bluuebunny/crossref_metadata_2025 huggingface dataset:
Sputtered porous Pt for wafer-scale manufacture of low-impedance flexible microelectrodes
Authors: Fan Bo , Rodriguez Alexander V , Vercosa Daniel G , Kemere Caleb , Robinson Jacob T
Published: May 2020

Objective. Recording electrical activity from individual cells in vivo is a key technology for basic neuroscience and has growing clinical applications. To maximize the number of independent recording channels as well as the longevity, and quality of these recordings, researchers often turn to small and flexible electrodes that minimize tissue damage and can isolate signals from individual neurons. One challenge when creating these small electrodes, however, is to maintain a low interfacial impedance by applying a surface coating that is stable in tissue and does not significantly complicate the fabrication process. Approach. Here we use a high-pressure Pt sputtering process to create low-impedance electrodes at the wafer scale using standard microfabrication equipment. Main results. We find that direct-sputtered Pt provides a reliable and well-controlled porous coating that reduces the electrode impedance by 5–9 fold compared to flat Pt and is compatible with the microfabrication technologies used to create flexible electrodes. These porous Pt electrodes show reduced thermal noise that matches theoretical predictions. In addition, we show that these electrodes can be implanted into rat cortex, record single unit activity, and be removed all without disrupting the integrity of the coating. We also demonstrate that the shape of the electrode (in addition to the surface area) has a significant effect on the electrode impedance when the feature sizes are on the order of tens of microns. Significance. Overall, porous Pt represents a promising method for manufacturing low-impedance electrodes that can be seamlessly integrated into existing processes for producing flexible neural probes.
Linking Statistics With Testing Policy to Manage COVID-19 in the Community
Authors: Hilborne Lee H , Wagner Zachary , Cabreros Irineo , Brook Robert H
Published: May 2020

Objectives

To determine the public health surveillance severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing volume needed, both for acute infection and seroprevalence.

Methods

Required testing volumes were developed using standard statistical methods based on test analytical performance, disease prevalence, desired precision, and population size.

Results

Widespread testing for individual health management cannot address surveillance needs. The number of people who must be sampled for public health surveillance and decision making, although not trivial, is potentially in the thousands for any given population or subpopulation, not millions.

Conclusions

While the contributions of diagnostic testing for SARS-CoV-2 have received considerable attention, concerns abound regarding the availability of sufficient testing capacity to meet demand. Different testing goals require different numbers of tests and different testing strategies; testing strategies for national or local disease surveillance, including monitoring of prevalence, receive less attention. Our clinical laboratory and diagnostic infrastructure are capable of incorporating required volumes for many local, regional, and national public health surveillance studies into their current and projected testing capacity. However, testing for surveillance requires careful design and randomization to provide meaningful insights.
Walking and talking with volunteers: what does walking offer the study of volunteering, space and place?
Authors: Daly Siobhan , Allen Michele
Published: May 2020

The walking interview is used to explore the lived experiences and meanings individuals attach to place(s). Despite scholarly interest in place and volunteering, attention to the walking interview is lacking. This article presents an exploratory study, which invited five volunteers to participate in a walking interview. Our aim is to discuss the walking interview to expand the range of methodologies employed in research on volunteering, particularly volunteering and place. The walking interview has novel implications for the conceptualization of volunteers and for the meanings individuals identify in their volunteer experience(s). Volunteers can be conceptualized as mobile subjects to explore the implications of physiological movement in place for the volunteer experience. Walking can unearth the significance of emotions and memories to volunteers’ negotiation of the ‘everyday politics’ of volunteering. The mobility of people and objects in sites of volunteering are salient as they reveal embodied aspects of the volunteer experience.
The articles.ELM resource: simplifying access to protein linear motif literature by annotation, text-mining and classification
Authors: Palopoli N , Iserte J A , Chemes L B , Marino-Buslje C , Parisi G , Gibson T J , Davey N E
Published: May 2020

Modern biology produces data at a staggering rate. Yet, much of these biological data is still isolated in the text, figures, tables and supplementary materials of articles. As a result, biological information created at great expense is significantly underutilised. The protein motif biology field does not have sufficient resources to curate the corpus of motif-related literature and, to date, only a fraction of the available articles have been curated. In this study, we develop a set of tools and a web resource, ‘articles.ELM’, to rapidly identify the motif literature articles pertinent to a researcher’s interest. At the core of the resource is a manually curated set of about 8000 motif-related articles. These articles are automatically annotated with a range of relevant biological data allowing in-depth search functionality. Machine-learning article classification is used to group articles based on their similarity to manually curated motif classes in the Eukaryotic Linear Motif resource. Articles can also be manually classified within the resource. The ‘articles.ELM’ resource permits the rapid and accurate discovery of relevant motif articles thereby improving the visibility of motif literature and simplifying the recovery of valuable biological insights sequestered within scientific articles. Consequently, this web resource removes a critical bottleneck in scientific productivity for the motif biology field. Database URL: http://slim.icr.ac.uk/articles/
Evaluation of different PNGase F enzymes in immunoglobulin G and total plasma N-glycans analysis
Authors: Vilaj Marija , Lauc Gordan , Trbojević-Akmačić Irena
Published: May 2020

Glycoproteins, proteins that are co- and posttranslationally modified by sugars (glycans), have significant roles in pathophysiology of many different diseases. One of the main steps in sample preparation for free N-glycan analysis is deglycosylation or glycan removal. The aim of this study was to compare different peptide N-glycosidase F (PNGase F) enzymes (Rapid PNGase F and two recombinant versions) for deglycosylation of total human plasma glycoproteins and different amounts of human immunoglobulin G (IgG). Deglycosylation with different PNGase F enzymes resulted in different IgG and plasma N-glycosylation hydrophilic interaction liquid chromatography ultra-performance liquid chromatography profiles. Additionally, one recombinant version of PNGase F is more efficient in deglycosylation of complex N-glycans compared with Rapid PNGase F and recombinant version of PNGase F from a different manufacturer. In terms of chromatographic peak intensities and coefficient of variation %Area values, all tested versions of PNGase F enzymes were very reproducible and on the similar level when used in optimal conditions. However, care should be taken in terms of which enzyme is used with which protocol, particularly when scaling up.
Is Affective Effective? Measuring Affective Learning in Simulations
Authors: Holland Martin , Sliwinski Krzysztof , Thomas Nicholas
Published: May 2020

Simulations have become a regular component of teaching toolkits. They provide teachers with a platform to take students’ knowledge and understanding of subject materials beyond the classroom. In doing so, simulations fulfill a critical pedagogical purpose in that they need to construct a learning space; one more efficacious in delivering learning opportunities than traditional modes of instruction. In order for simulations to be effective, students need to be able to place themselves in role. The more closely the students identify with their topic (the greater their affection for the subject), the closer the alignment between the exercise and the intended learning outcomes. This article considers how an affective learning environment can be created with simulations. The lens for this analysis is an international model European Union simulation that has been running in Hong Kong and New Zealand. Our argument is that the more affective the simulated environment, the more realistic it will be perceived to be by the participants. However, contrary to the prevailing literature, our findings suggest that affection does not necessarily have to be positively constructed in order for simulations to be effective pedagogical tools.
Combinations of (lipo)glycopeptides with β-lactams against MRSA: susceptibility insights
Authors: Kebriaei Razieh , Rice Seth A , Singh Nivedita B , Stamper Kyle C , Nguyen Logan , Sheikh Zain , Rybak Michael J
Published: May 2020

Background

Increasing application of vancomycin due to the high prevalence of MRSA infections has led to the emergence of vancomycin intermediate-resistant Staphylococcus aureus (VISA) and heterogeneous VISA (hVISA). Consequently, the need for alternative therapies that target MRSA has become evident.

Objectives

To evaluate the synergy between (lipo)glycopeptides (LGP/GPs) (vancomycin, teicoplanin, telavancin, dalbavancin and oritavancin) and β-lactams (ceftaroline, cefepime, cefazolin and oxacillin) against MRSA, hVISA, VISA and daptomycin non-susceptible (DNS) phenotypes.

Methods

Twenty randomly selected clinical MRSA strains (i.e. 5 MRSA, 5 hVISA, 5 VISA and 5 DNS) were assessed versus LGP/GPs alone and LGP/GPs in combination with β-lactams for MICs. Although verification of antibiotic potency against bacterial strains is assessed by the microbroth dilution (MBD) MIC method recommended by the CLSI, some antibiotics need modified assay conditions in order to demonstrate their optimal activity.

Results

Addition of β-lactams reduced MIC values of LGP/GPs against all strains (up to 160-fold reduction). In general, LGPs (dalbavancin, oritavancin and telavancin) were more active (significant differences in MIC values, up to 8-fold) compared with vancomycin and teicoplanin. The majority of these combinations were bactericidal and superior to any single agent.

Conclusions

This report has examined the susceptibility patterns of LGP/GPs and their combination with β-lactams. Of interest, the impact of susceptibility tests (in terms of MIC plates and their surface area) on the synergistic activity in 24 h time–kill experiments was apparent for LGPs. Further clinical research is required to investigate synergy with LGP/GPs and β-lactams against these Staphylococcus strains.
The Approach to Implementation of the Kilwa Decision: Communication 393/ 10–IHRDA and Others v. DRC (2016)
Authors:   Institute for Human Rights and Development in Africa
Published: May 2020

States are required to implement decisions adopted by human rights treaty bodies, the African Commission on Human and Peoples’ Rights being one of them. Although the responsibility to implement lies with the state, treaty mechanisms play an important role in ensuring compliance with their decisions. The African Commission does not have an institutionalized mechanism tasked with implementation. It does however use other means such as promotion visits and the consideration of state reports to follow up on implementation of its decisions. This practice note recalls the approaches that the Institute for Human Rights and Development in Africa (IHRDA) and its partners have used and plan to use to follow up on implementation of the Kilwa decision. After a brief background on the case, this note assesses the content of the Kilwa decision, and outlines the road map for implementation. The note concludes with a look at the impact expected from the implementation of the Kilwa decision.
Effects of Certain cis-Regulatory Elements on Stage-Specific vitellogenin Expression in the Bombyx mori (Lepidoptera: Bombycidae)
Authors: Shen Guanwang , Liu Hongling , Lin Ying , Xing Dongxu , Zhang Yujing , Xia Qingyou
Published: May 2020

Bombyx mori vitellogenin (BmVg) is highly upregulated during pupation, and the 20-hydroxyecdysone and amino acids may regulate stage-specific BmVg expression. However, previous studies showed that other factors may also affect stage-specific BmVg expression. Here, we characterized effective BmVg transcription factors by identifying the corresponding cis-regulatory elements (CREs). We prepared transgenic B. mori, in which DsRed was driven by various lengths of BmVg promoter. qRT-PCR analysis showed that DsRed expression driven by a 1.0-kb BmVg promoter (VgP1.0K) was consistent with endogenous BmVg. VgP1.0K specificity was closer to the endogenous BmVg promoter than that of VgP0.8K. These results suggest that CREs affecting stage-specific BmVg expression were localized to the 1.0-kb BmVg promoter. We investigated the effects of certain CREs that could influence the stage specificity of BmVg promoter on BmVg expression in transgenic B. mori. The relative DsRed expression was significantly reduced in transgenic female B. mori and the peak in DsRed expression was delayed after E-box CRE mutation. These results demonstrate that the E-box element enhanced BmVg expression and also affected stage-specific BmVg expression. Moreover, the relative DsRed expression was significantly increased in transgenic female of B. mori after 3×BD CRE mutation in BmVg promoter. However, the stage specificity of the mutated promoter was consistent with that of the endogenous BmVg promoter. The 3×BD element downregulated BmVg but had no effect on stage-specific BmVg expression. The present study promoted the process of elucidating the regulatory network for stage-specific BmVg expression and furnished a theoretical basis for the application of BmVg promoter.
COVID-19 Immunity Passport to Ease Travel Restrictions?
Authors: Chen Lin H , Freedman David O , Visser Leo G
Published: May 2020

‘Immunity passport’ (also called ''immunity certificate'' or ''immunity license'' has been suggested to certify traveler’ protection from SARS-CoV-2 infection. Some data have demonstrated development of neutralizing antibodies that may protect against reinfection and reduce disease severity in the short-term, and some tests correlate with virus neutralization. More evidence is needed on serologies for such certification to facilitate travel, to protect travelers and their destination countries.
Machine learning classification of new asteroid families members
Authors: Carruba V , Aljbaae S , Domingos R C , Lucchini A , Furlaneto P
Published: May 2020

Asteroid families are groups of asteroids that are the product of collisions or of the rotational fission of a parent object. These groups are mainly identified in proper elements or frequencies domains. Because of robotic telescope surveys, the number of known asteroids has increased from ${\simeq}10\, 000$ in the early 1990s to more than $750\, 000$ nowadays. Traditional approaches for identifying new members of asteroid families, like the hierarchical clustering method (HCM), may struggle to keep up with the growing rate of new discoveries. Here we used machine learning classification algorithms to identify new family members based on the orbital distribution in proper (a, e, sin (i)) of previously known family constituents. We compared the outcome of nine classification algorithms from stand-alone and ensemble approaches. The extremely randomized trees (ExtraTree) method had the highest precision, enabling to retrieve up to 97 per cent of family members identified with standard HCM.
Modelling the large-scale mass density field of the universe as a function of cosmology and baryonic physics
Authors: Aricò Giovanni , Angulo Raul E , Hernández-Monteagudo Carlos , Contreras Sergio , Zennaro Matteo , Pellejero-Ibañez Marcos , Rosas-Guevara Yetli
Published: May 2020

We present and test a framework that models the 3D distribution of mass in the universe as a function of cosmological and astrophysical parameters. Our approach combines two different techniques: a rescaling algorithm that modifies the cosmology of gravity-only N-body simulations, and a ‘baryonification’ algorithm that mimics the effects of astrophysical processes induced by baryons, such as star formation and active galactic nuclei (AGN) feedback. We show how this approach can accurately reproduce the effects of baryons on the matter power spectrum of various state-of-the-art hydrodynamical simulations (EAGLE, Illustris, Illustris-TNG, Horizon-AGN, and OWLS, Cosmo-OWLS and BAHAMAS), to better than 1 per cent from very large down to small, highly non-linear, scales ($k\sim 5 \, h\, {\rm Mpc}^{-1}$), and from z = 0 up to z ∼ 2. We highlight that, because of the heavy optimization of our algorithms, we can obtain these predictions for arbitrary baryonic models and cosmology (including massive neutrinos and dynamical dark energy models) with an almost negligible CPU cost. With these tools in hand, we explore the degeneracies between cosmological and astrophysical parameters in the non-linear mass power spectrum. Our findings suggest that after marginalizing over baryonic physics, cosmological constraints inferred from weak gravitational lensing should be moderately degraded.
What has quenched the massive spiral galaxies?
Authors: Luo Yu , Li Zongnan , Kang Xi , Li Zhiyuan , Wang Peng
Published: May 2020

Quenched massive spiral galaxies have attracted great attention recently, as more data are available to constrain their environment and cold gas content. However, the quenching mechanism is still uncertain, as it depends on the mass range and baryon budget of the galaxy. In this letter, we report the identification of a rare population of very massive, quenched spiral galaxies with stellar mass ≳1011 M⊙ and halo mass ≳1013 M⊙ from the Sloan Digital Sky Survey at redshift z ∼ 0.1. Our CO observations using the IRAM (Institute for Radio Astronomy in the Millimeter Range) 30-m telescope show that these galaxies contain only a small amount of molecular gas. Similar galaxies are also seen in the state-of-the-art semi-analytical models and hydrodynamical simulations. It is found from these theoretical models that these quenched spiral galaxies harbour massive black holes, suggesting that feedback from the central black holes has quenched these spiral galaxies. This quenching mechanism seems to challenge the popular scenario of the co-evolution between massive black holes and massive bulges.
Argonaute binding within 3′-untranslated regions poorly predicts gene repression
Authors: Chu Yongjun , Kilikevicius Audrius , Liu Jing , Johnson Krystal C , Yokota Shinnichi , Corey David R
Published: May 2020

Despite two decades of study, the full scope of RNAi in mammalian cells has remained obscure. Here we combine: (i) Knockout of argonaute (AGO) variants; (ii) RNA sequencing analysis of gene expression changes and (iii) Enhanced Crosslinking Immunoprecipitation Sequencing (eCLIP-seq) using anti-AGO2 antibody to identify potential microRNA (miRNA) binding sites. We find that knocking out AGO1, AGO2 and AGO3 together are necessary to achieve full impact on steady state levels of mRNA. eCLIP-seq located AGO2 protein associations within 3′-untranslated regions. The standard mechanism of miRNA action would suggest that these associations should repress gene expression. Contrary to this expectation, associations between AGO and RNA are poorly correlated with gene repression in wild-type versus knockout cells. Many clusters are associated with increased steady state levels of mRNA in wild-type versus knock out cells, including the strongest cluster within the MYC 3′-UTR. Our results suggest that assumptions about miRNA action should be re-examined.
Conservative Management of Type II Odontoid Fractures in Older People: A Retrospective Observational Comparison of Osseous Union Versus Nonunion
Authors: McIlroy Suzanne , Lam Jordan , Khan Muhammad Faheem , Mirza Asfand Baig , Philip Jerry Ajayi , Grahovac Gordan , Bell David
Published: May 2020

BACKGROUND

Type II odontoid fractures are a common cervical fracture in older people. Lower osseous-union rates are reported in those treated conservatively compared to surgically; however, the clinical relevance of a nonunion is unknown.

OBJECTIVE

To compare pain, disability, and quality of life in older people following conservative management of type II odontoid fractures demonstrating osseous-union and nonunion.

METHODS

Electronic records were searched from 2008 to 2018 for adults ≥65 yr with type II odontoid fracture, managed in a semi-rigid collar. Clinical and demographic data were retrieved from electronic patient notes. Surviving patients were invited to complete questionnaires to assess pain, disability, and quality of life. Ethical approval was granted.

RESULTS

A total of 125 patients were identified: 36 (29%) demonstrated osseous-union, 89 (71%) had nonunion, of which 33 (40%) had radiological instability. Mean age at fracture was 84 yr (osseous-union 83 yr; nonunion 84 yr). A total of 53 had deceased (41 nonunion). Median length of survival was 77 mo for osseous-union vs 50 mo for nonunion; P = .02. No patient developed myelopathy during the follow-up period. Questionnaire response rate was 39 (58%). There were no statistically significant differences between the groups in terms of pain, disability, or quality of life (P > .05). Both groups reported mild disability and pain but low quality of life.

CONCLUSION

Management with a semi-rigid collar in older people with type II odontoid fracture is associated with low levels of pain and disability without statistically significant differences between those demonstrating osseous-union or stable or unstable nonunions. Conservative management appears to be a safe treatment for older people with type II fractures.
Nitrogen Fixation and Resorption Efficiency Differences Among Twelve Upland and Lowland Switchgrass Cultivars
Authors: Roley Sarah S. , Ulbrich Tayler C. , Robertson G. Philip
Published: May 2020

In nitrogen (N)-limited terrestrial ecosystems, plants employ various strategies to acquire and conserve N, including translocation of N in perennial tissues and stimulation of N fixation in roots and soils. Switchgrass (Panicum virgatum) is a genotypically and phenotypically diverse perennial grass with two distinct ecotypes (lowland and upland) and numerous genotypes. It grows well in low-N soils, likely because of its ability to translocate N and to associate with N-fixing microbes, but little is known about variation in these traits among cultivars or even ecotypes. We measured N translocation, N fixation potential in roots and soils, soil net N mineralization, soil net nitrification, and biomass yields in 12 switchgrass cultivars grown in a replicated block experiment in southwestern Michigan, United States. Lowland cultivars had higher yields, rates of N translocation, soil net N mineralization, and N fixation potentials on washed, nonsterile roots, while upland cultivars exhibited higher N fixation potentials in root-free soil. N resorption efficiencies averaged 53 ± 5% (± standard error) for lowland versus 29 ± 3% for upland cultivars. Additionally, there were significant among-cultivar differences for all response variables except mineralization and nitrification, with differences likely explained by cultivar-specific physiologies and microbial communities. The ideal cultivar for biofuels is one that can maintain high yields with minimal fertilizer addition, and there appear to be several cultivars that meet these criteria. In addition, results suggest substantial N cycle differences among cultivars that might be exploited by breeders to create new or improved high-yielding, N-conserving switchgrass lines.
Outcomes of Operative Vaginal Delivery Managed by Residents Under Supervision and Attending Obstetricians: A Prospective Cross-sectional Study
Authors: Sentilhes L. , Madar H. , Ducarme G. , Hamel J. , Mattuizzi A. , Hanf M.
Published: May 2020

(Am J Obstet Gynecol. 2019;221:59.e1–59.e15)

Operative vaginal delivery is intended to expedite vaginal delivery during a prolonged second stage of delivery or for suspected fetal compromise. While every resident should be proficient with delivery requiring forceps and/or vacuum extractors by the end of their training, these procedures are associated with greater maternal and neonatal morbidity than spontaneous vaginal delivery in the short-term. Obstetricians are at greater litigation risk if neonatal trauma or brachial plexus injury occurs. Therefore, there has been a decrease in operative vaginal deliveries in different parts of the world during the last 2 decades. The United States has seen a decrease from 10% of all births in 1994 to 3% in 2014 for both vacuum and forceps assisted deliveries. This decrease is despite the American College of Obstetricians (ACOG) and the Society for Maternal-Fetal Medicine advocating the use of operative vaginal delivery as a means of reducing cesarean section rates. The aim of this study was to determine the maternal morbidity and neonatal morbidity in a large French observational study of attempted operative vaginal deliveries.
Association of Early Postnatal Transfer and Birth Outside a Tertiary Hospital With Mortality and Severe Brain Injury in Extremely Preterm Infants: Observational Cohort Study With Propensity Score Matching
Authors: Helenius K. , Longford N. , Lehtonen L. , Modi N. , Gale C.
Published: May 2020

(BMJ. 2019;367:1–11)

The occurrence of infants born <28 weeks gestation is rare in both the United Kingdom and the United States, but such incidents carry a very high risk of death, neonatal morbidity, and long-term disability. Previous research has indicated that the best outcomes for these infants are achieved when care is given in specialized tertiary hospitals. At-risk pregnant women who present at nontertiary hospitals are often transferred to more specialized facilities either before or after delivery; a number of recent studies have focused on the outcomes of infants who were transferred postnatally, with inconclusive results. These investigators conducted their research to determine if transferred infants had a higher incidence of mortality and severe brain injury compared with nontransferred infants born in tertiary hospitals.
Remifentanil Patient-controlled Analgesia in Labour: 6-Year Audit of Outcome Data of the RemiPCA SAFE Network (2010-2015)
Authors: Melber A.A. , Jelting Y. , Huber M. , Keller D. , Dullenkopf A. , Girard T. , Kranke P.
Published: May 2020

(Int J Obstet Anesth. 2019;39:12–21)

Remifentanil patient-controlled analgesia (PCA) has been used for ∼20 years during labor as an alternative analgesic approach. While many units utilize this analgesic option in patients who cannot receive neuraxial analgesia, some offer it routinely to their laboring patients. There are some potentially serious side effects of remifentanil PCA, such as respiratory depression and hypoxemia. Swiss researchers developed the RemiPCA SAFE Network in 2009 when the analgesic technique became available in their country. The purpose of the network was to monitor PCA use and assess maternal and neonatal outcomes. While initially developed for Swiss facilities, the network later allowed obstetric units from other countries to participate and provide their data. Data collected by the network helps individual facilities to evaluate their performance and allows the network committee to assess the overall outcomes of remifentanil PCA for labor. The goal of the current audit study was to accurately outline the quality assurance system used by the network and analyze outcomes on remifentanil PCA effectiveness and safety based on the data collected.
Dose-Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia
Authors: Xiao F. , Shen B , Xu W.P. , Feng Y. , Ngan Kee W.D. , Chen X.Z.
Published: May 2020

(Anesth Analg. 2020;130:187–193)

When performing a cesarean delivery, anesthesiologists are most likely to use spinal anesthesia or combined spinal-epidural anesthesia, although these methods are associated with high rates of hypotension. Phenylephrine is considered to be an acceptable vasopressor for hypotension prevention, but not much research has been done to determine the optimal dose for prophylactic phenylephrine infusions. The few studies that have examined phenylephrine infusions did not use infusion rates that had been properly adjusted for patient body weight, so more research is warranted. These investigators conducted their study to examine the dose-response relationship for a fixed-rate, weight-based phenylephrine infusion under combined spinal-epidural anesthesia during cesarean delivery. In addition, the authors aimed to determine the infusion dose that would adequately prevent hypotension for 50% (ED50) and 90% (ED90) of patients.
Ultrasound-guided Transmuscular Quadratus Lumborum Block for Elective Cesarean Section Significantly Reduces Postoperative Opioid Consumption and Prolongs Time to First Opioid Request: A Double-blind Randomized Trial
Authors: Hansen C.K. , Dam M. , Steingrimsdottir G.E. , Laier G.H. , Lebech M. , Poulsen T.D. , Chan V.W.S. , Wolmarans M. , Bendtsen T.F. , Børglum J.
Published: May 2020

(Reg Anesth Pain Med. 2019;44:896–900)

Reducing pain and opioid consumption after scheduled cesarean delivery is important for maternal comfort and bonding with her newborn. The quadratus lumborum block has been found to reduce pain after cesarean delivery. This study aimed to evaluate the analgesic effect of an ultrasound-guided transmuscular quadratus lumborum (TQL) block in reducing opioid consumption in the first 24 hours following cesarean delivery. The authors hypothesized a TQL block with ropivacaine would result in a minimum relevant difference of 50% reduction in opioid consumption during the first 24 hours compared with a TQL block with saline placebo.
Maternal Respiratory Distress and Successful Reversal With Sugammadex During Intrauterine Transfusion With Fetal Paralysis
Authors: Munro A. , McKeen D. , Coolen J.
Published: May 2020

(Int J Obstet Anesth. 2019;39:129–140)

Intrauterine transfusion (IUT) is a treatment for fetal anemia resulting from Rh(D) alloimmunization. Fetal paralysis is often utilized during an IUT procedure to improve its safety. Fetal bradycardia is one of the most common complications of the procedure, and use of paralysis has been found to significantly decrease the risk of fetal heart rate changes during IUT. There are several neuromuscular blocking agents (NMBA) available for inducing fetal paralysis, and a possible complication during IUT is inadvertent maternal administration of an NMBA. This case report involved maternal respiratory distress secondary to unintended neuromuscular blockade during IUT, which was treated with sugammadex administration.
Driving high-functioning clinical teams
Authors: Brooks Paula B. , Fulton Megan E.
Published: May 2020

Background:

Rapid changes in the healthcare marketplace are driving healthcare systems to modify operations by which advanced practice registered nurses (APRNs) and physician assistants (PAs) serve patients. By identifying more effective and efficient utilization workflows, organizations can meet these demands, resulting in high-functioning clinical teams.

Local problem:

With the growing number of APRNs and PAs in a large academic medical center, there was a recognized need to establish effective and efficient utilization practices for these healthcare providers.

Methods:

Directors of the APP Best Practice Center developed an internal NP/certified nurse midwife (CNM)/clinical nurse specialist (CNS)/PA assessment service which conducted evaluations to optimize APRN and PA practice at the clinical/department level. This assessment excluded certified registered nurse anesthetists.

Interventions:

Thirty-two clinical areas were evaluated between September 2016 and May 2019. This included an NP/CNM/CNS/PA survey and more than 200 individual NP/CNM/CNS/PA interviews. Assessments addressed utilization, billing practices, professional development, and communication among team members.

Results:

Qualitative and quantitative reports were compiled. Many common themes were identified. These were broken down into three major categories: productivity, clinical operations, and professional development/support.

Conclusions:

Several recommendations were presented to department leaders about NP/CNM/CNS/PA practice. Departments that implemented several of the recommendations showed positive outcomes. This was evidenced by increased financial gain (increased relative value units, increase in revenue generated), increased patient access (increased clinic densities), and overall NP/CNM/CNS/PA satisfaction.
Factors Affecting Changes of Cluster of Differentiation 4 Cell Counts Among Human Immunodeficiency Virus-positive People Who Inject Heroin and Receive Methadone Maintenance Treatment
Authors: Wu Kuen-Hong , Juan Shao-Chiu , Chan Chia-Hsiang , Chou Sun-Yuan , Chan Hung-Yu
Published: May 2020

Aims:

Opioids have been hypothesized to suppress the immune function and worsen outcomes among people living with human immunodeficiency virus (HIV). The study aimed to identify key factors associated with the increased cluster of differentiation 4 (CD4) cell counts among HIV-positive people who inject heroin and receive methadone maintenance treatment (MMT).

Methods:

This longitudinal study was conducted at a psychiatric hospital in Northern Taiwan. Participants were recruited from 2006 through 2011, and received CD4 cell counts and HIV viral load monitoring once every 4 to 6 months. Trend in CD4 cell counts, defined as change in CD4 cell count over time, was used as the outcome measure. Independent variables included MMT-related factors and baseline characteristics. Baseline characteristics included age, gender, CD4 cell count, HIV viral load, tests for other infections, liver function tests, and urine drug screens.

Results:

Three hundred and fifty one participants were recruited during the study period. The multivariate linear mixed model analysis revealed a higher MMT attendance rate, a higher baseline CD4 cell count, and a shorter duration of MMT were associated with an increase in CD4 cell count over time.

Conclusions:

The study showed better adherence to MMT was associated with better preserved immune functions. The negative impact of duration of MMT on CD4 cell counts may be ameliorated by improving the attendance rate, initiation of MMT earlier when the baseline CD4 cell count is still relatively high and by the other beneficial effects of MMT, such as healthier lifestyles with reduced use of short-acting opioids.
Mania Induced by a Single Dose of Synthetic Cannabinoid
Authors: Ekici Ayşegül Ş. , Şahin Şengül , Elboğa Gülçin , Altindağ Abdurrahman
Published: May 2020

Synthetic cannabinoids (SCs) are substances with chemical structures that comprise a family of compounds and have structures that can bind to cannabinoid receptors in human cells known as CB1 or CB2. Most SCs are stronger than tetrahydrocannabinol and pose a greater health risk. In this article, we present a mania case that was triggered by a single dose of the SC Bonzai and registered improvement after long-term inpatient treatment. In the literature, only one previous case has been reported of a manic attack induced by SC, and this previously reported case had manic symptoms that started after 6 months of SC use. In our case, we aimed to discuss the possible mechanisms of SC use, which may cause affective symptoms and a serious psychotic manic episode even in the absence of long-term exposure.
Relationship Between Corrective Saccades and Measures of Physical Function in Unilateral and Bilateral Vestibular Loss
Authors: Riska Kristal M. , Bellucci Jordan , Garrison Doug , Hall Courtney
Published: May 2020

Objectives:

Following the loss of vestibular function, some patients functionally improve and are minimally bothered by their loss of peripheral function while others remain more symptomatic and are unable to return to their activities of daily living. To date, the mechanisms for functional improvement remain poorly understood. The purpose of the present study was to examine the association between corrective saccades and measures of handicap, dynamic visual acuity, gait, and falls.

Design:

A retrospective chart review was performed to identify patients who were diagnosed with unilateral or bilateral vestibular hypofunction and who also completed a baseline vestibular rehabilitation evaluation. A total of 82 patients with unilateral vestibular hypofunction and 17 patients with bilateral vestibular hypofunction were identified. The video head impulse test results for each patient were grouped based on the type of presenting saccades. Specifically, the saccade grouping included the following: (1) covert, (2) overt, or (3) a combination of both types of saccades.

Results:

The results show that covert saccades are associated with better performance on measures of dynamic visual acuity, gait, and balance in patients with unilateral vestibular hypofunction. Patients exhibiting overt saccades or combination of both covert and overt saccades were more often found to have an abnormal gait speed and be characterized as being at risk for falls using the Dynamic Gait Index. We observed no differences in physical function for those patients with bilateral vestibular hypofunction as a function of saccade grouping.

Conclusions:

When comparing saccade groups (covert, overt, or combination of both), patients with unilateral vestibular hypofunction and covert saccades demonstrated better performance on standard baseline physical therapy measures of dynamic visual acuity and gait and balance. We did not observe any significant associations between saccade group and physical function in patients with bilateral vestibular hypofunction; however, additional studies are needed with adequate sample sizes. Our findings may suggest that corrective saccade latency in patients with unilateral vestibular hypofunction is related to measures of physical function. The extent to which saccade latency has the potential to be a useful target for vestibular rehabilitation is still to be determined and may be promising target to improve functional outcomes.
Management of nonarthritic meniscal tears: a qualitative, patient-centered assessment of decision making
Authors: Nelson Patrick , Bhatt Surabhi , Terry Michael , Tjong Vehniah
Published: May 2020

Background:

Meniscal lesions are the most common intraarticular knee injury. Treatment involves a decision for conservative management or surgery. Recent literature has demonstrated similar outcomes between these two methods in patients with meniscal tears and minimal arthritis. This study explores factors influencing a patient’s decision to choose operative versus nonoperative management in the treatment of nonarthritic meniscal lesions.

Methods:

Semistructured interviews were conducted with patients ages 18 to 50 yr old, with MRI confirmed diagnosis of meniscal tear and minimum of 2-year follow-up. Patients with Kellen-Lawrence Grade 2 or greater, with prior knee injuries, or knee surgeries were excluded. Qualitative analysis was performed to derive codes, categories, and themes. An assessment of patient-reported outcomes including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Marx activity score was also conducted.

Results:

Twenty-four patients with meniscal tears were interviewed. Those who chose surgical management with arthroscopic partial meniscectomy (n=12) cited significant pain, desire for definitive treatment, and aggressive personality traits. The nonoperative group (n=12) frequently had social constraints precluding surgery, more conservative personalities, and symptoms that did not affect their daily lives. The nonoperative group had significantly lower KOOS scores in symptoms (90.2 vs. 76.5, P=0.05), sports and recreation (84.2 vs. 64.2, P=0.05), and quality of life (QOL) (85.4 vs. 62.0, P=0.01).

Conclusions:

Psychological and social factors such as pain perception, personality, and time commitments affected patients’ decisions to undergo surgical or conservative management for meniscal tears. This study may help surgeons and other health care professionals better understand and educate patients contemplating surgery.

Level of Evidence:

Level IV.
Focal fibrocartilaginous dysplasia of the distal femur
Authors: Bian Zhen , Lyu XueMin , Guo Yuan , Zhu ZhenHua , Feng Chao , Yang Jie , Dong YiFei
Published: May 2020

Focal fibrocartilaginous dysplasia (FFCD) of the distal femur is a rare disorder that results in a varus or valgus of knee. Due to the small number of cases and unconfirmed natural history of the disease, treatment methods remain variable. This study aimed to determine a strategy to successfully manage distal femoral FFCD. Nine case of femoral FFCD treated in our department between 2008 and 2018, together with 22 cases from literature, were retrospectively reviewed. Tibiofemoral anatomical axis angle (TFA) was used to evaluate and follow the deformities. Treatment methods and outcome were analyzed. Five methods were used to manage the disease: osteotomy with tether release in 14 cases with mean TFA of 29°; simple tether release in eight cases with mean TFA of 31°; guide growth without tether release in 3 case with mean TFA of 27°; guide growth with tether release in 3 case with mean TFA of 27°; and observation in three cases with mean TFA of 23°.Deformity was resolved in all 31 patients. The analysis of the 31 cases in the literature and our experience suggests that femoral FFCD can be successfully managed by simple tether release and curettage. Osteotomy can be avoided. In case of mild deformity (TFA < 25°), it is reasonable to follow-up till 2–3 years of age; if no progress occurs, spontaneous resolution can be expected.
Patient Reported Outcomes in Patients Who Stop Following Up
Authors: Chen Darren A. , Vaishnav Avani S. , Louie Philip K. , Gang Catherine Himo , McAnany Steven J. , Iyer Sravisht , Albert Todd J. , Qureshi Sheeraz A.
Published: May 2020

Study Design.

Follow-up study.

Objective.

To determine whether minimally invasive lumbar spine surgery outcomes are different between those who are lost to follow-up and those who are not.

Summary of Background Data.

Lost to follow-up patients are a common source of selection bias for clinical outcomes research. Currently, there are no US based studies that evaluate the differences in outcomes of lost to follow-up patients after spine surgeries.

Methods.

A retrospective review of prospectively collected data of 289 patients who underwent minimally invasive lumbar surgery and were at least 1 year postsurgery was performed. Patients were divided into two groups: (1) lost to follow-up (LTF), defined as patients who had missed more than two consecutive follow-up visits and had not attended their 1-year follow-up appointment; and (2) not lost to follow-up. For the not-LTF cohort, patient response outcome measures (PROMs) (oswestry disability index (ODI), visual analog scale (VAS) back/leg, Short Form-12 (SF-12) Physical/Mental, PROMIS) and return to activities data were collected prospectively at each follow-up. For LTF patients, data were collected through emailed surveys or telephone interviews. PROMs and return to activities data of the two groups were compared. Sub-group analysis by type of surgery (decompression or fusion) was also performed.

Results.

For the entire cohort, independent t test analysis showed LTF patients had greater improvement in PROMIS Physical Function scores than those who were not-LTF (15.08 vs. 10.38, P = 0.026). For fusion surgeries, LTF patients showed a greater improvement in ODI (–30.94 vs. –16.23, P = 0.003) VAS back (–4.92 vs. –2.99, P = 0.044), and PROMIS-PF (16.09 vs. 10.38, P = 0.049). There were no significant differences in complication rates between LTF and not LTF patients.

Conclusion.

Patients undergoing minimally invasive lumbar surgery—in particular lumbar fusions—who are lost to follow-up and responded to subsequent email and phone interviews showed greater improvements in self-reported outcomes than those who continued to follow-up. Thus, our results suggest that a substantial subset of patients who are lost to follow-up do not fare worse than those who do follow-up. However, an opposite response cannot be excluded in those who did not respond to email and phone interviews.

Level of Evidence: 3
A New Surgical Strategy for Infective Spondylodiscitis
Authors: Choi Sung Hoon , Koo Ja Wook , Hur Jeong Min , Kang Chang-Nam
Published: May 2020

Study Design.

Retrospective comparative study.

Objective.

To investigate the radiographic and clinical effectiveness of surgical treatment using a posterior-only approach, as compared with a combined antero-posterior approach, in patients with infective spondylodiscitis.

Summary of Background Data.

Spondylodiscitis is the most common infectious disease of the spine. There is currently no consensus over the surgical approach, use of bone graft, and type of instrumentation for optimal treatment of infective spondylodiscitis.

Methods.

Seventy-nine patients who received surgical treatment for infective spondylodiscitis were divided into a combined antero-posterior (AP) group and a posterior-only (P) group. Significant differences in pre- and postoperative radiographic and clinical characteristics between the two groups were identified, and univariate and stepwise multivariate logistic regression analyses were used to determine the factors that affected the decision for treatment approach between the two groups.

Results.

Preoperatively, initial height loss, wedge angle, and kyphotic angle were significantly higher in the AP group. However, estimated blood loss, operation time, and last visual analogue scale score for back pain were significantly lower in the P group. There was no difference in postoperative time to reach solid fusion. Postoperative corrected kyphotic angle was 12.8° in the AP group and 5.3° in the P group. The regional wedge angle was identified as a factor that influenced use of the combined antero-posterior approach, with a sensitivity of 60%, and specificity of 89.8% at the optimal cut-off value of 8.2°.

Conclusion.

Interbody fusion with long-level pedicle screws fixation through a posterior-only approach was shown to be as effective as a combined antero-posterior approach for the surgical treatment of infective spondylodiscitis. A posterior-only approach is recommended when the regional wedge angle of the collapsed vertebra is less than 8.2°.

Level of Evidence: 4