bluuebunny/crossref_metadata_2025_split huggingface dataset:
Probing the Molecular Structure and Orientation of the Leaf Surface of Brassica oleracea L. by Polarization Modulation-Infrared Reflection-Absorption Spectroscopy
Authors: Hama Tetsuya , Seki Kousuke , Ishibashi Atsuki , Miyazaki Ayane , Kouchi Akira , Watanabe Naoki , Shimoaka Takafumi , Hasegawa Takeshi 
Published: April 2019

AbstractThe surface of most aerial plant organs is covered with the cuticle, a membrane consisting of a variety of organic compounds, including waxes, cutin (a polyester) and polysaccharides. The cuticle serves as the multifunctional interface between the plant and the environment, and plays a major role in protecting plants against various environmental stress factors. Characterization of the molecular arrangements in the intact cuticle is critical for the fundamental understanding of its physicochemical properties; however, this analysis remains technically challenging. Here, we describe the nondestructive characterization of the intact cuticle of Brassica oleracea L. leaves using polarization modulation-infrared (IR) reflection-absorption spectroscopy (PM-IRRAS). PM-IRRAS has a probing depth of less than several hundreds of nanometers, and reveals the crystalline structure of the wax covering the cuticle surface (epicuticular wax) and the nonhydrogen-bonding character of cutin. Combined analysis using attenuated total reflection-IR spectra suggested that hemicelluloses xylan and xyloglucan are present in the outer cuticle region close to the epicuticular wax, whereas pectins are dominant in the inner cuticle region (depth of ≤2 μm). PM-IRRAS can also determine the average orientation of the cuticular molecules, as indicated by the positive and negative spectral peaks. This unique advantage reveals the orientational order in the intact cuticle; the hydrocarbon chains of the epicuticular wax and cutin and the backbones of hemicelluloses are oriented perpendicular to the leaf surface. PM-IRRAS is a versatile, informative and easy-to-use technique for studying plant cuticles because it is nondestructive and does not require sample pretreatment and background measurements.
Recommendations for acquisition and interpretation of MRI of the spine and sacroiliac joints in the diagnosis of axial spondyloarthritis in the UK
Authors: Bray Timothy J P , Jones Alexis , Bennett Alexander N , Conaghan Philip G , Grainger Andrew , Hodgson Richard , Hutchinson Charles , Leandro Maria , Mandl Peter , McGonagle Denis , O’Connor Phill , Sengupta Raj , Thomas Marianna , Toms Andoni , Winn Naomi , Hall-Craggs Margaret A , Marzo-Ortega Helena , Machado Pedro M ,   British Society of Spondyloarthritis (BRITSpA)
Published: April 2019

Abstract

Objectives
To develop evidence-based recommendations on the use of MRI in the diagnosis of axial SpA (axSpA).

Methods
A working group comprising nine rheumatologists and nine musculoskeletal radiologists with an interest in axSpA was established, with support from the British Society of Spondyloarthritis (BRITSpA). Two meetings were held. In the first meeting, research questions were formulated. In the second meeting, the results of a systematic literature review designed to inform the recommendations were reviewed. An anonymized Delphi process was used to formulate the final set of recommendations. For each recommendation, the level of evidence and strength of recommendation was determined. The level of agreement was assessed using a 0–10 numerical rating scale.

Results
Two overarching principles were formulated, as follows: The diagnosis of axSpA is based on clinical, laboratory and imaging features (overarching principle 1), and patients with axSpA can have isolated inflammation of either the sacroiliac joints or the spine (overarching principle 2). Seven recommendations addressing the use of MRI in the assessment of patients with suspected axSpA were formulated, covering topics including recommended sequences, anatomical coverage, acquisition parameters and interpretation of active and structural MRI lesions. The level of agreement for each recommendation was very high (range 8.8–9.8).

Conclusion
A joint rheumatology and radiology consensus on the acquisition and interpretation of MRI in axSpA diagnosis was achieved, and a research agenda formulated. This consensus should help standardize practice around MRI and ensure a more informed, consistent approach to the diagnosis of axSpA.
0632 Time of Day and Time on Task Effects on Working Memory and Sleepiness of Bus Drivers
Authors: Maghsoudipour Maryam , Moradi Ramin , Pouyakian Mostafa , Yaseri Mehdi , Moghimi Sara 
Published: April 2019

Abstract

Introduction
Fatigue and sleepiness have direct effects on vigilance, and cognitive functions of drivers. The objective of this study was to analyze individual bus drivers' characteristics and work shift parameters and relation to the working memory performance and sleepiness.

Methods
This prospective study was conducted on 35 inter-city bus drivers by convenience sampling. We collected data during the time span of a 24-hour round trip by using the demographic questionnaire, Epworth Sleepiness Scale (ESS), Karolinska Sleepiness Scale (KSS), and reversed digit span memory test (part of the Wechsler-Adult Intelligence Test). A linear mixed model was used for statistic analysis.

Results
The mean (± SD) of Epworth Sleepiness Scale score was 6.4 (±2.7). 12.5% of drivers had excessive daytime sleepiness according to ESS results. The circadian effect of time of day on the drivers' working memories was statistically significant (P=0.001), and the working memory was minimum at 04:00 am (± 1). Additionally, the differences in sleepiness at different times of day were statistically significant (P=0.001); with the highest score at 04:00 am (± 1). Time on task and time of sleep parameters did not show a significant effect on working memory (p> 0.05). Time on task parameter affected sleepiness significantly (p=0.024).

Conclusion
The circadian factor was the most important predictor of cognitive performance compared to time on task (fatigue) and time of sleep. Although, time on task had a significant effect on sleepiness and sleepiness significantly decreased working memory. We conclude that optimizing the drivers' schedule is the most important intervention to optimize drivers' performance and increase road safety.

Support (If Any)
Not
0944 A Comparison Of Medical-grade Actigraphy Devices With Polysomnography During Inpatient Rehabilitation For Traumatic Brain Injury (TBI)
Authors: Guerrero Giselle Y , Schwartz Daniel , Silva Marc A , Zeitzer Jamie Marc , Monden Kimberley , Wittine Lara , Bogner Jennifer , Reljic Tea , Nakase-Richardson Risa 
Published: April 2019

Abstract

Introduction
Sleep disturbances in TBI population can have negative consequences on physical, psychological and cognitive recovery. While polysomnography (PSG) is the gold standard for evaluating sleep disorders, actigraphy has been widely used to screen for sleep-wake disorders, especially ones that change longitudinally. In a small sample of TBI patients (n=50, single center sample of convenience) during inpatient rehabilitation, we have previously found two models (Philips Actiwatch2/Actiwatch Spectrum) to be feasible and valid for collecting sleep data. Herein, we extend this validation to a prospective study of more than 200 TBI patients and include both the Actigraph Core wGT3X-BT (ACT-Core) and Philips Actiwatch Spectrum Plus (PASP).

Methods
This is a secondary analysis from a six-center, prospective, observational cohort study from the TBI Model System Lifetimes Study where overnight, fully attended polysomnography with concomitant actigraphy were conducted on moderate to severe TBI subjects during acute inpatient rehabilitation as part of an ongoing PCORI-funded clinical trial. Actigraphy variables of total sleep time (TST), sleep efficiency (SE), sleep latency (SL), wake after sleep onset (WASO) were compared between actigraphy devices and with Level 1, fully attended PSG (Phillips Sleepware-G3) to evaluate their concordance (Pearson). PASP-derived sleep was determined with Actiware (sensitivity=Automatic), while ACT-Core-derived sleep was determined with ActiLife (Cole-Kripke algorithm).

Results
Simultaneous collection of PSG and PASP (n=230) and ACT-Core (n=179) were examined. Correlations (p&gt;.01) with PSG were found for both PASP and ACT-Core for TST (r=.70, .69), SE (r=.33, .31), and WASO (r=-.19, -.24) respectively. Comparison of actigraphy devices to one another revealed correlations (p&gt;.01) for TST (r=.80), SE (r=.58), WASO (r=.68), and SL (r=.23).

Conclusion
This larger, prospective study across six-centers supports the use of actigraphy as a proxy measure of sleep quantity (TST, SE) in acute neurorehabilitation admissions with moderate to severe TBI. No relationship was found for SL with mixed findings for WASO. Sensitivity analyses with subsets of TBI survivors with comorbidities (sleep apnea, spasticity, muscle strength) may affect agreement and warrant further study.

Support (If Any)
PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015) for DVBIC, NIDILRR.
Dense Geographic and Genomic Sampling Reveals Paraphyly and a Cryptic Lineage in a Classic Sibling Species Complex
Authors: Linck Ethan , Epperly Kevin , Van Els Paul , Spellman Garth M , Bryson Robert W , McCormack John E , Canales-Del-Castillo Ricardo , Klicka John 
Published: April 2019

AbstractIncomplete or geographically biased sampling poses significant problems for research in phylogeography, population genetics, phylogenetics, and species delimitation. Despite the power of using genome-wide genetic markers in systematics and related fields, approaches such as the multispecies coalescent remain unable to easily account for unsampled lineages. The Empidonax difficilis/Empidonax occidentalis complex of small tyrannid flycatchers (Aves: Tyrannidae) is a classic example of widely distributed species with limited phenotypic geographic variation that was broken into two largely cryptic (or “sibling”) lineages following extensive study. Though the group is well-characterized north of the US Mexico border, the evolutionary distinctiveness and phylogenetic relationships of southern populations remain obscure. In this article, we use dense genomic and geographic sampling across the majority of the range of the E. difficilis/E. occidentalis complex to assess whether current taxonomy and species limits reflect underlying evolutionary patterns, or whether they are an artifact of historically biased or incomplete sampling. We find that additional samples from Mexico render the widely recognized species-level lineage E. occidentalis paraphyletic, though it retains support in the best-fit species delimitation model from clustering analyses. We further identify a highly divergent unrecognized lineage in a previously unsampled portion of the group’s range, which a cline analysis suggests is more reproductively isolated than the currently recognized species E.difficilis and E. occidentalis. Our phylogeny supports a southern origin of these taxa. Our results highlight the pervasive impacts of biased geographic sampling, even in well-studied vertebrate groups like birds, and illustrate what is a common problem when attempting to define species in the face of recent divergence and reticulate evolution.
Incidence of graft failure with Achilles tendon allograft combined with RetroScrewTM tibial fixation in primary anterior cruciate ligament reconstruction
Authors: Mantell Matthew , Fox Brad , Baker Matthew , Kappa Jason , Ho Anthony , Pandarinath Rajeev 
Published: April 2019

Background:
The purpose of this study was to determine the failure rate of primary anterior cruciate ligament (ACL) reconstruction with low-dose irradiated Achilles tendon allograft by a single surgeon using RetroscrewTM (Arthrex, Naples, FL) tibial fixation. The same surgical technique, source for the allograft tissue, and postoperative rehabilitation were used.

Methods:
Fifty patients undergoing primary ACL reconstruction with Achilles tendon allograft from 2010-2012 were available with a minimum of 2-years of follow-up. Patients were excluded if they had undergone previous ipsilateral knee surgery. The mean age was 31.3 yr old at the time of surgery. Patients were evaluated with International Knee Documentation Committee (IKDC) scores, subjective instability, and return to sports at latest follow-up. Failure was defined as need for revision ACL reconstruction based on subjective symptoms, objective physical findings of laxity on Lachman examination, and evidence of re-tear on MRI.

Results:
Twelve of the 51 operative knees had reruptures with continued instability (23.5%). There was no significant difference between the age of patients with intact (31) and patients with re-rupture (32.1; P=0.317). Patients presented with graft failure at an average of 1.65 yr postoperatively.

Conclusions:
The results of our study showed an unacceptably high rate of failure of irradiated fresh frozen Achilles allograft for primary ACL reconstruction using tibial Retroscrew fixation.
Seasonal changes in body composition in collegiate baseball players
Authors: Frantz Travis L. , Van Matre Brandon T. , Palmer Tyler S. , Ruiz Matthew D. 
Published: April 2019

Background:
Body composition is a growing concern in all sports, including baseball. This study was conducted to measure changes in body composition from the beginning of the season to the end and to determine if different changes occurred in position players compared to pitchers.

Methods:
Participants’ (n=29; age 19.90±1.14) body mass, body mass index (BMI), and percent body fat as estimated by skinfold calipers were recorded immediately before and after the baseball season.

Results:
There was a significant decrease in weight of nearly 1 kg (P=0.02) with a corresponding decrease in BMI (P=0.02) without a change in percent body fat (P=0.31). When examined by position, significant change in percent body fat did occur between position players (−0.9%) and pitchers (+0.2%). Specifically, pitchers had increased body fat in the triceps (P=0.04), subscapular (P=0.03), and suprailiac (P=0.04) regions when compared to position players.

Conclusions:
Body composition does change during the course of a baseball season, and these changes have the potential to impact performance and outcome measures as it relates to baseball. Principles of kinesiology suggest that it could significantly influence power, speed, agility, and quickness, but further study is needed to determine the practical on-field implications of the seasonal changes in body composition observed in baseball players.
Effect of chronic narcotic use on episode-of-care outcomes following primary anatomic total shoulder arthroplasty
Authors: Mayer Megan N. , Mulligan Ryan P. , Villarreal Arturo D. , Lonergan Timothy M. , Brolin Tyler J. , Azar Frederick M. , Throckmorton Thomas W. 
Published: April 2019

Background:
Bundled-care payments for total shoulder arthroplasty (TSA) make early outcomes relevant because they typically are tied to a 90-day episode-of-care. The purpose of this study was to determine the effect of chronic preoperative narcotic use on early postoperative pain relief, narcotic use, length of hospital stay, readmissions, and complications in patients with primary TSA.

Methods:
Chronic narcotic use was defined as use of narcotic pain medication for at least 3 mo before surgery. Narcotic use was converted to oral morphine equivalents (OME) for in-hospital use, discharge medications, and prescriptions at 2-, 6-, and 12-week visits. Statistical analyses used Fisher’s exact test for dichotomous variables and Student’s t-test for continuous variables. Differences with P<0.05 were considered statistically significant.

Results:
Of 152 patients with primary TSA, 27 were chronic preoperative narcotic users and 125 were not. There were no statistically significant differences between groups with regard to age, gender, laterality, or body mass index. At 2 wk postoperatively, there was no significant difference in visual analog scores VAS; however, at 6 and 12 wk, chronic narcotic users had significantly higher VAS and a significantly higher cumulative narcotic requirement. There were no significant differences in length of hospital stay, complications, or readmission rates.

Conclusions:
Chronic preoperative narcotic use is a risk factor for a more difficult postoperative course after TSA compared to that in narcotic-naïve patients. Chronic opioid users, however, do not necessarily require additional perioperative resources, which is relevant to risk stratification in the emergence of bundled payment programs for TSA.

Level of Evidence:
Level III, prognostic case-control study.
Quality of Life and 1-Year Survival in Patients With Early Septic Shock: Long-Term Follow-Up of the Australasian Resuscitation in Sepsis Evaluation Trial
Authors: Higgins Alisa M. , Peake Sandra L. , Bellomo Rinaldo , Cooper D. Jamie , Delaney Anthony , Harris Anthony H. , Howe Belinda D. , Nichol Alistair D. , Webb Steve A. , Williams Patricia J. 
Published: April 2019

Objectives:
To examine long-term survival and quality of life of patients with early septic shock.

Design:
Prospective, randomized, parallel-group trial.

Setting:
Fifty-one hospitals in Australia, New Zealand, Finland, Hong Kong, and the Republic of Ireland.

Patients:
One-thousand five-hundred ninety-one patients who presented to the emergency department with early septic shock between October 2008 and April 2014, and were enrolled in the Australasian Resuscitation in Sepsis Evaluation trial.

Interventions:
Early goal-directed therapy versus usual care.

Measurements and Main Results:
Long-term survival was measured up to 12 months postrandomization. Health-related quality of life was measured using the EuroQoL-5D-3L, Short Form 36 and Assessment of Quality of Life 4D at baseline, and at 6 and 12 months following randomization. Mortality data were available for 1,548 patients (97.3%) and 1,515 patients (95.2%) at 6 and 12 months, respectively. Health-related quality of life data were available for 85.1% of survivors at 12 months. There were no significant differences in mortality between groups at either 6 months (early goal-directed therapy 21.8% vs usual care 22.6%; p = 0.70) or 12 months (early goal-directed therapy 26.4% vs usual care 27.9%; p = 0.50). There were no group differences in health-related quality of life at either 6 or 12 months (EuroQoL-5D-3L utility scores at 12 mo early goal-directed therapy 0.65 ± 0.33 vs usual care 0.64 ± 0.34; p = 0.50), with the health-related quality of life of both groups being significantly lower than population norms.

Conclusions:
In patients presenting to the emergency department with early septic shock, early goal-directed therapy compared with usual care did not reduce mortality nor improve health-related quality of life at either 6 or 12 months.
Association Between Mean Arterial Pressure and Acute Kidney Injury and a Composite of Myocardial Injury and Mortality in Postoperative Critically Ill Patients: A Retrospective Cohort Analysis
Authors: Khanna Ashish K. , Maheshwari Kamal , Mao Guangmei , Liu Liu , Perez-Protto Silvia E. , Chodavarapu Praneeta , Schacham Yehoshua N. , Sessler Daniel I. 
Published: April 2019

Objectives:
Hypotension thresholds that provoke renal injury, myocardial injury, and mortality in critical care patients remain unknown. We primarily sought to determine the relationship between hypotension and a composite of myocardial injury (troponin T ≥ 0.03 ng/mL without nonischemic cause) and death up to 7 postoperative days. Secondarily, we considered acute kidney injury (creatinine concentration ≥ 0.3 mg/dL or 1.5 times baseline).

Design:
Retrospective cohort.

Setting:
Surgical ICU at an academic medical center.

Patients:
Two-thousand eight-hundred thirty-three postoperative patients admitted to the surgical ICU.

Interventions:
A Cox proportional hazard survival model was used to assess the association between lowest mean arterial pressure on each intensive care day, considered as a time-varying covariate, and outcomes. In sensitivity analyses hypotension defined as pressures less than 80 mm Hg and 70 mm Hg were also considered.

Measurements and Main Results:
There was a strong nonlinear (quadratic) association between the lowest mean arterial pressure and the primary outcome of myocardial injury after noncardiac surgery or mortality, with estimated risk increasing at lower pressures. The risk of myocardial injury after noncardiac surgery or mortality was an estimated 23% higher at the 25th percentile (78 mm Hg) of lowest mean arterial pressure compared with at the median of 87 mm Hg, with adjusted hazard ratio (95% CI) of 1.23 (1.12–1.355; p < 0.001). Overall results were generally similar in sensitivity analyses based on every hour of mean arterial pressure less than 80 mm Hg and any mean arterial pressure less than 70 mm Hg. Post hoc analyses showed that the relationship between ICU hypotension and outcomes depended on the amount of intraoperative hypotension. The risk of acute kidney injury increased over a range of minimum daily pressures from 110 mm Hg to 50 mm Hg, with an adjusted hazard ratio of 1.27 (95% CI, 1.18–1.37; p < 0.001).

Conclusions:
Increasing amounts of hypotension (defined by lowest mean arterial pressures per day) were strongly associated with myocardial injury, mortality, and renal injury in postoperative critical care patients.
Staged Implementation of Awakening and Breathing, Coordination, Delirium Monitoring and Management, and Early Mobilization Bundle Improves Patient Outcomes and Reduces Hospital Costs*
Authors: Hsieh S. Jean , Otusanya Olufisayo , Gershengorn Hayley B. , Hope Aluko A. , Dayton Christopher , Levi Daniela , Garcia Melba , Prince David , Mills Michele , Fein Dan , Colman Silvie , Gong Michelle Ng 
Published: April 2019

Objectives:
To measure the impact of staged implementation of full versus partial ABCDE bundle on mechanical ventilation duration, ICU and hospital lengths of stay, and cost.

Design:
Prospective cohort study.

Setting:
Two medical ICUs within Montefiore Healthcare Center (Bronx, NY).

Patients:
One thousand eight hundred fifty-five mechanically ventilated patients admitted to ICUs between July 2011 and July 2014.

Interventions:
At baseline, spontaneous (B)reathing trials (B) were ongoing in both ICUs; in period 1, (A)wakening and (D)elirium (AD) were implemented in both full and partial bundle ICUs; in period 2, (E)arly mobilization and structured bundle (C)oordination (EC) were implemented in the full bundle (B-AD-EC) but not the partial bundle ICU (B-AD).

Measurements and Main Results:
In the full bundle ICU, 95% patient days were spent in bed before EC (period 1). After EC was implemented (period 2), 65% of patients stood, 54% walked at least once during their ICU stay, and ICU-acquired pressure ulcers and physical restraint use decreased (period 1 vs 2: 39% vs 23% of patients; 30% vs 26% patient days, respectively; p < 0.001 for both). After adjustment for patient-level covariates, implementation of the full (B-AD-EC) versus partial (B-AD) bundle was associated with reduced mechanical ventilation duration (–22.3%; 95% CI, –22.5% to –22.0%; p < 0.001), ICU length of stay (–10.3%; 95% CI, –15.6% to –4.7%; p = 0.028), and hospital length of stay (–7.8%; 95% CI, –8.7% to –6.9%; p = 0.006). Total ICU and hospital cost were also reduced by 24.2% (95% CI, –41.4% to –2.0%; p = 0.03) and 30.2% (95% CI, –46.1% to –9.5%; p = 0.007), respectively.

Conclusions:
In a clinical practice setting, the addition of (E)arly mobilization and structured (C)oordination of ABCDE bundle components to a spontaneous (B)reathing, (A)wakening, and (D) elirium management background led to substantial reductions in the duration of mechanical ventilation, length of stay, and cost.