. Of the theoretical-based questions, the top 3 categories of most missed questions were geriatric trauma (n = 13; 81.2%), massive transfusion (n = 35; 72.9%), and traumatic brain injury (n = 35; 72.9%). Of the practice-based questions, the top 3 categories of most missed questions were dislocated extremity management (n = 54; 79.4%), basic airway (n = 31; 64.5%), and shock management (n = 30; 62.5%).

Conclusions:

Periodic identification and categorization of the ATCN course examination's most frequent knowledge gaps allow instructors to develop teaching aids to enhance instructor teaching and improve trauma nurses' knowledge.
Trauma Takeaways: Reception and Utilization of a Postsimulation Newsletter
Authors: Patel Katie J. , Williamson Kristy , LaMaina Laura , Bullaro Francesca
Published: July 2021

Background:

Simulation is incorporated into medical education to reinforce practical skills. Instructor methodologies allow for reflective practice through debriefing; however, this is limited to real-time audiences. Few studies have described education via supplemental materials.

Objective:

This educational initiative demonstrates the reception and use of a postsimulation newsletter for both participating and nonparticipating trauma team members.

Methods:

After each case, the Trauma Takeaways newsletter was distributed to all trauma team members at our Level I pediatric trauma center. The newsletter included a brief case summary, objectives, and debrief highlights regarding communication, medical management, and practical logistics. A survey was conducted to assess its utility 6 months after its introduction.

Results:

Of 69 interdisciplinary respondents, 46 reviewed the newsletter. The majority (69%) reported their trauma education is directly from simulation sessions. Thirty-nine percent of respondents found the newsletter most useful as a review when unable to attend, and 35% found it equally useful as compared with being an active participant. The majority of respondents found the newsletter either very helpful or extremely helpful.

Conclusions:

Medical simulation cases traditionally capture a select audience during educational debriefing sessions. However, because the majority of our respondents receive their trauma education from simulation sessions, the need for supplementation is paramount. Our team members found the Takeaways similarly useful both as a direct participant or as an indirect participant as a helpful reference for communication, management, and practical logistics in pediatric trauma care.
Wandering behavior in children with autism spectrum disorder and other developmental disabilities
Authors: T-Pederson Cassandra , Reisert Hailey , Adesman Andrew
Published: July 2021

Purpose of review

Approximately one in four children with autism spectrum disorder (ASD) ‘elope’ or wander away from supervision each year; however, many caregivers do not receive adequate information on how to address wandering behavior. The purpose of this review is to summarize the available research on elopement frequency, wandering patterns, and interventions to provide pediatricians and other childcare professionals with appropriate strategies to address wandering behavior.

Recent findings

Despite the high prevalence of wandering by children with ASD or other developmental disabilities, there is relatively limited research in this area. Recent research has identified common patterns and factors associated with risk of elopement and elopement frequency.

Pediatricians should counsel families on the common issues and intervention strategies related to elopement. By increasing awareness of wandering in children with ASD, caregivers can feel better prepared to make informed decisions regarding their child's wellbeing and safety.
Estimating the HIV Effective Reproduction Number in the United States and Evaluating HIV Elimination Strategies
Authors: Chen Yao-Hsuan , Farnham Paul G. , Hicks Katherine A. , Sansom Stephanie L.
Published: July 2021

Context:

The reproduction number is a fundamental epidemiologic concept used to assess the potential spread of infectious diseases and whether they can be eliminated.

Objective:

We estimated the 2017 United States HIV effective reproduction number, Re, the average number of secondary infections from an infected person in a partially infected population. We analyzed the potential effects on Re of interventions aimed at improving patient flow rates along different stages of the HIV care continuum. We also examined these effects by individual transmission groups.

Design:

We used the HIV Optimization and Prevention Economics (HOPE) model, a compartmental model of disease progression and transmission, and the next-generation matrix method to estimate Re. We then projected the impact of changes in HIV continuum-of-care interventions on the continuum-of-care flow rates and the estimated Re in 2020.

Setting:

United States.

Participants:

The HOPE model simulated the sexually active US population and persons who inject drugs, aged 13 to 64 years, which was stratified into 195 subpopulations by transmission group, sex, race/ethnicity, age, male circumcision status, and HIV risk level.

Main Outcome Measures:

The estimated value of Re in 2017 and changes in Re in 2020 from interventions affecting the continuum-of-care flow rates.

Results:

Our estimated HIV Re in 2017 was 0.92 [0.82, 0.94] (base case [min, max across calibration sets]). Among the interventions considered, the most effective way to reduce Re substantially below 1.0 in 2020 was to maintain viral suppression among those receiving HIV treatment. The greatest impact on Re resulted from changing the flow rates for men who have sex with men (MSM).

Conclusions:

Our results suggest that current prevention and treatment efforts may not be sufficient to move the country toward HIV elimination. Reducing Re to substantially below 1.0 may be achieved by an ongoing focus on early diagnosis, linkage to care, and sustained viral suppression especially for MSM.
Evans blue dye as an indicator of albumin permeability across a brain endothelial cell monolayer in vitro
Authors: Wu Meng-Chih , Hsu Jye-Lin , Lai Ted Weita
Published: July 2021

An increase in the brain endothelial (BEnd) cell permeability of blood albumin is often seen as an early sign of blood-brain barrier (BBB) disruption and can precede increases in the BEnd permeability of small molecules and other plasma proteins in the course of brain disease. Therefore, Evans blue dye (EBD), an albumin-binding fluorescent tracer that is simple to detect and quantify, has been widely utilized for studying BEnd permeability during BBB disruption. Here, we investigated whether EBD is a suitable indicator of albumin permeability across mouse BEnd cell monolayers, alone or cocultured with mouse cortical astrocytes, in an in-vitro permeability assay; given the strong affinity of EBD for albumin, we further asked whether EBD can affect albumin permeability and vice versa. Albumin and EBD readily crossed membrane cell culture inserts with pore diameters of no less than 1 µm in the absence of a cellular barrier, and their permeability was substantially reduced when the membranes were overlaid with a monolayer of BEnd cells. In line with albumin binding, the BEnd permeability of EBD was substantially reduced by the presence of albumin. While EBD at an EBD-to-albumin ratio similar to those typically used in in vivo BBB experiments had little effect on the BEnd permeability of albumin, a much higher concentration of EBD augmented the BEnd permeability of albumin. In conclusion, we investigated the use of EBD as an indicator of albumin permeability in vitro, explored some of its drawbacks and further demonstrated that EBD at the concentration used in vivo does not affect albumin permeability.
Ostreibacterium oceani gen. nov., sp. nov., isolated from oyster, and description of Ostreibacteriaceae fam. nov.
Authors: Wang Chao-Nan , Wang Feng-Qing , Liu Yuan , Wang Ming-Yi , Du Zong-Jun
Published: July 2021

A novel Gram-stain-negative, short rod-shaped, facultatively anaerobic, non-motile, non-gliding, oxidase-positive and catalase-negative bacterium, designated ML27T, was isolated from oyster homogenate in Rushan, Weihai, PR China. Growth occurred at 20–33 °C (optimum, 30 °C), at pH 7.0–9.0 (optimum, pH 7.5–8.0) and in the presence of 1–6 % (w/v) NaCl (optimum, 3 %). Phylogenetic analysis based on 16S rRNA gene sequences revealed that strain ML27T was 90.7 % similar to

Suttonella ornithocola

DSM 18249T, 89.2 % to

Suttonella indologenes

JCM 1478T and 88.2 % to

Cardiobacterium hominis

DSM 8339T; similarities to other species were less than 90 %. The average amino acid identity between strain ML27T,

S. indologenes

JCM 1478T,

S. ornithocola

DSM 18249T,

C. hominis

DSM 8339T and

Dichelobacter nodosus

ATCC 25549T were 46.23, 45.86, 45.54 and 45.84 %, respectively. Phylogenomic tree and phylogenetic analyses based on 16S rRNA gene sequences showed that the isolate formed a novel family-level clade in the order

Cardiobacteriales

. The sole respiratory quinone was ubiquinone-7 (Q-7). The dominant cellular fatty acids were summed feature 8 (C18 : 1 ω7c/C18 : 1 ω6c; 46.3 %), C16 : 0 (17.8 %) and summed feature 3 (C16 : 1 ω7c/C16 : 1 ω6c; 13.5 %). The DNA G+C content of strain ML27T was 45.6 mol%. Polar lipids included phosphatidylethanolamine, phosphatidylglycerol, diphosphatidylglycerol and one unidentified lipid. Comparative analyses of 16S rRNA gene sequences, genomic distinctiveness and characterization indicated that strain ML27T represents a novel species of a new genus within a novel family of the order

Cardiobacteriales

, for which the name Ostreibacterium oceani gen. nov., sp. nov. is proposed. The type strain of Ostreibacterium oceani is ML27T (=MCCC 1H00372T=KCTC 72155T). In addition, a novel family, Ostreibacteriaceae fam. nov., is proposed to accommodate the genus Ostreibacterium.
Curvivirga aplysinae gen. nov., sp. nov., a marine bacterium isolated from the sea sponge Aplysina fistularis
Authors: Goldberg Stacey R. , Haltli Brad A. , Correa Hebelin , Kerr Russell G.
Published: July 2021

A Gram-stain-negative, strictly aerobic, motile bacterium, designated strain RKSG073T, was isolated from the sea spongeAplysina fistularis, collected off the west coast of San Salvador, The Bahamas. Cells were curved-to-spiral rods with single, bipolar (amphitrichous) flagella, oxidase- and catalase-positive, non-nitrate-reducing and required salt for growth. RKSG073Tgrew optimally at 30–37 °C, pH 6–7, and with 2–3 % (w/v) NaCl. The predominant fatty acids of RKSG073Twere summed feature 8 (C18 : 1ω6cand/or C18 : 1ω7c) and C16 : 0. Major isoprenoid quinones were identified as Q-10 and Q-9. Phylogenetic analyses of nearly complete 16S rRNA genes and genome sequences positioned strain RKSG073Tin a clade with its closest relativeAestuariispira insulaeAH-MY2T(92.1 % 16S rRNA gene sequence similarity), which subsequently clustered withHwanghaeella grinnelliaeGri0909T,Marivibrio haloduransZC80Tand type species of the generaKiloniella,ThalassospiraandTerasakiella. The DNA G+C content calculated from the genome of RKSG073Twas 42.2 mol%. On the basis of phylogenetic distinctiveness and polyphasic analysis, here we propose that RKSG073T(culture deposit numbers: ATCC collection = TSD-74T, BCCM collection = LMG 29869T) represents the type strain of a novel genus and species within the familyKiloniellaceae, orderRhodospirillalesand classAlphaproteobacteria, for which the nameCurvivirga aplysinaegen. nov., sp. nov. is proposed.