bluuebunny/crossref_metadata_2025 huggingface dataset:
Conflict Actors and the International Criminal Court in Colombia
Authors: Jo Hyeran , Simmons Beth A , Radtke Mitchell
Published: September 2020

To answer the symposium’s thematic question — ‘Who’s afraid of the International Criminal Court?’ — we offer an explanation as to how deterrence might work in the case of the International Criminal Court’s (ICC) preliminary examination cases. We argue that, as long as conflict actors are aware of the Court’s influence and wary of the social and political repercussions associated with the broader anti-impunity norm, the Court can exert influence on the conflict actors’ behaviour. We examine and trace these actors’ responses to ICC’s actions during the Colombian conflict, the ICC’s longest running preliminary examination case. The analysis demonstrates that over the course of the conflict’s history, the main belligerents were not necessarily afraid of the Court, but they were aware and wary of the ICC’s influence, and that in turn, this caution reshaped their conflict behaviours and resulted in institutional changes that increased accountability in Colombia. The finding carries implications for the role of the Court in a time when the power of global justice is being questioned.
Data privacy considerations for telehealth consumers amid COVID-19
Authors: Bassan Sharon
Published: September 2020

The COVID-19 emergency poses particularly high infection risks in a clinical setting, where patients and health care providers are placed in the same room. Due to these risks, patients are encouraged to avoid clinics and instead use Telemedicine for safer consultations and diagnoses. In March, the Office for Civil Rights (OCR) at the U.S. Department for Health and Human Services (HHS) issued a notice titled Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency (the ‘Notification’). The Notification relaxes the enforcement of privacy and security safeguards established by the Health Insurance Portability and Accountability Act (HIPAA) until further notice, in order to facilitate the transition to telehealth services for the broader purpose of promoting public health during the pandemic. Specifically, covered healthcare providers can use telehealth to provide all services that, in their professional judgment, they believe can be provided through telehealth. If providers make good faith efforts to provide the most timely and accessible care possible, they will not be subject to penalties for breaching the HIPAA Privacy, Security, and Breach Notification Rules. This paper examines the implications of the Notification on patients’ health information privacy. It recommends that patients should undertake a careful reading of provider privacy policies to make sure their protected health information (PHI) is not at risk before switching to telehealth consultation. Acknowledging the limitations of patient self-protection from bad privacy practices when in need for medical treatment during pandemic, the paper proposes that consumers’ data privacy should be protected through one of two alternative regulatory interventions: the FTC’s authority under §5, or HIPAA’s business associates agreements.
Small bowel obstruction secondary to obturator hernia in an elderly female
Authors: Devarakonda Aneela , Gupta-Kaistha Aarav , Kulkarni Nikhil
Published: September 2020

Obturator hernia is an extremely rare type of pelvic hernia with relatively high mortality and morbidity due to delayed diagnosis. Most cases present with acute intestinal obstruction and typically affect elderly, emaciated females. A high index of suspicion is required for early diagnosis and timely surgical intervention. We present a rare case of an 81-year-old female who was initially discharged from the emergency department due to nonspecific symptoms. She represented with clinical features of bowel obstruction and was diagnosed preoperatively with computed tomography imaging identifying a left-sided obturator hernia with a loop of bowel extending through the obturator canal. She was taken to theater for lower midline laparotomy and repair of obturator hernia. Although many cases are identified intraoperatively, we will discuss preoperative means of diagnosis of obturator hernia from examination findings to imaging diagnosis.
Sarcomatoid malignant peritoneal mesothelioma presenting as a localized mesenteric tumor with no previous asbestos exposure
Authors: Notue Yves Alain , Mbessoh Ulrich Igor , Nganwa Grace , Pambe Judith Ngo , Mefire Alain Chichom , Moifo Boniface , Sando Zacharie
Published: September 2020

Sarcomatoid malignant peritoneal mesothelioma is the rarest and most lethal form of peritoneal mesothelioma. We present the case of a sarcomatoid malignant peritoneal mesothelioma presenting as a localized mesenteric tumor in a 54-year-old female with no previous asbestos exposure. This clinical presentation is extremely rare and is the first documented in Cameroon.
The HD-Zip IV transcription factor SlHDZIV8 controls multicellular trichome morphology by regulating the expression ofHairless-2
Authors: Xie Qingmin , Gao Yanna , Li Jing , Yang Qihong , Qu Xiaolu , Li Hanxia , Zhang Junhong , Wang Taotao , Ye Zhibiao , Yang Changxian
Published: September 2020

Trichomes are specialized epidermal appendages that serve as excellent models to study cell morphogenesis. Although the molecular mechanism underlying trichome morphogenesis in Arabidopsis has been well characterized, most of the regulators essential for multicellular trichome morphology remain unknown in tomato. In this study, we determined that the recessive hairless-2 (hl-2) mutation in tomato causes severe distortion of all trichome types, along with increased stem fragility. Using map-based cloning, we found that the hl-2 phenotype was associated with a 100 bp insertion in the coding region of Nck-associated protein 1, a component of the SCAR/WAVE complex. Direct protein-protein interaction was detected between Hl-2 and Hl (SRA1, specifically Rac1-associated protein) using yeast two-hybrid and co-immunoprecipitation assays, suggesting that these proteins may work together during trichome formation. In addition, knock-down of a HD-Zip IV transcription factor, HDZIPIV8, distorted trichomes similar to the hl-2 mutant. HDZIPIV8 regulates the expression of Hl-2 by binding to the L1-box in the Hl-2 promoter region, and is involved in organizing actin filaments. The brittleness of hl-2 stems was found to result from decreased cellulose content. Taken together, these findings suggest that the Hl-2 gene plays an important role in controlling multicellular trichome morphogenesis and mechanical properties of stems in tomato plants.
Unique contributions of chlorophyll and nitrogen to predict crop photosynthetic capacity from leaf spectroscopy
Authors: Wang Sheng , Guan Kaiyu , Wang Zhihui , Ainsworth Elizabeth A , Zheng Ting , Townsend Philip A , Li Kaiyuan , Moller Christopher , Wu Genghong , Jiang Chongya
Published: September 2020

The photosynthetic capacity or the CO2-saturated photosynthetic rate (Vmax), chlorophyll, and nitrogen are closely linked leaf traits that determine C4 crop photosynthesis and yield. Accurate, timely, rapid, and non-destructive approaches to predict leaf photosynthetic traits from hyperspectral reflectance are urgently needed for high-throughput crop monitoring to ensure food and bioenergy security. Therefore, this study thoroughly evaluated the state-of-the-art physically based radiative transfer models (RTMs), data-driven partial least squares regression (PLSR), and generalized PLSR (gPLSR) models to estimate leaf traits from leaf-clip hyperspectral reflectance, which was collected from maize (Zea mays L.) bioenergy plots with diverse genotypes, growth stages, treatments with nitrogen fertilizers, and ozone stresses in three growing seasons. The results show that leaf RTMs considering bidirectional effects can give accurate estimates of chlorophyll content (Pearson correlation r=0.95), while gPLSR enabled retrieval of leaf nitrogen concentration (r=0.85). Using PLSR with field measurements for training, the cross-validation indicates that Vmax can be well predicted from spectra (r=0.81). The integration of chlorophyll content (strongly related to visible spectra) and nitrogen concentration (linked to shortwave infrared signals) can provide better predictions of Vmax (r=0.71) than only using either chlorophyll or nitrogen individually. This study highlights that leaf chlorophyll content and nitrogen concentration have key and unique contributions to Vmax prediction.
Transcriptome analysis and association mapping reveal the genetic regulatory network response to cadmium stress in Populus tomentosa
Authors: Quan Mingyang , Liu Xin , Xiao Liang , Chen Panfei , Song Fangyuan , Lu Wenjie , Song Yuepeng , Zhang Deqiang
Published: September 2020

Long non-coding RNAs (lncRNAs) play essential roles in plant abiotic stress responses, but the response of lncRNA-mediated genetic networks to cadmium (Cd) treatment remain elusive in trees, the promising candidates for phytoremediation of Cd contamination. We identified 172 Cd-responsive lncRNAs and 295 differentially expressed target genes in the leaves of Cd-treated Populus tomentosa. Functional annotation revealed that these lncRNAs were involved in various processes, including photosynthesis, hormone regulation, and phenylalanine metabolism. Association studies identified 78 significant associations, representing 14 Cd-responsive lncRNAs and 28 target genes for photosynthetic and leaf physiological traits. Epistasis uncovered 83 pairwise interactions among these traits, revealing Cd-responsive lncRNA-mediated genetic networks for photosynthesis and leaf physiology in P. tomentosa. We focused on the roles of two Cd-responsive lncRNA–gene pairs, MSTRG.22608.1–PtoMYB73 and MSTRG.5634.1–PtoMYB27, in Cd tolerance of Populus, and detected insertions/deletions within lncRNAs as polymorphisms driving target gene expression. Genotype analysis of lncRNAs and heterologous overexpression of PtoMYB73 and PtoMYB27 in Arabidopsis indicated their effects on enhancing Cd tolerance, photosynthetic rate, and leaf growth, and the potential interaction mechanisms of PtoMYB73 with abiotic stresses. Our study identifies the genetic basis for the response of Populus to Cd treatment, facilitating genetic improvement of Cd tolerance in trees.
Evaluation of probabilistic photometric redshift estimation approaches for The Rubin Observatory Legacy Survey of Space and Time (LSST)
Authors: Schmidt S J , Malz A I , Soo J Y H , Almosallam I A , Brescia M , Cavuoti S , Cohen-Tanugi J , Connolly A J , DeRose J , Freeman P E , Graham M L , Iyer K G , Jarvis M J , Kalmbach J B , Kovacs E , Lee A B , Longo G , Morrison C B , Newman J A , Nourbakhsh E , Nuss E , Pospisil T , Tranin H , Wechsler R H , Zhou R , Izbicki R
Published: September 2020

Many scientific investigations of photometric galaxy surveys require redshift estimates, whose uncertainty properties are best encapsulated by photometric redshift (photo-z) posterior probability density functions (PDFs). A plethora of photo-z PDF estimation methodologies abound, producing discrepant results with no consensus on a preferred approach. We present the results of a comprehensive experiment comparing twelve photo-z algorithms applied to mock data produced forLarge Synoptic Survey Telescope The Rubin Observatory Legacy Survey of Space and Time (lsst) Dark Energy Science Collaboration (desc). By supplying perfect prior information, in the form of the complete template library and a representative training set as inputs to each code, we demonstrate the impact of the assumptions underlying each technique on the output photo-z PDFs. In the absence of a notion of true, unbiased photo-z PDFs, we evaluate and interpret multiple metrics of the ensemble properties of the derived photo-z PDFs as well as traditional reductions to photo-z point estimates. We report systematic biases and overall over/under-breadth of the photo-z PDFs of many popular codes, which may indicate avenues for improvement in the algorithms or implementations. Furthermore, we raise attention to the limitations of established metrics for assessing photo-z PDF accuracy; though we identify the conditional density estimate (CDE) loss as a promising metric of photo-z PDF performance in the case where true redshifts are available but true photo-z PDFs are not, we emphasize the need for science-specific performance metrics.
The R136 star cluster dissected with Hubble Space Telescope/STIS – II. Physical properties of the most massive stars in R136
Authors: Bestenlehner Joachim M , Crowther Paul A , Caballero-Nieves Saida M , Schneider Fabian R N , Simón-Díaz Sergio , Brands Sarah A , de Koter Alex , Gräfener Götz , Herrero Artemio , Langer Norbert , Lennon Daniel J , Maíz Apellániz Jesus , Puls Joachim , Vink Jorick S
Published: September 2020

We present an optical analysis of 55 members of R136, the central cluster in the Tarantula Nebula of the Large Magellanic Cloud. Our sample was observed with STIS aboard the Hubble Space Telescope, is complete down to about 40 M⊙, and includes seven very massive stars with masses over 100 M⊙. We performed a spectroscopic analysis to derive their physical properties. Using evolutionary models, we find that the initial mass function of massive stars in R136 is suggestive of being top-heavy with a power-law exponent γ ≈ 2 ± 0.3, but steeper exponents cannot be excluded. The age of R136 lies between 1 and 2 Myr with a median age of around 1.6 Myr. Stars more luminous than log L/L⊙ = 6.3 are helium enriched and their evolution is dominated by mass-loss, but rotational mixing or some other form of mixing could be still required to explain the helium composition at the surface. Stars more massive than 40 M⊙ have larger spectroscopic than evolutionary masses. The slope of the wind–luminosity relation assuming unclumped stellar winds is 2.41 ± 0.13 which is steeper than usually obtained (∼1.8). The ionizing ($\log Q_0\, [{\rm ph/s}] = 51.4$) and mechanical ($\log L_{\rm SW}\, [{\rm erg/s}] = 39.1$) output of R136 is dominated by the most massive stars ($\gt 100\, \mathrm{ M}_{\odot }$). R136 contributes around a quarter of the ionizing flux and around a fifth of the mechanical feedback to the overall budget of the Tarantula Nebula. For a census of massive stars of the Tarantula Nebula region, we combined our results with the VLT-FLAMES Tarantula Survey plus other spectroscopic studies. We observe a lack of evolved Wolf–Rayet stars and luminous blue and red supergiants.
Polyphenism of a Novel Trait Integrated Rapidly Evolving Genes into Ancestrally Plastic Networks
Authors: Casasa Sofia , Biddle Joseph F , Koutsovoulos Georgios D , Ragsdale Erik J
Published: September 2020

Developmental polyphenism, the ability to switch between phenotypes in response to environmental variation, involves the alternating activation of environmentally sensitive genes. Consequently, to understand how a polyphenic response evolves requires a comparative analysis of the components that make up environmentally sensitive networks. Here, we inferred coexpression networks for a morphological polyphenism, the feeding-structure dimorphism of the nematode Pristionchus pacificus. In this species, individuals produce alternative forms of a novel trait—moveable teeth, which in one morph enable predatory feeding—in response to environmental cues. To identify the origins of polyphenism network components, we independently inferred coexpression modules for more conserved transcriptional responses, including in an ancestrally nonpolyphenic nematode species. Further, through genome-wide analyses of these components across the nematode family (Diplogastridae) in which the polyphenism arose, we reconstructed how network components have changed. To achieve this, we assembled and resolved the phylogenetic context for five genomes of species representing the breadth of Diplogastridae and a hypothesized outgroup. We found that gene networks instructing alternative forms arose from ancestral plastic responses to environment, specifically starvation-induced metabolism and the formation of a conserved diapause (dauer) stage. Moreover, loci from rapidly evolving gene families were integrated into these networks with higher connectivity than throughout the rest of the P. pacificus transcriptome. In summary, we show that the modular regulatory outputs of a polyphenic response evolved through the integration of conserved plastic responses into networks with genes of high evolutionary turnover.
Elements at the 5′ end of Xist harbor SPEN-independent transcriptional antiterminator activity
Authors: Trotman Jackson B , Lee David M , Cherney Rachel E , Kim Susan O , Inoue Kaoru , Schertzer Megan D , Bischoff Steven R , Cowley Dale O , Calabrese J Mauro
Published: September 2020

The Xist lncRNA requires Repeat A, a conserved RNA element located in its 5′ end, to induce gene silencing during X-chromosome inactivation. Intriguingly, Repeat A is also required for production of Xist. While silencing by Repeat A requires the protein SPEN, how Repeat A promotes Xist production remains unclear. We report that in mouse embryonic stem cells, expression of a transgene comprising the first two kilobases of Xist (Xist-2kb) causes transcriptional readthrough of downstream polyadenylation sequences. Readthrough required Repeat A and the ∼750 nucleotides downstream, did not require SPEN, and was attenuated by splicing. Despite associating with SPEN and chromatin, Xist-2kb did not robustly silence transcription, whereas a 5.5-kb Xist transgene robustly silenced transcription and read through its polyadenylation sequence. Longer, spliced Xist transgenes also induced robust silencing yet terminated efficiently. Thus, in contexts examined here, Xist requires sequence elements beyond its first two kilobases to robustly silence transcription, and the 5′ end of Xist harbors SPEN-independent transcriptional antiterminator activity that can repress proximal cleavage and polyadenylation. In endogenous contexts, this antiterminator activity may help produce full-length Xist RNA while rendering the Xist locus resistant to silencing by the same repressive complexes that the lncRNA recruits to other genes.
Exploring sleep disturbance among adults with primary or secondary malignant brain tumors and their caregivers
Authors: Jeon Megan S , Dhillon Haryana M , Koh Eng-Siew , Nowak Anna K , Hovey Elizabeth , Descallar Joseph , Miller Lisa , Marshall Nathaniel S , Agar Meera R
Published: September 2020

Background

Emerging evidence supports the clinical impact of sleep disturbance (SD) on cancer patients. This study aimed to determine the prevalence and predictors of SD in people with malignant brain tumors and caregivers, and explore any relationship between the patient-caregiver dyad’s sleep.

Methods

Eighty-one adults with primary malignant (91%) or metastatic (9%) brain tumors and their family caregivers (n = 44) completed a series of self-report questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index, and the drowsiness item of The MD Anderson Symptom Inventory-Brain Tumor in an Australian ambulatory neuro-oncology setting. Participants were grouped by the PSQI cutoff (SD > 5), and binary logistic regression analyses were performed to identify risk factors.

Results

Of patients, 53% reported SD and 15% of those clinically significant insomnia, and 27% reported moderate to severe daytime drowsiness. Whereas anxiety, depression, fatigue, pain, neurocognitive symptoms, and antiemetic use were higher in patients with SD, fatigue and KPS were strong predictors of SD. In caregivers, 55% reported poor sleep and 13% clinical insomnia. Anxiety, caregiver burden, and comorbid illness were significantly associated with caregivers’ SD. The individual’s SD did not affect the chance of the other member of the patient-caregiver dyad experiencing SD.

Conclusions

More than half the sample had sleep disturbance, which was linked to many concomitant symptoms, such as fatigue in patients and anxiety in caregivers, potentially contributing to distress and functional impairment. Understanding underlying mechanisms of SD, the potential use of these clinical predictors in care settings, and options for management is warranted.
A functional MRI study of presurgical cognitive deficits in glioma patients
Authors: Schouwenaars Irena T , de Dreu Miek J , Rutten Geert-Jan M , Ramsey Nick F , Jansma Johan M
Published: September 2020

Background

The main goal of this functional MRI (fMRI) study was to examine whether cognitive deficits in glioma patients prior to treatment are associated with abnormal brain activity in either the central executive network (CEN) or default mode network (DMN).

Methods

Forty-six glioma patients, and 23 group-matched healthy controls (HCs) participated in this fMRI experiment, performing an N-back task. Additionally, cognitive profiles of patients were evaluated outside the scanner. A region of interest–based analysis was used to compare brain activity in CEN and DMN between groups. Post hoc analyses were performed to evaluate differences between low-grade glioma (LGG) and high-grade glioma (HGG) patients.

Results

In-scanner performance was lower in glioma patients compared to HCs. Neuropsychological testing indicated cognitive impairment in LGG as well as HGG patients. fMRI results revealed normal CEN activation in glioma patients, whereas patients showed reduced DMN deactivation compared to HCs. Brain activity levels did not differ between LGG and HGG patients.

Conclusions

Our study suggests that cognitive deficits in glioma patients prior to treatment are associated with reduced responsiveness of the DMN, but not with abnormal CEN activation. These results suggest that cognitive deficits in glioma patients reflect a reduced capacity to achieve a brain state necessary for normal cognitive performance, rather than abnormal functioning of executive brain regions. Solely focusing on increases in brain activity may well be insufficient if we want to understand the underlying brain mechanism of cognitive impairments in patients, as our results indicate the importance of assessing deactivation.
The Causal Effect of Opioid Agonist Treatment on Adherence to Direct-Acting Antiviral Treatment for Hepatitis C Virus
Authors: Min Jeong E , Pearce Lindsay A , Janjua Naveed Z , Ti Lianping , Nosyk Bohdan
Published: September 2020

Background

Opioid agonist treatment (OAT) supports adherence in medication regimens for other concurrent conditions. However, sparse evidence is available on its effect on promoting retention to direct-acting antivirals (DAAs) for people with opioid use disorder (PWOUD) with concurrent hepatitis C virus (HCV). Our objective was to determine the causal impact of OAT exposure on DAA adherence among HCV-positive PWOUD.

Methods

We executed a retrospective study using linked population-level data for British Columbia, Canada (January 1996–September 2018). We estimated the effect of OAT on DAA adherence using generalized estimating equations (GEEs) and marginal structural modeling (MSM) for time-varying confounding. The primary outcome was 85% DAA adherence (minimum 6 of 7 days).

Results

We included 2820 HCV-positive PWOUD who initiated a DAA regimen (32.6% female, 83.9% previously accessing OAT), with 2410 (95% among uncensored episodes) completing the regimen. The GEE-adjusted odds ratio of DAA adherence after OAT exposure was 1.05 (0.89–1.23), whereas the MSM-adjusted odds ratio was 0.97 (0.78–1.22).

Conclusions

In a setting with universal healthcare and widespread access to OAT and DAA treatment, DAA regimen completion rates were high regardless of OAT, and engagement in OAT did not increase DAA adherence. Nonengagement in OAT should not preclude DAA treatment for PWOUD.
Climate change and monetary policy: issues for policy design and modelling
Authors: McKibbin Warwick J , Morris Adele C , Wilcoxen Peter J , Panton Augustus J
Published: September 2020

This paper explores the interaction of monetary policy and climate change as they jointly influence macroeconomic outcomes, connecting policy and outcomes in each realm to the implications of the other. It also explores the nature of the macroeconomic model that would be required to explore the links between monetary policy and climate policy. The paper has four parts. First, it reviews the relevant macroeconomic outcomes of emissions mitigation policy and climatic disruption, exploring how negative supply shocks can affect central banks’ ability to forecast and manage inflation. Second, the paper reviews basic approaches to monetary policy, including inflation and output targeting, and other responsibilities that may fall to central bankers. Third, we bring together the two sets of issues to consider the appropriate monetary framework in a carbon-constrained and climatically disrupted world and to highlight the climate policy frameworks that can make monetary policies more efficient and effective. We then summarize the nature of the macroeconomic modelling framework that is needed to better analyse climate and monetary policy interactions. We conclude that policy responses to climate change can have important implications for monetary policy and vice versa and that, in light of the urgency of ambitious climate action, these policy spheres should be brought together more explicitly and more appropriate macroeconomic modelling frameworks developed.
Growth and ingestion rates of the freshwater jellyfish Craspedacusta sowerbii
Authors: Marchessaux Guillaume , Bejean Mickaël
Published: September 2020

The invasive freshwater hydromedusa Craspedacusta sowerbii Lankester, 1880 (phylum Cnidaria, class Hydrozoa, family Olindiidae) is native from East Asia but for more than 20 years, reports of this species have been increasing in Europe, North America, and Australia. Due to the sporadic presence of the medusa stage and difficulties in the sample polyp stage, there is a lack of data on the physiological parameters of C. sowerbii and its potential impact. We present data on growth and ingestion rates of the medusa stage measured at 29°C, temperature at which polyps are maintained in the Cinéaqua Aquarium (Paris). Medusa growth increased from 0.60 ± 0.08 to 9.0 ± 2.1 mm (mean: 0.28 ± 0.26 mm d−1), and gonads appeared after 11.5 ± 3.0 days. Ingestion rates increased significantly from 28 ± 16 prey ind−1 d−1 (<1 mm) to 442 ± 170 prey ind−1 d−1 (>7 mm).
Dry Needling of a Healthy Rat Achilles Tendon Increases Its Gene Expressions: A Pilot Study
Authors: Calderón-Díez Laura , Sánchez-Sánchez José Luis , Herrero-Turrión Javier , Cleland Joshua , Arias-Buría José L , Fernández-de-las-Peñas César
Published: September 2020

Background

Tendon dry needling is a potential treatment for tendinopathies. Several hypotheses have been proposed to explain its underlying mechanisms. No studies (to the best of our knowledge) have investigated changes in gene expression.

Objective

To investigate histological and gene expression changes after the application of dry needling to the healthy Achilles tendons of rats.

Methods

Six Sprague-Dawley male rats were randomly divided into two groups: no intervention or dry needling. Dry needling consisted of three sessions (once per week) to the Achilles tendon. Molecular expression of several genes involved in tendon repair and remodeling (e.g., Cox2, Mmp2, Mmp9, Col1a1, Col3a1, Vefg, and Scx) was assessed 7 days after the last needling session (day 28) or 28 days after for the no-intervention group. Histological tissue changes were determined with hematoxylin-eosin analyses.

Results

The hematoxylin-eosin–stained images revealed no substantial differences in collagen structure or the presence of inflammatory cells between the dry needling and no-intervention groups. A significant increase in the molecular expression of Cox2, Mmp2, Col3a1, and Scx genes was observed in Achilles tendons treated with dry needling when compared with the no-intervention group.

Conclusion

This animal pilot study found that the application of dry needling to the healthy Achilles tendons of rats is able to increase the expression of genes associated with collagen regeneration and tissue remodeling of the extracellular matrix with no further histological damage to the tendon.
Michigan Initiative for Anterior Cruciate Ligament Rehabilitation (MiACLR): A Protocol for a Randomized Clinical Trial
Authors: Rodriguez Kazandra , Garcia Steven A , Spino Cathie , Lepley Lindsey K , Pang Yuxi , Wojtys Edward , Bedi Asheesh , Angelini Mike , Ruffino Bethany , Bolley Tyler , Block Corey , Kellum Jessica , Swartout Andrew , Palmieri-Smith Riann M
Published: September 2020

Objective

Restoring quadriceps muscle strength following anterior cruciate ligament reconstruction (ACLR) may prevent the posttraumatic osteoarthritis that affects over 50% of knees with ACLR. However, a fundamental gap exists in our understanding of how to maximize muscle strength through rehabilitation. Neurological deficits and muscle atrophy are 2 of the leading mechanisms of muscle weakness after ACLR. High-intensity neuromuscular electrical stimulation (NMES) and eccentric exercise (ECC) have been shown to independently target these mechanisms. If delivered in succession, NMES and then ECC may be able to significantly improve strength recovery. The objectives of this study were to evaluate the ability of NMES combined with ECC to restore quadriceps strength and biomechanical symmetry and maintain cartilage health at 9 and 18 months after ACLR.

Methods

This study is a randomized, double-blind, placebo-controlled, single-center clinical trial conducted at the University of Michigan. A total of 112 participants between the ages of 14 and 45 years and with an anterior cruciate ligament rupture will be included. Participants will be randomly assigned 1:1 to NMES combined with ECC or NMES placebo combined with ECC placebo. NMES or NMES placebo will be delivered 2 times per week for 8 weeks beginning 10 to 14 days postoperatively and will be directly followed by 8 weeks of ECC or ECC placebo delivered 2 times per week. The co-primary endpoints are change from baseline to 9 months and change from baseline to 18 months after ACLR in isokinetic quadriceps strength symmetry. Secondary outcome measures include isometric quadriceps strength, quadriceps activation, quadriceps muscle morphology (cross-sectional area), knee biomechanics (sagittal plane knee angles and moments), indexes of patient-reported function, and cartilage health (T1ρ and T2 relaxation time mapping on magnetic resonance imaging).

Impact

The findings from this study might identify an intervention capable of targeting the lingering quadriceps weakness after ACLR and in turn prevent deterioration in cartilage health after ACLR, thereby potentially improving function in this patient population.
Moduli Spaces of Generalized Hyperpolygons
Authors: Rayan Steven , Schaposnik Laura P
Published: September 2020

We introduce the notion of generalized hyperpolygon, which arises as a representation, in the sense of Nakajima, of a comet-shaped quiver. We identify these representations with rigid geometric figures, namely pairs of polygons: one in the Lie algebra of a compact group and the other in its complexification. To such data, we associate an explicit meromorphic Higgs bundle on a genus-g Riemann surface, where g is the number of loops in the comet, thereby embedding the Nakajima quiver variety into a Hitchin system on a punctured genus-g Riemann surface (generally with positive codimension). We show that, under certain assumptions on flag types, the space of generalized hyperpolygons admits the structure of a completely integrable Hamiltonian system of Gelfand–Tsetlin type, inherited from the reduction of partial flag varieties. In the case where all flags are complete, we present the Hamiltonians explicitly. We also remark upon the discretization of the Hitchin equations given by hyperpolygons, the construction of triple branes (in the sense of Kapustin–Witten mirror symmetry), and dualities between tame and wild Hitchin systems (in the sense of Painlevé transcendents).
Predicting circadian misalignment with wearable technology: validation of wrist-worn actigraphy and photometry in night shift workers
Authors: Cheng Philip , Walch Olivia , Huang Yitong , Mayer Caleb , Sagong Chaewon , Cuamatzi Castelan Andrea , Burgess Helen J , Roth Thomas , Forger Daniel B , Drake Christopher L
Published: September 2020

Study Objectives

A critical barrier to successful treatment of circadian misalignment in shift workers is determining circadian phase in a clinical or field setting. Light and movement data collected passively from wrist actigraphy can generate predictions of circadian phase via mathematical models; however, these models have largely been tested in non-shift working adults. This study tested the feasibility and accuracy of actigraphy in predicting dim light melatonin onset (DLMO) in fixed night shift workers.

Methods

A sample of 45 night shift workers wore wrist actigraphs before completing DLMO in the laboratory (17.0 days ± 10.3 SD). DLMO was assessed via 24 hourly saliva samples in dim light (<10 lux). Data from actigraphy were provided as input to a mathematical model to generate predictions of circadian phase. Agreement was assessed and compared to average sleep timing on non-workdays as a proxy of DLMO. Model code and an open-source prototype assessment tool are available (www.predictDLMO.com).

Results

Model predictions of DLMO showed good concordance with in-lab DLMO, with Lin’s concordance coefficient of 0.70, which was twice as high as agreement using average sleep timing as a proxy of DLMO. The absolute mean error of the predictions was 2.88 h, with 76% and 91% of the predictions falling with 2 and 4 h, respectively.

Conclusion

This study is the first to demonstrate the use of wrist actigraphy-based estimates of circadian phase as a clinically useful and valid alternative to in-lab measurement of DLMO in fixed night shift workers. Future research should explore how additional predictors may impact accuracy.
Evaluation of hybrid rye on growth performance, carcass traits, and efficiency of net energy utilization in finishing steers
Authors: Rusche Warren C , Walker Julie Ann , Sexton Peter , Brattain Rebecca S , Smith Zachary K
Published: September 2020

Crossbred beef steers with a high percentage of Angus ancestry [n = 240, initial shrunk body weight (BW), 404 ± 18.5 kg] were used in a 117-d feedlot experiment to evaluate the effect of hybrid rye (Rye; KWS Cereals USA, LLC, Champaign, IL) as a replacement for dry-rolled corn (DRC) on growth performance, carcass traits, and comparative net energy (NE) value in diets fed to finishing steers. Rye from a single hybrid (KWS Bono) with an ergot alkaloid concentration of 392 ppb was processed with a roller mill to a processing index (PI) of 78.8 ± 2.29. Four treatments were used in a completely randomized design (n = 6 pens/treatment; 10 steers/pen), where DRC (PI = 86.9 ± 4.19) was replaced by varying proportions of Rye [DRC:Rye, dry matter (DM) basis (60:0), (40:20), (20:40), and (0:60)]. Liver abscess scores and carcass characteristics were collected at the abattoir. Carcass-adjusted performance was calculated from hot carcass weight (HCW)/0.625. Performance-adjusted NE was calculated using carcass-adjusted average daily gain (ADG), DM intake (DMI), and mean equivalent shrunk BW with the comparative NE values for rye calculated using the replacement technique. Data were analyzed using the GLIMMIX procedure of SAS 9.4 (SAS Inst. Inc., Cary, NC) with pen as the experimental unit. Treatment effects were tested using linear and quadratic contrasts, as well as between diets with and without Rye. Replacing DRC with Rye linearly decreased (P ≤ 0.01) carcass-adjusted final BW, ADG, DMI, and gain:feed (G:F). Feeding rye linearly decreased HCW and longissimus muscle area (P ≤ 0.04). Distributions of liver scores and USDA grades for quality and yield were unaffected by treatment (P ≥ 0.09). Estimated replacement NE for maintenance (NEm) and gain (NEg) values for rye, when included at 60% of diet DM, were 1.90 and 1.25 Mcal/kg, respectively. Rye can be a suitable feed ingredient in finishing diets for feedlot steers. Estimated replacement values of Rye when fed at 60% of diet DM closely agreed with current tabular standards but, when included at 20% of diet DM, estimated NEm and NEg values of Rye were increased 9.5% and 12.8%, respectively. Net energy value of Rye for gain is approximately 84% compared to DRC; thus, the complete replacement of DRC with Rye depressed DMI, ADG, G:F, and carcass weight.
A cross-sectional study comparing case scenarios and record review to measure quality of Integrated Community Case Management care in western Uganda
Authors: Miller James S , Mbusa Rapheal Kisolhu , Baguma Stephen , Patel Palka , Matte Michael , Ntaro Moses , Wesuta Andrew Christopher , Mumbere Nobert , Bwambale Shem , Mian-McCarthy Sara , Kenney Jessica , Guiles Daniel , Mulogo Edgar Mugema , Stone Geren S
Published: September 2020

Background

In Integrated Community Case Management (iCCM), village health workers (VHW) assess and treat malaria, pneumonia and diarrhea using a clinical algorithm. Study objectives included: 1) Compare VHWs’ performance on case scenario exercises to record review data; 2) assess impact of formal education on performance in the case scenario exercises.

Methods

36 VHWs in Bugoye Subcounty, Uganda completed the case scenarios exercise, which included video case scenarios and brief oral case vignettes, between July 2017 and February 2018. We obtained clinical records for all iCCM encounters in the same time period.

Results

In the video case scenarios, 45% of mock patients received all correct management steps (including all recommended education), while 94% received all critical management steps. Based on the level of data available from record review, 74% of patients in the record review dataset received overall correct management compared to 94% in the video case scenarios. In the case scenarios, VHWs with primary school education performed similarly to those with some or all secondary school education.

Conclusions

The case scenarios produced higher estimates of quality of care than record review. VHWs often omitted recommended health education topics in the case scenarios. Level of formal education did not appear to influence performance in the case scenarios.
Dental enamel structure in long-nosed armadillos (Xenarthra:Dasypus) and its evolutionary implications
Authors: Ciancio Martín R , Vieytes Emma C , Castro Mariela C , Carlini Alfredo A
Published: September 2020

Most xenarthrans have a reduced and simplified dentition that lacks enamel. However, the presence of prismatic enamel has been recorded in the Eocene armadillos Utaetus buccatus (Euphractinae) and Astegotherium dichotomus (Astegotheriini). Among extant xenarthrans, the occurrence of enamel has been recognized only in the long-nosed armadillo, Dasypus novemcinctus (Dasypodinae), but its microstructure has never been described. In this contribution, we analyse the enamel microstructure in deciduous and permanent teeth of four Dasypus species. In deciduous molariform teeth of some species, we identify an apical cap of vestigial enamel (without crystalline structure), interpreted as an amorphous ameloblastic secretion. In permanent teeth, a thin layer of true enamel is found in the apical portion of unworn molariforms. The enamel is prismatic in D. novemcinctus, but in Dasypus hybridus, Dasypus sabanicola and Dasypus punctatus it is prismless. Taking into account the Eocene species of armadillos, the ancestral condition of enamel in cingulates could have been more complex (as in other placentals) and undergone progressive reduction, as shown in the Dasypus lineage. In light of previous genetic and developmental studies, we review and briefly discuss the processes that can account for the reduction/loss of enamel in extant and extinct armadillos. The retention of enamel and the fact that this genus is the only living xenarthran with two functional generations of teeth support the early divergence of the Dasypus lineage among living cingulates. This is in agreement with morphological and molecular analyses.
Ethical Dilemmas for Nursing Students and Faculty: In Their Own Voices
Authors: Feeg Veronica D. , Mancino Diane J. , Rushton Cynda Hylton , Waligora Mendez Kyra J. , Baierlein Jennifer
Published: September 2020

AIM

The aim of this national study was to explore student and faculty personal experiences of ethical dilemmas in nursing education and clinical practice.

BACKGROUND

Nurses encounter complex ethical dilemmas in practice that can lead to moral distress when they cannot “do the right thing” because of external constraints.

METHOD

A mixed-methods study via online survey was conducted on senior nursing student members and faculty advisors of the National Student Nurses Association. Over 1,600 students and 600 faculty answered a “two-minute survey” with the question: “Please describe an ethical dilemma you have experienced.”

RESULTS

Descriptive statistics demonstrated a difference in student and faculty reports about the ethics content they received. The qualitative results from constant comparison of open-ended questions also supported differences in themes from student and faculty perspectives.

CONCLUSION

This study supports that students and faculty voice their concerns with different ethical dilemmas in their nursing education experiences.
New classification criteria for systemic lupus erythematosus
Authors: Aringer Martin , Petri Michelle
Published: September 2020

Purpose of review

To compare the recently published European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for SLE with the Systemic Lupus International Collaborating Centers (SLICC) criteria and the earlier ACR criteria, focusing on their key concepts.

Recent findings

Although the SLICC criteria introduced numbers of new criteria items, the new EULAR/ACR criteria added only noninfectious fever, based on an early SLE cohort study and an SLE patient survey, and condensed hematological, mucocutaneous and neurological items. Whereas the SLICC criteria maintained the overall structure familiar from the ACR criteria, the EULAR /ACR criteria use antinuclear antibodies (ANA) as an obligatory entry criterion, have weighted criteria and group these in domains. Where the SLICC criteria greatly increased sensitivity, losing some specificity, the EULAR/ACR criteria increased specificity again, for excellent classification criteria performance.

Despite differences in structure and statistical performance, the EULAR/ACR and SLICC criteria agree on the importance of both immunological and clinical findings, on the high impact of lupus nephritis by histology, and on most clinical items.
Hypoalbuminemia Increased the Length of Stay in the Treatment of Postoperative Acute Surgical Site Infection in Spinal Surgery
Authors: Yamamoto Yusuke , Shigematsu Hideki , Iwata Eiichiro , Nakajima Hiroshi , Tanaka Masato , Okuda Akinori , Kawasaki Sachiko , Suga Yuma , Masuda Keisuke , Tanaka Yasuhito
Published: September 2020

Study Design.

Multicenter retrospective study.

Objective.

The aim of this study was to identify specific risk factors for increased length of stay (LOS) in the management of acute surgical site infection (SSI) following spinal surgery.

Summary of Background Data.

Postoperative SSI is a serious complication of spinal surgery and is known to be associated with increased LOS and additional cost. Although many risk factors contribute to the development of SSI following spinal surgery, little is known about risk factors associated with the treatment of SSI that contribute to increased LOS.

Methods.

Patients at two institutions experiencing deep SSI following spinal surgery between January 2009 and December 2016 were identified. The patients were divided into two groups depending upon the median LOS attributable to SSI. The effects of patient characteristics, comorbidities, disease history, and invasiveness of the elective surgery on the risk of increased LOS were determined using univariate analyses and multivariate logistic regression.

Results.

Of the 1656 spinal surgery cases, 40 (2.4%) experienced deep SSI. The median LOS was 67 days. Multivariate logistic regression analysis revealed that hypoalbuminemia during hospitalization was associated with increased LOS (odds ratio 0.042, confidence interval 0.005–0.342; P = 0.003). We determined the appropriate diagnostic cutoff of hypoalbuminemia during hospitalization using receiver-operating characteristic curves. A serum albumin level <3.1 g/dL (sensitivity, 86.4%; specificity, 75.0%; area under the curve, 0.84) was indicative of a longer hospital stay.

Conclusion.

Low serum albumin level during hospitalization was an independent risk factor for increased LOS in the treatment of SSI following spinal surgery. When the serum albumin level is <3.1 g/dL in patients with SSI, we should consider interventions aimed at correcting this hypoalbuminemia.

Level of Evidence: 4
Neurophysiologic Detection of Spinal Cord Ischemia During Anterior Vertebral Tethering
Authors: Clark John Patrick , Diab Mohammad
Published: September 2020

Study Design.

Case report.

Objective.

The aim of this study was to present how computed tomographic angiography (CTA) and intraoperative neurophysiologic monitoring (IONM) detect spinal cord ischemia during anterior spine surgery. These data directed expedient surgical and anesthetic interventions that restored IONM signals and prevented neurologic sequalæ.

Summary of Background Data.

Anterior vertebral tethering (AVT) is a fusionless surgical treatment of adolescent idiopathic scoliosis (AIS).

Methods.

AVT was performed on a skeletally immature patient with AIS. Preoperative CTA detailed location of the dominant radicular artery (DRA). Transcranial motor (tcMEP) and somatosensory (SEP) evoked potentials were monitored during operation.

Results.

There was significant decline in tcMEP, but not SEP, after compression of the DRA during cable tensioning of AVT. There was complete tcMEP recovery following release of instrumentation.

Conclusion.

This article identifies a rare but potentially catastrophic vascular hazard associated with anterior spine operation, including AVT. Sacrifice of multiple unilateral segmental vessels may overwhelm the capacity of collateral spinal cord perfusion to compensate for DRA blood supply. This vascular risk may be eliminated by identifying the DRA in order that it may be preserved during the procedure.

Level of Evidence: 5