bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of Limb-Sparing Surgery for Osteomyelitis in the Diabetic Foot: Importance of the Histopathologic Margin
Authors: Johnson Matthew J , Shumway Nathan , Bivins Mark , Bessesen Mary T
Published: September 2019

Background

Diabetes mellitus affects up to 14% of Americans. Infection of the diabetic foot is a common complication, which may lead to amputation. If infection extends to involve bone, the risk of amputation is increased 4-fold. Presence of osteomyelitis at the histopathologic margin of resection portends a poor prognosis in osteomyelitis outside the setting of the diabetic foot. We aimed to assess the association of a positive histopathologic margin with the outcome of osteomyelitis in the diabetic foot.

Methods

Medical records were reviewed for all patients who underwent below-ankle amputation for osteomyelitis of the diabetic foot. Patients who had at least 1 year of follow-up, a histopathologic diagnosis of osteomyelitis, and a comment on whether the margin was involved were included.

Results

Thirty-nine of 66 (59%) cases had remission of osteomyelitis at 12 months. When comparing cases with remission with those who experienced recurrence in the 12 months of follow-up, there were no statistically significant differences in age, glycosylated hemoglobin, duration of antimicrobial therapy, Infectious Diseases Society of America class, or presence of osteomyelitis at the histopathologic margin. Among cases with a negative histopathologic margin, 29/48 (60.4%) were free of disease at 1 year, compared with 10/18 (55.6%) cases with a positive histopathologic margin (P = .72). Remission was significantly more frequent in cases undergoing amputation at the digit level (66.7%) compared with amputation at the metatarsal level (40.7%) (P = .045).

Conclusions

Osteomyelitis of the diabetic foot at the histopathologic margin of resection was not associated with increased risk of treatment failure. Resection at the level of the digit was associated with a lower risk of failure than at the metatarsal level.
Path optimization in $0+1$D QCD at finite density
Authors: Mori Yuto , Kashiwa Kouji , Ohnishi Akira
Published: September 2019

We investigate the sign problem in $0+1$D quantum chromodynamics at finite chemical potential by using the path optimization method. The SU(3) link variable is complexified to the SL(3,$\mathbb{C}$) link variable, and the integral path is represented by a feedforward neural network. The integral path is then optimized to weaken the sign problem. The average phase factor is enhanced to be greater than 0.99 on the optimized path. Results with and without diagonalized gauge fixing are compared and proven to be consistent. This is the first step in applying the path optimization method to gauge theories.
Appreciation of the Research-Practice Link: Authentic Learning Environments for Writing-Intensive Nursing Courses
Authors: Horning Melissa L. , Schneider Ryan , Beacham Barbara , McKechnie Anne C. , Kirk Laura , Emery Daniel , Lindquist Ruth
Published: September 2019

Undergraduate students often perceive a disconnect between research and nursing practice. To support student understanding of this relationship, an innovative, authentic learning environment was created in a writing-intensive, capstone-level nursing course. Authentic learning environments couple real-life situations/simulations with personal, experiential learner engagement. Students completed pre- and postsurveys assessing their beliefs about and confidence in using research to inform practice. Quantitative and open-ended qualitative responses were analyzed with inferential statistics and conventional content analysis techniques, respectively. Findings suggested the learning environment increased student confidence and facilitated connections between research and practice, supporting continued use and further evaluation of this approach.
Developing Interprofessional Competence: Results of Embedding TeamSTEPPS® in All Semesters of an Accelerated and Traditional BSN Program
Authors: Maneval Rhonda E. , Vermeesch Carol , Poindexter Kathleen , Lourens Gayle , Ventura-Dipersia Christina
Published: September 2019

This study assessed the effectiveness of a curriculum designed to teach interprofessional communication and teamwork skills to traditional and accelerated baccalaureate nursing students. The curriculum was designed to incorporate TeamSTEPPS® concepts using incremental learning experiences and a variety of instructional techniques throughout all clinical program semesters; more than 200 students representing four cohorts were enrolled in the study. Three tools were used to evaluate program effectiveness. Both accelerated and traditional groups demonstrated varying degrees of improvement on all tools. The curriculum design positively influenced students’ communication and teamwork skills, advancing their interprofessional competency.
Minimally Invasive Approach for the Reconstruction of the Peroneal Brevis Tendon Using Semitendinosus Autograft: An Alternative Technique to Avoid Soft Tissue Complications
Authors: Nishikawa Danilo Ryuko C. , Duarte Fernando A. , Saito Guilherme H. , Monteiro Augusto C. , Netto Cesar de Cesar , Prado Marcelo P.
Published: September 2019

Surgical treatment of irreparable tears of the peroneal brevis tendon has been widely performed with reconstruction of the tendon using semitendinosus tendon allograft or autograft. However, it is carried out through a long lateral curved incision prone to soft tissue complications such as scar tenderness, sural nerve lesion, wound dehiscence, and swelling. We present a less invasive approach through 2 short incisions, preserving the lateral soft tissues of the hindfoot. It represents an effective and safe alternative to the long lateral curved approach. Besides that, it can be useful to treat patients at risk of wound healing complications such as smokers, vasculopaths and diabetics.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Living With Intelligent Sensors
Authors: Galambos Colleen , Rantz Marilyn , Craver Andy , Bongiorno Marie , Pelts Michael , Holik Austin John , Jun Jung Sim
Published: September 2019

This qualitative study is part of a larger randomized prospective intervention study that examined the clinical and cost effectiveness of using sensor data from an environmentally embedded sensor system for early illness recognition. It explored the perceptions of older adults and family members on the sensor system's usefulness, impact on daily routine, privacy, and sharing of health information. This study was conducted in 13 assisted-living facilities in Missouri, and 55 older adults were interviewed. Data were collected over five points in time with a total of 188 interviews. From these five participant interview iterations, the following themes emerged: (1) understanding and purpose, (2) daily life and benefits, (3) impact on privacy, and (4) sharing of information. Three themes emerged from one round of family interviews: (1) benefits of bed sensors, (2) family involvement/staff interaction, and (3) privacy protection versus sensor benefits. The sensor suite was regarded as helpful in maintaining independence, health, and physical functioning. Responses suggest that the willingness to adopt the sensor suite was motivated by both a decline in functional status and a desire to remain independent. Participants were willing to share their health data with providers and select family members. Recommendations for future practice are provided.
The Effects of Simulation-Based Advanced Life Support Education for Nursing Students
Authors: Kim Sung Hwan , Issenberg Barry , Roh Young Sook
Published: September 2019

Advanced life support education for nursing students is very important because nurses are first responders in emergency situations. The purpose of this study was to identify the effects of simulation-based advanced life support education on nursing students' knowledge, performance, self-efficacy, and teamwork. A nonequivalent control group posttest-only design was used. Fourth-year nursing students were randomly assigned to either simulation-based Korean Advanced Life Support (n = 30) or lecture-based education (n = 30) groups. Data were analyzed using descriptive statistics and the Mann-Whitney U test. The experimental group showed statistically significant higher scores in knowledge (P < .001), performance (P < .001), and self-efficacy (P = .049) when compared with the control group. However, there was no significant difference in teamwork scores between the two groups (P = .529). The 4.5-hour simulation-based Korean Advanced Life Support education was more effective than the 4.5-hour lecture-based education for nursing students in terms of knowledge, performance, and self-efficacy. Nurse educators should adopt simulation-based advanced life support education into the curriculum for the optimal competence of nursing students.
Multiplicity of Nitric Oxide and Natriuretic Peptide Signaling in Heart Failure
Authors: Preedy Michael E. J. , Baliga Reshma S. , Hobbs Adrian J.
Published: September 2019

Heart failure (HF) is a common consequence of several cardiovascular diseases and is understood as a vicious cycle of cardiac and hemodynamic decline. The current inventory of treatments either alleviates the pathophysiological features (eg, cardiac dysfunction, neurohumoral activation, and ventricular remodeling) and/or targets any underlying pathologies (eg, hypertension and myocardial infarction). Yet, since these do not provide a cure, the morbidity and mortality associated with HF remains high. Therefore, the disease constitutes an unmet medical need, and novel therapies are desperately needed. Cyclic guanosine-3′,5′-monophosphate (cGMP), synthesized by nitric oxide (NO)- and natriuretic peptide (NP)-responsive guanylyl cyclase (GC) enzymes, exerts numerous protective effects on cardiac contractility, hypertrophy, fibrosis, and apoptosis. Impaired cGMP signaling, which can occur after GC deactivation and the upregulation of cyclic nucleotide-hydrolyzing phosphodiesterases (PDEs), promotes cardiac dysfunction. In this study, we review the role that NO/cGMP and NP/cGMP signaling plays in HF. After considering disease etiology, the physiological effects of cGMP in the heart are discussed. We then assess the evidence from preclinical models and patients that compromised cGMP signaling contributes to the HF phenotype. Finally, the potential of pharmacologically harnessing cardioprotective cGMP to rectify the present paucity of effective HF treatments is examined.
The Posterior Arm Flap for Reshaping the Postbariatric Breast
Authors: Vindigni Vincenzo , Marchica Paolo , Pagani Andrea , Bassetto Franco , Brambullo Tito
Published: September 2019

Background:

Postbariatric surgery, either by itself or in association with other procedures, tries to correct physical defects and body deformities. Because of the intrinsic complexity of massive weight loss (MWL) patients, more than a single procedure is, most of the time, required. We report a combined surgical method able to improve arms’ and breasts’ contour that aims to obtain a satisfying functional and aesthetic result by reducing surgical times and costs.

Methods:

A female MWL patient with proper body mass index was clinically evaluated and considered suitable for surgery. While authors performed a modified Pascal-Le Louarn brachioplasty for the upper arm, a standard McKissock mastopexy followed by a Wise pattern skin closure was selected to obtain the breast lift. By sparing the proximal pedicle, the fasciocutaneous flaps were harvested on both posteromedial sides of the arms. The posterior arm flaps (PAF) were tunneled and transposed below the subcutaneous skin bridge across the axilla and finally used to increase the breast mound.

Results:

In the immediate postoperative follow-up, no complications were reported. After the 6-month and 1-year follow-up, both arms’ silhouette was documented as healthy and symmetric. Breasts were soft, without any signs of ptosis and/or contracture. No skin disorders or scar hypertrophy or lymphedema were reported.

Conclusions:

PAF in breast contouring procedures is an interesting surgical option, but more patients need to be treated to validate the effectiveness of the procedure. This technique should be considered when there is a need for simultaneously improving arm’s contour and breast’s volume and shape.
How hospitals select their patient safety priorities
Authors: George Judy , Parker Victoria A. , Sullivan Jennifer L. , Greenan Mary A. , Chan Jeffrey , Shin Marlena H. , Chen Qi , Shwartz Michael , Rosen Amy K.
Published: September 2019

Background

Hospitals face ongoing pressure to reduce patient safety events. However, given resource constraints, hospitals must prioritize their safety improvements. There is limited literature on how hospitals select their safety priorities.

Purpose

The aim of this research was to describe and compare the approaches used by Veterans Health Administration (VA) hospitals to select their safety priorities.

Methodology

Semistructured telephone interviews with key informants (n = 16) were used to collect data on safety priorities in four VA hospitals from May to December 2016. We conducted a directed content analysis of the interview notes using an organizational learning perspective. We coded for descriptive data on the approaches (e.g., set of cues, circumstances, and activities) used to select safety priorities, a priori organizational learning capabilities (learning processes, learning environment, and learning-oriented leadership), and emergent domains. For cross-site comparisons, we examined the coded data for patterns.

Results

All hospitals used multiple approaches to select their safety priorities; these approaches used varied across hospitals. Although no single approach was reported as particularly influential, all hospitals used approaches that addressed system level or national requirements (i.e., externally required activities). Additional approaches used by hospitals (e.g., responding to staff concerns of patient safety issues, conducting a multidisciplinary team investigation) were less connected to externally required activities and demonstrated organizational learning capabilities in learning processes (e.g., performance monitoring), learning environment (e.g., staff’s psychological safety), and learning-oriented leadership (e.g., establishing a nonpunitive culture).

Practice Implications

Leaders should examine the approaches used to select safety priorities and the role of organizational learning in these selection approaches. Exclusively relying on approaches focused on externally required activities may fail to identify safety priorities that are locally relevant but not established as significant at the system or national levels. Organizational learning may promote hospitals’ use of varied approaches to guide their selection of safety priorities and thereby benefit hospital safety improvement efforts.
Measuring Fatigue in TBI: Development of the TBI-QOL Fatigue Item Bank and Short Form
Authors: Kisala Pamela A. , Bushnik Tamara , Boulton Aaron J. , Hanks Robin A. , Kolakowsky-Hayner Stephanie A. , Tulsky David S.
Published: September 2019

Objective:

To develop a traumatic brain injury (TBI)-specific, item response theory (IRT)-calibrated Fatigue item bank, short form, and computer adaptive test (CAT) as part of the Traumatic Brain Injury-Quality of Life (TBI-QOL) measurement system.

Setting:

Five TBI Model Systems rehabilitation centers in the US

Participants:

Adults with complicated mild, moderate, or severe TBI confirmed by medical record review.

Design:

Cross-sectional field testing via phone or in-person interview.

Main Measures:

TBI-QOL Fatigue item bank, short form, and CAT.

Results:

A total of 590 adults with TBI completed 95 preliminary fatigue items, including 86 items from the Patient-Reported Outcomes Measurement Information System (PROMIS) and 9 items from the Quality of Life in Neurological Disorders (Neuro-QOL) system. Through 4 iterations of factor analysis, 22 items were deleted for reasons such as local item dependence, misfit, and low item-total correlations. Graded response model IRT analyses were conducted on the 73-item set, and Stocking-Lord equating was used to transform the item parameters to the PROMIS (general population) metric. A short form and CAT, which demonstrate similar reliability to the full item bank, were developed. Test-retest reliability of the CAT was established in an independent sample (Pearson's r and intraclass correlation coefficient = 0.82 [95% confidence interval: 0.72-0.88]).

Conclusions:

The TBI-QOL Fatigue item bank, short form, and CAT provide rehabilitation researchers and clinicians with TBI-optimized tools for assessment of the patient-reported experience and impact of fatigue on individuals with TBI.
Development of the TBI-QOL Headache Pain Item Bank and Short Form
Authors: Tulsky David S. , Tyner Callie E. , Boulton Aaron J. , Kisala Pamela A. , Heinemann Allen W. , Roth Elliot J. , Carlozzi Noelle E.
Published: September 2019

Objective:

To develop, calibrate, and evaluate the test-retest reliability of a new patient-reported outcome measure of headache pain relevant for individuals with traumatic brain injury (TBI).

Setting:

Six TBI Model Systems rehabilitation centers in the United States.

Participants:

Adults with medically confirmed documentation of TBI.

Design:

Cross-sectional calibration field testing and test-retest reliability analyses.

Main Measures:

Traumatic Brain Injury—Quality of Life Headache Pain item bank.

Results:

Thirteen headache pain items were calibrated as a unidimensional measure using data from 590 participants. The new measure was reliable (α = .98; item-total correlation range: 0.71-0.91). Item parameter estimates were estimated using Samejima's Graded Response Model and a 10-item calibrated short form was created. Simulation testing confirmed that both the computer-adaptive test and the short-form administrations were equivalent to the full item bank. One- to-2-week test-retest reliability of the computer-adaptive test was high (Pearson r and intraclass correlation coefficients = 0.81). Approximately two-thirds of the sample reported at least 1 headache symptom.

Conclusion:

The Traumatic Brain Injury—Quality of Life Headache Pain item bank and short form provide researchers and clinicians with reliable measures of the subjective experience of headache symptoms for individuals with a history of TBI.
Management of Postoperative Inflammation and Dry Eye After Cataract Surgery
Authors: Kato Kumiko , Miyake Kensaku , Hirano Koji , Kondo Mineo
Published: September 2019

Surgical intervention is the most effective treatment for decreased vision resulting from cataracts. Although the current procedures for cataract surgery are safe and effective, it is well known that several complications can develop after surgery. Postoperative cystoid macular edema (CME) is a well-known complication, and prophylactic medications such as steroids and/or nonsteroidal antiinflammatory drugs are routinely used for its prevention. Ocular surface abnormalities, such as dry eye, have also been reported to develop after cataract surgery. However, the causative mechanisms for postoperative dry eye have not been definitively determined. At present, there are no prophylactic medications that are commonly used to prevent the development of postoperative dry eye. Although nonsteroidal antiinflammatory drugs are very effective in reducing the incidence and degree of postoperative CME, it is known that they can cause adverse side effects, including ocular surface abnormalities. Thus, perioperative medications must be carefully selected to improve surgical outcomes and patient satisfaction. Here, we summarize the results of recent studies on postoperative dry eye and CME that can develop after cataract surgery. We suggest appropriate combinations of medications that can be used to minimize these postsurgical complications.
Densitometry Analysis of Corneal Backscatter After Pre-Descemet Endothelial Keratoplasty for Pseudophakic Bullous Keratopathy
Authors: Kumar Dhivya Ashok , Agarwal Amar , Jaganathasamy Nagaraj
Published: September 2019

Purpose:

To quantify corneal backscattering by densitometry analysis after pre-Descemet endothelial keratoplasty (PDEK).

Design:

This is a prospective observational case series.

Methods:

Setting: Tertiary care hospital. Participants: Postoperative PDEK eyes with best-corrected visual acuity (BCVA) ≥20/40 without comorbidity. Observation procedure: Slit-lamp examination, Scheimpflug imaging (Pentacam; Oculus, Wetzlar, Germany), endothelial cell density (cells/mm2), and central corneal thickness (Visante; Carl Zeiss AG, Oberkochen, Germany) were performed. Corneal densitometry values for the entire depth of the cornea were compared between post-PDEK eyes and fellow eyes (non-PDEK). Main outcome measures: Mean densitometry (grayscale units, GSUs) of the anterior, posterior, central, total depth and concentric zones (0–2, 2–6, 6–10, and 10–12 mm) of the cornea.

Results:

Overall, 35 eyes (21 PDEK eyes and 14 control eyes) were evaluated. The mean total densitometry values in the anterior, central, and posterior corneas were 40.7 ± 7.6 GSU, 25.3 ± 4.8 GSU, and 20.9 ± 3.4 GSU, respectively. On inter-zone comparison between central and peripheral cornea, there was a statistically significant difference (P < 0.05) between 0 to 2 mm and 6 to 12 mm zones. There was no correlation between endothelial cell density and central corneal thickness with densitometry. However, there was a significant correlation of BCVA with corneal densitometry in 0 to 2 mm (r = 0.519, P = 0.016) and 6 to 2 mm (r = 0.556, P = 0.009) zones. In eyes with BCVA 20/20, there was no significant difference between PDEK and control eyes in the total corneal densitometry in the entire depth of the cornea (P = 0.662).

Conclusions:

Clinically clear corneas with visual acuity 20/20 showed no difference in the total corneal densitometry as compared to their fellow eye. Corneal backscatter was higher in the anterior cornea and in the central 0 to 6 mm zone.
Meibomian Gland Morphology: The Influence of Structural Variations on Gland Function and Ocular Surface Parameters
Authors: Llorens-Quintana Clara , Rico-del-Viejo Laura , Syga Piotr , Madrid-Costa David , Iskander D. Robert
Published: September 2019

Purpose:

To objectively and quantitatively characterize meibomian gland morphology and to investigate the influence of morphological variations on gland function and ocular surface and tear film parameters.

Methods:

One hundred fifty subjects were enrolled. The examinations included tear osmolarity, tear meniscus height, bulbar conjunctival hyperemia, noninvasive tear film breakup time, lid margin thickness, foam secretion, meibomian gland expressibility, count of functioning glands, corneal and conjunctival staining, fluorescein breakup time, lid wiper epitheliopathy, and Schirmer test. Patient symptoms were assessed using the Ocular Surface Disease Index questionnaire. Images from noncontact meibography were analyzed using an automated method that objectively estimates dropout area, number of glands, gland length and width, and gland irregularity.

Results:

Gland irregularity highly correlated with dropout area (r = −0.4, P < 0.001) and showed significant partial correlations with fluorescein breakup time (r = 0.162, P = 0.049) and the Ocular Surface Disease Index questionnaire (r = −0.250, P = 0.002) Subjects with dropout area <32% were divided into 2 groups: high and low irregularity. Gland expressibility was statistically significantly different between the 2 groups (U = 319.5, P = 0.006). In the high irregularity group, gland irregularity correlated with the Schirmer test (r = 0.530, P = 0.001) and corneal fluorescein staining (r = −0.377, P = 0.021).

Conclusions:

Automated morphological analysis of meibomian gland structure provides additional quantitative and objective information regarding gland morphology. The link between dropout area and gland function is not clear. Assessment of gland irregularity might better predict gland function and its effects on ocular surface and tear film parameters.
Myopathic Blepharoptoses: A New Classification System
Authors: Burnstine Michael , Greer Christine , Lee Diana K. , Kim Jonathan W.
Published: September 2019

The authors present a comprehensive and effective myopathic ptosis classification scheme to optimize surgical management and facilitate subspecialty care.

Purpose:

Myopathic blepharoptoses (ptoses) is a complex group of disorders. To date, no formal categorization scheme has been developed based on associated ocular and systemic findings, genetic fingerprint, treatment, and prognosis for each ptosis in this group. We report a new classification scheme for myopathic ptoses.

Methods:

Literature review and classification development.

Results:

A new classification scheme of myopathic ptoses includes isolated static myopathic ptosis (congenital ptosis), static myopathic ptosis associated with aberrant innervation and those associated with periocular abnormalities, and progressive myopathic ptoses that affect the levator muscle and other muscle groups in childhood and adulthood.

Conclusions:

Making the distinction of myopathic ptosis type early will maximize patient outcomes by optimizing surgical and systemic management and facilitating the recruitment of subspecialists to care for patients with these challenging conditions.
African American Women's Perceptions of Cardiovascular Disease After Myocardial Infarction
Authors: Jones Loretta , Williams Susan , Bydalek Kathryn , Elkins Casey , Fruh Sharon
Published: September 2019

Background

The primary cause of death among African American women older than 50 years is cardiovascular disease. Cardiovascular disease affects more than 16.8 million Americans and occurs when plaque builds up in the arteries that provide blood to the heart. This often leads to a partial or complete blockage, causing a myocardial infarction (heart attack). There is limited research regarding the lived experiences of African American women before and after a myocardial infarction.

Objective

The purpose of this qualitative study was to explore the experiences of African American women living in the southern region of the United States who have experienced a myocardial infarction.

Methods

A hermeneutic phenomenological framework guided the study. Semistructured, audiotaped interviews were conducted to elicit narratives from 7 participants. Interview data were transcribed verbatim and then coded and analyzed using Colaizzi's phenomenological analysis framework.

Results

The findings revealed 6 major themes: life before myocardial infarction, causes of my myocardial infarction, myocardial infarction warning signs, life after myocardial infarction, cardiac rehabilitation, and family support. Lifestyle changes must be implemented to prevent a second blockage. Attending cardiac rehabilitation and incorporating regular physical exercise are recommended to help prevent further heart damage and to improve quality of life.
Piloting a Tool to Measure Patient-Perceived Barriers to Dermatology Access
Authors: Cyr Melissa E. , Guthrie Barbara J. , Board Rhonda M. , Boucher Daryl , Benneyan James C.
Published: September 2019

Background

With malignant melanoma incidence rates at a historic national high and greater tumor thickness being the most significant prognostic determinant, early lesion detection and treatment remain the most crucial factors for improving health outcomes.

Objective

The aim of this study was to design and pilot a survey instrument to document patients’ perceived barriers to dermatology care access.

Methods

A retrospective, descriptive design and a convenience sample of 50 adult participants via a conceptually derived survey were used. Data analyses included descriptive statistics and frequencies; the survey was designed to be analyzed in a subsequent study with other types of data that were not collected as part of this pilot.

Results

Twenty-one (42%) of participants reported receipt of dermatology care, five (10%) reported no care, and 24 (48%) did not respond to this question. Overall, 30 surveys (60%) were returned incomplete to varying degrees.

Limitations

Limitations included a small sample size from a homogenous population with access to dermatology care. The reliability and validity of this tool were not evaluated.

Conclusions

It was unclear whether lower completion rates were attributed to the survey or study design, but several research-driven suggestions were made that may be helpful in improving this tool for future use.
External Factors Associated With Community Cohesion in Women Living With HIV
Authors: Hardin Robin N. , Thurston Idia B. , Howell Kathryn H. , Kamody Rebecca C. , Kaufman Caroline C.
Published: September 2019

Although community cohesion has been identified as a protective factor associated with positive health outcomes, less is known about factors that increase community cohesion for women living with HIV (WLWH). We examined risk/protective factors associated with community cohesion in WLWH (N = 56) in the US Mid-South (M
age = 41.2 years, SD = 9.01). Participants completed hour-long interviews. Hierarchical linear regression modeling was used to examine factors associated with community cohesion. The final model was significant, F(5, 50) = 6.42, p < .001, adj. R
2 = 33%; greater social support (b = .38, p < .01) and resilience (b = .27, p < .05) were significantly associated with better community cohesion. Given the protective benefits of community connectedness, findings suggest that nurses and community providers work with WLWH to harness friend- and family-support networks. In addition, strategies to enhance access to resilience resources would enable WLWH to recover from adversity.
Early Magnetic Resonance Imaging for Patients With Idiopathic Sudden Sensorineural Hearing Loss in an Emergency Setting
Authors: Conte Giorgio , Di Berardino Federica , Zanetti Diego , Iofrida Elisabetta Francesca , Scola Elisa , Sbaraini Sara , Filipponi Eliana , Cinnante Claudia , Gaini Lorenzo Maria , Ambrosetti Umberto , Triulzi Fabio , Pignataro Lorenzo , Capaccio Pasquale
Published: September 2019

Objective:

The role of magnetic resonance (MR) imaging in idiopathic sudden sensorineural hearing loss (ISSHL) is controversial due to the inhomogeneity of clinical and MR protocols. The aim of this work is to relate early MR findings obtained immediately after the admission, with the clinical presentation, the audiological findings, and the outcomes of treatment.

Study Design:

Prospective observational study.

Setting:

Tertiary referral university center.

Patients:

Forty-seven patients (22 M, 25 F; age: 54.4 ± 17.5 yr) consecutively referred to the Department of Emergency for ISSHL.

Interventions:

All patients underwent the diagnostic and therapeutic work-up for ISSHL, and MR imaging within 72 hours from the admission, independently of the symptoms onset. All patients received the same treatment (systemic steroid therapy, intratympanic steroid injection, and hyperbaric oxygen therapy).

Main Outcome Measure(s):

MR patterns, clinical, and laboratory findings.

Results:

MR imaging was positive in 25 of 47 cases (53%), with a perfect agreement between clinical and MR examinations (Cohen K = 1) upon the affected ear. Three different radiological patterns were observed: labyrinthine haemorrhage (n = 5), acute inflammatory process (n = 14), isolated blood–labyrinth barrier breakdown (n = 6). By binary logistic regression, only vertigo was associated with a positive MR imaging [B = 2.8; p = 0.011; OR = 9.5 (95% CI: 2.2–40.8)] and the latter was the only variable associated with an unfavorable outcome [(B = 2.8; p = 0.02 OR = 12.8 (95% CI: 2.9–56.7)].

Conclusion:

Patients affected by ISSHL with associated vertigo show a higher likelihood of having a positive MR imaging, which, in turn, seems to predict an unfavorable outcome.
Time to antibody detection and associated factors for presence of anti-drug antibodies in pediatric inflammatory bowel disease patients treated with anti-TNF therapy
Authors: Moses Jonathan , Lambert-Jenkins Kristin , Momotaz Hasina , Sattar Abdus , Debanne Sara M. , Splawski Judy , Sferra Thomas J.
Published: September 2019

Background:

Loss of response in pediatric inflammatory bowel disease patients treated with biologic medications can be due to development of anti-drug antibodies. Natural history of anti-drug antibodies development has not been well described in pediatric inflammatory bowel disease. The primary aim of this study was to describe a single-center experience for the temporal onset of anti-drug antibodies detection.

Methods:

We performed a retrospective, single-center chart review of pediatric inflammatory bowel disease patients at the Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Rainbow Babies and Children’s Hospital from 2010 to 2015. Patients were treated with infliximab or adalimumab and had at least two evaluations for anti-drug antibodies with the homogenous mobility shift assay. Demographics, laboratory and medication data, and clinical disease activity were collected.

Results:

A total of 75 subjects are included in the analysis. Eighty-one percent of subjects were treated with infliximab. Eleven subjects developed anti-drug antibodies; average time to anti-drug antibodies detection was 13.2 ± 7.3 months. Longer duration of inflammatory bowel disease, L1 location in Crohn’s disease, and not having immunomodulatory therapy before biologic was associated with higher risk of antibody detection. Antibody detection occurred more frequently with infliximab vs. adalimumab. Time-to-antibody detection for infliximab and adalimumab was 14.83 and 23.48 months, respectively.

Conclusion:

Chances of anti-drug antibodies detection in the infliximab group were higher than the adalimumab group. Time-to-antibody detection was 8.65 months longer in patients who received adalimumab when compared to infliximab. These results may have implications for long-term therapy and help guide use of concomitant immunomodulators.
Evidence for positive priming of leaf litter decomposition by contact with eutrophic pond sediments
Authors: Fortino Kenneth , Hoak Jessica , Waters Matthew N
Published: September 2019

Organic matter processing controls the flow of carbon and nutrients through ecosystems. Heterotrophic metabolism within ponds is supported by both terrestrial leaf litter and autochthonous production. We investigated the potential for the priming of leaf litter decomposition in small ponds using microcosms. We incubated senescent tulip poplar (Liriodendron tulipifera) leaf discs in the dark for 130 days either in contact with eutrophic pond sediments or isolated from sediment contact. Leaves that had been in contact with the sediments were significantly less tough and lost more carbon mass following the incubation than leaves that were not in contact with the sediments, indicating that they were decomposing faster. We calculated a positive priming effect of the sediments of 42% and 77% based on the change in toughness and C mass loss, respectively. We further found that leaf discs that were in contact with the sediments had significantly less fungal biomass, measured as ergosterol mass, and less leaf-derived N in fungal biomass than the leaf discs isolated from the sediments. These results indicate that the presence of the more labile organic matter of the sediments alters the rate of organic matter mineralization and the cycling of nitrogen and carbon.
Immunoinformatics Prediction of Epitope Based Peptide Vaccine Against Mycobacterium Tuberculosis PPE65 family Protein
Authors: Elhag Mustafa , Mohamed Sati Anfal Osama , Saadaldin Moaaz Mohammed , Hassan Mohammed A.
Published: September 2019

Introduction

Tuberculosis (TB) is a serious disease with varying rates of mortality and morbidity among infected individuals which estimates for approximately two million deaths/year. The number of deaths could increase by 60% if left untreated. It mainly affects immune-compromised individuals and people of third world, due to poverty, low health standards, and inadequate medical care. It has varying range of manifestations that is affected by the host immune system response, the strain causing the infection, its virulence, and transmissibility.

Materials and methods

A total of 1750Mycobacterium TuberculosisPPE65 family protein strains were retrieved from National Center for Biotechnology Information (NCBI) database on March 2019 and several tools were used for the analysis of the T- and B-cell peptides and homology modelling.

Results and conclusion

Four strong epitope candidates had been predicted in this study for having good binding affinity to HLA alleles, good global population coverage percentages. These peptides are YAGPGSGPM, AELDASVAM, GRAFNNFAAPRYGFK and a single B-cell peptide YAGP.

This study uses immunoinformatics approach for the design of peptide based vaccines for M. tuberculosis. Peptide based vaccines are safer, more stable and less hazardous/allergenic when compared to conventional vaccines. In addition, peptide vaccines are less labouring, time consuming and cost efficient. The only weakness is the need to introduce an adjuvant to increase immunogenic stimulation of the vaccine recipient.
Centrosome and ciliary abnormalities in fetal akinesia deformation sequence human fibroblasts
Authors: Jühlen Ramona , Martinelli Valérie , Vinci Chiara , Breckpot Jeroen , Fahrenkrog Birthe
Published: September 2019

Ciliopathies are clinical disorders of the primary cilium with widely recognised phenotypic and genetic heterogeneity. Here we found impaired ciliogenesis in fibroblasts derived from individuals with fetal akinesia deformation sequence (FADS), a broad spectrum of neuromuscular disorders arising from impaired foetal movement. We show that cells derived from FADS individuals have shorter and less primary cilia (PC), in association with alterations in post-translational modifications in α-tubulin. Similarly, siRNA-mediated depletion of two known FADS proteins, the scaffold protein rapsyn and the nucleoporin NUP88, resulted in defective PC formation. Consistent with a role in ciliogenesis, rapsyn and NUP88 localised to centrosomes and PC. By proximity-ligation assays, we show that rapsyn and NUP88 are adjacent and that both proteins are adjoining to all three tubulin isoforms (α, and γ rapsyn-NUP88 interface, as well as their contact to microtubules, is perturbed in the examined FADS cells. We suggest that the perturbed rapsyn-NUP88-tubulin interface leads to defects in PC formation and that defective ciliogenesis contributes to the pleiotropic defects seen in FADS.

Fibroblasts derived from fetal akinesia individuals are characterised by ciliary defects and rapsyn and NUP88 are required for proper formation of the primary cilium.
Maternal exposure to a mitochondrial toxicant results in life-long alterations in DNA methylation and gene expression in the offspring
Authors: Lozoya Oswaldo A. , Xu Fuhua , Grenet Dagoberto , Wang Tianyuan , Grimm Sara A. , Godfrey Veronica G. , Waidyanatha Suramya , Woychik Richard P. , Santos Janine H.
Published: September 2019

Mitochondrial-driven alterations of the epigenome have been reported but whether they are relevant at the organismal level remain unknown. The viable yellow agouti mouse (Avy) is a powerful epigenetic biosensor model that reports on the DNA methylation status of theAvylocus through the coat color of the animals. Here we show that maternal exposure to rotenone, a potent mitochondrial complex I inhibitor, changes the DNA methylation status of theAvylocus and broadly affects the liver DNA methylome of the offspring. These effects were accompanied by altered gene expression programs that persisted throughout life. Mitochondrial dysfunction was present in the mothers but not in the offspring until 12 months of age, when electron transport and antioxidant defenses were impaired. These results highlight a putative novel role for mitochondria in nuclear epigenetic remodeling during development, raising fundamental questions about the long-term impact of mitochondrial dysfunction to health and disease.
On the relative ease of speciation with periodic gene flow
Authors: Linck Ethan , Battey C.J.
Published: September 2019

Abstract

Common models of speciation with gene flow consider constant migration or admixture on secondary contact, but earth’s recent climatic history suggests many populations have experienced cycles of isolation and contact over the last million years. How does this process impact the rate of speciation, and how much can we learn about its dynamics by analyzing the genomes of modern populations? Here we develop a simple model of speciation through Bateson-Dobzhansky-Muller incompatibilities in the face of periodic gene flow and validate our model with forward time simulations. We then use empirical atmosphericCO2concentration data from the Vostok Ice Cores to simulate cycles of isolation and secondary contact in a tropical montane landscape, and ask whether they can be distinguished from a standard isolation-with-migration model by summary statistics or joint site frequency spectrum-based demographic inference. We find speciation occurs much faster under periodic than constant gene flow with equivalent effective migration rates (Nm). These processes can be distinguished through combinations of summary statistics or demographic inference from the site frequency spectrum, but parameter estimates appear to have little resolution beyond the most recent cycle of isolation and migration. Our results suggest speciation with periodic gene flow is a common force in generating species diversity through Pleistocene climate cycles, and highlight the limits of current inference techniques for demographic models mimicking the complexity of earth’s recent climatic history.
Direct anabolic three carbon metabolism via propionate to a six carbon metabolite occurs in human heart and in vivo across mouse tissues
Authors: Doan Mary T. , Neinast Michael D. , Varner Erika L , Bedi Kenneth , Bartee David , Jiang Helen , Trefely Sophie , Xu Peining , Singh Jay P , Jang Cholsoon , Rame Eduardo , Brady Donita , Meier Jordan L. , Marguiles Kenneth , Arany Zoltan , Snyder Nathaniel W.
Published: September 2019

Anabolic metabolism of carbon in mammals is mediated via the one and two carbon carriers S-adenosyl methionine and acetyl-coenzyme A (acetyl-CoA). In contrast, anabolic metabolism using three carbon units via propionate is not thought to occur. Mammals are primarily thought to oxidize the 3-carbon short chain fatty acid propionate by shunting propionyl-CoA to succinyl-CoA for entry into the TCA cycle. We found that this may not be absolute and that in mammals one non-oxidative fate of two units of propionyl-CoA is to condense to a six-carbon trans-2-methyl-2-pentenoyl-CoA (2M2PE-CoA). We confirmed this pathway using purified protein extracts provided limited substrates and confirmed the product with a synthetic standard. In whole-bodyin vivostable isotope tracing with infusion of13C-labeled valine achieving steady state, 2M2PE-CoA formed via propionyl-CoA in multiple murine tissues including heart, kidney, and to a lesser degree in brown adipose tissue, liver, and tibialis anterior muscle. Usingex vivoisotope tracing, we found that 2M2PE-CoA formed in human myocardial tissue incubated with propionate to a limited extent. While the complete enzymology of this pathway remains to be elucidated, these results confirm thein vivoexistence of at least one anabolic three to six carbon reaction conserved in humans and mice that utilizes three carbons via propionate.

Highlights

- Synthesis and confirmation of structure 2-methyl-2-pentenoyl-CoA

-In vivofate of valine across organs includes formation of a 6-carbon metabolite from propionyl-CoA

-Ex vivometabolism of propionate in the human heart includes direct anabolism to a 6-carbon product

- In both cases, this reaction occurred at physiologically relevant concentrations of propionate and valine

-In vitrothis pathway requires propionyl-CoA and NADH/NADPH as substrates
Oropouche virus detection in saliva and urine
Authors: do Nascimento Valdinete Alves , Santos João Hugo Abdalla , da Silva Monteiro Dana Cristina , Pessoa Karina Pinheiro , Cardoso Antonio José Leão , de Souza Victor Costa , Abdalla Ligia Fernandes , Naveca Felipe Gomes
Published: September 2019

Oropouche virus (OROV) is an arthropod-borne virus of the Peribunyaviridae family, transmitted to humans primarily by Culicoides paraensis. It is one of the main arboviruses that infect humans in Brazil, mainly in the Amazon region. We report the OROV detection in the saliva and urine five days after the symptom’s onset. Results were further confirmed by nucleotide sequencing and phylogenetic analysis. To our knowledge, this is the first report that OROV may be detected in the saliva and urine of infected patients. In addition, our results may contribute to the current knowledge regarding the natural history of Oropouche fever.
Polygenic Risk Scores for Cardio-renal-metabolic Diseases in the Penn Medicine Biobank
Authors: Kember R.L. , Verma A. , Verma S. , Lucas A. , Judy R. , Chen J. ,   Regeneron Genetics Center, Damrauer S. , Rader D.J. , Ritchie M.D.
Published: September 2019

Cardio-renal-metabolic (CaReMe) conditions are common and the leading cause of mortality around the world. Genome-wide association studies have shown that these diseases are polygenic and share many genetic risk factors. Identifying individuals at high genetic risk will allow us to target prevention and treatment strategies. Polygenic risk scores (PRS) are aggregate weighted counts that can demonstrate an individual’s genetic liability for disease. However, current PRS are often based on European ancestry individuals, limiting the implementation of precision medicine efforts in diverse populations. In this study, we develop PRS for six diseases and traits related to cardio-renal-metabolic disease in the Penn Medicine Biobank. We investigate their performance in both European and African ancestry individuals, and identify genetic and phenotypic overlap within these conditions. We find that genetic risk is associated with the primary phenotype in both ancestries, but this does not translate into a model of predictive value in African ancestry individuals. We conclude that future research should prioritize genetic studies in diverse ancestries in order to address this disparity.
A unified picture of neuronal avalanches arises from the understanding of sampling effects
Authors: Neto J. P. , Spitzner F. P. , Priesemann V.
Published: September 2019

To date, it is still impossible to sample the entire mammalian brain with single-neuron precision. This forces one to either use spikes (focusing on few neurons) or to use coarse-sampled activity (averaging over many neurons, e.g. LFP). Naturally, the sampling technique impacts inference about collective properties. Here, we emulate both sampling techniques on a spiking model to quantify how they alter observed correlations and signatures of criticality. We discover a general effect: when the inter-electrode distance is small, electrodes sample overlapping regions in space, which increases the correlation between the signals. For coarse-sampled activity, this can produce power-law distributions even for non-critical systems. In contrast, spike recordings enable one to distinguish the underlying dynamics. This explains why coarse measures and spikes have produced contradicting results in the past – that are now all consistent with a slightly subcritical regime.