bluuebunny/crossref_metadata_2025 huggingface dataset:
Full-waveform-based characterization of acoustic emission activity in a mine-scale experiment: a comparison of conventional and advanced hydraulic fracturing schemes
Authors: Niemz Peter , Cesca Simone , Heimann Sebastian , Grigoli Francesco , von Specht Sebastian , Hammer Conny , Zang Arno , Dahm Torsten
Published: March 2020

Understanding fracturing processes and the hydromechanical relation to induced seismicity is a key question for enhanced geothermal systems (EGS). Commonly massive fluid injection, predominately causing hydroshearing, are used in large-scale EGS but also hydraulic fracturing approaches were discussed. To evaluate the applicability of hydraulic fracturing techniques in EGS, six in situ, multistage hydraulic fracturing experiments with three different injection schemes were performed under controlled conditions in crystalline rock at the Äspö Hard Rock Laboratory (Sweden). During the experiments the near-field ground motion was continuously recorded by 11 piezoelectric borehole sensors with a sampling rate of 1 MHz. The sensor network covered a volume of 30×30×30 m around a horizontal, 28-m-long injection borehole at a depth of 410 m. To extract and characterize massive, induced, high-frequency acoustic emission (AE) activity from continuous recordings, a semi-automated workflow was developed relying on full waveform based detection, classification and location procedures. The approach extended the AE catalogue from 196 triggered events in previous studies to more than 19 600 located AEs. The enhanced catalogue, for the first time, allows a detailed analysis of induced seismicity during single hydraulic fracturing experiments, including the individual fracturing stages and the comparison between injection schemes. Beside the detailed study of the spatio-temporal patterns, event clusters and the growth of seismic clouds, we estimate relative magnitudes and b-values of AEs for conventional, cyclic progressive and dynamic pulse injection schemes, the latter two being fatigue hydraulic fracturing techniques. While the conventional fracturing leads to AE patterns clustered in planar regions, indicating the generation of a single main fracture plane, the cyclic progressive injection scheme results in a more diffuse, cloud-like AE distribution, indicating the activation of a more complex fracture network. For a given amount of hydraulic energy (pressure multiplied by injected volume) pumped into the system, the cyclic progressive scheme is characterized by a lower rate of seismicity, lower maximum magnitudes and significantly larger b-values, implying an increased number of small events relative to the large ones. To our knowledge, this is the first direct comparison of high resolution seismicity in a mine-scale experiment induced by different hydraulic fracturing schemes.
The multilevel identity politics of the 2019 Eurovision Song Contest
Authors: Press-Barnathan Galia , Lutz Naama
Published: March 2020

This article uses the 2019 Eurovision Song Contest (ESC) that took place in Tel Aviv to explore how cultural mega-events serve both as political arenas and as tools for identity construction, negotiation and contestation. These processes of identity politics are all conducted across national–subnational–international–transnational levels. The hosting of mega-events fleshes out these multiple processes in a very strong manner. We first discuss the politics of hosting mega-events in general. We then examine the identity politics associated more specifically with the Eurovision Song Contest, before examining in depth the complex forms of identity politics emerging around the competition following the 2018 Israeli victory. We suggest that it is important to study together the multiple processes—domestic, international and transnational—of identity politics that take place around the competition, as they interact with each other. Consequently, we follow the various stakeholders involved at these different levels and their interactions. We examine the internal identity negotiation process in Israel surrounding the event, the critical actors debating how to use the stage to challenge the liberal, western, ‘normal’ identity Israel hoped to project in the contest and how other stakeholders (participating states, national broadcasting agencies, participating artists) reacted to them, and finally we examine the behaviour of the institution in charge, the European Broadcasting Union, and national governments. We contribute to the study of mega-events as fields of contestation, to the understanding of the complex, multilevel nature of national identity construction, negotiation and contestation in the current era, and more broadly to the role that popular culture plays in this context.
Horror, apocalypse and world politics
Authors: Aistrope Tim , Fishel Stefanie
Published: March 2020

World politics generates a long list of anxiety-inspiring scenarios that threaten to unravel everyday life with sudden and violent destruction. From total war and the concentration camps, through nuclear firestorms, global pandemics and climate disaster, the diabolical violence of the recent past and conceivable future is the stuff of nightmares. Yet International Relations scholars and practitioners are often criticized for being disconnected from the human realities of international calamity. The challenge for both is to engage world politics in a way that foregrounds the human consequences of extreme violence and depravation. In this article, we explore these difficult experiences through popular culture representations of the apocalypse, a subject of intense interest for researchers in a discipline where global destruction is a distinct possibility. However, we take a different route by engaging the apocalypse through the horror genre, the one place where human suffering is explicitly accentuated. We argue that the horror genre is at once an access point for ethical engagement with the human consequences of extreme violence and a complex terrain where dark imaginings can be politically loaded, culturally specific and ethically ambiguous.
Bar Category of Modules and Homotopy Adjunction for Tensor Functors
Authors: Anno Rina , Logvinenko Timothy
Published: March 2020

Given a differentially graded (DG)-category ${{\mathcal{A}}}$, we introduce the bar category of modules ${\overline{\textbf{{Mod}}}-{\mathcal{A}}}$. It is a DG enhancement of the derived category $D({{\mathcal{A}}})$ of ${{\mathcal{A}}}$, which is isomorphic to the category of DG ${{\mathcal{A}}}$-modules with ${A_{\infty }}$-morphisms between them. However, it is defined intrinsically in the language of DG categories and requires no complex machinery or sign conventions of ${A_{\infty }}$-categories. We define for these bar categories Tensor and Hom bifunctors, dualisation functors, and a convolution of twisted complexes. The intended application is to working with DG-bimodules as enhancements of exact functors between triangulated categories. As a demonstration, we develop a homotopy adjunction theory for tensor functors between derived categories of DG categories. It allows us to show in an enhanced setting that given a functor $F$ with left and right adjoints $L$ and $R$, the functorial complex $FR \xrightarrow{F{\operatorname{act}}{R}} FRFR \xrightarrow{FR{\operatorname{tr}} - {\operatorname{tr}}{FR}} FR \xrightarrow{{\operatorname{tr}}} {\operatorname{Id}}$ lifts to a canonical twisted complex whose convolution is the square of the spherical twist of $F$. We then write down four induced functorial Postnikov systems computing this convolution.
LncRNA SDHAP1 confers paclitaxel resistance of ovarian cancer by regulating EIF4G2 expression via miR-4465
Authors: Zhao Hui , Wang Aixia , Zhang Zhiwei
Published: March 2020

Ovarian cancer has ranked as one of the leading causes of female morbidity and mortality around the world, which affects ∼239,000 patients and causes 152,000 deaths every year. Chemotherapeutic resistance of ovarian cancer remains a devastating actuality in clinic. The aberrant upregulation of long non-coding RNA succinate dehydrogenase complex flavoprotein subunit A pseudogene 1 (lncRNA SDHAP1) in the Paclitaxel (PTX)-resistant ovarian cancer cell lines has been reported. However, studies focussed on SDHAP1 in its regulatory function of chemotherapeutic resistance in ovarian cancer are limited, and the detailed mechanisms remain unclear. In this study, we demonstrated that SDHAP1 was upregulated in PTX-resistant SKOV3 and Hey-8 ovarian cancer cell lines while the level of miR-4465 was downregulated. Knocking-down SDHAP1 induced re-acquirement of chemo-sensitivity to PTX in ovarian cancer cells in vitro. Mechanically, SDHAP1 upregulated the expression of EIF4G2 by sponging miR-4465 and thus facilitated the PTX-induced apoptosis in ovarian cancer cells. The regulation network involving SDHAP1, miR-4465 and EIF4G2 could be a potential therapy target for the PTX-resistant ovarian cancer.
New Seed-Collection Zones for the Eastern United States: The Eastern Seed Zone Forum
Authors: Pike Carolyn , Potter Kevin M , Berrang Paul , Crane Barbara , Baggs Joanne , Leites Laura , Luther Tom
Published: March 2020

Abstract

Reforestation and restoration efforts have traditionally relied on “local” seed sources as planting stock. The term “local” has different meanings in different locales, since no single set of seed-collection zones has yet been widely adopted across the eastern United States. Given concerns about mitigating the effects of climate change, forest managers are increasingly seeking to move seed sources in a process called assisted migration, which would be facilitated if a common set of seed-collection zones were available. We developed a map of 245 seed-collection zones for 37 states by combining two ecologically important layers: plant hardiness zones and ecoregions. These new seed-collection zones should be used by seed collectors and nurseries to describe the origin of seed for plants and trees in the eastern United States. Common garden studies remain the gold standard for determining how far to move seed from any particular seed-collection zone. For species that have not been field-tested, seed movement that is limited either within a seed-collection zone or between adjacent seed-collection zones is a reasonable general guideline.
Characterization of a sweet basil acyltransferase involved in eugenol biosynthesis
Authors: Dhar Niha , Sarangapani Sreelatha , Reddy Vaishnavi Amarr , Kumar Nadimuthu , Panicker Deepa , Jin Jingjing , Chua Nam-Hai , Sarojam Rajani
Published: March 2020

Sweet basil (Ocimum basilicum) plants produce its characteristic phenylpropene-rich essential oil in specialized structures known as peltate glandular trichomes (PGTs). Eugenol and chavicol are the major phenylpropenes produced by sweet basil varieties whose synthetic pathways are not fully elucidated. Eugenol is derived from coniferyl acetate by a reaction catalysed by eugenol synthase. An acyltransferase is proposed to convert coniferyl alcohol to coniferyl acetate which is the first committed step towards eugenol synthesis. Here, we perform a comparative next-generation transcriptome sequencing of different tissues of sweet basil, namely PGT, leaf, leaf stripped of PGTs (leaf–PGT), and roots, to identify differentially expressed transcripts specific to PGT. From these data, we identified a PGT-enriched BAHD acyltransferase gene ObCAAT1 and functionally characterized it. In vitro coupled reaction of ObCAAT1 with eugenol synthase in the presence of coniferyl alcohol resulted in eugenol production. Analysis of ObCAAT1-RNAi transgenic lines showed decreased levels of eugenol and accumulation of coniferyl alcohol and its derivatives. Coniferyl alcohol acts as a common substrate for phenylpropene and lignin biosynthesis. No differences were found in total lignin content of PGTs and leaves of transgenic lines, indicating that phenylpropene biosynthesis is not coupled to lignification in sweet basil.
Plant nitrogen uptake and assimilation: regulation of cellular pH homeostasis
Authors: Feng Huimin , Fan Xiaorong , Miller Anthony J , Xu Guohua
Published: March 2020

The enzymatic controlled metabolic processes in cells occur at their optimized pH ranges, therefore cellular pH homeostasis is fundamental for life. In plants, the nitrogen (N) source for uptake and assimilation, mainly in the forms of nitrate (NO3–) and ammonium (NH4+) quantitatively dominates the anion and cation equilibrium and the pH balance in cells. Here we review ionic and pH homeostasis in plant cells and regulation by N source from the rhizosphere to extra- and intracellular pH regulation for short- and long-distance N distribution and during N assimilation. In the process of N transport across membranes for uptake and compartmentation, both proton pumps and proton-coupled N transporters are essential, and their proton-binding sites may sense changes of apoplastic or intracellular pH. In addition, during N assimilation, carbon skeletons are required to synthesize amino acids, thus the combination of NO3– or NH4+ transport and assimilation results in different net charge and numbers of protons in plant cells. Efficient maintenance of N-controlled cellular pH homeostasis may improve N uptake and use efficiency, as well as enhance the resistance to abiotic stresses.
Health Characteristics of the Madeira Riverine Population
Authors: de Mattos Oliveira Lízia Felix Cotias , Lennon Robert P , Roman John W , Sullivan John F , Milder Edmund A
Published: March 2020

Introduction

The Amazon River Basin is the largest and the most complex fluvial system in the world. The Brazilian government provides dental and medical care to the riverine populations in this region in part through medical assistance missions, conducted by four hospital ships. The Brazilian Navy invited U.S. Navy medical personnel to join the February 2019 mission aboard Navio de Assistência Hospitalar (NAsH) Carlos Chagas to provide care along the Madeira River.

Materials and Methods

In the course of providing primary care services, demographic, health, and dental data of the Madeira Riverine population were collected. Descriptive statistics were used to generate average health and dental data. Chi-square tests were used to compare population prevalence data. Linear regression was used to evaluate dental caries per patient with proximity to nearest large population center and village population. This project was approved by Naval Medical Center Portsmouth Institutional Review Board.

Results

The Madeira Riverine population has similar dental health to Brazilians living in urban centers. Their prevalence of hypertension and diabetes compared favorably with the U.S. averages (17.7% vs. 34.3% [P < 0.001] and 3% vs. 9.4% [P < 0.001], respectively). Based on the most prevalent ICD-10 code diagnoses, future missions can expect high volumes of patients with intestinal parasites, hypertension, common skin infections, women’s health concerns, and musculoskeletal complaints.

Conclusions

This study adds to the limited health data currently available on Brazilian Riverine populations. It demonstrates the effectiveness of the Hospital Assistance missions in providing dental care and documents some unique aspects of Riverine health that warrant further study.
Acute kidney injury demographics and outcomes: changes following introduction of electronic acute kidney injury alerts—an analysis of a national dataset
Authors: Holmes Jennifer , Donovan Kieron , Geen John , Williams John , Phillips Aled O
Published: March 2020

Background

Electronic alerts for acute kidney injury (AKI) have been widely advocated. Our aim was to describe the changes in AKI demographics and outcomes following implementation of a national electronic AKI alert programme.

Methods

A prospective national cohort study was undertaken to collect data on all cases of AKI in adult patients (≥18 years of age) between 1 April 2015 and 31 March 2019.

Results

Over the period of data collection, there were 193 838 AKI episodes in a total of 132 599 patients. The lowest incidence of AKI was seen in the first year after implementation of electronic alerts. A 30-day mortality was highest in Year 1 and significantly lower in all subsequent years. A direct comparison of mortality in Years 1 and 4 demonstrated a significantly increased relative risk (RR) of death in Year 1: RR = 1.08 [95% confidence interval (CI) 1.054–1.114 P < 0.001]. This translates into a number needed to treat in Year 4 for one additional patient to survive of 69.5 (95% CI 51.7–106.2) when directly comparing the outcomes across the 2 years. The increase in the number of cases and improved outcomes was more pronounced in community-acquired AKI, and was associated with a significant increase in patient hospitalization.

Conclusions

This study represents the first large-scale dataset to clearly demonstrate that a national AKI alerting system which highlights AKI is associated with a change in both AKI demographics and patient outcomes.
Community economic factors influence outcomes for patients with primary malignant glioma
Authors: Bower Aaron , Hsu Fang-Chi , Weaver Kathryn E , Yelton Caleb , Merrill Rebecca , Wicks Robert , Soike Mike , Hutchinson Angelica , McTyre Emory , Laxton Adrian , Tatter Stephen , Cramer Christina , Chan Michael , Lesser Glenn , Strowd Roy E
Published: March 2020

Background

Community economics and other social health determinants influence outcomes in oncologic patient populations. We sought to explore their impact on presentation, treatment, and survival in glioma patients.

Methods

A retrospective cohort of patients with glioma (World Health Organization grades III–IV) diagnosed between 1999 and 2017 was assembled with data abstracted from medical record review. Patient factors included race, primary care provider (PCP) identified, marital status, insurance status, and employment status. Median household income based on zip code was used to classify patients as residing in high-income communities (HICs; ie, above the median state income) or low-income communities (LICs; ie, below the median state income). The Kaplan–Meier method was used to assess overall survival (OS); Cox proportional hazards regression was used to explore associations with OS.

Results

Included were 312 patients, 73% from LICs. Survivors residing in LICs and HICs did not differ by age, sex, race, tumor grade, having a PCP, employment status, insurance, time to presentation, or baseline performance status. Median OS was 4.1 months shorter for LIC patients (19.7 vs 15.6 mo; hazard ratio [HR], 0.75; 95% CI: 0.56–0.98, P = 0.04); this difference persisted with 1-year survival of 66% for HICs versus 61% for LICs at 1 year, 34% versus 24% at 3 years, and 29% versus 17% at 5 years. Multivariable analysis controlling for age, grade, and chemotherapy treatment showed a 25% lower risk of death for HIC patients (HR, 0.75; 95% CI: 0.57–0.99, P < 0.05).

Conclusions

The economic status of a glioma patient’s community may influence survival. Future efforts should investigate potential mechanisms such as health care access, stress, treatment adherence, and social support.
Less Invasive Cervical Decompression via Unilateral Tubular Laminotomy Using 3-Dimensional Total Navigation: 2-Dimensional Operative Video
Authors: Kirnaz Sertac , Wipplinger Christoph , Wong Taylor , Schmidt Franziska Anna , Nangunoori Raj , Härtl Roger
Published: March 2020

This video demonstrates the step-by-step surgical technique for a less invasive cervical unilateral laminotomy for bilateral decompression (cervical ULBD). This technique allows surgeons to address bilateral cervical pathology while minimizing approach-related complications.
1
In the video, we present the case of a 72-yr-old female patient with a past medical history of C3-C4 anterior cervical discectomy and fusion who presented in clinic with persistent posterior spinal cord compression and signal change. The patient had bilateral hand numbness, weakness, poor dexterity, and a positive Hoffman's sign. The patient was treated via a C3-C4 less invasive cervical ULBD using a mobile 3-dimensional (3D) C-arm (Ziehm Vision RFD 3D®, Nürnberg, Germany) combined with 3D computer navigation. Patient consent was obtained prior to performing the procedure. Contrary to anterior techniques, posterior cervical approaches avoid potential dysphasia, recurrent laryngeal nerve injury, and adjacent segment degeneration. Furthermore, the less invasive cervical ULBD results in decreased pain and postoperative narcotic usage, shorter hospital stays and fewer infections compared to open approaches, as well as a lower risk for postlaminectomy kyphosis and deformity, since it requires less muscle disruption and bony removal. Additionally, the use of total 3D navigation facilitates the workflow and minimizes radiation exposure.
High-pressure Cu–Fe–S Phase Equilibria: some Experimental and Thermodynamic Constraints on Sulfides in Subduction Zones and the Lithospheric Mantle
Authors: Brown Julie L , Dyer Sabastien C , Mungall James E , Christy Andrew G , Ellis David J
Published: March 2020

High-pressure phase relations for much of the Cu–Fe–S system have not previously been determined experimentally. Experimental studies have concentrated on low-pressure phase relations and cannot explain high-pressure sulfide mineral inclusion assemblages in some natural blueschists and eclogites. In particular, the coexistence of pyrite + covellite at 1·0 GPa, and pyrite + bornite at 1·9 GPa, observed in New Caledonian rocks, is precluded by tie-lines between S and bornite, and S and the intermediate solid solution (iss), in the published low-pressure experimental topologies at corresponding temperatures. In addition, the Cu content (up to ∼10 at%) of pyrrhotite in eclogite exceeds the experimentally determined maximum for Cu in solid solution with pyrrhotite at low pressures and at corresponding temperatures. We have performed six experiments in which natural chalcopyrite starting material was equilibrated at conditions ranging from 1·0 to 1·7 GPa and 500 to 650 °C. At 1 GPa chalcopyrite is replaced by iss. The iss phase undergoes a terminal breakdown reaction between 1·0 and 1·7 GPa, being replaced by a new assemblage of bornite, pyrite, and pyrrhotite. Our experimental results confirm predictions from the SUPCRT thermodynamic database (Johnson et al., 1992; Computers & Geosciences 18, 899–947) but not that of Robie & Hemingway (1995; US Geological Survey Bulletin 2131). The former database is therefore recommended for calculation of high-pressure sulfide phase relations. Chalcopyrite and its high-temperature, low-fS2 equivalent, iss are not stable at pressures corresponding to much of blueschist–eclogite-facies metamorphism. These results are also applicable to sulfide assemblages in the lithospheric mantle along both oceanic and continental geotherms; the subsolidus Cu-rich mineral in the lithosphere at depths of 30 to >65 km must be bornite–digenite solid solution (bn-ss) rather than iss as is commonly assumed.
To split or to lump? Classifying the central disorders of hypersomnolence
Authors: Fronczek Rolf , Arnulf Isabelle , Baumann Christian R , Maski Kiran , Pizza Fabio , Trotti Lynn Marie
Published: March 2020

The classification of the central disorders of hypersomnolence has undergone multiple iterations in an attempt to capture biologically meaningful disease entities in the absence of known pathophysiology. Accumulating data suggests that further refinements may be necessary. At the 7th International Symposium on Narcolepsy, a group of clinician-scientists evaluated data in support of keeping or changing classifications, and as a result suggest several changes. First, idiopathic hypersomnia with long sleep durations appears to be an identifiable and meaningful disease subtype. Second, idiopathic hypersomnia without long sleep time and narcolepsy without cataplexy share substantial phenotypic overlap and cannot reliably be distinguished with current testing, and so combining them into a single disease entity seems warranted at present. Moving forward, it is critical to phenotype patients across a wide variety of clinical and biological features, to aid in future refinements of disease classification.
Evaluation of biomarkers for in vitro prediction of drug-induced nephrotoxicity in RPTEC/TERT1 cells
Authors: Qiu Xuan , Miao Yufa , Geng Xingchao , Zhou Xiaobing , Li Bo
Published: March 2020

There have been intensive efforts to identify in vivo biomarkers that can be used to monitor drug-induced kidney damage before significant impairment occurs. Kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, clusterin, β2-microglobulin and cystatin C (CysC) have been validated as clinical or preclinical biomarkers in urinary and plasma predictive of acute and chronic kidney injuries and diseases. A high-throughput in vitro assay predictive of nephrotoxicity could potentially be implemented in early drug discovery stage to reduce attrition at later stages of drug development. To assess the potential of these known in vivo biomarkers for in vitro evaluation of drug-induced nephrotoxicity, we selected four nephrotoxic agents (cisplatin, cyclosporin, aristolochic acid I and gentamicin) and detected their effects on the protein levels of nephrotoxic biomarkers in RPTEC/TERT1 cells. The protein levels of clusterin, CysC, GSTπ and TIMP-1 significantly increased in the conditioned media of RPTEC/TERT1 cells treated with cisplatin, cyclosporin, aristolochic acid I and gentamicin. The messenger RNA levels of clusterin, CysC, GSTπ and TIMP-1 also increased in RPTEC/TERT1 cells treated with cisplatin, cyclosporin, aristolochic acid I and gentamicin, indicating that drug-induced upregulation involves transcriptional activation. Taken together, the results clearly demonstrate that among the known in vivo nephrotoxic biomarkers, clusterin, CysC, GSTπ and TIMP-1 can be effectively used as in vitro biomarkers for drug-induced nephrotoxicity in RPTEC/TERT1 cells.
Late Protective Effect of Netrin-1 in the Murine Acetaminophen Hepatotoxicity Model
Authors: Duan Luqi , Woolbright Benjamin L , Jaeschke Hartmut , Ramachandran Anup
Published: March 2020

Acetaminophen (APAP) overdose-induced acute liver failure is an important clinical problem in the United States and the current antidote N-acetylcysteine, has a short early therapeutic window. Since most patients present late to the clinic, there is need for novel late-acting therapeutic options. Though the neuronal guidance cue netrin-1, has been shown to promote hepatic repair and regeneration during liver ischemia/reperfusion injury, its effect in APAP-induced hepatotoxicity is unknown. In the quest for a late-acting therapeutic intervention in APAP-induced liver injury, we examined the role of netrin-1 in a mouse model of APAP overdose. Male C57BL/6J mice were cotreated with exogenous netrin-1 or vehicle control, along with 300 mg/kg APAP and euthanized at 6, 12, and 24 h. Significant elevations in alanine aminotransferase indicative of liver injury were seen in control mice at 6 h and this was not affected by netrin-1 administration. Also, netrin-1 treatment did not influence mitochondrial translocation of phospho-JNK, or peroxynitrite formation indicating that there was no interference with APAP-induced injury processes. Interestingly however, netrin-1 administration attenuated liver injury at 24 h, as seen by alanine aminotransferase levels and histology, at which time significant elevations in the netrin-1 receptor, adenosine A2B receptor (A2BAR) as well as macrophage infiltration was evident. Removal of resident macrophages with clodronate liposomes or treatment with the A2BAR antagonist PSB1115 blocked the protective effects of netrin-1. Thus, our data indicate a previously unrecognized role for netrin-1 in attenuation of APAP hepatotoxicity by enhancing recovery and regeneration, which is mediated through the A2BAR and involves resident liver macrophages.
Development of a Transformative Standardized Approach for Written Communication Skills in an Online RN-BS Program
Authors: Lockett Leslie , Katz Kathi S. , Czerwinski Sandra , Gore Teresa , Gwartney Tiffany
Published: March 2020

The perceived quality of health care received is highly dependent upon the quality of communication between patients and their health care providers and between members of the health care team (Institute of Medicine, 2003). A comprehensive, standardized module for developing effective writing skills was established and integrated in a research-intensive university in the southeastern United States. One year after integration, more than 60 percent of students and 50 percent of targeted courses accessed and adopted the module. The impact of the module upon student outcomes is being measured.
Evaluating Nursing Students’ Perceptions of Using Quick Response Codes to Enhance Learning During Nursing Health Assessment
Authors: Marcus Jessica , Adebayo Modupeola , Cranwell-Bruce Lisa , Faulkner Melissa Spezia
Published: March 2020

Providing engaging activities to supplement classroom learning can be a challenge for today’s nurse educator. Quick response (QR) code technology provides hands-on clinical experiences without the use of high-fidelity simulators. The purpose of this article is to evaluate how QR codes during a health assessment simulation activity enhanced learning for first-semester baccalaureate nursing students. The use of QR codes increased student confidence during health assessment with a form of technology they found engaging.
Classroom Concepts in the Clinical Setting: Student Perceptions of Concept Cards
Authors: Gay Jessica E. , Phillips Christina J.
Published: March 2020

Concept-based curricula have been widely implemented to combat content oversaturation in undergraduate nursing education. While nursing programs have focused on changing the classroom environment, only a few have integrated conceptual learning into clinical education. This qualitative descriptive study measured student perceptions of the effectiveness of concept cards, a concept-based clinical learning activity, in maternity and medical-surgical clinical sites. Two phases of the study indicated that the use of concept cards in clinical practicum deepened and reinforced understanding of concepts and enhanced student learning in the clinical setting.
Confirming nasogastric tube placement in adults
Authors: Judd Maureen
Published: March 2020

Nurses are responsible for ensuring that short-term enteral feeding tubes are placed correctly before using them for gastric emptying, enteral nutrition, or medication administration. This article reviews evidence-based methods for assessing tube placement and discusses the limitations of each method with a focus on nasogastric tube placement.
Showing the way with gracious leadership
Authors: Kroning Maureen , Carey Adrienne , Crawford-Rosso Sophie
Published: March 2020

Like servant leaders, gracious leaders prioritize employee relationships in a way that also promotes optimal outcomes for both the patients and the healthcare organization. This article provides a mnemonic to describe the attributes of a gracious nurse leader.
Binaural Pitch Fusion: Binaural Pitch Averaging in Cochlear Implant Users With Broad Binaural Fusion
Authors: Oh Yonghee , Reiss Lina A. J.
Published: March 2020

Objectives:

Individuals who use hearing aids (HAs) or cochlear implants (CIs) can experience broad binaural pitch fusion, such that sounds differing in pitch by as much as 3 to 4 octaves are perceptually integrated across ears. Previously, it was shown in HA users that the fused pitch is a weighted average of the two monaural pitches, ranging from equal weighting to dominance by the lower pitch. The goal of this study was to systematically measure the fused pitches in adult CI users, and determine whether CI users experience similar pitch averaging effects as observed in HA users.

Design:

Twelve adult CI users (Cochlear Ltd, Sydney, Australia) participated in this study: six bimodal CI users, who wear a CI with a contralateral HA, and six bilateral CI users. Stimuli to HA ears were acoustic pure tones, and stimuli to CI ears were biphasic pulse trains delivered to individual electrodes. Fusion ranges, the ranges of frequencies/electrodes in the comparison ear that were fused with a single electrode (electrode 22, 18, 12, or 6) in the reference ear, were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus. Once the fusion ranges were measured, the fused binaural pitch of a reference-pair stimulus combination was measured by finding a pitch match to monaural comparison stimuli presented to the paired stimulus ear.

Results:

Fusion pitch weighting in CI users varied depending on the pitch difference of the reference-pair stimulus combination, with equal pitch averaging occurring for stimuli closer in pitch and lower pitch dominance occurring for stimuli farther apart in pitch. The averaging region was typically 0.5 to 2.3 octaves around the reference for bimodal CI users and 0.4 to 1.5 octaves for bilateral CI users. In some cases, a bias in the averaging region was observed toward the ear with greater stimulus variability.

Conclusions:

Fusion pitch weighting effects in CI users were similar to those observed previously in HA users. However, CI users showed greater inter-subject variability in both pitch averaging ranges and bias effects. These findings suggest that binaural pitch averaging could be a common underlying mechanism in hearing-impaired listeners.
Change in Bone CT Attenuation and C-reactive Protein Are Predictors of Bone Biopsy Culture Positivity in Patients With Vertebral Discitis/Osteomyelitis
Authors: Lee Harrison T. , Pukenas Bryan A. , Sebro Ronnie
Published: March 2020

Study Design.

Case-control study.

Objective.

The objective of this study was to identify the best laboratory and imaging factors to predict bone biopsy culture positivity in the setting of vertebral discitis/osteomyelitis (VDO).

Summary of Background Data.

Good predictors of bone biopsy culture positivity in the setting of VDO are unknown.

Methods.

Retrospective review was performed for 46 patients who underwent CT-guided bone biopsy for the evaluation of clinically confirmed VDO. Erythrocyte sedimentation rate, C-reactive protein (CRP), mean CT attenuation of the biopsied bone, and the change in the CT attenuation of the bone compared to unaffected vertebral bone (delta CT attenuation) were measured. Receiver-operator characteristic curve analyses were performed to identify the optimal threshold value for each variable. A multivariable logistic regression model was used to predict the probability of a positive bone culture using delta CT attenuation and CRPx100% fold above normal.

Results.

For one of the 46 VDO patients, bone cultures were not obtained. Approximately 35.6% (16/45) of bone cultures were positive. The most significant predictors of bone culture positivity were CRP x100% fold above normal (P = 0.011) and delta CT attenuation (P = <0.001). Optimized predictive thresholds were calculated to be CRP 4-fold above normal reference value (90.9% sensitivity, 73.7% specificity), or if the CT attenuation of the affected vertebral body was >25.9 HU lower relative to unaffected bone (93.8% sensitivity, 75.0% specificity).

Conclusion.

Delta CT attenuation, as well as CRP level over four times the upper limits of normal, were the strongest predictors for bone culture positivity in patients with VDO.

Level of Evidence: 3
Association Between Metabolic Syndrome and Endometrial Cancer Survival in a SEER-Medicare Linked Database
Authors: Jin Jingxiao , Dalwadi Shraddha M. , Masand Ramya P. , Hall Tracilyn R. , Anderson Matthew L. , Ludwig Michelle S.
Published: March 2020

Background:

Metabolic syndrome has previously been linked to increased risk of endometrial cancer. This study examines the association between metabolic syndrome and cancer-specific survival (CSS) in early stage and locoregionally advanced endometrial cancer.

Methods:

The SEER-Medicare linked database was used to identify a cohort of patients with endometrial cancer between 1992 and 2011 who underwent hysterectomy. Patients with incomplete stage or grade information were excluded. Patients were stratified into early stage (stage I to II) or locoregionally advanced (stage III to IVa) disease. Metabolic syndrome status was determined through Medicare claims 1 year before diagnosis. The relationship between metabolic syndrome and CSS was evaluated using univariable and multivariable Cox proportional hazards regression analyses.

Results:

A total of 10,090 patients with endometrial cancer were identified. The mean age was 75 and the majority (91.5%) were white. At diagnosis, 86.6% of patients were early stage and 13.4% were locoregionally advanced. Sixteen percent of patients had metabolic syndrome. On stage stratified multivariable analysis, race, income quartile, year of diagnosis, histopathology, and adjuvant treatment were associated with CSS in early stage disease. Presence of metabolic syndrome was associated with worse CSS in early stage disease (hazard ratio=1.28, 95% confidence interval: 1.09-1.53); this difference did not exist for locoregionally advanced disease (hazard ratio=1.18, 95% confidence interval: 0.93-1.49).

Conclusions:

In elderly early stage endometrial cancer patients, metabolic syndrome is associated with worse CSS. Control of metabolic syndrome through lifestyle and pharmacologic therapies may improve cancer prognosis in this population.
Peripheral Palisading in Melanoma Mimicking Basal Cell Carcinoma: A Case Report
Authors: Wang Yanqing , Guo Ying
Published: March 2020

The incidence of melanoma has been increasing over the past few decades. Because of its phenotypic diversity, melanoma may present in various clinical and histopathological manifestations, and it can mimic varieties of skin lesions from benign to malignant and from epithelial to nonepithelial. Accurate diagnosis of melanoma is crucial because delayed treatment leads to worse prognoses. Here, we describe a case of melanoma in an 82-year-old man with an unusual histopathologic presentation, namely, the presence of neoplastic aggregates with a palisaded periphery resembling basal cell carcinoma.
OnabotulinumtoxinA Treatment for Moderate to Severe Forehead Lines: A Review
Authors: De Boulle Koenraad , Carruthers Alastair , Solish Nowell , Carruthers Jean , Philipp-Dormston Wolfgang G. , Fagien Steven , Sangha Sara , Silberberg Michael , Mao Cheri
Published: March 2020

Background:

With onabotulinumtoxinA approved for the treatment of glabellar and crow’s feet lines and, most recently, for forehead lines (FHL), it is possible to simultaneously treat multiple areas of the upper face that are of high concern and treatment priority for aesthetically oriented individuals. This review aims to present key insights on the use of onabotulinumtoxinA for the treatment of moderate to severe FHL.

Methods:

Double-blind, placebo-controlled registration trials of onabotulinumtoxinA for the treatment of FHL were included. Using findings from 3 such published studies, we discuss key concepts and clinical experience for the treatment of moderate to severe FHL with onabotulinumtoxinA (20 U in the frontalis and 20 U in the glabellar complex, with/without 24 U in crow’s feet lines), including injection pattern, dose selection, efficacy and safety data, and considerations for patient selection.

Results:

Across the 2 pivotal phase 3 studies, responder rates on investigator- and subject-assessed measures of appearance of FHL severity were significantly higher with onabotulinumtoxinA versus placebo for the treatment of FHL at day 30 (P < 0.0001), and results were maintained through 3 cycles of onabotulinumtoxinA.

Conclusions:

OnabotulinumtoxinA treatment also resulted in high patient satisfaction rates. The incidence of eyebrow and of eyelid ptosis was low, and no new safety signals were detected. OnabotulinumtoxinA is safe and effective and an appropriate option for patients with moderate to severe FHL encountered in clinical practice.
Heritability and genetic correlations of obesity indices with ambulatory and office beat-to-beat blood pressure in the Oman Family Study
Authors: Man Tengfei , Nolte Ilja M. , Jaju Deepali , Al-Anqoudi Zahir A.M. , Muñoz M. Loretto , Hassan Mohammed O. , Al-Yahyaee Said , Bayoumi Riad A. , Comuzzie Anthony G. , Floras John S. , van Roon Arie M. , Riese Harriëtte , Albarwani Sulayma , Snieder Harold
Published: March 2020

Objective:

To more precisely and comprehensively estimate the genetic and environmental correlations between various indices of obesity and BP.

Methods:

We estimated heritability and genetic correlations of obesity indices with BP in the Oman family study (n = 1231). Ambulatory and office beat-to-beat BP was measured and mean values for SBP and DBP during daytime, sleep, 24-h and 10 min at rest were calculated. Different indices were used to quantify obesity and fat distribution: BMI, percentage of body fat (%BF), waist circumference and waist-to-height ratio (WHtR). SOLAR software was used to perform univariate and bivariate quantitative genetic analyses adjusting for age, age2, sex, age-sex and age2--sex interactions.

Results:

Heritabilities of BP ranged from 30.2 to 38.2% for ambulatory daytime, 16.8--21.4% for sleeping time, 32.1--40.4% for 24-h and 22--24.4% for office beat-to-beat measurements. Heritabilities for obesity indices were 67.8% for BMI, 52.2% for %BF, 37.3% for waist circumference and 37.9% for WHtR. All obesity measures had consistently positive phenotypic correlations with ambulatory and office beat-to-beat SBP and DBP (r-range: 0.14--0.32). Genetic correlations of obesity indices with SBP and DBP were higher than environmental correlations (r
G: 0.16--0.50; r
E: 0.01--0.31).

Conclusion:

The considerable genetic overlap between a variety of obesity indices and both ambulatory and office beat-to-beat BP highlights the relevance of pleiotropic genes. Future GWAS analyses should discover the specific genes both influencing obesity indices and BP to help unravel their shared genetic background.
Ectopic Lacrimal Gland Tissue: A Systematic Review
Authors: Nagendran Sonali , Alsamnan Mazen , Strianese Diego , Malhotra Raman
Published: March 2020

We review the clinical and histopathological findings associated with ectopic lacrimal gland tissue. Ectopic lacrimal gland tissue is susceptible to neoplastic transformation in the same way as is the lacrimal gland.

Supplemental Digital Content is available in the text.

Purpose:

To review the clinical and histopathological findings associated with ectopic lacrimal gland tissue.

Methods:

A systematic review of the literature on ectopic lacrimal gland tissue was performed. Studies which met clinical and histolopathological criteria for ectopic lacrimal gland tissue written in English and published in peer-reviewed journals were included.

Results:

Sixty-nine publications detailing 180 cases of ectopic lacrimal gland tissue were published between 1946 and 2018. Males were affected slightly more than females (57% vs. 43%) and 95% cases were unilateral. Patients presented at a mean age of 21 years, most commonly with a mass, although orbital lesions commonly presented with proptosis. The most common location for ectopic lacrimal gland tissue was epibulbar conjunctiva (62%), other locations included orbital (16%), eyelid (11%), intraocular (9%), lacrimal sac (2%), and nasal mucosa (0.6%) sites. Most lesions (86%) were locally resected. The most common histological types were complex choristomas (56%) and simple choristomas (38%). However, neoplastic transformation to pleomorphic adenoma (5%), adenocystic carcinoma (0.6%), and adenocarcinoma (0.6%) was reported.

Conclusions:

Ectopic lacrimal gland tissue is rare but should be considered in the differential diagnosis of masses in the epibulbar conjunctiva, eyelid, orbit, and lacrimal sac, particularly in childhood, as the diverse way it presents means that it may mimic more common choristomas. It can undergo neoplastic transformation in the same way as can the lacrimal gland and incomplete excision can result in recurrence.
Enhanced mindfulness-based stress reduction in episodic migraine: a randomized clinical trial with magnetic resonance imaging outcomes
Authors: Seminowicz David A. , Burrowes Shana A.B. , Kearson Alexandra , Zhang Jing , Krimmel Samuel R. , Samawi Luma , Furman Andrew J. , Keaser Michael L. , Gould Neda F. , Magyari Trish , White Linda , Goloubeva Olga , Goyal Madhav , Peterlin B. Lee , Haythornthwaite Jennifer A.
Published: March 2020

We aimed to evaluate the efficacy of an enhanced mindfulness-based stress reduction (MBSR+) vs stress management for headache (SMH). We performed a randomized, assessor-blind, clinical trial of 98 adults with episodic migraine recruited at a single academic center comparing MBSR+ (n = 50) with SMH (n = 48). MBSR+ and SMH were delivered weekly by group for 8 weeks, then biweekly for another 8 weeks. The primary clinical outcome was reduction in headache days from baseline to 20 weeks. Magnetic resonance imaging (MRI) outcomes included activity of left dorsolateral prefrontal cortex (DLPFC) and cognitive task network during cognitive challenge, resting state connectivity of right dorsal anterior insula to DLPFC and cognitive task network, and gray matter volume of DLPFC, dorsal anterior insula, and anterior midcingulate. Secondary outcomes were headache-related disability, pain severity, response to treatment, migraine days, and MRI whole-brain analyses. Reduction in headache days from baseline to 20 weeks was greater for MBSR+ (7.8 [95% CI, 6.9-8.8] to 4.6 [95% CI, 3.7-5.6]) than for SMH (7.7 [95% CI 6.7-8.7] to 6.0 [95% CI, 4.9-7.0]) (P= 0.04). Fifty-two percent of the MBSR+ group showed a response to treatment (50% reduction in headache days) compared with 23% in the SMH group (P= 0.004). Reduction in headache-related disability was greater for MBSR+ (59.6 [95% CI, 57.9-61.3] to 54.6 [95% CI, 52.9-56.4]) than SMH (59.6 [95% CI, 57.7-61.5] to 57.5 [95% CI, 55.5-59.4]) (P= 0.02). There were no differences in clinical outcomes at 52 weeks or MRI outcomes at 20 weeks, although changes related to cognitive networks with MBSR+ were observed. Enhanced mindfulness-based stress reduction is an effective treatment option for episodic migraine.
Functional Outcomes Graded With Normative Data Can Predict Postdischarge Falls and 30-Day Readmissions in Hospitalized Older Adults
Authors: Fischer Mary G. , Josef Kristine L. , Russell Jena H.
Published: March 2020

Purpose:

Acute care physical therapists are asked to determine safe discharge plans for older patients who may be at risk for falls. Quantifying risk based on functional tests may be an effective way to educate patients on their risk and reduce falls after discharge.

Methods:

A total of 110 ambulatory patients 65 years and older on the medicine service of an acute care hospital were tested for the American Geriatric Society's top 5 fall risk factors. Results on functional tests of leg strength (5 times sit-to-stand), balance (functional reach test), gait deviation (gait speed), use of assistive device (yes or no), and history of falls (yes or no) were compared to normative data and entered into an algorithm that calculated a “fall risk score.” Participants were followed up via phone at 1, 3, 6, 9, and 12 months postdischarge.

Results:

Our tool predicted repeated falls (P = .05) but not whether or not a participant would fall. Individual factors including history of falls (odds ratio [OR] 2.4 entire cohort, OR 8.7 females) and balance impairment (OR 13.14 females) did predict falls. An incidental finding linked history of falls with 30-day readmissions for the entire cohort (OR 4.6) and in particular for females (OR 14.8).

Conclusion:

Testing functional measures prior to discharge can predict fall rate and 30-day readmission rate in older patients.