bluuebunny/crossref_metadata_2025 huggingface dataset:
Accomplishments, Maintenance, and Relapse Prevention
Authors: Barlow David H. , Craske Michelle G.
Published: May 2022

This chapter highlights the process of evaluating one’s progress, maintaining progress, and relapse prevention. One can use the Your Practice Plan form to list all of the things to be practiced over the next few weeks in terms of breathing skills, thinking skills, facing agoraphobia situations, and facing symptoms. The chapter then looks at several ways to maintain the progress that one has made so far. It is helpful to anticipate the kinds of stressful events one may experience ahead of time and to prepare for them in a matter-of-fact way. A panic attack or resurgence of anxiety does not mean that one is getting worse or that one has lost all of the progress that one has gained. The most important thing to do when one has a flare-up of anxious symptoms is to repeat everything one has already done.
Facing Fear Out There
Authors: Craske Michelle G. , Barlow David H. , Woodard Lauren S.
Published: May 2022

This chapter focuses on the process of continuing to face one’s fear of physical symptoms, and learning to face fear of activities that produce physical symptoms as well as feared agoraphobia situations. Avoidance (both direct and indirect) is to be prevented. Usually, avoidance happens because of the continued mistaken belief that the symptoms are harmful. It is thus important to remember that the symptoms are not harmful. As with the symptom exercises, the use of medication has to be considered, particularly medications that either block all of one’s feelings or that one relies on to reduce one’s fear at the moment. In the end, it will be essential for one to face the symptoms and the anxiety directly, even at very intense levels, or when alone, or at times when already feeling anxious, or without the influence of benzodiazepines, because these are the conditions in which symptoms happen in normal day-to-day life, now or in the future.
Identification of four compounds from the Pharmakon library with antifungal activity against Candida auris and species of Cryptococcus
Authors: de Oliveira Haroldo C , Castelli Rafael F , Alves Lysangela R , Nosanchuk Joshua D , Salama Ehab A , Seleem Mohamed , Rodrigues Marcio L
Published: May 2022

There is an urgent need to develop novel antifungals. In this study, we screened 1600 compounds for antifungal activity against Cryptococcus neoformans and Candida auris. We evaluated 4 promising compounds against 24 additional isolates of Cr. neoformans, Ca. auris, Cr. deuterogattii, and Cr. gattii. The four compounds, dequalinium chloride (DQC), bleomycin sulfate (BMS), pentamidine isethionate salt (PIS), and clioquinol (CLQ), varied in their efficacy against these pathogens but were generally more effective against cryptococci. The compounds exerted their antifungal effect via multiple mechanisms, including interference with the capsule of cryptococci and induction of hyphal-like morphology in Ca. auris. Our results indicate that DQC, BMS, PIS, and CLQ represent potential prototypes for the future development of antifungals.

Lay Summary

Fungal infections can be lethal and the options to fight them are scarce. We tested 1600 molecules for their ability to control the growth of two important fungal pathogens, namely Candida auris and species of Cryptococcus. Four of these compounds showed promising antifungal activities.
Fundamental effective temperature measurements for eclipsing binary stars – III. SPIRou near-infrared spectroscopy and CHEOPS photometry of the benchmark G0V star EBLM J0113+31
Authors: Maxted P F L , Miller N J , Hoyer S , Adibekyan V , Sousa S G , Billot N , Fortier A , Simon A E , Cameron A Collier , Swayne M I , Gutermann P , Triaud A H M J , Southworth J , Alibert Y , Alonso R , Anglada G , BÃ¡rczy T , Navascues D Barrado y , Barros S C C , Baumjohann W , Beck M , Beck T , Benz W , Bonfils X , Brandeker A , Broeg C , Buder M , Cabrera J , Charnoz S , van Damme C Corral , Csizmadia Sz , Davies M B , Deleuil M , Delrez L , Demangeon O , Demory B-O , Ehrenreich D , Erikson A , Fossati L , Fridlund M , Gandolfi D , Gillon M , GÃ¼del M , Heng K , Leon J E HernÃ¡ndez , Isaak K G , Kiss L L , Laskar J , Etangs A Lecavelier des , Lendl M , Lovis C , Magrin D , Munari M , Nascimbeni V , Olofsson G , Ottensamer R , Pagano I , PallÃ© E , Peter G , Piotto G , Pollacco D , Queloz D , Ragazzoni R , Rando N , Rauer H , Ribas I , Santos N C , Scandariato G , SÃ©gransan D , Smith A M S , Steinberger M , Steller M , SzabÃ³ Gy M , Thomas N , Udry S , Van Grootel V , Walton N
Published: May 2022

EBLM J0113+31 is moderately bright (V=10.1), metal-poor ([Fe/H] ≈−0.3) G0V star with a much fainter M dwarf companion on a wide, eccentric orbit (=14.3 d). We have used near-infrared spectroscopy obtained with the SPIRou spectrograph to measure the semi-amplitude of the M dwarf’s spectroscopic orbit, and high-precision photometry of the eclipse and transit from the CHEOPS and TESS space missions to measure the geometry of this binary system. From the combined analysis of these data together with previously published observations we obtain the following model-independent masses and radii: M1 = 1.029 ± 0.025M⊙, M2 = 0.197 ± 0.003M⊙, R1 = 1.417 ± 0.014R⊙, R2 = 0.215 ± 0.002R⊙. Using R1 and the parallax from Gaia EDR3 we find that this star’s angular diameter is θ = 0.0745 ± 0.0007 mas. The apparent bolometric flux of the G0V star corrected for both extinction and the contribution from the M dwarf (<0.2 per cent) is ${\mathcal {F}}_{\oplus ,0} = (2.62\pm 0.05)\times 10^{-9}$ erg cm−2 s−1. Hence, this G0V star has an effective temperature Teff, 1 = 6124 K ± 40 K (rnd.) ± 10 K (sys.). EBLM J0113+31 is an ideal benchmark star that can be used for “end-to-end” tests of the stellar parameters measured by large-scale spectroscopic surveys, or stellar parameters derived from asteroseismology with PLATO. The techniques developed here can be applied to many other eclipsing binaries in order to create a network of such benchmark stars.
Slow convection and fast rotation in crystallization-driven white dwarf dynamos
Authors: Ginzburg Sivan , Fuller Jim , Kawka Adela , Caiazzo Ilaria
Published: May 2022

It has been recently suggested that white dwarfs generate magnetic fields in a process analogous to the Earth. The crystallization of the core creates a compositional inversion that drives convection, and combined with rotation, this can sustain a magnetic dynamo. We reanalyse the dynamo mechanism, arising from the slow crystallization of the core, and find convective turnover times tconv of weeks to months – longer by orders of magnitude than previously thought. With white dwarf spin periods P ≪ tconv, crystallization-driven dynamos are almost always in the fast-rotating regime, where the magnetic field B is at least in equipartition with the convective motion and is possibly further enhanced by a factor of B ∝ (tconv/P)1/2, depending on the assumed dynamo scaling law. We track the growth of the crystallized core using mesa and compute the magnetic field B(Teff) as a function of the white dwarf’s effective temperature Teff. We compare this prediction with observations and show that crystallization-driven dynamos can explain some – but not all – of the ∼MG magnetic fields measured for single white dwarfs, as well as the stronger fields measured for white dwarfs in cataclysmic variables, which were spun up by mass accretion to short P. Our B(Teff) curves might also explain the clustering of white dwarfs with Balmer emission lines around Teff ≈ 7500 K.
Genomic Shifts, Phenotypic Clines, and Fitness Costs Associated With Cold Tolerance in the Asian Tiger Mosquito
Authors: Sherpa Stéphanie , Tutagata Jordan , Gaude Thierry , Laporte Frédéric , Kasai Shinji , Ishak Intan H. , Guo Xiang , Shin Jiyeong , Boyer Sébastien , Marcombe Sébastien , Chareonviriyaphap Theeraphap , David Jean-Philippe , Chen Xiao-Guang , Zhou Xiaohong , Després Laurence
Published: May 2022

Climatic variation is a key driver of genetic differentiation and phenotypic traits evolution, and local adaptation to temperature is expected in widespread species. We investigated phenotypic and genomic changes in the native range of the Asian tiger mosquito, Aedes albopictus. We first refine the phylogeographic structure based on genome-wide regions (1,901 double-digest restriction-site associated DNA single nucleotide polymophisms [ddRAD SNPs]) from 41 populations. We then explore the patterns of cold adaptation using phenotypic traits measured in common garden (wing size and cold tolerance) and genotype–temperature associations at targeted candidate regions (51,706 exon-capture SNPs) from nine populations. We confirm the existence of three evolutionary lineages including clades A (Malaysia, Thailand, Cambodia, and Laos), B (China and Okinawa), and C (South Korea and Japan). We identified temperature-associated differentiation in 15 out of 221 candidate regions but none in ddRAD regions, supporting the role of directional selection in detected genes. These include genes involved in lipid metabolism and a circadian clock gene. Most outlier SNPs are differently fixed between clades A and C, whereas clade B has an intermediate pattern. Females are larger at higher latitude yet produce no more eggs, which might favor the storage of energetic reserves in colder climate. Nondiapausing eggs from temperate populations survive better to cold exposure than those from tropical populations, suggesting they are protected from freezing damages but this cold tolerance has a fitness cost in terms of egg viability. Altogether, our results provide strong evidence for the thermal adaptation of A. albopictus across its wide temperature range.
Epistasis Creates Invariant Sites and Modulates the Rate of Molecular Evolution
Authors: Patel Ravi , Carnevale Vincenzo , Kumar Sudhir
Published: May 2022

Invariant sites are a common feature of amino acid sequence evolution. The presence of invariant sites is frequently attributed to the need to preserve function through site-specific conservation of amino acid residues. Amino acid substitution models without a provision for invariant sites often fit the data significantly worse than those that allow for an excess of invariant sites beyond those predicted by models that only incorporate rate variation among sites (e.g., a Gamma distribution). An alternative is epistasis between sites to preserve residue interactions that can create invariant sites. Through computer-simulated sequence evolution, we evaluated the relative effects of site-specific preferences and site-site couplings in the generation of invariant sites and the modulation of the rate of molecular evolution. In an analysis of ten major families of protein domains with diverse sequence and functional properties, we find that the negative selection imposed by epistasis creates many more invariant sites than site-specific residue preferences alone. Further, epistasis plays an increasingly larger role in creating invariant sites over longer evolutionary periods. Epistasis also dictates rates of domain evolution over time by exerting significant additional purifying selection to preserve site couplings. These patterns illuminate the mechanistic role of epistasis in the processes underlying observed site invariance and evolutionary rates.
Decoupled Trace Element and Isotope Compositions Recorded in Orthopyroxene and Clinopyroxene in Composite Pyroxenite Veins from the Xiugugabu Ophiolite (SW Tibet)
Authors: Zhang Zhen-Yu , Liu Chuan-Zhou , Liang Yan , Zhang Chang , Liu Tong , Zhang Wei-Qi , Ji Wen-Bin
Published: May 2022

Pyroxenite veins and dikes are commonly observed in the mantle section of ophiolites. Because of their mantle occurrence, these pyroxenites are free from crustal contamination and offer a unique opportunity for studying mantle compositions and melt–rock interaction processes. We conducted an integrated petrological and geochemical study of a suite of composite orthopyroxenite, websterite, and pyroxene-bearing dunite veins from the Xiugugabu ophiolite located on the western segment of Yarlung–Zangbo Suture Zone. The dunite is separated from the host peridotite by a layer of pyroxenite, forming a composite vein system. Systematic variations in major, minor, and trace element compositions in minerals across the composite veins are observed. Two generations of orthopyroxenes in the pyroxenites are characterized by high Mg#, low TiO2 concentrations, and depleted patterns of incompatible trace elements. Clinopyroxenes in the pyroxenites are characterized by high Mg#, low contents of TiO2 and Na2O, spooned shaped REE patterns, and a negative Zr anomaly. Through major and trace element modeling, we showed that both orthopyroxene and clinopyroxene were in equilibrium with melts with different compositions. This hypothesis is further confirmed by distinct initial Nd and Hf isotope ratios in the two pyroxenes. A model for the formation of composite pyroxenite veins is developed, whereby hydrous and silica-rich melts percolate along the margins of a dunite channel. The orthopyroxenite was formed by the reaction between a hydrous, silica-rich melt and the surrounding peridotite. The websterite is formed by reactive crystallization of a hybrid melt produced by mixing silica-rich melt and the melt formed by remelting of previously depleted peridotite in the deeper part of the mantle column. The extremely enriched Nd–Hf isotope compositions of the pyroxenite veins (εNd = −20.3 to +11.5 and εHf = −13.2 to +25.3, 125 million years ago) can be explained by the addition of ancient, recycled sediments to the mantle source in a supra-subduction setting. Based on the low-Cr# spinel in the Xiugugabu dunites (Cr# = 19–50) and the depleted nature of the parental melt of the Xiugugabu pyroxenites, we deduced that the formation of pyroxenites postdate the formation of the Xiugugabu ophiolite at ~125–130 Ma. Collectively, results from this study have provided support to the hypothesis that the Xiugugabu ophiolite experience a two-stage evolution, i.e., firstly formed in a mid-ocean ridge setting and subsequently modified in a supra subduction zone.
A chemoproteoinformatics approach demonstrates that aspirin increases sensitivity to MEK inhibition by directly binding to RPS5
Authors: Watanabe Motoki , Boku Shogen , Kobayashi Kaito , Kurumida Yoichi , Sukeno Mamiko , Masuda Mitsuharu , Mizushima Katsura , Kato Chikage , Iizumi Yosuke , Hirota Kiichi , Naito Yuji , Mutoh Michihiro , Kameda Tomoshi , Sakai Toshiyuki
Published: May 2022

MEK inhibitors are among the most successful molecularly targeted agents used as cancer therapeutics. However, to treat cancer more efficiently, resistance to MEK inhibitor-induced cell death must be overcome. Although previous genetic approaches based on comprehensive gene expression analysis or RNAi libraries led to the discovery of factors involved in intrinsic resistance to MEK inhibitors, a feasible combined treatment with the MEK inhibitor has not yet been developed. Here, we show that a chemoproteoinformatics approach identifies ligands overcoming the resistance to cell death induced by MEK inhibition as well as the target molecule conferring this resistance. First, we used natural products, perillyl alcohol and sesaminol, which induced cell death in combination with the MEK inhibitor trametinib, as chemical probes, and identified ribosomal protein S5 (RPS5) as their common target protein. Consistently, trametinib induced cell death in RPS5-depleted cancer cells via upregulation of the apoptotic proteins BIM and PUMA. Using molecular docking and molecular dynamics (MD) simulations, we then screened FDA- and EMA-approved drugs for RPS5-binding ligands and found that acetylsalicylic acid (ASA, also known as aspirin) directly bound to RPS5, resulting in upregulation of BIM and PUMA and induction of cell death in combination with trametinib. Our chemoproteoinformatics approach demonstrates that RPS5 confers resistance to MEK inhibitor-induced cell death, and that aspirin could be repurposed to sensitize cells to MEK inhibition by binding to RPS5.
Prolonged Sitting Results in Microvascular, but not Macrovascular, Dysfunction in Healthy Young Women
Authors: Vranish Jennifer R. , Young Benjamin E. , Kaur Jasdeep , Patik Jordan C. , Padilla Jaume , Fadel Paul J.
Published: May 2022

On average, Americans spend more than half of their waking hours sitting. Previous work has demonstrated impairments in leg micro‐ and macro‐vascular function following prolonged sitting, as assessed by reactive hyperemia and flow‐mediated dilation (FMD), respectively. However these studies were performed predominantly in young men, and the effects of sitting in women have yet to be identified. This is important given known differences in vascular function between sexes. Accordingly, we assessed popliteal artery reactive hyperemia and FMD, before (PreSIT) and after (PostSIT) a 3 hr sitting period in 12 women and 8 age‐ and BMI‐matched men. Popliteal artery hemodynamics (duplex Doppler ultrasound), heart rate (ECG), and calf circumference were measured throughout. During sitting, resting popliteal artery shear rate was reduced in women (−48.5±8.4 s−1) and men (−52.9±12.3 s−1; P = 0.448); which was accompanied by similar increases in calf circumference in both groups (P = 0.370). Following the sitting period, popliteal artery FMD (ANCOVA‐corrected for hyperemic shear rate AUC), was significantly reduced in men (PreSIT: 5.6±0.7%, PostSIT: 1.5±0.7%; P = 0.001) but not women (PreSIT: 4.5±0.6%, PostSIT: 3.5±0.6%; P = 0.502), whereas both groups exhibited similar reductions in hyperemic shear rate AUC (women: −33,199±8,516 a.u., men: −24,350±8,803 a.u.; P = 0.494). These preliminary findings indicate that with prolonged sitting, the leg vasculature is susceptible to similar microvascular impairments in men and women, however macrovascular function appears protected from sitting in young women.

Support or Funding Information

Supported by UTA College of Nursing and Health Innovation.
Method of Hormonal Contraception and Protective Effects Against Ectopic Pregnancy
Authors: Kopp-Kallner Helena , Linder Marie , Cesta Carolyn E. , Segovia Chacón Silvia , Kieler Helle , Graner Sofie
Published: May 2022

OBJECTIVE:

To estimate the incidence rates for ectopic pregnancy by contraceptive method in a cohort of women using hormonal contraception in Sweden between 2005 and 2016.

METHOD:

Women aged 15–49 years with a filled prescription for a hormonal contraceptive in the Swedish Prescribed Drug Register between 2005 and 2016 were included. For each woman, all exposed woman-years were allocated to treatment episodes depending on the method of contraception. Treatment time started on the day the prescription was filled and ended on the first day of the end of supply, new eligible dispensing, pregnancy-related diagnosis and its associated estimated last menstrual period, or removal procedure. Ectopic pregnancy was defined as having at least two records of International Classification of Diseases, Tenth Revision code O00-, including O00.0, O00.1, O00.2, O00.8, O00.9, within 30 days or one episode of O00- and one surgical procedure for ectopic pregnancy (NOMESCO Classification of Surgical Procedures code LBA, LBC, LBD, LBE, LBW). Incidence rates per 1,000 woman-years and 95% CIs were calculated for each method of contraception.

RESULTS:

The study included 1,663,242 women and 1,915 events of ectopic pregnancy. The incidence rate (95% CI) for ectopic pregnancy per method of hormonal contraception was estimated: 13.5-mg levonorgestrel (LNG) hormonal intrauterine device (IUD), 2.76 (2.26–3.35) per 1,000 woman-years; 52-mg LNG hormonal IUD, 0.30 (0.28–0.33) per 1,000 woman-years; combined oral contraception, 0.20 (0.19–0.22) per 1,000 woman-years; progestogen implants, 0.31 (0.26–0.37) per 1,000 woman-years; oral medium-dose progestogen (desogestrel 75 mg), 0.24 per 1,000 woman-years, (0.21–0.27); and oral low-dose progestogen (norethisterone 0.35 mg and lynestrenol 0.5 mg), 0.81 (0.70–0.93) per 1,000 woman-years.

CONCLUSION:

Hormonal contraception lowers the risk of ectopic pregnancy markedly. The incidence rate of ectopic pregnancy among women using a low-dose hormonal IUD (13.5 mg LNG) was substantially higher than that in women using other types of hormonal contraception. This study provides real-world evidence to inform best clinical practice for women-centered contraceptive counseling.
Maternal and Neonatal Morbidity After Attempted Operative Vaginal Delivery
Authors: Froeliger Alizée , Mattuizzi Aurélien , Madar Hugo , Hamel Jean-François , Bouchghoul Hanane , Sentilhes Loïc
Published: May 2022

OBJECTIVE:

To assess severe short-term maternal and neonatal morbidity and pelvic floor disorders at 6 months postpartum after attempted operative vaginal delivery according to the instrument used.

METHODS:

We conducted a prospective study of women with live, singleton, term fetuses in vertex presentation. Patients attempted operative vaginal delivery in a French tertiary care university hospital from December 2008 through October 2013. We used multivariable logistic regression and propensity score methods to control for indication bias and compare outcomes associated with vacuum-assisted or forceps- or spatula-assisted delivery. Severe maternal and neonatal morbidity were composite primary endpoints. Symptoms of urinary incontinence (UI) and anal incontinence (AI) were assessed 6 months after delivery by validated self-administered questionnaires.

RESULTS:

Among 2,128 attempted operative vaginal deliveries, 30.7% (n=654) used vacuum and 69.3% (n=1,474) used forceps or spatulas. Severe maternal morbidity occurred in 5.4% (n=35; 95% CI 3.8–7.4) of vacuum attempts and 10.5% (n=154; 95% CI 8.3–12.1) of forceps or spatula attempts (P<.001); severe neonatal morbidity occurred in 8.4% (n=55; 95% CI 6.4–10.8) and 10.2% (n=155; 95% CI 8.7–11.8), respectively (P=.2). Although attempted operative vaginal deliveries with forceps or spatula were significantly associated with more frequent severe maternal morbidity (adjusted odds ratio [aOR] 1.99 95% CI 1.27–3.10) in the multivariable logistic regression analysis, this association was no longer significant after propensity score matching (aOR 1.46 95% CI 0.72–2.95). Attempted operative vaginal deliveries with forceps or spatula were not significantly associated with more frequent severe neonatal morbidity after multivariable logistic regression or propensity score matching. Among the 934 women (43.9%) who responded to questionnaires at 6 months, the prevalence of symptoms of UI and AI were 22.7% and 22.0%, respectively, with no significant differences between the groups.

CONCLUSION:

In singleton term pregnancies, neither severe short-term maternal or neonatal morbidity nor UI or AI were more frequent after attempted operative vaginal delivery by forceps or spatulas than by vacuum after controlling for indication bias with a propensity score analysis.
Mifepristone and Misoprostol for Undesired Pregnancy of Unknown Location
Authors: Goldberg Alisa B. , Fulcher Isabel R. , Fortin Jennifer , Hofer Rebecca K. , Cottrill Alex , Dethier Divya , Gilbert Allison , Janiak Elizabeth , Roncari Danielle
Published: May 2022

OBJECTIVE:

To compare immediate initiation with delayed initiation of medication abortion among patients with an undesired pregnancy of unknown location.

METHODS:

This retrospective cohort study used electronic medical record data from the Planned Parenthood League of Massachusetts (2014–2019) for patients who requested medication abortion with a last menstrual period (LMP) of 42 days or less and pregnancy of unknown location (no gestational sac) on initial ultrasonogram. Clinicians could initiate medication abortion with mifepristone followed by misoprostol while simultaneously excluding ectopic pregnancy with serial serum human chorionic gonadotropin (hCG) testing (same-day-start group) or establish a diagnosis with serial hCG tests and repeat ultrasonogram before initiating treatment (delay-for-diagnosis group). We compared primary safety outcomes (time to diagnosis of pregnancy location [rule out ectopic], emergency department visits, adverse events, and nonadherence with follow-up) between groups. We also reported secondary efficacy outcomes: time to complete abortion, successful medication abortion (no uterine aspiration), and ongoing pregnancy.

RESULTS:

Of 5,619 medication abortion visits for patients with an LMP of 42 days or less, 452 patients had pregnancy of unknown location (8.0%). Three patients underwent immediate uterine aspiration, 55 had same-day start, and 394 had delay for diagnosis. Thirty-one patients (7.9%), all in the delay-for-diagnosis group, were treated for ectopic pregnancy, including four that were ruptured. Among patients with no major ectopic pregnancy risk factors (n=432), same-day start had shorter time to diagnosis (median 5.0 days vs 9.0 days; P=.005), with no significant difference in emergency department visits (adjusted odds ratio [aOR] 0.90, 95% CI 0.43–1.88) or nonadherence with follow-up (aOR 0.92, 95% CI 0.39–2.15). Among patients who proceeded with abortion (n=270), same-day start had shorter time to complete abortion (median 5.0 days vs 19.0 days; P<.001). Of those who had medication abortion with known outcome (n=170), the rate of successful medication abortion was lower (85.4% vs 96.7%; P=.013) and the rate of ongoing pregnancy was higher (10.4% vs 2.5%; P=.041) among patients in the same-day-start group.

CONCLUSION:

In patients with undesired pregnancy of unknown location, immediate initiation of medication abortion is associated with more rapid exclusion of ectopic pregnancy and pregnancy termination but lower abortion efficacy.
Chromosomal Microarray Analysis Compared With Noninvasive Prenatal Testing in Pregnancies With Abnormal Maternal Serum Screening
Authors: Sagi-Dain Lena , Salzer Sheelo Liat , Brabbing-Goldstein Dana , Matar Reut , Kahana Sarit , Agmon-Fishman Ifaat , Klein Cochava , Gurevitch Merav , Basel-Salmon Lina , Maya Idit
Published: May 2022

OBJECTIVE:

To examine the effect of maternal age on the rate of clinically significant chromosomal microarray analysis results in pregnancies with abnormal maternal serum screening and to establish the residual risk for abnormal microarray findings after omitting noninvasive prenatal testing (NIPT)–detectable aberrations in pregnancies with abnormal maternal serum screening.

METHODS:

This retrospective study included all chromosomal microarray analysis tests performed in pregnancies with abnormal maternal serum screening and normal ultrasonogram results over the years 2013–2021. The rate of clinically significant (pathogenic and likely pathogenic) chromosomal microarray analysis findings was compared with a local control cohort of 7,235 pregnancies with normal maternal serum screening and ultrasonogram results, stratified by maternal age. Calculation of residual risk for clinically significant chromosomal microarray analysis results after normal NIPT was performed by omission of common NIPT-detectable anomalies. Systematic review for studies examining the yield of chromosomal microarray analysis in pregnancies with abnormal maternal serum screening was performed from inception to October 2021, with no time or language restrictions.

RESULTS:

Of the 559 amniocenteses performed due to abnormal maternal serum screening, 21 (3.8%; 95% CI 2.4–5.7%) clinically significant chromosomal microarray analysis results were found. The residual risk for chromosomal microarray analysis aberrations after theoretically normal NIPT was estimated to be 2.0% (95% CI 1.1–3.6%) (1/50) and was significantly higher for women younger than age 35 years with abnormal maternal serum screening, compared with women with low-risk pregnancies. Systematic review yielded six articles encompassing 4,890 chromosomal microarray analysis results in pregnancies with abnormal maternal serum screening, demonstrating 2.3% residual risk for chromosomal microarray analysis anomalies after theoretically normal NIPT.

DISCUSSION:

Clinically significant chromosomal microarray analysis findings can be found in 1 of every 50 pregnancies with high-risk maternal serum screening after theoretically normal NIPT, implying that invasive testing and not NIPT should be recommended in such pregnancies. In addition, NIPT use as a first-tier screening modality instead of maternal serum screening would miss pregnancies at increased risk not only for common autosomal trisomies but for additional chromosomal microarray analysis–detectable disorders.
A database study on incidence and trends in traumatic lower extremity amputations in the United States
Authors: Herzog Leah N. , Johnson Charles A. , Gross Christopher E.
Published: May 2022

Introduction:

There is minimal focus on traumatic lower extremity amputations due to their relatively low incidence, but they often come with a higher morbidity and mortality than their upper extremity counterparts. The purpose of this study was to evaluate the incidence and trends of lower extremity amputations in the United States over 10 yr.

Methods:

The National Electronic Injury Surveillance System (NEISS) was queried from 2008 to 2017 for lower extremity amputations presenting to U.S. emergency departments. Date of presentation, age at presentation, amputated appendage, disposition, and cause of the amputation were reported and used for statistical analysis.

Results:

From 2008 to 2017, 393 patients were reported to have sustained lower extremity amputations within the NEISS database with an estimated total of 11,475 patients sustaining a lower extremity amputation over the past 10 yr and an incidence of 2.2 per 100,000 person-years. The incidence of lower extremity amputations is highest in those under five years old. Lawnmowers were the most common mechanism of injury in all age groups.

Discussion:

Due to the high morbidity and mortality associated with these injuries, it is prudent to follow the trends in lower extremity amputations. This is particularly important in promoting awareness and prevention of the more common mechanisms such as lawnmower incidents.

Level of Evidence:

Level IV.
Rami Comminution Is Associated With Displacement of Minimally Displaced Lateral Compression Type 1 Injuries on Lateral Stress Radiographs
Authors: Hadeed Michael M. , Tucker Nicholas J. , Heare Austin , Mauffrey Cyril , Parry Joshua A.
Published: May 2022

Objectives:

To determine whether displacement on lateral stress radiographs (LSRs) in patients with minimally displaced lateral compression type 1 pelvic ring injuries is associated with any demographic and/or injury characteristics.

Design:

Retrospective comparative cohort.

Setting:

Urban level 1 trauma center.

Patients/Participants:

Ninety-three consecutive patients with minimally displaced lateral compression type 1 injuries.

Intervention:

Displacement of pelvic ring injury on LSR (≥10 mm vs. <10 mm).

Main Outcome Measurements:

Demographic and injury characteristics (mechanism of injury, Nakatani rami classification, rami comminution, Denis zone, complete/incomplete sacral fracture, sacral comminution).

Results:

65.6% of patients (n = 61) had ≥10 mm of displacement on LSR. On univariate analysis, displacement was associated with increased age [median difference 11: confidence interval (CI), 2–23], female sex [proportional difference (PD): 25.1%, CI, 3.9%–44.4%], Nakatani classification (type I PD: 27.9%, type II PD: −19.5%), and rami comminution (PD: 55.6%, CI, 35.4%–71.3%). On multivariate analysis, displacement was only associated with rami comminution (odds ratio: 16.48, CI, 4.67–58.17). Displacement was not associated with energy of injury mechanism, sacral fracture Denis zone, complete sacral fracture, sacral comminution, or bilateral rami fractures.

Conclusions:

Although rami comminution was the only variable found to be independently associated with displacement ≥10 mm on LSR, no single variable perfectly predicted displacement. Future studies are needed to determine whether displacement on stress radiographs should change the management of these injuries.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Rare Presentation of Pediatric Multiple Enchondromatosis Limited to Single Ray or Single Nerve Distribution in the Hand: A Multicenter Case Series
Authors: Muffly Brian T. , O’Shaughnessy Maureen A. , Fazal Faris Z. , Riley Scott A. , Shah Apurva S. , Cornwall Roger , Burke Charity S.
Published: May 2022

Background:

Multiple enchondromas in the pediatric hand is a relatively rare occurrence and the literature regarding its incidence and treatment is sparse. Within this rare subset of patients, we identified a unique cohort in which lesions are confined to multiple bones in a single ray or adjacent rays within a single nerve distribution. We review the clinical and pathologic characteristics and describe the indications for and outcomes of treatment in this unique subset of patients as well as offer conjectures about its occurrence.

Methods:

Institutional review board (IRB)-approved retrospective multicenter study between 2010 and 2018 identified subjects with isolated multiple enchondromas and minimum 2-year follow-up. Data analyzed included demographics, lesion quantification and localization, symptoms and/or fracture(s), treatment of lesion(s), complications, recurrence, and presence of malignant transformation.

Results

Ten patients were evaluated with average age at presentation of 9 years (range: 4 to 16) and mean clinical follow-up of 6 years (range: 2.8 to 8.6). Five subjects had multiple ray involvement in a single nerve distribution and 5 had single ray involvement with an average of 4 lesions noted per subject (range: 2 to 8). All children in the study had histopathologic-proven enchondromas and underwent operative curettage±bone grafting. Indications for surgical intervention included persistent pain, multiple prior pathologic fractures, impending fracture and deformity. During the study period three subjects experienced pathologic fracture treated successfully with immobilization. Recurrence was noted in 40% at an average of 105 weeks postoperatively (range: 24 to 260) and appears higher than that reported in the literature. No case of malignant transformation was observed during the study period.

Conclusions:

A rare subset of pediatric patients with multiple enchondromas of the hand is described with lesions limited to a single ray or single nerve distribution. Further awareness of this unique subset of patients may increase our understanding of the disease and improve patient outcomes.

Level of Evidence:

Level IV—therapeutic (case series).
Single-cell analysis of transcription factor regulatory networks reveals molecular basis for subtype-specific dysregulation in acute myeloid leukemia
Authors: Sun Ruixia , Sun Lina , Xie Xiaowei , Li Xuan , Wu Peng , Wang Lu , Zhu Ping
Published: May 2022

Highly heterogeneous acute myeloid leukemia (AML) exhibits dysregulated transcriptional programs. Transcription factor (TF) regulatory networks underlying AML subtypes have not been elucidated at single-cell resolution. Here, we comprehensively mapped malignancy-related TFs activated in different AML subtypes by analyzing single-cell RNA sequencing data from AMLs and healthy donors. We first identified six modules of regulatory networks which were prevalently dysregulated in all AML patients. AML subtypes featured with different malignant cellular composition possessed subtype-specific regulatory TFs associated with differentiation suppression or immune modulation. At last, we validated that ERF was crucial for the development of hematopoietic stem/progenitor cells by performing loss- and gain-of-function experiments in zebrafish embryos. Collectively, our work thoroughly documents an abnormal spectrum of transcriptional regulatory networks in AML and reveals subtype-specific dysregulation basis, which provides a prospective view to AML pathogenesis and potential targets for both diagnosis and therapy.
Cardiovascular and Hematologic Complications of COVID-19 Vaccines
Authors: Herblum Jordana , Frishman William H.
Published: May 2022

COVID-19 is a prothrombotic and cardiac-damaging disease. There are 4 vaccines against COVID-19 currently approved in North America, including the mRNA vaccines by Pfizer and Moderna, and the adenovirus vector vaccines by Johnson and Johnson and AstraZeneca. These vaccines have been proven effective in reducing morbidity and preventing mortality in patients who were exposed to COVID-19 infection, but the vaccines have also been associated with complications. Vaccine-induced thrombotic thrombocytopenia (VITT) has a similar pathogenesis to heparin-induced thrombocytopenia, with an inappropriate immune response leading to platelet activation, consumption of platelets, and thrombosis. It appears to be more common with the adenovirus vector vaccines. Secondary immune thrombocytopenic purpura has been reported with all COVID-19 vaccines and is distinct from VITT because there is no sign of platelet activation or thrombotic events. Myocarditis and pericarditis are often reported in young males following mRNA vaccines and is often associated with a full recovery. The long-term effects of VITT, secondary immune thrombocytopenic purpura, myocarditis, and pericarditis secondary to COVID-19 vaccines have yet to be elucidated. Continued surveillance for these complications after vaccination is crucial for accurate diagnosis and effective management. Patients should consult their physicians regarding repeated vaccine doses after experiencing an adverse effect.
Mild-to-Moderate COVID-19 Infection and Myocarditis: A Review
Authors: Bailey Eric , Frishman William H.
Published: May 2022

The coronavirus disease 2019 (COVID-19) pandemic has taken a massive toll on healthcare systems internationally. Severe illness has been seen in a range of patient populations, but those living with cardiovascular disease have suffered to a greater extent, likely because of their comorbidities. In patients with diabetes, hypertension, heart failure, and other chronic illnesses, COVID-19 has manifested severe illnesses such as coagulopathies, myocarditis, and arrhythmias, complicating the disease course for those already suffering from underlying illness. There have been numerous studies done exploring the cardiovascular complications of COVID-19. Some of the more concerning findings have revealed a correlation between severe illness and the increasing likelihood for developing cardiovascular manifestations. However, what is more concerning were the studies revealing the presence of myocarditis and other cardiac sequelae in previously healthy patients with mild or asymptomatic COVID-19. The goal of this article is to review the literature to compile information available about whether there is a significant risk of myocarditis in those patients who do not develop severe initial COVID-19 disease.
Bullous Impetigo Following an Abrasion in a 17-Year-Old Female
Authors: Medepalli Vidya M. , Srikakolapu Siddharth , Preda-Naumescu Ana , Brodell Robert T. , Nahar Vinayak K.
Published: May 2022

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of bullous impetigo.
Experiences of Participating in an Academic–Hospital Partnership Nursing Program: A Qualitative Study
Authors: LEE Li-Hung , CHEN Shu-Ling , TSAY Shiow-Luan , YANG Cheng-I
Published: May 2022

Background

Although 5-year colleges account for 41.7% of all nursing graduates in Taiwan, most of these graduates go on to university and earn a bachelor's degree. In 2015, four universities received approval from the Ministry of Education of Taiwan and started to enroll students in the academic–hospital partnership nursing program to guide nursing graduates from 5-year colleges into the nursing workplace. The effects of this program have never been examined, especially from the perspective of the students.

Purpose

The aim of this study was to explore the experiences of students currently participating in the academic–hospital partnership nursing program.

Methods

A qualitative approach was used in this study. Twelve students were invited to participate in a focus group that met for five sessions over 3 years to understand the motivations for and experiences of participating in the academic–hospital partnership nursing program. Data were analyzed using thematic analysis.

Results

Six themes were identified: (a) incentives for participating in the academic–hospital partnership nursing program, (b) worries about making the wrong decision, (c) worries about future adaptation, (d) facing the real workplace, (e) confusion about role perception and benefits, and (f) administrator support.

Conclusions/Implications for Practice

The findings of this study enhance the general understanding of nursing student experiences and the changes over time in the academic–hospital partnership nursing programs. Moreover, the findings may be used to help teachers and nursing administrators at healthcare institutes better support the needs of students at each program stage. In addition, the findings may serve as a reference for the government in refining the design of these programs in the future.
Development of Burnout in Physical Therapist Students and Associated Factors: A Study During COVID-19
Authors: Smith Allison , Ellison Jennifer , Bogardus Jennifer , Gleeson Peggy
Published: May 2022

Introduction.

Burnout is a negative response to work-related stress and follows a developmental process that might begin during students' academic studies.

Review of Literature.

Numerous factors affect burnout in graduate students, and few published studies have assessed burnout in physical therapist students.

Subjects.

Participants included 1,340 Doctor of Physical Therapy (DPT) students from DPT programs across the United States.

Method.

Students completed a Psychdata survey in fall 2020 that assessed burnout using the Oldenburg Burnout Inventory for Students (OLBI-S), resilience using the Connor-Davidson Resilience Scale (CD-RISC), perceived stress using the Perceived Stress Scale (PSS), and additional questions regarding levels of support and the learning environment. Burnout levels for each year in a DPT program were determined using 2 one-way independent analysis of variances, 1 for each OLBI-S subscale. Cutoff scores to group students into the burnout and nonburnout groups were determined using quartiles. Logistic regression was used to identify factors that may have an influence on the development of burnout.

Results.

No significant difference was found in burnout scores among students in different years in a DPT program. Using cutoff scores, 35.4% of DPT students were in the burnout group. Factors found to be statistically significant in predicting burnout were satisfaction with the level of support from faculty, satisfaction with overall learning environment, CD-RISC score, and PSS score (χ2(4) = 266.827,P< .001). The final model explained 24.8% of the variance and correctly classified 72.1% of cases.

Discussion and Conclusion.

Students who have higher levels of perceived stress, lower levels of satisfaction with the level of support from faculty, and lower levels of satisfaction with their overall learning environment at DPT school may be more likely to develop burnout, while students who have higher levels of resilience may be less likely to develop burnout. This study was conducted during the COVID-19 pandemic and may not be generalizable to nonpandemic times.
Machine Learning for the Prevalence and Severity of Coronary Artery Calcification in Nondialysis Chronic Kidney Disease Patients
Authors: Zhu Haitao , Yin Changqing , Schoepf U. Joseph , Wang Dongqing , Zhou Changsheng , Lu Guang Ming , Zhang Long Jiang
Published: May 2022

Purpose:

This study sought to determine whether machine learning (ML) can be used to better identify the risk factors and establish the prediction models for the prevalence and severity of coronary artery calcification (CAC) in nondialysis chronic kidney disease (CKD) patients and compare the performance of distinctive ML models with conventional logistic regression (LR) model.

Materials and Methods:

In all, 3701 Chinese nondialysis CKD patients undergoing noncontrast cardiac computed tomography (CT) scanning were enrolled from November 2013 to December 2017. CAC score derived from the cardiac CT was calculated with the calcium scoring software and was used to assess and stratify the prevalence and severity of CAC. Four ML models (LR, random forest, support vector machine, and k-nearest neighbor) and the corresponding feature ranks were conducted. The model that incorporated the independent predictors was shown as the receiver-operating characteristic (ROC) curve. Area under the curve (AUC) was used to present the prediction value. ML model performance was compared with the traditional LR model using pairwise comparisons of AUCs.

Results:

Of the 3701 patients, 943 (25.5%) patients had CAC. Of the 943 patients with CAC, 764 patients (20.6%) and 179 patients (4.8%) had an Agatston CAC score of 1 to 300 and ≥300, respectively. The primary cohort and the independent validation cohort comprised 2957 patients and 744 patients, respectively. For the prevalence of CAC, the AUCs of ML models were from 0.78 to 0.82 in the training data set and the internal validation cohort. For the severity of CAC, the AUCs of the 4 ML models were from 0.67 to 0.70 in the training data set and from 0.53 to 0.70 in the internal validation cohort. For the prevalence of CAC, the AUC was 0.80 (95% confidence interval [CI]: 0.77-0.83) for ML (LR) versus 0.80 (95% CI: 0.77-0.83) for the traditional LR model (P=0.2533). For the severity of CAC, the AUC was 0.70 (95% CI: 0.63-0.77) for ML (LR) versus 0.70 (95% CI: 0.63-0.77) for traditional LR model (P=0.982).

Conclusions:

This study constructed prediction models for the presence and severity of CAC based on Agatston scores derived from noncontrast cardiac CT scanning in nondialysis CKD patients using ML, and showed ML LR had the best performance.
Entering the Digital Therapy Room
Authors: Bolden William , Grogan-Johnson Sue
Published: May 2022

School-based speech–language pathologists (SLPs) have been plunged into telepractice service delivery with the ongoing COVID-19 pandemic. However, this temporary shift to provide online instruction is not the same as fully implementing a telepractice service delivery model that is comparable with in-person service delivery. The purpose of this article is to provide the practicing SLP with a framework for delivering effective intervention services to school-age students with language impairments via telepractice. Within this framework, the SLP still must consider the available evidence base for an intervention and implement its core components, including repeated opportunities for skill and knowledge acquisition with sufficient intensity, systematic scaffolding, and an explicit focus (Ukrainetz, 2006a). Particular attention must be given to aspects of intervention planning, manipulation of the therapy context, collaboration with relevant stakeholders, specific intervention materials, and prompting because these are among the most likely to differ between the telepractice and in-person service delivery. We discuss these aspects and provide examples.