bluuebunny/crossref_metadata_2025 huggingface dataset:
Divergence-preserving reconstructions on polygons and a really pressure-robust virtual element method for the Stokes problem
Authors: Frerichs Derk , Merdon Christian
Published: September 2020

Nondivergence-free discretizations for the incompressible Stokes problem may suffer from a lack of pressure-robustness characterized by large discretizations errors due to irrotational forces in the momentum balance. This paper argues that also divergence-free virtual element methods on polygonal meshes are not really pressure-robust as long as the right-hand side is not discretized in a careful manner. To be able to evaluate the right-hand side for the test functions, some explicit interpolation of the virtual test functions is needed that can be evaluated pointwise everywhere. The standard discretization via an $L^2$-best approximation does not preserve the divergence, and so destroys the orthogonality between divergence-free test functions and possibly eminent gradient forces in the right-hand side. To repair this orthogonality and restore pressure-robustness, another divergence-preserving reconstruction is suggested based on Raviart–Thomas approximations on local subtriangulations of the polygons. All findings are proven theoretically and are demonstrated numerically in two dimensions. The construction is also interesting for hybrid high-order methods on polygonal or polyhedral meshes.
Sub-Riemannian Limit of the Differential Form Heat Kernels of Contact Manifolds
Authors: Albin Pierre , Quan Hadrian
Published: September 2020

We study the behavior of the heat kernel of the Hodge Laplacian on a contact manifold endowed with a family of Riemannian metrics that blow-up the directions transverse to the contact distribution. We apply this to analyze the behavior of global spectral invariants such as the $\eta $-invariant and the determinant of the Laplacian. In particular, we prove that contact versions of the relative $\eta $-invariant and the relative analytic torsion are equal to their Riemannian analogues and hence topological.
Lower mgpB diversity in macrolide-resistant Mycoplasma genitalium infecting men visiting two sexually transmitted infection clinics in Montpellier, France
Authors: Guiraud Jennifer , Lounnas Manon , Boissière Anne , Le Roy Chloé , Elguero Eric , Banuls Anne Laure , Bébéar Cécile , Godreuil Sylvain , Pereyre Sabine
Published: September 2020

Objectives

Men engaged in high-risk sexual behaviour, such as MSM, are likely to be infected by resistant Mycoplasma genitalium strains. Understanding the transmission dynamics is challenging. We aimed to investigate the molecular epidemiology of M. genitalium in men visiting sexually transmitted infection (STI) clinics.

Patients and methods

Between June 2017 and February 2018, 95 M. genitalium-positive specimens from 78 men, including 76.9% MSM, visiting two STI clinics in Montpellier, France, were analysed for SNPs in the mgpB adhesin gene and number of tandem repeats in the MG_309 gene. Macrolide and fluoroquinolone resistance were determined. Typing results were compared with antibiotic resistance, sexual behaviour, sampling site, HIV pre-exposure prophylaxis (PrEP) usage and HIV status.

Results

Thirty-eight mgpB STs were identified, including 23 new STs, with ST4 being most prevalent. The mgpB/MG_309 typing method identified 52 genetic profiles, resulting in a discriminatory index of 0.979. Macrolide and fluoroquinolone resistance-associated mutations were detected in 58.3% and 10.8% of patients, respectively. The macrolide resistance rate was higher among MSM than among men who have sex with women only (68.4% versus 9.1%; adjusted OR, 1.57; 95% CI, 1.13–2.18; P = 0.007). A lower mgpB diversity of 0.870 was found among macrolide-resistant strains in comparison with 0.978 in macrolide-susceptible strains, with an over-representation of mgpB ST62 and ST153.

Conclusions

Although macrolide resistance spread appears polyclonal in M. genitalium, the lower diversity of mgpB types among macrolide-resistant strains may reflect the easier spread of a few specific mgpB types or the occurrence of sexual networks among MSM.
Determination of norvancomycin epidemiological cut-off values (ECOFFs) for Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus hominis
Authors: Yang Qiwen , Li Xue , Jia Peiyao , Giske Christian , Kahlmeter Gunnar , Turnidge John , Yu Yunsong , Lv Yuan , Wang Minggui , Sun Ziyong , Lin Jie , Li Yun , Zheng Bo , Hu Fupin , Guo Yan , Chen Zhongju , Li Haixia , Zhang Ge , Zhang Jingjia , Kang Wei , Duan Simeng , Wang Tong , Jing Ran , Xu Yingchun ,   the Chinese Committee on Antimicrobial Susceptibility Testing (ChiCAST)
Published: September 2020

Objectives

To determine the epidemiological cut-off values (ECOFFs) of norvancomycin for Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus hominis.

Methods

We collected 1199 clinical isolates of Staphylococcus species from five laboratories located in four cities in China. MICs and inhibitory zone diameters of norvancomycin were determined by broth microdilution and the disc diffusion method, separately. ECOFFs of norvancomycin for four species were calculated by ECOFFinder software following EUCAST principles. Methicillin and vancomycin resistance genes (mecA/mecC and vanA/vanB/vanC/vanD/vanE) were screened for by PCR in all isolates. Pearson correlation and χ2 test were used to calculate the correlation of MICs and inhibition zone diameters, and MICs and resistance genes, respectively.

Results

MICs of norvancomycin for all strains from five laboratories fell in the range of 0.12–2 mg/L. ECOFFs of norvancomycin were determined to be 2 mg/L for S. epidermidis and S. haemolyticus and 1 mg/L for S. aureus and S. hominis. A weak correlation was observed between MIC values and zone diameters for S. haemolyticus (r = −0.36) and S. hominis (r = −0.26), while no correlation was found for S. epidermidis and S. aureus. The mecA gene was detected in 63.1% of Staphylococcus, whereas no isolate carried mecC, vanA, vanB, vanC, vanD or vanE. ECOFFs of norvancomycin were not correlated with mecA gene carriage in Staphylococcus species.

Conclusions

ECOFFs of norvancomycin for four Staphylococcus species were determined, which will be helpful to differentiate WT strains. The correlation of MICs and zone diameters of norvancomycin was weak in Staphylococcus species.
Treatment of Partial Thickness Burns: A Prospective, Randomized Controlled Trial Comparing Four Routinely Used Burns Dressings in an Ambulatory Care Setting
Authors: Aggarwala Shivani , Harish Varun , Roberts Sarah , Brady Megan , Lajevardi Sepehr , Doherty James , D’Souza Mario , Haertsch Peter A , Maitz Peter K M , Issler-Fisher Andrea C
Published: September 2020

This prospective, randomized controlled trial study compared the effects of four dressings for adult partial thickness burns, focusing on re-epithelialization time and cost effectiveness. Adults with partial thickness burns meeting inclusion criteria were randomized to either Biobrane™, Acticoat™, Mepilex® Ag, or Aquacel® Ag. Primary endpoint for analysis was >95% re-epithelialization. Incremental cost-effectiveness ratios were calculated based on dressing costs. Dominance probabilities between treatment arms were calculated from bootstrap resampling trial data. One hunderd thirty-one partial thickness burn wounds in 119 patients were randomized. Adjusting for sex, age, smoking status, burn mechanism, TBSA, and first aid adequacy, Mepilex® Ag had a reduced time to re-epithelialization compared to Biobrane™ (IRR: 1.26; 95% CI: 1.07–1.48, P < .01). Economic analysis showed that there was a 99%, 71%, and 53% probability that Mepilex® Ag dominated (cheaper and more effective) Biobrane™, Acticoat™, and Aquacel® Ag, respectively. Mepilex® Ag achieved faster re-epithelialization and better cost effectiveness. Patient satisfaction and comfort seems better with Biobrane™ although not reflected within the end outcome of the healed wound. It is the patients’ (after extensive education) and clinicians’ choice, level of experience, and availability of products in praxis that will guide the decision as to which the product is used individually on which patient.
A risk scoring system to identify travellers who qualify for pre-exposure rabies vaccination
Authors: Croughs Mieke , Soentjens Patrick
Published: September 2020

We want to introduce a free online scoring system to identify high risk travellers who qualify for pre-travel rabies vaccination. The system uses evidence based risk predictors and the probable availability of HRIG at the destination.
Rab-dependent vesicular traffic affects female gametophyte development in Arabidopsis
Authors: Rojek Joanna , Tucker Matthew R , Pinto Sara C , Rychłowski Michał , Lichocka Małgorzata , Soukupova Hana , Nowakowska Julita , Bohdanowicz Jerzy , Surmacz Gabriela , Gutkowska Małgorzata
Published: September 2020

Eukaryotic cells rely on the accuracy and efficiency of vesicular traffic. In plants, disturbances in vesicular trafficking are well studied in quickly dividing root meristem cells or polar growing root hairs and pollen tubes. The development of the female gametophyte, a unique haploid reproductive structure located in the ovule, has received far less attention in studies of vesicular transport. Key molecules providing the specificity of vesicle formation and its subsequent recognition and fusion with the acceptor membrane are Rab proteins. Rabs are anchored to membranes by covalently linked geranylgeranyl group(s) that are added by the Rab geranylgeranyl transferase (RGT) enzyme. Here we show that Arabidopsis plants carrying mutations in the gene encoding the β-subunit of RGT (rgtb1) exhibit severely disrupted female gametogenesis and this effect is of sporophytic origin. Mutations in rgtb1 lead to internalization of the PIN1 and PIN3 proteins from the basal membranes to vesicles in provascular cells of the funiculus. Decreased transport of auxin out of the ovule is accompanied by auxin accumulation in tissue surrounding the growing gametophyte. In addition, female gametophyte development arrests at the uni- or binuclear stage in a significant portion of the rgtb1 ovules. These observations suggest that communication between the sporophyte and the developing female gametophyte relies on Rab-dependent vesicular traffic of the PIN1 and PIN3 transporters and auxin efflux out of the ovule.
Radio Galaxy Zoo: new giant radio galaxies in the RGZ DR1 catalogue
Authors: Tang H , Scaife A M M , Wong O I , Kapińska A D , Rudnick L , Shabala S S , Seymour N , Norris R P
Published: September 2020

In this paper, we present the identification of five previously unknown giant radio galaxies (GRGs) using Data Release 1 of the Radio Galaxy Zoo citizen science project and a selection method appropriate to the training and validation of deep learning algorithms for new radio surveys. We associate one of these new GRGs with the brightest cluster galaxy (BCG) in the galaxy cluster GMBCG J251.67741+36.45295 and use literature data to identify a further 13 previously known GRGs as BCG candidates, increasing the number of known BCG GRGs by $\gt 60$ per cent. By examining local galaxy number densities for the number of all known BCG GRGs, we suggest that the existence of this growing number implies that GRGs are able to reside in the centres of rich (∼1014 M⊙) galaxy clusters and challenges the hypothesis that GRGs grow to such sizes only in locally underdense environments.
Catholicism and the Concept of ‘the State’ in the Irish (1937) Constitution
Authors: Kissane Bill
Published: September 2020

The concept of the State is expressed more frequently and in more ways in the Irish (1937) constitution than in most European constitutions. The previous 1922 constitution had hardly mentioned the concept at all. Using the tools of conceptual history this article shows how a combination of Catholicism and nationalism led to the inflation of the State in 1937. The article also considers what this inflation of the State tells us about the controversy over the religious origins of the constitution. Rejecting the possibility that it was ‘contaminated’ by the values of the 1930s, the language of statehood is seen rather as an example of how a constitution could harmonize religious with secular values without ‘contaminating’ the secular meaning of the State.
Preventing Attrition among Women and Minority Police Applicants
Authors: Gibbs Jennifer C
Published: September 2020

Diversifying has been a challenge for police agencies, despite their increased efforts to attract qualified candidates. Even when recruiters manage an adequately diverse applicant pool, the dropout rate of candidates throughout the notably long hiring process threatens the representativeness of the applicant pool. Thus, police agencies are eager to examine why applicants—especially women and minority applicants—withdraw from the hiring process to address any common reasons and retain desirable candidates. To explore reasons for withdrawal, 143 women and minority police applicants who withdrew from the hiring process reported their reason for withdrawal during a telephone interview conducted in the spring and summer of 2016. The primary reasons for applicant attrition, after changing their mind or another personal reason, was finding other employment and the length of the hiring process. Recommendations for policy include increasing communication to applicants, shortening the hiring process and hiring on a continuous basis. Implications are discussed.
CEO Noncompete Agreements, Job Risk, and Compensation
Authors: Kini Omesh , Williams Ryan , Yin Sirui
Published: September 2020

Using hand-collected data on CEO noncompete agreements (NCAs), we find that NCAs are less common when CEOs expect to incur greater personal costs from reduced job mobility and more common when firms expect to suffer greater economic harm if departing CEOs leave to work for a competitor. Additionally, turnover-performance sensitivity is stronger when CEOs have NCAs. Finally, total compensation and incentive pay are higher if CEOs have more enforceable NCAs. Our identification strategy exploits staggered state-level changes in NCA enforceability. Overall, our findings suggest that restrictions on job mobility have important implications for how CEOs are monitored and compensated.
The PPP View of Multihorizon Currency Risk Premiums
Authors: Chernov Mikhail , Creal Drew
Published: September 2020

Exposures of expected future nominal depreciation rates to the current interest rate differential violate the UIP hypothesis in a pattern that is a nonmonotonic function of horizon. Forward expected nominal depreciation rates are monotonic. We explain the two patterns by simultaneously incorporating the weak form of PPP into a joint model of the stochastic discount factor, the nominal exchange rate, and domestic and foreign yield curves. Departures from PPP generate the first pattern. The risk premiums for these departures generate the second pattern. Thus, the variance of the stochastic discount factor is related to the real exchange rate.
Making community-supported agriculture accessible to low-income families: findings from the Farm Fresh Foods for Healthy Kids process evaluation
Authors: Garner Jennifer A , Jilcott Pitts Stephanie B , Hanson Karla L , Ammerman Alice S , Kolodinsky Jane , Sitaker Marilyn H , Seguin-Fowler Rebecca A
Published: September 2020

A randomized trial of Farm Fresh Foods for Healthy Kids (F3HK) was initiated across 4 states and 12 farms to test whether cost-offset community-supported agriculture (CO-CSA) could improve diet quality among children in low-income families. Intervention households purchased a 50% subsidized share of local produce and were invited to nine complimentary nutrition classes.

The purpose of this study was to assess F3HK reach, dose, and fidelity via a mixed methods process evaluation. Screening and enrollment records indicated reach; study records and postlesson educator surveys tracked dose delivered; CSA pickup logs, lesson sign-in sheets, postseason participant surveys, and postlesson caregiver surveys assessed dose received; and coordinator audits and educator surveys tracked fidelity. Educator interviews contextualized findings. The results of this study were as follows. Reach: enrolled caregivers (n = 305) were older (p = .005) than eligible nonenrollees (n = 243) and more likely to be female (p < .001). Dose: mean CSA season was 21 weeks (interquartile range [IQR]: 19–23). Median CSA pickup was 88% of the weeks (IQR: 40–100). All sites offered each class at least once. Most adults (77%) and children (54%) attended at least one class; few attended all. Eighty-two percent of caregivers indicated that their household consumed most or all produce. Median lesson activity ratings were 5/5 (“very useful”). Fidelity: CSA locations functioned with integrity to project standards. Educators taught 92% of activities but frequently modified lesson order. This study demonstrates the feasibility of pairing a CO-CSA intervention with nutrition education across geographically dispersed sites. Greater integration of intervention elements and clearer allowance for site-level modifications, particularly for educational elements, may improve intervention dose and, ultimately, impact.
Familiarity with a Tool Influences Peripersonal Space and Primary Motor Cortex Excitability of Muscles Involved in Haptic Contact
Authors: Biggio M , Bisio A , Avanzino L , Ruggeri P , Bove M
Published: September 2020

Long-term experience with a tool stably enlarges peripersonal space (PPS). Also, gained experience with a tool modulates internal models of action. The aim of this work was to understand whether the familiarity with a tool influences both PPS and motor representation. Toward this goal, we tested in 13 expert fencers through a multisensory integration paradigm the embodiment in their PPS of a personal (pE) or a common (cE) épée. Then, we evaluated the primary motor cortex excitability of proximal (ECR) and distal (APB) muscles during a motor imagery (MI) task of an athletic gesture when athletes handled these tools. Results showed that pE enlarges subjects’ PPS, while cE does not. Moreover, during MI, handling tools increased cortical excitability of ECR muscle. Notably, APB’s cortical excitability during MI only increased with pE as a function of its embodiment in PPS. These findings indicate that the familiarity with a tool specifically enlarges PPS and modulates the cortical motor representation of those muscles involved in the haptic contact with it.
Characterizing the Genetic Architecture of Nonhost Resistance in Barley Using Pathogenically Diverse Puccinia Isolates
Authors: Haghdoust R. , Singh D. , Park R. F. , Dracatos P. M.
Published: September 2020

Barley is an intermediate or near nonhost to many cereal rust pathogens that infect grasses, making it a highly suitable model to understand the evolution and genetic basis of nonhost resistance (NHR) in plants. To characterize the genetic architecture of NHR in barley, we used the Oregon Wolfe Barley doubled haploid and Morex × SusPtrit recombinant inbred line mapping populations. To elicit a wide array of NHR responses, we tested 492 barley accessions and both mapping populations with pathogenically diverse cereal rust isolates representing distinct formae speciales adapted to Avena, Hordeum, Triticum, and Lolium spp.: P. coronata f. sp. avenae (oat crown rust pathogen) and P. coronata f. sp. lolii (ryegrass crown rust pathogen), P. graminis f. sp. avenae (oat stem rust pathogen) and P. graminis f. sp. lolii (the ryegrass stem rust pathogen), and P. striiformis f. sp. tritici (wheat stripe rust pathogen) and P. striiformis f. sp. pseudo-hordei (barley grass stripe rust pathogen). With the exception of P. coronata f. sp. lolii and P. coronata f. sp. avenae, susceptibility and segregation for NHR was observed in the barley accessions and both mapping populations. Quantitative trait loci (QTLs) for NHR were mapped on all seven chromosomes. NHR in barley to the heterologous rusts tested was attributable to a combination of QTLs with either or both overlapping and distinct specificities. Across both mapping populations, broadly effective NHR loci were also identified that likely play a role in host specialization.
One-year prospective analysis of hand and forearm injuries in children
Authors: Sozbilen Murat Celal , Dastan Ali Engin , Gunay Huseyin , Kucuk Levent
Published: September 2020

The primary aim of this study was to assess the epidemiological evaluation of acute pediatric hand injuries frequently encountered in emergency department units. Its secondary aim was to identify the risk factors associated with such injuries. Out of the 1547 acute hand and forearm injury cases admitted to emergency trauma department between March 2017 and March 2018, the 129 injuries pertaining to children were included in the study. Mechanism, time, etiology, injured structures, anatomical regions, cut structures, and occupational accident status were determined in addition to demographic information. The injuries were evaluated according to circadian rhythm in order to ascertain the hours of intensification. The Modified Hand Injury Severity Score (MHISS) was used to assess injury severity. The mean age of 129 patients was 10.1 years. The most injuries were observed in the groups of patients over 12 years of age (57, 44%), and 0–6 years of age (42, 32%), respectively. Nineteen students participating in vocational internships were injured (14%). Twenty-six cases (20%) in the 12-year-old group involved punching glass, and 34 (26%) cases in the 0–6 age groups involved fingertip crush injuries. Temporal injury intensity was seen to have increased between 12.00 and 19.00 hours. The mean MHISS was 41 (8–120). Injury prevention measures need to be increased, particularly for fingertip injuries. A specific injury severity assessment system is also required for pediatric hand injuries, which are often simpler and easier to treat than adult hand injuries. Additionally, training and increasing awareness are believed to be important steps in preventing pediatric hand injuries.
Induction chemotherapy in nonlaryngeal human papilloma virus-negative high-risk head and neck cancer: a real-world experience
Authors: Mezi Silvia , Pomati Giulia , Botticelli Andrea , Roberto Michela , Cerbelli Bruna , Cirillo Alessio , Di Gioia Cira , Corsi Alessandro , Vullo Francesco , De Vincentiis Marco , Polimeni Antonella , Tombolini Vincenzo , Valentini Valentino , Marchetti Paolo
Published: September 2020

The role of induction chemotherapy in the multidisciplinary treatment of locally advanced, nonlaryngeal high-risk human papilloma virus (HPV)-negative head and neck squamous cells carcinoma (HNSCC) is uncertain in terms of overall survival (OS). The primary objective of this study was to identify possible predictive factors of survival and outcome in patients with HNSCC who were treated with induction chemotherapy. Fifty-nine patients with stage IVa/b HPV-negative non-laryngeal HNSCC (mostly originating from the oral cavity) who underwent induction chemotherapy at Policlinico Umberto I were reviewed. Treatment outcomes in term of objective response rate (ORR), progression-free survival (PFS), OS and toxicities were analyzed. A significant association between nodal status, ORR, ongoing smoking use, toxicities and OS was demonstrated. ORR (obtained in 61% of patients) was associated with a reduction in mortality of 80% (P< 0.0001). Early discontinuation after just one cycle of induction chemotherapy was associated to a significantly shorter OS. In oral cavity radical surgery with negative margins was obtained in 15/16 patients. In 42% of patients G3-G4 toxicity occurred. Toxicity requiring hospitalization occurred in 42% and 21% of patients with oropharyngeal and oral cavity carcinoma, respectively. Five patients died of treatment-related causes. No treatment-related mortality occurred in oral cavity patients. G5 toxicities were different according to the sub-sites of disease (P = 0.05). Induction chemotherapy in non-laryngeal high-risk HNSCC is an active strategy, most importantly in oral cavity cancer, even though burdened with a high (G ≥ 3) toxicity and early discontinuation rate. These data will however need to be confirmed in further and larger studies.
Circ_0074027 contributes to the progression of non-small cell lung cancer via microRNA-362-3p/clathrin heavy chain axis
Authors: Jiang Zhenzhu , Yin Jing , Peng Guangyao , Long Xiaoping
Published: September 2020

Circular RNAs are involved in the occurrence and development of different types of cancers. We aimed to illustrate the expression profile and mechanism of circ_0074027 in non-small cell lung cancer (NSCLC). Quantitative real-time PCR was employed to detect the expression of circ_0074027, paired like homeodomain 1 (PITX1) mRNA (mPITX1) and microRNA-362-3p (miR-362-3p). Western blot assay was utilized to measure the levels of clathrin heavy chain (CLTC), cyclin D1, BCL2-associated X, apoptosis regulator Bax (Bax), vimentin and matrix metallopeptidase 9. The clonogenicity, apoptosis and metastasis of NSCLC cells were examined by colony formation assay, flow cytometry and transwell migration and invasion assays. The target relationship between miR-362-3p and circ_0074027 or CLTC was predicted by starBase website and was validated by dual-luciferase reporter assay. Murine xenograft assay was applied to explore the function of circ_0074027 in vivo. We found that The enrichment of circ_0074027 and CLTC protein was elevated, and a significant reduction in the expression of miR-362-3p was observed in NSCLC tissues and cells relative to adjacent normal tissues and human bronchial epithelial cells 16HBE. Circ_0074027 possessed a stable circular structure. Circ_0074027 and CLTC could accelerate the colony formation and metastasis and suppress the apoptosis of NSCLC cells. Circ_0074027/miR-362-3p/CLTC axis was first found to regulate the malignance of NSCLC cells. The biological influence caused by circ_0074027 depletion on NSCLC cells was alleviated by the accumulation of CLTC. Circ_0074027 acted as an oncogene to promote the growth of NSCLC tumors in vivo. In conclusion, Circ_0074027 contributed to the progression of NSCLC through promoting the proliferation and motility while hampering the apoptosis of NSCLC cells via miR-362-3p/CLTC axis.
Metabolic and Cardiovascular Effects of Body Weight Support Treadmill Walking in Healthy Adults
Authors: Van Zant R. Scott , Colchagoff Wick , Kunish Mike , Kunz Tamara , Marshall Mark , McDermott Sara , Myers Trevor , Sunga Byron
Published: September 2020

Purpose:

Limited and conflicting evidence exists regarding the metabolic and cardiovascular responses of body weight support (BWS) treadmill training (BWSTT). The purpose of this study was to describe the metabolic (as assessed by oxygen uptake) and cardiovascular responses to varying levels of BWSTT in healthy adult subjects.

Methods:

Twenty-one subjects (10 females; 34.5 [6.7] yr.; 74.6 [14.3] kg; 170.8 [6.9] cm; 26.1 [5.3] kg/m2) provided their informed consent to participate in 3 5-minute walking trials at a self-selected treadmill speed, with BWS of 0%, 15%, and 30%. Test order was randomized. Subjects rested at least 5 minutes between trials and did not begin another trial until the heart rate (HR) was <5 bpm of HR rest. Mean HR, blood pressure (BP), oxygen uptake, and rating of perceived exertion (RPE) were determined from the last 3 minutes of each trial. Mean values for all variables were assessed for difference between trials using repeated-measures analysis of variance.

Results:

At rest, HR was 78.2 (11.5) bpm and BP was 121.2 (7.9)/76.9 (8.0) mm Hg. Mean walking speed of subjects was 65.4 m/min. Heart rate and systolic BP significantly (P < .05) increased from rest with exercise at each level of BWS, with no significant difference in diastolic BP seen from rest to exercise at all BWS levels. There was no statistical difference among levels of BWS for HR, BP, RPE, oxygen uptake, respiratory exchange ratio, respiratory rate, tidal volume, and metabolic equivalent of tasks.

Conclusions:

Healthy adult subjects walking at self-selected speeds at BWS levels up to 30% fail to demonstrate significant changes in metabolic and cardiovascular responses.
Beyond Skin Tumors: A Systematic Review of Mohs Micrographic Surgery in the Treatment of Deep Cutaneous Fungal Infections
Authors: Zargham Hanieh , Gabrielli Sofianne , Giordano Cerrene N. , Higgins Harold William
Published: September 2020

BACKGROUND

Deep cutaneous fungal infections (DCFIs) can cause significant morbidity in immunocompromised patients and often fail medical and standard surgical treatments because of significant subclinical extension. Although rarely considered in this setting, Mohs micrographic surgery (MMS) offers the advantages of comprehensive margin control and tissue conservation, which may be beneficial in the treatment of DCFIs that have failed standard treatment options.

OBJECTIVE

To review the benefits, limitations, and practicality of MMS in patients with DCFIs.

METHODS

A systematic review of PubMed and EMBASE was conducted to identify all cases of fungal skin lesions treated with MMS.

RESULTS

Eight case reports were identified consisting of a total of 8 patients. A majority of patients had a predisposing comorbidity (75%), with the most common being a solid organ transplant (n = 3, 37.5%). The most commonly diagnosed fungal infection was phaeohyphomycosis (n = 5, 62.5%), followed by mucormycosis (n = 2, 25%). No recurrence or complication post-MMS was noted at a mean follow-up of 11.66 months.

CONCLUSION

Although not a first-line treatment, MMS can be considered as an effective treatment alternative for DCFIs in cases of treatment failure and can be particularly helpful in areas where tissue conservation is imperative.
Orbital Osteomas: Report of 3 Rapidly Progressive Cases in Adolescents and Systematic Literature Review
Authors: Tooley Andrea A. , Paulose Sefy A. , Tran Ann Q. , Godfrey Kyle J. , Kazim Michael
Published: September 2020

Purpose:

The purpose of this study was to describe the clinical characteristics, management, and outcomes of orbital osteomas in the pediatric age group, and compare these to osteomas managed in the adult population.

Methods:

A retrospective review of 3 cases of rapidly progressive orbital osteomas in young patients was performed. In addition, a systematic review of the literature following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted to describe the clinical characteristics, management, and outcomes of orbital osteomas in the pediatric age group. The PubMed/MEDLINE database was searched in December 2019 for studies reporting data on patients with orbital osteomas.

Results:

Fifty-nine patients were included in this pediatric review, 39 male patients (68%), 18 female patients (32%), and 2 cases with unreported genders. Average age was 15.9 years with a range of 4–21 years. Average osteoma size measured 30.7 mm with a range of 9–60 mm. Adult osteoma size for comparison was smaller than 10 mm in majority of cases. The most common location of pediatric osteomas was the ethmoid sinus. The frontal sinus was the most common location in adult patients. Ninety-seven percent of reported pediatric cases required surgical intervention, compared with only 6.5% in adults.

Conclusions:

Orbital osteomas in younger patients are larger when identified, grow faster, are more likely to be symptomatic, and more likely to require surgical intervention compared with those identified in older patients. We recommend close monitoring of osteomas identified in young patients as well as counseling regarding the potential need for future resection.
Femtosecond laser–assisted cataract surgery in eyes with shallow anterior chamber depth: comparison with conventional phacoemulsification
Authors: Mencucci Rita , De Vitto Chiara , Cennamo Michela , Vignapiano Roberto , Buzzi Matilde , Favuzza Eleonora
Published: September 2020

Purpose:

To compare the postoperative outcomes between femtosecond laser–assisted cataract surgery (FLACS) and conventional phacoemulsification in eyes with shallow anterior chamber depth (ACD).

Setting:

Eye Clinic, NEUROFARBA Department, University of Florence, Italy.

Design:

Prospective case series.

Methods:

Forty eyes of 40 patients with senile cataract and true ACD less than 2.00 mm underwent FLACS (femto group, n = 20) or manual phacoemulsification (phacoemulsification group, n = 20). Preoperatively and 1 week and 1 month and 6 months postoperatively, central corneal thickness (CCT) and endothelial cell density were evaluated; basal epithelial cell (BEC) and Langerhans dendritic cell (LDC) densities and keratocyte activation were assessed using in vivo corneal confocal microscopy. Intraoperative parameters such as cumulative dissipated energy (CDE) and ultrasound (US) power were recorded.

Results:

Endothelial cell loss (ECL) was significantly lower in the femto group at all timepoints (P ≤ .001). In the phacoemulsification group, the CCT was significantly higher 1 week (P < .001) and 1 month (P < .001) postoperatively than preoperatively; conversely, in the femto group, it was higher only after 1 week (P < .001). BECs and LDCs significantly increased at 1 postoperative week (P < .001), returning to preoperative values after 1 month in both groups. Keratocyte activation remained significantly higher at 1 postoperative month only in the phacoemulsification group (P = .005). CDE and US power were lower in the femto group (P = .017 and P = .001, respectively); they were correlated with ECL (r = 0.662, P = .000; r = 0.389, P = .013).

Conclusions:

In eyes with shallow ACD, FLACS was a safe and an effective technique, significantly reducing the postoperative ECL and corneal inflammation compared with conventional phacoemulsification.
Artificial intelligence in global ophthalmology: using machine learning to improve cataract surgery outcomes at Ethiopian outreaches
Authors: Brant Arthur R. , Hinkle John , Shi Siyu , Hess Olivia , Zubair Talhah , Pershing Suzann , Tabin Geoffrey C.
Published: September 2020

Differences between target and implanted intraocular lens (IOL) power in Ethiopian cataract outreach campaigns were evaluated, and machine learning (ML) was applied to optimize the IOL inventory and minimize avoidable refractive error. Patients from Ethiopian cataract campaigns with available target and implanted IOL records were identified, and the diopter difference between the two was measured. Gradient descent (an ML algorithm) was used to generate an optimal IOL inventory, and we measured the models performance across varying surplus levels. Only 45.6% of patients received their target IOL power and 23.6% received underpowered IOLs with current inventory (50% surplus). The ML-generated IOL inventory ensured that more than 99.5% of patients received their target IOL when using only 39% IOL surplus. In Ethiopian cataract campaigns, most patients have avoidable postoperative refractive error secondary to suboptimal IOL inventory. Optimizing the IOL inventory using this ML model might eliminate refractive error from insufficient inventory and reduce costs.
Chlamydia Prevalence by Age and Correlates of Infection Among Pregnant Women
Authors: Simons Janice Leahgrace , McKenzie Jessica S. , Wright Nicole C. , Sheikh Shainela A. , Subramaniam Akila , Tita Alan T. N. , Dionne-Odom Jodie
Published: September 2020

Background

There is a paucity of population-based data on chlamydia in pregnancy despite rising rates in US women. Our objectives were to assess chlamydia prevalence by age group and to identify factors associated with infection in pregnant women to inform screening guidelines.

Methods

This cross-sectional study included pregnant women tested for chlamydia who delivered at the University of Alabama at Birmingham between November 1, 2012, and December 31, 2017. The primary outcome was chlamydia prevalence, defined as a positive urogenital chlamydia nucleic acid amplification test result documented in the electronic medical record. Multivariable logistic regression was used to identify factors associated with infection.

Results

Among 17,796 women who delivered during the study period, 13,657 (77%) had chlamydia testing performed at the University of Alabama at Birmingham. Chlamydia prevalence (95% confidence interval) was 7.4% (7.0%–7.9%). Age-stratified prevalence rates were 14.6%, 4.3%, and 1.7% for women younger than 25 years, 25 to 29 years, and 30 years or older, respectively. Chlamydia in pregnancy remained strongly associated with age (adjusted odds ratio [95% confidence interval], 7.2 [5.6–9.2] for age <25 years, and 2.3 [1.7–3.0] for ages 25–29 years, when compared with >30 years) after adjustment for race, urban residence, and insurance status.

Conclusions

Among pregnant women living in the southeastern United States, chlamydia was detected in 1 of 14 women who were tested. Chlamydia positivity was highest among women younger than 30 years. Study findings support broad screening for chlamydia in pregnancy.
Fluid Reservoir Thickness and Corneal Edema during Open-eye Scleral Lens Wear
Authors: Fisher Damien , Collins Michael J. , Vincent Stephen J.
Published: September 2020

SIGNIFICANCE

There is debate concerning corneal oxygenation during scleral lens wear due to the potential additive hypoxic effect of a lens plus a fluid reservoir. This study investigated the agreement between theoretical models and empirical measurements of scleral lens–induced corneal edema with respect to central fluid reservoir thickness.

PURPOSE

The purpose of this study was to examine the effect of altering the fluid reservoir thickness on central corneal edema during short-term open-eye scleral lens wear and to compare these empirical measurements with predictive theoretical models.

METHODS

Ten participants (age, 30 ± 4 years) with normal corneas wore highly oxygen-permeable scleral lenses (141 Dk ×10−11 cm3 O2 (cm)/[(s) (cm2) (mmHg)]) on separate days with either a low (mean, 144; 95% confidence interval [CI], 127 to 160 μm), medium (mean, 487; 95% CI, 443 to 532 μm), or high (mean, 726; 95% CI, 687 to 766 μm) initial fluid reservoir thickness. Epithelial, stromal, and total corneal edema were measured using high-resolution optical coherence tomography after 90 minutes of wear, before lens removal. Data were calculated or extracted from published theoretical models of scleral lens–induced corneal edema for comparison.

RESULTS

Scleral lens–induced central corneal edema was stromal in nature and increased with increasing fluid reservoir thickness; mean total corneal edema was 0.69% (95% CI, 0.34 to 1.04%), 1.81% (95% CI, 1.22 to 2.40%), and 2.11% (95% CI, 1.58 to 2.65%) for the low, medium, and high thickness groups, respectively. No significant difference in corneal edema was observed between the medium and high fluid reservoir thickness groups (P = .37). “Resistance in series” oxygen modeling overestimated the corneal edema observed for fluid reservoir thickness values greater than 400 μm.

CONCLUSIONS

Scleral lens–induced central corneal edema increases with increasing reservoir thickness, but plateaus at a thickness of around 600 μm, in agreement with recent theoretical modeling that incorporates factors related to corneal metabolism.
Case Report: Managing a Postgraft Keratoconus Patient with Scleral Lenses
Authors: Gulmiri Anita , Jawanda Amrit
Published: September 2020

SIGNIFICANCE

Because the prognosis of corneal regrafting is worse than a primary graft, it is pertinent to recognize other clinical management options to postpone the need for surgical intervention. Scleral lenses are a viable option in achieving excellent vision and comfort for post-graft patients; however, close monitoring is vital to success.

PURPOSE

The purpose of this study was to report a case in which a post-graft keratoconus patient can be successfully fit and refit with scleral lenses as their corneal tissue changes shape with time. Ultimately, the goal for this patient was to delay the need for regrafting procedures.

CASE REPORT

This case presents a 57-year-old patient who has undergone penetrating keratoplasty in both eyes secondary to keratoconus. His original corneal grafts were 15 years or older. Because of a history of graft rejection in the right eye, he had a regraft in 2004. The left eye has signs of early rejection. The patient has been a scleral lens wearer since 2008. Within the past 24 months, he has required lens adjustments and refits because his fragile corneal tissue has changed shape. Lens changes were indicated when he presented with complaints of fogging associated with redness and irritation. We continued to work closely with the patient's corneal ophthalmologist, who recommended we maximize scleral lens wear in lieu of a corneal regraft. Because of the change from an oblate to prolate cornea, fitting this patient in a scleral lens has been a challenging task.

CONCLUSIONS

Scleral lenses are a viable option in post-graft patients who present with ectatic changes to their corneal tissue. This patient continues to see 20/20 in each eye and comfortably wears his lenses for up to 6 hours. By fitting this patient in a scleral lens, we have been able to avoid the need for a regraft and the possible negative outcomes that can be associated.
Scleral Lens–Induced Corneal Edema after Penetrating Keratoplasty
Authors: Kumar Mukesh , Shetty Rohit , Khamar Pooja , Vincent Stephen J.
Published: September 2020

SIGNIFICANCE

Modern highly oxygen-permeable nonfenestrated scleral lenses induce approximately 1 to 2% corneal edema after short periods of lens wear in healthy individuals. This study investigated the magnitude and regional variation in scleral lens-induced central corneal edema after penetrating keratoplasty.

PURPOSE

The purpose of this study was to examine the magnitude and regional variation in corneal edema after a short period of scleral lens wear in post–penetrating keratoplasty eyes and a control group of eyes with healthy corneas.

METHODS

Nine post–penetrating keratoplasty eyes (nine participants; mean age, 32 years) were fitted with highly oxygen-permeable nonfenestrated scleral lenses (Dk 100 × 10−11 cm3 O2 (cm)/[(s) (cm2) (mmHg)]). Central corneal thickness was measured using Scheimpflug imaging before lens insertion and immediately after lens removal (mean wearing time, 6.2 hours). Corneal edema was quantified across the central 6 mm and compared with data obtained from a historical control group of healthy eyes using a similar experimental paradigm.

RESULTS

Post–penetrating keratoplasty eyes exhibited significant corneal edema after lens wear (2.99% [95% confidence interval, 1.13 to 4.85%]) averaged across the central 6 mm (P = .006) and regional variations in edema (P < .001) (greater swelling toward the graft-host junction inferiorly). Compared with healthy eyes, post–penetrating keratoplasty eyes displayed a greater magnitude of corneal edema (by ~3×) and greater variability in the corneal response (by ~2.5×).

CONCLUSIONS

Scleral lens–induced central corneal edema is greater in post–penetrating keratoplasty eyes and varies regionally compared with healthy corneas after short-term wear. Lens design and fitting factors contributing to hypoxic and mechanical corneal stress should be carefully considered for all post–penetrating keratoplasty scleral lens fits to minimize potential graft rejection or failure in the longer-term.
Integration of Chronic Disability Management in a Medical Student Curriculum
Authors: Bosques Glendaliz , Philip Kemly , Francisco Gerard E.
Published: September 2020

Increasing exposure to the needs of patients with chronic disability is important in fostering confidence and comfort in disability knowledge and management among medical students and residents of all disciplines. The 2013 Association of American Medical Colleges Graduation Survey of graduating medical students revealed that 33% expressed inadequate exposure to disability management and rehabilitative care. To address this, a 3- to 4-wk rehabilitation elective course was modified to include lectures, media-based reflections, and a hands-on wheelchair experience. Responses and reflections from students from November 2015 to February 2019 were analyzed to assess the impact of the intervention on medical student knowledge and clinical practice using a disability pretest and posttest design. Preintervention data revealed limited knowledge of terminology in disability health that improved greatly in the postelective assessment. Medical students also gained knowledge on disability laws, available resources, and improved identification of appropriate accommodations to limit barriers to care. Moreover, this novel, interdisciplinary rehabilitation elective experience increased medical student knowledge and exposure of disability management. Incorporating these changes into the medical school curriculum will be invaluable in training future physicians to close the gap in access to care for persons with disabilities.
Performance of a short, self-report adherence scale in a probability sample of persons using HIV antiretroviral therapy in the United States
Authors: Wilson Ira B. , Tie Yunfeng , Padilla Mabel , Rogers William H. , Beer Linda
Published: September 2020

Background:

Excellent adherence to HIV antiretroviral therapy (ART) remains a cornerstone of HIV care. A three-item adherence self-report scale was recently developed and validated, but the scale has not been previously tested in a nationally representative sample.

Design:

We administered the adherence scale to participants in the Centers for Disease Control and Prevention's Medical Monitoring Project, which is a probability sample of US adults with diagnosed HIV.

Methods:

We combined sociodemographic and clinical participant data from three consecutive cycles of the Medical Monitoring Project (6/2015–5/2018). We used medical record reviews to determine most recent viral load, and whether viral loads were suppressed at all measurement points in the past 12 months. We describe the relationship between adherence scale score and two measures of viral load suppression (most recent and sustained), and estimate linear regression models using sampling weights to determine independent predictors of ART adherence scores.

Results:

Of those using ART, the median adherence score was 93 (100 = perfect adherence), and the standardized Cronbach's alpha was 0.83. For both measures of viral load suppression, the relationship with the adherence score was generally linear; there was no ‘cutoff’ point indicating good vs. poor adherence. In the multivariable model, younger age, nonwhite race, poverty, homelessness, depression, binge-drinking, and both non-IDU and IDU were independently associated with lower adherence.

Conclusion:

The adherence measure had good psychometric qualities and a linear relationship with viral load, supporting its use in both clinical care and research. Adherence interventions should focus on persons with the highest risk of poor adherence.