bluuebunny/crossref_metadata_2025 huggingface dataset:
Coseismic electric and magnetic signals observed during 2017 Jiuzhaigou Mw 6.5 earthquake and explained by electrokinetics and magnetometer rotation
Authors: Gao Yongxin , Zhao Guoze , Chong Jiajun , Klemperer Simon L , Han Bing , Jiang Feng , Wen Jian , Chen Xiaobin , Zhan Yan , Tang Ji , Xiao Qibin , Wang Lifeng
Published: August 2020

Very clear coseismic electric and magnetic signals accompanying seismic waves were observed during the 2017 Mw 6.5 Jiuzhaigou earthquake, which took place in western China. In order to understand the generation mechanism of these observed signals, we simulate electric and magnetic responses to this specific earthquake based on three mechanisms, namely, the electrokinetic effect, the motional induction effect and the rotation effect of the coil-type magnetometer. We conduct the simulations using a point source model and a realistic layered earth model and compare to the observed data in the frequency band 0.05–0.3 Hz. Our results show that the electrokinetic effect can explain the observed electric fields in both waveform and amplitude, but it cannot explain the magnetic signals accompanying the Rayleigh wave. The motional induction effect cannot explain either the coseismic electric or magnetic data because it predicts much weaker coseismic electric and magnetic fields than the observed data. The magnetic fields resulting from the rotation of the magnetometer agree with the observed data in the waveforms though their amplitudes are two to four times smaller than the observed data. Our simulations suggest that the electrokinetic effect is responsible for the generation of coseismic electric fields and that rotation of the coil magnetometer is likely the main cause of coseismic magnetic fields. The results improve our interpretation of the coseismic electromagnetic (EM) phenomenon and are useful for understanding other kinds of earthquake-associated EM phenomena.
The IBD-F Patient Self-Assessment Scale Accurately Depicts the Level of Fatigue and Predicts a Negative Effect on the Quality of Life of Patients With IBD in Clinical Remission
Authors: Varbobitis Ioannis , Kokkotis Georgios , Gizis Michael , Perlepe Nikoletta , Laoudi Efrosini , Bletsa Maria , Bekiari Despoina , Koutsounas Ioannis , Kounadis Georgios , Xourafas Vassileios , Lagou Stilliani , Kolios George , Papakonstantinou Ioannis , Bamias Giorgos
Published: August 2020

Background

Fatigue is highly prevalent among patients with inflammatory bowel disease (IBD) and may have an unfavorable impact on quality of life (QoL). The IBD-Fatigue scale (with components SCORE1 and SCORE2) is a recently developed disease-specific questionnaire. We sought to validate a Greek version of IBD-F and use it to assess the severity and characteristics of fatigue and its effect on QoL in our study population.

Methods

The IBD-F scale was validated and used to obtain fatigue-related data from patients with IBD attending a tertiary care hospital. Correlations with other fatigue and QoL instruments were performed.

Results

The Greek IBD-F showed high internal consistency and test-retest reliability (Cronbach’s alpha = 0.901/0.966 and intraclass correlation coefficient = 0.876/0.895 for SCORE1/SCORE2, respectively). A SCORE1 >7.5 suggested “significant” fatigue. In a cohort of 157 patients (mean age = 35.8 y; male patients = 52.2%; patients with Crohn disease = 65.6%), both SCORE1 and SCORE2 were significantly associated with Crohn disease (odds ratio [OR] = 4.17; 95% confidence interval [CI], 2.05-8.47; b = 8.5; 95% CI, 2.8-14.1, respectively), female sex (OR = 7.27; 95% CI, 3.19-16.6; b = 15.3; 95% CI, 9-21.6), and Harvey-Bradshaw Index/Simple Clinical Colitis Activity Index score (OR = 1.22; 95% CI, 1.06-1.39; b = 1.8; 95% CI, 0.9-2.8). A SCORE1 >7.5 was present in 46% of patients in remission, and 82% of patients with a baseline SCORE1 >7.5 remained fatigued at serial measurements. The SCORE1 was significantly associated with impaired QoL (P < 0.001).

Conclusions

The validated IBD-F scale is a useful and applicable instrument for use in the IBD population. A large proportion of patients have significant fatigue, which is maintained longitudinally, independent of inflammatory activity. Fatigue impairs QoL, thus necessitating interventions that may lead to its amelioration in the IBD population.
Authoritarianism as an Institution? The Case of Central Asia
Authors: Costa Buranelli Filippo
Published: August 2020

While much of the English School has focused on liberal aspects of solidarism, forms of “illiberal solidarism” in contemporary international society remain underexplored. Drawing on archival material and elite interviews conducted in Central Asia in the period 2013–2019, this paper advances the claim that the Central Asian elites have developed the institution of authoritarianism in their region through the mechanisms of mimicry/emulation and praise/blame. By looking at specific discourses and practices over the last two decades, the paper discusses how the Central Asian governments have been using the new elements of the “democratic transition” in combination with the traditional legitimation offered by diplomatic recognition to secure authoritarian regimes in the democratic age, to create authoritarian state-centric solidarity in the region, and to make “avtoritet” and “stabil'nost'” fundamental pillars of the Central Asian regional order. The paper contributes to the English School literature by providing an initial account of illiberal solidarism and by showing how authoritarianism can potentially be an institution of specific regional international societies; to the authoritarian diffusion literature by demonstrating that authoritarianism can have a deontic component alongside considerations of domestic survival; and to the broader norm diffusion literature by focusing on the spread of illiberal values.
The influence of coping types on post-traumatic growth in patients with primary breast cancer
Authors: Fujimoto Tomomi , Okamura Hitoshi
Published: August 2020

Background

The physical and mental impacts of breast cancer diagnosis on women are substantial. Several studies have investigated the negative mental health effects of breast cancer. However, in recent years, there has also been growing interest in post-traumatic growth, a positive response to stressful events. Considering positive psychology focuses on such virtues, proactive coping theory was chosen as a theoretical guide. This study investigates how breast cancer patients’ post-traumatic growth is associated with proactive coping and mental well-being.

Methods

A self-administered questionnaire survey was conducted with 80 breast cancer patients aged 20–70 years attending an outpatient clinic. The survey was conducted using the Posttraumatic Growth Inventory-Japanese version (PTGI-J), Proactive Coping Inventory-Japanese version and the Japanese version of the General Health Questionnaire. Single regression and multiple regression analyses with PTGI-J as the dependent variable were performed.

Results

The multiple regression analysis extracted proactive coping (P = 0.006), emotional support seeking (P = 0.004) and avoidance coping (P = 0.001) as factors associated with post-traumatic growth in breast cancer patients.

Conclusions

These results suggest that using proactive coping for conflicts caused by a breast cancer diagnosis and temporary avoidant coping for daily stresses during the treatment process may enhance post-traumatic growth while preventing deterioration in mental well-being. Additionally, seeking emotional support is important for post-traumatic growth.
A combined approach to correct posterior left ventricular aneurysm, aortic stenosis and coronary artery disease
Authors: Patel Akshay J , Mohamed Saifullah , Iqbal Yassir , Kar Ashok , Soppa Gopal
Published: August 2020

Ischaemic heart disease and aortic stenosis are potentially life-threatening conditions. A post-infarct left ventricular aneurysm, when combined with the above, is particularly hazardous. We present a case where all three conditions occurred simultaneously and describe the surgical approach undertaken to attempt correction. The patient underwent aneurysmectomy together with aortic valve replacement and two-vessel coronary artery bypass grafting. The aneurysm was excised with direct linear closure of the walls using a Teflon-buttressed interrupted mattress suture technique. Post-operatively, ventricular systolic function was good (LVEF 40%) together with a well-seated aortic valve showing no paravalvular leaks. This case highlights the importance of meticulous removal of thrombus from the aneurysm and everting the edges thereby eliminating a thrombogenic surface and the risk of embolic stroke. The restorative procedure itself serves to underline the importance of ventricular shape in the effective functioning of the myocardium for sustaining an adequate stroke volume with normalized physiology.
Tracking the spread of COVID-19 in India via social networks in the early phase of the pandemic
Authors: Azad Sarita , Devi Sushma
Published: August 2020

Background

The coronavirus pandemic (COVID-19) has spread worldwide via international travel. This study traced its diffusion from the global to national level and identified a few superspreaders that played a central role in the transmission of this disease in India.

Data and methods

We used the travel history of infected patients from 30 January to 6 April 6 2020 as the primary data source. A total of 1386 cases were assessed, of which 373 were international and 1013 were national contacts. The networks were generated in Gephi software (version 0.9.2).

Results

The maximum numbers of connections were established from Dubai (degree 144) and the UK (degree 64). Dubai’s eigenvector centrality was the highest that made it the most influential node. The statistical metrics calculated from the data revealed that Dubai and the UK played a crucial role in spreading the disease in Indian states and were the primary sources of COVID-19 importations into India. Based on the modularity class, different clusters were shown to form across Indian states, which demonstrated the formation of a multi-layered social network structure. A significant increase in confirmed cases was reported in states like Tamil Nadu, Delhi and Andhra Pradesh during the first phase of the nationwide lockdown, which spanned from 25 March to 14 April 2020. This was primarily attributed to a gathering at the Delhi Religious Conference known as Tabliqui Jamaat.

Conclusions

COVID-19 got induced into Indian states mainly due to International travels with the very first patient travelling from Wuhan, China. Subsequently, the contacts of positive cases were located, and a significant spread was identified in states like Gujarat, Rajasthan, Maharashtra, Kerala and Karnataka. The COVID-19’s spread in phase one was traced using the travelling history of the patients, and it was found that most of the transmissions were local.
Galaxy–group (halo) alignments from SDSS DR7 and the ELUCID simulation
Authors: Zhang Youcai , Yang Xiaohu , Guo Hong
Published: August 2020

Based on galaxies from the Sloan Digital Sky Survey (SDSS) and subhaloes in the corresponding reconstructed region from the constrained simulation of ELUCID, we study the alignment of central galaxies relative to their host groups in the group catalogue, as well as the alignment relative to the corresponding subhaloes in the ELUCID simulation. Galaxies in observation are matched to dark matter subhaloes in the ELUCID simulation using a novel neighborhood abundance matching method. In observation, the major axes of galaxies are found to be preferentially aligned to the major axes of their host groups. There is a colour dependence of galaxy–group alignment that red centrals have a stronger alignment along the major axes of their host groups than blue centrals. Combining galaxies in observation and subhaloes in the ELUCID simulation, we also find that central galaxies have their major axes to be aligned to the major axes of their corresponding subhaloes in the ELUCID simulation. We find that the galaxy–group and galaxy–subhalo alignment signals are stronger for galaxies in more massive haloes. We find that the alignments between main subhaloes and the SDSS-matched subhalo systems in simulation are slightly stronger than the galaxy–group alignments in observation.
Monophyletic Origin and Divergent Evolution of Animal Telomerase RNA
Authors: Logeswaran Dhenugen , Li Yang , Podlevsky Joshua D , Chen Julian J -L
Published: August 2020

Telomerase RNA (TR) is a noncoding RNA essential for the function of telomerase ribonucleoprotein. TRs from vertebrates, fungi, ciliates, and plants exhibit extreme diversity in size, sequence, secondary structure, and biogenesis pathway. However, the evolutionary pathways leading to such unusual diversity among eukaryotic kingdoms remain elusive. Within the metazoan kingdom, the study of TR has been limited to vertebrates and echinoderms. To understand the origin and evolution of TR across the animal kingdom, we employed a phylogeny-guided, structure-based bioinformatics approach to identify 82 novel TRs from eight previously unexplored metazoan phyla, including the basal-branching sponges. Synthetic TRs from two representative species, a hemichordate and a mollusk, reconstitute active telomerase in vitro with their corresponding telomerase reverse transcriptase components, confirming that they are authentic TRs. Comparative analysis shows that three functional domains, template-pseudoknot (T-PK), CR4/5, and box H/ACA, are conserved between vertebrate and the basal metazoan lineages, indicating a monophyletic origin of the animal TRs with a snoRNA-related biogenesis mechanism. Nonetheless, TRs along separate animal lineages evolved with divergent structural elements in the T-PK and CR4/5 domains. For example, TRs from echinoderms and protostomes lack the canonical CR4/5 and have independently evolved functionally equivalent domains with different secondary structures. In the T-PK domain, a P1.1 stem common in most metazoan clades defines the template boundary, which is replaced by a P1-defined boundary in vertebrates. This study provides unprecedented insight into the divergent evolution of detailed TR secondary structures across broad metazoan lineages, revealing ancestral and later-diversified elements.
Acute Pancreatitis as the Initial Manifestation in 2 Cases of COVID-19 in Wuhan, China
Authors: Wang Kaige , Luo Jianfei , Tan Fen , Liu Jiasheng , Ni Zhong , Liu Dan , Tian Panwen , Li Weimin
Published: August 2020

Clinical data on coronavirus disease 2019 (COVID-19) with pancreatic injury are extremely limited. An acute manifestation of acute pancreatitis in COVID-19 has not been reported. We describe here 2 cases of COVID-19 with acute pancreatitis as the initial manifestation in Wuhan, China. Patient 1 died despite maximal mechanical ventilatory support and circulation support, while patient 2 was finally discharged after showing significant improvement. Low T cells in peripheral blood may indicate a poor outcome.
Four Challenges Associated With Current Mathematical Modeling Paradigm of Infectious Diseases and Call for a Shift
Authors: Chen Shi , Robinson Patrick , Janies Daniel , Dulin Michael
Published: August 2020

Mathematical models are critical tools to characterize COVID-19 dynamics and take action accordingly. We identified 4 major challenges associated with the current modeling paradigm (SEIR) that hinder the efforts to accurately characterize the emerging COVID-19 and future epidemics. These challenges included (1) lack of consistent definition of “case”; (2) discrepancy between patient-level clinical insights and population-level modeling efforts; (3) lack of adequate inclusion of individual behavioral and social influence; and (4) allowing little flexibility of including new evidence and insights when our knowledge evolved rapidly during the pandemic. Therefore, these challenges made the current SEIR modeling paradigm less practical to handle the complex COVID-19 and future pandemics. Novel and more reliable data sources and alternative modeling paradigms are needed to address these issues.
Marginalization or Incorporation? Welfare Receipt and Political Participation among Young Adults
Authors: Sugie Naomi F , Conner Emma
Published: August 2020

Prior scholarship finds that participation in means-tested welfare programs, including cash assistance and food stamps, deters political participation among groups that are already politically and socioeconomically marginalized. We revisit these findings within a contemporary context using nationally representative data, along with fixed-effects models that adjust for time-stable unobserved and time-varying observed characteristics. In contrast to prior research, we find little evidence that cash assistance is related to participation. However, food stamps—a benefits program that has undergone substantial changes in recent years—is positively associated with being registered to vote. Moreover, food stamps has countervailing associations with voting—e.g., marginalizing and incorporating—that depend on a person’s attention to politics. Together, these findings revise our understanding of how welfare influences political inequalities and advances policy feedback scholarship by identifying heterogeneity by political attentiveness as a focus of future inquiry.
Integrating behavioral health and primary care: a qualitative analysis of financial barriers and solutions
Authors: Shmerling Alison C , Gold Stephanie B , Gilchrist Emma C , Miller Benjamin F
Published: August 2020

The objective of this study was to characterize financial barriers and solutions for the integration of behavioral health in primary care at the practice and system levels.

Semi-structured interviews were conducted March–August of 2015 with 77 key informants. Initially a broad thematic coding approach was used, and data coded as “financing” was further analyzed in ATLAS.ti using an inductive thematic approach by three coders. Themes identified included the following: fragmentation of payment and inadequate investment limit movement toward integration; the evidence base for integration is not well known and requires appropriately structured further study; fee-for-service limits the movement to integration—an alternative payment system is needed; there are financial considerations beyond specific models of payment, including incentivizing innovation, prevention, and practice transformation support; stakeholders need to be engaged and aligned to support this process. There was consensus that the current fragmented, fee-for-service system with inadequate baseline reimbursement significantly hinders progression toward integrated behavioral health and primary care. Funding is needed both to support integrated care and to facilitate the transition to a new model. Multiple suggestions were offered regarding interim solutions to move toward an integrated model and ultimately global payment. Payment, in terms of both adequate amount and model, is a significant obstacle to integrating behavioral health and primary care. Future policy efforts must focus on ensuring stakeholder collaboration, multi-payer alignment, increasing investment in behavioral health and primary care, and moving away from fee-for-service toward a global and value-based payment model.
Lessons learned from service design of a trial of a digital mental health service: Informing implementation in primary care clinics
Authors: Graham Andrea K , Greene Carolyn J , Powell Thomas , Lieponis Pauli , Lunsford Amanda , Peralta Chris D , Orr L Casey , Kaiser Susan M , Alam Nameyeh , Berhane Helom , Kalan Ozan , Mohr David C
Published: August 2020

Implementing a digital mental health service in primary care requires integration into clinic workflow. However, without adequate attention to service design, including designing referral pathways to identify and engage patients, implementation will fail. This article reports results from our efforts designing referral pathways for a randomized clinical trial evaluating a digital service for depression and anxiety delivered through primary care clinics. We utilized three referral pathways: direct to consumer (e.g., digital and print media, registry emails), provider referral (i.e., electronic health record [EHR] order and provider recommendation), and other approaches (e.g., presentations, word of mouth). Over the 5-month enrollment, 313 individuals completed the screen and reported how they learned about the study. Penetration was 13%, and direct to consumer techniques, most commonly email, had the highest yield. Providers only referred 16 patients through the EHR, half of whom initiated the screen. There were no differences in referral pathway based on participants’ age, depression severity, or anxiety severity at screening. Ongoing discussions with providers revealed that the technologic implementation and workflow design may not have been optimal to fully affect the EHR-based referral process, which potentially limited patient access. Results highlight the importance of designing and evaluating referral pathways within service implementation, which is important for guiding the implementation of digital services into practice. Doing so can ensure that sustained implementation is not left to post-evaluation bridge-building. Future efforts should assess these and other referral pathways implemented in clinical practice outside of a research trial.
Behavioral health policy for improving population health and wellbeing: opportunities for investment in evidence-based policymaking
Authors: Crowley Max , Green Lawrie , Scott Taylor , Long Elizabeth
Published: August 2020

The high cost of behavioral health problems across the population continues to highlight the need to integrate high-quality behavioral interventions across a variety of service settings. To successfully achieve such a system-wide transformation will require supporting federal policies that invest in sustainable high-quality services. To support these efforts we provide a mixed-method study of all federal mental health legislation over the last three decades. Results indicate that mental and behavioral health policies have grown. Further, specific characteristics that comprise bills that are successfully enacted into law are identified. Finally, opportunities for the field to engage with policymakers to support widespread integration of behavioral health services are offered.
Phylogeny, taxonomic reassessment and ‘ecomorph’ relationship of theOrientallactaga sibiricacomplex (Rodentia: Dipodidae: Allactaginae)
Authors: Cheng Jilong , Xia Lin , Feijó Anderson , Shenbrot Georgy I , Wen Zhixin , Ge Deyan , Lu Liang , Yang Qisen
Published: August 2020

The ecological gradient–morphological variation (‘ecomorph’) relationship has long interested ecologists and evolutionary biologists, but it is applied far less frequently than genetic differentiation in cryptic species detection and species identification. With integrative methods, we revise taxonomic uncertainties in the Orientallactaga sibirica complex (OSC), with 298 sequence specimens and 469 voucher specimens from 138 localities covering nearly the entire distribution of the OSC. Phylogenetic relationships are assessed by Bayesian inference and maximum likelihood using two mitochondrial and nine nuclear genes. We use species-delimitation approaches to divide and validate the ‘candidate species’. We evaluate correlations between ecological divergence and phylogenetic splits, and visualize geographical patterns of morphological variation. The OSC is divided into four phylogenetic groups, the Ognevi, Altay, Bogda and Sibirica groups, and the OSC exhibits a significant ecomorph relationship and ecological divergence pattern. Morphological variations not only follow the general regularity under a large gradient of ecological factors, but are also closely related to the local environment/habitat. We suggest considering the comprehensive ecomorph relationship to identify species. Molecular analyses reveal that the OSC more easily forms deeply divergent lineages in the foothills and this differentiation depth may be related to mountain system size.
Further Investigation on Limb Dieback of Fig (Ficus carica) Caused by Neoscytalidium dimidiatum in California
Authors: Gusella Giorgio , Morgan David P. , Michailides Themis J.
Published: August 2020

Fig limb dieback is a cosmopolitan disease caused by Neoscytalidium dimidiatum (Botryosphaeriaceae), characterized by branch and shoot cankers, discoloration of woody tissues, and dieback. The present study investigated the etiology of the disease in California that seems to have become prevalent among fig orchards in the last several years. During orchard surveys in Fresno, Kern, and Madera Counties over 3 years, we isolated consistently and evaluated the pathogenicity of N. dimidiatum under laboratory and field conditions. The effect of summer and winter pruning on the disease severity and the effects of different environmental and mechanical stresses, such as sunburn and wounding by mallets, were assayed. In addition, the susceptibility of six different cultivars and the effects of eradicating cankered shoots from the fig trees as a method to combat the spread of the disease were studied. Pathogenicity tests demonstrated that N. dimidiatum induces cankers on fig, mainly on wounded shoots. Results from the remaining experiments revealed that summer infection leads to more severe canker lesions than those induced by winter infection and that stressed shoots are more susceptible to infection than nonstressed shoots. ‘Brown Turkey’, ‘Conadria’, and ‘Calimyrna’ cultivars (all nonpersistent figs, i.e., needing pollination for fruit development) were less susceptible than the more susceptible ‘Kadota’, ‘Sierra’, and ‘Black Mission’ (all persistent figs, i.e., not needing pollination for fruit development). Canker removal from the orchard seems to be a good agronomic practice to avoid the spread of disease.
Righting the Autonomy-Supervision Pendulum: Understanding the Impact of Independent Rounds on Medical Students, Residents, and Faculty
Authors: Moriarty Jessica A. , Vellanki Srisindu , Trope Lee A. , Hilgenberg Sarah L. , Blankenburg Rebecca L.
Published: August 2020

Purpose

To explore trainee and faculty perspectives on an independent rounding intervention on general pediatrics wards at 2 institutions.

Method

In July 2018, the authors introduced independent rounds 1 to 2 times a week at 2 training sites. In this qualitative study, the authors conducted semistructured focus groups with a purposive sample of junior trainees (clerkship medical students and postgraduate year [PGY] 1 residents), senior trainees (PGY-2 and PGY 3–5 residents), and hospital medicine faculty between October 2018 and May 2019. Focus groups were audio-recorded, transcribed verbatim, and analyzed for themes using the constant comparative approach associated with grounded theory.

Results

Focus groups included 27 junior trainees, 20 senior trainees, and 18 faculty. Six themes emerged: (1) Independent rounds contributed to all trainees’ development; (2) Senior residents described increased motivation to take full ownership of their patients and educational needs of the team; (3) Faculty expressed concerns about decreased opportunities for teaching and feedback; however, all trainees reported unique learning from having faculty both present and absent from rounds; (4) No significant patient safety events were reported; (5) All participants identified communication and patient progression concerns; and (6) A tension emerged between decreased faculty and enhanced trainee career satisfaction. Participants identified solutions to identified barriers to further improve this educational intervention.

Conclusions

As a result of independent rounding, trainees described increased motivation to take ownership of their patients and team. Both rounding experiences contributed to their development as physicians in different ways. Further studies should explore patient and caregiver perspectives and concerns about communication and patient care progression when designing future interventions to promote resident autonomy.
The Evolution of Assessment: Thinking Longitudinally and Developmentally
Authors: Holmboe Eric S. , Yamazaki Kenji , Hamstra Stanley J.
Published: August 2020

Becoming a physician or other health care professional is a complex and intensely developmental process occurring over a prolonged period of time. The learning path for each medical student, resident, and fellow varies due to different individual learner abilities and curricular designs, clinical contexts, and assessments used by the training program. The slow and uneven evolution to outcomes-based medical education is partly the result of inadequate approaches to programmatic assessment that do not fully address all essential core competencies needed for practice or account for the developmental nature of training. Too many assessments in medical education still focus on single point-in-time performance or function as indirect proxies for actual performance in clinical care for patients and families.

Milestones are a modest first step of providing predictive, longitudinal data on a national scale. Longitudinal Milestones data can facilitate the continuous improvement efforts of programs in assessment. However, Milestone judgments are only as good as the assessment data and group processes that inform them. Programmatic assessment should be longitudinally focused and provide all learners with comprehensive and actionable data to guide their professional development and support creation of meaningful individualized action plans. Efforts are urgently needed to rebalance programmatic assessment away from an overreliance on assessment proxies toward more effectively using developmentally focused work-based assessments, routinely incorporate clinical performance and patient experience data, and partner with learners through iterative coproduced assessment activities.
Recognizing the Role of Language in the Hidden Curriculum of Undergraduate Medical Education: Implications for Equity in Medical Training
Authors: Wong Bonnie O. , Blythe Jacob A. , Batten Jason N. , Turner Brandon E. , Lau James N. , Hosamani Poonam , Hanks William F. , Magnus David
Published: August 2020

Medical education involves a transition from “outsider” to “insider” status, which entails both rigorous formal training and an inculturation of values and norms via a hidden curriculum. Within this transition, the ability to “talk the talk” designates an individual as an insider, and learning to talk this talk is a key component of professional socialization. This Article uses the framework of “patterns of medical language” to explore the role of language in the hidden curriculum of medical education, exploring how students must learn to recognize and participate fluently within patterns of medical language to be acknowledged and evaluated as competent trainees. The authors illustrate this by reframing the Association of American Medical Colleges’ Core Entrustable Professional Activities for Entering Residency as a series of overlapping patterns of medical language that students are expected to master before residency. The authors propose that many of these patterns of medical language are learned through trial and error, taught via a hidden curriculum rather than through explicit instruction. Medical students come from increasingly diverse backgrounds and therefore begin medical training further from or closer to insider status. Thus, evaluative practices based on patterns of medical language, which are not explicitly taught, may exacerbate and perpetuate existing inequities in medical education. This Article aims to bring awareness to the importance of medical language within the hidden curriculum of medical education, to the role of medical language as a marker of insider status, and to the centrality of medical language in evaluative practices. The authors conclude by offering possible approaches to ameliorate the inequities that may exist due to current evaluative practices.
Double standard: why electrocardiogram is standard care while electroencephalogram is not?
Authors: Li Yun , Bohringer Christian , Liu Hong
Published: August 2020

Purpose of review

Major adverse cardiovascular and cerebrovascular events (MACCE) significantly affect the surgical outcomes. Electrocardiogram (ECG) has been a standard intraoperative monitor for 30 years. Electroencephalogram (EEG) can provide valuable information about the anesthetized state and guide anesthesia management during surgery. Whether EEG should be a standard intraoperative monitor is discussed in this review.

Recent findings

Deep anesthesia has been associated with postoperative delirium, especially in elderly patients. Intraoperative EEG monitoring has been demonstrated to reduce total anesthesia drug use during general anesthesia and postoperative delirium.

Unlike ECG monitoring, the EEG under general anesthesia has not been designated as a standard monitor by anesthesiologist societies around the world. The processed EEG technology has been commercially available for more than 25 years and EEG technology has significantly facilitated its intraoperative use. It is time to consider EEG as a standard anesthesia monitor during surgery.
Sutureless and Equipment-Free Technique for Contact Lens Viewing System During Vitreoretinal Surgery
Authors: Silpa-Archa Sukhum
Published: August 2020

Purpose:

To report a sutureless and equipment-free technique for contact lens wide-angle viewing system during vitreoretinal surgery.

Methods:

A step-by-step procedure and a surgical video using this technique were proposed.

Results:

This technique needs only three-finger control of contact lens either by the left hand (for the right-handed surgeon) or right hand (for the left-handed surgeon). The contact lens is not fixed to the environment (lid speculums, cannulas, corneoscleral limbus); therefore, it allows the surgeon to move and tilt the contact lens freely while keeping a clear view of the retina.

Conclusion:

The sutureless and equipment-free technique for contact lens viewing system during vitreoretinal surgery has been tried and tested, and it is practical and effective in the real world.
Enhancing Distraction Osteogenesis With Carbon Fiber Reinforced Polyether Ether Ketone Bone Pins and a Three-Dimensional Printed Transfer Device to Permit Artifact-Free Three-Dimensional Magnetic Resonance Imaging
Authors: Eley Karen A. , Moazen Mehran , Delso Gaspar , Javidan Maryam , Kaggie Joshua , Kalaskar Deepak M. , Knowles Jonathan C. , Owji Nazanin , Watt-Smith Stephen R.
Published: August 2020

Objectives:

To: (1) design an artifact-free 3D-printed MR-safe temporary transfer device, (2) engineer bone-pins from carbon fiber reinforced polyether ether ketone (CFR-PEEK), (3) evaluate the imaging artifacts of CFR-PEEK, and (4) confirm the osteointegration potential of CFR-PEEK, thus enhancing 3D-planning of bony advancements in hemifacial microsomia using sequential magnetic resonance imaging (MRI).

Study Design:

Engineered CRF-PEEK bone pins and a 3D printed ex-fix device were implanted into a sheep head and imaged with MRI and computed tomography . The osseointegration and bony compatibility potential of CFR-PEEK was assessed with scanning electron microscopy images of MC3T3 preosteoblast cells on the surface of the material.

Results:

The CFR-PEEK pins resulted in a signal void equivalent to the dimension of the pin, with no adjacent areas of MR-signal loss or computed tomography artifact. MCT3 cells adhered and proliferated on the surface of the discs by forming a monolayer of cells, confirming compatibility and osseointegration potential.

Conclusion:

A 3D printed transfer device could be utilized temporarily during MRI to permit artifact-free 3D planning. CFR-PEEK pins eliminate imaging artifact permitting sequential MRI examination. In combination, this has the potential to enhance distraction osteogenesis, by permitting accurate three-dimensional planning without ionizing radiation.
Terricaulis silvestris gen. nov., sp. nov., a novel prosthecate, budding member of the family Caulobacteraceae isolated from forest soil
Authors: Vieira Selma , Pascual Javier , Boedeker Christian , Geppert Alicia , Riedel Thomas , Rohde Manfred , Overmann Jörg
Published: August 2020

The family

Caulobacteraceae

comprises prosthecate bacteria with a dimorphic cell cycle and also non-prosthecate bacteria. Cells of all described species divide by binary fission. Strain 0127_4T was isolated from forest soil in Baden Württemberg (Germany) and determined to be the first representative of the family

Caulobacteraceae

which divided by budding. Cells of strain 0127_4T were Gram-negative, rod-shaped, prosthecate, motile by means of a polar flagellum, non-spore-forming and non-capsulated. The strain formed small white colonies and grew aerobically and chemo-organotrophically utilizing organic acids, amino acids and proteinaceous substrates. 16S rRNA gene sequence analysis indicated that this bacterium was related to

Aquidulcibacter paucihalophilus

TH1-2T and

Asprobacter aquaticus

DRW22-8T with 91.3 and 89.7% sequence similarity, respectively. Four unidentified glycolipids were detected as the major polar lipids and, unlike all described members of the family

Caulobacteraceae

, phosphatidylglycerol was absent. The major fatty acids were summed feature 8 (C18 : 1ω7c/C18 : 1ω6c), summed feature 9 (iso-C17 : 1ω9c/C16 : 0 10-methyl), C16 : 0 and summed feature 3 (C16 : 1
ω6c/C16 : 1
ω7c). The major respiratory quinone was Q-10. The G+C content of the genomic DNA was 63.5 %. Based on the present taxonomic characterization, strain 0127_4T represents a novel species of a new genus, Terricaulis silvestris gen. nov., sp. nov. The type strain of Terricaulis silvestris is 0127_4T (=DSM 104635T=CECT 9243T).
Genetic and physiological analysis of biofilm formation on different plastic surfaces by Sphingomonas sp. strain S2M10 reveals an essential function of sphingan biosynthesis
Authors: Czieborowski Michael , Hübenthal Anna , Poehlein Anja , Vogt Ines , Philipp Bodo
Published: August 2020

Alphaproteobacteria belonging to the group of the sphingomonads are frequently found in biofilms colonizing pure-water systems, where they cause technical and hygienic problems. In this study, physiological properties of sphingomonads for biofilm formation on plastic surfaces were analysed.

Sphingomonas

sp. strain S2M10 was isolated from a used water-filtration membrane and submitted to transposon mutagenesis for isolating mutants with altered biofilm formation. Mutants showing strongly decreased biofilm formation carried transposon insertions in genes for the biosynthesis of the polysaccharide sphingan and for flagellar motility. Flagella-mediated attachment was apparently important for biofilm formation on plastic materials of intermediate hydrophobicity, while a mutant with defect in spnB, encoding the first enzyme in sphingan biosynthesis, showed no biofilm formation on all tested materials. Sphingan-dependent biofilm formation was induced in the presence of specific carbon sources while it was not induced in complex medium with yeast extract and tryptone. The regulation of sphingan-based biofilm formation was investigated by interfering with the CckA/ChpT/CtrA phosphorelay, a central signal-transduction pathway in most Alphaproteobacteria. Construction and ectopic expression of a kinase-deficient histidine kinase CckA caused cell elongation and massive sphingan-dependent cell aggregation. In addition, it caused increased activity of the promotor of spnB. In conclusion, these results indicate that sphingan-based biofilm formation by sphingomonads might be triggered by specific carbon sources under prototrophic conditions resembling a milieu that often prevails in pure-water systems.
ALegionellaeffector ADP-ribosyltransferase inactivates glutamate dehydrogenase
Authors: Black Miles H. , Osinski Adam , Gradowski Marcin , Servage Kelly A. , Pawłowski Krzysztof , Tagliabracci Vincent S.
Published: August 2020

ADP-ribosyltransferases (ARTs) are a widespread superfamily of enzymes frequently employed in pathogenic strategies of bacteria.Legionella pneumophila, the causative agent of Legionnaire’s disease, has acquired over 330 translocated effectors that showcase remarkable biochemical and structural diversity. Here we took a bioinformatic approach to search theLegionellaeffector repertoire for additional divergent members of the ART superfamily and identified an ART domain in Lpg0181. We show thatL.pneumophilaLpg0181 targets a specific class of 120-kDa NAD+-dependent glutamate dehydrogenase (GDH) enzymes found in fungi and protists, including many natural hosts ofLegionella. Lpg0181 targets a conserved arginine residue in the NAD+ -binding pocket of GDH, thereby blocking oxidative deamination of glutamate. While intracellular pathogens employ diverse virulence mechanisms to overcome host-limited nutrient availability, Lpg0181 is––to the best of our knowledge––the first example of aLegionellaeffector which directly targets a host metabolic enzyme.
Dynamic NHE1-Calmodulin complexes of varying stoichiometry and structure regulate Ca2+-dependent NHE1 activation
Authors: Sjøgaard-Frich Lise M. , Prestel Andreas , Pedersen Emilie S. , Severin Marc , Olsen Johan G. , Kragelund Birthe B. , Pedersen Stine F.
Published: August 2020

Calmodulin (CaM) engages in Ca2+-dependent interactions with numerous proteins, including human Na+/H+-exchanger NHE1. Using nuclear magnetic resonance (NMR) spectroscopy, isothermal titration calorimetry, and fibroblasts expressing wildtype and mutant NHE1, we discovered multiple accessible states of this important complex existing in different NHE1:CaM stoichiometries and structures. We solved the NMR solution structure of a ternary complex in which CaM links two NHE1 cytosolic tails.In vitro, stoichiometries and affinities were tunable by variations in NHE1:CaM ratio and calcium ([Ca2+]) and by phosphorylation of S648 in the first CaM-binding α-helix. In cells, Ca2+-CaM-induced NHE1 activity was reduced by mimicking S648 phosphorylation or mutating the first CaM-binding helix, whereas Ca2+-induced NHE1 activity was unaffected by inhibition of Akt, one of several kinases phosphorylating S648. Our results reveal the diversity of NHE1:CaM interactions and suggest that CaM may contribute to NHE1 dimerization. We propose that similar structural diversity is relevant to other CaM complexes.
Specificity and Performance of Nucleocapsid and Spike-based SARS-CoV-2 Serologic Assays
Authors: Tehrani Zahra Rikhtegaran , Saadat Saman , Saleh Ebtehal , Ouyang Xin , Constantine Niel , DeVico Anthony L. , Harris Anthony D , Lewis George K. , Kottilil Shyam , Sajadi Mohammad M.
Published: August 2020

There is an urgent need for an accurate antibody test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this paper, we have developed 3 ELISA methods, trimer spike IgA, trimer spike IgG, and nucleocapsid IgG, for detecting anti-SARS-CoV-2 antibodies. We evaluated their performance in comparison with four commercial ELISAs, EDI™ Novel Coronavirus COVID-19 ELISA IgG and IgM, Euroimmun Anti-SARS-CoV-2 ELISA IgG and IgA, and one lateral flow assay, DPP® COVID-19 IgM/IgG System (Chembio). Both sensitivity and specificity were evaluated and the causes of false-positive reactions were determined.

The assays were compared using 300 pre-epidemic samples and 100 PCR-confirmed COVID-19 samples. The sensitivities and specificities of the assays were as follows: 90%/100% (in-house trimer spike IgA), 90%/99.3% (in-house trimer spike IgG), 89%/98.3% (in-house nucleocapsid IgG), 73.7%/100% (EDI nucleocapsid IgM), 84.5%/95.1% (EDI nucleocapsid IgG), 95%/93.7% (Euroimmun S1 IgA), 82.8%/99.7% (Euroimmun S1 IgG), 82.0%/91.7% (Chembio nucleocapsid IgM), 92%/93.3% (Chembio nucleocapsid IgG).

The presumed causes of positive signals from pre-epidemic samples in commercial and in-house assays were mixed. In some cases, positivity varied with assay repetition. In other cases, reactivity was abrogated by competitive inhibition (spiking the sample with analyte prior to performing the assay). In other cases, reactivity was consistently detected but not abrogated by analyte spiking.

Overall, there was wide variability in assay performance using our samples, with in-house tests exhibiting the highest combined sensitivity and specificity. The causes of “false positivity” in pre-epidemic samples may be due to plasma antibodies apparently reacting with the analyte, or spurious reactivity may be directed against non-specific components in the assay system. Identification of these targets will be essential to improving assay performance.
Ripples at Edges of Blooming Lilies and Torn Plastic Sheets
Authors: Portet Thomas , Holmes Peter N. , Keller Sarah L.
Published: August 2020

Ripples arise at edges of petals of bloomingLilium casablancaflowers and at edges of torn plastic sheets. In both systems, ripples are a consequence of excess length along the edge of a sheet. Through the use of both time-lapse videos of blooming lilies and still images of torn plastic sheets, we find that ripples in both systems are well-described by the scaling relationship, whereais amplitude,wis wavelength, andLis arc length. By approximating that the arc length is proportional to the wavelength, we recover a phenomenological relationship previously reported for self-similar ripple patterns, namely ⟨a⟩ ∝ ⟨w⟩. Our observations imply that a broad class of systems in which morphological changes are driven by excess length along an edge will produce ripples described by.

Significance Statement

Early in the blooming process ofLilium casablancaflowers, large ripples appear in the edges of their petals. As blooming progresses, smaller ripples arise on top of the original ones. All ripples are characterized by three variables, an amplitude, a wavelength, and an arc length. Here, we derive an equation that relates these variables. To test the equation, we collect movies of blooming lilies. We find that the equation quantitatively describes single ripples in the petals. The equation is general, so it applies to all systems in which ripples arise by the same mechanism. To illustrate this point, we show that the equation holds for single ripples that appear at the edges of torn plastic sheets.
Reduced placental transfer of antibodies against microbial and vaccine antigens in HIV-infected women in Mozambique
Authors: Alonso Selena , Vidal Marta , Ruiz-Olalla Gemma , González Raquel , Manaca M. Nelia , Jairoce Chenjerai , Vázquez-Santiago Miquel , Balcells Reyes , Vala Anifa , Ruperez María , Cisteró Pau , Fuente-Soro Laura , Cova Marta , Angov Evelina , Nhacolo Arsenio , Sevene Esperança , Aponte John J. , Macete Eusébio , Aguilar Ruth , Mayor Alfredo , Menéndez Clara , Dobaño Carlota , Moncunill Gemma
Published: August 2020

Antibody transplacental transfer is essential for conferring protection in newborns against infectious diseases. This transfer may be affected by gestational age and maternal infections, although the effects are not consistent across studies. We measured total IgG and IgG subclasses by quantitative suspension array technology against fourteen pathogens and vaccine antigens, including target of maternal immunization, in 341 delivering HIV− and HIV+ mother-infant pairs from southern Mozambique. Maternal antibody levels were the main determinant of cord antibody levels. HIV broadly reduced the placental transfer and cord levels of IgG and IgG1, but also IgG2 to half of the antigens.Plasmodium falciparumexposure and prematurity were negatively associated with cord antibody levels and placental transfer but this was antigen-subclass dependent. These findings suggest maternal infections may impact the efficacy of maternal immunization and confirm the lower transfer of antibodies as one of the causes underlying increased susceptibility to infections in HIV-exposed infants.