bluuebunny/crossref_metadata_2025 huggingface dataset:
The dynamics and impact of compositionally originating provinces in a mantle convection model featuring rheologically obtained plates
Authors: Langemeyer Sean M , Lowman Julian P , Tackley Paul J
Published: December 2019

Previous geodynamic studies have indicated that the presence of a compositionally anomalous and intrinsically dense (CAID) mantle component can impact both core heat flux and surface features, such as plate velocity, number and size. Implementing spherical annulus geometry mantle convection models, we investigate the influence of intrinsically dense material in the lower mantle on core heat flux and the surface velocity field. The dense component is introduced into a system that features an established plate-like surface velocity field, and subsequently we analyse the evolution of the surface velocity as well as the interior thermal structure of the mantle. The distribution and mobility of the CAID material is investigated by varying its buoyancy ratio relative to the ambient mantle (ranging from 0.7 to 1.5), its total volume (3.5–10 per cent of the mantle volume) and its intrinsic viscosity (0.01–100 times the ambient mantle viscosity). We find at least three distinct distributions of the dense material can occur adjacent to the core–mantle boundary (CMB), including multiple piles of varying topography, a core enveloping layer and two diametrically opposed provinces (which can on occasion break into three distinct piles). The latter distribution mimics the morphology of the seismically observed large low shear wave velocity provinces (LLSVPs) and can occur over the entire range of CAID material viscosities. However, diametrically opposed provinces occur primarily in cases with CAID material buoyancy numbers of 0.7–0.85 (corresponding to contrasts in density between ambient and CAID material of 130 and 160 kg m−3, respectively) in our model (with an effective Rayleigh number of order 106). Steep and high topography piles are also obtained for cases featuring buoyancy ratios of 0.85 and viscosities 10–100 times that of the ambient mantle. An increase in relative density, as well as larger volumes of CAID material, lead to the development of a core enveloping layer. Our findings show that when two provinces are present core heat flux can be reduced by up to 50 per cent relative to cases in which CAID material is absent. Surface deformation quantified by Plateness is minimally influenced by variation of the properties of the dense material. Surface velocity is found to be reduced in general but mostly substantially in cases featuring high CAID material viscosities and large volumes (i.e. 10 per cent) or buoyancy ratios.
Strain energy released by earthquake faulting with random slip components
Authors: Saito Tatsuhiko , Noda Akemi
Published: December 2019

This study investigates the strain energy change caused by earthquake faulting. While conventional theories often assumed uniform stress change on the fault plane, this study supposed the slip fluctuation and non-uniform stress change on the fault. By using a stochastic modelling of the slip distribution, we represent the ensemble average of the strain energy change by using the power spectral density function of the slip fluctuation. This yields the following results. (1) When the initial stress is uniform and the earthquake contains a fluctuating slip distribution, the released strain energy is less than the one by an earthquake with the uniform stress change on the fault with the same seismic moment. (2) On the other hand, when the initial stress is fluctuating, the earthquake contains a fluctuating slip distribution, and the final stress is uniform, the released strain energy is more than the one by an earthquake with the uniform stress change on the fault. (3) The stress drop becomes large due to the fluctuating slip distribution from the viewpoint of the strain energy release. We derived the analytical solution of the stress change by using the power spectral density function of the random slip fluctuation. (4) The strain energy change is proportional to the seismic moment when ${\epsilon ^2}/a \propto {( {{M_0}} )^{ - 1/3}}$ (${\epsilon ^2}$ is the variance of the fractional slip fluctuation and $a$ is the correlation distance). (5) The energy balance gives the value of initial stress that is required for the earthquake generation. In order to generate an earthquake, the initial stress needs to be larger than the sum of half of the stress drop and the apparent stress. In other words, earthquakes having rich short-wavelength components in the slip distribution are not generated under a low initial stress level.
A new 3-D P-wave velocity model for the Gulf of Cadiz and adjacent areas derived from controlled-source seismic data: application to nonlinear probabilistic relocation of moderate earthquakes
Authors: Lozano Lucía , Cantavella Juan Vicente , Barco Jaime
Published: December 2019

The SW Iberian margin is well known for its complex tectonic setting and crustal structure and by the occurrence of moderate magnitude earthquakes and some great tsunamigenic earthquakes. Fortunately, many seismic reflection and refraction profiles have been carried out, providing detailed information about the crustal structure of the main geologic domains in this region. These studies show a first-order variation due to the transition from oceanic to continental domain, large-scale heterogeneities within the crust and an irregular Moho topography. Routine earthquake locations in this area have been usually computed using a general 1-D velocity model which is clear that cannot account for such a heterogeneous structure. In addition, regional seismic stations used to locate the Gulf of Cadiz seismicity are on land and far away to the east, implying large azimuthal gaps and distances. In this context, a 3-D approach seems necessary to properly solve the crustal velocity field and improve earthquake location in this area. With this purpose, we present a new digital 3-D P-wave velocity distribution for the crust and uppermost mantle derived from previously published controlled-source seismic experiments carried out in SW Iberia and the Gulf of Cadiz over the last 40 yr. We have reviewed more than 50 wide-angle and multichannel seismic reflection and refraction profiles and digitized the most significant published 2-D seismic velocity models, performing an updated compilation of crustal parameters (P-wave velocities and geometry and depth of the main crustal interfaces). These velocities as a function of position and depth have been interpolated using ordinary kriging algorithm to obtain, in the form of a regular georeferenced 20 × 20 × 1 km grid spacing, a high-resolution 3-D P-wave velocity distribution for the crust and uppermost mantle and a continuous Moho depth map of the whole area of this study (33°N–41°N latitude and 15°W–5°W longitude). Since current seismic location tools allow the implementation of 3-D grid structures, we have applied our 3-D model to relocate a selection of moderate earthquakes occurred in the studied region using a probabilistic nonlinear method. In the Gulf of Cadiz area the probabilistic approximation provides maximum likelihood hypocentres located within the uppermost mantle with the majority of depths ranging between 20 and 45 km. This model would subsequently be implemented at the Spanish Seismic Network for the routine relocation of the seismicity of the area.
A theory of porous media and harmonic wave propagation in poroelastic body
Authors: Brito da Silva Romulo , Liu I-Shih , Antonio Rincon Mauro
Published: December 2019

The present work is based on a mixture theory of poroelastic media which is consistent with the classical Darcy’s law and uplift force in soil mechanics. In addition, it also results in having an inertial effect on the motion of solid constituent as commonly expected, in contrast to Biot’s theory, where relative acceleration is introduced as an interactive force between solid and fluid constituents to account for the apparent inertial effect. The propagation of plane harmonic waves in homogeneously deformed region is considered. For different poroelastic models with either incompressible solid or incompressible fluid constituent, phase speeds and attenuation coefficients are analysed and numerically determined with convenient data from a nonlinear material model for comparison with some available results in the literature.
The Law and Ethics of Switching from Biologic to Biosimilar in Canada
Authors: Murdoch Blake , Caulfield Timothy
Published: December 2019

Governments and financial institutions in several jurisdictions are planning or implementing nonmedical/‘forced’ switches by cutting drug coverage for reference biologics and funding only less expensive biosimilars. Switches raise numerous ethical and legal challenges, as the drugs are framed as not being identical and, despite strong evidence for noninferiority of some biosimilars, there is controversy over whether switching can sometimes lead to adverse events. Canadian law generally requires physicians to give precedence to their patients’ best interests over social interests such as cost containment. The primacy of patients’ interests is also clearly reflected in professional policies and codes of ethics. Moreover, physicians are obligated to disclose everything a reasonable person in the patient’s position would want to know when obtaining informed consent for treatment, including addressing not only scientific information but also relevant social controversy about nonmedical switches. Under Canadian law, physicians may be obligated to tell patients about the ability to access unfunded biologics, even if patients lack the resources to obtain them. In sum, while there is no inherent right to funding for reference biologics in Canada, physicians in some circumstances may have a legal obligation as fiduciaries to advocate on behalf of patients to remain on a reference biologic. At a minimum, the controversy surrounding switching will necessitate, as part of the consent process, a robust and thorough disclosure of relevant risks, benefits and reasonable alternatives.
Is standard radical surgery necessary for elderly patients with early-stage epithelial ovarian carcinoma? ~Propensity score matched analysis~
Authors: Kajiyama Hiroaki , Yoshihara Masato , Tamauchi Satoshi , Yoshikawa Nobuhisa , Niimi Kaoru , Suzuki Shiro , Shibata Kiyosumi , Kikkawa Fumitaka
Published: December 2019

Objective

The impact of ‘standard full-staged radical surgery (SRS)’ on overall survival (OS) in elderly patients with early-stage epithelial ovarian cancer (EOC) remains unclear. In the current study, we investigated the impact of SRS on OS in elderly patients with early-stage EOC in a multicentric analysis using a propensity score (PS)-matching technique.

Methods

Between 1986 and 2017, 3227 patients with EOC were registered and accumulated by the Tokai Ovarian Tumor Study Group, consisting of 14 collaborating institutions, after a central pathological review. Among them, 204 elderly patients aged older than or equal to 65 years who had a stage I EOC were analyzed, including 72 patients who had received SRS (Group I) and 132 who had undergone non-SRS limited surgery (Group II). Oncologic outcomes were compared between the two groups using a PS-matching technique to adjust for various clinicopathologic risk factors.

Results

The median follow-up duration of all surviving patients was 55.9 months. Consequently, 54 patients (26.5%) developed recurrence. In addition, 33 patients (16.2%) died of the disease. In the original cohort, the 5-year OS rates of Groups I and II were 95.8 and 82.3%, respectively. We identified a marginally significant difference between the two groups (Log-rank: P = 0.086). In the PS-matched cohort after adjustment for multiple clinicopathologic factors, there was no significant difference in OS between the two groups [OS (Group I vs. II), HR: 0.766 (95% CI: 0.271–2.165), P = 0.615].

Conclusions

After adjustment for clinicopathologic factors, non-SRS limited surgery may not worsen the oncologic outcome in elderly women with early-stage EOC. A large-scale clinical study is necessary to validate the findings.
Experimental Demonstration of Reservoir Competence of the White-Footed Mouse, Peromyscus leucopus (Rodentia: Cricetidae), for the Lyme Disease Spirochete, Borrelia mayonii (Spirochaetales: Spirochaetaceae)
Authors: Parise Christina M , Breuner Nicole E , Hojgaard Andrias , Osikowicz Lynn M , Replogle Adam J , Eisen Rebecca J , Eisen Lars
Published: December 2019

The white-footed mouse, Peromyscus leucopus (Rafinesque), is a reservoir for the Lyme disease spirochete Borrelia burgdorferi sensu stricto in the eastern half of the United States, where the blacklegged tick, Ixodes scapularis Say (Acari: Ixodidae), is the primary vector. In the Midwest, an additional Lyme disease spirochete, Borrelia mayonii, was recorded from naturally infected I. scapularis and P. leucopus. However, an experimental demonstration of reservoir competence was lacking for a natural tick host. We therefore experimentally infected P. leucopus with B. mayonii via I. scapularis nymphal bites and then fed uninfected larvae on the mice to demonstrate spirochete acquisition and passage to resulting nymphs. Of 23 mice fed on by B. mayonii-infected nymphs, 21 (91%) developed active infections. The infection prevalence for nymphs fed as larvae on these infected mice 4 wk post-infection ranged from 56 to 98%, and the overall infection prevalence for 842 nymphs across all 21 P. leucopus was 75% (95% confidence interval, 72–77%). To assess duration of infectivity, 10 of the P. leucopus were reinfested with uninfected larval ticks 12 wk after the mice were infected. The overall infection prevalence for 480 nymphs across all 10 P. leucopus at the 12-wk time point was 26% (95% confidence interval, 23–31%), when compared with 76% (95% confidence interval, 71–79%) for 474 nymphs from the same subset of 10 mice at the 4-wk time point. We conclude that P. leucopus is susceptible to infection with B. mayonii via bite by I. scapularis nymphs and an efficient reservoir for this Lyme disease spirochete.
A Case-Control Study Examining Disparities in Clinical Trial Participation Among Breast Surgical Oncology Patients
Authors: Fayanju Oluwadamilola M , Ren Yi , Thomas Samantha M , Greenup Rachel A , Hyslop Terry , Hwang E Shelley , Stewart John H
Published: December 2019

Background

Clinical trial participation among racial and ethnic minorities remains low despite national efforts. We sought to determine how participation in clinical trials by breast surgical oncology patients has changed over time and what characteristics are associated with participation.

Methods

Women with breast cancer enrolled in National Cancer Institute–sponsored, cooperative-group trials from 2000 to 2012 and who underwent oncologic surgery (n = 17 125) were compared with trial-eligible women in the National Cancer Database diagnosed in 2000–2012 (n = 792 719). Race-specific trial participation was plotted over time by income and reported as a proportion of the combined cohorts. Factors associated with trial participation were estimated using logistic regression; we report odds ratios (ORs) with 95% confidence intervals (CIs). A P value less than  .05 was considered statistically significant for all analyses. All tests were two-sided.

Results

Participation declined across all groups over time because of a decrease in the scale and number of trials. In 2000–2003, Asian–Pacific Islander (7.17%), Hispanic (3.48%), and white (7.13%) patients from the highest income group had higher participation than their lower-income counterparts (Asian–Pacific Islander: 3.95%; Hispanic: 2.67%; white: 5.96%), but by 2008–2012, only high-income white patients participated more than lower-income whites (0.32% vs 0.25%, all P < .01). Black (OR = 0.80, 95% CI = 0.75 to 0.85) and Hispanic (OR = 0.84, 95% CI = 0.77 to 0.92) patients were less likely to participate than whites, but there were statistically significant interactions between income and race and ethnicity, with high-income black patients being approximately 50% less likely to participate than lower-income blacks (all P < .001).

Conclusions

Multifaceted interventions addressing the intersectionality of race, ethnicity, and other patient characteristics are needed to address persistent disparities in trial participation among breast surgical oncology patients.
Press Freedom and Investor–State Dispute Settlement: Past, Present and Future
Authors: King Aphiwan Natasha
Published: December 2019

This article argues in favour of the use of Investor–State Dispute Settlement (ISDS) as a mechanism for enforcing global freedom of the press. Commentators have increasingly recognized the potential of investor–State arbitration as a method for promoting good governance by host States. Given the shared preoccupation of international human rights law and ISDS with the protection of the individual against State action, it is unsurprising that the right to property, due process, and non-discrimination each has its analogue in investment treaty standards. This article summarizes disputes in which news and media organizations, as commercial actors, have successfully sought provisional measures and awards to address State controls on freedom of expression, through common investment protections such as Fair and Equitable Treatment (FET). Through this, the article highlights both the substantive and procedural advantages of this mode of dispute settlement, as well as the risks inherent in initiating arbitration against a State.
Shading of the mother plant during seed development promotes subsequent seed germination in soybean
Authors: Chen Feng , Zhou Wenguan , Yin Han , Luo Xiaofeng , Chen Wei , Liu Xin , Wang Xingcai , Meng Yongjie , Feng Lingyang , Qin Yuanyuan , Zhang Cuiying , Yang Feng , Yong Taiwen , Wang Xiaochun , Liu Jiang , Du Junbo , Liu Weiguo , Yang Wenyu , Shu Kai
Published: December 2019

The effect of shading during seed development on subsequent germination remains largely unknown. In this study, two soybean (Glycine max) seed production systems, monocropping (MC) and maize–soybean intercropping (IC), were employed to examine the effects of shading of the mother plant on subsequent seed germination. Compared to the MC soybean seeds, which received light, the developing IC seeds were exposed to shade resulting from the taller neighboring maize plants. The IC seeds germinated faster than the MC seeds, although there was no significant difference in the thickness of the seed coat. The concentration of soluble pro-anthocyanidin in the IC seed coat was significantly lower than that in the MC seed coat. Changes in the concentrations of several types of fatty acids in IC seeds were also observed, the nature of which were consistent with the effect on germination. The expression levels of genes involved in abscisic acid (ABA) biosynthesis were down-regulated in IC seeds, while the transcription levels of the genes related to gibberellin (GA) biosynthesis were up-regulated. This was consistently reflected in decreased ABA concentrations and increased active GA4 concentrations in IC seeds, resulting in an increased GA4/ABA ratio. Our results thus indicated that shading of the mother plant during seed development in soybean promoted subsequent germination by mediating the biosynthesis of pro-anthocyanidins, fatty acids, and phytohormones.
‘Which Story do you Prefer?’: The Limits of the Symbolic in Yann Martel’s Life of Pi
Authors: Karam Ally Hamza
Published: December 2019

This article investigates the symbolic and the material in Yann Martel’s novel Life of Pi. I develop through psychoanalytical and phenomenological argumentation a reading of Martel’s book as an updating of Herman Melville’s Moby Dick, in the sense that each tempts its protagonist to try to glimpse the presence of the divine within the indifferent mutability of animal natures. Like Ishmael, who alternatively perceives Ahab as Jonah and Job, Martel’s castaway Piscine asks us to choose which ‘story’ about the universe we prefer, one in which nature is a window into God’s mind, and the other in which it refuses us this desire.
Freedom at sea
Authors: Nesiah Vasuki
Published: December 2019

The Amistad case deals with an 1839 slave-ship rebellion seeking to reverse the middle passage. The rebels reimagine freedom in counterpoint to liberal freedom and legal authority—a domain that intertwined emancipation and enslavement, the age of liberty and the Black Atlantic, the distance between continents and tides binding them together, redemption of American humanism and attacks on Black humanity.
The USU Global Health Distance Learning Program: An International Educational Consortium for Global Health Engagement
Authors: Boetig Bradley , Kumpf Josh , Jindal Rahul M , Lawry Lynn Lieberman , Baines Lindsay , Cullison Thomas R
Published: December 2019

USU’s Global Health Distance Learning Program has successfully enrolled over 400 students from all four services spread across six continents. British and Australian military physicians have joined as international partners, and the program now invites additional international, as well as USG interagency and war college partnerships. The program should also be employed as a tool for global health engagement itself.
Sudden and steady orbital period changes across the classical nova eruptions of DQ Her and BT Mon
Authors: Schaefer Bradley E
Published: December 2019

I report two new measures of the sudden change in the orbital period (P) across the nova eruption (ΔP) and the steady period change in quiescence ($\dot{P}$) for classical novae (CNe) DQ Her and BT Mon. The fractional changes (ΔP/P) in parts per million (ppm) are −4.46 ± 0.03 for DQ Her and +39.6 ± 0.5 for BT Mon. For BT Mon, the ΔP/P value is not large enough (i.e. >1580 ppm) to allow for hibernation in this system. The negative ΔP/P for DQ Her is a confident counterexample of the hibernation model for the evolution of cataclysmic variables. Further, published models of period changes by nova eruptions do not allow for such a negative value, so some additional mechanism is required, with this perhaps being due to asymmetric ejection of material. My program has also measured the first long-term $\dot{P}$ for CNe, with 0.00 ± 0.02 for DQ Her and −2.3 ± 0.1 for BT Mon, all with units of 10−11 d cycle−1. These can be directly compared to the predictions of the magnetic braking model, where the long-term average $\dot{P}$ is a single universal function of P. The predicted values are −0.027 for DQ Her and −0.33 for BT Mon. For both novae, the measured $\dot{P}$ is significantly far from the predictions for magnetic braking. Further, the observed ΔP for BT Mon imposes an additional positive period change of +0.60 × 10−11 d cycle−1 when averaged over the eruption cycle, so this system actually has a long-term rise in P.
Identifying stellar streams in Gaia DR2 with data mining techniques
Authors: Borsato Nicholas W , Martell Sarah L , Simpson Jeffrey D
Published: December 2019

Streams of stars from captured dwarf galaxies and dissolved globular clusters are identifiable through the similarity of their orbital parameters, a fact that remains true long after the streams have dispersed spatially. We calculate the integrals of motion for 31 234 stars, to a distance of 4 kpc from the Sun, which have full and accurate 6D phase space positions in the Gaia DR2 catalogue. We then apply a novel combination of data mining, numerical, and statistical techniques to search for stellar streams. This process returns five high confidence streams (including one which was previously undiscovered), all of which display tight clustering in the integral of motion space. Colour–magnitude diagrams indicate that these streams are relatively simple, old, metal-poor populations. One of these resolved streams shares very similar kinematics and metallicity characteristics with the Gaia-Enceladus dwarf galaxy remnant, but with a slightly younger age. The success of this project demonstrates the usefulness of data mining techniques in exploring large data sets.
Rest-frame UV properties of luminous strong gravitationally lensed Lyα emitters from the BELLS GALLERY Survey
Authors: Marques-Chaves R , Pérez-Fournon I , Shu Y , Colina L , Bolton A , Álvarez-Márquez J , Brownstein J , Cornachione M , Geier S , Jiménez-Ángel C , Kojima T , Mao S , Montero-Dorta A , Oguri M , Ouchi M , Poidevin F , Shirley R , Zheng Z
Published: December 2019

We present deep rest-frame UV spectroscopic observations using the Gran Telescopio Canarias of six gravitationally lensed Lyα emitters (LAEs) at 2.36 < z < 2.82 selected from the BELLS GALLERY survey. By taking the magnifications into account, we show that LAEs can be as luminous as LLyα ≃ 30 × 1042 erg s−1 and MUV ≃ −23 (AB) without invoking an AGN component, in contrast with previous findings. We measure Lyα rest-frame equivalent widths, $EW_{0}\,\rm (Ly\alpha)$, ranging from 16 to 50 Å and Lyα escape fractions, $f_{\rm esc}\, \rm (Ly\alpha)$, from 10 per cent to 40 per cent. Large $EW_{0}\, \rm (Ly\alpha)$ and $f_{\rm esc}\, \rm (Ly\alpha)$ are found predominantly in LAEs showing weak low-ionization ISM absorption (EW0 ≲ 1 Å) and narrow Lyα profiles (≲300 km s−1 FWHM) with their peak close (≲80 km s−1) to their systemic redshifts, suggestive of less scatter from low H i column densities that favours the escape of Lyα photons. We infer stellar metallicities of Z/Z⊙ ≃ 0.2 in almost all LAEs by comparing the P-Cygni profiles of the wind lines N v1240 Å and C iv1549 Å with those from stellar synthesis models. We also find a trend between MUV and the velocity offset of ISM absorption lines, such as the most luminous LAEs experience stronger outflows. The most luminous LAEs show star formation rates up to ≃180 M⊙ yr−1, yet they appear relatively blue (βUV ≃ −1.8 to −2.0) showing evidence of little dust attenuation [E(B − V) = 0.10–0.14]. These luminous LAEs may be particular cases of young starburst galaxies that have had no time to form large amounts of dust. If so, they are ideal laboratories to study the early phase of massive star formation, stellar and dust mass growth, and chemical enrichment histories of starburst galaxies at high-z.
Differential Composition of Vaginal Microbiome, but Not of Seminal Microbiome, Is Associated With Successful Intrauterine Insemination in Couples With Idiopathic Infertility: A Prospective Observational Study
Authors: Amato Virginia , Papaleo Enrico , Pasciuta Renée , Viganò Paola , Ferrarese Roberto , Clementi Nicola , Sanchez Ana Maria , Quaranta Lavinia , Burioni Roberto , Ambrosi Alessandro , Salonia Andrea , Clementi Massimo , Candiani Massimo , Mancini Nicasio
Published: December 2019

Background

Vaginal and seminal microbiomes have gained increasing interest for their involvement in reproductive health and fertility. However, their role in reproductive outcome is not fully understood yet. In this study, we aimed to correlate the vaginal and the seminal microbiome of 23 couples with idiopathic infertility to the clinical pregnancy rate after intrauterine insemination (IUI).

Methods

Vaginal swabs and seminal fluids were collected on the day of IUI procedure and analyzed through polymerase chain reaction amplification of variable regions 3 and 4 (V3–V4) of 16S ribosomal ribonucleic acid genes and Illumina MiSeq sequencing. The taxonomic data were then correlated to IUI success.

Results

Idiopathic infertile women showed a different average composition of vaginal microbiome compared with control sequences, whereas for seminal counterpart no relevant differences were observed. Furthermore, among idiopathic infertile women, different patterns of Lactobacillus species dominations were observed, with a predominance either of Lactobacillus crispatus, a marker of a healthy vaginal ecosystem, or of Lactobacillus iners and Lactobacillus gasseri, associated with a more dysbiosis-prone environment. More important, considering all investigated variables, vaginal L crispatus domination was the only factor strongly associated to IUI success (P = .0002).

Conclusions

Our results strengthen the potential role of L crispatus in promoting a favorable environment for pregnancy and suggest that microbiome characterization could be useful, together with standard clinical and laboratory assessments, in the pre-IUI evaluation of infertile couples.
Transylvian Clip Occlusion of an Enlarging High-Flow Tentorial Arteriovenous Fistula: 2-Dimensional Operative Video
Authors: Cohen-Cohen Salomon , Link Michael J , Rangel-Castilla Leonardo
Published: December 2019

Endovascular therapy is the primary treatment for the majority of tentorial dural arteriovenous fistulas (dAVF). Surgical occlusion is an effective alternative when embolization is not possible. This video demonstrates microsugical occlusion of a right-sided tentorial dAVF in a symptomatic 45-yr-old male. The dAVF was fed directly by meningohypophyseal trunk. Venous drainage was retrograde through the sphenoparietal sinus, superficial sylvian vein, vein of Labee, and transverse sinus. The patient underwent a right-sided pterional craniotomy; the sylvian fissure was widely opened. Subarachoid dissection was performed until a large arterialized draining vein was identified exiting dura subtemporally. Intraoperative indocyanine green angiography confirmed the fistulous site and the draining vein was occluded and divided. The patient remained neurologically intact after surgery. Immediate angiography demonstrates complete occlusion of the dAVF. This video demonstrates the surgical access obtained through a transylvian approach for this tentorial dAVF. Occlusion of the draining vein, with or without resection of the fistula, is enough to permanently treat these lesions.
Deformity Correction Through the Use of Reduction Towers: 2-Dimensional Operative Video
Authors: Buchholz Avery L , Buell Thomas J , Shaffrey Mark E , Haid Regis W , Shaffrey Christopher I
Published: December 2019

Spinal deformity management can be difficult. The decision for surgery, approach, number of levels, and surgical technique all present challenges. Even when other issues are managed appropriately the process of how to correct the deformity needs special consideration.

Numerous techniques have been studied including vertebra-to-rod, rod de-rotation, 3-rod-techniques, and cantilever maneuvers. While cantilever is the preferred technique when treating sagittal plane deformity, scoliosis often requires a combination of techniques due to the complexity of deformity in coronal and transverse planes.

This video illustrates an adult scoliosis correction using sequential reduction towers and de-rotation techniques. Using this method the step of hook holders is eliminated and tension is distributed evenly across the rod using sequential reduction of the reduction towers across the length of the rod. This has led to a very efficient correction of our deformity as well as a powerful de-rotation tool. We routinely use this technique for flexible and rigid deformities, which is assessed pre-op with a computed tomography.

The patient is a 67-yr-old female with prior lumbar decompressions and worsening back pain with radiculopathy. No significant sagittal malalignment is present but pelvic tilt is elevated and a coronal deformity exists. pelvic incidence measures 59°, LL50°, PT28° and lumbar scoliosis shows a coronal Cobb angle of 50.8°. Briefly, surgery involved transpedicular instrumentation from T10-S1 with bilateral iliac screw fixation. To achieve mobility posterior column osteotomies were performed at T12-L1, L1-2, L2-3, L3-4, L4-5, and L5-S1 levels. TLIF was performed at L4-5, L5-S1 for fusion. Postoperative scoliosis X-rays demonstrated improved sagittal and coronal alignment with PI59°, LL59°, PT22°, and coronal Cobb angle of 12°.
Multiple Iterations of Magnetic Resonance-Guided Laser Interstitial Thermal Ablation of Brain Metastases: Single Surgeon's Experience and Review of the Literature
Authors: Eichberg Daniel G , Menaker Simon A , Jermakowicz Walter J , Shah Ashish H , Luther Evan M , Jamshidi Aria M , Semonche Alexa M , Di Long , Komotar Ricardo J , Ivan Michael E
Published: December 2019

BACKGROUND

Prior treatment with magnetic resonance-guided, laser-induced thermal therapy (LITT) is widely assumed not to be a contraindication for further treatment of brain lesions, including further iterations of LITT. However, the safety and efficacy of repeat LITT treatments have never been formally investigated.

OBJECTIVE

To evaluate treatment with multiple iterations of LITT.

METHODS

All patients treated with LITT at least twice at our institution were included in the study. Outcomes and neurological examinations from before and after surgery were retrospectively examined from clinic notes. Perilesonal edema was determined at various timepoints using volumetric data derived from manual tracings of fluid-attenuated inversion recovery (FLAIR) enhancement on magnetic resonance imaging (MRI). Finally, a literature review of prior cases of repeat LITT was performed.

RESULTS

A total of 9 patients underwent 18 treatments with LITT; all but 1 of whom were treated for metastatic brain lesions. One patient had a transient cerebrospinal fluid leak, whereas a second patient had a superficial wound infection, both of which resolved with standard medical care. The remaining 7 patients tolerated all LITT procedures without complication. Analysis of perilesional edema volume demonstrated a correlation with the amount of energy delivered during LITT. Literature review found 5 published papers describing 9 patients who underwent LITT more than once, the majority of whom tolerated repeat LITT well.

CONCLUSION

LITT is a safe and promising treatment modality and may be used multiple times without issue. There appears to be an association between the amount of energy delivered during a LITT session and the degree of postoperative perilesional edema.
Endoscopic Endonasal Transclival Resection of a Pontine Metastasis: Case Report and Operative Video
Authors: Gerges Mina M , Godil Saniya S , Kacker Ashutosh , Schwartz Theodore H
Published: December 2019

BACKGROUND AND IMPORTANCE

Brainstem lesions are challenging to manage, and surgical options have been controversial. Stereotactic radiosurgery (SRS) has been used for local control, but life-threatening toxicities from 0% to 9.5% have been reported. Several microsurgical approaches involving safe entry zones have been developed to optimize the exposure and minimize complications in different portions of the brainstem, but require extensive drilling and manipulation of neurovascular structures. With recent advancements, the endoscopic endonasal approach (EEA) can provide direct visualization of ventral brainstem. No case has been reported of EEA to remove a brainstem metastasis.

CLINICAL PRESENTATION

We present an illustrative case of a 68-yr-old female with metastatic colon cancer who presented with 2.8 × 2.7 × 2.1 cm (7.9 cm3) heterogeneously enhancing, right ventral pontine lesion with extensive edema. She underwent endoscopic endonasal transclival approach, and gross total resection of the lesion was achieved.

CONCLUSION

The endoscopic approach may offer certain advantages for removal of ventral brainstem lesions, as it can provide direct visualization of important neurovascular structures, especially, if the lesion displaces the tracts and comes superficial to the pial surface.
3-Dimensionally Printed Biomimetic Surgical Simulation—Operative Technique of a Transforaminal Lumbar Interbody Fusion: 2-Dimensional Operative Video
Authors: Clifton William , Damon Aaron , Nottmeier Eric , Pichelmann Mark
Published: December 2019

We present a surgical video highlighting the technical demonstration and microsurgical anatomy of an L4-5 transforaminal lumbar interbody fusion utilizing a combination of thermoplastic polymers and 3-dimensional printing technology to create a biomimetic lumbar spine surgical simulator. The posterior elements of L4-5 and the inferior portion of L3 are exposed in their entirety, including the transverse processes in order to identify the appropriate landmarks for pedicle screw insertion. The interspinous ligament of L4-5 is removed, and an interlaminar spreader is used to distract the facet joint. An inferior L4 facetectomy is performed for local autograft harvesting. The L4 and L5 pedicles are skeletonized to completely open the foramen in order to ensure that the exiting nerve root will not be compromised during cage insertion. The ligamentum flavum is then removed, exposing the common thecal sac and L5 traversing root. The L4 exiting nerve root is then identified, completing Kambin's triangle and location of the disc space. The disc is incised, and a combination of punches and curettes are used to completely remove the disc. After an interbody trial is used to assess the proper cage size, the cage is packed with graft and inserted into the midline of the disc space. Pedicle screws are then placed using an anatomic freehand technique, and intraoperative fluoroscopy is performed in order to evaluate the instrumentation and interbody position. If a contralateral decompression is required, a facet-sparing technique is performed in order to preserve bony surface for the fusion. Patient consent was not required for this simulation video.
Role of the right anterior insular cortex in joint attention-related identification with a partner
Authors: Koike Takahiko , Tanabe Hiroki C , Adachi-Abe Saori , Okazaki Shuntaro , Nakagawa Eri , Sasaki Akihiro T , Shimada Koji , Sugawara Sho K , Takahashi Haruka K , Yoshihara Kazufumi , Sadato Norihiro
Published: December 2019

Understanding others as intentional agents is critical in social interactions. We perceive others’ intentions through identification, a categorical judgment that others should work like oneself. The most primitive form of understanding others’ intentions is joint attention (JA). During JA, an initiator selects a shared object through gaze (initiative joint attention, IJA), and the responder follows the direction of the initiator’s gaze (reactive joint attention, RJA). Therefore, both participants share the intention of object selection. However, the neural underpinning of shared intention through JA remains unknown. In this study, we hypothesized that JA is represented by inter-individual neural synchronization of the intention-related activity. Additionally, JA requires eye contact that activates the limbic mirror system; therefore, we hypothesized that this system is involved in shared attention through JA. To test these hypotheses, participants underwent hyperscanning fMRI while performing JA tasks. We found that IJA-related activation of the right anterior insular cortex of participants was positively correlated with RJA-related activation of homologous regions in their partners. This area was activated by volitional selection of the target during IJA. Therefore, identification with others by JA is likely accomplished by the shared intentionality of target selection represented by inter-individual synchronization of the right anterior insular cortex.
Legal and practical issues arising from Lehtimaki v Children’s Investment Fund Foundation (UK)
Authors: Hogan Gregor
Published: December 2019

Next year the Supreme Court will hear the appeal from Lehtimaki v Children’s Investment Fund Foundation (UK) [2018] EWCA Civ 1605 (‘CIFF’) (reported as Children’s Investment Fund Foundation (UK) v Attorney General [2017] EWHC 1379 (Ch) at first instance). This article addresses the legal and practical issues that might arise from the Court of Appeal’s judgment by considering various structures of membership of charitable companies limited by guarantee. It also considers the significance of the Court of Appeal’s observations on the courts’ powers to intervene in the exercise of discretion by fiduciaries in the charities context.
Differential drought resistance strategies of co-existing woodland species enduring the long rainless Eastern Mediterranean summer
Authors: Väänänen Päivi J , Osem Yagil , Cohen Shabtai , Grünzweig José M
Published: December 2019

In anticipation of a drier climate and to project future changes in forest dynamics, it is imperative to understand species-specific differences in drought resistance. The objectives of this study were to form a comprehensive understanding of the drought resistance strategies adopted by Eastern Mediterranean woodland species, and to elaborate specific ecophysiological traits that can explain the observed variation in survival among these species. We examined leaf water potential (𝛹), gas exchange and stem hydraulics during 2–3 years in mature individuals of the key woody species Phillyrea latifolia L., Pistacia lentiscus L. and Quercus calliprinos Webb that co-exist in a dry woodland experiencing ~ 6 rainless summer months. As compared with the other two similarly functioning species, Phillyrea displayed considerably lower 𝛹 (minimum 𝛹 of −8.7 MPa in Phillyrea vs −4.2 MPa in Pistacia and Quercus), lower 𝛹 at stomatal closure and lower leaf turgor loss point (𝛹TLP ), but reduced hydraulic vulnerability and wider safety margins. Notably, Phillyrea allowed 𝛹 to drop below 𝛹TLP under severe drought, whereas the other two species maintained positive turgor. These results indicate that Phillyrea adopted a more anisohydric drought resistance strategy, while Pistacia and Quercus exhibited a more isohydric strategy and probably relied on deeper water reserves. Unlike the two relatively isohydric species, Phillyrea reached complete stomatal closure at the end of the dry summer. Despite assessing a large number of physiological traits, none of them could be directly related to tree mortality. Higher mortality was observed for Quercus than for the other two species, which may result from higher water consumption due to its 2.5–10 times larger crown volume. The observed patterns suggest that similar levels of drought resistance in terms of survival can be achieved via different drought resistance strategies. Conversely, similar resistance strategies in terms of isohydricity can lead to different levels of vulnerability to extreme drought.
Characterization of a New Orthotospovirus from Chilli Pepper in Yunnan Province, China
Authors: Zheng Kuanyu , Chen Tsung-Chi , Wu Kuo , Kang Ya-Chi , Yeh Shyi-Dong , Zhang Zhongkai , Dong Jiahong
Published: December 2019

Chilli pepper (Capsicum annuum L.) is one of the most important crops in Yunnan Province, China. An orthotospovirus isolate 14YV855 was isolated from a diseased chilli pepper plant exhibiting yellow ringspots and necrosis on leaves in Shiping County, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province in 2014. The complete genome sequence of 14YV855 was determined. The small, medium, and large RNAs are 3,428, 4,781, and 8,917 nucleotides long, respectively. The complete nucleocapsid (N) protein of 14YV855 shares a high amino acid identity of 84.8 to 89.9% to that of Capsicum chlorosis virus (CaCV), Groundnut bud necrosis virus (GBNV), Watermelon bud necrosis virus (WBNV), and Watermelon silver mottle virus (WSMoV), which is slightly less than the 90% identity threshold for the demarcation of new Orthotospovirus sp. Phylogenetic analyses revealed that the N protein and RNA-dependent RNA polymerase of 14YV855 are the most related to WSMoV, while the NSs, NSm, and Gn/Gc proteins are similar to those of GBNV. As expected, 14YV855 is serologically related to CaCV, GBNV, WBNV, and WSMoV when the monoclonal antibody against the N protein of WSMoV was used; however, 14YV855 can be distinguished from other orthotospoviruses by reverse-transcription PCR using the specific primers. Our results indicate that 14YV855 is a new Orthotospovirus sp. belonging to the WSMoV serogroup and is provisionally named Chilli yellow ringspot virus.
Spatial and Temporal Dynamics of Mal Secco Disease Spread in Lemon Orchards in Israel
Authors: Ben-Hamo Miriam , Ezra David , Krasnov Helena , Blank Lior
Published: December 2019

Mal Secco is a severe disease of citrus in which the fungus Plenodomus tracheiphilus (formerly Phoma tracheiphila) penetrates the vascular system of the host. In this study, we characterized the spatial dynamics of the disease in seven lemon orchards. A representative block of trees from each orchard was evaluated monthly during 3 consecutive years. In addition, scouts assessed disease severity in 75 orchards from three different geographical regions and tested for association between disease severity and measures of orchard management, environmental factors, cultural practices, and cultivar type. We assessed disease incidence and characteristics of spatial patterns using Ripley’s K function and fitted logistic regression models for different neighboring tree structures followed by model selection methods to provide insight into the spatial and temporal dynamics of disease progress. We found different rates of disease spread in different orchards, which are most likely the result of differences in orchard management practices or less likely the result of differences in climatic conditions. There was an indication that agricultural tools contribute to spread of the disease within rows of trees. The results confirm that the lemon cultivar Interdonato is less susceptible compared with other citrus cultivars, and they suggest that the density of urban terrain surrounding each orchard is positively correlated with the severity of the disease. In contrast to our expectations, no correlation was found between the density of lemon orchards surrounding an orchard and the severity of the disease within it, which corroborates previous findings regarding the limited distribution of the disease.
Defining and Implementing Value-Based Health Care: A Strategic Framework
Authors: Teisberg Elizabeth , Wallace Scott , O’Hara Sarah
Published: December 2019

Value in health care is the measured improvement in a person’s health outcomes for the cost of achieving that improvement. While some descriptions conflate value-based health care and cost reduction, quality improvement, or patient satisfaction, those efforts—while important—are not the same as value, which focuses primarily on improving patient health outcomes. A decade of research into organizations that have achieved better outcomes while often lowering costs suggests a strategic framework for value-based health care implementation that starts with identifying and understanding a segment of patients whose health and related circumstances create a consistent set of needs. An interdisciplinary team of caregivers then comes together to design and deliver comprehensive solutions to address those needs. The team measures the health outcomes and costs of its care for each patient and uses that information to drive ongoing improvements. Care provided in this way aligns delivery with how patients experience their health and reconnects clinicians to their purpose as healers. It also asks physicians to think differently about their role within the larger care team and about the services that team provides. The authors suggest medical schools should incorporate education on the principles and implementation of value-based health care throughout the undergraduate medical curriculum to prepare their graduates to lead the transformation to value-based health care as they enter the physician workforce.