bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Transcriptomics Reveals How Wheat Responds to Infection by Zymoseptoria tritici
Authors: Ma Xin , Keller Beat , McDonald Bruce A. , Palma-Guerrero Javier , Wicker Thomas
Published: November 2017

The fungus Zymoseptoria tritici causes septoria tritici blotch (STB) on wheat, an important disease globally and the most damaging wheat disease in Europe. Despite the global significance of STB, the molecular basis of wheat defense against Z. tritici is poorly understood. Here, we use a comparative transcriptomic study to investigate how wheat responds to infection by four distinct strains of Z. tritici. We examined the response of wheat across the entire infection cycle, identifying both shared responses to the four strains and strain-specific responses. We found that the early asymptomatic phase is characterized by strong upregulation of genes encoding receptor-like kinases and pathogenesis-related proteins, indicating the onset of a defense response. We also identified genes that were differentially expressed among the four fungal strains, including genes related to defense. Genes involved in senescence were induced during both the asymptomatic phase and at late stages of infection, suggesting manipulation of senescence processes by both the plant and the pathogen. Our findings illustrate the need, when identifying important genes affecting disease resistance in plants, to include multiple pathogen strains.
“The Questions Shape the Answers”: Assessing the Quality of Published Survey Instruments in Health Professions Education Research
Authors: Artino Anthony R. , Phillips Andrew W. , Utrankar Amol , Ta Andrew Q. , Durning Steven J.
Published: November 2017

Purpose

Surveys are widely used in health professions education (HPE) research, yet little is known about the quality of the instruments employed. Poorly designed survey tools containing unclear or poorly formatted items can be difficult for respondents to interpret and answer, yielding low-quality data. This study assessed the quality of published survey instruments in HPE.

Method

In 2017, the authors performed an analysis of HPE research articles published in three high-impact journals in 2013. They included articles that employed at least one self-administered survey. They designed a coding rubric addressing five violations of established best practices for survey item design and used it to collect descriptive data on the validity and reliability evidence reported and to assess the quality of available survey items.

Results

Thirty-six articles met inclusion criteria and included the instrument for coding, with one article using 2 surveys, yielding 37 unique surveys. Authors reported validity and reliability evidence for 13 (35.1%) and 8 (21.6%) surveys, respectively. Results of the item-quality assessment revealed that a substantial proportion of published survey instruments violated established best practices in the design and visual layout of Likert-type rating items. Overall, 35 (94.6%) of the 37 survey instruments analyzed contained at least one violation of best practices.

Conclusions

The majority of articles failed to report validity and reliability evidence, and a substantial proportion of the survey instruments violated established best practices in survey design. The authors suggest areas of future inquiry and provide several improvement recommendations for HPE researchers, reviewers, and journal editors.
What Every Graduating Resident Needs to Know About Quality Improvement and Patient Safety: A Content Analysis of 26 Sets of ACGME Milestones
Authors: Lane-Fall Meghan B. , Davis Joshua J. , Clapp Justin T. , Myers Jennifer S. , Riesenberg Lee Ann
Published: November 2017

Purpose

Quality improvement (QI) and patient safety (PS) are broadly relevant to the practice of medicine, but specialty-specific milestones demonstrate variable expectations for trainee competency in QI/PS. The purpose of this study was to develop a unifying portrait of QI/PS expectations for graduating residents irrespective of specialty.

Method

Milestones from 26 residency programs representing the 24 member boards of the American Board of Medical Specialties were downloaded from the Accreditation Council for Graduate Medical Education (ACGME) Web site in 2015. A codebook was generated by in-depth reading of all milestone sets by two authors. Using a content analytic approach, milestones were then coded by a single author, with a 25% sample double coded by another author. Descriptive statistics were used to characterize frequency counts.

Results

Of 612 total milestones, 249 (40.7%) made mention of QI/PS. A median 10 milestones per specialty (interquartile range, 5.25–11.75) mentioned QI/PS. There were 446 individual references to QI, 423 references to PS, and another 1,065 references to QI/PS-related concepts, including patient-centered care, cost-effective practice, documentation, equity, handoffs and care transitions, and teamwork. QI/PS references reflected expectations about both individual-level practice (531/869; 61.1%) and practice within a health care system (338/869; 38.9%). QI and PS references were linked to all six ACGME core competencies.

Conclusions

Although there is variability in the emphasis placed on QI/PS across specialties, overall, QI/PS is reflected in more than 40% of residency milestones. Graduating residents in all specialties are expected to demonstrate competence in QI, PS, and multiple related concepts.
Vive la Différence: The Freedom and Inherent Responsibilities When Designing and Implementing Multiple Mini-Interviews
Authors: Reiter Harold , Eva Kevin
Published: November 2017

The literature on multiple mini-interviews (MMIs) is replete with heterogeneous study results related to the constructs measured, correlations with other measures, and demographic relationships. Rather than view these results as contradictory, the authors ask, What if all of the results are correct? They point out that the MMI is not an assessment tool but, rather, an assessment method. Design and implementation of locally conducted MMIs in medical school admissions processes should reflect local needs. As with other local assessments, MMIs should be considered separate from nationally conducted assessments that reflect more universal competencies. With the freedom to exercise unique values in locally constructed MMIs, individual institutions, or small bands of like-minded institutions, in parallel carry the responsibility to ensure local assessment tool validity.
Diagnostic Accuracy of Zero-Echo Time MRI for the Evaluation of Cervical Neural Foraminal Stenosis
Authors: Argentieri Erin C. , Koff Matthew F. , Breighner Ryan E. , Endo Yoshimi , Shah Parina H. , Sneag Darryl B.
Published: November 2017

Study Design.

A cohort study.

Objective.

The aim of this study was to evaluate the clinical utility of Zero-Echo-Time (ZTE) magnetic resonance imaging (MRI) for the assessment of cervical neural foraminal stenosis (CNFS) through the comparison of inter-modality [computed tomography (CT) and ZTE-MRI] CNFS grade severity agreements.

Summary of Background Data.

Conventional MRI limited in its ability to provide direct visualization of cortical bone. The highly organized tissue structure of cortical bone results in very short T2 values that preclude acquisition of sufficient signal intensity and positive image contrast. ZTE imaging permits visualization of tissues with very short transverse relaxation times, and is capable of displaying images with CT-like contrast.

Methods.

Thirty-four subjects were recruited from a clinical cohort of patients undergoing standard of care MRI and CT imaging for evaluation of CNFS. Standard of care CT imaging studies were obtained on all subjects within 6 months of their ZTE-MRI acquisition (mean time interval: 25.3 ± 54.1 days; median: 0 days). ZTE-MRI and CT imaging studies were evaluated and severity of CNFS was graded on a scale from 0 to 5 (0 = none; 5 = severe). Weighted-kappa statistics were used to assess agreement between ZTE and CT grades of CNFS on both sides (right and left) of each motion segment. Ordinal logistic mixed-effects regression analyses evaluated the effects of inter-modality position differences (flexion-extension curvature) on inter-modality differences in CNFS grade.

Results.

Substantial agreement (κ = 0.72) was found between ZTE- and CT-based grades of CNFS. Significant inter-modality differences in cervical spine curvature were found for all motion segments, except C2–3 and C3–4 (P < 0.05). However, no significant relationship was found between inter-modality differences in curvature, and inter-modality differences in CNFS grade for any motion segment (P = 0.28).

Conclusion.

Results of the current study suggest that ZTE-MRI is well-suited for the evaluation of CNFS and may have the potential to obviate the need for concurrent CT scans in some cases.

Level of Evidence: 2
Impact of Iliac Instrumentation on the Quality of Life of Patients With Adult Spine Deformity
Authors: Martín-Buitrago Mar Pérez , Pizones Javier , Sánchez Pérez-Grueso Francisco Javier , Díaz Almirón Mariana , Vila-Casademunt Alba , Obeid Ibrahim , Alanay Ahmet , Kleinstück Frank , Acaroglu Emre R. , Pellisé Ferran
Published: November 2017

Study Design.

Retrospective comparative analysis of data collected prospectively in an adult spine deformity (ASD) multicenter database.

Objective.

To evaluate the impact of the iliac screws on the quality of life of ASD patients compared with those instrumented above the pelvis (L5/S1/S2).

Summary of Background Data.

The impact on patient's daily activities and functions, of immobilizing the sacroiliac joint with iliac screws for the treatment of ASD is still underexplored.

Methods.

Inclusion criteria were ASD patients with a long arthrodesis of at least eight levels and whose lowest instrumented vertebrae (LIV) were L5 or below. We analyzed the following preoperative and 2 years’ follow-up variables: age, Cobb angle, coronal and sagittal alignment, number of instrumented levels, Oswestry Disability Index (ODI), Core Outcome Measures Index (COMI), Scoliosis Research Society-22 (SRS-22), and Short Form 36 (SF-36) questionnaires. Statistical analysis was performed with Mann–Whitney U test, and Wilcoxon test.

Results.

A total of 129 patients were included, and separated into two groups: “Iliac Yes,” with the LIV at the Ilium (N = 104), and “iliac No,” with the LIV at L5/S1/S2 (N = 25). Patients instrumented with Iliac screws were older (x = 66 vs. 56 yr, P = 0.008), and had lower Cobb magnitude (x = 31° vs. 45°, P = 0.019). No statistically significant differences were found in the health related quality of life (HRQOL) questionnaires prior to surgery or at 2-years’ follow up. The “Iliac Yes” group significantly improved all radiographic and HRQOL scores parameters 2 years after surgery (P < 0.005). While the “Iliac No” group failed to significantly improve (coronal balance, sagittal vertical axis, SF-36 Physical functioning, SF-36 General health, and COMI) (P > 0.05)

Conclusion.

ASD patients instrumented with iliac screws significantly improved all their HRQOL questionnaires 2 years after surgery. The 2 years’ postoperative HRQOL scores were similar in both groups, regardless of the sacroiliac joint immobilization. Therefore, with the currently available tools, we cannot state that iliac instrumentation has a negative influence on patient's quality of life.

Level of Evidence: 4
Improvement of Blood-Brain Barrier Integrity in Traumatic Brain Injury and Hemorrhagic Shock Following Treatment With Valproic Acid and Fresh Frozen Plasma
Authors: Nikolian Vahagn C. , Dekker Simone E. , Bambakidis Ted , Higgins Gerald A. , Dennahy Isabel S. , Georgoff Patrick E. , Williams Aaron M. , Andjelkovic Anuska V. , Alam Hasan B.
Published: November 2017

Objective:

Combined traumatic brain injury and hemorrhagic shock are highly lethal. Following injuries, the integrity of the blood-brain barrier can be impaired, contributing to secondary brain insults. The status of the blood-brain barrier represents a potential factor impacting long-term neurologic outcomes in combined injuries. Treatment strategies involving plasma-based resuscitation and valproic acid therapy have shown efficacy in this setting. We hypothesize that a component of this beneficial effect is related to blood-brain barrier preservation.

Design:

Following controlled traumatic brain injury, hemorrhagic shock, various resuscitation and treatment strategies were evaluated for their association with blood-brain barrier integrity. Analysis of gene expression profiles was performed using Porcine Gene ST 1.1 microarray. Pathway analysis was completed using network analysis tools (Gene Ontology, Ingenuity Pathway Analysis, and Parametric Gene Set Enrichment Analysis).

Subjects:

Female Yorkshire swine were subjected to controlled traumatic brain injury and 2 hours of hemorrhagic shock (40% blood volume, mean arterial pressure 30-35 mmHg).

Interventions:

Subjects were resuscitated with 1) normal saline, 2) fresh frozen plasma, 3) hetastarch, 4) fresh frozen plasma + valproic acid, or 5) hetastarch + valproic acid (n = 5 per group). After 6 hours of observation, brains were harvested for evaluation.

Measurements and Main Results:

Immunofluoroscopic evaluation of the traumatic brain injury site revealed significantly increased expression of tight-junction associated proteins (zona occludin-1, claudin-5) following combination therapy (fresh frozen plasma + valproic acid and hetastarch + valproic acid). The extracellular matrix protein laminin was found to have significantly improved expression with combination therapies. Pathway analysis indicated that valproic acid significantly modulated pathways involved in endothelial barrier function and cell signaling.

Conclusions:

Resuscitation with fresh frozen plasma results in improved expression of proteins essential for blood-brain barrier integrity. The addition of valproic acid provides significant improvement to these protein expression profiles. This is likely secondary to activation of key pathways related to endothelial functions.
Low-dose Sinapic Acid Abates the Pyroptosis of Macrophages by Downregulation of lncRNA-MALAT1 in Rats With Diabetic Atherosclerosis
Authors: Han Yong , Qiu Hong , Pei Xing , Fan Yigang , Tian Hongyan , Geng Jie
Published: November 2017

Pyroptosis is a type of programmed cell death, which has been associated with multiple inflammatory diseases including diabetic atherosclerosis (DA). This study aims to explore the role of sinapic acid (SA) in the pyroptosis of macrophages in DA. Our results from the in vivo experiments showed that low-dose (≤50 mg/kg) chronic SA administration suppressed serum endothelin 1 (ET-1) and interleukin-1β (IL-1β) contents, pyroptotic death of bone marrow–derived macrophages, and the expression of pyroptotic proteins ASC, NRLP3, and caspase-1. Besides, lncRNA-metastasis associated lung adenocarcinoma transcript 1 (MALAT1) was robustly upregulated in the macrophages of rats with DA and could be lowered by low-dose SA administration. Gene overexpression and knockdown experiments showed that MALAT1 had a modestly positive effect on the pyroptosis of normal macrophages. Moreover, in macrophages incubated with high-glucose and Ox-LDL, 1-μM SA treatment displayed a suppressive effect on the cell pyroptosis similar to that of MALAT1 knockdown. Transfection of the pcDNA-MALAT1 expression vector counteracted the decrease in MALAT1 expression and macrophage pyroptosis caused by SA. In conclusion, low-dose SA can abate the pyroptosis of macrophages by downregulation of lncRNA-MALAT1 in rats with DA.
OCULAR PERFUSION PRESSURE AND CHOROIDAL THICKNESS IN CENTRAL SEROUS CHORIORETINOPATHY AND PIGMENT EPITHELIOPATHY
Authors: Yun Cheolmin , Han Ji Yun , Cho Sungwon , Hwang Soon-Young , Kim Seong-Woo , Oh Jaeryung
Published: November 2017

Purpose:

To investigate ocular perfusion pressure (OPP) in patients with central serous chorioretinopathy (CSC) and pigment epitheliopathy (PE).

Methods:

In this retrospective study, we included patients with acute idiopathic unilateral CSC and age- and sex-matched normal controls. The patients with CSC were classified into two groups according to the PE presence on their fellow eyes. We compared OPP among CSC patients with or without PE and normal controls.

Results:

Among a total of 47 patients with CSC, 21 were classified into the PE group and 26 into the non-PE group. The mean OPP (±SD) of CSC and fellow eyes in the PE group (50.02 ± 4.98 and 50.83 ± 4.12 mmHg, respectively) was greater than that in the non-PE group (43.69 ± 6.88 and 44.0 ± 6.57 mmHg, respectively) and normal controls (45.64 ± 8.73 mmHg) (all, P < 0.05). The mean macular choroidal thickness of CSC and fellow eyes in the PE group (344.4 ± 31.8 and 310.1 ± 37.0 μm, respectively) was thicker than that in the non-PE group (318.5 ± 43.8 and 282.8 ± 36.1 μm, respectively) (all, P < 0.05). Greater macular choroidal thickness and higher OPP were associated with PE (P = 0.002 and P = 0.003).

Conclusion:

Forty-five percent of the patients with acute unilateral CSC had PE in their fellow eyes. Increased OPP may influence the development of bilateral CSC characteristics.
INTRAOCULAR PRESSURE CHANGES AFTER DEXAMETHASONE IMPLANT IN PATIENTS WITH GLAUCOMA AND STEROID RESPONDERS
Authors: Srinivasan Rekha , Sharma Unnati , George Ronnie , Raman Rajiv , Sharma Tarun ,   for the Sankara Nethralaya Vitreoretinal Study Group (SNVR Study Group)
Published: November 2017

Purpose:

To assess the changes in intraocular pressure (IOP) after dexamethasone (DEX) implant in patients with glaucoma or history of steroid responders.

Methods:

A retrospective study of patients who received DEX implant was conducted in a tertiary care center in India. Demographic details and IOP measurements at preinjection and postinjection were collected. The proportion of patients with and without IOP rise after DEX implant was noted, and the number of antiglaucoma medications to control the IOP was analyzed. The changes in IOP were also compared in the group with no glaucoma/steroid responder.

Results:

A total of 815 patients, 767 patients in the nonglaucoma group and 48 patients in the glaucoma referral group, who underwent DEX implant were included in this study. The overall mean (SD) age of study participants was 56.3 (SD = 12.6) years. The overall mean (SD) IOP at baseline and at follow-up after injection for both nonglaucoma and glaucoma referral groups was found to be significant (P < 0.001). The differences in IOP measurements across follow-ups after DEX implant were found to be significant in both nonglaucoma (P < 0.001) and glaucoma referral groups (P < 0.001). Among the study patients in the IOP-rise group, 46.43% had maximum IOP rise in 1-week follow-up and 39% in 2-week follow-up, where 78.6% showed IOP controlled with 1 antiglaucoma medication.

Conclusion:

The rise in IOP after DEX implant was noted within first 2 weeks, which can be managed with topical antiglaucoma medications. Hence, with a close early follow-up monitoring of IOP, and timely medical intervention, DEX implant can be performed in patients with glaucoma.
Effect of Suture Removal on Refraction and Graft Curvature After Deep Anterior Lamellar Keratoplasty in Patients With Keratoconus
Authors: Feizi Sepehr , Javadi Mohammad Ali , Behnaz Nazanin , Fani-Hanife Sadaf , Jafarinasab Mohammad Reza
Published: November 2017

Purpose:

To evaluate the effect of suture removal on refraction and keratometry measurements after deep anterior lamellar keratoplasty (DALK).

Methods:

This retrospective study enrolled 54 keratoconus-affected eyes that underwent DALK. A combined suturing technique consisting of a 16-bite single running and 8-bite interrupted 10-0 nylon sutures was used at the time of keratoplasty. Selective interrupted suture removal was performed in a subgroup of patients to reduce postkeratoplasty astigmatism. In another subgroup, all sutures were removed at a single session. Adjustment of the running suture tension was not performed in any case. The effect of suture removal on refractive outcomes was investigated in the entire study group, and the 2 subgroups were compared.

Results:

Mean patient age was 26.6 ± 6.7 years at the time of keratoplasty. The mean interval from surgery to complete suture removal was 17.4 ± 5.9 months. Compared with the pre-suture removal values, there was a significant increase in the magnitude of myopia (−1.12 ± 1.73 D, P = 0.001), refractive astigmatism (−0.89 ± 2.47 D, P = 0.04), mean keratometry (1.39 ± 1.64 D, P = 0.001), and keratometric astigmatism (2.61 ± 2.43 D, P < 0.001) after complete suture removal. Subgroup analysis revealed that selective removal of interrupted sutures was effective as long as remaining interrupted and running sutures were left in place.

Conclusions:

Complete suture removal was followed by an unpredictable and significant increase in post-DALK refraction and keratometry readings. In the subgroup that underwent early selective removal of interrupted sutures before complete suture removal, the desirable effects of this procedure significantly diminished after all remaining sutures were completely removed.
Di (2‐Ethylhexyl) Phthalate and Its Role in Developing Cholestasis
Authors: Gaitantzi Haristi , Hakenberg Priska , Theobald Jannick , Heinlein Hagen , Cai Chen , Loff Steffan , Wölfl Stefan , Ebert Matthias P. , Breitkopf‐Heinlein Katja , Subotic Ulrike
Published: November 2017

Objectives:

Di(2‐ethylhexyl) phthalate (DEHP) is a plasticizer used in many polyvinylchloride medical devices and is washed out easily. Thereby critically ill infants can become exposed to DEHP concentrations significantly exceeding the recommended threshold. We suspect DEHP to play an important role in the development of intestinal failure‐associated liver disease. The aim of this study was therefore to determine the direct influence of DEHP on different liver cell types.

Methods:

HepG2, human upcyte hepatocytes, primary murine hepatocytes, LX‐2, human upcyte hepatic stellate cells, and liver organoids were cultured with DEHP (0.5–500 μmol/L) and parameters including cytotoxicity, cell–cell interactions, and expression of metabolizing enzymes were investigated.

Results:

DEHP modulated the expression of xenobiotic metabolizing enzymes, reduced the formation of bile canaliculi and cell polarity, and inhibited Cyp‐activity in hepatocytes. DEHP had a toxic effect on LX‐2 and induced the fibrogenic activation of hepatic stellate cells. The mode of action of DEHP was different in monolayer cultures compared to 3D‐liver organoids, which were more sensitive to DEHP.

Conclusions:

This study suggests that DEHP modulates expression and activity of drug‐detoxifying liver enzymes in humans at a clinically relevant concentration. Furthermore, it may contribute to the development of cholestasis and fibrosis. These findings strongly support the opinion, that there is a significant potential for serious adverse effects of DEHP derived from medical devices on human health, especially in very young infants with immature livers.
Identifying Nonprovider Factors Affecting Pediatric Emergency Medicine Provider Efficiency
Authors: Saleh Fareed , Breslin Kristen , Mullan Paul C. , Tillett Zachary , Chamberlain James M.
Published: November 2017

Objective

The aim of this study was to create a multivariable model of standardized relative value units per hour by adjusting for nonprovider factors that influence efficiency.

Methods

We obtained productivity data based on billing records measured in emergency relative value units for (1) both evaluation and management of visits and (2) procedures for 16 pediatric emergency medicine providers with more than 750 hours worked per year. Eligible shifts were in an urban, academic pediatric emergency department (ED) with 2 sites: a tertiary care main campus and a satellite community site. We used multivariable linear regression to adjust for the impact of shift and pediatric ED characteristics on individual-provider efficiency and then removed variables from the model with minimal effect on productivity.

Results

There were 2998 eligible shifts for the 16 providers during a 3-year period. The resulting model included 4 variables when looking at both ED sites combined. These variables include the following: (1) number of procedures billed by provider, (2) season of the year, (3) shift start time, and (4) day of week. Results were improved when we separately modeled each ED location. A 3-variable model using procedures billed by provider, shift start time, and season explained 23% of the variation in provider efficiency at the academic ED site. A 3-variable model using procedures billed by provider, patient arrivals per hour, and shift start time explained 45% of the variation in provider efficiency at the satellite ED site.

Conclusions

Several nonprovider factors affect provider efficiency. These factors should be considered when designing productivity-based incentives.
Clinical Experience in a Community Setting During Pediatric Emergency Medicine Fellowship Training
Authors: Marchese Ronald F. , Gala Payal K. , Seiden Jeffrey A. , Scarfone Richard , Belfer Robert A. , Posner Jill
Published: November 2017

Objectives

The aim of this study is to explore current community emergency department (ED) experiences available to pediatric emergency medicine (PEM) trainees and estimate the proportion of graduates taking positions that involve working in a community ED setting.

Methods

We conducted an e-mail–based survey among PEM fellowship directors and assistant directors.

Results

There were 55 program director respondents (74% response rate). Thirty-one percent of the surveyed PEM fellowship programs provide training exposure to a community ED setting. Twenty-nine percent of the surveyed programs reported that 25% to 49% of graduating trainees accepted positions that involve working in a community hospital ED setting, 13% responded 50% to 74%, and 4% report 75% to 100% from 2012 to 2016.

Conclusions

There is an overall paucity of a dedicated community rotation for PEM trainees, yet many graduates are seeking employment in community-based EDs. Because the need for community-based PEM physicians continues to rise and to adequately prepare the PEM workforce, PEM fellowship training should consider a curriculum that includes community-based ED clinical experiences.
HIV outcomes among migrants from low-income and middle-income countries living in high-income countries: a review of recent evidence
Authors: Ross Jonathan , Cunningham Chinazo O. , Hanna David B.
Published: November 2017

Purpose of review

Migrants living in high-income countries are disproportionately affected by HIV infection and frequently have characteristics associated with poor HIV clinical outcomes. HIV epidemiology among migrants is influenced by changes in migration patterns and variations in transmission risk behaviors. Here we review the recently published literature on known HIV outcomes among migrants from low-income and middle-income countries living in high-income countries.

Recent findings

High proportions of migrants acquire HIV after migration, and this group frequently presents to care late. Once established in care, migrants are often more likely to experience worse HIV treatment outcomes compared with native populations. Multiple individual and structural factors influence HIV diagnosis and treatment outcomes among migrants, including disruption of social networks, increased sexual risk behaviors, communication barriers, limited access to care, and stigma. Few studies have examined interventions targeted at improving HIV outcomes among migrants.

Stigma and limited access to care appear to be primary drivers of poor HIV outcomes among migrants in high-income countries. Addressing these disparities is limited by difficulties in identifying and monitoring this population as well as a lack of evidence regarding appropriate interventions for migrants living with HIV. Improving outcomes for this group requires interventions that are specifically targeted at this marginalized and growing population.
Safety of Revision Sleeve Gastrectomy Compared to Roux-Y Gastric Bypass After Failed Gastric Banding
Authors: Janik Michał R. , Rogula Tomasz G. , Mustafa Rami R. , Alhaj Saleh Adel , Khaitan Leena
Published: November 2017

Objective:

The aim of this study was to assess the safety of revisional surgery to laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-Y gastric bypass (LRYGB) after failed laparoscopic adjustable gastric banding (LAGB).

Background:

The number of reoperations after failed gastric banding rapidly increased in the United States during the last several years. A common approach is band removal with conversion to another weight loss procedure such as gastric bypass or sleeve gastrectomy in a single procedure. The safety profile of those procedures remains controversial.

Methods:

Preoperative characteristics and 30-day outcomes from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Files 2015 were selected for all patients who underwent a 1-stage conversion of LAGB to LSG (conv-LSG) or LRYGB (conv-LRYGB). Conv-LSG cases were matched (1:1) with conv-LRYGB patients by age (±1 year), body mass index (±1 kg/m2), sex, and comorbidities including diabetes, hypertension, hyperlipidemia, venous stasis, and sleep apnea.

Results:

A total of 2708 patients (1354 matched pairs) were included in the study. The groups were closely matched as intended. The mean operative time in conv-LRYGB was significantly longer in comparison to conv-LSG patients (151 ± 58 vs 113 ± 45 minutes, P < 0.001). No mortality was observed in either group. Patients after conv-LRYGB had a clinically increased anastomotic leakage rate (2.07% vs 1.18%, P = 0.070) and significantly increased bleed rate (2.66% vs 0.44%, P < 0.001). Thirty-day readmission rate was significantly higher in conv-LRYGB patients (7.46% vs 3.69%, P < 0.001), as was 30-day reoperation rate (3.25% vs 1.26%, P < 0.001). The length of hospital stay was longer in conv-LRYGB.

Conclusions:

A single-stage conversion of failed LAGB leads to greater morbidity and higher complication rates when converted to LRYGB versus LSG in the first 30 days postoperatively. These differences are particularly notable with regards to bleed events, 30-day reoperation, 30-day readmission, operative time, and hospital stay.
The Effect of Apneic Oxygenation on Reducing Hypoxemia During Rapid Sequence Induction and Intubation in the Acutely Ill or Injured
Authors: Riddell Autumn
Published: November 2017

Apneic oxygenation during intubation is the application of oxygen via a nasal cannula, which is left in place throughout laryngoscopy. The flow rate of oxygen is set to at least 15 L/min and theoretically reduces the risk of oxygen desaturation and hypoxemia during the procedure. Over the last 5 years, there have been several studies published on this topic with differing results. Despite conflicting results, use of apneic oxygenation is becoming more prevalent and is being implemented into standard operating procedures in some clinical settings. Because of the low risk of adding a nasal cannula during intubation and the potential benefit of reducing the incidence of hypoxemia and severe oxygen desaturation, it would be prudent to implement apneic oxygenation when available.
Dynamics of phytoplankton blooms in turbulent vortex cells
Authors: Lindemann Christian , Visser Andre , Mariani Patrizio
Published: November 2017

Turbulence and coherent circulation structures, such as submesoscale and mesoscale eddies, convective plumes and Langmuir cells, play a critical role in shaping phytoplankton spatial distribution and population dynamics. We use a framework of advection–reaction–diffusion equations to investigate the effects of turbulent transport on the phytoplankton population growth and its spatial structure in a vertical two-dimensional vortex flow field. In particular, we focus on how turbulent flow velocities and sinking influence phytoplankton growth and biomass aggregation. Our results indicate that conditions in mixing and growth of phytoplankton can drive different vertical spatial structures in the mixed layer, with the depth of the mixed layer being a critical factor to allow coexistence of populations with different sinking speed. With increasing mixed layer depth, positive growth for sinking phytoplankton can be maintained with increasing turbulent flow velocities, allowing the apparently counter-intuitive persistence of fast sinking phytoplankton populations in highly turbulent and deep mixed layers. These dynamics demonstrate the role of considering advective transport within a turbulent vortex and can help to explain observed phytoplankton biomass during winter in the North Atlantic, where the overturn of deep convection has been suggested to play a critical role in phytoplankton survival.
Legionella pneumophilaCsrA regulates a metabolic switch from amino acid to glycerolipid metabolism
Authors: Häuslein Ina , Sahr Tobias , Escoll Pedro , Klausner Nadine , Eisenreich Wolfgang , Buchrieser Carmen
Published: November 2017

Legionella pneumophilaCsrA plays a crucial role in the life-stage-specific expression of virulence phenotypes and metabolic activity. However, its exact role is only partly known. To elucidate how CsrA impactsL. pneumophilametabolism we analysed the CsrA depended regulation of metabolic functions by comparative13C-isotopologue profiling and oxygen consumption experiments of aL. pneumophilawild-type (wt) strain and its isogeniccsrA−mutant. We show that acsrA−mutant has significantly lower respiration rates when serine, alanine, pyruvate, α-ketoglutarate or palmitate is the sole carbon source. By contrast, when grown in glucose or glycerol, no differences in respiration were detected. Isotopologue profiling uncovered that the transfer of label from [U-13C3]serine via pyruvate into the citrate cycle and gluconeogenesis was lower in the mutant as judged from the labelling patterns of protein-derived amino acids, cell-wall-derived diaminopimelate, sugars and amino sugars and 3-hydroxybutyrate derived from polyhydroxybutyrate (PHB). Similarly, the incorporation of [U-13C6]glucose via the glycolysis/Entner–Doudoroff (ED) pathway but not via the pentose phosphate pathway was repressed in thecsrA−mutant. On the other hand, fluxes due to [U-13C3]glycerol utilization were increased in thecsrA−mutant. In addition, we showed that exogenous [1,2,3,4-13C4]palmitic acid is efficiently used for PHB synthesis via13C2-acetyl-CoA. Taken together, CsrA induces serine catabolism via the tricarboxylic acid cycle and glucose degradation via the ED pathway, but represses glycerol metabolism, fatty acid degradation and PHB biosynthesis, in particular during exponential growth. Thus, CsrA has a determining role in substrate usage and carbon partitioning during theL. pneumophilalife cycle and regulates a switch from amino acid usage in replicative phase to glycerolipid usage during transmissive growth.
Bioclimatic niches are conserved and unrelated to pollination syndromes in Antillean Gesneriaceae
Authors: Alexandre Hermine , Faure Julie , Ginzbarg Steven , Clark John , Joly Simon
Published: November 2017

The study of the evolution of abiotic niches can be informative regarding the speciation drivers in a given group. Yet, two factors that could potentially affect niche evolution have seldom been addressed concomitantly, which are biotic interactions and geographical isolation. In this study, we used as a model group the Antillean plant generaGesneriaandRhytidophyllum(Gesneriaceae) to evaluate the effect of pollinators and geographical isolation on the bioclimatic niche. These genera possess species characterized by interspecific geographical isolation in different islands and are pollinated by different pollinators. Some species are pollinated by hummingbirds, other by bats, while some are more generalists and are pollinated by pollinators from both functional groups. After describing the bioclimatic niches of plant species, we measured niche overlap for species pairs and we fitted Brownian motion and Ornstein–Uhlenbeck (OU) evolution models with multiple evolutionary regimes to test for an effect of pollination strategy or geographical isolation on bioclimatic niche evolution of these plants. The analysis of niche overlap between plant species, which could not be corrected for phylogenetic relationships, showed that it was significantly influenced by pollination mode and island distribution. By contrast, the best fitting evolutionary model on niche optima and tolerance was always an OU model with a unique selective regime, suggesting that neither pollination strategy nor island isolation had an important effect on bioclimatic niches at a macroevolutionary scale. Instead, we conclude that bioclimatic niches of Antillean Gesneriaceae evolved under phylogenetic conservatism and hypothesize that this macroevolutionary pattern could result from adaptation to temporally variable climates in the Antilles.
Elevated
p
CO
2
affects tissue biomass composition, but not calcification, in a reef coral under two light regimes
Authors: Wall C. B. , Mason R. A. B. , Ellis W. R. , Cunning R. , Gates R. D.
Published: November 2017

Ocean acidification (OA) is predicted to reduce reef coral calcification rates and threaten the long-term growth of coral reefs under climate change. Reduced coral growth at elevated
p
CO
2
may be buffered by sufficiently high irradiances; however, the interactive effects of OA and irradiance on other fundamental aspects of coral physiology, such as the composition and energetics of coral biomass, remain largely unexplored. This study tested the effects of two light treatments (7.5 versus 15.7 mol photons m
−2
 d
−1
) at ambient or elevated
p
CO
2
(435 versus 957 µatm) on calcification, photopigment and symbiont densities, biomass reserves (lipids, carbohydrates, proteins), and biomass energy content (kJ) of the reef coral
Pocillopora acuta
from Kāne‘ohe Bay, Hawai‘i. While
p
CO
2
and light had no effect on either area- or biomass-normalized calcification, tissue lipids gdw
−1
and kJ gdw
−1
were reduced 15% and 14% at high
p
CO
2
, and carbohydrate content increased 15% under high light. The combination of high light and high
p
CO
2
reduced protein biomass (per unit area) by approximately 20%. Thus, under ecologically relevant irradiances,
P. acuta
in Kāne‘ohe Bay does not exhibit OA-driven reductions in calcification reported for other corals; however, reductions in tissue lipids, energy content and protein biomass suggest OA induced an energetic deficit and compensatory catabolism of tissue biomass. The null effects of OA on calcification at two irradiances support a growing body of work concluding some reef corals may be able to employ compensatory physiological mechanisms that maintain present-day levels of calcification under OA. However, negative effects of OA on
P. acuta
biomass composition and energy content may impact the long-term performance and scope for growth of this species in a high
p
CO
2
world.
Synthesis and applications of MANs/poly(MMA-co-BA) nanocomposite latex by miniemulsion polymerization
Authors: Gong Sheng , Chen Huayao , Zhou Xinhua , Gunasekaran Sundaram
Published: November 2017

We have synthesized core-shell structured 3-methacryloxypropyltrimethoxysilane (MPS) functionalized antimony-doped tin oxide nanoparticles (MANs)–poly(methyl methacrylate-co-butyl acrylate) (PMMA-co-BA, PMB) nanocomposite latex particles via miniemulsion polymerization method. Polymerizable anionic surfactant DNS-86 (allyloxy polyoxyethylene(10) nonyl ammonium sulfate) was first introduced to synthesize core-shell nanocomposite. The morphologies of synthesized MANs and MANs/PMB latex nanocomposite particles were studied with transmission electron microscopy, which revealed particles, on average 70 nm in size, with a core-shell structure. Owing to the uniformity and hydrophobicity of MANs, the MANs-embedded PMB latex nanocomposite can be tailored more precisely than other nanoparticles-embedded nanocomposites. Films incorporating 10 wt% of MANs in the MAN/PMB latex nanocomposite exhibit good transmittance in the visible region, and excellent opacity in the near infrared region. The MANs/PMB nanocomposite film also appears suitable for heat insulation applications.
An empirical measure of nonlinear strain for soft tissue indentation
Authors: MacManus D. B. , Gilchrist M. D. , Murphy J. G.
Published: November 2017

Indentation is a primary tool in the investigation of the mechanical properties of very soft tissue such as the brain. However, the usual material characterization protocols are not applicable because the resulting deformation is inhomogeneous, with even the identification of the amount of strain ambiguous and uncertain. Focusing on spherical indentation only, a standard is needed to quantify the amount of strain in terms of the probe radius and displacement so that different indentation experiments can be compared and contrasted. It is shown here that the minimum axial value of the Eulerian logarithmic strain tensor has many desirable properties of such a standard, such as invariance under the choice of material model, and experimental conditions for a given probe displacement. The disadvantage of this measure is that sophisticated finite element techniques need to be used in its determination. An empirical relation is obtained between this strain and the probe radius and displacement to circumvent this problem, and it is shown that this relationship is an excellent predictor of the strain measure. Two essential features of this empirical measure for nonlinear strains are that the exact strain measure for the linear theory is recovered on restriction to infinitesimal deformations and that the simulations use models based on reliable and accurate indentation data obtained from freshly harvested murine brains using a bespoke micro-indentation device.
Portable device for the detection of colorimetric assays
Authors: Luka G. S. , Nowak E. , Kawchuk J. , Hoorfar M. , Najjaran H.
Published: November 2017

In this work, a low-cost, portable device is developed to detect colorimetric assays for in-field and point-of-care (POC) analysis. The device can rapidly detect both pH values and nitrite concentrations of five different samples, simultaneously. After mixing samples with specific reagents, a high-resolution digital camera collects a picture of the sample, and a single-board computer processes the image in real time to identify the hue–saturation–value coordinates of the image. An internal light source reduces the effect of any ambient light so the device can accurately determine the corresponding pH values or nitrite concentrations. The device was purposefully designed to be low-cost, yet versatile, and the accuracy of the results have been compared to those from a conventional method. The results obtained for pH values have a mean standard deviation of 0.03 and a correlation coefficient
R
2
of 0.998. The detection of nitrites is between concentrations of 0.4–1.6 mg l
−1
, with a low detection limit of 0.2 mg l
−1
, and has a mean standard deviation of 0.073 and an
R
2
value of 0.999. The results represent great potential of the proposed portable device as an excellent analytical tool for POC colorimetric analysis and offer broad accessibility in resource-limited settings.
Evolution of external female genital mutilation: why do males harm their mates?
Authors: Mouginot Pierick , Uhl Gabriele , Fromhage Lutz
Published: November 2017

Sperm competition may select for male reproductive traits that influence female mating or oviposition rate. These traits may induce fitness costs to the female; however, they may be costly for the males as well as any decrease in female fitness also affects male fitness. Male adaptations to sperm competition manipulate females by altering not only female behaviour or physiology, but also female morphology. In orb-weaving spiders, mating may entail mutilation of external structures of the female genitalia, which prevents genital coupling with subsequent males. Here, we present a game theoretical model showing that external female genital mutilation is favoured even under relatively high costs of mutilation, and that it is favoured by a high number of mate encounters per female and last-male sperm precedence.
Species-specific impacts of suspended sediments on gill structure and function in coral reef fishes
Authors: Hess Sybille , Prescott Leteisha J. , Hoey Andrew S. , McMahon Shannon A. , Wenger Amelia S. , Rummer Jodie L.
Published: November 2017

Reduced water quality, in particular increases in suspended sediments, has been linked to declines in fish abundance on coral reefs. Changes in gill structure induced by suspended sediments have been hypothesized to impair gill function and may provide a mechanistic basis for the observed declines; yet, evidence for this is lacking. We exposed juveniles of three reef fish species (
Amphiprion melanopus
,
Amphiprion percula
and
Acanthochromis polyacanthus
) to suspended sediments (0–180 mg l
−1
) for 7 days and examined changes in gill structure and metabolic performance (i.e. oxygen consumption). Exposure to suspended sediments led to shorter gill lamellae in
A. melanopus
and
A. polyacanthus
and reduced oxygen diffusion distances in all three species. While
A. melanopus
exhibited impaired oxygen uptake after suspended sediment exposure, i.e. decreased maximum and increased resting oxygen consumption rates resulting in decreased aerobic scope, the oxygen consumption rates of the other two species remained unaffected. These findings imply that species sensitive to changes in gill structure such as
A. melanopus
may decline in abundance as reefs become more turbid, whereas species that are able to maintain metabolic performance despite suspended sediment exposure, such as
A. polyacanthus
or
A. percula
, may be able to persist or gain a competitive advantage.
Body condition explains migratory performance of a long-distance migrant
Authors: Duijns Sjoerd , Niles Lawrence J. , Dey Amanda , Aubry Yves , Friis Christian , Koch Stephanie , Anderson Alexandra M. , Smith Paul A.
Published: November 2017

Body condition (i.e. relative mass after correcting for structural size) affects the behaviour of migrating birds, but how body condition affects migratory performance, timing and fitness is still largely unknown. Here, we studied the effects of relative body condition on individual departure decisions, wind selectivity, flight speed and timing of migration for a long-distance migratory shorebird, the red knot
Calidris canutus rufa.
By using automated VHF telemetry on a continental scale, we studied knots' migratory movements with unprecedented temporal resolution over a 3-year period. Knots with a higher relative body condition left the staging site later than birds in lower condition, yet still arrived earlier to their Arctic breeding grounds compared to knots in lower relative body condition. They accomplished this by selecting more favourable winds at departure, thereby flying faster and making shorter stops
en route
. Individuals with a higher relative body condition in spring migrated south up to a month later than individuals in lower condition, suggesting that individuals in better condition were more likely to have bred successfully. Moreover, individuals with a lower relative body condition in spring had a lower probability of being detected in autumn, suggestive of increased mortality. The pressure to arrive early to the breeding grounds is considered to be an important constraint of migratory behaviour and this study highlights the important influence of body condition on migratory decisions, performance and potentially fitness of migrant birds.