bluuebunny/crossref_metadata_2025 huggingface dataset:
ER membrane protein complex is required for the insertions of late-synthesized transmembrane helices of Rh1 in Drosophila photoreceptors
Authors: Hiramatsu Naoki , Tago Tatsuya , Satoh Takunori , Satoh Akiko K.
Published: September 2019

Most membrane proteins are synthesized on and inserted into the membrane of the endoplasmic reticulum (ER), in eukaryote. The widely conserved ER membrane protein complex (EMC) facilitates the biogenesis of a wide range of membrane proteins. In this study, we investigated the EMC function using Drosophila photoreceptor as a model system. We found that the EMC was necessary only for the biogenesis of a subset of multipass membrane proteins such as rhodopsin (Rh1), TRP, TRPL, Csat, Cni, SERCA, and Na+K+ATPase α, but not for that of secretory or single-pass membrane proteins. Additionally, in EMC-deficient cells, Rh1 was translated to its C terminus but degraded independently from ER-associated degradation. Thus, EMC exerted its effect after translation but before or during the membrane integration of transmembrane domains (TMDs). Finally, we found that EMC was not required for the stable expression of the first three TMDs of Rh1 but was required for that of the fourth and fifth TMDs. Our results suggested that EMC is required for the ER membrane insertion of succeeding TMDs of multipass membrane proteins.
Relatedness economies, absorptive capacity, and economic catch-up: firm-level evidence from China
Authors: Howell Anthony
Published: September 2019

This paper examines the effect of agglomeration economies on firm productivity and the role of absorptive capacity in China. Taking into account the transitioning economy context, I further exploit the gradual and spatially uneven implementation of market-oriented reforms to track the relative importance of firms’ absorptive capacity for economic catch-up. The three main results are as follows. First, firms exhibit higher productivity when located in an area with a denser network of related activities, particularly for firms with higher absorptive capacity. Second, the sources of the productivity gains are driven by externalities that arise from better access to inputs, similar workers and technological-related knowledge spillovers. Third, the role of absorptive capacity becomes more important for boosting productivity following more versus less intensive market-oriented economic reforms. These findings have important policy implications for transitioning economies and suggest that market reforms promote efficiency improvements related to performing actual R&D as well as encourage firms to seek out external sources of knowledge in order to attain market competitiveness.
Holes in the Dike: The Global Savings Glut, U.S. House Prices, and the Long Shadow of Banking Deregulation
Authors: Hoffmann Mathias , Stewen Iryna
Published: September 2019

We show how capital inflows into and financial deregulation within the United States interacted in driving the recent boom and bust in U.S. housing prices. Interstate banking deregulation during the 1980s cast a long shadow: in states that opened their banking markets to out-of-state banks earlier, house prices were more sensitive to aggregate U.S. capital inflows during 1997–2012. Capital inflows relaxed the value-at-risk constraints of geographically diversified (“integrated”) U.S. banks more than those of local banks. Therefore, integrated banks absorbed a larger share of capital inflows and expanded mortgage lending more. This drove up housing prices.
A New Flea Species of the Genus Palaeopsylla (Insecta: Siphonaptera: Ctenophthalmidae) From Turkey
Authors: Keskin Adem
Published: September 2019

A new flea (Insecta: Siphonaptera) species belonging to the Palaeopsylla minor-group, Palaeopsylla (Palaeopsylla) beaucournui n. sp. is described and illustrated. Specimens (14 males and seven females) of this new species were collected from Talpa levantis Thomas (Mammalia: Talpidae) in the deciduous mixed forest in Bursa province of Marmara Region, Turkey.
Arabidopsis CPK6 positively regulates ABA signaling and drought tolerance through phosphorylating ABA-responsive element-binding factors
Authors: Zhang Hanfeng , Liu Daoyin , Yang Bo , Liu Wu-Zhen , Mu Bangbang , Song Huaxin , Chen Bingyou , Li Yuan , Ren Dongtao , Deng Hanqing , Jiang Yuan-Qing
Published: September 2019

Arabidopsis calcium-dependent protein kinase CPK6 positively regulates seed germination, seedling growth, and drought tolerance via phosphorylating ABF and ABI5 transcription factors.
Prolonged oxygen depletion in microwounded cells of Chara corallina detected with novel oxygen nanosensors
Authors: Alova Anna , Erofeev Alexander , Gorelkin Petr , Bibikova Tatyana , Korchev Yury , Majouga Alexander , Bulychev Alexander
Published: September 2019

The use of a novel nanoelectrode shows that mechanical microinjury of the cell wall of Chara corallina with a pointed instrument induces localized anoxia and alkalinization near the cell surface.
Interplay between turgor pressure and plasmodesmata during plant development
Authors: Hernández-Hernández Valeria , Benítez Mariana , Boudaoud Arezki
Published: September 2019

Plasmodesmata traverse cell walls, generating connections between neighboring cells. They allow intercellular movement of molecules such as transcription factors, hormones, and sugars, and thus create a symplasmic continuity within a tissue. One important factor that determines plasmodesmal permeability is their aperture, which is regulated during developmental and physiological processes. Regulation of aperture has been shown to affect developmental events such as vascular differentiation in the root, initiation of lateral roots, or transition to flowering. Extensive research has unraveled molecular factors involved in the regulation of plasmodesmal permeability. Nevertheless, many plant developmental processes appear to involve feedbacks mediated by mechanical forces, raising the question of whether mechanical forces and plasmodesmal permeability affect each other. Here, we review experimental data on how one of these forces, turgor pressure, and plasmodesmal permeability may mutually influence each other during plant development, and we discuss the questions raised by these data. Addressing such questions will improve our knowledge of how cellular patterns emerge during development, shedding light on the evolution of complex multicellular plants.
Thera-SAbDab: the Therapeutic Structural Antibody Database
Authors: Raybould Matthew I J , Marks Claire , Lewis Alan P , Shi Jiye , Bujotzek Alexander , Taddese Bruck , Deane Charlotte M
Published: September 2019

The Therapeutic Structural Antibody Database (Thera-SAbDab; http://opig.stats.ox.ac.uk/webapps/therasabdab) tracks all antibody- and nanobody-related therapeutics recognized by the World Health Organisation (WHO), and identifies any corresponding structures in the Structural Antibody Database (SAbDab) with near-exact or exact variable domain sequence matches. Thera-SAbDab is synchronized with SAbDab to update weekly, reflecting new Protein Data Bank entries and the availability of new sequence data published by the WHO. Each therapeutic summary page lists structural coverage (with links to the appropriate SAbDab entries), alignments showing where any near-matches deviate in sequence, and accompanying metadata, such as intended target and investigated conditions. Thera-SAbDab can be queried by therapeutic name, by a combination of metadata, or by variable domain sequence - returning all therapeutics that are within a specified sequence identity over a specified region of the query. The sequences of all therapeutics listed in Thera-SAbDab (461 unique molecules, as of 5 August 2019) are downloadable as a single file with accompanying metadata.
Geriatric assessment of glioblastoma patients is feasible and may provide useful prognostic information
Authors: Lorimer Cressida F , Walsh Gill , MacKinnon Mairi , Corbett Alison , Bedborough Katie , Greenwood Kathy , Saran Frank , Chalmers Anthony J , Brock Juliet
Published: September 2019

Background

Glioblastoma (GBM) is the most common and most lethal primary brain tumor in adults. Clinical trials in older patients with GBM have explored the use of single and multimodality treatment regimens with modest survival benefits; however, trial criteria are commonly based on chronological age and do not reflect the heterogeneity of this cohort. Geriatric assessment (GA) techniques predict survival and treatment tolerance in other tumor sites and thus may objectively guide the decision-making process, but data are lacking in the neuro-oncology cohort.

Methods

We performed a prospective, multicenter feasibility study involving patients age 65 years or older with newly diagnosed GBM. A modified GA was undertaken in the outpatient setting prior to starting treatment. Feasibility was determined primarily by recruitment rate, alongside data completeness, impact on clinic time, and acceptability to patients and staff. Factors associated with survival were explored using Cox regression models.

Results

Fifty patients were recruited within a prespecified time period with a recruitment rate of 82% (target 80%). Data completeness was greater than 80% in all except one assessment. Median overall survival was 9.5 months (95% confidence interval [CI] 5.0-14.0 months). Among the GA screening factors analyzed, a baseline impaired Montreal Cognitive Assessment (hazard ratio [HR] = 2.7, 95% CI 1.128-6.530) and impairment in instrumental activities of daily living (HR = 2.9 95% CI 0.983-8.541) were associated with poorer survival.

Conclusion

In the first study of this kind among elderly GBM patients, we have shown that undertaking a neurologically focused GA screen is feasible and may provide useful prognostic information.
Foreign Policy Decision-Making
Authors: Blankshain Jessica D.
Published: September 2019

The study of foreign policy decision-making seeks to understand how states formulate and enact foreign policy. It views foreign policy as a series of decisions made by particular actors using specific decision-making processes. The origins of this focus on decision-making are generally traced to the 1950s and 1960s, with the literature increasing in complexity and diversity of approaches in more recent decades. Foreign policy decision-making is situated within foreign policy analysis (a subfield of international relations subfield), which applies theories and methods from an array of disciplines—political science, public administration, economics, psychology, sociology—to understand how states make foreign policy, and how these policies translate into geopolitical outcomes. The literature on foreign policy decision-making is often subdivided based on assumptions about the process by which actors make foreign policy decisions—primarily falling into rational and nonrational decision-making; about who is assumed to make the decision—states, individuals, groups, or organizations; and about the influences believed to be most important in affecting those decisions—international factors, domestic political factors, interpersonal dynamics, etc. While much of the literature focuses on foreign policy decision-making in the United States, there have been attempts to apply models developed in the US context to other states, as well as to generate generalizable theories about foreign policy decision-making that apply to certain types of states.
Argentine Government and Politics
Authors: Micozzi Juan Pablo
Published: September 2019

Even long before its last democratic restoration in 1983, Argentina has been a salient case for comparative political analyses. Several relevant concepts and events—such as the bureaucratic-authoritarian state and the presence of an impossible game developed by O’Donnell; the paradox of underdevelopment compared to Australia or Canada, as explained by Platt, Martin, and Di Tella; the emergence of a rara avis called Peronism in the work of Gino Germani and others; or the path of transition by collapse depicted by O’Donnell, Schmitter, and Whitehead—kept the profile of this country high in the consideration of academic scholarship. History helped to bring about this high profile in an undeniable manner. Within a century, Argentina hosted multiple military coups and further democratic restorations, successive calls for elections where the plurality party was banned from competition, an almost never-ending cycle of economic crises, and even a war against a NATO member that triggered the last return to democracy in 1983. Throughout the more than three straight decades of contemporary democracy, different dimensions of politics and government in Argentina have been analyzed by the literature. The complex interactions among actors and institutions in a country characterized by presidentialism, federalism, political mobilization, interruptions of executive mandates, a wide middle class, redistributive claims, a past of repression, and cyclical economic shocks, among others, forged substantive political dynamics. Most of these dimensions will be reviewed in this chapter, whose contributions have been published in the most relevant journals and presses, especially in the areas of institutions, subnational politics, and clientelism and patronage.
Higher Education Faculty Characteristics and Trends in the United States and Europe
Authors: Leišytė Liudvika , Zeeman Nadine
Published: September 2019

The characteristics of higher education faculty described in the literature include gender, disciplinary affiliation, institutional affiliation, type of contract, and rank. This bibliography will focus on the literature characterizing the faculty in these categories. Specific attention will be paid to the faculty situation in the United States and in Europe, including country cases within Europe. The concentration on the United States and Europe provides interesting insights, as the characteristics of faculty are influenced by the higher education governance model in place. On both sides of the Atlantic, the governance arrangements and working conditions differ to some extent, and this determines the types of faculty positions and their characteristics. In the United States the higher education system is characterized by a departmental model, whereas in most European countries a chair model can be observed in academia. Both employment contracts and the division of labor are influenced by the higher education governance system in place. Faculty employment contracts can take various forms and be permanent or temporary. In the US system, tenure-track faculty positions have been common, where tenure is achieved based on performance within the same institution. In European systems traditionally, faculty and especially professors have been civil servants and had to win an open competition to get the position. Further, variations of contracts appear, as faculty can either have a part-time or full-time position. Faculty are involved in teaching and research, and more recently in service and knowledge commercialization. These employment contracts and faculty activities have changed over time due to changes in higher education governance systems, including the increasing massification, marketization, and privatization of higher education. Studying higher education faculty change over time, we observe a number of trends. An increasing percentage of faculty in the United States are on non-tenure-track appointments with teaching-only responsibilities. In Europe, precarious faculty positions are also on the rise across a number of higher education systems. Overall, a diversification of faculty roles and activities, as well as intensification of work, can be observed.
Productivity and Higher Education
Authors: Croucher Gwilym
Published: September 2019

The study of productivity in higher education, and its contribution to local and global economies, has become an increasingly important area of focus for scholars, as well as for those who fund and administer higher education institutions. The reason for greater attention in part comes from the increasing scale of postsecondary education in most countries. Both developed and developing countries have grown their provision of higher education in the last seventy years, and along with this, there has been an increase in per capita enrolment. This growth accelerated during the 1990s and 2000s when the proportion of the worldwide population entering higher education more than doubled. Across all countries one in three young people are now enrolled, requiring the establishment of many more universities, colleges, and other higher education institutions. Universities and colleges now demand a greater proportion of public and private resources and form a larger part of the economic life of most countries. Higher education contributes to growth and economic efficacy and, hence, the overall productivity of an economy. While few scholars dispute the productivity-augmenting power of education, and often research looks at the role of higher education alongside that of primary and secondary education, there remains much debate over the size of the contribution it makes to economic growth, economic efficiency, and, hence, to raising productivity overall. Significant questions remain as to the correlation between higher education system performance and economic growth and whether or not relationships are causal. The most prominent theory linking higher education to economic productivity has been its function in contributing to the development of human capital through the production of skilled graduates. At the same time, the capacity for universities and colleges to contribute to greater economic efficiency depends on their own productivity in educating students and undertaking research. Given the scale of higher education worldwide, how efficient and effective universities and colleges are at educating students is an important productivity question. Research by economists, management scholars, and those who study public administration provides an important entry point for readers who want to access the breadth of research examining productivity and higher education.
Legal Status of Military Forces Abroad
Authors: Voetelink Joop
Published: September 2019

Today, states routinely deploy elements of their armed forces on the territory of other states within the framework of international military cooperation or international military operations carried out with the receiving state’s consent (crisis management operations). It is in the interest of the states sending their forces abroad (sending states), as well as the states receiving these foreign forces with their consent (host states), that the legal position of the visiting forces is abundantly clear. Absent a universal convention covering the status of visiting forces, states and international organizations regularly enter into specific agreements and arrangements setting out the rights and obligations of these forces. These international agreements are part of the international law on military operations and are typically referred to as Status of Forces Agreements (SOFAs). Clearly, SOFAs will not be concluded where armed forces have entered another state’s territory without its consent, e.g., in an armed conflict situation. The legal status of the troops operating on hostile territory is then based on international humanitarian law, in particular the law of belligerent occupation. This specific field of law does not apply between allied states fighting a common enemy. Yet, the presence of a vast number of foreign troops has a marked impact on host states. Not surprisingly, the first set of bilateral agreements that today would qualify as SOFAs were concluded in World War I between a number of Allied states. Drawing from long-standing international practice, the agreements all focused on the exercise of criminal jurisdiction over the visiting forces and granted the sending states exclusive jurisdiction over their service members operating on the territory of other Allied states. During and after World War II, SOFAs evolved into more elaborate instruments covering a wider array of topics of interest to the states involved, such as claims and taxes. The core element of all these SOFAs, however, continued to be the exercise of criminal jurisdiction by either the host states or the sending states over service members of the visiting forces and over associated civilians, such as family members and contractors. States and international organizations in charge of crisis management operations regard SOFAs as an essential requirement to temporarily station armed forces abroad. Consequently, failure to come to an adequate agreement with host state authorities may hamper deployment of the troops or lead to termination of an ongoing operation, as happened in Iraq in 2011, when the United States and Iraq could not agree on the terms of a new SOFA for the US troops stationed in Iraq.
International Regulation of the Internet
Authors: Segura Serrano Antonio
Published: September 2019

The international regulation of the Internet may be understood in two different ways. From a narrow point of view, it may be conceived as equivalent to Internet governance, i.e. comprising exclusively the institutional arrangements that enable the Internet to function. From a comprehensive point of view, it may be interpreted more widely, including all sectors and areas where international law rules that intersect or interact with the Internet may be found. The Internet is a pervasive network that nowadays touches upon the lives of public and private actors. This article aims to present an account of the many domains in which international regulation may be found or may be needed if universal or community interests are to be protected. If although state practice and the codification of international law rules regarding the Internet are now in flux, due to the unwillingness of states or, in other words, the impossibility of finding universal consensus on the matter, it is possible to identify areas in international law that already apply to online activities. To be sure, this use is in many instances a difficult one, as this new technology challenges the extant legal framework. But today the applicability of international law to activities carried out with respect to the Internet is not only possible, it is also necessary as this new medium is truly global. Even though if there is not a new demos, or because of that, international law rules in the traditional sense are needed to solve the new challenges. This is why traditional doctrines on jurisdiction and state responsibility, together with cybersecurity rules (warfare is not the object of this contribution), have been put to work, with adjustments necessary to make their functioning appropriate to the new circumstances. Furthermore, taking into account the reinforced role of nonstate actors in this field, international cooperation is needed to address the problems of cybercrime, cyber espionage, and cyber terrorism, although in this the latter is not as ubiquitous as the former. Moreover, international human rights norms must be confirmed with respect to the Internet, as those rights are exposed to the same risks, if not more, by state activities as in the real world. Finally, the issue of Internet governance as addressed in this article is treated as one in which it is necessary to ensure in the long run that this new medium is organized following the principles of democracy and inclusion.
Angel Island Poetry
Authors: Xu Ying
Published: September 2019

Angel Island poetry refers to Chinese poems carved on the barrack walls of the US Angel Island Immigration Station in San Francisco Bay, which was in operation from 1910 to 1940. An estimated 50,000 Chinese were processed and detained during that period there and left their words, recording a dark chapter of racial exclusion in history. These poems were written in the classical style of Chinese poetry and were discovered by California State Parks ranger Alexander Weiss in 1970, who contacted his teacher George Araki from San Francisco State College. Araki brought the site to the attention of the community and invited San Francisco photographer Mak Takahashi to photograph these poems. Today, around two hundred poems from the Angel Island barracks have been deciphered and published in various places, though many still remain indecipherable. The Angel Island poetry sources include the Jann and Yee collections, Mak Takahashi’s photographs, Kearny Street Workshop (KSW) rubbings, poems published in various Chinese newspapers, and the findings of poetry consultants commissioned in 2003 by the Angel Island Immigration Station Foundation for an evaluation. In this article, the Angel Island poetry more specifically refers to two editions of Island: Poetry and History of Chinese Immigrants on Angel Island, 1910–1940, edited by Him Mark Lai (who passed away in 2009, between publication of the two editions), Genny Lim, and Judy Yung, since most scholarship has derived from these two books. The first edition of Island was self-published in 1980, which set up a model of editing and presenting Chinese-language material, consisting of a historical introduction, 135 poems in Chinese and English, excerpts from thirty-nine oral-history interviews, and twenty-two photographs. Island went into a second printing in 1983 and was republished by the University of Washington Press in 1991. The second edition of Island, published in 2014, combines all 135 poems into one section and expands the Chinese poems by adding those on the walls from the immigration stations at Ellis Island in New York and Victoria, British Columbia. Yung and Lim rewrote the historical introduction and replaced the excerpts of oral histories in the first edition with twenty full profiles and stories, with new translations, correction of errors in the first edition, and more photographs. Island possesses a unique place in Asian American studies, ethnic studies, US immigration history, and American literature classes.
Global Talent Management
Authors: Vaiman Vlad , Gallardo-Gallardo Eva , Thunnissen Marian
Published: September 2019

Global talent management (GTM) has its origins in international human resource management, and it emerged around the turn of the 21st century as a key strategic issue for multinational corporations (MNCs) confronted with talent shortages and mobility of staff on a global scale. It refers to the activities and processes that involve the systematic identification of key positions which significantly contribute to the organization’s sustainable competitive advantage, and the identification, attraction, selection, recruitment, development, and retention of talented individuals on a global scale to effectively fill in these roles. So, as a concept, GTM is both broader than leadership succession and more exclusive than human resource management. It focuses on key positions considering the global scope of the organization, key individuals (with high levels of talent) to step into these roles, and a differentiated human resource architecture to effectively manage such talented individuals. GTM is differentiated from strategic talent management (TM), since strategic TM deals with the TM matters of domestic organizations, while GTM is focused on the TM issues of organizations operating on a global scale. GTM, however, is strategic and multidisciplinary in nature. As mentioned previously, it is mostly rooted in the subjects of international human resource management, international management, economics, and organizational psychology. Other contributing disciplines include sociology and political science.
An attempt to identify reproducible high-density EEG markers of PTSD during sleep
Authors: Wang Chao , Ramakrishnan Sridhar , Laxminarayan Srinivas , Dovzhenok Andrey , Cashmere J David , Germain Anne , Reifman Jaques
Published: September 2019

Study Objectives

We examined electroencephalogram (EEG) spectral power to study abnormalities in regional brain activity in post-traumatic stress disorder (PTSD) during sleep. We aimed to identify sleep EEG markers of PTSD that were reproducible across nights and subsamples of our study population.

Methods

Seventy-eight combat-exposed veteran men with (n = 31) and without (n = 47) PTSD completed two consecutive nights of high-density EEG recordings in a laboratory. We performed spectral-topographical EEG analyses on data from both nights. To assess reproducibility, we used the first 47 consecutive participants (18 with PTSD) for initial discovery and the remaining 31 participants (13 with PTSD) for replication.

Results

In the discovery analysis, compared with non-PTSD participants, PTSD participants exhibited (1) reduced delta power (1–4 Hz) in the centro-parietal regions during nonrapid eye movement (NREM) sleep and (2) elevated high-frequency power, most prominent in the gamma band (30–40 Hz), in the antero-frontal regions during both NREM and rapid eye movement (REM) sleep. These findings were consistent across the two study nights, with reproducible trends in the replication analysis. We found no significant group differences in theta power (4–8 Hz) during REM sleep and sigma power (12–15 Hz) during N2 sleep.

Conclusions

The reduced centro-parietal NREM delta power, indicating reduced sleep depth, and the elevated antero-frontal NREM and REM gamma powers, indicating heightened central arousal, are potential objective sleep markers of PTSD. If independently validated, these putative EEG markers may offer new targets for the development of sleep-specific PTSD diagnostics and interventions.
Understanding Debriefing: A Qualitative Study of Event Reconstruction at an Academic Medical Center
Authors: Sweeney Rachel E. , Clapp Justin T. , Arriaga Alexander F. , Muralidharan Madhavi , Burson Randall C. , Gordon Emily K.B. , Falk Scott A. , Baranov Dimitry Y. , Fleisher Lee A.
Published: September 2019

Purpose

This qualitative study sought to characterize the role of debriefing after real critical events among anesthesia residents at the Hospital of the University of Pennsylvania.

Method

From October 2016 to June 2017 and February to April 2018, the authors conducted 25 semistructured interviews with 24 anesthesia residents after they were involved in 25 unique critical events. Interviews focused on the experience of the event and the interactions that occurred thereafter. A codebook was generated through annotation, then used by 3 researchers in an iterative process to code interview transcripts. An explanatory model was developed using an abductive approach.

Results

In the aftermath of events, residents underwent a multistage process by which the nature of critical events and the role of residents in them were continuously reconstructed. Debriefing—if it occurred—was 1 stage in this process, which also included stages of internal dialogue, event documentation, and lessons learned. Negotiated in each stage were residents’ culpability, reputation, and the appropriateness of their affective response to events.

Conclusions

Debriefing is one of several stages of interaction that occur after a critical event; all stages play a role in shaping how the event is interpreted and remembered. Because of its dynamic role in constituting the nature of events and residents’ role in them, debriefing can be a high-stakes interaction for residents, which can contribute to their reluctance to engage in it. The function and quality of debriefing can be assessed in more insightful fashion by understanding its relation to the other stages of event reconstruction.
Mortality and Cause of Death in Patients With Vertebral Fractures
Authors: Choi Hyo Geun , Lee Joon Kyu , Sim Songyong , Kim Miyoung
Published: September 2019

Study Design.

A retrospective study using the Korean Health Insurance Review and Assessment Service—National Sample Cohort was performed.

Objective.

To determine the rate and causes of mortality in vertebral fracture patients.

Summary of Background Data.

Vertebral fractures are associated with increased mortality in prior studies.

Methods.

Of 1,125,691 patients, we collected data of 23,026 patients of all ages who experienced thoracic or lumber vertebral fractures between 2002 and 2013. The vertebral fracture participants were matched 1:4 with control participants, accounting for age, group, sex, income, and region of residence. Finally, 21,759 vertebral fracture participants and 87,036 control participants were analyzed. The index date was the date of diagnosis of vertebral fracture; participants from the control group were followed from the same index date as their matched counterparts. The follow-up duration was the index date to the death date or the last date of study (December 31, 2013). Patients were followed until death or censoring of the data. Death was ascertained in the same period, and causes of death were grouped into 12 classifications according to the Korean Standard Classification of Disease. A stratified Cox proportional hazards model was used.

Results.

The adjusted hazard ratio (HR) for mortality of vertebral fracture was 1.28 (P < 0.001) with the higher adjusted HR in younger patients. Mortalities caused by neoplasms; neurologic, circulatory, respiratory, digestive, and muscular diseases; and trauma were higher in the vertebral fracture group (P < 0.05), with muscular disease showing the highest odds ratio for mortality.

Conclusion.

Vertebral fractures were associated with increased mortality in Korean. Disease in muscuoskeletal system and connective tissue that possibly be associated with the fractures was most responsible for elevated death rates following vertebral fracture. Our findings may help caregivers provide more effective care, ultimately decreasing the mortality rate of vertebral fracture patients.

Level of Evidence: 3
Non–culture-based Methods to Aide in the Diagnosis of Implant-associated Infection After Fracture Surgery
Authors: Natoli Roman M. , Harro Janette , Shirtliff Mark
Published: September 2019

Implant-associated infection after fracture surgery is an unfortunate reality for patients and physicians that has long-term, far-reaching implications for treatment, functional recovery, and health care costs. Classically, culture-based methods are used for diagnosis, though “culture-negative” infection is not an uncommon clinical scenario. On the other side, false-positive results can lead to unnecessary antibiotic treatment or surgical intervention. For all parties involved, timely, accurate, and noninvasive diagnostic methods are desirable. It is recognized that bacterial biofilms complicate culture-based diagnostic methods and circumvent the host’s immune response and standard treatment modalities, such as antibiotic therapy. Infection may be diagnosed by indirect means, such as measure of host inflammatory response, or direct detection of pathogen presence. Until recently, the Orthopedic Trauma community has not had a standardized definition for fracture-related infection. This definition, along with recent changes in, or the development of, sonication, histopathology, biomarkers, detection of host immune response, and molecular methods for detecting bacterial presence represent progress in using non–culture-based methods to aide in the diagnosis of implant-associated infection after fracture surgery. This review will examine the current state of these emerging technologies. Building on the success over the past decade of our total joint arthroplasty colleagues in diagnosing periprosthetic joint infection, it is expected that these methodologies will improve our ability to diagnose fracture-related infection.
Outcomes in Critically Ill Patients With Traumatic Brain Injury: Ethnicity, Documentation, and Insurance Status
Authors: Ram Payal , Miah Fardina T. , Wyrick Jonathan M. , Kalosza Brittany A. , Coritsidis George N.
Published: September 2019

Objectives:

Disparities in traumatic brain injury outcomes for ethnic minorities and the uninsured have previously been demonstrated; however, outcomes in undocumented immigrants have not been examined. We wanted to determine whether ethnicity, insurance, and documentation status served as risk factors for disparities in traumatic brain injury outcomes between undocumented immigrants and documented residents.

Design:

Retrospective study.

Setting:

Patients diagnosed with traumatic brain injury admitted to the surgical/trauma ICU at a level 1 trauma center serving a large immigrant population in New York City from 2009 to 2016.

Patients:

Four-hundred seventy-one traumatic brain injury patients requiring surgical/trauma ICU admission.

Interventions:

None.

Measurements and Main Results:

Undocumented immigrants constituted 29% of the population, were younger (39 vs 57 yr old, respectively; p < 0.0001), Hispanic (83%; p < 0.0001), and uninsured (87%; p < 0.0001). Falls resulted in the majority of traumatic brain injuries in the total population, however, undocumented immigrants were almost twice as likely to be assaulted (p = 0.0032). There was no difference in presence of midline shifts, Injury Severity Score, Glasgow Coma Score, hypotension, hypoxia, and pupillary reactions between undocumented immigrants and documented residents. Undocumented immigrants presented with significantly more effaced basilar cisterns (p = 0.0008). There was no difference in hospital care between undocumented immigrants and documented residents as determined by emergency department to surgical/trauma ICU transfer times (p = 0.967). Undocumented immigrants were more likely to be discharged home (53% vs 33%, respectively; p = 0.0009) and less likely to be sent to rehabilitation (25% vs 32%, respectively; p = 0.0009). After adjusting length of stay and mortality for covariates, undocumented immigrants had shorter length of stay (p < 0.05) and there was no difference in hospital mortality between undocumented immigrants and documented residents.

Conclusions:

Undocumented immigrants with traumatic brain injuries were more likely to be younger, have shorter length of stay, and experience similar mortality rates to documented residents. Social economic status may play a role in events prior to hospitalization and likely does in disposition outcomes.
Role of Potassium-Sparing Diuretics in the Management of Hypokalemia in Peritoneal Dialysis
Authors: Nguyen Timothy , Ren Steven , Hussain Jaweria , Balaoro Jessica J.
Published: September 2019

Background:

Patients with kidney disease are at a higher risk of experiencing potassium imbalance. The kidney plays an important role in maintaining potassium homeostasis. A common dyskalemia that peritoneal dialysis (PD) patients experience is hypokalemia.

Areas of Uncertainty:

Potassium-sparing diuretics such as spironolactone causes increased amounts of sodium and water to be excreted, while potassium is retained. Owing to its potassium-sparing effects, it may correct hypokalemia that PD patients experience. The proper usage of potassium-sparing diuretics in PD patients and data on the efficacy and safety are being explored.

Data Sources:

Four relevant trials were identified. One randomized double-blind placebo-controlled cross-over study (n = 20), one interventional study without the control group (n = 20), one retrospective single-center chart review (n = 53), and one cross-sectional review (n = 75) trial. The randomized controlled trial did not note a statistically significant change in K levels (P > 0.05); the other 3 trials observed an increase in potassium levels in the potassium-sparing diuretics groups, but trials contained small participants and inadequate statistic rigor.

Therapeutic Opinions:

The role of potassium-sparing diuretics use for hypokalemia management in PD patients remains unclear.
Risk stratification for multidrug-resistant Gram-negative infections in ICU patients
Authors: Burillo Almudena , Muñoz Patricia , Bouza Emilio
Published: September 2019

Purpose of review

Antimicrobial resistance among Gram-negative microorganisms has alarmingly increased in the past 10 years worldwide. Infections caused by these microorganisms are difficult to treat, especially in critically ill patients.

The present review examines how to accurately predict which patients carry a greater risk of colonization or infection on which to base the timely choice of an effective empirical antibiotic treatment regimen and avoid antibiotic overuse.

Recent findings

There are many risk factors for acquiring one of many multidrug-resistant Gram-negative microorganisms (MDR-GN); however, scores anticipating colonization, infection among those colonized, or mortality among those infected have a variable accuracy. Accuracy of scores anticipating colonization is low. Scores predicting infections among colonized patients are, in general, better, and ICU patients infected with MDR-GN have a worse prognosis than those infected by non-resistant microorganisms. Scores are, in general, better at excluding patients.

Despite these limitations, scores continue to gain popularity including those by Giannella, Tumbarello, Johnson, or the scores INCREMENT carbapenem-producing Enterobacteriaceae score, Cano, Tartof, or CarbaSCORE.
Neisseria meningitidis and meningococcal disease: recent discoveries and innovations
Authors: Read Robert C.
Published: September 2019

Purpose of review

Meningococcal disease is a severe consequence of infection with Neisseria meningitidis, a pathobiont of the pharynx. This organism is panmitic so virulent clones transformed with new genetic material can emerge and cause severe outbreaks. The key to sustainable prevention is to restrict carriage of disease-causing strains and thus reduce the chances of transmission between human hosts.

Recent findings

Meningococcal population biology has changed recently with emergence of virulent strains linked to a number of sublineages of clonal complex 11. These strains have variously expressed the capsular material of serogroups C and W and caused severe disease in various countries. Glycoconjugate vaccines including quadrivalent (ACWY) and now pentavalent (ACWYX) vaccines are highly immunogenic and prevent disease and carriage due to their respective serogroups. For NmB, new vaccines (4CMenB and MenB-FHbp) containing conserved outer membranes proteins have been deployed and are immunogenic and protective at population level, but clones exist which do not express cognate antigens. In contrast to glycoconjugate vaccines they may not have potent carriage-reducing activity. Mass chemoprophylaxis is gaining credence as an alternative strategy is effective, but has significant shortcomings in sustainability.

Meningococcal disease is well defined genomically for epidemiological purposes. There is potential for unpredictable emergence of clones that may have reduced susceptibility even to modern vaccines, and continued surveillance and vigilance is necessary. However, tremendous strides have been made in recent years.
The Impact of Service Quality on Patient Satisfaction and Revisiting Intentions: The Case of Public Emergency Departments
Authors: Amarantou Vasiliki , Chatzoudes Dimitrios , Kechagia Vasiliki , Chatzoglou Prodromos D.
Published: September 2019

Background and Objectives:

This study attempts to (a) identify the main quality indicators that affect “service quality” and (b) examine the effect of “patient satisfaction” on patient “revisiting intentions.”

Methods:

The sample includes patients of 2 hospitals, 1 urban and 1 provincial. The comparative analysis of 2 emergency departments (EDs) with different characteristics aims at understanding their diverse problems and their specific needs from a patient point of view. Empirical data were collected in the fall of 2015. Three hundred questionnaires were distributed in person. A total of 169 valid questionnaires, 80 from hospital A and 89 from hospital B, were returned, with a response rate of 56.3%.

Results:

The Structural Equation Modeling technique revealed that overall satisfaction is strongly influenced by “perceived service quality” (β = .79), while it positively affects patient “behavioral intentions” (β = .39). Also, “perceived waiting time” proved to have a more intense impact on “perceived service quality” (β = −.59), rather than on “perceived technical and functional quality” (β = .18). Moreover, it was determined that patients visiting the urban ED pay more attention in waiting times, while patients visiting the provincial ED care about receiving both quality and timely health care services. Overall, the study provides insight about the main factors affecting “perceived service quality” and “overall satisfaction.” These factors fall into 2 distinct categories: “perceived technical and functional quality” and “perceived waiting time.”

Conclusions:

The study concludes that “overall satisfaction” acts as a mediator between “perceived service quality” and patient “behavioral intentions,” while “perceived waiting time” is the most significant indicator of service quality and the most crucial predictor of ED patient satisfaction. Moreover, it offers empirical evidence concerning the differences in the way patients rate the services offered by a hospital, based on the hospital size and the region it is located (urban or provincial).
Extended Molecular Profiling Improves Stratification and Prediction of Survival After Resection of Colorectal Liver Metastases
Authors: Lang Hauke , Baumgart Janine , Heinrich Stefan , Tripke Verena , Passalaqua Monia , Maderer Annett , Galle Peter R. , Roth Wilfried , Kloth Michael , Moehler Markus
Published: September 2019

Objective:

The aim of this study was to assess the effect of cancer-related genes and their mutations analyzed by next-generation sequencing (NGS) on the oncological outcome after resection of colorectal liver metastases (CRLM).

Background:

Traditional prognostic scores include clinical and pathological parameters of primary tumor and metastases. The modified clinical risk score (m-CS), based on size of metastases, primary tumor nodal status, and RAS mutation status outperformed traditional scores. We hypothesized to further improve the scoring system based on the results of NGS.

Methods:

Cancer tissues of 139 patients with CRLM were used for NGS. The work-up included the analysis of recurrent somatic mutations and copy number changes of 720 genes. Clinical data were extracted from a prospectively collected institutional liver database.

Results:

Depending on significance, the following cancer-related genes and their alterations (%) were further investigated: APC (86%), TP53 (78%), KRAS (29%), SMAD4 (15%), PIK3CA (14%), BRAF (8%), ERBB2 (6%), SMAD3 (5%), SMAD2 (4%), and NRAS (4%). The most predictive parameters for poor oncological outcome were alterations in the SMAD family (P = 0.0186) and RAS-RAF pathway (P = 0.032). Refining the m-CS by replacing RAS with RAS-RAF pathway and adding SMAD family resulted in an extended clinical risk score which is highly predictive for oncological outcome (P < 0.0001).

Conclusion:

In conclusion, mutations of the SMAD family revealed a strong prognostic effect after surgery for CRLM. Integration of alterations of the SMAD family as well as the RAS/RAF pathway resulted in a new, still simple but highly prognostic score.