bluuebunny/crossref_metadata_2025 huggingface dataset:
A Minimal Representation of the Orthosymplectic Lie Supergroup
Authors: Barbier Sigiswald , Frahm Jan
Published: August 2019

We construct a minimal representation of the orthosymplectic Lie supergroup $OSp(p,q|2n)$ for $p+q$ even, generalizing the Schrödinger model of the minimal representation of $O(p,q)$ to the super case. The underlying Lie algebra representation is realized on functions on the minimal orbit inside the Jordan superalgebra associated with $\mathfrak{osp}(p,q|2n)$, so that our construction is in line with the orbit philosophy. Its annihilator is given by a Joseph-like ideal for $\mathfrak{osp}(p,q|2n)$, and therefore the representation is a natural generalization of a minimal representation to the context of Lie superalgebras. We also calculate its Gelfand–Kirillov dimension and construct a nondegenerate sesquilinear form for which the representation is skew-symmetric and which is the analogue of an $L^2$-inner product in the supercase.
MenAfriNet: A Network Supporting Case-Based Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Africa
Authors: Patel Jaymin C , Soeters Heidi M , Diallo Alpha Oumar , Bicaba Brice W , Kadadé Goumbi , Dembélé Assétou Y , Acyl Mahamat A , Nikiema Christelle , Lingani Clement , Hatcher Cynthia , Acosta Anna M , Thomas Jennifer D , Diomande Fabien , Martin Stacey , Clark Thomas A , Mihigo Richard , Hajjeh Rana A , Zilber Catherine H , Aké Flavien , Mbaeyi Sarah A , Wang Xin , Moisi Jennifer C , Ronveaux Olivier , Mwenda Jason M , Novak Ryan T ,   MenAfriNet Consortium
Published: August 2019

Meningococcal meningitis remains a significant public health threat, especially in the African meningitis belt where Neisseria meningitidis serogroup A historically caused large-scale epidemics. With the rollout of a novel meningococcal serogroup A conjugate vaccine (MACV) in the belt, the World Health Organization recommended case-based meningitis surveillance to monitor MACV impact and meningitis epidemiology. In 2014, the MenAfriNet consortium was established to support strategic implementation of case-based meningitis surveillance in 5 key countries: Burkina Faso, Chad, Mali, Niger, and Togo. MenAfriNet aimed to develop a high-quality surveillance network using standardized laboratory and data collection protocols, develop sustainable systems for data management and analysis to monitor MACV impact, and leverage the surveillance platform to perform special studies. We describe the MenAfriNet consortium, its history, strategy, implementation, accomplishments, and challenges.
Personal and Clinical Vaginal Lubricants: Impact on Local Vaginal Microenvironment and Implications for Epithelial Cell Host Response and Barrier Function
Authors: Wilkinson Ellen M , Łaniewski Paweł , Herbst-Kralovetz Melissa M , Brotman Rebecca M
Published: August 2019

Vaginal lubricants are widely used both in-clinic and for personal use. Here, we employed monolayer and 3-dimensional vaginal epithelial cell models to show that select hyperosmolar lubricants induce cytotoxicity, reduce cell viability, and alter barrier and inflammatory targets.
Barcelona Court clarifies level of originality required for an industrial design to obtain cumulative protection under design and copyright law
Authors: Louredo Casado Sara
Published: August 2019

Casa OTS Holding, S.L. and others vs. BD Barcelona 1972, S.L. and others, Judgment 764/2019 of the Provincial Court of Barcelona (section 15th), 26 April 2019

This judgment analyses what level of originality is required for the cumulation of industrial design and copyright protection, and the value that expert reports may have in such assessment.
CJEU permits sampling of phonograms under a de minimis rule and the quotation exception
Authors: Justin Jütte Bernd
Published: August 2019

CJEU, Pelham and Others v Hütter and Others, Case C-476/17, EU:C:2019:624, 29 July 2019

The reproduction of small samples does not infringe the right of phonogram producers under Article 2(c) of Directive 2001/29 if the sample is modified and cannot be recognized. Longer and recognizable samples can only benefit from the quotation exception if they—inter alia—enter into a ‘dialogue’ with the original work.
Gravitational wave emission from unstable accretion discs in tidal disruption events
Authors: Toscani Martina , Lodato Giuseppe , Nealon Rebecca
Published: August 2019

Gravitational waves can be emitted by accretion discs if they undergo instabilities that generate a time varying mass quadrupole. In this work we investigate the gravitational signal generated by a thick accretion disc of 1 M⊙ around a static supermassive black hole of 106 M⊙, assumed to be formed after the tidal disruption of a solar type star. This torus has been shown to be unstable to a global non-axisymmetric hydrodynamic instability, the Papaloizou–Pringle instability, in the case where it is not already accreting and has a weak magnetic field. We start by deriving analytical estimates of the maximum amplitude of the gravitational wave signal, with the aim to establish its detectability by the Laser Interferometer Space Antenna (LISA). Then, we compare these estimates with those obtained through a numerical simulation of the torus, made with a 3D smoothed particle hydrodynamics code. Our numerical analysis shows that the measured strain is two orders of magnitude lower than the maximum value obtained analytically. However, accretion discs affected by the Papaloizou–Pringle instability may still be interesting sources for LISA, if we consider discs generated after deeply penetrating tidal disruptions of main-sequence stars of higher mass.
Revised and updated catalogue of the First Byurakan Survey of Late-Type Stars: second edition
Authors: Gigoyan K S , Mickaelian A M , Kostandyan G R
Published: August 2019

A total of 18 lists of the First Byurakan Survey of Late-Type Stars (FBS LTS) were published between 1990 and 2016. The stars were found on FBS low-dispersion spectroscopic plates. A systematic search and selection were carried out on a surface of ∼16 000 deg2 on almost the whole area of the FBS. As a result, the ‘Revised and Updated Catalogue of the First Byurakan Survey of Late-Type Stars’ was generated (FBS LTS v1; 1045 objects). We present the second version of the catalogue of FBS LTS with new data (FBS LTS v2), comprising 1471 objects. It is a homogeneous and complete data base for high-Galactic-latitude, late-type stars, including M and C types. Since 2007, all FBS low-resolution spectral plates have been digitized. All digitized FBS (DFBS) spectral plates have been analysed with FITSView and SAO Image ds9, and numerous relatively faint LTSs have been discovered. We have performed cross-correlations with DFBS, USNO-B1.0, 2MASS, AllWISE, IRAS PSC/FSC, AKARI, ROSAT BSC/FSC, GCVS, SDSS and added updated SIMBAD data. For numerous new detected objects, we present accurate DSS2 positions, approximate spectral subtypes refined from the DFBS low-dispersion spectra, luminosity classes estimated from 2MASS colours, and available proper motions for 1471 FBS LTSs. The Revised and Updated Catalogue v2 lists a large number of completely new objects, which promises to extend very significantly the census of M giants, faint N-type asymptotic giant branch carbon stars, CH-type carbon giants at high Galactic latitudes, and M dwarfs in the Solar vicinity up to 16.0–17.0 mag in the visual. Some important data from Gaia DR2 and supplementary spectra from the Byurakan Astrophysical Observatory 2.6-m and LAMOST telescopes are presented.
High-velocity outflows in massive post-starburst galaxies at z > 1
Authors: Maltby David T , Almaini Omar , McLure Ross J , Wild Vivienne , Dunlop James , Rowlands Kate , Hartley William G , Hatch Nina A , Socolovsky Miguel , Wilkinson Aaron , Amorin Ricardo , Bradshaw Emma J , Carnall Adam C , Castellano Marco , Cimatti Andrea , Cresci Giovanni , Cullen Fergus , De Barros Stephane , Fontanot Fabio , Garilli Bianca , Koekemoer Anton M , McLeod Derek J , Pentericci Laura , Talia Margherita
Published: August 2019

We investigate the prevalence of galactic-scale outflows in post-starburst (PSB) galaxies at high redshift (1 < z < 1.4), using the deep optical spectra available in the UKIDSS Ultra Deep Survey (UDS). We use a sample of ∼40 spectroscopically confirmed PSBs, recently identified in the UDS field, and perform a stacking analysis in order to analyse the structure of strong interstellar absorption features such as Mg ii (λ2800 Å). We find that for massive ($M_* \gt 10^{10}\rm \, M_{\odot }$) PSBs at z > 1, there is clear evidence for a strong blue-shifted component to the Mg ii absorption feature, indicative of high-velocity outflows ($v_{\rm out}\sim 1150\pm 160\rm \, km\, s^{-1}$) in the interstellar medium. We conclude that such outflows are typical in massive PSBs at this epoch, and potentially represent the residual signature of a feedback process that quenched these galaxies. Using full spectral fitting, we also obtain a typical stellar velocity dispersion σ* for these PSBs of $\sim 200\rm \, km\, s^{-1}$, which confirms they are intrinsically massive in nature (dynamical mass $M_{\rm d}\sim 10^{11}\rm \, M_{\odot }$). Given that these high-z PSBs are also exceptionally compact (re ∼ 1–$2\rm \, kpc$) and spheroidal (Sérsic index n ∼ 3), we propose that the outflowing winds may have been launched during a recent compaction event (e.g. major merger or disc collapse) that triggered either a centralized starburst or active galactic nuclei (AGN) activity. Finally, we find no evidence for AGN signatures in the optical spectra of these PSBs, suggesting they were either quenched by stellar feedback from the starburst itself, or that if AGN feedback is responsible, the AGN episode that triggered quenching does not linger into the post-starburst phase.
Power spectrum of the flux in the Lyman-alpha forest from high-resolution spectra of 87 QSOs
Authors: Day Aaron , Tytler David , Kambalur Bharat
Published: August 2019

We measure and calibrate the power spectrum of the flux in the Ly α forest at 1.8 < z < 4.6 for wavenumbers 0.003 ≤ k ≤ 0.1 s km−1 from the spectra of 87 QSOs obtained with HIRES on the Keck-I telescope. This is the largest sample using high-resolution spectra, yielding the smallest statistical errors, and we have applied calibrations to reduce new systematic errors. We fit Voigt profiles to the damped Ly α absorbers and we remove them. We subtract metal lines statistically based on metal absorption on the red side of the Ly α emission peak. We find that when performing a statistical subtraction of metal lines, a systematic offset due to the blending of metal and hydrogen lines must be taken into account. This offset was not accounted for in previous analyses, and requires up to a $3 {{\ \rm per\ cent}}$ reduction in the BOSS Ly α forest flux power spectrum, increasing the allowed neutrino mass. For the first time in a Ly α forest power spectrum measurement from high-resolution spectra, we correct for spectral leakage by applying Welch’s window function. Our treatment of metal line removal as well as our elimination of errors due to spectral leakage leads to a more accurate measurement of the Ly α forest power spectrum at the smallest scales. We find evidence that previously published values of the power are systematically too high at scales log k ≥ −1.3 (k ≥ 0.05) s km−1, which implies that the intergalactic medium is hotter than previously deduced from the Ly α forest flux power spectrum.
Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, and Carotid Cavernous Fistulas
Authors: Limbucci Nicola , Leone Giuseppe , Renieri Leonardo , Nappini Sergio , Cagnazzo Federico , Laiso Antonio , Muto Mario , Mangiafico Salvatore
Published: August 2019

Flow diverter devices have gained wide acceptance for the treatment of unruptured intracranial aneurysms. Most studies are based on the treatment of large aneurysms harboring on the carotid syphon. However, during the last years the “off-label” use of these stents has widely grown up even if not supported by randomized studies. This review examines the relevant literature concerning “off-label” indications for flow diverter devices, such as for distal aneurysms, bifurcation aneurysms, small aneurysms, recurrent aneurysms, and direct carotid cavernous fistulas.
Mycoviruses in Biological Control: From Basic Research to Field Implementation
Authors: García-Pedrajas M. D. , Cañizares M. C. , Sarmiento-Villamil J. L. , Jacquat A. G. , Dambolena J. S.
Published: August 2019

Mycoviruses from plant pathogens can induce hypovirulence (reduced virulence) in their host fungi and have gained considerable attention as potential biocontrol tools. An increasing number of mycoviruses that induce fungal hypovirulence, from a wide variety of taxonomic groups, are currently being reported. Successful application of these viruses in disease management is greatly dependent on their ability to spread in the natural populations of the pathogen. Mycoviruses generally lack extracellular routes of transmission. Hyphal anastomosis is the main route of horizontal mycovirus transmission to other isolates, and conidia of vertical transmission to the progeny. Transmission efficiencies are influenced by both the fungal host and the infecting virus. Interestingly, artificial transfection methods have shown that potential biocontrol mycoviruses often have the ability to infect a variety of fungi. This expands their possible use to the control of pathogens others than those where they were identified. Mycovirus research is also focused on gaining insights into their complex molecular biology and the molecular bases of fungus−virus interactions. This knowledge could be exploited to manipulate the mycovirus and/or the host and generate combinations with enhanced properties in biological control. Finally, when exploring the use of mycoviruses in field conditions, the pathogen life style and the characteristics of the disease and crops affected will deeply impact the specific challenges to overcome, and the development of biocontrol formulations and delivery methods.
Human muscular mitochondrial fusion in athletes during exercise
Authors: Huertas Jesús R. , Ruiz‐Ojeda Francisco Javier , Plaza‐Díaz Julio , Nordsborg Nikolai B. , Martín‐Albo Jesús , Rueda‐Robles Ascensión , Casuso Rafael A.
Published: August 2019

The main objective of this work was to investigate whether mitochondrial fusion occurs in the skeletal muscle of well‐trained athletes in response to high‐intensity exercise. Well‐trained swimmers (n = 9) performed a duration‐matched sprint interval training (SIT) and high‐intensity high‐volume training (HIHVT) session on separate days. Muscle samples from triceps brachii were taken before, immediately after, and 3 h after the training sessions. Transmission electron microscopy (TEM) was applied to assess mitochondrial morphology. Moreover, expression of genes coding for regulators of mitochondrial fusion and fission were assessed by real‐time quantitative PCR. In addition, mitofusin (MFN)2 and optic atrophy 1 (OPA1) were quantified by Western blot analysis. TEM analyses showed that mitochondrial morphology remained altered for 3 h after HIHVT, whereas SIT‐induced changes were only evident immediately after exercise. Only SIT increased MFN1 and MFN2 mRNA expression, whereas SIT and HIHVT both increased MFN2 protein content 3 h after exercise. Notably, only HIHVT increased OPA1 protein content. Mitochondrial morphologic changes that suggest fusion occurs in well‐adapted athletes during exercise. However, HIHVT appears as a more robust inducer of mitochondrial fusion events than SIT. Indeed, SIT induces a rapid and transient change in mitochondrial morphology.—Huertas, J. R., Ruiz‐Ojeda, F. J., Plaza‐Díaz, J., Nordsborg, N. B., Martín‐Albo, J., Rueda‐Robles, A., Casuso, R. A. Human muscular mitochondrial fusion in athletes during exercise. FASEB J. 33, 12087‐12098 (2019). www.fasebj.org
Alcohol Medical Intervention Clinic: A Rapid Access Addiction Medicine Model Reduces Emergency Department Visits
Authors: Corace Kimberly , Willows Melanie , Schubert Nicholas , Overington Louise , Mattingly Sean , Clark Eric , Leduc Nathaniel , Hutton Brian , Hebert Guy
Published: August 2019

Objectives:

Problematic alcohol use accounts for a large proportion of Emergency Department (ED) visits and revisits. We developed the Alcohol Medical Intervention Clinic (AMIC), a Rapid Access Addiction Medicine (RAAM) service, to reduce alcohol-related ED re-utilization and improve care for individuals with alcohol problems. This article describes the AMIC model and reports on an evaluation of its impact on patients and the ED system.

Methods:

Individuals presenting to The Ottawa Hospital Emergency Departments (TOH-ED) for an alcohol-related issue were referred to AMIC. Using data collected via medical chart review, and also self-report questionnaires, we assessed ED visits, revisits, and changes in alcohol use and mental health symptoms in patients before and after receiving services in AMIC. The incidence of alcohol-related ED visits and re-visits from 12-month periods before and after the introduction of AMIC were compared using data from TOH Data Warehouse. Connections made to additional services and patient satisfaction was also assessed.

Results:

For patients served by AMIC, from May 26, 2016 to June 30, 2017 (n = 194), there was an 82% reduction in 30-day visits and re-visits (P < 0.001). An 8.1% reduction in total alcohol-related 30-day TOH-ED revisit rates and a 10% reduction in total alcohol-related TOH-ED visits were found. After receiving AMIC services, clients reported reductions in alcohol use, depression, and anxiety (P < 0.001).

Conclusions:

AMIC demonstrated positive impacts on patients and the healthcare system. AMIC reduced ED utilization, connected people with community services, and built system capacity to serve people with alcohol problems.
Potential Effects of Regionalized Maternity Care on U.S. Hospitals
Authors: Easter Sarah Rae , Robinson Julian N. , Menard M. Kathryn , Creanga Andreea A. , Xu Xinling , Little Sarah E. , Bateman Brian T.
Published: August 2019

OBJECTIVE:

To examine the current patterns of care for women at high risk for delivery-related morbidity to inform discussions about the feasibility of this regionalized approach.

METHODS:

We performed a cross-sectional study and linked 2014 American Hospital Association survey and State Inpatient Database data from seven representative states. We used American Hospital Association–reported hospital characteristics and State Inpatient Database procedure codes to assign a level of maternal care to each hospital. We then assigned each patient to a minimum required level of maternal care (I–IV) based on maternal comorbidities captured in the State Inpatient Database. Our outcome was delivery at a hospital with an inappropriately low level of maternal care. Comorbidities associated with delivery at an inappropriate hospital were assessed using descriptive statistics.

RESULTS:

The analysis included 845,545 deliveries occurring at 556 hospitals. The majority of women had risk factors appropriate for delivery at level I or II hospitals (85.1% and 12.6%, respectively). A small fraction (2.4%) of women at high risk for maternal morbidity warranted delivery in level III or IV hospitals. The majority (97.6%) of women delivered at a hospital with an appropriate level of maternal care, with only 2.4% of women delivering at a hospital with an inappropriate level of maternal care. However, 43.4% of the 19,988 high-risk patients warranting delivery at level III or IV hospitals delivered at level I or II hospitals. Women with comorbidities likely to benefit from specialized care (eg, maternal cardiac disease, placenta previa with prior uterine surgery) had high rates of delivery at hospitals with an inappropriate level of maternal care (68.2% and 37.7%, respectively).

CONCLUSION:

Though only 2.41% of deliveries occurred at hospitals with an inappropriate level of maternal care, a substantial fraction of women at risk for maternal morbidity delivered at hospitals potentially unequipped with resources to manage their needs. Promoting triage of high-risk patients to hospitals optimized to provide risk-appropriate care may improve maternal outcomes with minimal effect on most deliveries.
Minimally Invasive Hysterectomy and Bariatric Surgery to Improve Endometrial Cancer Survivorship
Authors: Shafa Anousheh , Kumar Amanika , Torres Diogo , McKenzie Travis J.
Published: August 2019

BACKGROUND:

Surgery is curative for the majority of early-stage endometrial cancers. Postoperatively, patients are actually at much higher risk of mortality from obesity-related comorbidities unless they have sustained weight loss.

CASE:

A 54-year-old woman with class III obesity, type II diabetes mellitus complicated by neuropathy and retinopathy, hypertension, sleep apnea, and fatty liver disease was diagnosed with grade 1 endometrioid uterine cancer. She underwent dual surgery with laparoscopic bariatric surgery and robotic-assisted laparoscopic hysterectomy. The perioperative period was uncomplicated, and final pathology was consistent with a stage IA grade 1 endometrial cancer. In 12 months, the patient lost 41.3 kg and required less insulin, metformin, and antihypertensive medication.

CONCLUSION:

Combined minimally invasive hysterectomy and bariatric surgery for obese women with endometrial cancer can promote sustained weight loss and improve survivorship.
Hormonal Contraception and Vaginal Infections Among Couples Who Are Human Immunodeficiency Virus Serodiscordant in Lusaka, Zambia
Authors: Haddad Lisa B. , Wall Kristin M. , Tote Katherine , Kilembe William , Vwailika Bellington , Sharkey Tyronza , Brill Ilene , Chomba Elwyn , Tichacek Amanda , Allen Susan
Published: August 2019

OBJECTIVE:

To examine the relationship between hormonal contraception and vaginal infections with bacterial vaginosis, vaginal candidiasis, or trichomoniasis.

METHODS:

Couples who were human immunodeficiency virus (HIV) serodiscordant in Zambia were enrolled in a longitudinal cohort study. From 1994 to 2002, both partners were seen quarterly and received physical exams including genital examinations. Separate rates for three outcome infections of interest (bacterial vaginosis, vaginal candidiasis, and trichomoniasis) were calculated. Bivariate associations between baseline and time-varying covariates and outcome infections of interest were evaluated using unadjusted Anderson-Gill survival models. Adjusted hazard ratios (aHRs) were generated using multivariable Anderson-Gill survival models that included demographic and clinical factors associated with both hormonal contraceptive use and each infection of interest.

RESULTS:

There were 1,558 cases of bacterial vaginosis, 1,529 cases of vaginal candidiasis, and 574 cases of trichomoniasis over 2,143 person-years of observation. Depot medroxyprogesterone acetate (DMPA) users had significantly lower rates of trichomoniasis and bacterial vaginosis. In adjusted models, DMPA was protective for bacterial vaginosis (aHR=0.72; 95% CI 0.54–0.95), candidiasis (aHR 0.75, 95% CI 0.57–1.00) and trichomoniasis (aHR=0.43, 95% CI 0.25–0.74). Oral contraceptive pills were protective for candidiasis (aHR=0.79, 95% CI 0.65–0.97).

CONCLUSION:

We confirm that DMPA use was associated with reduced rates of the three most common causes of vaginitis, and oral contraceptive pill use was associated with reduced rates of candidiasis among women in couples who were HIV discordant.
Externally Validated Score to Predict Cesarean Delivery After Labor Induction With Cervical Ripening
Authors: Jochum Floriane , Le Ray Camille , Blanc-Petitjean Pauline , Langer Bruno , Meyer Nicolas , Severac François , Sananes Nicolas
Published: August 2019

OBJECTIVE:

To build a score to predict the risk of cesarean delivery after labor induction with cervical ripening, and to compare its predictive capacities with other already existing scores.

METHODS:

This study is a secondary analysis of data collected in the prospective multicenter observational French population-based cohort study Methods of Induction of Labor and Perinatal Outcomes, the primary objective of which was to obtain national data regarding labor induction practices in 94 maternity units. A total of 1,692 patients were randomly split into a derivation data set of 1,024 patients (60%) and an internal validation set of 668 patients (40%). Statistical analyses were performed using a Bayesian approach, allowing the use of priors (ie, previous results published in the literature). The final score is a simplified 50-point score. The score was validated using the internal validation set and an external data set of 4,242 patients from the National Institutes of Health's Consortium for Safe Labor database. We compared the area under the curve (AUC) of our score with two other scores: the modified Bishop score and the Levine score, which is a recently published risk calculator for cesarean delivery after labor induction with unfavorable cervix.

RESULTS:

In the multivariate analysis, height, body mass index, gestational age, parity, dilation, effacement, fetal head station, medical indication, suspicion of macrosomia, premature rupture of membranes and concerning fetal status were found to be strongly associated with cesarean delivery. The AUC in the derivation set and internal validation set were 0.76 (0.73–0.79) and 0.74 (0.70–0.78), respectively. On the external validation set, the AUC for the present score, the Levine score, and the modified Bishop score were 0.81 (0.79–0.82), 0.76 (0.75–0.78), and 0.74 (0.73–0.76), respectively.

CONCLUSION:

Our easy-to-use, externally validated score is efficient in predicting cesarean delivery after labor induction with cervical ripening.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02477085.
Human Papillomavirus Genotyping Compared With a Qualitative High-Risk Human Papillomavirus Test After Treatment of High-Grade Cervical Intraepithelial Neoplasia
Authors: Bottari Fabio , Iacobone Anna D. , Passerini Rita , Preti Eleonora P. , Sandri Maria T. , Cocuzza Clementina E. , Gary Devin S. , Andrews Jeffrey C.
Published: August 2019

OBJECTIVE:

To systematically examine human papillomavirus (HPV) genotyping compared with qualitative high-risk HPV result during follow-up after treatment of high-grade cervical intraepithelial neoplasia (CIN), for risk estimation of posttreatment high-grade CIN.

DATA SOURCES:

MEDLINE, Cochrane, and ClinicalTrials.gov were searched from January 2000 to April 2019 for prospective studies of women and retrospective studies of residual specimens from women, tested using HPV assays with genotype reporting.

METHODS OF STUDY SELECTION:

The primary outcome was posttreatment high-grade CIN after treatment of high-grade CIN. Risk of bias (individual study quality) was evaluated with a modified Newcastle-Ottawa Scale. Overall quality of evidence for the risk estimate outcomes was evaluated using modified GRADE methodology for observational diagnostic studies.

TABULATION, INTEGRATION, AND RESULTS:

Of the 233 identified abstracts, 33 full-text articles were retrieved, and seven studies were included in the synthesis. The risk of bias was deemed to be low. Either a positive qualitative HPV test result or a positive test result for the same genotype that was present pretreatment have a sensitivity for predicting posttreatment high-grade CIN that approaches 100%. However, the positive predictive value (PPV) for the same genotype result pretreatment and posttreatment (median 44.4%) is about double the PPV (median 22.2%) for qualitative HPV results. The PPV of a new HPV infection posttreatment approximates zero. Human papillomavirus genotyping discriminated risk of posttreatment high-grade CIN to a clinically significant degree for women after treatment procedures for high-grade CIN lesions, when same-genotype persistence was compared with new genotype infection.

CONCLUSION:

There is moderately high-quality evidence to support the improved clinical utility of HPV genotyping compared with qualitative HPV positivity to follow-up after treatment of high-grade CIN.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO: CRD42018091095.

FUNDING SOURCE:

Becton, Dickinson and Company, BD Life Sciences—Diagnostic Systems.
Vaginal Hysterectomy Suturing Skills Training Model and Curriculum
Authors: Balgobin Sunil , Owens David M. , Florian-Rodriguez Maria E. , Wai Clifford Y. , McCord Eddie H. , Hamid Cherine A.
Published: August 2019

BACKGROUND:

Declining vaginal hysterectomy numbers in obstetrics and gynecology training programs highlights the need for innovative methods to teach vaginal surgical skills. We describe our experience with a vaginal hysterectomy skills simulation curriculum.

INSTRUMENT:

A low-fidelity bench model was constructed to simulate four vaginal hysterectomy suturing tasks. A polyvinyl chloride downspout adapter and low-cost materials simulate the Heaney pedicle stitch, simple pedicle stitch, double ligature, and continuous running stitch.

EXPERIENCE:

Faculty expert vaginal surgeons established proficiency levels for each task. Resident (N=30) pass rates for tasks 1, 2, and 3 were 1 of 30 (3.3%), 7 of 30 (23.3%), and 4 of 30 (13.3%), respectively, for the left side, and 3 of 30 (10%), 9 of 30 (30%), and 10 of 30 (33.3%), respectively, for the right side. For task 4, the pass rate was 14 of 30 (46.7%). The majority of residents felt that the model simulates the technical skills required for vaginal hysterectomy and agreed that vaginal skills laboratory training would improve their ability to perform procedures in the operating room. Ninety-two percent of residents felt that a vaginal surgery skills curriculum would be a useful addition to their simulation education.

CONCLUSION:

A proficiency-based vaginal hysterectomy skills simulation curriculum using a low-fidelity model may be an important training and evaluation tool for vaginal surgical skills training.
Does Operative Intervention Provide Early Pain Relief for Patients With Unilateral Sacral Fractures and Minimal or No Displacement?
Authors: Tornetta Paul , Lowe Jason A. , Agel Julie , Mullis Brian H. , Jones Clifford B. , Teague David , Kempton Laurence , Brown Krista , Friess Darin , Miller Anna N. , Spitler Clay A. , Kubiak Erik , Gary Joshua L. , Leighton Ross , Morshed Saam , Vallier Heather A.
Published: August 2019

Objectives:

To compare pain after operative versus nonoperative pelvic ring injuries with unilateral sacral fractures.

Design:

Prospective, multicenter, observational.

Setting:

Sixteen trauma centers.

Patients/Participants:

Skeletally mature patients with pelvic ring injury and minimally displaced unilateral zone 1 or 2 sacral fractures and without anteroposterior compression injuries.

Main Outcome Measurements:

Pelvic displacement was documented on injury plain radiographs and computed tomography scans; a 10 point Visual Analog Scale (VAS) was used to evaluate pain was obtained in the anterior and posterior pelvic ring during the time of union (12 weeks).

Results:

One hundred ninety-four patients with unilateral sacral fractures displaced less than 5 mm, mean age of 38.7, and mean Injury Severity Score of 14.5 were included. Ninety-nine percent had lateral compression injuries, and 62% were in zone 1. Seventy-four percent were treated nonoperatively. Nonoperative patients had more zone 1 fractures (71%, P = 0.004). Nonoperative patients reported mean VAS 2.7 points higher in the posterior pelvis (P = 0.01) and 1.9 points higher anteriorly (P = 0.11) 24 hours after injury compared with patients treated operatively. After 3 months, nonoperative patients reported higher VAS scores than operative patients: 4.0 versus 2.9 posteriorly (P = 0.019) and 3.2 versus 2.3 anteriorly (P = 0.035).

Conclusions:

For sacrum fractures with minimal or no displacement, slight differences in the VAS were noted within 24 hours after injury or surgery, but limited differences were seen at 3 months for either operatively treated minimally or undisplaced sacrum fractures. It is unknown whether this represents clinical relevance. These differences were below the minimally important clinical difference for VAS scores for other orthopaedic conditions.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Intramedullary Nails Yield Superior Results Compared With Plate Fixation When Using the Masquelet Technique in the Femur and Tibia
Authors: Morwood Michael P. , Streufert Benjamin D. , Bauer Amy , Olinger Catherine , Tobey Devon , Beebe Michael , Avilucea Frank , Buitrago Andres R. , Collinge Cory , Sanders Roy , Mir Hassan
Published: August 2019

Objectives:

To determine the optimal fixation method [intramedullary nail (IMN) vs. plate fixation (PF)] for treating critical bone defects with the induced membrane technique, also known as the Masquelet technique.

Design:

Retrospective cohort study.

Setting:

Four Level 1 Academic Trauma Centers.

Patients/Participants:

All patients with critical bone defects treated with the induced membrane technique, or Masquelet technique, between January 1, 2005, and January 31, 2018.

Intervention:

Operative treatment with a temporary cement spacer to induce membrane formation, followed by spacer removal and bone grafting at 6–8 weeks.

Main Outcome Measurements:

Time to union, number/reason for reoperations, time to full weight-bearing, and any complications.

Results:

One hundred twenty-one patients (56 tibias and 65 femurs) were treated with a mean follow-up of 22 months (range 12–148 months). IMN was used in 57 patients and plates in 64 patients. Multiple grafting procedures were required in 10.5% (6/57) of those with IMN and 28.1% (18/64) of those with PF (P = 0.015). Reoperation for all causes occurred in 17.5% (10/57) with IMN and 46.9% (30/64) with PF (P = 0.001). Average time to weight-bearing occurred at 2.44 versus 4.63 months for those treated with IMN and plates, respectively (P = 0.002). The multivariable adjusted analysis showed that PF is 6.4 times more likely to require multiple grafting procedures (P = 0.017) and 7.7 times more likely to require reoperation (P = 0.003) for all causes compared with IMN.”

Conclusions:

This is the largest study to date evaluating the Masquelet technique for critical size defects in the femur and tibia. Our results indicate that patients treated with IMN had faster union, fewer grafting procedures, and fewer reoperations for all causes than those treated with plates, with differences more evident in the femur. The authors believe this is a result of both the development of an intramedullary canal and circumferential stress on the graft with early weight-bearing when using an IMN, as opposed to a certain degree of stress shielding and delayed weight-bearing when using PF. We, therefore, recommend the use of an IMN whenever possible as the preferred method of fixation for tibial and femoral defects when using the Masquelet technique.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Implementation of an ICU Recovery Clinic at a Tertiary Care Academic Center
Authors: Bakhru Rita N. , Davidson James F. , Bookstaver Rebeca E. , Kenes Michael T. , Peters Stephen P. , Welborn Kristin G. , Creech Oksana R. , Morris Peter E. , Files D. Clark
Published: August 2019

Objectives:

Post-ICU clinics may facilitate the care of survivors of critical illness, but there is a paucity of data describing post-ICU clinic implementation. We sought to describe implementation of our ICU recovery clinic, including an assessment of barriers and facilitators to clinic attendance.

Design:

Adults admitted to the medical ICU of a large tertiary care academic hospital with shock and/or respiratory failure requiring mechanical ventilation were screened for participation in a newly formed ICU recovery clinic. Participant selection and attendance rates were tracked. Reasons for nonattendance were assessed by phone call in a subset of patients.

Setting:

A newly formed ICU recovery clinic of a large tertiary care academic hospital.

Patients:

All patients admitted to the medical ICU were screened.

Interventions:

ICU recovery clinic appointments were scheduled for all eligible patients. A subset of nonattenders were called to assess reasons for nonattendance.

Measurements and Main Results:

Over 2 years, we admitted 5,510 patients to our medical ICU. Three hundred sixty-two were screened into the recovery clinic. One-hundred sixty-six were not scheduled for clinic; major reasons included discharge to hospice/death in the hospital (n = 55) and discharge to a facility (n = 50). One-hundred ninety-six patients were scheduled for a visit and of those, 101 (52%) arrived to clinic. Reasons for nonattendance in a surveyed subset of nonattenders included patient’s lack of awareness of the appointment (50%, n = 9/18), financial concerns (17%, n = 3/18), and transportation difficulty (17%, n = 3/18).

Conclusions:

ICU recovery clinics may address the needs of survivors of critical illness. Barriers to clinic attendance include high mortality rates, high rates of clinic appointment cancelations and nonattendance, and discharge to locations such as skilled nursing facilities or long-term acute care hospitals. Improved communication to patients about the role of the clinic may facilitate attendance and minimize canceled appointments.
Incidence of Dexmedetomidine Withdrawal in Adult Critically Ill Patients: A Pilot Study
Authors: Bouajram Rima H. , Bhatt Krupa , Croci Rhiannon , Baumgartner Laura , Puntillo Kathleen , Ramsay James , Thompson Ashley
Published: August 2019

Objectives:

To determine the incidence of dexmedetomidine withdrawal in adult critically ill patients.

Design:

This was a prospective, observational study of patients from November 2017 to December 2018.

Setting:

Medical-surgical, cardiothoracic, and neurosurgical ICUs in a tertiary care hospital.

Patients:

Adult critically ill patients on dexmedetomidine infusions for at least 3 days.

Interventions:

Indicators of withdrawal were assessed at baseline and at least daily during the dexmedetomidine wean period. Delirium was assessed using the Confusion Assessment Method for the ICU. Sedation was assessed using the Richmond Agitation-Sedation Scale. The Withdrawal Assessment Tool-1 was performed and vital signs were recorded during each assessment. Patients were considered positive for dexmedetomidine withdrawal if they had two or more of the following symptoms: positive Confusion Assessment Method for the ICU, Richmond Agitation-Sedation Scale greater than +1, positive Withdrawal Assessment Tool-1 assessment, tachycardia (heart rate > 90 beats/min), and hypertension (systolic blood pressure > 140 mm Hg or mean arterial pressure > 90).

Measurements and Main Results:

Forty-two patients were included in the study, with 64% of patients experiencing signs of dexmedetomidine withdrawal. The median time on dexmedetomidine for all patients was 9.6 days (5.8–12.7 d), and the median dose of dexmedetomidine received was 0.8 µg/kg/hr (0.5–1 µg/kg/hr). Of the patients who were positive for withdrawal, the most prevalent withdrawal symptoms observed included delirium, hypertension, and agitation (93%, 48%, and 33%, respectively). We found no correlation between chronic opioid tolerance and incidence of withdrawal symptoms. Peak dexmedetomidine doses greater than 0.8 µg/kg/hr and cumulative daily doses of dexmedetomidine greater than 12.9 µg/kg/d were associated with a higher incidence of withdrawal.

Conclusions:

The majority of patients in our study demonstrated signs that may be indicative of dexmedetomidine withdrawal. Peak and cumulative daily dexmedetomidine dose, rather than duration of therapy, may be associated with a higher incidence of withdrawal signs. Regular screening of patients on prolonged dexmedetomidine infusions is recommended to ensure safe and effective use in critically ill patients.
Triple-Plane Augmentation Mastopexy
Authors: Ismail Karima T. , Ismail Mariam T. , Ismail Taher A. , Ismail Ahmed T. , Toth Bryant A.
Published: August 2019

Background:

Dual-plane augmentation mammaplasty has gained wide popularity in treating breast ptosis. However, in our experience, dual-plane augmentation mastopexy fails to treat severe cases of ptosis (grade 3) and glandular ptosis. Therefore, we conceived a method to manage these cases effectively. The aim was to achieve harmonious, natural fullness, better projection, and appropriate size with limited scarring. We named this technique triple-plane augmentation mastopexy as three planes are used: the first plane is the subfascial plane, the second is the subglandular plane, and the third is the subpectoral plane.

Methods:

A retrospective review was performed of 75 consecutive cases of grade 3 or glandular ptosis treated in a single clinic by three separate surgeons adopting the same technique from January 2010 to January 2017. Triple-plane augmentation mastopexy begins by undermining the breast tissue through a tunnel until the second rib is in the prepectoral plane. Then, the subpectoral pocket for the implant is dissected with release of the lower border of the pectoralis major and avoiding release of the sternal border. Subsequently, the breast tissue is suspended at the lower border of the second rib, followed by subpectoral insertion of the implant and skin envelope excision.

Results:

Surgical follow-up varied from a minimum of 6 months to a maximum of 6 years, with an average of 3 years. Among a total of 75 patients, 64 patients (85.3%) complied with follow-up and 49 (76.5%) of these patients were satisfied. Complications varied from early complications (14.6%) to late complications (21.5%).

Conclusions:

Grade 3 and glandular ptosis represent a challenge to plastic surgeons. Traditional techniques may fail to achieve optimized results. Triple-plane augmentation mastopexy is a safe, reliable procedure that ensures long-term desired aesthetic outcomes with limited scarring.
Direct Comparison of Patient-completed and Physician-completed Caprini Scores for Plastic Surgery Patients
Authors: Veith Jacob , Collier Willem , Rockwell W. Bradford , Pannucci Christopher
Published: August 2019

Background:

We examined the ability of plastic surgery patients to perform their own venous thromboembolism (VTE) risk stratification using a previously validated patient-completed Caprini risk scoring sheet.

Methods:

Patients’ Caprini scores were obtained by an attending physician at an office visit through interview and chart review. Subsequently, patients independently completed a previously validated patient reported scoring sheet. We compared patient and physician reported Caprini scores by each Caprini subquestion and by the overall score. We described discordance of scores using frequencies and proportions, quantified the level of agreement using Cohen’s Kappa coefficient, Spearman’s correlation coefficient, and the Wilcoxon rank-sum test, and visualize scoring differences using Bland–Altman plots, where appropriate.

Results:

We prospectively enrolled 50 patients. Only 24% (n = 12) of patients had exact matches in physician-completed and patient-completed Caprini scores. Among the 76% (n = 38) with discrepancies, 26 received a higher patient-reported score (median = 2 points, range 1–8 points) and 12 received a lower patient-reported score (median = −1.5 points, range −1 to −6 points). Existing venous thromboembolism prophylaxis guidelines support chemical prophylaxis for inpatients with Caprini scores ≥7. Among 38 patients with score discrepancies, 8 (21.1%) would have been incorrectly prescribed chemical prophylaxis and 4 (10.5%) would have been incorrectly denied chemical prophylaxis.

Conclusions:

Plastic surgery patients cannot reliably calculate their own 2005 Caprini scores. Reliance on patient completed scores alone would promote ~25% of patients receiving inappropriate prophylaxis strategies.
A Modified Technique of Transposition of Temporalis Muscle in Selected Cases of Longstanding Facial Paralysis
Authors: Askar Sherif M. , Mohammed Nasser N. , Elibiary Hassan A.
Published: August 2019

The authors present a modified technique of temporalis muscle transposition technique in cases of longstanding facial paralysis. Slips of the temporalis fascia were passed through the tunnels to reach the contralateral para-median plane. The procedure provides 2 point of fixation to the transferred muscle. Local flaps were used for temporal hollow obliteration and for temporalis muscle elongation.

This case series included 11 patients. The modified technique was performed for all patients to reanimate the lower face while gold weight impanation in the upper eye lid was used for re-animation of the eye in 9 patients. By the end of follow up, the procedure was considered successful in 9 patients. Eight patients expressed their satisfaction and 7 patients were happy with the regained facial movement.

The modified temporalis muscle transfer technique might be a valuable option in cases of longstanding facial paralysis. The lips would be camouflaged, non-stretched and would move with the whole mid-face.
Radiographic Assessment of Nasopalatine Canal Using Cone Beam Computed Tomography
Authors: Al-Ghurabi Zainab H. , Al-Bahrani Zainab M.
Published: August 2019

Purpose:

To assess the morphology of nasopalatine canal and to determine the variation of this canal in correlations to age and gender in Iraqi sample using cone beam computed tomography (CBCT).

Materials and methods:

A total of 200 requested CBCT images for nasopalatine canal evaluation before dental implantology at the anterior maxillary region. The morphology of canals was classified into 3 groups in coronal cross-sections. The effects of age and gender were also measured.

Results:

The study comprised 100 males and 100 females with mean age of 30.64 ± 9.46 years. Most of the cases showed Y-shape configuration type III 43.5% followed by type I single canal 35.5%, and type II with 2 parallel canals 21%,

Conclusion:

Due to the wide variation in the morphology of nasopalatine canals, it is highly recommended to perform CBCT evaluation to the anterior maxilla before dental implantology in order to prevent any damage to the neurovascular bundle.
Facial Rejuvenation Using a Mixture of Calcium Hydroxylapatite Filler and Hyaluronic Acid Filler
Authors: Chang Jung Woo , Koo Won Young , Kim Eun-Kyung , Lee Sun Woo , Lee Jang Hyun
Published: August 2019

Calcium hydroxylapatite filler is a popular dermal filler, as it provides long-lasting results. However, it sometimes undergoes unexpected early volume loss, due to rapid gel absorption before neocollagenesis. To compensate for this phenomenon, hyaluronic acid filler was added to calcium hydroxylapatite filler for injection as a mixture. Twenty-five patients who scored 1 or 2 on the Merz 5-point scale for the nasolabial fold and jawline were injected with 3.0 mL of the mixture. The mixture was prepared with 1.0 mL of hyaluronic acid filler, 0.5 mL of lidocaine, and 1.5 mL of calcium hydroxylapatite filler. A visual analog scale (VAS) and the 5-point global satisfaction scale (GSS) were used for objective and subjective assessments. In a subset of patients, for histologic analysis, 0.1 mL of the mixture and 0.1 mL of only calcium hydroxylapatite filler were injected into the right and left postauricular areas, respectively. The histologic analysis was performed 6 months after implantation. The mean VAS and GSS scores for both sets of wrinkles were above “fair” at every follow-up, including at short-term and long-term periods. The skin biopsies from both postauricular areas from selected patients showed increased dermal collagen bundles without inflammation. The mixture of calcium hydroxylapatite filler and hyaluronic acid filler maintained constant volume with high satisfaction, as hyaluronic acid filler compensated for the unexpected early volume loss of calcium hydroxylapatite filler. This procedure can be applied safely, and it is also convenient, because no retouching procedure is needed.