bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurology Residents as Comprehensive Educators (Neuro RACE)
Authors: Santini Veronica E. , Wu Connie K. , Hohler Anna D.
Published: August 2018

Residents are expected to be educators often without any formal schooling, and many continue a career in academic medicine where they play a pivotal role in education. However, few resident curricula have been published to include instruction in teaching, particularly in the field of Neurology. To guide Neurology residents as they take on their role as a clinician-educator, we developed a 1-year curriculum (Neurology Residents as Comprehensive Educators “Neuro RACE”) with monthly sessions divided into didactics, small group discussions, and interactive kinetic learning. A postcurriculum survey was used to evaluate the residents’ response to this curriculum. Residents reported an overall improvement in their comfort and confidence in their teaching abilities. As an integral part of academic training, residents-as-teachers curricula should take a prominent role in Neurology training programs.
Wall-eyed Bilateral Internuclear Ophthalmoplegia (WEBINO) in a Patient With Idiopathic Intracranial Hypertension
Authors: Keereman Vincent , Platteau Elise , Crevits Luc , Algoed Luc
Published: August 2018

Introduction:

Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a variant syndrome of internuclear ophthalmoplegia, consisting of primary gaze exotropia, adduction impairment, nystagmus of the abducting eye, and vertical gaze-evoked nystagmus. It seems to be most frequently associated with multiple sclerosis, although other etiologies such as brainstem ischemia or hydrocephalus have also been described.

Case Report:

We report the case of a 25-year-old woman who presented with subacute progressive oculomotor disturbances, resulting in the development of a WEBINO over a few days. Fundoscopy showed papilledema first in the right and afterwards also in the left eye. Brain magnetic resonance imaging was normal. Lumbar puncture demonstrated an opening pressure of 38 cm H2O, without pleiocytosis and with normal protein. As no other cause of intracranial hypertension could be identified by imaging or extensive biochemical testing, the patient was treated with acetazolamide for idiopathic intracranial hypertension. As there was further progression despite increase of acetazolamide dosing, more aggressive therapy was pursued, and a ventriculoperitoneal shunt was placed by our neurosurgeons. Clinical follow-up showed progressive recovery of normal oculomotor function and disappearance of papilledema over the course of 6 weeks.

Conclusions:

To our knowledge this is the first case description of a patient with WEBINO and idiopathic intracranial hypertension. The diagnosis is supported by the very high opening pressure, the absence of neuroimaging abnormalities, the papilledema, and the response to ventriculoperitoneal drainage.
Preventing Congenital Syphilis—Opportunities Identified by Congenital Syphilis Case Review Boards
Authors: Rahman Mohammad Mamun-ur , Hoover Ashley , Johnson Chaquetta , Peterman Thomas A.
Published: August 2018

Background

Louisiana has had the highest rates of congenital syphilis (CS) in the nation since 2012. Congenital syphilis case review boards were established statewide in 2016 to study CS cases and identify interventions.

Methods

We summarized the findings of CS review boards, assessed which cases were preventable by prenatal care providers, reviewed recommended interventions, and assessed subsequent improvement in provider practices.

Results

All 79 CS cases reported from January 2016 to July 2017 were reviewed by boards during August 2016 to August 2017. Twenty-six (33%) cases that could have been prevented by prenatal care providers had: lack of rescreening at 28 to 32 weeks (n = 15), lack of any screening (n = 5), treatment delay (n = 4), or incorrect interpretation of test results (n = 2). Twenty-one (27%) cases were possibly preventable by providers including: mother did not return for follow-up and treatment (n = 19), late third trimester reactive test with premature delivery (n = 1), or incomplete treatment and lack of follow-up by health department staff (n = 1). Thirty-two (40%) cases that were unlikely to be prevented by providers had: nonreactive test at 28–32 weeks then reactive test <30 days before delivery (n = 10), no prenatal care (n = 9), mother adequately treated, case by infant criteria (n = 8), first/second trimester nonreactive, reactive at preterm delivery (n = 4), or mother adequately treated, reinfected before delivery (n = 1). Providers were advised to adhere to CDC recommended syphilis screening and treatment protocols and rapidly report pregnant women with syphilis. Many providers changed their procedures.

Conclusions

Congenital syphilis case review boards identified practices with inadequate screening, treatment, or reporting. Sharing these findings with providers changed practices and may prevent future cases.
Feasibility of Telerehabilitation for Low Vision: Satisfaction Ratings by Providers and Patients
Authors: Bittner Ava Katherine , Yoshinaga Patrick , Bowers Angie , Shepherd John D. , Succar Tony , Ross Nicole C.
Published: August 2018

SIGNIFICANCE

This pilot study demonstrated feasibility and acceptability of telerehabilitation between a provider in-office and a low vision patient at home as an approach to provide follow-up care to improve reading ability with magnification devices and that would help overcome barriers related to transportation and paucity of providers.

PURPOSE

A recent systematic review found no publications with results on the topic of telerehabilitation for low vision. Our goal was to perform the initial steps to develop, administer, refine, and evaluate components required to deliver follow-up low vision telerehabilitation services.

METHODS

Three low vision providers (ophthalmic technician or optometrist) conducted telerehabilitation sessions from their office with 10 visually impaired older adults in their homes, who recently received a handheld magnification device for reading and self-reported difficulty with returning for follow-up training at their provider's office. All except one participant had never used videoconferencing before our study, and three had never used the Internet. Participants and providers rated the use of loaner hardware devices (i.e., tablets, MiFi mobile hotspot) and Health Insurance Portability and Accountability Act–compliant, secure videoconference services during telerehabilitation sessions at which participants read MNREAD cards and received feedback on magnifier use.

RESULTS

Providers reported little to no difficulty with evaluating participants' reading speed, reading accuracy, and working distance with their magnifier. Both providers and participants rated video quality as excellent to good. Audio quality ratings were variable, generally related to signal strength or technical issues during some sessions. All participants agreed that they were satisfied and comfortable receiving telerehabilitation and evaluation via videoconferencing. Eight of 10 reported that their magnifier use improved after telerehabilitation. All except one reported that they were very interested in receiving telerehabilitation services again if their visual needs change.

CONCLUSIONS

Positive feedback from both participants and providers in this pilot study supports the feasibility, acceptability, and potential value of low vision telerehabilitation.
Subjective and Objective Measures of Daytime Activity and Sleep Disturbance in Retinitis Pigmentosa
Authors: Bittner Ava Katherine , Haythornthwaite Jennifer A. , Patel Chandni , Smith Michael T.
Published: August 2018

SIGNIFICANCE

Objectively measured limitations in daytime activity levels appear to be inextricably linked with sleep disturbances in retinitis pigmentosa (RP) patients, as well as associated with unemployment status and central vision loss. Innovative interventional strategies should be developed to help improve these issues and overall quality of life for RP patients.

PURPOSE

Novel sensor devices are emerging as valuable tools to objectively assess behavior. We used validated measures of wrist accelerometry to determine relationships between sleep, vision, and physical activity in RP subjects.

METHODS

For one week, 33 RP adults wore a wrist Actiwatch to detect movement during the day (average total activity counts) and disturbed sleep at night. They completed Early Treatment Diabetic Retinopathy Study visual acuity testing, Pelli-Robson contrast sensitivity, Goldmann V4e visual fields, and sleep diaries and validated questionnaires to assess their sleep and general health.

RESULTS

Greater wake after sleep onset time measured with actigraphy (i.e., sleep disruption) (P = .01), loss of visual acuity (P = .009), and nonemployment/student status (P = .002) were all significant predictors of reduced daytime average total activity counts in a multiple linear regression model, after adjusting for contrast sensitivity as a cooperative suppressor variable (P = .01) (R
2 = 0.54). Fragmentation measured with actigraphy (i.e., restlessness during sleep) (P = .07) and decreased sleep quality ratings reported upon awakening by the participants in a sleep diary (P = .06) were each marginally associated with reduced daytime average total activity counts, whereas nonemployment/student status, reduced visual acuity, and contrast sensitivity were still significant predictors. Objective and subjective measures of sleep or daytime activity were not statistically significantly correlated (P > .05).

CONCLUSIONS

We find nonemployment/student status and sleep disturbances appear to be related to reduced daytime activity levels in adults with central vision loss due to RP. These findings underscore the importance of developing and evaluating interventions to help RP patients maintain engagement in productive activities and improve their disturbed sleep.
Performance of Real-world Functional Tasks Using an Updated Oral Electronic Vision Device in Persons Blinded by Trauma
Authors: Grant Patricia , Maeng Meesa , Arango Tiffany , Hogle Rich , Szlyk Janet , Seiple William
Published: August 2018

SIGNIFICANCE

There is an immediate need for noninvasive therapies to improve the functional abilities of persons blinded by traumatic injury. The BrainPort Vision Pro, an updated hands-free oral electronic vision device, enables perception of visual information using the tongue as a substitute for the eye.

PURPOSE

The purpose of this study was to evaluate the impact of the BrainPort Vision Pro on real-world functional task performance in persons who are profoundly blind (light perception or worse) due to traumatic injury (ocular or cortical).

METHODS

This was a prospective, within-subjects, repeated-measures study. Participants received ten hours of device training and were required to use the device independently for 1 year. Functional performance measures of object identification, orientation and mobility, word identification, and environmental awareness were assessed at baseline, post-device training, and quarterly throughout the year.

RESULTS

Seventeen profoundly blind adults were enrolled in the study. No clinically significant device-related adverse events were reported, demonstrating minimal risks associated with the BrainPort Vision Pro. None of the participants could successfully perform any of the functional tasks at baseline, without the device. After 1 year of independent device use, all participants could identify objects, and 41% identified words beyond chance level while using the device. Forty-one percent of participants could locate a sign, 94% followed a line without veering off, 71% avoided obstacles, 71% walked through a doorway without collision, 100% of participants recognized a door, and 71% identified a window.

CONCLUSIONS

Results demonstrate significant improvements in real-world functional task performance in skill areas important to everyday life. The BrainPort Vision Pro offers a nonsurgical method for improving visual function in persons blinded by trauma. The device can enhance independence and support the successful integration of profoundly blind persons, including veterans and returning service members, into community life.
Comparing Haptic Pattern Matching on Tablets and Phones: Large Screens Are Not Necessarily Better
Authors: Tennison Jennifer L. , Carril Zachary S. , Giudice Nicholas A. , Gorlewicz Jenna L.
Published: August 2018

SIGNIFICANCE

Touchscreen-based, multimodal graphics represent an area of increasing research in digital access for individuals with blindness or visual impairments; yet, little empirical research on the effects of screen size on graphical exploration exists. This work probes if and when more screen area is necessary in supporting a pattern-matching task.

PURPOSE

Larger touchscreens are thought to have distinct benefit over smaller touchscreens for the amount of space available to convey graphical information nonvisually. The current study investigates two questions: (1) Do screen size and grid density impact a user's accuracy on pattern-matching tasks? (2) Do screen size and grid density impact a user's time on task?

METHODS

Fourteen blind and visually impaired individuals were given a pattern-matching task to complete on either a 10.5-in tablet or a 5.1-in phone. The patterns consisted of five vibrating targets imposed on sonified grids that varied in density (higher density = more grid squares). At test, participants compared the touchscreen pattern with a group of physical, embossed patterns and selected the matching pattern. Participants were evaluated on time exploring the pattern on the device and their pattern-matching accuracy. Multiple and logistic regressions were performed on the data.

RESULTS

Device size, grid density, and age had no statistically significant effects on the model of pattern-matching accuracy. However, device size, grid density, and age had significant effects on the model for grid exploration. Using the phone, exploring low-density grids, and being older were indicative of faster exploration time.

CONCLUSIONS

A trade-off of time and accuracy exists between devices that seems to be task dependent. Users may find a tablet most useful in situations where the accuracy of graphic interpretation is important and is not limited by time. Smaller screen sizes afforded comparable accuracy performance to tablets and were faster to explore overall.
Peripheral Prisms Improve Obstacle Detection during Simulated Walking for Patients with Left Hemispatial Neglect and Hemianopia
Authors: Houston Kevin E. , Bowers Alex R. , Peli Eli , Woods Russell L.
Published: August 2018

SIGNIFICANCE

The first report on the use of peripheral prisms (p-prisms) for patients with left neglect and homonymous visual field defects (HVFDs).

PURPOSE

The purpose of this study was to investigate if patients with left hemispatial neglect and HVFDs benefit from p-prisms to expand the visual field and improve obstacle detection.

METHODS

Patients (24 with HVFDs, 10 of whom had left neglect) viewed an animated, virtual, shopping mall corridor and reported if they would have collided with a human obstacle that appeared at various offsets up to 13.5° from their simulated walking path. There were 40 obstacle presentations on each side, with and without p-prisms. No training with p-prisms was provided, and gaze was fixed at the center of expansion.

RESULTS

Detection on the side of the HVFD improved significantly with p-prisms in both groups, from 26 to 92% in the left-neglect group and 43 to 98% in the non-neglect group (both P < .001). There was a tendency for greater improvement in the neglect patients with p-prisms. For collision judgments, both groups exhibited a large increase in perceived collisions on the side of the HVFD with the prisms (P < .001), with no difference between the groups (P = .93). Increased perceived collisions represent a wider perceived safety margin on the side of the HVFD.

CONCLUSIONS

Within the controlled conditions of this simulated, collision judgment task, patients with left neglect responded well to initial application of p-prisms exhibiting improved detection and wider safety margins on the side of the HVFD that did not differ from non-neglect patients. Further study of p-prisms for neglect patients in free-gaze conditions after extended wear and in real-world mobility tasks is clearly warranted.
Novel MEIS1-NCOA2 Gene Fusions Define a Distinct Primitive Spindle Cell Sarcoma of the Kidney
Authors: Argani Pedram , Reuter Victor E. , Kapur Payal , Brown James E. , Sung Yun-Shao , Zhang Lei , Williamson Richard , Francis Glen , Sommerville Scott , Swanson David , Dickson Brendan C. , Antonescu Cristina R.
Published: August 2018

We describe 2 cases of a distinct sarcoma characterized by a novelMEIS1-NCOA2gene fusion. This gene fusion was identified in the renal neoplasms of 2 adults (21-y-old male, 72-y-old female). Histologically, the resected renal neoplasms had a distinctively nodular appearance, and while one renal neoplasm was predominantly cystic, the other demonstrated solid architecture, invasion of perirenal fat, and renal sinus vasculature invasion. The neoplasms were characterized predominantly by monomorphic plump spindle cells arranged in vague fascicles with a whorling pattern; however, a more primitive small round cell component was also noted. Both neoplasms were mitotically active and one case showed necrosis. The neoplasms did not have a distinctive immunohistochemical profile, though both labeled for TLE1. The morphologic features are distinct from other sarcomas associated withNCOA2gene fusions, including mesenchymal chondrosarcoma, congenital/infantile spindle cell rhabdomyosarcoma, and soft tissue angiofibroma. While we have minimal clinical follow-up, the aggressive histologic features of these neoplasms indicate malignant potential, thus warranting classification as a novel subtype of sarcoma.
Recommendations on RBC Transfusions in Critically Ill Children With Acute Respiratory Failure From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Authors: Demaret Pierre , Emeriaud Guillaume , Hassan Nabil E. , Kneyber Martin C. J. , Valentine Stacey L. , Bateman Scot T. , Tucci Marisa
Published: August 2018

Objectives:

To present the recommendations and supporting literature for RBC transfusions in critically ill children with bleeding developed by the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.

Design:

Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children.

Methods:

The panel of 38 experts developed evidence-based and, when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children. The respiratory subgroup included six experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases from 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method.

Results:

Transfusion and Anemia Expertise Initiative experts developed seven recommendations focused on children with acute respiratory failure. All recommendations reached agreement (> 80%). Transfusion of RBCs in children with respiratory failure with an hemoglobin level less than 5 g/dL was strongly recommended. It was strongly recommended that RBCs not be systematically administered to children with respiratory failure who are hemodynamically stable and who have a hemoglobin level greater than or equal to 7 g/dL. Experts could not make a recommendation for children with hemodynamic instability, with severe hypoxemia and/or with an hemoglobin level between 5 and 7 g/dL. Specific RBC transfusion strategies using physiologic-based metrics and biomarkers could not be elaborated.

Conclusions:

The Transfusion and Anemia Expertise Initiative Consensus Conference developed specific recommendations regarding RBC transfusion management in critically ill children with respiratory failure, as well as recommendations to guide future research. Clinical recommendations emphasize relevant hemoglobin thresholds. Research recommendations emphasize the need to identify appropriate physiologic thresholds, suggest a better understanding of alternatives to RBC transfusion, and identify the need for better evidence on hemoglobin thresholds that might be used in specific subpopulations of critically ill children.
Confluent Retropharyngeal, Lateral Pharyngeal, and Peritonsilar MRSA Abscess in an Infant
Authors: Alansari Khalid , Sheikh Rashid , Sheehan Patrick Z. , Joseph Viju , Hoffman Robert J
Published: August 2018

Neck abscesses such as retropharyngeal, peritonsilar, and lateral pharyngeal are well described, typically cause a characteristic illness, and have a known epidemiology. We present a rare occurrence of case of confluent, mixed retropharyngeal, lateral pharyngeal, and peritonsilar abscess in a 9-month-old female infant. The symptoms at presentation were very mild and not expected in association with this extensive an abscess. The causative organism was methicillin-resistantStaphylococcus aureus.
Asthma-Related Educational Needs of Families With Children With Asthma in an Urban Pediatric Emergency Department
Authors: Kwok Maria Y. , Pusic Martin V. , Cabrera Keven I. , York Deborah V. , Lee June , Evans David
Published: August 2018

Objective

The aim of this study was to identify the educational needs of inner-city children with persistent asthma and their caregivers who utilize the emergency department (ED) for asthma care as well as determine their guideline adherence, factors associated with ED use, and comfort with computers.

Methods

Cross-sectional survey of children aged 2 to 18 years with previous diagnosis of asthma presenting with asthma-related complaints or acute asthma exacerbations to an urban pediatric ED. Data on demographics, families' response to acute asthma, approach to asthma prevention, access to care, educational topics of interest, and sources of health information were collected.

Results

Of approximately 1500 asthma-related visits, 218 caregivers were approached, and 200 completed the survey. In the past 12 months, 31% had experienced at least 1 asthma-related hospitalization, and 55.5% had had at least 3 ED visits. Although 184 (92.9%) of 198 caregivers were able to identify a primary physician, 37% reported they were more likely to take their child to the ED in response to acute asthma during the day as opposed to their physician (17%). Approximately half of patients were not on any preventive medication, with 57% not having had received an Asthma Action Plan. Caregivers expressed the most interest in learning about long-term controller medications (44.2%), use of metered dose inhalers or nebulizers (44.2%), and trigger avoidance (35.2%). Most caregivers (approximately 68%) reported ease of use with computers and the Internet.

Conclusion

There was discordance between caregivers' reports of primary care provider teaching on asthma management and the use of the controller medications and possession of the Asthma Action Plans for persistent asthma. Education could focus on caregiver concerns of the safety and benefits of the controller medications.
Usability of Transthoracic Shear Wave Elastography in Differentiation of Subpleural Solid Masses
Authors: Ozgokce Mesut , Yavuz Alpaslan , Akbudak Ibrahim , Durmaz Fatma , Uney Ibrahim , Aydin Yener , Yildiz Hanifi , Batur Abdussamet , Arslan Harun , Dundar Ilyas
Published: August 2018

In this study, the effectiveness of transthoracic ultrasound elastography in the benign and malign distinction of subpleural/pleural solid lesions was investigated.Between July 2015 and December 2016, 33 consecutive patients with subpleural solid lesions detected via computed tomography (CT) of the thorax were identified and prospectively included in this study. The average for each lesion's shear wave velocity (SWV) value was detected, and benign and malignant lesions' SWV values are statistically compared. The CT and pathology results were used as a reference to compare these values. A receiver operating characteristic analysis was used to determine the cutoff value for benign/malignant neoplasms.The 33 patients (10 female, 23 male) included in the study had a mean age of 56.2 ± 15.40 years (range, 17–84 years), and the mean SWV value of the lesions in 13 (39%) cases evaluated benign after a CT scan, histopathological examination, or both 2.18 ± 0.49 m/s. The mean SWV value of the lesions which were histopathologically diagnosed as malign in 23 (61%) cases was 3.50 ± 0.69 m/s. (P < 0.001). When the cutoff value was set as 2.47 m/s for the SVW value, sensitivity and specificity were determined to be 97.7%.The present study has shown that transthoracic ultrasound shear wave elastography can be an effective radiological examination method in the benign and malign differentiation of subpleural lesions and has the potential for use in the routine clinical application of transthoracic ultrasound elastography, a noninvasive method for evaluating the malignancy potentials of such lesions.
Translabial Ultrasound in Midurethral Sling (Mesh) Visualization and Erosion Detection in Women With Stress Urinary Incontinence
Authors: Viragh Karoly A. , Cohen Seth A. , Raz Shlomo , Lo Jocelyn , Raman Steven S.
Published: August 2018

Sling erosion is a significant complication of midurethral sling (mesh) placement for stress urinary incontinence, a common pelvic floor disorder. The goal of this retrospective case-control pilot study was to evaluate the performance of translabial ultrasound (TLUS) and magnetic resonance imaging in diagnosing mesh erosion. Therefore, women who underwent surgery in the setting of prior failed midurethral sling for stress urinary incontinence were identified from the hospital database. The case subcohort comprised all women with intraoperatively documented erosion, and the control subcohort comprised an equal number of randomly selected patients without erosion. The data consisted of selected clinical parameters, the presence of erosion at surgery (reference standard) and at cystourethroscopy, and dual-reader preoperative TLUS consensus interpretation for mesh location (intraluminal, mural, and extramural) and erosion (defined as intraluminal or mural mesh location). Odds ratios were calculated for the selected clinical parameters. Of the 198 women identified, 15 (8%) had mesh erosion at surgery into the lower urinary tract. The sensitivity, specificity, and accuracy of TLUS and cystourethroscopy in detecting erosion in the combined group of cases and controls (30 women) were 93%, 88%, and 90%, as well as 67%, 100%, and 83%, respectively (TLUS Cohen κ = 0.85). Thus, TLUS may be a good diagnostic tool in diagnosing mesh erosion. Only 7 of 30 women had pelvic magnetic resonance examination, and mesh fragments were not visualized. Case-control comparison of the selected clinical parameters was not statistically significant.
Three Skulls Dating from the French Revolutionary Years Diagnosed with Tinea Capitis: A Paleopathologic Approach
Authors: Tourreil Virginie , Giran Guillaume , Benmoussa Nadia , Paternoster Giovanna , Conan Patrick , Charlier Philippe , Khonsari Roman Hossein
Published: August 2018

The Musée Dupuytren was a Parisian pathology museum established in 1835. This museum hosted 3 skulls with severe craniofacial lesions initially tagged as aggressive forms of tinea capitis. The aim of this study was to investigate these specimens and discuss the initial diagnosis. Historical investigations were conducted based on the biographic data from the tags of the 3 skulls and entries on the catalog of the museum. Age was determined using dentition and the patency of cranial base synchondroses. The computed tomography scans were performed using standard medical devices. The 3 skulls were from the late 18th to early 19th century. Skull № 1 was a 5-year-old child and presented with microcephaly and extensive vault osteolysis compatible with an aggressive benign lesion, a malignant tumor, or a chronic infection. Skull № 2 was a 12- to 18-year-old teenager and presented with symmetrical porotic hyperostosis compatible with undernutrition and various hematologic conditions causing prolonged anemia, but also with chronic inflammation and/or infection. Skull № 3 was also from a 12- to 18-year-old teenager and presented with focal temporal osteolysis compatible with an aggressive benign or a low-grade malignant temporal soft-tissue lesion or with chronic infection. These skulls contribute to the understanding of the concept of tinea in the 19th century. They are furthermore windows on the sanitary and social conditions in Paris in the years following the French revolution and during the Napoleonian wars.
Impact of Reduced Preincision Antibiotic Infusion Time on Surgical Site Infection Rates
Authors: Malhotra Neil R. , Piazza Matthew , Demoor Rebecca , McClintock Scott D. , Hamilton Keith , Sharma Nikhil , Osiemo Benjamin , Berger Ian , Hossain Erik , Borovskiy Yuliya , Maloney Eileen , Smith Lachlan J. , Grady Michael Sean
Published: August 2018

Objective:

Our objective was to determine the impact of total preincision infusion time on surgical site infections (SSIs) and establish an optimal time threshold for subsequent prospective study.

Background:

SSIs remain a major cause of morbidity. Although regulated, the total time of infusion of preincision antibiotics varies widely. Impact of infusion time on SSI risk is poorly understood.

Methods:

All consecutive patients (n = 46,791) undergoing inpatient surgical intervention were retrospectively enrolled (2014–2015) and monitored for 1 year. Primary outcomes: the presence of SSI infection as predicted by reduced preoperative antibiotic infusion time. Secondary outcomes: preintervention compliance, the impact of a quality improvement algorithm to optimize infusion time compliance. Multivariate logistic regression of the retrospective cohort demonstrated predictors of infection. Receiver-operating characteristic analysis demonstrated the timing threshold predictive of infection. Cost impact of avoidable infections was analyzed.

Results:

Only 36.1% of patients received preincision infusion of vancomycin in compliance with national and institutional standards (60–120 min). Cephalosporin infusion times were 53 times more likely to be compliant [odds ratio (OR) 53.33, P < 0.001]. Vancomycin infusion times that were not compliant with national standards (less than standard 60–120 min) did not predict infection. However, significantly noncompliant, reduced preincision infusion time, significantly predicted SSI (<24.6 min infusion, AUC = 0.762). Vancomycin infusion, initiated too close to surgical incision, predicted increased SSI (OR = 4.281, P < 0.001). Implementation of an algorithm to improve infusion time, but not powered to demonstrate infection /reduction, improved vancomycin infusion start time (257% improvement, P < 0.001) and eliminated high-risk infusions (sub-24.6 min).

Conclusions:

Initially, vancomycin infusion rarely met national guidelines; however, minimal compliance breach was not associated with SSI implications. The retrospective data here suggest a critical infusion time for infection reduction (24.6 min before incision). Prospective implementation of an algorithm led to 100% compliance. These data suggest that vancomycin administration timing should be studied prospectively.
Neural Representations of Faces are Tuned to Eye Movements
Authors: Stacchi Lisa , Ramon Meike , Lao Junpeng , Caldara Roberto
Published: August 2018

Eye movements provide a functional signature of how human vision is achieved. Many recent studies have reported idiosyncratic visual sampling strategies during face recognition. Whether these inter-individual differences are mirrored by idiosyncratic neural responses has not been investigated yet. Here, we tracked observers’ eye movements during face recognition; additionally, we obtained an objective index of neural face discrimination through EEG that was recorded while subjects fixated different facial information.

Across all observers, we found that those facial features that were fixated longer during face recognition elicited stronger neural face discrimination responses. This relationship occurred independently of inter-individual differences in fixation biases. Our data show that eye movements play a functional role during face processing by providing the neural system with information that is diagnostic to a specific observer. The effective processing of face identity involves idiosyncratic, rather than universal representations.
Methodologic Issues in Doubly Labeled Water Measurements of Energy Expenditure During Very Low-Carbohydrate Diets
Authors: Hall Kevin D. , Guo Juen , Chen Kong Y. , Leibel Rudolph L. , Reitman Marc L. , Rosenbaum Michael , Smith Steven R. , Ravussin Eric
Published: August 2018

Background

Very low-carbohydrate diets have been reported to substantially increase human energy expenditure as measured by doubly labeled water (DLW) but not by respiratory chambers. Do the DLW data reflect true physiological differences that are undetected by respiratory chambers? Alternatively, are the apparent DLW energy expenditure a consequence of failure to fully account for respiratory quotient (RQ) differences between diets?

Objective

To examine energy expenditure differences between diets varying drastically in carbohydrate and to quantitatively compare DLW data with respiratory chamber and body composition measurements within an energy balance framework.

Design

DLW measurements were obtained during the final two weeks of month-long baseline (BD; 50% carbohydrate, 35% fat, 15% protein) and isocaloric ketogenic diets (KD; 5% carbohydrate, 80% fat, 15% protein) in 17 men with BMI 25-35 kg/m2. Subjects resided 2d/week in respiratory chambers to measure energy expenditure (EEchamber). DLW expenditure was calculated using chamber-determined respiratory quotients (RQ) either unadjusted (EEDLW) or adjusted (EEDLWΔRQ) for net energy imbalance using diet-specific coefficients. Accelerometers measured physical activity. Body composition changes were measured by dual-energy X-ray absorptiometry which were combined with energy intake measurements to calculate energy expenditure by balance (EEbal).

Results

After transitioning from BD to KD, neither EEchamber nor EEbal were significantly changed (∆EEchamber=24±30 kcal/d; p=0.43 and ∆EEbal=-141±118 kcal/d; p=0.25). Similarly, physical activity (−5.1±4.8%; p=0.3) and exercise efficiency (−1.6±2.4%; p=0.52) were not significantly changed. However, EEDLW was 209±83 kcal/d higher during the KD (p=0.023) but was not significantly increased when adjusted for energy balance (EEDLWΔRQ =139±89 kcal/d; p=0.14). After removing 2 outliers whose EEDLW were incompatible with other data, EEDLW and EEDLW∆RQ were marginally increased during the KD by 126±62 kcal/d (p=0.063) and 46±65 kcal/d (p=0.49), respectively.

Conclusions

DLW calculations failing to account for diet-specific energy imbalance effects on RQ erroneously suggest that very low carbohydrate diets substantially increase energy expenditure.
The effects of fixational tremor on the retinal image
Authors: Bowers Norick R. , Boehm Alexandra E. , Roorda Austin
Published: August 2018

The study of fixational eye motion (FEM) has implications for the neural and computational underpinnings of vision. One component of FEM is tremor, a high-frequency oscillatory jitter reported to be anywhere from ∼5 to 60 seconds of arc in amplitude. In order to isolate the effects of tremor on the retinal image directly and in the absence of optical blur, high-frequency, high-resolution eye traces were collected in 6 subjects from videos recorded with an Adaptive Optics Scanning Laser Ophthalmoscope. Videos were acquired while subjects engaged in an active fixation task where they fixated on a tumbling E stimulus and reported changes in its orientation. Spectral analysis was conducted on isolated segments of optical drift. The resultant amplitude spectra showed a slight deviation from the traditional 1/f nature of optical drift in the frequency range of 50-100 Hz, which is indicative of tremor; however, the amplitude of this deviation rarely exceeded one second of arc, smaller than any magnitude previously reported.
BIOLOGICAL SCIENCES: Genetics
Authors: Hsiao Jack S. , Germain Noelle D. , Wilderman Andrea , Stoddard Christopher , Wojenski Luke A. , Villafano Geno J. , Core Leighton , Cotney Justin , Chamberlain Stormy J.
Published: August 2018

Angelman syndrome (AS) is a severe neurodevelopmental disorder caused by the loss of function from the maternal allele of UBE3A, a gene encoding an E3 ubiquitin ligase. UBE3A is only expressed from the maternally-inherited allele in mature human neurons due to tissue-specific genomic imprinting. Imprinted expression of UBE3A is restricted to neurons by expression of UBE3A antisense transcript (UBE3A-ATS) from the paternally-inherited allele, which silences the paternal allele of UBE3A in cis. However, the mechanism restricting UBE3A-ATS expression and UBE3A imprinting to neurons is not understood. We used CRISPR/Cas9-mediated genome editing to functionally define a bipartite boundary element critical for neuron-specific expression of UBE3A-ATS in humans. Removal of this element led to upregulation of UBE3A-ATS without repressing paternal UBE3A. However, increasing expression of UBE3A-ATS in the absence of the boundary element resulted in full repression of paternal UBE3A, demonstrating that UBE3A imprinting requires both the loss of function from the boundary element as well as upregulation of UBE3A-ATS. These results suggest that manipulation of the competition between UBE3A-ATS and UBE3A may provide a potential therapeutic approach for AS.

SIGNIFICANCE STATEMENT

Angelman syndrome is a neurodevelopmental disorder caused by loss of function from the maternal allele of UBE3A, an imprinted gene. The paternal allele of UBE3A is silenced by a long, non-coding antisense transcript in mature neurons. We have identified a boundary element that stops the transcription of the antisense transcript in human pluripotent stem cells, and thus restricts UBE3A imprinted expression to neurons. We further determined that UBE3A imprinting requires both the loss of the boundary function and sufficient expression of the antisense transcript to silence paternal UBE3A. These findings provide essential details about the mechanisms of UBE3A imprinting that may suggest additional therapeutic approaches for Angelman syndrome.
Rapid detection of cytochromecd1-containing nitrite reductase encoding genenirSwith loop-mediated isothermal amplification assay
Authors: Yang Qianqian , Zhang Xuzhi , Jiang Xiaoyu , Wang Xiaochun , Li Yang , Zhao Jun , Hao Zhihui , Wang Pingping , Qu Keming
Published: August 2018

The cytochromecd1-containing nitrite reductase,nirS, plays an important role in biological denitrification. Consequently, investigating the presence and abundance ofnirSis a commonly used approach to understand the distribution and potential activity of denitrifying bacteria, in addition to denitrifier communities. Herein, a new molecular biology technique termed loop-mediated isothermal amplification (LAMP) was developed to rapidly detectnirSgene using those ofPseudomonas aeruginosato optimize the assay. The LAMP assay relied on a set of four primers that were designed to recognize six target sequence sites, resulting in high target specificity. The specificity of the assay was confirmed by the lack of amplification when using DNA from 15 other bacterial species lackingnirSgene. The limit of detection for the LAMP assay under optimized conditions was 1.87 pg/reaction of genomic DNA, which was an order of magnitude lower than that required by conventional PCR assays. Moreover, a cell-template based LAMP assay was also developed for detectingnirSgene that directly used bacterial cells as template rather than genomic DNA. Only 1 h was needed from the addition of bacterial cells to the reaction to the verification of amplification success, and bulky and sophisticated equipment were not needed. Further, thenirSgene ofP. aeruginosain spiked seawater samples could be detected with both the DNA-template based LAMP assay and the cell-template based LAMP assay, thereby demonstrating the practicality of in-field use of them. In summary, the LAMP assays described here represent a rapid, user-friendly, and cost-effective alternative to conventional PCR.
Genetic continuity in the last seven Millennia in human hepatitis B viruses
Authors: Lei Xiaoyun , Zhang Ye , Huang Shi
Published: August 2018

Hepatitis B virus (HBV) is a major human pathogen and yet the evolution history of HBV has largely remained uncertain. With a better theoretical understanding of genetic diversity, we here used a new method to examine the previously published ancient and present day HBV genomes. We identified an informative region in the HBV polymerase that is slow evolving and used it to study genetic distances among HBVs. Three ancient human HBV isolates from 4488-7074 years ago in Germany were identified as genotype G that is also presently common in the same country. We constructed a new phylogenetic tree of HBVs that placed genotype D as the most basal branch with an inferred age of ~20500 years, which is remarkably consistent with the worldwide distribution and a most parsimonious migration route of HBV genotypes today. These results help resolve the evolutionary history of HBV and provide a useful method for studying the phylogenetics of HBV and other viruses in general.
Spatial distribution of mammography adherence in a Swiss urban population and its association with socioeconomic status
Authors: Sandoval José Luis , Himsl Rebecca , Theler Jean-Marc , Gaspoz Jean-Michel , Joost Stéphane , Guessous Idris
Published: August 2018

Purpose

Local physical and social environment has a defining influence on individual behaviour and health-related outcomes. However, it remains undetermined if its impact is independent of individual socioeconomic status. In this study, we evaluated the spatial distribution of mammography adherence in the state of Geneva (Switzerland) using individual-level data and assessed its independence from socioeconomic status (SES).

Methods

Geo-referenced individual-level data from the population-based cross-sectional Bus Santé study (n = 5,002) were used to calculate local indicators of spatial association (LISA) and investigate the spatial dependence of mammography adherence. Spatial clusters are reported without adjustment; adjusted for neighbourhood income and individual educational attainment; and demographic factors (age and Swiss nationality). The association between adjusted clusters and the proximity to the nearest screening centre was also evaluated.

Results

Mammography adherence was not randomly distributed throughout Geneva with clusters geographically coinciding with known SES distributions. After adjustment for SES indicators, clusters were reduced to 56.2% of their original size (n = 1,033). Adjustment for age and nationality further reduced the number of individuals exhibiting spatially dependent behaviour (36.5% of the initial size). The identified SES-independent hot spots and cold-spots of mammography adherence were not explained by proximity to the nearest screening centre.

Conclusions

SES and demographic factors play an important role in shaping the spatial distribution of mammography adherence. However, the spatial clusters persisted after confounder adjustment indicating that additional neighbourhood-level determinants could influence mammography adherence and be the object of targeted public health interventions.
Calcium nanodomains in spindles
Authors: Mo Guolong , Li Ruizhen , Swider Zachary , Tao Yong , Mikoshiba Katsuhiko , Bement William M. , Liu X. Johné
Published: August 2018

The role of calcium signaling in specific events of animal cell meiosis or mitosis (M-phase) is a subject of enduring controversy. Early efforts suggested that increases in intracellular free calcium ([Ca2+]i) promote spindle disassembly 1, 2 while subsequent work suggested that global [Ca2+]i increases trigger nuclear envelope breakdown, spindle assembly, the metaphase-anaphase transition, and cytokinesis 3-6. However, further studies led to the conclusion that elevation of [Ca2+]i either has no role in these events, plays a permissive role in these events, or functions as an auxiliary signaling pathway that supplements other mechanisms 7. One potential explanation of the controversy is that specific M-phase events might depend on highly localized increases in [Ca2+]i, variously referred to as microdomains 8 or nanodomains 9, as proposed recently 10. Such domains are hypothesized to arise from rapid shuttling of calcium between closely positioned sources and sinks, rendering them potentially difficult to detect with traditional dyes and largely insensitive to slow chelators such as EGTA 9. Here a novel microtubule-binding calcium sensor—TubeCamp--was used to test the hypothesis 10 that spindles are associated with calcium nanodomains. TubeCamp imaging revealed that spindles in Xenopus eggs, Xenopus embryos, and HeLa cells were all associated with calcium nanodomains at the spindle poles. Calcium nanodomains also formed in spindles assembled in cell extracts and at the center of monopolar spindles, suggesting that they are a basic feature of spindle self-assembly. Disruption of calcium nanodomains via perturbation of inositol-1,4,5-trisphosphate signaling or rapid chelation of [Ca2+]i resulted in spindle disassembly in vivo and vitro. The results demonstrate the existence of spindle-associated calcium nanodomains and indicate that such domains are an essential and common feature of spindles in vertebrates.
Evaluation of rearing parameters of a self-limiting strain of the Mediterranean fruit fly,Ceratitis capitata(Diptera: Tephritidae)
Authors: Rachid Elaini , Asadi Romisa , Naish Neil , Koukidou Martha , Ahmed Mazih
Published: August 2018

The Mediterranean fruit fly,Ceratitis capitata, (medfly) is an important pest of stone and pome fruit, causing significant economic losses worldwide. Current control is primarily based on insecticides, often mixed with protein baits. Chemical approaches are effective but there are label limits to avoid residues in fruits and harm to the environment and sustained use will lead to pesticide resistance in the medfly pest. In recent years, emphasis has been placed on environmentally friendly methods to control medfly.

Oxitec has developed a self-limiting medfly strain (OX3864A) that demonstrates conditional female-specific mortality in the early life stages. Sustained release of OX3864A males offers a mating-based approach to medfly control, which should lead to significant economic benefits in area-wide programmes. Furthermore, a heritable fluorescent marker provides quick and accurate identification of released OX3864A males for efficient monitoring in the field.

An important prerequisite of mating-based control programmes is the availability of adequate numbers of high-quality male flies in a sustainable and cost-effective manner. This paper summarises rearing optimisations for the OX3864A strain and the production of OX3864A males.