bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adrenocortical sarcomatoid carcinoma: a case report and review of the literature
Authors: Sabrine Derqaoui , Zakia Bernoussi , Kaoutar Znati 
Published: June 2020

Abstract
Adrenal sarcomatoid carcinoma (ASC) is a very rare aggressive variant of adrenocortical carcinoma showing carcinomatous and sarcomatous differentiation. It is a poorly differentiated carcinoma with poor prognosis. The diagnosis requires careful histological and immunohistochemical investigation. We describe a new case of ASC to raise awareness on this extremely rare entity. A 27-year-old woman presented with a right flank pain. Imaging revealed a tissular mass of the right adrenal gland without metastases. After adrenalectomy, histology revealed sheets of epithelioid cells that stained for synaptophysin and Melan-A; and spindled cells staining for S-100. We have reported the clinical and histopathological features of ACS’s case; as it is an extremely rare cancer with a challenging diagnosis. There is a need for a further understanding of ASC’s biology to improve it poor prognosis.
Convergence, continuity, recurrence and Turing completeness in dynamic epistemic logic1
Authors: Klein Dominik , Rendsvig Rasmus K 
Published: June 2020

AbstractThe paper analyses dynamic epistemic logic from a topological perspective. The main contribution consists of a framework in which dynamic epistemic logic satisfies the requirements for being a topological dynamical system thus interfacing discrete dynamic logics with continuous mappings of dynamical systems. The setting is based on a notion of logical convergence, demonstratively equivalent with convergence in Stone topology. Presented is a flexible, parametrized family of metrics inducing the Stone topology, used as an analytical aid. We show maps induced by action model transformations continuous with respect to the Stone topology and present results on the recurrent behaviour of said maps. Among the recurrence results, we show maps induced by finite action models may have uncountably many recurrent points, even when initiated on a finite input model. Several recurrence results draws on the class of action models being Turing complete, for which the paper provides proof in the postcondition-free case. As upper bounds, it is shown that either 1 atom, 3 agents and preconditions of modal depth 18 or 1 atom, 7 agents and preconditions of modal depth 3 suffice for Turing completeness.
The universal acceleration scale from stellar feedback
Authors: Grudić Michael Y , Boylan-Kolchin Michael , Faucher-Giguère Claude-André , Hopkins Philip F 
Published: May 2020

ABSTRACT
It has been established for decades that rotation curves deviate from the Newtonian gravity expectation given baryons alone below a characteristic acceleration scale $g_{\dagger }\sim 10^{-8}\, \rm {cm\, s^{-2}}$, a scale promoted to a new fundamental constant in MOND. In recent years, theoretical and observational studies have shown that the star formation efficiency (SFE) of dense gas scales with surface density, SFE ∼ Σ/Σcrit with $\Sigma _{\rm crit} \sim \langle \dot{p}/m_{\ast }\rangle /(\pi \, G)\sim 1000\, \rm {M_{\odot }\, pc^{-2}}$ (where $\langle \dot{p}/m_{\ast }\rangle$ is the momentum flux output by stellar feedback per unit stellar mass in a young stellar population). We argue that the SFE, more generally, should scale with the local gravitational acceleration, i.e. that SFE ${\sim}g_{\rm tot}/g_{\rm crit}\equiv (G\, M_{\rm tot}/R^{2}) / \langle \dot{p}/m_{\ast }\rangle$, where Mtot is the total gravitating mass and $g_{\rm crit}=\langle \dot{p}/m_{\ast }\rangle = \pi \, G\, \Sigma _{\rm crit} \approx 10^{-8}\, \rm {cm\, s^{-2}} \approx \mathit{ g}_{\dagger }$. Hence, the observed g† may correspond to the characteristic acceleration scale above which stellar feedback cannot prevent efficient star formation, and baryons will eventually come to dominate. We further show how this may give rise to the observed acceleration scaling $g_{\rm obs}\sim (g_{\rm baryon}\, g_{\dagger })^{1/2}$ (where gbaryon is the acceleration due to baryons alone) and flat rotation curves. The derived characteristic acceleration g† can be expressed in terms of fundamental constants (gravitational constant, proton mass, and Thomson cross-section): $g_{\dagger }\sim 0.1\, G\, m_{\mathrm{ p}}/\sigma _{\rm T}$.
Effectiveness of Implementation Strategies to Improve Adherence of Physical Therapist Treatment Choices to Clinical Practice Guidelines for Musculoskeletal Conditions: Systematic Review
Authors: Zadro Joshua R , O’Keeffe Mary , Allison Jodie L , Lembke Kirsty A , Forbes Joanna L , Maher Christopher G 
Published: May 2020

Abstract

Objective
The objective of this study was to evaluate the effectiveness of implementation strategies aimed at improving the adherence of physical therapists’ treatment choices to clinical practice guidelines for a range of musculoskeletal conditions.

Methods
For this review, searches were performed in several databases combining terms synonymous with “practice patterns” and “physical therapy” until August 2019. The review included randomized controlled trials that investigated any intervention to improve the adherence of physical therapists’ treatment choices to clinical practice guidelines or research evidence. Treatment choices assessed by surveys, audits of clinical notes, and treatment recording forms were the primary measures of adherence. Self-reported guideline adherence was the secondary measure. Three reviewers independently assessed risk of bias. Because of heterogeneity across studies, only a narrative synthesis of the results was performed.

Results
Nine studies were included. Four demonstrated a positive effect on at least 1 measure of treatment choices for low back pain and acute whiplash. One involved a comparison with no intervention, and 3 involved a comparison with another active intervention. The interventions that demonstrated a positive effect included dissemination of clinical practice guidelines, with additional elements including interactive educational meetings (3 studies), tailored interventions and monitoring of the performance of health care delivery (1 study), peer assessment (1 study), and local opinion leaders plus educational outreach visits (1 study).

Conclusions
Although this review revealed limited trials evaluating interventions to increase physical therapists’ use of evidence-based treatments for musculoskeletal conditions compared with no intervention, it highlighted some interventions that may be effective.

Impact
Dissemination of clinical practice guidelines, interactive educational meetings, tailored interventions and monitoring the performance of health care delivery, peer assessment, and use of local opinion leaders plus educational outreach visits should be implemented to improve physical therapists’ adherence to clinical practice guidelines for a range of musculoskeletal conditions.
Metabolome analysis using cerebrospinal fluid from narcolepsy type 1 patients
Authors: Shimada Mihoko , Miyagawa Taku , Kodama Tohru , Toyoda Hiromi , Tokunaga Katsushi , Honda Makoto 
Published: May 2020

Abstract
Narcolepsy type 1 (NT1) is a hypersomnia characterized by excessive daytime sleepiness and cataplexy. Inappropriate regulation of fatty acid metabolism has been suggested to be involved in the pathophysiology of NT1, but the detailed mechanisms remain uncertain. Here we performed a metabolomic analysis of cerebrospinal fluid samples from 14 NT1 and 17 control subjects using a novel capillary electrophoresis coupled with Fourier transform mass spectrometry. A total of 268 metabolites were identified and the amount of histidine was the most significantly increased in NT1 patients (p = 4.0 × 10–4). Validation analysis using high-performance liquid chromatography (HPLC) including independent replication samples also identified the association of histidine (p = 2.02 × 10–3). Further, levels of histamine, which is synthesized from histidine, were also examined using HPLC and were found to be significantly decreased in NT1 patients (p = 6.12 × 10–4). Pathway analysis with nominally significant metabolites identified several pathways related to the metabolism of glycogenic amino acids, suggesting that glycogenesis is enhanced in NT1 as a compensatory mechanism for fatty acid metabolism. We performed further exploratory analysis, searching for metabolites associated with sleep variables from polysomnography and the multiple sleep latency test. As a result, 5′-deoxy-5′-methylthioadenosine showed a significant association with apnea–hypopnea index (p = 2.66 ×10–6). Moreover, gamma aminobutyric acid displayed a negative correlation with rapid eye movement sleep latency (REML), and thus might represent an intriguing target for future studies to elucidate how the controlling circuit of REM sleep is associated with abnormally short REML in NT1.
Homeostatic state of microglia in a rat model of chronic sleep restriction
Authors: Hall Shannon , Deurveilher Samüel , Robertson George S , Semba Kazue 
Published: May 2020

AbstractChronic sleep restriction (CSR) negatively impacts brain functions. Whether microglia, the brain’s resident immune cells, play any role is unknown. We studied microglia responses to CSR using a rat model featuring slowly rotating wheels (3 h on/1 h off), which was previously shown to induce both homeostatic and adaptive responses in sleep and attention. Adult male rats were sleep restricted for 27 or 99 h. Control rats were housed in locked wheels. After 27 and/or 99 h of CSR, the number of cells immunoreactive for the microglia marker ionized calcium-binding adaptor molecule-1 (Iba1) and the density of Iba1 immunoreactivity were increased in 4/10 brain regions involved in sleep/wake regulation and cognition, including the prelimbic cortex, central amygdala, perifornical lateral hypothalamic area, and dorsal raphe nucleus. CSR neither induced mitosis in microglia (assessed with bromodeoxyuridine) nor impaired blood–brain barrier permeability (assessed with Evans Blue). Microglia appeared ramified in all treatment groups and, when examined quantitatively in the prelimbic cortex, their morphology was not affected by CSR. After 27 h, but not 99 h, of CSR, mRNA levels of the anti-inflammatory cytokine interleukin-10 were increased in the frontal cortex. Pro-inflammatory cytokine mRNA levels (tumor necrosis factor-α, interleukin-1β, and interleukin-6) were unchanged. Furthermore, cortical microglia were not immunoreactive for several pro- and anti-inflammatory markers tested, but were immunoreactive for the purinergic P2Y12 receptor. These results suggest that microglia respond to CSR while remaining in a physiological state and may contribute to the previously reported homeostatic and adaptive responses to CSR.
Strategies and Tools to Enhance Patient Safety: HROs, HEROs, and Safety Culture
Authors: Shea Kevin G. 
Published: June 2020

Introduction:
The Institute of Medicine has defined multiple domains to improve safety, efficiency, and effectiveness of health care. High-Reliability Organizations (HROs) address these issues and promote safety/reliability at the highest level.

Methods:
HROs create a bottom-up, top-down culture that focuses upon continuous improvement by withholding blame on individuals yet requiring all members to be accountable for continuous improvement.

Results:
Supporting staff to speak up, identify, and engage on the path to perfect care and zero harm are elements of a safety culture. In addition to safety, HROs can also focus on effectiveness and efficiency. This may be accomplished by creating consistent care practices that reduce irrational variation, decrease complexity, and lower risk.

Discussion:
Developing a culture focused upon reliability, safety, and staff resilience is critical for HROs. HROs support and empower all staff to be vigilant and report concerns about any issue related to safety and support the development of a “Safety Culture.” HROs focus upon safety will be enhanced by an expanded focus upon effectiveness and efficiency to improve value. A focus on standard clinical practices and clinician integration into the supply chain will help organizations produce better value and be an essential tool to reduce complexity and risk within health care systems.
Curbing Burnout Hysteria With Self-Compassion: A Key to Physician Resilience
Authors: Sotile Wayne M. , Fallon Rebecca , Orlando Julia 
Published: June 2020

Background:
Never before has physician suffering received as much attention in the peer-reviewed medical literature and popular media as now. The purpose of this paper is to propose that the manner in which these concerns are being addressed is further complicating physician and medical family well-being due to the perpetuation of work ambivalence.

Methods:
A search of the English literature was conducted using PubMed to identify papers addressing physician burnout and other forms of psychosocial suffering. In addition, a review of case records from the past 40 years of clinical experiences as counselors and life coaches to physicians and their life mates was conducted.

Results:
Reported levels of physician burnout and psychosocial morbidity have escalated over the past 10 years, as have clinically observed levels of work/life conflict expressed both by physicians and their spouses.

Discussion:
We contend that the contemporary rhetoric addressing physicians’ psychosocial experience is yielding the iatrogenic effect of promoting work ambivalence, which is a key building block in fostering physician burnout and its sequelae. We propose that curbing physician burnout requires a combination of empathy about the plight of physicians today, compassion that fuels workplace redesigns and family support, and self-compassion on the part of individual physicians.

Conclusions:
Both clinical experience and research suggest that physician well-being can be enhanced by coaching physicians to protect positive engagement in their work while practicing resilience-enhancing tactics and strategies.
TATTOO-ASSOCIATED CASES OF POSTERIOR SEGMENT UVEITIS WITH VOGT–KOYANAGI–HARADA DISEASE-LIKE FEATURES
Authors: Kesav Natasha P. , Kaplan Alexander J. , Hwang Christopher K. , Okeagu Chinwe , Sen H. Nida 
Published: June 2020

Purpose:
To present two patients with treatment-naïve posterior segment uveitis with Vogt–Koyanagi–Harada-like features associated with tattoo-related inflammatory skin changes.

Methods:
Retrospective report of two cases.

Results:
Using clinical history and multimodal imaging, a diagnosis of posterior segment uveitis with Vogt–Koyanagi–Harada-like features was made in association with tattoo skin changes in both patients.

Conclusion:
Physicians should be aware that tattoo-associated posterior segment uveitis with Vogt–Koyanagi–Harada-like features can occur.
Three-Fourths of ICU Physical Therapists Report Use of Assistive Equipment and Technology in Practice: Results of an International Survey
Authors: Mayer Kirby P. , Carper Ramona A. , Henson Samantha C. , Clonce Emily A. , Christian Warren Jay , Seif Sherif M. , Pastva Amy M. , Needham Dale M. , Morris Peter E. 
Published: June 2020

Introduction:
Patients surviving critical illness develop persistent functional mobility impairments that significantly impact their quality of life. Early rehabilitation interventions in the intensive care unit (ICU) may mitigate the sequelae of critical illness. However, implementation of such interventions is very low in clinical practice. Assistive rehabilitation equipment and technology, such as tilt beds and cycle ergometers, provide physical therapists (PTs) with strategies to complement functional mobility interventions.

Purpose:
To determine PTs' self-reported use of assistive rehabilitation equipment and technology in their clinical practices in the ICU and to describe the rationale for their use.

Methods:
An online survey (Qualtrics), with closed- and open-ended questions, was distributed to PTs working in the ICU, via e-mail through the Academy of Acute Care Physical Therapy “PTinICU” e-mail listserv and the online ICU Recovery Network and Twitter. Descriptive statistics were used to assess frequency and rationale for the use of specific equipment and technology.

Results:
PTs (n = 206, mean age 39.6 ± 9.7 years, 82% female) completed the survey (81% in the United States and 19% from 12 countries outside of the United States). Respondents (153/206, 74%) reported using at least one type of equipment or technology. The most commonly used were hospital tilt beds and tilt tables (n = 106, 51%), mobilization chairs (n = 80, 39%), standing frames (n= 66, 32%), cycle ergometers (n = 63, 31%), and exercise platforms (n = 36, 17%). The most common rationale for use was as a bridge to functional mobility (response ranging from 17% to 44% depending on the technology). The most common reason for not using equipment or technology was limited or no access (71%, 37/53). PTs from outside the United States (vs US-based PTs) reported greater use of equipment or technology (n = 206, 92% vs 70%, P = .001).

Conclusions:
Approximately 75% of PTs completing this survey report use of assistive rehabilitation equipment and technology in their ICU clinical practice, emphasizing the need for further research to understand the clinical approaches for use and the efficacy of such technology.
The Effect of Aging on the Electrically Evoked Compound Action Potential
Authors: Mussoi Bruna S. , Brown Carolyn J. 
Published: June 2020

Objectives:To examine the effect of aging on electrically evoked compound action potential (eCAP) growth functions and their relationship with speech recognition in noise in cochlear implant (CI) users.Background:Aging typically leads to difficulty understanding speech in background noise. Previous research has explored cognitive and central auditory mechanisms contributing to these age-related changes. However, it is likely that the peripheral auditory system may also play a role. One challenge is separating the effects of aging on cochlear structures from the effects of aging on the auditory nerve in humans. CI users provide a unique way to address this issue, as intracochlear electrical stimulation bypasses surviving hair cells and activates the auditory nerve directly. Studies in animal models suggest that age-related loss of spiral ganglion cells could lead to shallower eCAP growth functions and/or increased eCAP thresholds and potentially negatively impact speech recognition.Methods:Ten younger and 10 older postlingually deafened, adult CI recipients participated in this study. eCAP amplitude-intensity functions were recorded from a mid-array electrode and fit using linear functions. Speech recognition in noise was assessed using the Quick Speech-in-Noise (QuickSIN) test.Results:Older CI users had significantly shallower eCAP growth functions and higher eCAP thresholds than younger CI users. eCAP growth functions were not correlated with speech recognition in noise.Conclusion:Results of this study suggest that older adults may have poorer neural survival, resulting in higher eCAP thresholds and shallower eCAP growth functions. These findings expand our understanding of mechanisms underlying age-related changes in the peripheral auditory system.
Mental Health Care Utilization and Psychiatric Diagnoses in a Sample of Military Suicide Decedents and Living Matched Controls
Authors: Ryan Arthur T. , Ghahramanlou-Holloway Marjan , Wilcox Holly C. , Umhau John C. , Deuster Patricia A. 
Published: June 2020

Abstract
This article examines mental health care utilization and psychiatric diagnoses among US military personnel who died by suicide. We employed an existing electronic health record dataset including 800 US military suicide decedents and 800 matched controls. Suicide decedents were more likely to have received outpatient and inpatient mental health care and to have been diagnosed with depression, bipolar, and nonaffective psychotic disorders. Younger decedents and those in the US Marine Corps were less likely to receive MH care before suicide. Given that approximately half of the suicide decedents in our sample had no mental health care visits before their death, our study suggests the need for programs to increase treatment engagement by at-risk individuals. Such programs could address barriers to care such as stigma regarding mental illness and concerns that seeking mental health care would damage a service member's career.
HIV-1 induced changes in HLA-C∗03 : 04-presented peptide repertoires lead to reduced engagement of inhibitory natural killer cell receptors
Authors: Ziegler Maja C. , Nelde Annika , Weber Jeffrey K. , Schreitmüller Christian M. , Martrus Glòria , Huynh Tien , Bunders Madeleine J. , Lunemann Sebastian , Stevanovic Stefan , Zhou Ruhong , Altfeld Marcus 
Published: June 2020

Objective:
Viral infections influence intracellular peptide repertoires available for presentation by HLA-I. Alterations in HLA-I/peptide complexes can modulate binding of killer immunoglobuline-like receptors (KIRs) and thereby the function of natural killer (NK) cells. Although multiple studies have provided evidence that HLA-I/KIR interactions play a role in HIV-1 disease progression, the consequence of HIV-1 infection for HLA-I/KIR interactions remain largely unknown.

Design:
We determined changes in HLA-I presented peptides resulting from HIV-1-infection of primary human CD4+ T cells and assessed the impact of changes in peptide repertoires on HLA-I/KIR interactions.

Methods:
Liquid chromatography-coupled tandem mass spectrometry to identify HLA-I presented peptides, cell-based in-vitro assays to evaluate functional consequences of alterations in immunopeptidome and atomistic molecular dynamics simulations to confirm experimental data.

Results:
A total of 583 peptides exclusively presented on HIV-1-infected cells were identified, of which only 0.2% represented HIV-1 derived peptides. Focusing on HLA-C∗03 : 04/KIR2DL3 interactions, we observed that HLA-C∗03 : 04-presented peptides derived from noninfected CD4+ T cells mediated stronger binding of inhibitory KIR2DL3 than peptides derived from HIV-1-infected cells. Furthermore, the most abundant peptide presented by HLA-C∗03 : 04 on noninfected CD4+ T cells (VIYPARISL) mediated the strongest KIR2DL3-binding, while the most abundant peptide presented on HIV-1-infected cells (YAIQATETL) did not mediate KIR2DL3-binding. Molecular dynamics simulations of HLA-C∗03 : 04/KIR2DL3 interactions in the context of these two peptides revealed that VIYPARISL significantly enhanced the HLA-C∗03 : 04/peptide contact area to KIR2DL3 compared with YAIQATETL.

Conclusion:
These data demonstrate that HIV-1 infection-induced changes in HLA-I-presented peptides can reduce engagement of inhibitory KIRs, providing a mechanism for enhanced activation of NK cells by virus-infected cells.