bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictively modelling the distribution of the threatened brush-tailed rock-wallaby (
Authors: Thurtell Lachlan , Rajaratnam Rajanathan , Thomas Piers , Ballard Guy , Bayne Paul , Vernes Karl
Published: September 2021

Abstract Context Species Distribution Models (SDM) can be used to investigate and understand relationships between species occurrence and environmental variables, so as to predict potential distribution. These predictions can facilitate conservation actions and management decisions. Oxley Wild Rivers National Park (OWRNP) is regarded as an important stronghold for the threatened brush-tailed rock-wallaby (Petrogale penicillata), on the basis of the presence of the largest known metapopulation of the species. Adequate knowledge of the species’ ecology and distribution in OWRNP is a key objective in the national recovery plan for the species occurring in the Park. Aims To model distribution using key GIS-derived environmental factors for the brush-tailed rock-wallaby in OWRNP and to ground-truth its presence through field surveys in areas of high habitat suitability. Methods We used Maxent to model the distribution of the brush-tailed rock-wallaby within OWRNP on the basis of 282 occurrence records collected from an online database, elicitation of informal records from experts, helicopter surveys and historic records. Environmental variables used in the analysis were aspect, distance to water, elevation, geology type, slope and vegetation type. Key results Vegetation type (37.9%) was the highest contributing predictor of suitable habitat, whereas aspect (4.8%) contributed the least. The model produced an area under the curve (AUC) of the receiver operating characteristic (ROC) of 0.780. The model was able to discriminate between suitable and non-suitable habitat for brush-tailed rock-wallabies. Areas identified in our model as being highly suitable yielded eight new occurrence records during subsequent ground-truthing field surveys. Conclusions Brush-tailed rock-wallaby distribution in OWRNP is primarily associated with vegetation type, followed by distance to water, elevation, geology, slope and aspect. Field surveys indicated that the model was able to identify areas of high habitat suitability. Implications This model represents the first predicted distribution of brush-tailed rock-wallaby in OWRNP. By identifying areas of high habitat suitability, it can be used to survey and monitor the species in OWRNP, and, thus, contribute to its management and conservation within the Park.
Deep learning identifies synergistic drug combinations for treating COVID-19
Authors: Jin Wengong , Stokes Jonathan M. , Eastman Richard T. , Itkin Zina , Zakharov Alexey V. , Collins James J. , Jaakkola Tommi S. , Barzilay Regina
Published: September 2021

Significance

COVID-19 has caused more than 2.5 million deaths worldwide. It is imperative that we develop therapies that can mitigate the effect of the disease. While searching for individual drugs for this purpose has been met with difficulties, synergistic drug combinations offer a promising alternative. However, the lack of high-quality training data pertaining to drug combinations makes it challenging to use existing machine learning methods for effective novel combination prediction tasks. Our proposed approach addresses this challenge by leveraging additional readily available data, such as drug−target interactions, thus enabling an effective in silico search for synergistic combinations against SARS-CoV-2.
Summative and formative pronunciation assessment in Polish
secondary schools
Authors: Baran-Lucarz Malgorzata
Published: September 2021

This chapter reports on a study verifying the
frequency with which summative (SA) and formative assessment (FA) of
pronunciation is used during EFL courses in secondary schools in
Poland. It also shows aspects of pronunciation students are
typically assessed for and types of tasks chosen by teachers as a
basis for pronunciation assessment provision. Additionally, it
presents students’ opinions on the consequences of the amount and
quality of pronunciation feedback and assessment offered to them
during their secondary school education. The chapter opens with an
overview of SA and FA and the types and roles of assessment in
pronunciation teaching. It closes with several practical
implications related to the use of pronunciation SA and FA, derived
from the reported study.
Corrective feedback and unintelligibility
Authors: Scheuer Sylwia , Horgues Céline
Published: September 2021

This chapter addresses the relative salience of
L2 English pronunciation errors, which may inform teaching
priorities in contexts where learners are consciously oriented
towards a native speaker model. Error salience is considered from
two interrelated viewpoints: errors’ potential for leading to
miscommunication (unintelligibility), and their capacity for
eliciting remedial response from interlocutors (corrective
feedback). Our study, which builds on our previous research into the
two domains, uses the bilingual French-English SITAF tandem corpus.
The analysis of the English conversational data reveals that L2
mispronunciation was the single most important factor leading to
communication breakdowns, whereas vocabulary was most likely to
generate corrective feedback (CF) from native English interlocutors.
Pronunciation-induced miscommunication was principally linked to
suprasegmental features, especially erroneous word stress.
Mobile apps for pronunciation training
Authors: Walesiak Beata
Published: September 2021

This chapter explores adult learners’
perceptions towards using apps for pronunciation training and the
engagement and retention rates of mobile technologies for
pronunciation practice. The study focuses on five apps that address
different areas of pronunciation selected by the teacher-researcher.
The findings show that learners are keen on using pronunciation apps
to learn pronunciation, but the frequency of self-reported mobile
app use and time devoted to their use dwindle without the teacher’s
guidance. A discussion of the learners’ engagement with and
retention of the apps is offered, together with a number of
recommendations to facilitate the integration of apps into
pronunciation instruction.
Educating the animal welfare practitioners of the future.
Authors: Dwyer Cathy , Bacon Heather , Coombs Tamsin , Langford Fritha
Published: September 2021

This chapter discusses the different ethical viewpoints and addresses why people make choices or behave in ways that may not seem rational or appropriate. Understanding science and human decision making, and how behaviour is influenced, are crucial in improving animal welfare. It also describes how animal welfare practitioners must require a scientific understanding of animal wants and needs, and an ability to carry out ethical reasoning and to advocate for animal welfare in legal and policy decisions.
Applying the science of animal welfare to build more responsible food supply chains: reflections from a corporate sustainability professional.
Authors: Motupalli Priya
Published: September 2021

This chapter describes the animal production, welfare conditions, challenges and management improvements of the IKEA Food company in the USA, and the experiences and duties of the author Priya Motupalli while working for the company.
Protecting animals in India: a government perspective through history to the present day.
Authors: Singh Vijay Pal , Khanna Sujoy
Published: September 2021

In this chapter, the authors describe the welfare challenges and opportunities of modern-day India, with a particular focus on street animals and performing animals. They explore how ancient laws and religions have shaped today's society, the government and laws and how these are enforced, and the role of practitioners in India who want to make changes to benefit animal welfare.
Heat has larger impacts on labor in poorer areas
*
Authors: Behrer A P , Park R J , Wagner G , Golja C M , Keith D W
Published: September 2021

Hotter temperature can reduce labor productivity, work hours, and labor income. The effects of heat are likely to be a joint consequence of both exposure and vulnerability. Here we explore the impacts of heat on labor income in the US, using regional wealth as a proxy for vulnerability. We find that one additional day >32 °C (90 °F) lowers annual payroll by 0.04%, equal to 2.1% of average weekly earnings. Accounting for humidity results in slightly more precise estimates. Proxying for wealth with dividend payments we find smaller impacts of heat in counties with higher average wealth. Temperature projections for 2040–50 suggest that earnings impacts may be 95% smaller for US counties in the richest decile relative to the poorest. Considering the within country distribution of vulnerability, in addition to exposure, to climate change could substantially change estimated within-country differences between the rich and poor in income losses from climate change.
SEQEL: a tool for biological sequence manipulation in Emacs
Authors: Xu Zhenjiang Zech , Lu Hui
Published: September 2021

Sequences are arguably the most common biological data. An easy-to-use tool can greatly facilitate daily manipulation and analysis of biological sequences. Here, we present SEQEL, a tool providing a convenient environment for editing, formatting and rendering of DNA, RNA and protein sequences. This is accomplished by extending the commonly used text editor, Emacs, which is available for Windows, Linux and Mac OS.

Availability and Implementation

The unit tested ELISP source code for seqel is freely available from https://github.com/rnaer/seqel along with documentation.

Contact

zhenjiang.xu@gmail.com
Phylogenetic diversity and clustering in modern vegetation communities reflects habitat formation and age during the late Cenozoic in New Zealand
Authors: Heenan Peter B , McCarthy James K , Richardson Sarah J , McGlone Matt S
Published: September 2021

Phylogenetic diversity analyses were used to interpret the timing and assembly of vegetation communities in temperate New Zealand. A data set comprising 1638 permanent vegetation plots provided plant-distributional data, and a plastid rbcL phylogenetic tree provided phylogenetic metrics. Mean crown age, standardized effect size of mean pairwise distance and standardized effect size of mean nearest taxon distance were analysed in relation to taxonomic groups (angiosperms, gymnosperms and pteridophytes), life form (woody angiosperms, non-woody angiosperms) and temperature and precipitation using generalized additive models. Angiosperms in South Island have a younger crown age than those in most North Island sites, and phylogenetic clustering is prevalent throughout. Angiosperms and pteridophytes from drier and cooler open-habitat communities in central and eastern South Island have younger crown ages and phylogenetic clustering compared to wetter and warmer closed-habitat communities of western South Island and North Island, with older crown ages and phylogenetic over-dispersion. Phylogenetic clustering is consistent with species-rich radiations that have diversified into newly available niches during the late Miocene to Plio-Pleistocene. Pteridophytes displayed less phylogenetic relatedness than angiosperms, reflecting their older crown ages. These findings are consistent with a view that northern New Zealand retained older lineages of subtropical origin during glaciations, whereas novel habitats in cool, dry climates in southern New Zealand facilitated more recent radiations. These results emphasize the strong legacy of history in the modern-day composition of plant communities.
Combined thoracic endovascular aortic repair and endovascular aneurysm repair and the long-term consequences of altered cardiovascular haemodynamics on morbidity and mortality: case series and literature review
Authors: Sultan Sherif , Acharya Yogesh , Hazima Mohiey , Salahat Hiba , Parodi Juan Carlos , Hynes Niamh
Published: September 2021

Background

Thoracic and abdominal aortic stent grafts are firmer and more rigid than the native aorta. Aortic implanted devices have been implicated in the development of acute systolic hypertension, elevated pulse pressure, and reduced coronary perfusion.

Case summary

We report four cases of staged thoracic endovascular aortic repair (TEVAR) and then endovascular aneurysm repair (EVAR). All patients had TEVAR first for thoracic aortic aneurysm and later on developed infra-renal abdominal aortic aneurysm (AAA) that required EVAR. There were three males and one female with a median age of 74.5 years (range 67.5–78.5). None of the patients developed aortic-related major clinical adverse effects or required any aortic intervention during their follow-up. However, within 2 years, all patients developed symptomatic left ventricular hypertrophy with diastolic dysfunction. All patients had bilateral lower limb oedema, with on and off chest pain and shortness of breath (SOB), necessitating coronary angiograms, which showed no evidence of coronary artery disease. Three patients died from cardiovascular-related morbidities, and the fourth patient is still complaining of SOB despite a normal coronary angiogram.

Discussion

Aortic-endograft compliance mismatch is an invisible enemy, with troubling consequences for the aorta proximal and distal to the endograft. Aortic stiffness due to vascular endograft could lead to cardiovascular adverse events, even in the absence of direct aortic-related complications. After combined TEVAR and EVAR, the compliance mismatch and elasticity loss are even more pronounced than with TEVAR alone, which necessitates patient monitoring for the development of cardiovascular complications.
A case report of a patient with wide complex tachycardia due to Wolff–Parkinson–White syndrome mimicking ventricular tachycardia
Authors: Preisendörfer Stefan , Hessling Gabriele , Deisenhofer Isabel , Bourier Felix
Published: September 2021

Background

Wide complex tachycardia (WCT) associated with syncope as manifestation of an underlying, life-threatening arrhythmia might potentially be the harbinger of sudden cardiac death. Identifying the aetiology of a WCT is imperative to provide appropriate treatment and prevent recurrence.

Case summary

We report the case of a 22-year-old male who had been experiencing haemodynamically significant WCT leading to syncope at the age of 13 years. As the patient and the family rejected an electrophysiological (EP) study, he had received an implantable cardioverter-defibrillator (ICD) for secondary prevention. After 7 years of experiencing multiple shocks, the patient finally gave consent to an EP study, which identified a left-sided accessory atrioventricular pathway that was successfully ablated during the same procedure.

Discussion

The differential diagnosis of WCT might be challenging and includes both ventricular and supraventricular tachycardias. In young patients without structural heart disease experiencing WCT, an EP study should be offered before ICD implantation to make a final diagnosis with the potential to provide definitive treatment.
Associations between health indicators and sleep duration of American adults: NHANES 2011–16
Authors: You Yueyue , Luo Jie , Elstgeest L E M , Zhang Yujian , Tan Siok Swan , Raat Hein
Published: September 2021

Background

This study aimed to investigate associations between health indicators and sleep duration in the general population.

Methods

This cross-sectional data from the National Health and Nutrition Examination Survey. Self-reported sleep duration was classified into short sleep (<7 h/day), regular sleep (7–8 h/day) and long sleep duration (>8 h/day). Health indicators included lifestyle indicators (smoking, alcohol use and physical inactivity), general health indicators (waist circumference and self-reported health condition) and chronic conditions [overweight/obesity, hypertension, diabetes, high cholesterol, chronic low back pain (CLBP) and oral health problems]. A series of multinomial logistic regression analysis were performed, controlling for confounders (age, sex, marital status, ethnic background, education level and poverty-to-income ratio).

Results

Data of 12 835 participants were analyzed. The mean (SD) age of participants was 50.0 (±17.4) years, and 50.6% were women. After adjusting for all health indicators, current smoking (OR: 1.37; 95% CI: 1.17–1.61), a poor (OR: 1.52; 95% CI: 1.23–1.88) health condition, CLBP (OR: 1.40; 95% CI: 1.16–1.69) and oral health problems (OR: 1.28; 95% CI: 1.10–1.49) were associated with short sleep duration. No independent association with long sleep duration was observed in this study.

Conclusions

The results confirm that lifestyle indicators (current smoking and physical inactivity), general health indicators (self-reported health condition) and presence of some chronic conditions (CLBP and oral health problems) are associated with short sleep duration. The results did not confirm that any health indicator was associated with long sleep duration.
Mechanisms and clinical importance of bacteriophage resistance
Authors: Egido Julia E , Costa Ana Rita , Aparicio-Maldonado Cristian , Haas Pieter-Jan , Brouns Stan J J
Published: September 2021

We are in the midst of a golden age of uncovering defense systems against bacteriophages. Apart from the fundamental interest in these defense systems, and revolutionary applications that have been derived from them (e.g. CRISPR-Cas9 and restriction endonucleases), it is unknown how defense systems contribute to resistance formation against bacteriophages in clinical settings. Bacteriophages are now being reconsidered as therapeutic agents against bacterial infections due the emergence of multidrug resistance. However, bacteriophage resistance through defense systems and other means could hinder the development of successful phage-based therapies. Here, we review the current state of the field of bacteriophage defense, highlight the relevance of bacteriophage defense for potential clinical use of bacteriophages as therapeutic agents and suggest new directions of research.
Free French francs? Wartime monetary sovereignty (1940–1944)
Authors: Foulk David A
Published: September 2021

This article asks whether the concept of ‘monetary sovereignty’ can be applied to General Charles de Gaulle’s Free French movement during the Second World War. It explains the creation of the Caisse centrale de la France libre, the Free French semi-central bank, and the role of its personnel, alongside those of the Bank of England and HM Treasury. Using social network analysis, the role of important intermediaries, including John Lithiby and Allen Bartholomew of the Bank of England, comes to the fore. The article demonstrates the importance of international relations to the economic situation of the territories rallied to the Free French. The part played by the Free French delegations in helping to fund the movement is also underlined. Ultimately, the Free French were far from being monetarily sovereign during this period, but retained limited aspects of economic independence, nonetheless.
Jesting culture and religious politics in seventeenth-century England
Authors: Somers Tim
Published: September 2021

This article argues that jestbooks performed important functions within seventeenth-century religious politics. These functions were distinct from the ‘biting’ polemic and satire that more often catches the eyes of scholars. The article identifies ubiquitous ‘popular jests’ and discusses how jesting opened up space to engage playfully with controversial topics. In doing so, it challenges the historiographical dominance of the ‘superiority theory’ of laughter and the othering of dissenters and Catholics. The second section discusses jesting in relation to tension in the 1630s, while the final section discusses royalism, humorous manuscript chronicling and the way jesting shaped the memory of the civil wars.
On desingularization of steady vortex for the lake equations
Authors: Cao Daomin , Zhan Weicheng , Zou Changjun
Published: September 2021

In this paper, we constructed a family of steady vortex solutions for the lake equations with a general vorticity function, which constitutes a desingularization of a singular vortex. The precise localization of the asymptotic singular vortex is shown to be the deepest position of the lake. We also study global nonlinear stability for these solutions. Some qualitative and asymptotic properties are also established.
The Role of Phage Therapy in Burn Wound Infections Management: Advantages and Pitfalls
Authors: Azevedo Maria Manuel , Pina-Vaz Cidália , Rodrigues Acácio G
Published: September 2021

Burn wound infections are often the source of bacteria responsible for systemic infections, including bloodstream infections and pneumonia that ultimately can result in multisystem organ failure and death. Any rapid change in the burn wound appearance or the clinical condition of the burn patient may herald burn wound infection or sepsis. The revival of phage therapy, either in single mode or in combination with conventional antibiotics may represent a valuable alternative, to treat specific bacterial infections such as burn wound infections, including those caused by multidrug-resistant organisms. This systematic review addresses the: 1) general characteristics of bacteriophages; 2) activity of bacteriophages vs conventional antibiotics; 3) activity of bacteriophages against biofilms; 4) bacteriophage administration; and 5) use of bacteriophages in burn wound infections. Although several scientific organizations/societies recognized that phage therapy could be of key value in modern wound care, specific aspects are critical for a burn surgeon and might represent pitfalls discouraging phage therapy adoption in burn wound management; in particular, the unavailability of consensual therapeutic guidelines/regulatory policies and the lack of laboratorial support that might be predictive of its efficacy. The availability of a product/formulation convenient to use, with adequate stability and shelf half-life is also a key condition.
Patterns and Outcomes of High-Voltage vs Low-Voltage Pediatric Electrical Injuries: An 8-Year Retrospective Analysis of a Tertiary-Level Burn Center
Authors: Gurbuz Kayhan , Demir Mete
Published: September 2021

Although electrical injuries (EIs) are rare traumas in the pediatric age group, they are considered one of the most devastating injuries. We aimed to evaluate the patterns and outcomes of pediatric high-voltage injuries (HVIs) vs low-voltage injuries (LVIs), admitted to the burn center within the efforts of determining evidence-based data for contributing to burn prevention strategies. A retrospective study was conducted on children with EIs hospitalized in the Burn Center of Adana City Training and Research Hospital for 8 years (2013–2020). Data including the patients’ clinical and demographic characteristics, the percentage of total body surface area with burns (%TBSA), length of hospital stay, exposure place, electrical current type, and treatment results were collected and analyzed. EIs were detected in 57 (2.5%) of 2243 acute pediatric burn injury admissions. EIs were most frequently observed in the form of HVIs, among children within the age range of 13 to 18 years, mostly in residential outdoor environments, where the high-power lines still passing close to the home roofs and balconies, resulting from contact with them. Besides, to a lesser extent in LVIs, in the home environment among children younger than 5 years, which was caused by connection with substandard electrical cords/poor-quality electrical devices and inserting an object into the electric sockets. Concerning the mean of %TBSA, HVIs suffered more extensive burns than LVIs. The most frequently affected anatomical regions among HVIs and LVIs were the upper limb, followed by the lower limb. While superficial partial- and deep partial-thickness burns were significantly more common among the LVIs, full-thickness burns were more prevalent among the HVIs. The amputation rate was 12% of which only one of them was major amputation (forearm above the elbow joint). HVIs had more elevated creatine kinase (CK) and CK-myocardial band (CK-MB) levels than LVIs but were not correlated with electrocardiography findings. Only one death (caused by HVI) was observed, with a mortality rate of 1.8%. Pediatric EIs are less common than scald or fire flame-related burns in this age group but can cause significant morbidity and even mortality, especially in severe burns. It is possible to prevent possible morbidity and mortality by strengthening compliance with safety precautions, especially with parental education and raising social awareness. In this context, taking necessary precautions for passing high-voltage power lines under the ground, the standardization of electrical cables by the relevant legal regulations, the use of socket covers in homes, promoting the widespread use of residual current relays, and arrangements to be taken against the use of illegal electricity are among measures for the prevention strategy.
Refiguring the Poetic Elegy in Music: The Rhetoric of Mourning in Parry’s Elegy for Brahms
Authors: Allis Michael
Published: September 2021

Of Hubert Parry’s relatively neglected works, his Elegy for Brahms for orchestra (1897) is particularly intriguing. Written to mark Brahms’s death, it was not premiered until Parry’s own memorial concert in 1918. After contextualizing the work in terms of Parry’s clear admiration for Brahms and highlighting significant British orchestral elegies at the turn of the twentieth century, this article suggests how studies of the poetic elegy can be used as a hermeneutic tool to identify a musico-rhetorical structure at the heart of Parry’s composition. Specifically, elegiac conventions and devices identified by Peter Sacks as significant features of poetic models (including the use of repetition, elegiac questioning, processional, the division of mourning voices, and the issue of fame and inheritance) can be identified in Parry’s musical design. This interdisciplinary approach not only creates a distinctive new reading of Parry’s Elegy, but has wider implications for elegiac music in general.
Tissue Engineering and Regenerative Medicine Cranioplasty Using Polycaprolactone-Tricalcium Phosphate: Management and Treatment Outcomes
Authors: Hwang Kihwan , Villavicencio Jay B , Agdamag Anna May P
Published: September 2021

BACKGROUND

Cranioplasty is a procedure commonly performed as the next step in management for patients with decompressive craniectomy. It is commonly associated with complications that might result in implant failure and reoperation. Tissue engineering and regenerative medicine (TERM) involve the development of biological substitutes that restore tissue function and regrow and replace damaged tissues. TERM is a potential solution that might allow for improved long-term outcomes in cranioplasty.

OBJECTIVE

To present a case series that describes the management and treatment outcomes of using TERM in cranioplasty, using polycaprolactone-tricalcium phosphate (PCL-TCP) implants in 2 patients.

METHODS

In 2 young adults, large bone defects of the skull following decompressive craniectomy were reconstructed using patient-specific implants manufactured from PCL-TCP. Bone marrow aspirate was used as autologous biologic that incorporates stem cell and growth factors into the implant.

RESULTS

Both patients recovered without any complications following surgery. Physical examination shows favorable healing outcomes with the defect area having a hard texture upon palpation. Postoperative imaging performed at 8 and 20 months for each patient, respectively, demonstrated ossification over the defect area.

CONCLUSION

Satisfactory bone growth is seen with TERM cranioplasty. The PCL-TCP implant is a novel and recommendable alternative to currently available patient-specific implants used in cranioplasty. TERM cranioplasty is the potential solution to the quest of finding the ideal cranioplasty implant.
A Pragmatic Approach to Adverse Outcome Pathway Development and Evaluation
Authors: Svingen Terje , Villeneuve Daniel L , Knapen Dries , Panagiotou Eleftheria Maria , Draskau Monica Kam , Damdimopoulou Pauliina , O’Brien Jason M
Published: September 2021

The adverse outcome pathway (AOP) framework provides a practical means for organizing scientific knowledge that can be used to infer cause-effect relationships between stressor events and toxicity outcomes in intact organisms. It has reached wide acceptance as a tool to aid chemical safety assessment and regulatory toxicology by supporting a systematic way of predicting adverse health outcomes based on accumulated mechanistic knowledge. A major challenge for broader application of the AOP concept in regulatory toxicology, however, has been developing robust AOPs to a level where they are peer reviewed and accepted. This is because the amount of work required to substantiate the modular units of a complete AOP is considerable, to the point where it can take years from start to finish. To help alleviate this bottleneck, we propose a more pragmatic approach to AOP development whereby the focus becomes on smaller blocks. First, we argue that the key event relationship (KER) should be formally recognized as the core building block of knowledge assembly within the AOP knowledge base (AOP-KB), albeit framing them within full AOPs to ensure regulatory utility. Second, we argue that KERs should be developed using systematic review approaches, but only in cases where the underlying concept does not build on what is considered canonical knowledge. In cases where knowledge is considered canonical, rigorous systematic review approaches should not be required. It is our hope that these approaches will contribute to increasing the pace at which the AOP-KB is populated with AOPs with utility for chemical safety assessors and regulators.
Response of Xanthomonas citri pv. malvacearum Isolates to Cotton Differing in Susceptibility to the Bacterium and Their Predicted Type III Effectors
Authors: Wheeler Terry A. , Harris Taylor , Bart Rebecca S. , Isakeit Thomas , Woodward Jason , Allen Tom W. , Kemerait Robert C.
Published: September 2021

From 2015 to 2020, 342 isolates of Xanthomonas citri pv. malvacearum (Xcm) were obtained from cotton fields in Texas, including 64 isolates collected from symptomatic cultivars that were thought to be resistant to race 18 strains of Xcm (the predominant race in the United States). Symptoms on highly resistant cultivars prompted concern that a new race of Xcm was present. The 342 isolates were inoculated on a race 18 susceptible (DP 1747NR B2XF) and race 18 resistant (S295) cotton cultivar, and none of the isolates caused blight-type symptoms (water soaking and chlorosis) on S295, indicating that the B12 resistant gene was still beneficial for disease management. Four cultivars, varying in their field response to bacterial blight, were inoculated with each of 17 isolates of Xcm, and the incidence of plants exhibiting bacterial blight symptoms averaged 87% for DP 1747NR B2XF, 51% for partially susceptible NG 4936 B3XF, 16% for partially resistant DP 1646 B2XF, and 0% for S295. Xcm isolates from Texas (11), Georgia (1), and Oklahoma (1) were sequenced, and their type three effectors (T3Es) were predicted. All isolates (Georgia, Oklahoma, and Texas) had the same T3E proteins as previously identified Xcm race 18 isolates (tested for 25 genes), including XopJ. Race 1, 2, 3, and 12 of Xcm included in the comparisons were all missing the XopJ gene. Use of cultivars with the B12 gene is an effective strategy to manage bacterial blight of cotton.
International Medical Graduate Resident Wellness: Examining Qualitative Data From J-1 Visa Physician Recipients
Authors: Symes Hilary A. , Boulet John , Yaghmour Nicholas A. , Wallowicz Tracy , McKinley Danette Waller
Published: September 2021

Purpose

International medical graduates (IMGs), approximately 25% of the U.S. physician workforce, have unique needs as they enter residency programs. This study identified wellness barriers and challenges that IMGs encounter as they transition to the United States.

Method

The authors analyzed results from 3 open-ended questions in a 21-item survey. This survey was administered in December 2019 to 11,504 IMG resident physicians sponsored by the Educational Commission for Foreign Medical Graduates’ J-1 visa program. These questions asked respondents to describe challenges to their wellness, how they maintain wellness, and resources that would have aided their transition. Data were analyzed using a mixed-methods approach, including both qualitative descriptions and category frequencies.

Results

Of the surveys administered, 7,817 responses (68% response rate) were received. Respondents identified challenges navigating cultural differences (1,314, 17%), health care system (1,108, 14%), distance from family and friends (890, 11%), bureaucratic barriers (724, 9%), and language/communication and finances (575, 7%; 565, 7%, respectively). They also specified that friendships/relationships (2,800, 36%) followed by exercise (2,318, 30%), family (1,822, 23%), socialization (1,001, 13%), and healthy eating (775, 10%) were factors important to their wellness. Respondents requested more information about socialization (741, 9%), bureaucratic support (456, 6%), IMG support networks (427, 5%), financial support (404, 5%), and greater online resources (240, 3%).

Conclusions

IMGs have needs and concerns specific to their demographic group. Participants’ responses suggested that they wanted additional support in the workplace and their personal lives. Answers also indicated that IMGs experienced a unique set of stressors such as fluctuating immigration laws that U.S. medical graduates do not face. Finally, this study supports a body of research that connects social and physical wellness. By identifying and describing these challenges, the authors seek to inform the development of specific programs and resources to improve IMG resident wellness.
Latina Women in the U.S. Physician Workforce: Opportunities in the Pursuit of Health Equity
Authors: Balderas-Medina Anaya Yohualli , Hsu Paul , Martínez Laura E. , Hernandez Stephanie , Hayes-Bautista David E.
Published: September 2021

Purpose

Some progress has been made in gender diversity in undergraduate medical education and the physician workforce, but much remains to be done to improve workforce disparities for women, particularly women from underrepresented populations, such as Latinas. This study examines the current level of representation and demographic characteristics of Latina physicians, including age, language use, nativity, and citizenship status.

Method

The authors used data from the 2014–2018 U.S. Census Bureau’s American Community Survey (ACS) 5-year estimates for their analyses. During the time period covered by this analysis, ACS response rates ranged from 92.0% to 96.7%. The authors included in this study individuals who self-reported their occupation as physician and who self-identified their race/ethnicity as either non-Hispanic White (NHW) or Hispanic/Latino, regardless of race. The authors used person-level sampling weights provided by the ACS to convert the original 1% sample to a 100% enumeration of the population.

Results

According to the ACS 2014–2018 5-year estimates, NHW physicians make up 65.8% (660,031/1,002,527) of physicians in the United States. Women comprise 36.1% (361,442) of the total U.S. physician population; however, Hispanic/Latina women comprise only 2.4% (24,411). The female physician population is younger than the male physician population, and Hispanic female physicians are the youngest. Latina physicians are far more likely to speak Spanish at home than NHW physicians. Immigrants make up 40.1% (9,782/24,411) of the Hispanic female physician population, and 12.3% (3,012/24,411) of Hispanic female physicians are not U.S. citizens.

Conclusions

This study suggests that Latina physicians in the United States are younger, more likely to be bilingual and speak Spanish at home, and very underrepresented, compared with NHW female and male physicians. Increasing their share of the U.S. physician workforce would benefit the pursuit of health equity for an ever more diverse population.
Examining Employment and Employment Barriers Among a Sample of Patients in Medication-Assisted Treatment in the United States
Authors: Ware Orrin D. , Frey Jodi J. , Cloeren Marianne , Mosby Amanda , Imboden Rachel , Bazell Alicia T. , Huffman Margo , Hochheimer Martin , Greenblatt Aaron D. , Sherman Stephan A.
Published: September 2021

Background:

Barriers to employment are a considerable problem for individuals recovering from an opioid use disorder (OUD). Being unemployed while receiving OUD treatment is associated with poorer treatment outcomes.

Objectives:

Apply the biopsychosocial model to examine employment status and the association of barriers to employment among a sample of adults receiving Methadone for OUD.

Materials and Methods:

Administrative data from an east coast midsized urban medication-assisted treatment provider in the United States were obtained from a state database. Univariate analyses were used to describe the sample, and bivariate analyses were used to examine the relationship between employment status and select variables. A logistic regression model was used to predict employment status.

Results:

Sample characteristics include 80.8% unemployed, 63.1% male, 49.6% White, and 65.3% never married. Employment status was significantly associated with past 30-day depression/sadness (χ2
(1)=11.361, P<0.01), past 30-day anxiety/tension (χ2
(1)=8.799, P<0.01), receiving financial support (χ2
(1)=6.550, P<0.05), having a driver’s license (χ2
(1)=12.984, P<0.001) and having a vehicle (χ2
(1)=43.208, P<0.001). The logistic regression model found those with a vehicle were less likely to be unemployed (odds ratio=0.248, P<0.01), while those awaiting a trial/charge were more likely to be unemployed (odds ratio=9.253, P<0.001).

Conclusions:

This study identified potential barriers (ie, psychological, transportation, criminal justice system involvement) from a biopsychosocial framework, associated with employment status among a sample of individuals in Methadone treatment. Identifying employment barriers in this population will help with treatment based clinical interventions.
BRD4 Inhibition Protects Against Myocardial Ischemia/Reperfusion Injury by Suppressing Inflammation and Oxidative Stress Through the PI3K/AKT Signaling Pathway
Authors: Wei Hongwei , Xue Qingjian , Sun Lei , Lv Jie
Published: September 2021

This study aims to investigate the effect and the related mechanisms of bromodomain-containing protein 4 (BRD4) inhibition on myocardial ischemia/reperfusion (I/R) injury. In vivo and in vitro myocardial I/R models were constructed. Expression of BRD4 was examined by RT-qPCR and Western blot. I/R injury was evaluated by analyzing cardiac function and the activity of biochemical markers of myocardial injury. Inflammation and oxidative stress were determined by measuring the levels of myeloperoxidase, TNF-α, IL-6, malondialdehyde, and superoxide dismutase. The activation of the PI3K/AKT signaling pathway was tested by the phosphorylation of p85 and AKT. We found BRD4 was significantly increased in the myocardial tissues after myocardial I/R injury. BRD4 inhibition suppressed the indices of cardiac function and the biochemical markers of myocardial injury. I/R-induced inflammation and oxidative stress were suppressed by shBRD4 in vivo and in vitro. In addition, BRD4 inhibition significantly increased the relative protein expression levels of p-p85, p-AKT T308, and p-AKT S473. In conclusion, this study for the first time demonstrated the protective effect of BRD4 inhibition on myocardial I/R injury in vivo and in vitro, and this effect was related to the suppression of inflammation and oxidative stress through the activation of the PI3K/AKT signaling pathway.
A Tool to Distinguish Viral From Bacterial Pneumonia
Authors: Tagarro Alfredo , Moraleda Cinta , Domínguez-Rodríguez Sara , Rodríguez Mario , Martín María Dolores , Herreros María Luisa , Jensen Julia , López Agustín , Galán Juan Carlos , Otheo Enrique
Published: September 2021

Background:

Establishing the etiology of community-acquired pneumonia (CAP) in children at admission is challenging. Most of the admitted children with CAP receive antibiotics. We aimed to build and validate a diagnostic tool combining clinical, analytical and radiographic features to differentiate viral from bacterial CAP, and among bacterial CAP, typical from atypical bacteria.

Methods:

Design—observational, multi-center, prospective cohort study was conducted in 2 phases. Settings: 24 secondary and tertiary hospitals in Spain. Patients—A total of 495 consecutive hospitalized children between 1 month and 16 years of age with CAP were enrolled. Interventions—A score with 2 sequential steps was built (training set, 70% patients, and validation set 30%). Step 1 differentiates between viral and bacterial CAP and step 2 between typical and atypical bacterial CAP. Optimal cutoff points were selected to maximize specificity setting a high sensitivity (80%). Weights of each variable were calculated with a multivariable logistic regression. Main outcome measures—Viral or bacterial etiology.

Results:

In total, 262 (53%) children (median age: 2 years, 52.3% male) had an etiologic diagnosis. In step 1, bacterial CAPs were classified with a sensitivity = 97%, a specificity = 48%, and a ROC’s area under the curve = 0.81. If a patient with CAP was classified as bacterial, he/she was assessed with step 2. Typical bacteria were classified with a sensitivity = 100%, a specificity = 64% and area under the curve = 0.90. We implemented the score into a mobile app named Pneumonia Etiology Predictor, freely available at usual app stores, that provides the probability of each etiology.

Conclusions:

This 2-steps tool can facilitate the physician’s decision to prescribe antibiotics without compromising patient safety.
Are functional outcomes and reoperation rates really better than those of cementless stems in displaced femoral neck fractures? An updated systematic review and meta-analysis of randomized controlled trials in current-generation stem designs
Authors: Fu Chun-Wei , Ma Hsuan-Hsiao , Liu Yueh-Ching , Lu Yung-Chang , Huang Tung-Fu , Chang Ming-Chau , Chen Wei-Ming
Published: September 2021

Background:

The aim of the study was to conduct a systematic review and meta-analysis to compare the functional outcomes and reoperation rates of cemented and cementless hip arthroplasty for treating displaced femoral neck fractures in elderly patients.

Methods:

Systematic searches were conducted of literature up to December 2018 on PubMed, Embase, Cochrane, and Web of Science for randomized controlled trials (RCTs) concerning current-generation stem designs only. Two reviewers independently determined eligibility, extracted the outcome data and assessed the risk of bias of eligible studies. The follow-up data and complication rates were pooled by using random-effects models and fixed-effects models, with mean differences and risk ratios for continuous and dichotomous variables, respectively.

Results:

Eight RCTs involving 1361 patients (1361 hips) were included in the meta-analysis. Cemented stems were associated with fewer implant-related complications (odds ratio [OR] = 0.303; 95% confidence interval [CI], 0.185%-0.496%; p < 0.001) and reoperations (OR = 0.492; 95% CI, 0.247%-0.977%; p = 0.043). There were no statistically significant differences between groups in functional outcomes, including those assessed by the EuroQol(EQ)-5D and Harris Hip Score, mortality rates, major systemic complications, minor local complications, operation times, intraoperative blood losses, and lengths of hospital stays.

Conclusion:

In treating displaced femoral neck fracture in elderly patients with hip arthroplasty with current-generation stems, cemented stems were found to have fewer implant-related complications and reoperations than those of cementless stems. Functional outcomes and mortality rates were similar between the groups.
Increased incidence of neurogenic bladder after radical hysterectomy for cervical cancer: A nationwide population-based cohort study
Authors: Chou Meng-Han , Meng En , Wu Sheng-Tang , Cha Tai-Lung , Sun Guang-Huan , Yu Dah-Shyong , Chung Chi-Hsiang , Chien Wu-Chien
Published: September 2021

Background:

The effect of radical hysterectomy for patients with cervical cancer on voiding function remains controversial. The purpose of this study was to examine the association between radical hysterectomy for patients with cervical cancer and the odds of developing neurogenic bladder by using data from the National Health Insurance Research Database (NHIRD) in Taiwan.

Methods:

We identified 17 936 patients who underwent radical hysterectomy for cervical cancer between 2000 and 2013 among inpatients registered in the Longitudinal Health Insurance Database in Taiwan. Of the patients, those diagnosed as having cervical cancer without radical hysterectomy were selected and compared as a matched control group. Patients diagnosed as having cervical cancer before the index date, those with neurogenic bladder dysfunction before tracking, and those aged <20 years were excluded. The hazard ratios (HRs) of neurogenic bladder and other variants of interest were further calculated using a multivariate Cox regression analysis. The cutoff p value of <0.05 was regarded as statistically significant.

Results:

The adjusted HR (aHR) of subsequent neurogenic bladder was higher in the hysterectomy group (aHR = 1.205; 95% CI, 1.086-1.440; p = 0.029) than in the control group during the follow-up period. As to the age subgroups, the patients aged 20 to 44 years (aHR = 3.321, p = 0.001) had a significantly increased risk of developing neurogenic bladder after radical hysterectomy as compared with those aged 45 to 64 years (aHR = 1.193, p = 0.012).

Conclusion:

Patients with cervical cancer undergoing radical hysterectomy have an increased risk of neurogenic bladder, which may result from nerve denervation caused by the operation. These patients should be informed of the potential risk of voiding dysfunction during discussion of the subsequent management for cervical cancer.
Effect of epidural analgesia on long-term outcomes after curative surgery for pancreatic cancer: A single-center cohort study in Taiwan
Authors: Lin Kuan-Ju , Hsu Fu-Kai , Shyr Yi-Ming , Ni Yu-Wei , Tsou Mei-Yung , Chang Kuang-Yi
Published: September 2021

Background:

Whether epidural anesthesia and analgesia (EA) improves long-term outcomes after pancreatic cancer surgery remains controversial. We conducted this retrospective cohort study to investigate the influence of EA on cancer recurrence and overall survival after surgery for pancreatic cancer.

Methods:

We conducted an electronic medical chart review of patients with pancreatic cancer who underwent curative resection at our hospital from 2008 to 2017 and were followed up until December 2019. Patient demographics, anesthetic and surgical characteristics, and pathologic features were also collected. The effects of EA on postoperative cancer recurrence and overall survival were evaluated using proportional hazards regression models with inverse probability of treatment weighting (IPTW) based on propensity scores to balance unequal distributions of observed covariates. For sensitivity analysis, multivariable regression modeling and quintile-stratified propensity adjustments were also used.

Results:

Among the 252 included patients, the median follow-up period was 15.9 months (interquartile range 6.8–28.2 months), and 88 (35%) received EA after pancreatic cancer surgery. EA was not associated with greater cancer recurrence (IPTW adjusted HR: 0.98; 95% CI, 0.78%-1.24%; p = 0.87) or all-cause mortality (IPTW adjusted HR: 1.02; 95% CI, 0.82%-1.27%; p = 0.85) after pancreatic cancer resection. In sensitivity analysis, both the multivariable and stratified Cox regression analyses failed to demonstrate significant effects of EA on cancer recurrence and survival after surgery.

Conclusion:

There were no significant associations between EA and cancer recurrence and overall survival after curative surgery for pancreatic cancer. Prospective studies should be considered to elucidate the relationship between EA and cancer outcomes after pancreatic cancer surgery.