bluuebunny/crossref_metadata_2025 huggingface dataset:
The COS Absorption Survey of Baryon Harbors: unveiling the physical conditions of circumgalactic gas through multiphase Bayesian ionization modelling
Authors: Haislmaier Karl J , Tripp Todd M , Katz Neal , Prochaska J Xavier , Burchett Joseph N , O’Meara John M , Werk Jessica K
Published: November 2020

Quasar absorption systems encode a wealth of information about the abundances, ionization structure, and physical conditions in intergalactic and circumgalactic media. Simple (often single-phase) photoionization models are frequently used to decode such data. Using five discrete absorbers from the COS Absorption Survey of Baryon Harbors (CASBaH) that exhibit a wide range of detected ions (e.g. Mg ii, S ii – S vi, O ii – O vi, Ne viii), we show several examples where single-phase ionization models cannot reproduce the full set of measured column densities. To explore models that can self-consistently explain the measurements and kinematic alignment of disparate ions, we develop a Bayesian multiphase ionization modelling framework that characterizes discrete phases by their unique physical conditions and also investigates variations in the shape of the UV flux field, metallicity, and relative abundances. Our models require at least two (but favour three) distinct ionization phases ranging from T ≈ 104 K photoionized gas to warm-hot phases at T ≲ 105.8 K. For some ions, an apparently single absorption ‘component' includes contributions from more than one phase, and up to 30 per cent of the H i is not from the lowest ionization phase. If we assume that all of the phases are photoionized, we cannot find solutions in thermal pressure equilibrium. By introducing hotter, collisionally ionized phases, however, we can achieve balanced pressures. The best models indicate moderate metallicities, often with subsolar N/α, and, in two cases, ionizing flux fields that are softer and brighter than the fiducial Haardt & Madau UV background model.
Multiband light-curve analysis of the 40.5-min period eclipsing double-degenerate binary SDSS J082239.54+304857.19
Authors: Kosakowski Alekzander , Kilic Mukremin , Brown Warren
Published: November 2020

We present the Apache Point Observatory BG40 broad-band and simultaneous Gemini r-band and i-band high-speed follow-up photometry observations and analysis of the 40.5-min period eclipsing detached double-degenerate binary SDSS J082239.54+304857.19. Our APO data spans over 318 d and includes 13 primary eclipses, from which we precisely measure the system’s orbital period and improve the time of mid-eclipse measurement. We fit the light curves for each filter individually and show that this system contains a low-mass DA white dwarf with radius RA = 0.031 ± 0.006 R⊙ and a RB = 0.013 ± 0.005 R⊙ companion at an inclination of i = 87.7 ± 0.2○. We use the best-fitting eclipsing light curve model to estimate the temperature of the secondary star as Teff = 5200 ± 100 K. Finally, while we do not record significant offsets to the expected time of mid-eclipse caused by the emission of gravitational waves with our 1-yr baseline, we show that a 3σ significant measurement of the orbital decay due to gravitational waves will be possible in 2023, at which point the eclipse will occur about 8  s earlier than expected.
Sirius: a prototype astronomical intensity interferometer using avalanche photodiodes in linear mode
Authors: Oh Junghwan , Wagner Jan , Trippe Sascha , Lee Taeseok , Lee Bangwon , Kim Chang Hee
Published: November 2020

Optical intensity interferometry, developed in the 1950s, is a simple and inexpensive method for achieving angular resolutions on microarcsecond scales. Its low sensitivity has limited intensity interferometric observations to bright stars so far. Substantial improvements are possible by using avalanche photodiodes (APDs) as light detectors. Several recent experiments used APDs in single-photon detection mode; however, these either provide low electronic bandwidths (few MHz) or require very narrow optical bandpasses. We present here the results of laboratory measurements with a prototype astronomical intensity interferometer using two APDs observing an artificial star in continuous (‘linear’) detection mode with an electronic bandwidth of 100 MHz. We find a photon–photon correlation of about 10−6, as expected from the ratio of the coherence times of the light source and the detectors. In a configuration where both detectors are on the optical axis (zero baseline), we achieve a signal-to-noise ratio of ∼2700 after 10 min of integration. When measuring the correlation as a function of baseline, we find a Gaussian correlation profile with a standard deviation corresponding to an angular half-width of the artificial star of 0.55 arcsec, in agreement with the estimate by the manufacturer. Our results demonstrate the possibility to construct large astronomical intensity interferometers using linear-mode APDs.
Assessing uncertainties in the predicted very high energy flux of globular clusters in the Cherenkov Telescope Array era
Authors: Ndiyavala-Davids Hambeleleni , Venter Christo , Kopp Andreas , Backes Michael
Published: November 2020

Terzan 5 is the only Galactic globular cluster that has plausibly been detected in the very high energy range. Stacking upper limits by High-Energy Stereoscopic System on the integral γ-ray flux of a population of other globular clusters are very constraining for leptonic cluster emission models. We demonstrate that uncertainty in model parameters leads to a large spread in the predicted flux, and there are indeed regions in parameter space for which the stringent stacking upper limits are satisfied. We conduct two more case studies: we study the uncertainties in differential TeV flux for M15, showing that our model can satisfy the stringent MAGIC upper limits for this cluster, for typical cluster parameters. We also calculate the differential flux at TeV energies for ω Cen, from which five pulsars have recently been detected at radio energies. It is thus important to increase measurement accuracy on key model parameters in order to improve predictions of cluster fluxes so as to better guide the observational strategy of the Cherenkov Telescope Array.
Stellar splashback: the edge of the intracluster light
Authors: Deason Alis J , Oman Kyle A , Fattahi Azadeh , Schaller Matthieu , Jauzac Mathilde , Zhang Yuanyuan , Montes Mireia , Bahé Yannick M , Dalla Vecchia Claudio , Kay Scott T , Evans Tilly A
Published: November 2020

We examine the outskirts of galaxy clusters in the C-EAGLE simulations to quantify the ‘edges’ of the stellar and dark matter distribution. The radius of the steepest slope in the dark matter, commonly used as a proxy for the splashback radius, is located at $\sim \, r_{200 \rm m}$; the strength and location of this feature depends on the recent mass accretion rate, in good agreement with previous work. Interestingly, the stellar distribution (or intracluster light, ICL) also has a well-defined edge, which is directly related to the splashback radius of the halo. Thus, detecting the edge of the ICL can provide an independent measure of the physical boundary of the halo, and the recent mass accretion rate. We show that these caustics can also be seen in the projected density profiles, but care must be taken to account for the influence of substructures and other non-diffuse material, which can bias and/or weaken the signal of the steepest slope. This is particularly important for the stellar material, which has a higher fraction bound in subhaloes than the dark matter. Finally, we show that the ‘stellar splashback’ feature is located beyond current observational constraints on the ICL, but these large projected distances (≫1 Mpc) and low surface brightnesses (μ ≫ 32 mag arcsec−2) can be reached with upcoming observational facilities such as the Vera C. Rubin Observatory, the Nancy Grace Roman Space Telescope, and Euclid.
Gaia pulsars and where to find them
Authors: Antoniadis John
Published: November 2020

While the majority of massive stars have a stellar companion, most pulsars appear to be isolated. Taken at face value, this suggests that most massive binaries break apart due to strong natal kicks received in supernova explosions. However, the observed binary fraction can still be subject to strong selection effects, as monitoring of newly discovered pulsars is rarely carried out for long enough to conclusively rule out multiplicity. Here, we use the second Gaia data release to search for companions to 1534 rotation-powered pulsars with positions known to better than 0.5 arcsec. We find 22 matches to known pulsars, including 1 not reported elsewhere, and 8 new possible companions to young pulsars. We examine the photometric and kinematic properties of these systems and provide empirical relations for identifying Gaia sources with potential millisecond pulsar companions. Our results confirm that the observed multiplicity fraction is small. However, we show that the number of binaries below the sensitivity of Gaia and radio timing in our sample could still be significantly higher. We constrain the binary fraction of young pulsars to be $f_{\rm young}^{\rm true}\le 5.3(8.3){{\ \rm per\ cent}}$ under realistic (conservative) assumptions for the binary properties and current sensitivity thresholds. For massive stars (≥10 M⊙) in particular, we find $f_{\rm OB}^{\rm true}\le 3.7{{\ \rm per\ cent}}$, which sets a firm independent upper limit on the Galactic neutron star merger rate, ≤7.2 × 10−4 yr−1. Ongoing and future projects, such as the CHIME/pulsar program, MeerTime, HIRAX, and ultimately the SKA, will significantly improve these constraints in the future.
Pairing function of visual binary stars
Authors: Chulkov Dmitry
Published: November 2020

An all-sky sample of 1227 visual binaries based on Washington Double Star catalogue is constructed to infer the initial mass function (IMF), mass ratio, and projected distance distribution with a dedicated population synthesis model. Parallaxes from Gaia DR2 and Hipparcos are used to verify the distance distribution. The model is validated on the single-star Tycho-2 sample and successfully reproduces the observed magnitudes and angular separations. The projected separation distribution follows f(s) ∼ s−1.2 in 102–2 × 103  au range for 1–4.5 m⊙ primary stars. Several algorithms are explored as pairing functions. Random pairing is confidently rejected. Primary-constrained pairing (PCP) and split-core pairing (SCP), the scenarios adopting primary component’s or total system’s mass as fundamental, are considered. The preferred IMF slope is α ∼ 2.8 either way. A simple power-law mass ratio distribution is unlikely, but the introduction of a twin excess provides a favourable result. PCP with f(q) ∼ q−1 is preferred with a tiny twin fraction, models with f(q) ∼ q−1.5 are acceptable when a larger twin excess is allowed. SCP is similar to PCP when a larger slope of the power law is adopted: f(q) ∼ qβ + 0.7.
RCSB Protein Data Bank: powerful new tools for exploring 3D structures of biological macromolecules for basic and applied research and education in fundamental biology, biomedicine, biotechnology, bioengineering and energy sciences
Authors: Burley Stephen K , Bhikadiya Charmi , Bi Chunxiao , Bittrich Sebastian , Chen Li , Crichlow Gregg V , Christie Cole H , Dalenberg Kenneth , Di Costanzo Luigi , Duarte Jose M , Dutta Shuchismita , Feng Zukang , Ganesan Sai , Goodsell David S , Ghosh Sutapa , Green Rachel Kramer , Guranović Vladimir , Guzenko Dmytro , Hudson Brian P , Lawson Catherine L , Liang Yuhe , Lowe Robert , Namkoong Harry , Peisach Ezra , Persikova Irina , Randle Chris , Rose Alexander , Rose Yana , Sali Andrej , Segura Joan , Sekharan Monica , Shao Chenghua , Tao Yi-Ping , Voigt Maria , Westbrook John D , Young Jasmine Y , Zardecki Christine , Zhuravleva Marina
Published: November 2020

The Research Collaboratory for Structural Bioinformatics Protein Data Bank (RCSB PDB), the US data center for the global PDB archive and a founding member of the Worldwide Protein Data Bank partnership, serves tens of thousands of data depositors in the Americas and Oceania and makes 3D macromolecular structure data available at no charge and without restrictions to millions of RCSB.org users around the world, including >660 000 educators, students and members of the curious public using PDB101.RCSB.org. PDB data depositors include structural biologists using macromolecular crystallography, nuclear magnetic resonance spectroscopy, 3D electron microscopy and micro-electron diffraction. PDB data consumers accessing our web portals include researchers, educators and students studying fundamental biology, biomedicine, biotechnology, bioengineering and energy sciences. During the past 2 years, the research-focused RCSB PDB web portal (RCSB.org) has undergone a complete redesign, enabling improved searching with full Boolean operator logic and more facile access to PDB data integrated with >40 external biodata resources. New features and resources are described in detail using examples that showcase recently released structures of SARS-CoV-2 proteins and host cell proteins relevant to understanding and addressing the COVID-19 global pandemic.
Against ‘Good for’/‘Well-Being’, for ‘Simply Good’
Authors: Hurka Thomas
Published: November 2020

This paper challenges the widely held view that ‘good for’, ‘well-being’, and related terms express a distinctive evaluative concept of central importance for ethics and separate from ‘simply good’ as used by G. E. Moore and others. More specifically, it argues that there's no philosophically useful good-for or well-being concept that's neither merely descriptive in the sense of naturalistic nor reducible to ‘simply good’. The paper distinguishes two interpretations of the common claim that the value ‘good for’ expresses is distinctively ‘subject-relative’. One concerns the ground of this value, or the properties that make something good for you; it says these must involve some relation to you. The other concerns the resulting value itself, or what supervenes on this ground; it says that too involves a relation. Neither interpretation, the paper argues, yields a significantly distinct evaluative concept. The ethically fundamental evaluative concept is just ‘simply good’.
Comparative Efficacy and Safety of Conservative Care for Pregnancy-Related Low Back Pain: A Systematic Review and Network Meta-analysis
Authors: Chen Lingxiao , Ferreira Manuela L , Beckenkamp Paula R , Caputo Eduardo L , Feng Shiqing , Ferreira Paulo H
Published: November 2020

Objective

More than one-half of pregnant women experience pregnancy-related low back pain (LBP). Pregnancy-related LBP greatly affects activities of daily life, and although many interventions have been proposed, the optimal treatment for pregnancy-related LBP remains unclear. The purpose of this study was to compare conservative care strategies on their efficacy and safety for women with pregnancy-related LBP through systematic review with pairwise meta-analysis and network meta-analysis.

Methods

MEDLINE, Embase, the Cochrane Library, AMED, CINAHL, PEDro, PsycINFO, and ClinicalTrials.gov were searched from inception to November 2019. Randomized controlled trials and observational controlled studies were included without restriction to language, sample size, or duration of follow-up. Two independent investigators extracted the data and assessed the risk of bias. The quality of evidence was evaluated through Grading of Recommendations Assessment, Development and Evaluation.

Results

Twenty-three studies were included in the qualitative synthesis (18 randomized controlled trials were included in the network meta-analysis). For women with LBP during pregnancy, progressive muscle relaxation therapy (mean difference = −3.96; 95% CI = −7.19 to −0.74; moderate-quality evidence) and Kinesio Taping (mean difference = −3.71; 95% CI = −6.55 to −0.87; low-quality evidence) reduced pain intensity (Visual Analog Scale, range = 0 to 10) compared with placebo. Moderate-quality evidence suggested that transcutaneous electrical nerve stimulation improved physical function (mean difference = −6.33; 95% CI = −10.61 to −2.05; Roland Morris Disability Questionnaire, range = 0–24) compared with placebo.

Conclusion

For patients with LBP during pregnancy, progressive muscle relaxation therapy and Kinesio Taping may help to decrease pain, and transcutaneous electrical nerve stimulation may improve physical function.

Impact

This review helps fill the gap in evidence regarding optimal treatment for pregnancy-related LBP.

Lay Summary

If you have LBP during pregnancy, your physical therapist has evidence to support the use of progressive muscle relaxation therapy and Kinesio Taping to help decrease pain and the use of transcutaneous electrical nerve stimulation to help improve physical function.
Relationship between motion, using the GaitSmartTM system, and radiographic knee osteoarthritis: an explorative analysis in the IMI-APPROACH cohort
Authors: van Helvoort Eefje M , Hodgins Diana , Mastbergen Simon C , Marijnissen Anne Karien , Guehring Hans , Loef Marieke , Kloppenburg Margreet , Blanco Francisco , Haugen Ida K , Berenbaum Francis , Lafeber Floris P J G , Welsing Paco M J
Published: November 2020

Objectives

To assess underlying domains measured by GaitSmartTMparameters and whether these are additional to established OA markers including patient reported outcome measures (PROMs) and radiographic parameters, and to evaluate if GaitSmart analysis is related to the presence and severity of radiographic knee OA.

Methods

GaitSmart analysis was performed during baseline visits of participants of the APPROACH cohort (n = 297). Principal component analyses (PCA) were performed to explore structure in relationships between GaitSmart parameters alone and in addition to radiographic parameters and PROMs. Logistic and linear regression analyses were performed to analyse the relationship of GaitSmart with the presence (Kellgren and Lawrence grade ≥2 in at least one knee) and severity of radiographic OA (ROA).

Results

Two hundred and eighty-four successful GaitSmart analyses were performed. The PCA identified five underlying GaitSmart domains. Radiographic parameters and PROMs formed additional domains indicating that GaitSmart largely measures separate concepts. Several GaitSmart domains were related to the presence of ROA as well as the severity of joint damage in addition to demographics and PROMs with an area under the receiver operating characteristic curve of 0.724 and explained variances (adjusted R2) of 0.107, 0.132 and 0.147 for minimum joint space width, osteophyte area and mean subchondral bone density, respectively.

Conclusions

GaitSmart analysis provides additional information over established OA outcomes. GaitSmart parameters are also associated with the presence of ROA and extent of radiographic severity over demographics and PROMS. These results indicate that GaitsmartTM may be an additional outcome measure for the evaluation of OA.
Slow oscillation density and amplitude decrease across development in pediatric Duchenne and Becker muscular dystrophy
Authors: Simon Katharine C , Malerba Paola , Nakra Neal , Harrison Amy , Mednick Sara C , Nagel Marni
Published: November 2020

Study Objectives

From childhood through adolescence, brain rhythms during non-rapid eye movement (NREM) sleep show dramatic development that mirror underlying brain maturation. For example, the function and characteristics of slow oscillations (SOs, <1 Hz) in healthy children are linked to brain development, motor skill, and cognition. However, little is known of possible changes in pediatric populations with neurologic abnormalities.

Methods

We measured slow oscillations in 28 Duchenne and Becker muscular dystrophy male patients from age 4 to 20 years old during overnight in-lab clinical sleep studies. We compared our pediatric patients by age to evaluate the developmental changes of SOs from childhood to early and late adolescence.

Results

Consistent with the current neuro- and physically typical literature, we found greater slow oscillation density (count of SOs per minute of each sleep stage) in NREM N3 than N2, and significantly greater slow oscillation density in frontal compared to central and occipital regions. However, separating patients into age-defined groups (child, early adolescent, and late adolescent) revealed a significant age effect, with a specific decline in the rate and amplitude of SOs.

Conclusions

We found that with age, pediatric patients with Duchenne muscular dystrophy show a significant decline in slow oscillation density. Given the role that slow oscillations play in memory formation and retention, it is critical to developmentally characterize these brain rhythms in medically complex populations. Our work converges with previous pediatric sleep literature that promotes the use of sleep electroencephalographic markers as prognostic tools and identifies potential targets to promote our patients’ quality of life.
Older Workers With Disabilities: A Person-Centered Approach to Understanding the Effect of Comorbidity on Work Outcomes
Authors: Thrasher Gregory R , Markel Karen S , Barclay Lizabeth A
Published: November 2020

Research on persons with disabilities (PWD) has identified robust challenges faced by these individuals within the context of work. Although there are clear associations between disability status and employment outcomes, the literature on PWD suffers from two primary gaps: (1) there is currently little to no research on the comorbidity of disability characteristics and (2) the consideration of how disability status uniquely affects the ever-increasing population of older workers has been understudied. The current study takes a person-centered approach, via latent class analysis, to examine the effects of disability characteristics on employment outcomes for older workers. We present findings from a sample of 328 older workers who self-identified as having at least one of several disabilities. Results suggest that there are six different classes of older workers with disabilities defined by varying levels of comorbidity. Across these classes, we find significant differences in ratings of job satisfaction, turnover intentions, and perceptions of workplace discrimination.
Global Genetic Diversity and Mating Type Distribution of Calonectria pauciramosa: An Important Wide-Host-Range Plant Pathogen
Authors: Li JieQiong , Barnes Irene , Liu FeiFei , Wingfield Michael J. , Chen ShuaiFei
Published: November 2020

The fungal pathogen, Calonectria pauciramosa, has caused serious diseases of many important plants worldwide. Understanding the genetic diversity and mating type distribution of this pathogen provides an essential step toward the development of disease control measures. In this study, we designed 15 polymorphic microsatellite markers by using genome sequences of two Ca. pauciramosa isolates having opposite mating type and from different countries. These markers were used to determine the genetic diversity of 145 isolates representing 13 different hosts (12 plant hosts residing in 12 genera, and soil) from 10 countries. In addition, mating type genes were amplified to investigate the reproduction mode of the pathogens in these populations by using mating type primers designed for Calonectria spp. Results revealed that a single dominant genotype, isolated from 11 plant genera residing in eight families, was present in seven countries across five continents. Only mating type MAT1-1 or MAT1-2 was amplified in each of the isolates, confirming that Ca. pauciramosa is heterothallic. Both mating types were detected in isolates from Eucalyptus in South Africa and Uruguay. The MAT1-2 phenotype was widely distributed in isolates from 12 different hosts (11 plant hosts and soil) collected in 10 countries. Overall, the results suggest that there has been substantial global movement of Ca. pauciramosa and that this has shaped its current population structure.
Genetic Dissection of Adult Plant Resistance to Sharp Eyespot Using an Updated Genetic Map of Niavt14 × Xuzhou25 Winter Wheat Recombinant Inbred Line Population
Authors: Liu Caiyun , Guo Wei , Zhang Qiaofeng , Fu Bisheng , Yang Zujun , Sukumaran Sivakumar , Cai Jin , Liu Ying , Zhai Wenling , Wu Xiaoyou , Wu Jizhong
Published: November 2020

Wheat sharp eyespot, a disease mainly caused by soilborne fungus Rhizoctonia cerealis, is a threat to world wheat production. Wheat’s genetic resistance to sharp eyespot is a potential approach to reducing the application of fungicides and farming practice inputs. To identify the genetic basis of sharp eyespot resistance in Niavt14, a recombinant inbred line population comprising 215 F8 lines from Niavt14 × Xuzhou25, was developed. An earlier linkage map (148 simple sequence repeat markers) was updated with 5,792 polymorphic Affymetrix Axiom 55K single-nucleotide polymorphisms to a new map of 5,684.2 centimorgans with 1,406 nonredundant markers. The new linkage map covered all 21 chromosomes of common wheat and showed a good collinearity with the IWGSC RefSeq v1.0 genome. We conducted quantitative trait locus (QTL) mapping for sharp eyespot resistance using the adult plant response data from the field of five consecutive growing seasons and one greenhouse test. Two stable QTL on chromosomes 2B and 7D that were identified in the previous study were confirmed, and three novel, stable QTL, explaining 4.0 to 17.5% phenotypic variation, were mapped on 1D, 6D, and 7A, which were independent of QTL for phenology and plant height. The QTL on 1D, 2B, 6D, and 7A showed low frequencies in 384 landraces (0 to 10%) and 269 elite cultivars (5 to 23%) from the southern winter wheat region and the Yellow and Huai River Valley facultative wheat region in China, respectively. These identified QTL could be used in wheat breeding programs for improving sharp eyespot resistance through marker-assisted selection.
Evolution and Adaptation of Forest and Crop Pathogens in the Anthropocene
Authors: Hessenauer Pauline , Feau Nicolas , Gill Upinder , Schwessinger Benjamin , Brar Gurcharn S. , Hamelin Richard C.
Published: November 2020

Anthropocene marks the era when human activity is making a significant impact on earth, its ecological and biogeographical systems. The domestication and intensification of agricultural and forest production systems have had a large impact on plant and tree health. Some pathogens benefitted from these human activities and have evolved and adapted in response to the expansion of crop and forest systems, resulting in global outbreaks. Global pathogen genomics data including population genomics and high-quality reference assemblies are crucial for understanding the evolution and adaptation of pathogens. Crops and forest trees have remarkably different characteristics, such as reproductive time and the level of domestication. They also have different production systems for disease management with more intensive management in crops than forest trees. By comparing and contrasting results from pathogen population genomic studies done on widely different agricultural and forest production systems, we can improve our understanding of pathogen evolution and adaptation to different selection pressures. We find that in spite of these differences, similar processes such as hybridization, host jumps, selection, specialization, and clonal expansion are shaping the pathogen populations in both crops and forest trees. We propose some solutions to reduce these impacts and lower the probability of global pathogen outbreaks so that we can envision better management strategies to sustain global food production as well as ecosystem services.
Boxed Warning Removed from Canagliflozin Labeling
Authors: Aschenbrenner Diane S.
Published: November 2020

Canagliflozin's labeling no longer carries a boxed warning for an increased risk of amputation with drug use. The risk has been downgraded to the warnings and precautions section of the labeling.
Dispensing a Naloxone Kit at Hospital Discharge: A Retrospective QI Project
Authors: Train Meghan K. , Patel Nilbhi , Thapa Kriti , Pasho Marissa , Acquisto Nicole M.
Published: November 2020

Purpose:

The aim of this quality improvement (QI) project was to increase the coprescription of naloxone kits at patient discharge as a harm reduction strategy to combat the opioid epidemic. An interdisciplinary team identified hospitalized medical patients who were at high risk for an opioid overdose or opioid-related adverse event.

Methods:

Led by a physician champion, an interdisciplinary QI team composed of physicians (MDs and doctors of osteopathic medicine), advanced practice providers (NPs and physician assistants), RNs, care coordinators, social workers, and pharmacists developed and implemented a naloxone distribution program on one medical unit at an academic tertiary care center. The team developed and implemented criteria to identify high-risk patients, workflow for patient screening, staff and patient education programs, and processes for naloxone kit delivery to the patient's bedside. Data on naloxone kit distribution from the seven months prior to implementation (March 2018 to September 2018) and the seven months after implementation (October 2018 to April 2019) were evaluated and are reported descriptively.

Results:

Two patients preimplementation and 64 patients postimplementation received a naloxone kit at discharge. In the postimplementation group, common reasons for identifying a patient as at high risk for an overdose or adverse event were a prescription for a pain medication at a daily dosage greater than or equal to 50 morphine milligram equivalents (50% of patients), concomitant opioid and benzodiazepine use (19%), history of substance use disorder (11%), and medication-assisted treatment (9%). Most patients in the postimplementation group (86%) received a naloxone kit at a personal cost of $1 or less.

Conclusion:

This unit-based pilot project was successful in identifying patients at high risk for an opioid overdose or opioid-related adverse event and in providing naloxone kits and education at hospital discharge.
Posttraumatic osteoarthritis: what have we learned to advance osteoarthritis?
Authors: Watt Fiona E.
Published: November 2020

Purpose of review

Current thinking in the study of posttraumatic osteoarthritis (PTOA) is overviewed: the osteoarthritis which follows acute joint injury. The review particularly highlights important publications in the last 18 months, also reflecting on key older literature, in terms of what have we have we learned and have yet to learn from PTOA, which can advance the osteoarthritis field as a whole.

Recent findings

PTOA is a mechanically driven disease, giving insight into mechanical drivers for osteoarthritis. A mechanosensitive molecular tissue injury response (which includes activation of pain, degradative and also repair pathways) is triggered by acute joint injury and seen in osteoarthritis. Imaging features of PTOA are highly similar to osteoarthritis, arguing against it being a different phenotype. The inflammatory pathways activated by injury contribute to early joint symptoms. However, later structural changes appear to be dissociated from traditional measures of synovial inflammation.

PTOA remains an important niche in which to understand processes underlying osteoarthritis and seek interventional targets. Whether PTOA has true molecular or clinical differences to osteoarthritis as a whole remains to be understood. This knowledge is important for a field where animal modelling of the disease relies heavily on the link between injury and osteoarthritis.
Lowest Instrumented Vertebra Selection in Posterior Cervical Fusion
Authors: Labrum Joseph T. , Khan Inamullah , Archer Kristin R. , Abtahi Amir M. , Stephens Byron F.
Published: November 2020

Study Design.

Retrospective.

Objective.

The purpose of this study is to evaluate the effect of posterior cervical fusion lowest instrumented vertebra (PCF LIV) selection on incidence of mechanical failure, revision surgery, and patient-reported outcomes (PROs).

Summary of Background Data.

Recent studies indicate that the LIV in PCF may contribute to the risk of mechanical failure. To date, the evidence available to guide spine surgeons in the selection of PCF LIV remains limited.

Methods.

All patients undergoing PCF at a single institution were prospectively entered into a spine registry which was retrospectively queried. Data collection included demographics, pathology, operative variables, construct LIV, outcomes of mechanical failure, revision surgery, and patient-reported disability, pain, and quality of life.

Results.

Of 438 patients undergoing PCF from 2006 to 2019, 106 patients had an LIV of C7, T1, or T2, a minimum of 1-year follow-up, and met all study inclusion criteria. LIV cohorts were C7 LIV (36), T1 LIV (42), and T2 LIV (28). There were no between-group differences in patient demographics, operative variables, or postoperative follow-up across the three LIV cohorts. Mechanical failure rates for C7, T1, and T2 LIV were 30.6%, 23.8%, and 0%, respectively (P = 0.007). Revision rates for C7, T1, and T2 LIV were 25.0%, 11.9%, and 0%, respectively (P = 0.013). No difference was noted in average time to revision/failure between C7 (39.68 months) and T1 (29.85 months) LIV cohorts. No differences in baseline, 3-month, and 12-month postoperative PRO measures were noted in the C7 and T1 LIV cohort when compared to the T2 LIV cohort.

Conclusion.

The findings in this study indicate that PCF LIV selection may play a significant role in the development of mechanical complications and need for revision surgery. T2 LIV selection demonstrated a significantly lower rate of mechanical failure and revision surgery. Postoperative PROs up to 36 months are needed to evaluate effect of LIV selection on PROs.

Level of Evidence: 3
The Use of Mechanical Cardiopulmonary Resuscitation May Be Associated With Improved Outcomes Over Manual Cardiopulmonary Resuscitation During Inhospital Cardiac Arrests
Authors: Crowley Conor P. , Wan Emily S. , Salciccioli Justin D. , Kim Edy
Published: November 2020

Objectives:

We aimed to investigate the impact of mechanical cardiopulmonary resuscitation devices over manual cardiopulmonary resuscitation on outcomes from inhospital cardiac arrests.

Design:

Restrospective review.

Setting:

Single academic medical center.

Participants:

Data were collected on all patients who suffered cardiac arrest from December 2015 to November 2019.

Main Outcomes and Measures:

Primary end point was return of spontaneous circulation. Secondary end points included survival to discharge and survival to discharge with favorable neurologic outcomes.

Results:

About 104 patients were included in the study: 59 patients received mechanical cardiopulmonary resuscitation and 45 patients received manual cardiopulmonary resuscitation during the enrollment period. Return of spontaneous circulation rate was 83% in the mechanical cardiopulmonary resuscitation group versus 48.8% in the manual group (p = 0.009). Survival-to-discharge rate was 32.2% in the mechanical cardiopulmonary resuscitation group versus 11.1% in those who received manual cardiopulmonary resuscitation (p = 0.02). Of the patients who survived to discharge and received mechanical cardiopulmonary resuscitation, 100% (n = 19) had a favorable neurologic outcome versus 40% (two out of five) of patients who survived and received manual cardiopulmonary resuscitation (p = 0.005).

Conclusions:

Our findings demonstrate a significant association of improved outcomes with mechanical cardiopulmonary resuscitation over manual cardiopulmonary resuscitation during inhospital cardiac arrests. Mechanical cardiopulmonary resuscitation may improve rates of return of spontaneous circulation, survival to discharge, and favorable neurologic outcomes.
Accuracy of Heparin-Binding Protein in Diagnosing Sepsis: A Systematic Review and Meta-Analysis
Authors: Wu Yi-Luen , Yo Chia-Hung , Hsu Wan-Ting , Qian Frank , Wu Bo-Sheng , Dou Qing-Li , Lee Chien-Chang
Published: November 2020

OBJECTIVES:

Existing studies evaluating the accuracy of heparin-binding protein for the diagnosis of sepsis have been inconsistent. We conducted a systematic review and meta-analysis to assess the totality of current evidence regarding the utility of heparin-binding protein to diagnose sepsis in patients with presumed systemic infection.

DATA SOURCE:

PubMed, Embase, the China National Knowledge infrastructure, and WangFang electronic database were searched from inception to December of 2019.

STUDY SELECTION:

Two independent reviewers identified eligible studies. Cohort and case-control studies, which measured serum levels of heparin-binding protein among adult patients with suspected sepsis, were eligible for inclusion.

DATA EXTRACTION:

Two reviewers independently extracted data elements from the selected studies. A bivariate random-effects meta-analysis model was used to synthesize the prognostic accuracy measures. Risk of bias of studies was assessed with Quality Assessment of Diagnostic Accuracy Studies 2 tool.

DATA SYNTHESIS:

We identified 26 studies with 3,868 patients in the meta-analysis. Heparin-binding protein had a pooled sensitivity of 0.85 (95% CI, 0.79–0.90) and a pooled specificity of 0.91 (95% CI, 0.82–0.96) for the diagnosis of sepsis. There was low heterogeneity between the studies (I

2
= 12%), and no evidence of publication bias was detected. Heparin-binding protein had a higher sensitivity and specificity when compared with procalcitonin (0.75 [95% CI, 0.62–0.85] and 0.85 [95% CI, 0.73–0.92]) as well as C-reactive protein (0.75 [95% CI, 0.65–0.84] and 0.71 [95% CI, 0.63–0.77]). Serial measurements of heparin-binding protein also showed that heparin-binding protein levels rose significantly at least 24 hours before a diagnosis of sepsis.

CONCLUSIONS:

The diagnostic ability of heparin-binding protein is favorable, demonstrating both high sensitivity and specificity in predicting progression to sepsis in critically ill patients. Future studies could assess the incremental value that heparin-binding protein may add to a multimodal sepsis identification and prognostication algorithm for critically ill patients.
De Novo Renal Failure and Clinical Outcomes of Patients With Critical Coronavirus Disease 2019
Authors: Forest Stephen J. , Michler Robert E. , Skendelas John P. , DeRose Joseph J. , Friedmann Patricia , Parides Michael K. , Forest Stefanie K. , Chauhan Dhaval , Goldstein Daniel J.
Published: November 2020

Objectives:

To describe the characteristics and outcomes associated with concomitant renal and respiratory failure in patients with critical coronavirus disease 2019.

Design, Setting, and PATIENTS:

This is a case series of patients from a U.S. healthcare system in New York City. All adult patients (≥ 18 yr) admitted to the hospital with positive coronavirus disease 2019 testing between March 10, 2020, and March 31, 2020, who required mechanical ventilatory support were included. Patients who remained hospitalized were followed through May 1, 2020.

Interventions:

Renal replacement therapy included at least one session of dialysis, continued venovenous hemofiltration, or peritoneal dialysis.

Measurements and Main Results:

Baseline characteristics, laboratory markers, 30-day in-hospital outcomes, ventilator days, and survival to discharge were included. Multivariate predictors for mortality and need for renal replacement therapy were identified. A total of 330 patients were included in this analysis and were most commonly greater than or equal to 70 years (40%), male (61%), Black or African American (41%), and Hispanic or Latino (38%). Renal replacement therapy was required in 101 patients (29%), most commonly among Blacks or African Americans (50%). Elevated d-dimer, C-reactive protein, and procalcitonin were associated with renal replacement therapy, compared with the nondialysis cohort. Overall, 243 patients (74%) died and 56 (17%) were discharged from the hospital, of which 9 (3%) required renal replacement therapy. Male sex (odds ratio, 2.0; 1.1–3.5; p = 0.020), Black race (odds ratio, 1.8; 1.0–3.1; p = 0.453), and history of hypertension (odds ratio, 2.7; 1.3–5.4; p = 0.005) were predictors for requiring renal replacement therapy. Risk factors for in-hospital mortality included age greater than or equal to 60 years (odds ratio, 6.2; 3.0–13.0; p < 0.0001), male sex (odds ratio, 3.0; 1.4–6.4; p = 0.004), and body mass index greater than or equal to 30 kg/m2 (odds ratio, 2.1; 1.0–4.4; p = 0.039). Concomitant renal failure in critical coronavirus disease 2019 was not a significant predictor of death (odds ratio, 2.3; 0.98–5.5; p = 0.057).

Conclusions:

This case series concludes that respiratory failure conveys significant mortality risk in patients with coronavirus disease 2019 and that survival with concomitant renal failure is rare.
Determinants of healing among patients with coronavirus disease 2019: the results of the SARS-RAS study of the Italian Society of Hypertension
Authors: Mancusi Costantino , Grassi Guido , Borghi Claudio , Carugo Stefano , Fallo Francesco , Ferri Claudio , Giannattasio Cristina , Grassi Davide , Letizia Claudio , Minuz Pietro , Muiesan Maria Lorenza , Perlini Stefano , Pucci Giacomo , Rizzoni Damiano , Salvetti Massimo , Sarzani Riccardo , Sechi Leonardo , Veglio Franco , Volpe Massimo , Iaccarino Guido
Published: November 2020

Objective:

The burst of COVID-19 epidemics in Italy prompted the Italian Society of Hypertension to start an observational study to explore the characteristics of the hospitalized victims of the disease. The current analysis aimed to investigate the predictors of healing among Italian COVID-19 patients. We also assessed the effect of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers on the outcome.

Methods:

We designed a cross-sectional, observational, multicenter, nationwide survey in Italy to explore the demographic and clinical characteristics of patients with confirmed COVID-19 infection. We analyzed information from 2446 charts of Italian patients admitted for certified COVID-19 in 27 hospitals. Healing from COVID-19 infection, defined as two consecutive negative swabs, was reported in 544 patients (22.2%), 95% of them were hospitalized.

Results:

Age and Charlson Comorbidity Index were significantly lower in healing compared with nonhealing patients (63 ± 15 vs. 69 ± 15 and 2 ± 2 vs. 3 ± 2, both P < 0.05). In multivariable regression model, predictors of healing were younger age (OR: 0.99; 95% CI 0.98–0.99, P = 0.0001), absence of chronic kidney disease (OR: 0.35; 95% CI 0.17–0.70, P = 0.003) or heart failure (OR: 0.44; 95% CI, 0.28–0.70, P = 0.001). In the subgroup of patients suffering from hypertension and/or heart failure (n = 1498), no differences were observed in the use of ACE inhibitors and angiotensin receptor blockers.

Conclusion:

Our study demonstrated that younger age and absence of comorbidities play a major role in determining healing in patients with COVID-19. No effects of ACE inhibitors and angiotensin receptor blockers on the outcome was reported.
Longitudinal sleep characteristics and hypertension status: results from the Wisconsin Sleep Cohort Study
Authors: Moon Chooza , Hagen Erika W. , Johnson Heather M. , Brown Roger L. , Peppard Paul E.
Published: November 2020

Aims:

Sleep characteristics such as short sleep duration or sleep-disordered breathing are established predictors of hypertension. However, few studies have used in-lab polysomnography with a longitudinal design to measure how hypertension is associated with different sleep stages over time. The purpose of this study is to examine whether hypertension is associated with the longitudinal course of sleep quality over time.

Methods:

The current study evaluated data from the Wisconsin Sleep Cohort Study, which consists of 1525 adults in a community-based population of middle-aged to older adults followed for approximately 12–25 years. Sleep characteristics were objectively measured using polysomnography and subjectively assessed using a self-report questionnaire on insomnia complaints. We used linear mixed-effects regression models and cumulative logit models to assess whether the interaction of hypertension and time is associated with objective and subjective sleep.

Results:

We found people with hypertension exhibited a greater decline in total sleep time in rapid eye movement sleep (%) over time than those without hypertension (P < 0.05). Individuals with hypertension had less decline in % N3 sleep over time than those without hypertension (P < 0.05). Among the subjective insomnia complaints, our findings indicate hypertensive individuals have a higher probability of having higher levels of ‘difficulties in falling asleep’ compared with people without hypertension.

Conclusion:

These findings suggest that hypertension is associated with modified longitudinal changes of objective and subjective sleep characteristics.
Relations of aortic stiffness with arterial damage beyond brachial pressure are both dependent and independent of central arterial pulsatile load
Authors: Motau Tshegofatso H. , Norton Gavin R. , Mmopi Keneilwe N. , Bello Hamza , Peterson Vernice R. , Libhaber Carlos , Sadiq Eitzaz , Naran Ravi , Da Silva Fernandes Daniel , Masiu Mohlabani , Mthembu Nonhlanhla , Gomes Monica , Monareng Taalib , Abdool-Carrim Talib , Veller Martin , Cassimjee Ismail , Peters Ferande , Modi Girish , Sareli Pinhas , Woodiwiss Angela J.
Published: November 2020

Aim:

We aimed to determine whether the impact of aortic stiffness on atherosclerotic or small vessel end organ damage beyond brachial blood pressure depends in-part on stiffness-induced increases in central arterial pressures produced by an enhanced resistance to flow (characteristic impedance, Zc).

Methods:

We studied 1021 participants, 287 with stroke or critical limb ischaemia, and 734 from a community sample with atherosclerotic or small vessel end organ measures. Central arterial haemodynamics were determined from arterial pressure (SphygmoCor) and velocity and diameter assessments in the outflow tract (echocardiography).

Results:

Although Zc and carotid–femoral pulse wave velocity (PWV) were correlated (P < 0.0001), these relations were not independent of confounders (P = 0.90). Both Zc and hence central arterial pressures generated by the product of Zc and aortic flow (Q) (PQxZc), as well as PWV were independently associated with carotid intima–media thickness, estimated glomerular filtration rate (eGFR), endothelial activation markers [vascular cell adhesion molecule-1 (V-CAM-1)] and events. With further adjustments for brachial pulse pressure (PP) or SBP, PWV and PQxZc were both associated with eGFR and V-CAM-1. Relationships between PWV and eGFR or V-CAM-1 were independent of PQxZc (P < 0.05) and relationships between PQxZc and eGFR and V-CAM-1 were independent of PWV (P < 0.005). Similarly, with adjustments for confounders and brachial PP or SBP, across the full adult lifespan, both aortic PWV and PQxZc were increased in those with arterial events (P < 0.005). Relationships between PWV and events were again independent of PQxZc (P < 0.005) and between PQxZc and events were independent of PWV (P < 0.0001).

Conclusion:

Beyond brachial blood pressure, the impact of aortic stiffness on arterial damage involves effects that are both dependent (proximal aortic Zc and hence PQxZc) and independent (full aortic length indexed by PWV) of central arterial pulsatile load. Hence, PWV and brachial PP may be insufficient to account for all of the damage mediated by increases in aortic stiffness.