bluuebunny/crossref_metadata_2025 huggingface dataset:
The pristine dwarf-galaxy survey – III. Revealing the nature of the Milky Way globular cluster Sagittarius II
Authors: Longeard Nicolas , Martin Nicolas , Ibata Rodrigo A , Starkenburg Else , Jablonka Pascale , Aguado David S , Carlberg Raymond G , Côté Patrick , González Hernández Jonay I , Lucchesi Romain , Malhan Khyati , Navarro Julio F , Sánchez-Janssen Rubén , Thomas Guillaume F , Venn Kim , McConnachie Alan W
Published: March 2021

We present a new spectroscopic study of the faint Milky Way satellite Sagittarius II. Using multiobject spectroscopy from the Fibre Large Array Multi-Element Spectrograph, we supplement the data set of Longeard et al. with 47 newly observed stars, 19 of which are identified as members of the satellite. These additional member stars are used to put tighter constraints on the dynamics and the metallicity properties of the system. We find a low velocity dispersion of $\sigma _\mathrm{v}^\mathrm{SgrII} = 1.7 \pm 0.5$ km s−1, in agreement with the dispersion of Milky Way globular clusters of similar luminosity. We confirm the very metal-poor nature of the satellite ([Fe/H]$_\mathrm{spectro}^\mathrm{SgrII} = -2.23 \pm 0.07$) and find that the metallicity dispersion of Sgr II is not resolved, reaching only 0.20 at the 95 per cent confidence limit. No star with a metallicity below −2.5 is confidently detected. Therefore, despite the unusually large size of the system (r$_h = 35.5 ^{+1.4}_{-1.2}$ pc), we conclude that Sgr II is an old and metal-poor globular cluster of the Milky Way.
Studying galaxy cluster morphological metrics with mock-X
Authors: Cao Kaili , Barnes David J , Vogelsberger Mark
Published: March 2021

Dynamically relaxed galaxy clusters have long played an important role in galaxy cluster studies because it is thought their properties can be reconstructed more precisely and with less systematics. As relaxed clusters are desirable, there exist a plethora of criteria for classifying a galaxy cluster as relaxed. In this work, we examine 9 commonly used observational and theoretical morphological metrics extracted from $54\, 000$mock-X synthetic X-ray images of galaxy clusters taken from the IllustrisTNG, BAHAMAS, and MACSIS simulation suites. We find that the simulated criteria distributions are in reasonable agreement with the observed distributions. Many criteria distributions evolve as a function of redshift, cluster mass, numerical resolution, and subgrid physics, limiting the effectiveness of a single relaxation threshold value. All criteria are positively correlated with each other, however, the strength of the correlation is sensitive to redshift, mass, and numerical choices. Driven by the intrinsic scatter inherent to all morphological metrics and the arbitrary nature of relaxation threshold values, we find the consistency of relaxed subsets defined by the different metrics to be relatively poor. Therefore, the use of relaxed cluster subsets introduces significant selection effects that are non-trivial to resolve.
The final core collapse of pulsational pair instability supernovae
Authors: Powell Jade , Müller Bernhard , Heger Alexander
Published: March 2021

We present 3D core-collapse supernova simulations of massive Population III progenitor stars at the transition to the pulsational pair instability regime. We simulate two progenitor models with initial masses of $85$ and $100\, \mathrm{M}_\odot$ with the LS220, SFHo, and SFHx equations of state. The $85\, \mathrm{M}_{\odot }$ progenitor experiences a pair instability pulse coincident with core collapse, whereas the $100\, \mathrm{M}_{\odot }$ progenitor has already gone through a sequence of four pulses $1500$ yr before collapse in which it ejected its H and He envelope. The $85\, \mathrm{M}_{\odot }$ models experience shock revival and then delayed collapse to a black hole (BH) due to ongoing accretion within hundreds of milliseconds. The diagnostic energy of the incipient explosion reaches up to $2.7\times 10^{51}\, \mathrm{erg}$ in the SFHx model. Due to the high binding energy of the metal core, BH collapse by fallback is eventually unavoidable, but partial mass ejection may be possible. The $100\, \mathrm{M}_\odot$ models have not achieved shock revival or undergone BH collapse by the end of the simulation. All models exhibit relatively strong gravitational-wave emission both in the high-frequency g-mode emission band and at low frequencies. The SFHx and SFHo models show clear emission from the standing accretion shock instability. For our models, we estimate maximum detection distances of up to $\mathord {\sim }46\, \mathrm{kpc}$ with LIGO and $\mathord {\sim } 850\, \mathrm{kpc}$ with Cosmic Explorer.
Closed loop predictive control of adaptive optics systems with convolutional neural networks
Authors: Swanson Robin , Lamb Masen , Correia Carlos M , Sivanandam Suresh , Kutulakos Kiriakos
Published: March 2021

Predictive wavefront control is an important and rapidly developing field of adaptive optics (AO). Through the prediction of future wavefront effects, the inherent AO system servo-lag caused by the measurement, computation, and application of the wavefront correction can be significantly mitigated. This lag can impact the final delivered science image, including reduced strehl and contrast, and inhibits our ability to reliably use faint guide stars. We summarize here a novel method for training deep neural networks for predictive control based on an adversarial prior. Unlike previous methods in the literature, which have shown results based on previously generated data or for open-loop systems, we demonstrate our network’s performance simulated in closed loop. Our models are able to both reduce effects induced by servo-lag and push the faint end of reliable control with natural guide stars, improving K-band Strehl performance compared to classical methods by over 55 per cent for 16th magnitude guide stars on an 8-m telescope. We further show that LSTM based approaches may be better suited in high-contrast scenarios where servo-lag error is most pronounced, while traditional feed forward models are better suited for high noise scenarios. Finally, we discuss future strategies for implementing our system in real-time and on astronomical telescope systems.
Searching for Mg ii absorbers in and around galaxy clusters
Authors: Lee Jong Chul , Hwang Ho Seong , Song Hyunmi
Published: March 2021

To study environmental effects on the circumgalactic medium (CGM), we use the samples of redMaPPer galaxy clusters, background quasars, and cluster galaxies from the Sloan Digital Sky Survey (SDSS). With ∼82 000 quasar spectra, we detect 197 Mg ii absorbers in and around the clusters. The detection rate per quasar is 2.7 ± 0.7 times higher inside the clusters than outside the clusters, indicating that Mg ii absorbers are relatively abundant in clusters. However, when considering the galaxy number density, the absorber-to-galaxy ratio is rather low inside the clusters. If we assume that Mg ii absorbers are mainly contributed by the CGM of massive star-forming galaxies, a typical halo size of cluster galaxies is smaller than that of field galaxies by 30 ± 10 per cent. This finding supports that galaxy haloes can be truncated by interaction with the host cluster.
The effect of a solar flare on chromospheric oscillations
Authors: Millar David C L , Fletcher Lyndsay , Milligan Ryan O
Published: March 2021

Oscillations in the solar atmosphere have long been observed both in quiet conditions and during solar flares. The chromosphere is known for its 3-min signals, which are strong over sunspot umbrae, and have periods determined by the chromosphere’s acoustic cut-off frequency. A small number of observations have shown the chromospheric signals to be affected by energetic events such as solar flares, however the link between flare activity and these oscillations remains unclear. In this work, we present evidence of changes to the oscillatory structure of the chromosphere over a sunspot which occurs during the impulsive phase of an M1 flare. Using imaging data from the CRISP instrument across the H α and Ca ii 8542  Å spectral lines, we employed a method of fitting models to power spectra to produce maps of where there is evidence of oscillatory signals above a red-noise background. Comparing results taken before and after the impulsive phase of the flare, we found that the oscillatory signals taken after the start of the flare differ in two ways: the locations of oscillatory signals had changed and the typical periods of the oscillations had tended to increase (in some cases increasing from <100 s to ∼200 s). Both of these results can be explained by a restructuring of the magnetic field in the chromosphere during the flare activity, which is backed up by images of coronal loops showing clear changes to magnetic connectivity. These results represent one of the many ways that active regions can be affected by solar flares.
Observing the influence of the youngest super star clusters in NGC 1569: Keck Brackett α spectroscopy
Authors: Cohen Daniel P , Turner Jean L , Beck Sara C , Consiglio S Michelle
Published: March 2021

We report Keck–NIRSPEC observations of the Brackett α 4.05 μm recombination line across the two candidate embedded super star clusters (SSCs) in NGC 1569. These SSCs power a bright H ii region and have been previously detected as radio and mid-infrared sources. Supplemented with high-resolution VLA mapping of the radio continuum along with IRTF–TEXES spectroscopy of the [S iv] 10.5 μm line, the Brackett α data provide new insight into the dynamical state of gas ionized by these forming massive clusters. Near-infrared sources detected in 2 μm images from the slit-viewing Camera are matched with Gaia sources to obtain accurate celestial coordinates and slit positions to within ∼0${_{.}^{\prime\prime}}$1. Br α is detected as a strong emission peak powered by the less luminous infrared source, MIR1 (LIR ∼ 2 × 107 $\rm L_\odot$). The second candidate SSC MIR2 is more luminous (LIR ≳ 4 × 108 $\rm L_\odot$) but exhibits weak radio continuum and Br α emission, suggesting the ionized gas is extremely dense (ne ≳ 105 cm−3), corresponding to hypercompact H ii regions around newborn massive stars. The Br α and [S iv] lines across the region are both remarkably symmetric and extremely narrow, with observed line widths Δv ≃ 40 $\rm km\, s^{-1}$, full width at half-maximum. This result is the first clear evidence that feedback from NGC 1569’s youngest giant clusters is currently incapable of rapid gas dispersal, consistent with the emerging theoretical paradigm in the formation of giant star clusters.
Pandemic shocks and fiscal-monetary policies in the Eurozone: COVID-19 dominance during January–June 2020
Authors: Jinjarak Yothin , Ahmed Rashad , Nair-Desai Sameer , Xin Weining , Aizenman Joshua
Published: March 2021

We compare the importance of market factors against that of coronavirus disease-19 (COVID-19) dynamics and policy responses in explaining Eurozone sovereign spreads. First, we estimate a multifactor model for changes in credit default swap (CDS) spreads over 2014 to June 2019. Then, we apply a synthetic control-type procedure to extrapolate model-implied changes in CDS. The factor model does very well over the rest of 2019 but breaks down during the pandemic, especially during March 2020. We find that the March 2020 divergence is well accounted for by COVID-specific risks and associated policies, mortality outcomes, and policy announcements, rather than traditional determinants. Daily CDS widening ceased almost immediately after the European Central Bank announced the Pandemic Emergency Purchase Programme, but the divergence between actual and model-implied changes persisted. This points to COVID-19 Dominance—widening spreads during the pandemic has led to unconventional monetary policies that primarily aim to mitigate short-run fears, temporarily pushing away concerns over fiscal risk.
Downregulation of the E2 Subunit of 2-Oxoglutarate Dehydrogenase Modulates Plant Growth by Impacting Carbon–Nitrogen Metabolism inArabidopsis thaliana
Authors: Condori-Apfata Jorge A , Batista-Silva Willian , Medeiros David Barbosa , Vargas Jonas Rafael , Valente Luiz M Lopes , Pérez-Díaz Jorge Luis , Fernie Alisdair R , Araújo Wagner L , Nunes-Nesi Adriano
Published: March 2021

In Arabidopsis thaliana, two genes encode the E2 subunit of the 2-oxoglutarate dehydrogenase (2-OGDH), a multimeric complex composed of three subunits. To functionally characterize the isoforms of E2 subunit, we isolated Arabidopsis mutant lines for each gene encoding the E2 subunit and performed a detailed molecular and physiological characterization of the plants under controlled growth conditions. The functional lack of expression of E2 subunit isoforms of 2-OGDH increased plant growth, reduced dark respiration and altered carbohydrate metabolism without changes in the photosynthetic rate. Interestingly, plants from e2-ogdh lines also exhibited reduced seed weight without alterations in total seed number. We additionally observed that downregulation of 2-OGDH activity led to minor changes in the levels of tricarboxylic acid cycle intermediates without clear correlation with the reduced expression of specific E2-OGDH isoforms. Furthermore, the e2-ogdh mutant lines exhibited a reduction by up to 25% in the leaf total amino acids without consistent changes in the amino acid profile. Taken together, our results indicate that the two isoforms of E2 subunit play a similar role in carbon–nitrogen metabolism, in plant growth and in seed weight.
Bacterial effector targeting of a plant iron sensor facilitates iron acquisition and pathogen colonization
Authors: Xing Yingying , Xu Ning , Bhandari Deepak D , Lapin Dmitry , Sun Xinhua , Luo Xuming , Wang Yeqiong , Cao Jidong , Wang Hongbin , Coaker Gitta , Parker Jane E , Liu Jun
Published: March 2021

Acquisition of nutrients from different species is necessary for pathogen colonization. Iron is an essential mineral nutrient for nearly all organisms, but little is known about how pathogens manipulate plant hosts to acquire iron. Here, we report that AvrRps4, an effector protein delivered by Pseudomonas syringae bacteria to plants, interacts with and targets the plant iron sensor protein BRUTUS (BTS) to facilitate iron uptake and pathogen proliferation in Arabidopsis thaliana. Infection of rps4 and eds1 by P. syringae pv. tomato (Pst) DC3000 expressing AvrRps4 resulted in iron accumulation, especially in the plant apoplast. AvrRps4 alleviates BTS-mediated degradation of bHLH115 and ILR3(IAA-Leucine resistant 3), two iron regulatory proteins. In addition, BTS is important for accumulating immune proteins Enhanced Disease Susceptibility1 (EDS1) at both the transcriptional and protein levels upon Pst (avrRps4) infections. Our findings suggest that AvrRps4 targets BTS to facilitate iron accumulation and BTS contributes to RPS4/EDS1-mediated immune responses.
Building Social Cohesion in Ethnically Mixed Schools: An Intervention on Perspective Taking
Authors: Alan Sule , Baysan Ceren , Gumren Mert , Kubilay Elif
Published: March 2021

We evaluate the effect of an educational program that aims to build social cohesion in ethnically mixed schools by developing perspective-taking ability in children. The program is implemented in Turkish elementary schools affected by a large influx of Syrian refugee children. We measure a comprehensive set of outcomes that characterize a cohesive school environment, including peer violence incidents, the prevalence of interethnic social ties, and prosocial behavior. Using randomized variation in program implementation, we find that the program significantly lowers peer violence and victimization on school grounds. The program also reduces the likelihood of social exclusion and increases interethnic social ties in the classroom. We find that the program significantly improves prosocial behavior, measured by incentivized tasks: treated students exhibit significantly higher trust, reciprocity, and altruism toward each other as well as toward anonymous out-school peers. We show that this enhanced prosociality is welfare improving from the ex post payoff perspective. We investigate multiple channels that could explain the results, including ethnic bias, impulsivity, empathetic concern, emotional intelligence, behavioral norms, and perspective taking. Children’s increased effort to take others’ perspectives emerges as the most robust mechanism to explain our results.
The representation of mental state information in schizophrenia and first-degree relatives: a multivariate pattern analysis of fMRI data
Authors: Dodell-Feder David , Tully Laura M , Dudek Emily , Hooker Christine I
Published: March 2021

Individuals with a schizophrenia-spectrum disorder (SSD) and those at familial high risk (FHR) for SSDs experience social difficulties that are related to neural abnormalities in the network of brain regions recruited during theory of mind (ToM). Prior work with these groups has focused almost exclusively on characterizing the involvement of these regions in ToM. Here, we examine the representational content of these regions using multivariate pattern analysis. We analyzed two previously collected datasets of SSD, FHR and control participants who, while undergoing functional magnetic resonance imaging, completed the false-belief task in which they read stories describing beliefs or physical representations (e.g. photographs). Univariate and multivariate analyses were performed in regions of interest to evaluate group differences in task-based activation and representational content, respectively. Compared to non-SSDs, SSDs showed reduced decoding accuracy for the category of mental states in the right temporo-parietal junction—which was related to false-belief accuracy—and the dorsal medial prefrontal cortex (DMPFC) and reduced involvement of DMPFC for mental state understanding. FHR showed no differences in decoding accuracy or involvement compared to non-FHR. Given prior studies of disrupted neural involvement in FHR and the lack of decoding differences observed here, the onset of illness may involve processes that corrupt how mental state information is represented.
The Legacy of Joseph A. Moylan, M.D.: “It’s About Everyone Else”
Authors: Mosca Paul J. , Zani Sabino , Haglund Michael M. , Collins Bradley H. , Wasiolek Sue , Pappas Theodore N. , Kirk Allan D. , Cendales Linda C.
Published: March 2021

The history of modern American surgery is marked by larger-than-life pioneers who have made transformative contributions to our field. These extraordinary individuals have been known primarily for their technical and clinical mastery, development of novel surgical procedures and techniques, extraordinary abilities in the education and training of surgeons, and/or innovative discoveries in biomedical science. While mastery in clinical surgery, education, and research have come to characterize the consummate academic surgeon, challenging social inequities of today now demand deeper engagement in another vital arena. This historical account is the story of a truly exceptional surgeon and visionary who spent much of his life leading that very charge. Early in his career, Dr. Joseph Moylan recognized and embraced this obligation to go beyond the walls of the hospital and out into the community to combat social factors leading to adverse outcomes for at-risk young men. His legacy itself represents a vehicle for empowering youth confronted with barriers to educational opportunities and experiences. Furthermore, recounting Joe’s journey conveys the over-arching thesis that surgeons have the opportunity—and, indeed, are well positioned—to engage more deeply with their communities, to lead efforts to address social determinants at their roots and to create a pipeline of bright young scholars and potential future surgeons.
Coronavirus disease 2019 and cardiovascular complications: focused clinical review
Authors: Saeed Sahrai , Tadic Marijana , Larsen Terje H. , Grassi Guido , Mancia Giuseppe
Published: March 2021

The coronavirus disease 2019 (COVID-19) may cause not only an acute respiratory distress syndrome (ARDS) but also multiple organ damage and failure requiring intensive care and leading to death. Male sex, advanced age, chronic lung disease, chronic kidney disease and cardiovascular disease, such as hypertension, diabetes and obesity have been identified as risk factors for the COVID-19 severity. Presumably, as these three cardiovascular risk factors are associated with a high prevalence of multiorgan damage. In the present focused clinical review, we will discuss the cardiovascular complications of COVID-19 including acute cardiovascular syndrome (acute cardiac injury/COVID cardiomyopathy, thromboembolic complications and arrhythmias) and post-COVID-19 sequelae. Preliminary data shows that the cause of acute cardiovascular syndrome may be multifactorial and involve direct viral invasion of the heart and vascular system, as well as through the immune and inflammation-mediated systemic cytokine storm. COVID-19 survivors may also show persistently elevated blood pressure and sinus tachycardia at rest. Furthermore, poor diabetic control, persistent renal damage and cerebral sequelae, such as persistent cognitive and neuropsychiatric alterations are also frequently reported. A particular attention should be paid towards cardiovascular protection in COVID-19 patients who develop acute cardiovascular syndromes during hospitalization, and/or permanent/semipermanent sequelae after recovery from COVID-19. These conditions may require careful clinical assessment, treatment and close follow-up to avoid short-term and long-term complications.
Novel Claims-Based Outcome Phenotypes in Survivors of Pediatric Traumatic Brain Injury
Authors: Maddux Aline B. , Sevick Carter , Cox-Martin Matthew , Bennett Tellen D.
Published: March 2021

Objective:

For children hospitalized with acute traumatic brain injury (TBI), to use postdischarge insurance claims to identify: (1) healthcare utilization patterns representative of functional outcome phenotypes and (2) patient and hospitalization characteristics that predict outcome phenotype.

Setting:

Two pediatric trauma centers and a state-level insurance claim aggregator.

Patients:

A total of 289 children, who survived a hospitalization after TBI between 2009 and 2014, were in the hospital trauma registry, and had postdischarge insurance eligibility.

Design:

Retrospective cohort study.

Main Measures:

Unsupervised machine learning to identify phenotypes based on postdischarge insurance claims. Regression analyses to identify predictors of phenotype.

Results:

Median age 5 years (interquartile range 2-12), 29% (84/289) female. TBI severity: 30% severe, 14% moderate, and 60% mild. We identified 4 functional outcome phenotypes. Phenotypes 3 and 4 were the highest utilizers of resources. Morbidity burden was highest during the first 4 postdischarge months and subsequently decreased in all domains except respiratory. Severity and mechanism of injury, intracranial pressure monitor placement, seizures, and hospital and intensive care unit lengths of stay were phenotype predictors.

Conclusions:

Unsupervised machine learning identified postdischarge phenotypes at high risk for morbidities. Most phenotype predictors are available early in the hospitalization and can be used for prognostic enrichment of clinical trials targeting mitigation or treatment of domain-specific morbidities.
Research Letter: Blast Exposure and Brain Volume
Authors: Martindale Sarah L. , Shura Robert D. , Rostami Ramona , Taber Katherine H. , Rowland Jared A.
Published: March 2021

Objective:

To determine whether blast exposure is associated with brain volume beyond posttraumatic stress disorder (PTSD) diagnosis and history of traumatic brain injury (TBI).

Setting:

Veterans Affairs Medical Center.

Participants:

One hundred sixty-three Iraq and Afghanistan combat veterans, 86.5% male, and 68.10% with a history of blast exposure. Individuals with a history of moderate to severe TBI were excluded.

Main Measures:

Clinician-Administered PTSD Scale (CAPS-5), Mid-Atlantic MIRECC Assessment of TBI (MMA-TBI), Salisbury Blast Interview (SBI), and magnetic resonance imaging. Maximum blast pressure experienced from a blast event represented blast severity.

Methods:

Hierarchical regression analysis evaluated effects of maximum pressure experienced from a blast event on bilateral volume of hippocampus, anterior cingulate cortex, amygdala, orbitofrontal cortex, precuneus, and insula. All analyses adjusted for effects of current and lifetime PTSD diagnosis, and a history of deployment mild TBI.

Results:

Maximum blast pressure experienced was significantly associated with lower bilateral hippocampal volume (left: ΔR2 = 0.032, P < .001; right: ΔR2 = 0.030, P < .001) beyond PTSD diagnosis and deployment mild TBI history. Other characteristics of blast exposure (time since most recent exposure, distance from closest blast, and frequency of blast events) were not associated with evaluated volumes.

Conclusion:

Exposure to a blast is independently associated with hippocampal volume beyond PTSD and mild TBI; however, these effects are small. These results also demonstrate that blast exposure in and of itself may be less consequential than severity of the exposure as measured by the pressure gradient.
Healthcare Providers' Self-Reported Pediatric Mild Traumatic Brain Injury Diagnosis, Prognosis, and Management Practices: Findings From the 2019 DocStyles Survey
Authors: Sarmiento Kelly , Daugherty Jill , Haarbauer-Krupa Juliet
Published: March 2021

Objective:

To assess adherence to 5 key recommendations in the Centers for Disease Control and Prevention evidence-based guideline on pediatric mild traumatic brain injury, this article presents results from the 2019 DocStyles survey.

Study Design:

Cross-sectional, web-based survey of 653 healthcare providers.

Results:

Most healthcare providers reported adhering to the recommendations regarding the use of computed tomography and providing education and reassurance to patients and their families. However, less than half reported routinely examining their patients with mild traumatic brain injury (mTBI) using age-appropriate, validated symptom scales, assessing for risk factors for prolonged recovery, and advising patients to return to noncontact, light aerobic activities within 2 to 3 days. Self-reported mTBI diagnosis, prognosis, and management practices varied by specialty. Only 3.8% of healthcare providers answered all 7 questions in a way that is most consistent with the 5 recommendations examined from the Centers for Disease Control and Prevention Pediatric mTBI Guideline.

Conclusion:

This study highlights several important information gaps regarding pediatric mTBI diagnosis and management. Further efforts to improve adoption of guideline recommendations may be beneficial to ensure optimal outcomes for children following an mTBI.
Diagnosis and management of Clostridioides difficile infection in patients with inflammatory bowel disease
Authors: Dalal Rahul S. , Allegretti Jessica R.
Published: March 2021

Purpose of review

Clostridioides difficile infection (CDI) may complicate the course of ulcerative colitis and Crohn's disease. The clinical presentation of CDI in this population is often atypical, and patients may experience exacerbations of their underlying inflammatory bowel disease (IBD) secondary to C. difficile. In this review, we aim to review the risk factors, diagnosis, and management of CDI in the context of IBD.

Recent findings

Patients with colonic involvement of their IBD are at higher risk for CDI and colonization may be more common than in the general population. Therefore, CDI is confirmed using a two-step approach to stool testing. Oral vancomycin or fidaxomicin are the preferred agents for nonfulminant disease, and oral metronidazole is no longer recommended as first-line therapy. For all patients with CDI recurrence, fecal microbiota transplant (FMT) should be considered, as this has been shown to be safe and effective. Among those who have worsening of their underlying IBD, retrospective research suggest that outcomes are improved for those who undergo escalation of immunosuppression with appropriate antimicrobial treatment of C. difficile, however prospective data are needed.

CDI may complicate the course of IBD, however the presentation may not be typical. Therefore, all patients with worsening gastrointestinal symptoms should be evaluated for both CDI and IBD exacerbation. Providers should consider FMT for all patients with recurrent CDI as well as escalation of immunosuppression for patients who fail to improve with appropriate antimicrobial therapy.
Consequences of coronavirus infections for primitive and mature hematopoietic cells: new insights and why it matters
Authors: Ropa James , Trinh Thao , Aljoufi Arafat , Broxmeyer Hal E.
Published: March 2021

Purpose of review

In recent history there have been three outbreaks of betacoronavirus infections in humans, with the most recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; causing Coronavirus disease 2019 [COVID-19]) outbreak leading to over two million deaths, with a rapidly rising death toll. Much remains unknown about host cells and tissues affected by coronavirus infections, including the hematopoietic system. Here, we discuss the recent findings examining effects that coronavirus infection or exposure has on hematopoietic cells and the clinical implications for these effects.

Recent findings

Recent studies have centered on SARS-CoV-2, demonstrating that hematopoietic stem and progenitor cells and mature immune cells may be susceptible to infection and are impacted functionally by exposure to SARS-CoV-2 Spike protein. These findings have important implications regarding hematologic complications arising from COVID-19 and other coronavirus-induced disease, which we discuss here.

Infection with coronaviruses sometimes leads to hematologic complications in patients, and these hematologic complications are associated with poorer prognosis. These hematologic complications may be caused by coronavirus direct infection or impact on primitive hematopoietic cells or mature immune cells, by indirect effects on these cells, or by a combination thereof. It is important to understand how hematologic complications arise in order to seek new treatments to improve patient outcomes.
A Concept Analysis of Oral Anticancer Agent Self-management
Authors: Mason Madilyn , Harris Marcelline R. , Greer Joseph A. , Jiang Yun
Published: March 2021

Background

The rapid development and adoption of oral anticancer agents (OAAs) for cancer management have shifted patients’ roles from recipient to owner of their care delivery, assuming their responsibilities for self-managing their OAA treatments at home, while the concept of oral anticancer agent self-management (OAA-SM) has not been well clarified and defined.

Objective

This study was to clarify the concept of OAA-SM and identify major components, influential factors, and consequences of OAA-SM, as well as propose a representative conceptual model of OAA-SM.

Methods

A literature review was conducted concerning the concept and application of OAA-SM. The Walker and Avant method for concept analysis was utilized to guide the examination of OAA-SM.

Results

OAA-SM is a multifaceted and dynamic process that requires continuous adaptation by patients as multiple self-management challenges can emerge throughout OAA treatments. The defining attributes of OAA-SM include OAA adherence, adverse-effect self-management, patient-provider communication, and OAA safe storage, handling, and administration practices. Oral anticancer agent–SM is potentially influenced by a variety of patient-related, OAA-related, and healthcare system factors. Effective OAA-SM is associated with better patient and healthcare outcomes.

Conclusions

The clarification of the concept of OAA-SM and the identification of attributes of OAA-SM and their interrelationships contribute to the body of knowledge in OAA-SM.

Implications for Practice

This concept analysis provides the foundation to increase healthcare providers’ understanding of patients’ needs for OAA-SM support and guides the development of patient-centered interventions to empower and engage patients and their families in effective OAA-SM, and improve patients’ quality of life and care.
Spouse Caregivers’ Experiences of Suffering in Relation to Care for a Partner With Brain Tumor
Authors: Francis Sara R. , Hall Elisabeth O. C. , Delmar Charlotte
Published: March 2021

Background

Spouses often undertake the main caring role for a partner with primary malignant brain tumor (PMBT). Yet, demanding and challenging caring responsibilities especially because of the partner’s cognitive declines can affect the spouse caregiver’s well-being.

Objective

The aim of this study was to investigate spouses’ experiences of suffering in their role as main caregiver of a partner with PMBT.

Methods

A hermeneutical qualitative design was used to collect and analyze data. Ten spouses (aged 36–76 years) were interviewed in depth twice 1 year apart, using semistructured interview guides.

Results

The spouse caregivers’ experiences of suffering in their role as their partner’s main caregiver were interpreted according to 3 central themes: “Enduring everyday life,” “Being overlooked and hurt,” and “Being acknowledged and feeling good.”

Conclusion

Spouse caregivers of a partner with PMBT are suffering from exhaustion and suppression of their own emotions to endure the caring responsibilities. They need support to manage their everyday hardship; however, their experiences seem to be easily overlooked. This causes disappointment and hurts their dignity. Acknowledgment through simple acts of practical help or time to talk are consoling and alleviate their experiences of suffering.

Implications for Practice

An intervention that supports healthcare professionals to facilitate the spouse caregivers’ suffering is welcoming. The focus of the intervention may involve a sensitive awareness toward the spouse caregiver’s individual resources and limitations and the relational and communicative competences of the healthcare professionals in their encounters with spouse caregivers that avoid hurting the spouse caregiver’s dignity.
FOS Rearrangement and Expression in Cementoblastoma
Authors: Lam Suk Wai , Cleven Arjen H.G. , Briaire-de Bruijn Inge H. , Schreuder Willem H. , Kroon Herman M. , Savci-Heijink Dilara C. , Suurmeijer Albert J.H. , Szuhai Karoly , Bovée Judith V.M.G. , Baumhoer Daniel
Published: March 2021

Cementoblastomas are rare odontogenic tumors developing in close proximity to the roots of teeth. Due to their striking morphologic resemblance to osteoblastomas of the peripheral skeleton, we set out to determine whether cementoblastomas harbor the same FOS rearrangements with overexpression of c-FOS as has recently been described for osteoblastomas. In total, 16 cementoblastomas were analyzed for FOS expression by immunohistochemistry and for FOS rearrangements by fluorescence in situ hybridization (FISH). We observed strong and diffuse staining of c-FOS in 71% of cementoblastomas and identified a FOS rearrangement in all cases (n=3) applicable for FISH. In the remaining cases, FISH failed due to decalcification. Cementoblastomas harbor similar FOS rearrangements and show overexpression of c-FOS like osteoblastomas, suggesting that both entities might represent parts of the spectrum of the same disease.
Influencing Medical Students’ Knowledge and Attitudes Related to Disability
Authors: Almhdawi Khader A.
Published: March 2021

Purposes

The aims of the study were to evaluate and to compare the efficacy of an online and a traditionally delivered undergraduate elective course in improving medical students’ disability-related knowledge and attitudes.

Methods

A randomized controlled design was implemented. Participants were medical students randomly assigned into summer 8-wk disability and the society (OT100) online course, OT100 traditional course, or wellness and lifestyles (PT100) control. Demographics were collected in addition to participants’ level disability knowledge and attitudes toward people with disability scale scores (1 wk before the semester and 1 wk after it). Multivariate analysis of covariance using general linear model was conducted to evaluate groups’ differences in main outcome measures.

Results

In total, 198 undergraduate medical students successfully completed the study conditions: OT100 online (n = 74), OT100 traditional (n = 59), and PT100 (n = 65). OT100 groups (traditional and online) change scores were statistical similar for disability knowledge (P = 0.966) and attitudes (P = 0.705) but significantly better (P < 0.001) than the control group.

Conclusions

OT100 course delivered traditionally or online seemed effective in improving medical students’ disability knowledge and attitudes toward people with disability. More studies are needed to create effective methods improving healthcare professionals’ disability-related knowledge and attitudes.
What is the Impact of Prenatal Counseling on Postnatal Cleft Treatment? Multidisciplinary Pathway for Prenatal Orofacial Cleft Care
Authors: Zimmerman Carrie E. , Folsom Nancy , Humphries Laura S. , Kalmar Christopher L. , Vu Giap H. , Bushold Julia , Swanson Jordan W. , Taylor Jesse A.
Published: March 2021

In the pediatric general surgery literature, it has been shown that prenatal diagnosis of a congenital anomaly is an independent predictor of parental psychological distress. Surgical prenatal counseling can decrease parental anxiety by helping families understand the surgical needs and potential outcomes of their infant. In this retrospective analysis (n = 440), the authors sought to present our care pathway for prenatally diagnosed cleft lip and palate (CL/P) and explore the impact of cleft lip and palate-specific prenatal counseling on patient care by comparing the timing of clinical and surgical care between a cohort of patients who received prenatal CL/P consultation and a cohort of patients only seen postnatally. The authors hypothesize that our multidisciplinary prenatal care intervention is associated with earlier postnatal clinic visits and surgical repair. The care of all patients whose mother's presented for prenatal CL/P consultation (prenatal cohort, n = 118) was compared to all new CL/P patients without prenatal consultation at our institution (postnatal cohort, n = 322) from January 2015 through August 2019. 81.4% (n = 96) of the prenatal cohort returned for care postnatally while 2 pregnancies were interrupted, four neonates died, and 15 patients did not return for care. Prenatal consultation was associated with earlier postnatal clinic appointments (P < 0.001) as well as a shorter time to CL repair in patients with CL only (P = 0.002) and CLP (P = 0.047). Our described pre- and postnatal CL/P pathway is a multidisciplinary model associated with high retention rates from the prenatal period through complete surgical repair.
Throat Packs in Cleft and Craniofacial Surgery
Authors: Martin Serena , Blacklock Calum , McBride Michael , Quinn James , Hill Chris
Published: March 2021

Throat packs are used in a wide range of surgical and dental procedures. Indications for use include; airway stabilization, reducing the risk of aspiration, and postoperative nausea and vomiting. Despite these perceived benefits, a retained throat pack can be fatal. This has been highlighted since the 1970s but as of yet no effective fail-safe mechanisms exist to prevent the potential tragic consequences of a retained throat pack.

A multifaceted questionnaire was distributed at the annual Craniofacial Society of Great Britain and Ireland 2017 to identify current views and practices amongst cleft surgeons. The questionnaire contained seventeen questions related to throat pack use. The responses to the questions were collated and discussed in the context of the current literature.

Twenty-four cleft surgeons completed the questionnaire; 67% always use a throat pack, with 84% not securing the throat pack in any way. Almost half (48%) had encountered a serious adverse incident secondary to the use of a throat pack.

This survey and review of the literature highlight ongoing discrepancies and a lack of standardization on a national basis. Adverse incidents and fatalities are still occurring. Overwhelming evidence now confirms the lack of benefit regarding postoperative nausea and vomiting and the authors urge both surgeons and anesthetists to strongly consider the need for a throat pack in routine elective procedures.
Modified Intraoral C-Osteotomy
Authors: da Costa Senior Oliver , De Temmerman Griet , Falter Bart , Politis Constantinus
Published: March 2021

Repeated sagittal split osteotomy might impose an increased risk for damage of the inferior alveolar nerve. Another contemporary orthognathic issue is surgical management of malocclusion following condylar resorption. Here we describe a modified C-osteotomy technique as a proposed solution for these difficulties in orthognathic surgery. The modified C-osteotomy might induce less stress on the condyles reducing the risk for relapse subsequent to condylar resorption, as well as reduce the risk of inferior alveolar nerve damage.
Sports-Related Craniofacial Injuries Among Pediatric and Adolescent Females: A National Electronic Injury Surveillance System Database Study
Authors: Kim Minji , Moeller Ellie , Thaller Seth R.
Published: March 2021

Background:

Number of female athletes continues to exponentially increase in all sports; however, available literature detailing craniofacial injuries remains scarce. Compared to male athletes, female athletes may experience different types of injuries. These may be related to sex differences such as craniofacial pain and dimensions. Thus, this study assesses the type of sport and craniofacial injuries that pediatric and adolescent female athletes sustain.

Methods:

National Electronic Injury Surveillance System was analyzed for all hospital admissions for young female athletes (5–24 years old) experiencing a sports-related craniofacial injury. These included contusions and abrasions, lacerations, fractures, and hematomas. Following sports were analyzed for craniofacial injury: basketball, golf, soccer, ice skating, swimming, softball, horseback riding, volleyball, field hockey, and football.

Results:

Most of the sports-related craniofacial injury occurred in female athletes who are between 10 and 19 years old. Across all age groups, softball (34.9%), basketball (28.1%), and soccer (15.6%) caused majority of the craniofacial injuries. The most common presenting craniofacial injury types were contusions and abrasions as well as lacerations.

Conclusions:

There is a need for improved protective gear, such as face shields and low-impact balls, especially in softball and basketball. Physicians should consider the differences in female versus male and child versus adult injury pattern when treating female athletes in order to prevent long-term complications, such as scarring and depression. Overall, sports-related craniofacial injuries among female athletes need to be further examined as the epidemiology of their injuries and their health needs are unique.
Development and Implementation of a Novel Computer-Based Training Module for the Standardization of Splenic Flexure Mobilization
Authors: Benlice Cigdem , Ismail Erkin , Akyol Cihangir , Akkoca Muzaffer , Korkmaz Alican , Coban Ismail , Acar Halil Ibrahim , Kuzu Mehmet Ayhan
Published: March 2021

Background:

Computer-based training modules use various multimedia components such as text, graphics, animation, and videos that can theoretically facilitate the learning process. Splenic flexure mobilization (SFM) is a crucial step for tension-free colorectal/anal anastomosis that can be a technically demanding step. This study is designed to demonstrate our novel training module for SFM with high-vessel ligation during surgery and present the anatomical landmarks and embryological plans for SFM.

Materials and Methods:

A step-by-step educational video was prepared to standardize and teach the technical steps of the SFM. 3D animation was prepared and cadaveric dissection was performed in a step-by-step manner similar to minimally invasive surgery. This is followed by the laparoscopic technique. Since we have started this modular training program in our department, a consecutive of 100 patients underwent laparoscopic low anterior resection and coloanal anastomosis with covering stoma. Demographics, characteristics, and postoperative outcomes were evaluated.

Results:

Surgical anatomical planes and important vascular structures/variations are both shown by 3D animation, cadaveric dissection, and laparoscopic surgery. Out of 100 consecutive cases, there were no mortality, 5 anastomotic leakages 1 of which necessitates reoperation, and 2 splenic injuries which were managed conservatively.

Conclusion:

This unique educational video module for SFM demonstrates surgical anatomical planes and important vascular structures/variations. The employment and implementation of time-independent multimedia components lead to effective training and can theoretically facilitate the learning process.
Mediastinoscopy-assisted Transhiatal Esophagectomy (MATHE) in End-stage Achalasia and Gastric Bypass: Technique and Early Results
Authors: Gergen Anna K. , Weyant Michael J. , McCarter Martin D. , Pratap Akshay
Published: March 2021

Introduction:

Approximately 5% of patients who have undergone prior Heller myotomy and Roux en Y gastric bypass progress to end-stage achalasia (ESA). Surgical options for ESA are often limited to esophagectomy for management of severe dysphagia or life-threatening aspiration episodes. Mediastinoscopy-assisted transhiatal esophagectomy (MATHE) by a small left neck incision combined with an abdominal incision, without using a transthoracic approach, has been reported to reduce pulmonary complications. We herein present the first report of MATHE in 2 consecutive patients with ESA and gastric bypass.

Materials and Methods:

Between August 2017 and September 2020, 2 patients who had undergone Heller myotomy and Roux en Y gastric bypass underwent MATHE for ESA. Transhiatal esophagectomy with mediastinoscopy-assisted dissection was performed. The remnant stomach was used as the conduit in both cases. The embedded Supplemental Digital Content 1 (http://links.lww.com/SLE/A269) reports our novel technique.

Results:

Both cases were completed laparoscopically without conversion to laparotomy or thoracotomy. Median length of hospital stay was 9 days (range, 6 to 11 d). Postoperatively, 1 patient developed a cervical anastomotic leak, which healed with conservative management. No other major complications were observed.

Conclusions:

MATHE can be safely performed in patients with a history of gastric bypass and ESA without requiring thoracoscopic mobilization of the esophagus. Further studies are required to validate reproducibility of our technique as an alternative to using a thoracic incision.