bluuebunny/crossref_metadata_2025 huggingface dataset:
Realizations and orientation of implicit systems
Authors: Vafiadis Dimitris
Published: July 2021

The paper considers the problem of model orientation, i.e. the classification of the external signals into inputs and outputs. The problem is considered in the behavioural context where the external model is an autoregressive system. Orientation of a system automatically induces equivalent first order models in state–space or descriptor form via a realization procedure. A new realization procedure is proposed where the realization is implemented in two steps, first an intermediate ARMA realization is obtained. Then, this realization is transformed into the final descriptor system via an appropriate reduction procedure corresponding to the input/output partition of the external variables. Studying the dependency of the resulting system properties and invariants on the different selections of input and output variables and the structure of the initial external behaviour is considered in the paper.
Water, Sanitation, and Hygiene Practices in Urban Slums of Eastern India
Authors: Kanungo Suman , Chatterjee Pranab , Saha Jayanta , Pan Tania , Chakrabarty Nandini Datta , Dutta Shanta
Published: July 2021

Background

The Sustainable Development Goals identified universal access to water and sanitation facilities as key components for improving health. We assessed water, sanitation, and hygiene (WASH) practices and associated determinants among residents of urban slums in Kolkata, India.

Methods

Information on WASH practices was collected in 2 surveys (2018 and 2019) from participants of a prospective enteric fever surveillance conducted in 2 municipal wards of Kolkata. A composite WASH practice score was computed and a hierarchical stepwise multiple linear regression model constructed to identify key determinants of improved WASH score.

Results

Over 90% of households had access to piped water; 6% reported access to continuous supply. Adult women (61% in 2018; 45% in 2019) spent 20 minutes daily to fetch water. Access to improved latrines was almost universal, although 80% used shared facilities. Unhealthy disposal of children’s stools was reported in both rounds. Food hygiene practices were high, with most (>90%) washing uncooked items before eating; frequent consumption of street food items was reported.

Conclusions

The study area reported high WASH coverage. Unhygienic behavioral patterns predisposing to food- or water-borne diseases were also noted. Awareness building and sustainable community mobilization for food hygiene needs to be emphasized to ensure community well-being.
Healthcare Utilization Survey in the Hybrid Model of the Surveillance for Enteric Fever in India (SEFI) Study: Processes, Monitoring, Results, and Challenges
Authors: Raju Reshma , Kezia Angelin J , Karthikeyan Arun S , Kumar Dilesh , Kumar R Ranjith , Sahai Nikhil , Ramanujam Karthikeyan , Murhekar Manoj , Elangovan A , Samuel Prasanna , John Jacob , Kang Gagandeep
Published: July 2021

Background

Lack of reliable data in India drove the “Surveillance of Enteric Fever in India” (SEFI) concept. Hybrid surveillance, combining facility-based surveillance for the crude incidence, and a community-based healthcare utilization survey (HCUS) to calculate the factor needed to arrive at the adjusted incidence, was used in 6 sites. The HCUS aimed to determine the percentage of utilization of study facilities by the catchment population for hospitalizations due to febrile illness.

Methods

Population proportional to size sampling and systematic random sampling, in 2 stages, were used to survey 5000 households per site. Healthcare utilization was assessed.

Results

Febrile illness accounted for 20% of admissions among 137 990 individuals from 30 308 households. Only 9.6%–38.3% of those admitted with febrile illness sought care in the study hospitals. The rate of rural utilization of the private sector for hospitalization was 67.6%. The rate of hospitalization for febrile illness, per 1000 population, ranged from 2.6 in Manali to 9.6 in Anantapur; for 25.8% of the deaths associated with febrile illness, no facility was used before death.

Conclusions

One in 5 hospitalizations were associated with fever. Rural utilization of the private sector for hospitalization due to febrile illness was more than that of the public sector. Healthcare utilization patterns for hospital admissions due to febrile illness varied across sites. A meticulously performed HCUS is pivotal for accurate incidence estimation in a hybrid surveillance.

Clinical Trials Registration

ISRCTN72938224.
Genomic Diversity of Haemophilus influenzae Serotype a in an Outbreak Community—Alaska, 2018
Authors: Nolen Leisha D , DeByle Carolynn , Topaz Nadav , Simons Brenna C , Tiffany Amanda , Reasonover Alisa , Castrodale Louisa , McLaughlin Joseph , Klejka Joe , Wang Xin , Bruce Michael
Published: July 2021

Background

Haemophilus influenzae serotype a (Hia) can cause severe invasive disease, especially in young children. In 2018, 4 invasive Hia cases occurred in an Alaska community. We used whole-genome sequencing (WGS) to evaluate the relationship of the bacteria from this community and other Alaska patients with invasive Hia.

Methods

All carriage (n = 15) and invasive (n = 4) Hia isolates from the outbreak community, together with 15 nonoutbreak Alaska invasive Hia surveillance isolates from 2018, were tested for antimicrobial susceptibility and characterized using WGS.

Results

Phylogenetic analysis of both invasive and carriage Hia isolates revealed 2 major clades that differed by an average of 300 core single-nucleotide polymorphisms (SNPs). All isolates from the outbreak community were clustered in 1 subclade, within a larger clade containing 3 nonoutbreak invasive Hia isolates. Comparative genomics did not reveal any genetic mutations that distinguished carriage from invasive isolates. Three (20%) community isolates were rifampin resistant and had a previously unreported mutation in the rpoB gene.

Conclusions

In the outbreak community, Hia isolates from carriers were indistinguishable from the invasive Hia isolates. Overall, invasive Hia isolates from Alaska in 2018 were genetically similar. The rifampin resistance mutation is concerning as rifampin is the first-line medication for Hia prophylaxis.
Macrophages in lung fibrosis
Authors: Ogawa Tatsuro , Shichino Shigeyuki , Ueha Satoshi , Matsushima Kouji
Published: July 2021

Pulmonary fibrosis (PF) is a disease in which excessive extracellular matrix (ECM) accumulation occurs in the lungs, which induces thickening of the alveolar walls, ultimately leading to the destruction of alveolar structures and respiratory failure. Idiopathic PF, the cause of which is unknown, has a poor prognosis with a median survival of 2–4 years after diagnosis. There is currently no known curative treatment. The mechanism underlying PF is thought to be initiated by the dysfunction of type II alveolar epithelial cells, which leads to ECM overproduction through the activation of fibroblasts. In addition, it has been suggested that a variety of cells contribute to fibrotic processes. In particular, clinical and basic research findings examining the roles of macrophages suggest that they may be pivotal regulators of PF. In this review, we discuss the characteristics, functions and origins of subsets of macrophages involved in PF, including resident alveolar, interstitial and monocyte-derived macrophages.
Vancomycin in adult prescribing: is it time to move on from trough-based dosing in the UK?
Authors: Heard F , Sehgal A
Published: July 2021

Vancomycin remains a useful agent in the infection doctor’s toolkit, particularly for Staphylococcus aureus and MRSA infections. Therapeutic drug monitoring (TDM) is essential to maintain efficacy and avoid toxicity. Until recently, trough-based dosing has been the recommended method but in recent years the reliability of this has been questioned. The 2020 Infectious Diseases Society of America (IDSA) vancomycin guideline update has sent a clear message that trough-based dosing is not to be relied on, instead recommending dosing via 24 h AUC/MIC. The UK, however, has yet to follow suit in this, despite the wealth of evidence showing that trough-based dosing puts patients at higher risk of nephrotoxicity. Clearly, it is time to incorporate AUC/MIC-based dosing to utilize this effective antibiotic safely.
Car Seat Heater Burns: Awareness and Prevention
Authors: Richman Evan H , Brown Parker J , Reilly Debra
Published: July 2021

The demand for car seat heaters is on the rise due to the added comfort they offer passengers. However, such luxury is not without risk and prolonged exposure to high surface temperatures of the seat may result in severe burns. We present a unique case of an 18-year-old paraplegic patient who sustained severe full-thickness burns requiring operative intervention after prolonged exposure to a car seat heater. We then tested 10 car seat heaters manufactured after 2014 to establish maximum temperature settings and safety features. We also examine the importance of raising awareness of this issue and share the concerns of previous publications regarding the lack of manufacturer standards in car seat heaters.
Structural Change and Global Trade
Authors: Lewis Logan T , Monarch Ryan , Sposi Michael , Zhang Jing
Published: July 2021

Services, which are less traded than goods, rose from 55% of world expenditure in 1970 to 75% in 2015. Using a Ricardian trade model incorporating endogenous structural change, we quantify how this substantial shift in consumption has affected trade. Without structural change, we find that the world trade to GDP ratio would be 13 percentage points higher by 2015, about half the boost delivered from declining trade costs. In addition, a world without structural change would have had about 40% greater welfare gains from the trade integration over the past four decades. Absent further reductions in trade costs, ongoing structural change implies that world trade as a share of GDP would eventually decline. Going forward, higher-income countries gain relatively more from reducing services trade costs than from reducing goods trade costs.
Exit, Voice, and Sabotage: Public Service Motivation and Guerrilla Bureaucracy in Times of Unprincipled Political Principals
Authors: Schuster Christian , Mikkelsen Kim Sass , Correa Izabela , Meyer-Sahling Jan-Hinrik
Published: July 2021

Democratic backsliding has multiplied “unprincipled” political principals: governments with weak commitment to the public interest. Why do some bureaucrats engage in voice and guerrilla sabotage to thwart policies against the public interest under “unprincipled principals,” yet others do not? Despite its centrality in contemporary governance, this conundrum has not seen quantitative research. We address this gap with survey evidence from 1,700 Brazilian public servants during the Temer Presidency, widely perceived to lack democratic legitimacy and integrity. We focus on one key explanator: public service motivation (PSM). We argue that bureaucrats with greater PSM are more likely to engage in voice and sabotage of “unprincipled policies,” and exit to avoid implementing “unprincipled policies.” Structural equation models support these hypotheses. Public service-motivated bureaucracies are thus short-run stalwarts against “unprincipled” political principals. Over time, they look to depart, however, leaving “unprincipled” principals a freer hand to pursue policies against the public interest.
Reactive oxygen species homeostasis and circadian rhythms in plants
Authors: Jiménez Ana , Sevilla Francisca , Martí María Carmen
Published: July 2021

Elucidation of the molecular mechanisms by which plants sense and respond to environmental stimuli that influence their growth and yield is a prerequisite for understanding the adaptation of plants to climate change. Plants are sessile organisms and one important factor for their successful acclimation is the temporal coordination of the 24 h daily cycles and the stress response. The crosstalk between second messengers, such as Ca2+, reactive oxygen species (ROS), and hormones is a fundamental aspect in plant adaptation and survival under environmental stresses. In this sense, the circadian clock, in conjunction with Ca2+- and hormone-signalling pathways, appears to act as an important mechanism controlling plant adaptation to stress. The relationship between the circadian clock and ROS-generating and ROS-scavenging mechanisms is still not fully understood, especially at the post-transcriptional level and in stress situations in which ROS levels increase and changes in cell redox state occur. In this review, we summarize the information regarding the relationship between the circadian clock and the ROS homeostasis network. We pay special attention not only to the transcriptional regulation of ROS-generating and ROS-scavenging enzymes, but also to the few studies that have been performed at the biochemical level and those conducted under stress conditions.
Deep forest: Neural network reconstruction of the Lyman-α forest
Authors: Huang Lawrence , Croft Rupert A C , Arora Hitesh
Published: July 2021

We explore the use of Deep Learning to infer physical quantities from the observable transmitted flux in the Ly α forest. We train a Neural Network using redshift z = 3 outputs from cosmological hydrodynamic simulations and mock data sets constructed from them. We evaluate how well the trained network is able to reconstruct the optical depth for Ly α forest absorption from noisy and often saturated transmitted flux data. The Neural Network outperforms an alternative reconstruction method involving log inversion and spline interpolation by approximately a factor of 2 in the optical depth root mean square error. We find no significant dependence in the improvement on input data signal to noise, although the gain is greatest in high optical depth regions. The Ly α forest optical depth studied here serves as a simple, one dimensional, example but the use of Deep Learning and simulations to approach the inverse problem in cosmology could be extended to other physical quantities and higher dimensional data.
AGNIFS survey of local AGN: GMOS-IFU data and outflows in 30 sources
Authors: Ruschel-Dutra D , Storchi-Bergmann T , Schnorr-Müller A , Riffel R A , Dall’Agnol de Oliveira B , Lena D , Robinson A , Nagar N , Elvis M
Published: July 2021

We analyse optical data cubes of the inner kiloparsec of 30 local (z ≤ 0.02) active galactic nucleus (AGN) hosts that our research group, AGNIFS, has collected over the past decade via observations with the integral field units of the Gemini Multi-Object Spectrographs. Spatial resolutions range between 50 and 300 pc and spectral coverage is from 4800 or 5600 to 7000 Å, at velocity resolutions of ≈50 $\rm ~km~s^{-1}$. We derive maps of the gas excitation and kinematics, and determine the AGN ionization axis – which has random orientation relative to the galaxy – and the kinematic major axes of the emitting gas. We find that rotation dominates the gas kinematics in most cases, but is disturbed by the presence of inflows and outflows. Outflows have been found in 21 nuclei, usually along the ionization axis. The gas velocity dispersion is traced by W80 (velocity width encompassing 80 per cent of the line flux), adopted as a tracer of outflows. In seven sources, W80 is enhanced perpendicularly to the ionization axis, indicating lateral expansion of the outflow. We have estimated mass-outflow rates $\dot{M}$ and powers $\dot{E}$, finding median values of $\log \, [\dot{M}/({\rm \, M_\odot \, yr^{-1}})]=-2.1_{-1.0}^{+1.6}$ and $\log \, [\dot{E}/({\rm \, erg\, s^{-1}})]=38.5_{-0.9}^{+1.8}$, respectively. Both quantities show a mild correlation with the AGN luminosity (LAGN). $\dot{E}$ is of the order of 0.01 LAGN for four sources, but much lower for the majority (nine) of the sources, with a median value of $\log \, [\dot{E}/L_{\rm AGN} ]=-5.34_{-0.9}^{+3.2}$, indicating that typical outflows in the local Universe are unlikely to significantly impact their host galaxy evolution.
Neurosurgical resection for locally recurrent brain metastasis
Authors: Hulsbergen Alexander F C , Abunimer Abdullah M , Ida Fidelia , Kavouridis Vasileios K , Cho Logan D , Tewarie Ishaan A , Mekary Rania A , Schucht Philippe , Phillips John G , Verhoeff Joost J C , Broekman Marike L D , Smith Timothy R
Published: July 2021

Background

In patients with locally recurrent brain metastases (LRBMs), the role of (repeat) craniotomy is controversial. This study aimed to analyze long-term oncological outcomes in this heterogeneous population.

Methods

Craniotomies for LRBM were identified from a tertiary neuro-oncological institution. First, we assessed overall survival (OS) and intracranial control (ICC) stratified by molecular profile, prognostic indices, and multimodality treatment. Second, we compared LRBMs to propensity score-matched patients who underwent craniotomy for newly diagnosed brain metastases (NDBM).

Results

Across 180 patients, median survival after LRBM resection was 13.8 months and varied by molecular profile, with >24 months survival in ALK/EGFR+ lung adenocarcinoma and HER2+ breast cancer. Furthermore, 102 patients (56.7%) experienced intracranial recurrence; median time to recurrence was 5.6 months. Compared to NDBMs (n = 898), LRBM patients were younger, more likely to harbor a targetable mutation and less likely to receive adjuvant radiation (P < 0.05). After 1:3 propensity matching stratified by molecular profile, LRBM patients generally experienced shorter OS (hazard ratio 1.67 and 1.36 for patients with or without a mutation, P < 0.05) but similar ICC (hazard ratio 1.11 in both groups, P > 0.20) compared to NDBM patients with similar baseline. Results across specific molecular subgroups suggested comparable effect directions of varying sizes.

Conclusions

In our data, patients with LRBMs undergoing craniotomy comprised a subgroup of brain metastasis patients with relatively favorable clinical characteristics and good survival outcomes. Recurrent status predicted shorter OS but did not impact ICC. Craniotomy could be considered in selected, prognostically favorable patients.
Complications Associated With Oblique Lumbar Interbody Fusion at L5-S1: A Systematic Review of the Literature
Authors: Pham Martin H , Hassan Omron , Diaz-Aguilar Luis Daniel , Lehman Ronald A
Published: July 2021

INTRODUCTION

Oblique lumbar interbody fusion (OLIF) at L5-S1, also known as a lateral decubitus anterior lumbar interbody fusion (ALIF) or anterior-to-psoas (ATP) approach, is a technique that provides a minimally invasive corridor to a key segment in the spine for degenerative conditions and deformity correction. However, the evaluation of complications associated with this level has been difficult as prior reports include other levels that have different anatomic considerations.

OBJECTIVE

To present a systematic review of previously reported cases of OLIF, lateral ALIF, and an ATP approach at L5-S1 to discuss their associated complications.

METHODS

Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a PubMed search was performed up to January 2021 to identify literature describing OLIF, lateral ALIF, and ATP approaches involving the L5-S1 levels. A quality assessment with risk of bias analysis was performed using the methodological index for non-randomized studies (MINORS) assessment tool for each study. Data we then extracted to identify all complications.

RESULTS

The initial search yielded 532 publications. After screening, there were 18 studies with 553 total patients who underwent OLIF including L5-S1. Analysis of these studies demonstrated a vascular complication rate of 2.5%, bowel-associated complication rate of 0.5%, ureteral injury rate of 0%, neurological injury rate of 1.9%, pseudarthrosis rate of 7.3%, and reoperation rate of 2.2%.

CONCLUSION

The L5-S1 level remains an important target for sagittal alignment in both degenerative and deformity surgery. The OLIF surgical corridor to this level presents special anatomic and clinical considerations and is a safe approach to minimize morbidity with minimally invasive access.
A Single Xyloglucan Xylosyltransferase Is Sufficient for Generation of the XXXG Xylosylation Pattern of Xyloglucan
Authors: Zhong Ruiqin , Phillips Dennis R , Ye Zheng-Hua
Published: July 2021

Xyloglucan is the most abundant hemicellulose in the primary cell walls of dicots. Dicot xyloglucan is the XXXG type consisting of repeating units of three consecutive xylosylated Glc residues followed by one unsubstituted Glc. Its xylosylation is catalyzed by xyloglucan 6-xylosyltransferases (XXTs) and there exist five XXTs (AtXXT1-5) in Arabidopsis. While AtXXT1 and AtXXT2 have been shown to add the first two Xyl residues in the XXXG repeat, which XXTs are responsible for the addition of the third Xyl residue remains elusive although AtXXT5 was a proposed candidate. In this report, we generated recombinant proteins of all five Arabidopsis XXTs and one rice XXT (OsXXT1) in the mammalian HEK293 cells and investigated their ability to sequentially xylosylate Glc residues to generate the XXXG xylosylation pattern. We found that like AtXXT1/2, AtXXT4 and OsXXT1 could efficiently xylosylate the cellohexaose (G6) acceptor to produce mono- and di-xylosylated G6, whereas AtXXT5 was only barely capable of adding one Xyl onto G6. When AtXXT1-catalyzed products were used as acceptors, AtXXT1/2/4 and OsXXT1, but not AtXXT5, were able to xylosylate additional Glc residues to generate tri- and tetra-xylosylated G6. Further characterization of the tri- and tetra-xylosylated G6 revealed that they had the sequence of GXXXGG and GXXXXG with three and four consecutive xylosylated Glc residues, respectively. In addition, we have found that although tri-xylosylation occurred on G6, cello-oligomers with a degree of polymerization of 3 to 5 could only be mono- and di-xylosylated. Together, these results indicate that each of AtXXT1/2/4 and OsXXT1 is capable of sequentially adding Xyl onto three contiguous Glc residues to generate the XXXG xylosylation pattern and these findings provide new insight into the biochemical mechanism underlying xyloglucan biosynthesis.
Hospital readmission in systemic sclerosis associated pulmonary hypertension: Results from the PHAROS registry
Authors: Showalter Kimberly , Pinheiro Laura C , Jannat-Khah Deanna , Sobol Irina , Szymonifka Jackie , Finik Jackie , Steen Virginia D , Gordon Jessica K
Published: July 2021

Objective

To identify individual-level factors associated with hospital readmission among individuals with SSc-associated pulmonary hypertension (SSc-PH).

Methods

Individuals enrolled in the Pulmonary Hypertension Assessment and Recognition of Outcomes in Scleroderma (PHAROS) registry contributed clinical data related to SSc-PH disease severity and hospital admissions. Readmission was defined as a subsequent hospitalization within 12 months of any hospital discharge. Characteristics were compared between individuals with and without readmissions using Fisher’s exact test, Wilcoxon rank-sum test, or Kruskal–Wallis test. Logistic regression was used to estimate associations between clinical predictors and likelihood of readmission.

Results

Of 572 individuals with SSc-PH enrolled in PHAROS, 54% had ≥1 hospitalizations between 2005 and 2016. Among individuals ever-hospitalized, 34% had ≥1 readmission. Individuals with vs without readmissions had shorter median (IQR) time between index hospitalization date and next PHAROS visit [37 (3, 80) vs 81 (42, 136) days, P <0.001]. Index admissions related to PH or SSc (vs non-PH/SSc related) were associated with an increased odds of 12-month readmission [aOR 6.6 (95% CI 3.2, 13.6) and aOR 2.2 (95% CI 1.1, 4.5), respectively]. Readmission was less likely among home oxygen users (vs non-users) (aOR 0.44; 95% CI 0.22, 0.89). Race, age, sex, disease duration and disease subtype were not associated with readmission.

Conclusion

The strongest predictor for 12-month readmission was an index hospitalization reason related to PH. Home oxygen use was associated with lower odds of readmission. Future studies should determine whether testing for the need for home oxygen mediates the risk of readmission in SSc-PH.
Subjective loss of clinical response to TNFi in axSpA relates to recurrence of MRI bone marrow oedema particularly with long-acting agents
Authors: Harrison Stephanie R , Ansell Rebecca , Mathieson Hannah R , Merashli Mira , Busquets-Pérez Noemi , McGonagle Dennis , Marzo-Ortega Helena
Published: July 2021

Objectives

Subjective loss of response immediately prior to routine TNFi therapy can occur in axial spondyloarthritis (axSpA). We investigated clinical outcomes in patients taking the first three licenced TNFis and correlated this with recurrence of MRI bone marrow oedema (MRI-BMO).

Methods

Proof-of-concept study including axSpA patients established on etanercept (ETA), adalimumab (ADA) or infliximab (IFX) reporting symptom deterioration prior to next dose. MRI/clinical data were collected prior to scheduled dose (v1), 4 days post-dose (v2) and at the time of patient-reported symptom return (v3). MRI spine/sacroiliac joints utilizing 3 T were scored using the semi-quantitative Leeds MRI scoring system.

Results

A total of 113 clinical assessments and MRIs were performed in 38 participants (ADA = 16, ETA = 12, IFX = 10), mean age 42.1 years ± 24.4(2SD, n = 38), 71.1% male (n = 27/38), 69.7% HLA-B27 positive (n = 23/33). At v1, all patients had high disease activity [ASDAS-CRP = 3 (2.7–3.7)] and 57.9% had MRI-BMO (number of MRI-BMO: ETA = 26, ADA = 59, IFX = 28). Improved clinical responses were seen at v2 [ASDAS-CRP −0.41(−0.81 − 0.30), P =0.018; BASDAI −0.58(−2.2 − 0.52), P =0.024]. Despite just a 4-day interval between v1 and v2, a numerical reduction in MRI-BMO lesions between v1/v2 was observed (ETA = −6, ADA = −10, IFX = −3). By v3, comparatively fewer new BMO lesions were detected in the ETA and ADA groups compared with IFX (ETA = −1, ADA = +3, IFX = +8), although the numbers were too small to enable testing for statistical significance.

Conclusions

Short-lived fluctuations in MRI-BMO were commoner with longer-acting agents and corresponded with subjective loss of clinical response before next scheduled TNFi dose. Larger studies are needed to confirm the possible pathogenic implications of this phenomenon.
The Identification of Tautoneura mori as the Vector of Mulberry Crinkle Leaf Virus and the Infectivity of Infectious Clones in Mulberry
Authors: Lu Quan-You , Ma Yu , Smith William Kojo , Yu Jing , Cheng Yong-Yuan , Zhang Peng , Han Tao-Tao
Published: July 2021

Mulberry crinkle leaf virus (MCLV) is a novel geminivirus identified from mulberry. The pathogenicity and natural vector transmission of MCLV remain unknown. Here, infectious clones consisting of the complete tandem dimeric genome of MCLV in a binary vector were constructed and agroinoculated into young mulberry plants. The results showed that the infectious clones of MCLV were systemically infectious in mulberry, but the infected mulberry plants did not show any virus infection-like symptoms. The natural transmission vectors of MCLV were also identified from possible vector insects occurring on the MCLV-infected mulberry plants. The vector ability of Tautoneura mori was identified through an inoculation assay. Three of 21 (14.3%) plants inoculated with T. mori collected from MCLV-infected mulberry plants grown naturally were found to be MCLV-positive 50 days postinoculation. These MCLV-positive mulberry plants did not show any virus infection-like symptoms. Collectively, these results suggest that MCLV is infectious to mulberry plants but, by itself, does not induce infection symptoms. The leafhopper T. mori was experimentally determined to be a transmission vector of MCLV for the first time.
Genotype Groups of the Wheat Leaf Rust Fungus Puccinia triticina in the United States as Determined by Genotyping by Sequencing
Authors: Kolmer J. A. , Herman A. , Fellers J. P.
Published: July 2021

Wheat leaf rust caused by Puccinia triticina is a widespread disease of wheat in the United States and worldwide. Populations of P. triticina are characterized by virulence phenotypes that change rapidly because of selection by wheat cultivars with leaf rust resistance genes. The objective of this study was to genotype collections of P. triticina from 2011 to 2018 in the United States using restriction site-associated genotyping by sequencing (GBS) to determine if recently identified new virulence phenotypes belong to established genotype groups or to groups previously not detected. A total of 158 isolates were phenotyped for virulence on 20 lines of Thatcher wheat that are isogenic for leaf rust resistance genes and also genotyped for single nucleotide polymorphism. Eight distinct groups of P. triticina genotypes from common wheat were described based on coancestry, nucleotide divergence, and principal coordinate plots. A separate genotype group had isolates with virulence to durum wheat. Isolates within groups had similar virulence phenotypes, and the overall population had high levels of heterozygosity and high levels of linkage disequilibria, which were all indicators of clonality. Two new genotype groups were described, thereby raising the possibility of new introductions of P. triticina; however, genotypes in these groups may have also originated from somatic nuclear exchange and recombination. A genome-wide association study detected 19 single nucleotide polymorphisms that were highly associated with virulence to 11 resistance genes in the Thatcher near-isogenic lines.
Hand Dermatitis among Nurses during the COVID-19 Pandemic: Frequency and Factors
Authors: Aydın Ayla İrem , Atak Meryem , Özyazıcıoğlu Nurcan , Dalkızan Vahit
Published: July 2021

OBJECTIVE

To determine the frequency of hand dermatitis among nurses during the COVID-19 pandemic and factors affecting its prevalence.

METHODS

The research sample consisted of 175 nurses working in state hospitals. Research data were collected via Google survey between September and October 2020. The data were collected using a sociodemographic data collection form, and a self-assessment form was used to determine dermatologic symptoms.

RESULTS

The frequency of hand dermatitis among nurses was 70.9%. A statistically significant difference was found between sex, allergy history, and increased frequency of handwashing and the frequency of hand dermatitis. No significant difference in terms of the frequency of hand dermatitis was found between nurses who provided care to patients who were COVID-19 positive versus nurses who provided care to patients who were COVID-19 negative. However, the frequency of washing hands and using hand disinfectants and hand creams was found to have increased significantly during the COVID-19 pandemic compared to the prepandemic period.

CONCLUSIONS

The frequency of hand dermatitis increased among nurses during the pandemic. The increased frequency of handwashing during the pandemic poses a risk for hand dermatitis among nurses, although this should not discourage nurses from appropriate hygiene.
Evaluating Leadership Behaviors and Patient Safety Competencies During a Timed Multiple-Patient Simulation
Authors: Darby Wendy , DeFoor Melissa , Brown Neysa , Kirkman Tera
Published: July 2021

A digital count-up clock was incorporated into a multiple-patient simulation that required nursing students to respond to laboratory values and administer medications in a timely fashion. This study utilized observational methodology to analyze student response times and leadership behaviors. Results indicated a count-up clock can be utilized to assess attainment of patient safety competencies. Leadership behaviors observed included time management and collaboration. Utilization of the count-up clock enabled faculty to determine that quality and safety measures were being achieved. This pilot study sets precedence for more rigorous research to measure nursing student competencies where time matters.
Entrustment Decision Making in the Core Entrustable Professional Activities: Results of a Multi-Institutional Study
Authors: Brown David R. , Moeller Jeremy J. , Grbic Douglas , Biskobing Diane M. , Crowe Ruth , Cutrer William B. , Green Michael L. , Obeso Vivian T. , Wagner Dianne P. , Warren Jamie B. , Yingling Sandra L. , Andriole Dorothy A.
Published: July 2021

Purpose

In 2014, the Association of American Medical Colleges defined 13 Core Entrustable Professional Activities (EPAs) that all graduating students should be ready to do with indirect supervision upon entering residency and commissioned a 10-school, 5-year pilot to test implementing the Core EPAs framework. In 2019, pilot schools convened trained entrustment groups (TEGs) to review assessment data and render theoretical summative entrustment decisions for class of 2019 graduates. Results were examined to determine the extent to which entrustment decisions could be made and the nature of these decisions.

Method

For each EPA considered (4–13 per student), TEGs recorded an entrustment determination (ready, progressing but not yet ready, evidence against student progressing, could not make a decision); confidence in that determination (none, low, moderate, high); and the number of workplace-based assessments (WBAs) considered (0–>15) per determination. These individual student-level data were de-identified and merged into a multischool database; chi-square analysis tested the significance of associations between variables.

Results

The 2,415 EPA-specific determinations (for 349 students by 4 participating schools) resulted in a decision of ready (n = 997/2,415; 41.3%), progressing but not yet ready (n = 558/2,415; 23.1%), or evidence against student progression (n = 175/2,415; 7.2%). No decision could be made for the remaining 28.4% (685/2,415), generally for lack of data. Entrustment determinations’ distribution varied across EPAs (chi-square P < .001) and, for 10/13 EPAs, WBA availability was associated with making (vs not making) entrustment decisions (each chi-square P < .05).

Conclusions

TEGs were able to make many decisions about readiness for indirect supervision; yet less than half of determinations resulted in a decision of readiness to perform this EPA with indirect supervision. More work is needed at the 10 schools to enable authentic summative entrustment in the Core EPAs framework.
Nonpharmacologic Pain Management Among Hospitalized Inpatients
Authors: Powers Mark B. , Carl Emily , Levihn-Coon Andrew , Van Veldhuizen Melissa , Caven Andrew , Pogue Jamie , Fresnedo Michelle , Turner Emma D. , Adams Maris , Leonard Kiara , Conroy Haley , Lantrip Crystal , Caven Thomas , Isbell Claire , Regner Justin , Garmon Emily , Foreman Michael , Miller Wayne , Fares Lorie A. , Carlbring Per , Otto Michael W. , Weiss Daniel N. , Hughes James , Bernhardt Jay M. , Roy Rob , Oh Jeeyun , Copt Ryan , MacClements Jonathan , Warren Ann M. , Rosenfield Benjamin , Rosenfield David , Minns Sean , Telch Michael J. , Smits Jasper A.J.
Published: July 2021

Objectives:

Nonpharmacologic pain management strategies are needed because of the growing opioid epidemic. While studies have examined the efficacy of virtual reality (VR) for pain reduction, there is little research in adult inpatient settings, and no studies comparing the relative efficacy of standard animated computer-generated imagery (CGI) VR to Video Capture VR (360 degrees 3D/stereoscopic Video Capture VR). Here, we report on a randomized controlled trial of the relative efficacy of standard CGI VR versus Video Capture VR (matched for content) and also compared the overall efficacy of VR to a waitlist control group.

Materials and Methods:

Participants (N=103 hospitalized inpatients reporting pain) were randomized to 1 of 3 conditions: (1) waitlist control, (2) CGI VR, or (3) Video Capture VR. The VR and waitlist conditions were 10 minutes in length. Outcomes were assessed pretreatment, post-treatment, and after a brief follow-up.

Results:

Consistent with hypotheses, both VR conditions reduced pain significantly more relative to the waitlist control condition (d=1.60, P<0.001) and pain reductions were largely maintained at the brief follow-up assessment. Both VR conditions reduced pain by ∼50% and led to improvements in mood, anxiety, and relaxation. Contrary to prediction, the Video Capture VR condition was not significantly more effective at reducing pain relative to the CGI VR condition (d=0.25, P=0.216). However, as expected, patients randomized to the Video Capture VR rated their experience as more positive and realistic (d=0.78, P=0.002).

Discussion:

Video Capture VR was as effective as CGI VR for pain reduction and was rated as more realistic.
Pain Catastrophizing Throughout the Perioperative Period in Adolescents With Idiopathic Scoliosis
Authors: Chabot Bianca , Sweatman Hilary , Ocay Don D. , Premachandran Shajenth , Roy Mathieu , Ferland Catherine E.
Published: July 2021

Objectives:

Pain catastrophizing in children and adolescents has been associated to unfavorable postsurgical outcomes. However, pain catastrophizing is rarely measured throughout the perioperative period. Using a prospective longitudinal approach, the present study aimed to identify how pain catastrophizing changes over the perioperative period in pediatric surgical patients with adolescent idiopathic scoliosis.

Materials and Methods:

Adolescent patients undergoing spinal fusion surgery completed the Pain Catastrophizing Scale for Children and additional questionnaires to assess pain intensity, state and trait anxiety, and kinesiophobia before surgery, and 1, 2, 5 days, 6 weeks, and 6 months after surgery.

Results:

Patients who had higher levels of pain catastrophizing before surgery were more likely to be anxious, avoid activity that may cause pain, report higher pain intensity before surgery and anticipate more pain after surgery. Low pain catastrophizers increased into a moderate level of pain catastrophizing before decreasing after discharge from the hospital. Meanwhile, moderate and high pain catastrophizers both decreased into lower and moderate levels of catastrophizing, respectively, after discharge from the hospital.

Discussion:

These findings demonstrate that pain catastrophizing in adolescents changes over the perioperative period. Observing changes in pain catastrophizing throughout the perioperative period may help in recognizing when patients are most vulnerable during this time. Decreasing pain catastrophizing before surgery or in the acute postoperative period through therapies that target pain catastrophizing may help reduce the patient’s likelihood of experiencing unfavorable postoperative outcomes.
Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain
Authors: Cohen Steven P. , Greuber Emileigh , Vought Kip , Lissin Dmitri
Published: July 2021

Objective:

Epidural steroid injections (ESIs) are a commonly utilized treatment for lumbosacral radicular pain caused by intervertebral disc herniation or stenosis. Although effective in certain patient populations, ESIs have been associated with serious complications, including paralysis and death. In 2014, the US Food and Drug Administration (FDA) issued a safety warning on the risk of injecting corticosteroids into the epidural space. The aims of this article were to review the neurological complications associated with ESIs and to compare the formulations, safety, and effectiveness of commercially available corticosteroids given by transforaminal, interlaminar, or caudal injection.

Methods:

Serious adverse events associated with ESIs were identified by a search of the FDA Adverse Event Reporting System (FAERS) database. A MEDLINE search of the literature was conducted to identify clinical trials comparing the safety and effectiveness of nonparticulate and particulate corticosteroid formulations.

Results:

Neurological complications with ESIs were rare and more often associated with the use of particulate corticosteroids administered by transforaminal injection. Among the 10 comparative-effectiveness studies reviewed, 7 found nonparticulate steroids had comparable efficacy to particulate steroids, and 3 studies suggested reduced efficacy or shorter duration of effect for nonparticulate steroids.

Discussion:

The risk of complications for transforaminal ESI is greater with particulate corticosteroids. Nonparticulate corticosteroids, which are often recommended as first-line therapy, may have a short duration of effect, and many commercial formulations contain neurotoxic preservatives. The safety profile of ESIs may continue to improve with the development of safer, sterile formulations that reduce the risk of complications while maintaining efficacy.
Clinical Effectiveness of an Outpatient Multidisciplinary Chronic Pain Management Telementoring Service
Authors: Gersch William D. , Delate Thomas , Bergquist Karly M. , Smith Karen
Published: July 2021

Objective:

The objective of this study was to assess the effectiveness of a Pain E-Consult Program (PEP), a multidisciplinary telementoring service based on the Extension for Community Healthcare Outcomes (ECHO) model to reduce opioid use in the outpatient setting.

Materials and Methods:

This was a retrospective matched cohort study conducted in an integrated health care delivery system. Adult patients without cancer and with a 90-day morphine milligram equivalent (MME) ≥30 mg/d between April 1, 2016, and June 30, 2017, were included. Patients whose primary care clinician received the PEP (observation) were compared with usual care (control) patients. Observation patients were matched up to 1:5 to control patients. Outcomes included change in MME and initiation of nonopioid alternative medications. Multivariable regression analyses were performed.

Results:

A total of 665 patients were matched: 125 and 540 in the observation and control groups, respectively. Patients were primarily female, white, and Medicare beneficiaries. The observation group had a statistically significantly greater decrease in median MME/day during the 6-month (−7.4 vs. 1.5 mg, P=0.002) and 12-month (−15.1 vs. −2.8 mg, P<0.001) follow-up and rates of ≥20% decrease (6 mo: 41.6% vs. 24.6%, P=0.003; 12 mo: 48.0% vs. 32.6%, P=0.017). There were no differences in the rates of initiation of nonopioid alternative medications.

Conclusions:

A PEP was associated with greater reductions in MME/day compared with usual care despite similar rates of nonopioid alternative medication initiation. A prospective randomized study of this program should be undertaken to confirm these findings.
A Teacher Affects Eternity; He Can Never Tell Where His Influence Stops: A Reassessment of the Contributions of Barney Brooks, A Consummate Educator
Authors: Merrill Walter H.
Published: July 2021

Barney Brooks, MD, was the first Professor of Surgery in the newly reconstituted Vanderbilt University School of Medicine in 1925, a position he held until 1951. He was born on the remote plains of Texas and came from obscure beginnings, but through much hard work and determination, he rose to occupy a position of prominence and was a leader in surgery of national scope. Of his major contributions, he considered teaching to be of the utmost importance, and it was for his efforts in teaching that he was most widely known. His reputation as a stern taskmaster was well deserved, but there are other aspects of this most complex man that bear a closer look. An examination of his archived correspondence is revealing, and it shows him to have been a caring and compassionate individual who formed lasting bonds with medical students and residents, members of his faculty, and others. Thus, his life and contributions to surgery and surgical education should be remembered and celebrated.
Is severe COVID-19 a cytokine storm syndrome: a hyperinflammatory debate
Authors: Mehta Puja , Fajgenbaum David C.
Published: July 2021

Purpose of review

The COVID-19 pandemic is a global public health crisis with considerable mortality and morbidity. A role for cytokine storm and therapeutic immunomodulation in a subgroup of patients with severe COVID-19 was proposed early in the pandemic. The concept of cytokine storm in COVID-19 has been criticised, given the lack of clear definition and relatively modest cytokinaemia (which may be necessary for viral clearance) compared with acute respiratory distress syndrome and bacterial sepsis. Here we consider the arguments for and against the concept of cytokine storm in COVID-19.

Recent findings

Several criteria have been proposed to identify the subgroup of COVID-19 patients exhibiting a cytokine storm. The beneficial effects of corticosteroids and interleukin-6 inhibition suggest that inflammation is a modifiable pathogenic component of severe COVID-19. The presence of genetic polymorphisms and pathogenic auto-autoantibodies in severe COVID-19 also suggests a significant contribution of immune dysregulation to poor outcomes.

Hyperinflammation is a key component of severe COVID-19, residing underneath the cytokine storm umbrella term, associated with poor outcomes. Better understanding of the aetiopathogenesis, with identification of biomarkers to predict treatment responses and prognosis, will hopefully enable a stratified and ultimately precision medicine approach.
Analysis of Factors Associated with Return-to-Work After Lumbar Surgery up to 2-Years Follow-up
Authors: Macki Mohamed , Anand Sharath Kumar , Hamilton Travis , Lim Seokchun , Mansour Tarek , Bazydlo Michael , Schultz Lonni , Abdulhak Muwaffak M. , Khalil Jad G. , Park Paul , Aleem Ilyas , Easton Richard , Schwalb Jason M. , Nerenz David , Chang Victor
Published: July 2021

Study Design.

Michigan Spine Surgery Improvement Collaborative (MSSIC) prospectively collects data on all patients undergoing operations for degenerative and/or deformity indications.

Objective.

We aimed to identify which factors are significantly associated with return-to-work after lumbar surgery at long-term follow-up.

Summary of Background Data.

Prior publications have created a clinically relevant predictive model for return-to-work, wherein education, gender, race, comorbidities, and preoperative symptoms increased likelihood of return-to-work at 3 months after lumbar surgery. We sought to determine if these trends 1) persisted at 1 year and 2 years postoperatively; or 2) differed among preoperatively employed versus unemployed patients.

Methods.

MSSIC was queried for all patients undergoing lumbar operations (2014–2019). All patients intended to return-to-work postoperatively. Patients were followed for up to 2 years postoperatively. Measures of association were calculated with multivariable generalized estimating equations.

Results.

Return-to-work increased from 63% (3542/5591) at 90 days postoperatively to 75% (3143/4147) at 1 year and 74% (2133/2866) at 2 years postoperatively. Following generalized estimating equations, neither clinical nor surgical variables predicted return-to-work at all three time intervals: 90 days, 1 year, and 2 years postoperatively. Only socioeconomic factors reached statistical significance at all follow-up points. Preoperative employment followed by insurance status had the greatest associations with return-to-work. In a subanalysis of patients who were preoperatively employed, insurance was the only factor with significant associations with return-to-work at all three follow-up intervals. The return-to-work rates among unemployed patients at baseline increased from 29% (455/1100) at 90 days, 44% (495/608) at 1 year, and 46% (366/426) at 2 years postoperatively. The only two significant factors associated with return-to-work at all three follow-up intervals were Medicaid, as compared with private insurance, and male gender.

Conclusion.

In patients inquiring about long-term return-to-work after lumbar surgery, insurance status represents the important determinant of employment status.

Level of Evidence: 2