bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic Indicators of Yang’s Arthroscopic Technique for Management of Temporomandibular Joint Anterior Disc Displacement: Part 1- Clinical Predictors.
Authors: Sah Manoj Kumar , Abdelrehem Ahmed , Chen Shihui , Shen Pei , Jiao ZiXian , Hu Ying Kai , Yang Chi
Published: September 2021

In order to optimize the patient selection for specific treatment modality and to achieve favorable treatment outcomes, prognostic indicators impacting the results are important to analyze. This longitudinal retrospective study aimed to analyze various prognostic factors impacting the surgical outcomes following Yang’s arthroscopic discopexy for management of temporomandibular joint anterior disc displacement using success criteria based on pain, maximal interincisal opening, diet, and quality of life. Furthermore, a quantitative MRI assessment of disc position and condylar height was performed pre- and postoperatively. Multinomial analysis was used to evaluate various prognostic variables including gender, age, duration of illness, Wilkes staging, parafunctional habits, and splint/orthodontic therapy. A total of 169 patients (234 joints) were included. The outcome was categorized as excellent (n = 67/39.6%), good (n = 72/42.6%), improved (n = 22/13.01%) or poor (n = 8/4.73%) with a success rate of 95.26%. Patients aged from 11–15 years old were significantly more likely to be in the good outcome group (odds ratio (OR), 0.20; P < 0.05). Also, patients with shorter duration of illness (OR, 0.29; P < 0.05) and with Wilkes stage III (OR, 0.11; P < 0.05) were more likely to be in the improved outcome group. Better outcomes can be achieved at younger patients with shorter disease history and earlier Wilkes staging.
Comparative Transcriptome and Metabolome Analyses Reveal the Methanol Dissimilation Pathway of Pichia Pastoris
Authors: Yu Yi-fan , Yang Jiashuo , Zhao Fengguang , Lin Ying , Han Shuangyan
Published: September 2021

Background: Pichia pastoris (Komagataella phaffii) is a model organism widely used for the recombinant expression of eukaryotic proteins, and it can metabolize methanol as its sole carbon and energy source. Methanol is oxidized to formaldehyde by alcohol oxidase (AOX), which is further metabolized either in the assimilation or dissimilation pathway. In the dissimilation pathway, formaldehyde is oxidized to CO2 by formaldehyde dehydrogenase (FLD), S-hydroxymethyl glutathione hydrolase (FGH) and formate dehydrogenase (FDH). In addition, formaldehyde induces DNA-protein crosslinks (DPCs). Formaldehyde dehydrogenase is critical to minimize formaldehyde-mediated DNA lesions. Although phenotypes have been studied in engineered strains by modified dissimilation, there is a clear lack of systematic studies at the whole-omics level, especially transcriptomics and metabolomics.Results: Focusing on the dissimilation pathway being cut off, we compared the transcriptomes and metabolomes from a formaldehyde dehydrogenase-deficient strain (Δfld), an S-hydroxymethyl glutathione dehydrogenase-deficient strain (Δfgh), a formate dehydrogenase deficient-strain (Δfdh) and the wild type (GS115). First, the differences between strains were most apparent after FLD knockout. When methanol was used as the sole carbon source, the differential metabolites between GS115 and Δfld were mainly enriched in ABC transporters, amino acid biosynthesis, and protein digestion and absorption. Second, analysis of differentially expressed genes (DEGs) between knockout and wild type strains under methanolic incubation showed that oxidative phosphorylation, glycolysis and the TCA cycle were downregulated, while proteasomes, autophagy and peroxisomes were upregulated. Transcription of alcohol metabolism was upregulated. It is worth noting that the degree of variation was positively correlated with the gene order of dissimilation pathway knockdown. In addition, there were significant differences in amino acid metabolism and glutathione redox cycling that raised our concerns about formaldehyde sorption in cells.Conclusions: This is the first time that integrity of dissimilation pathway analysis was carried out in Pichia pastoris on the basis of transcriptomics and metabolomics. Truncation of the dissimilation pathway affected methanol metabolism, and knockdown of FLD impaired formaldehyde assimilation. The significant downregulation of oxidative phosphorylation may reveal that FLD and FGH are key enzymes in the energy utilization of cellular methanol metabolism. In addition, formaldehyde can not only bind glutathione but also react with amino acids, especially cysteine. The upregulation of the proteasome and autophagy may solve the problem of DNA-protein crosslinking caused by formaldehyde.
Diamondoids and Thiadiamondoids Generated From Hydrothermal Pyrolysis of Crude Oil and TSR Experiments
Authors: Peng Yanyan , Cai Chunfang , Fang Chenchen , Wu Liangliang , Liu Jinzhong , Sun Peng , Liu Dawei
Published: September 2021

Diamondoid compounds are widely used to reflect thermal maturation of high mature source rocks or oils and oil cracking extents. However, diamondoids and thiadiamondoids were demonstrated to have newly been generated and decomposed in our hydrothermal pyrolysis of crude oil and TSR experiments. Our results show that adamantanes and diamantanes are generated primarily within the maturity range 0.48–2.1% and 1.2–3.0% EasyRo, respectively. Their formation is enhanced and the decomposition of diamantanes obviously lags behind at elevated temperatures compared with anhydrous experiments. MDI, EAI, DMAI-1, DMDI-2 may serve as reliable maturity proxies at > ca.1.0% EasyRo, and other isomerization indices (TMAI-1, TMAI-2 and DMAI-2) are effective for the highly mature organic matter at EasyRo > 2.0%. The extent of oil cracking (EOC) calculated from the broadly used 3-+4-MD method (Dahl et al., 1999) is proven to overestimate, especially for highly cracked samples due to the new generation of 3-+4-MD. Still, it can be corrected using a new formula at <3.0% EasyRo. Other diamondoid-related indices (e.g. EAI, DMDI-2, As/Ds, MAs/MDs, DMAs/DMDs, and DMAs/MDs) can also be used to estimate EOC. However, these indices cannot be applied to TSR-altered petroleum. TSR is experimentally confirmed to generate diamantanes and thiaadmantanes at 1.81% EasyRo via direct reactions of reduced S species with hydrocarbons and accelerate the decomposition of diamantanes at > 3.0% EasyRo compared with thermal chemical alteration (TCA).
Comparison of radiomic pre-processing steps in the reproducible prediction of disease free survival across multi-scanners/centers
Authors: Ferreira Marta , Lovinfosse Pierre , Hermesse Johanne , Decuypere Marjolein , Rousseau Caroline , Lucia François , Schick Ulrike , Reinhold Caroline , Robin Philippe , Hatt Mathieu , Visvikis Dimitris , Bernard Claire , Leijenaar Ralph T.H. , Kridelka Frédéric , Lambin Philippe , Hustinx Roland , Meyer Patrick E.
Published: September 2021

Background

Features reproducibility and the generalizability of the models are currently among the most important limitations when integrating radiomics into the clinics. Radiomic features are sensitive to imaging acquisition protocols, reconstruction algorithms and parameters, as well as by the different steps of the usual radiomics workflow. We propose a framework for comparing the reproducibility of different pre-processing steps in PET/CT radiomic analysis in the prediction of disease free survival (DFS) across multi-scanners/centers.
Results

We evaluated and compared the prediction performance of several models that differ in i) the type of intensity discretization, ii) feature selection method, iii) features type i.e, original or tumour to liver ratio radiomic features (OR or TLR). We trained our models using data from one scanner/center and tested on two external scanner/centers. Our results show that there is a low reproducibility in predictions across scanners and discretization methods. Despite of this, TLR based models were generally more robust than OR. Maximum relevance minimum redundancy (MRMR) forward feature selection with Pearson correlation was the feature selection method that had the best mean area under the precision recall curve when using it combining the features from all discretization’s bin’s number (D_All_FBN) with TLR features for two of the four classifiers.
Conclusion

We evaluated and compared the prediction performance of several models in a data set containing hundred fifty-eight patients with locally advanced cervical cancer (LACC) from three distinct scanners. In our cohort of LAAC patients pre-processing of radiomic features in [18F]FDG PET affects DFS predictions performances across scanners and combining the D_All_FBN TLR approach with the MRMR forward Pearson feature selection method might help increasing robustness of radiomic studies.
Differences in the stemness characteristics and molecular markers of distinct human oral tissue neural crest-derived multilineage cells
Authors: Abe Shigehiro , Kaida Atsushi , Nakazato Keiichiro , Yokomizo Naoko , Kobayashi Yutaka , Miura Masahiko , Miki Toshio , Hidai Chiaki , Kitano Hisataka , Yoda Tetsuya
Published: September 2021

Background
Although multilineage cells derived from oral tissue, especially the dental pulp, apical papilla, periodontal ligament, and oral mucosa, have neural crest-derived stem cell (NCSC)-like properties, the differences in the characteristics of these progenitor cell compartments remain unknown. The primary aim of the current study was to elucidate these differences.
Methods
Multilineage sphere-forming apical papilla-derived cells (APDCs), periodontal ligament-derived cells (PDLDCs), and oral mucosa stroma-derived cells (OMSDCs) from the same individuals were isolated from impacted developing teeth. All sphere-forming cells were characterized by biological analyses of stem cells. Additionally, composites of these cells and multiporous hydroxyapatite scaffolds were transplanted into immunocompromised mice.
Results
All sphere-forming cells expressed neural crest-related markers. Although APDCs and PDLDCs showed greater mineralized-cell differentiation, they exhibited poorer differentiation into adipocytes in vitro than OMSDCs. In immunocompromised mice, APDCs were better able to form hard tissues than PDLDCs and OMSDCs. Moreover, the expression of certain tissue-specific markers, such as CD24 and CD56 (NCAM1), differed among the tissue-derived cells. Surprisingly, the expression of only CD24 and CD56 could be discriminated among human tissues.
Conclusions
Our results suggest that although cells having NCSC-like properties present the same phenotype, they differ in the expression of certain markers and differentiation abilities. The present study is the first to demonstrate the differences in differentiation ability and molecular markers among multilineage human APDCs, PDLDCs, and OMSDCs obtained from the same patients and, concomitantly, the same sites and identify these tissue-specific markers in the human tooth developmental process.
Active Earth Pressure Against Flexible Retaining Wall For Finite Soils Under The Drum Deformation Mode
Authors: Weidong Hu , Xinnian Zhu , Yongqing Zeng , Liu Xiaohong , Chucai Peng
Published: September 2021

A reasonable method is proposed to calculate the active earth pressure of finite soils based on the drum deformation mode of the flexible retaining wall close to the basement’s outer wall. The flexible retaining wall with cohesionless sand is studied, and the ultimate failure angle of finite soils close to the basement’s outer wall is obtained using the Coulomb theory. Soil arch theory is led to get the earth pressure coefficient in the subarea using the trace line of minor principal stress of circular arc after stress deflection. The soil layers at the top and bottom part of the retaining wall are restrained when the drum deformation occurs, and the soil layers are in a non-limit state. The linear relationship between the wall movement’s magnitude and the mobilization of the internal friction angle and the wall friction anger is presented. The level layer analysis method is modified to propose the resultant force of active earth pressure, the action point’s height, and the pressure distribution. Model tests are carried out to emulate the process of drum deformation and soil rupture with limited width. Through image analysis, it is found that the failure angle of soil within the limited width is larger than that of infinite soil. With the increase of the aspect ratio, the failure angle gradually reduces and tends to be constant. Compared with the test results, it is showed that the horizontal earth pressure reduces with the reduction of the aspect ratio within critical width, and the resultant force decreases with the increase of the limit state region under the same ratio. The middle part of the distribution curve is concave. The active earth pressure strength decreases less than Coulomb’s value, the upper and lower soil layers are in the non-limit state, and the active earth pressure strength is more than Coulomb’s value.
Phenylboronic acid modification augments the lysosome escape and antitumor efficacy of a cylindrical polymer brush-based prodrug
Authors: Wang Ruonan , Yin Changfeng , Liu Changren , Sun Ying , Xiao Panpan , Li Jia , Yang Shuo , Wu Wei , Jiang Xiqun
Published: September 2021

Timely lysosome escape is very important for nanomedicines to avoid premature degradation. Herein, we report an exciting finding that phenylboronic acid (PBA) modification can greatly facilitate the lysosome escape of cylindrical polymer brushes (CPBs), and further promote their exocytosis and transcellular transfer. This fundamental finding for the first time reveals that PBA groups improve the tumor penetration of nanomaterials via an active transcytosis mechanism. We speculate that the mechanism of the PBA-enhanced lysosome escape is associated with the specific interactions of the PBA group with the lysosomal membrane proteins and hot shock proteins. The featured advantage of the PBA modification over the known lysosome escape strategies is that it does not cause significant adverse effects on the properties of the CPBs. Furthermore, doxorubicin was conjugated to the PBA-modified CPBs with drug loading content larger than 20%. This CPBs-based prodrug could eradicate the tumors established in mice by multiple intravenous administration.
Transport in Fusion Plasmas: Is the Tail Wagging the Dog?
Authors: Dif-Pradalier Guilhem , Ghendrih Philippe , Sarazin Yanick , Caschera Elisabetta , Clairet Frederic , Camenen Yann , Garbet Xavier , Grandgirard Virginie , Munschy Yann , Vermare Laure , Widmer Fabien
Published: September 2021

Turbulent plasmas notably self-organize to higher energy states upon application of additional free energy sources or modification of edge operating conditions. Mechanisms whereby such bifurcations occur have been actively debated for decades, mostly on the basis of reduced models. Here we unravel a surprising causal chain of events in the onset of an improved confinement state, by applying generic entropy-based and information theoretic measures to the primitive kinetic equations. Interfacial contamination of a large, stable region (the ‘dog’) by locally-borne peripheral turbulent fluctuations (the ‘tail’) is found to be central to explaining transport properties, globally. These results, highly relevant to the quest for magnetic fusion advocate the use of such data-driven methods to many problems in fluids and plasmas where interfacial turbulent contamination is active.
Extracellular Vesicle-derived miR-320a Targets ZC3H12B to Inhibit Tumorigenesis, Invasion, and Angiogenesis in Ovarian Cancer
Authors: Huang Yan , Xu Midie , Jing Chuyu , Wu Xiaohua , Chen Xiaojun , Zhang Wei
Published: September 2021

Extracellular vesicles (EVs) play crucial roles in intercellular communication. miRNAs derived from EVs emerge as promising diagnostic indicators and therapeutic targets in a variety of malignancies. Tremendous studies have revealed the function of miRNAs derived from EVs in tumorigenesis, metastasis and other aspects. The mechanism of action of EV-derived miRNAs, however, in ovarian cancer remains largely unknown. In this study, EVs were enriched from the ovarian cancer cell lines. EVs as a whole could promote cell proliferation, invasion and new vasculature formation. However, the down-regulated EV-derived miR-320a was demonstrated to potentially suppress tumorigenesis, metastasis and angiogenesis. . Moreover, EV-derived miR-320a has been proved to directly regulate a previously unknown target, ZC3H12B. An unreported role of ZC3H12B in promoting ovarian cancer cell proliferation has been elucidated and miR-320a could mediate the expression of ZC3H12B, thereby inhibiting the downstream response. As for the practical clinic values, lower expression of EV-derived miR-320a correlates with shorter survival period, indicating that EV-derived miR-320a may also serve as a prognostic biomarker in ovarian cancer. This research provides new insight into the molecular mechanism of EV-derived miR-320a in ovarian cancer and may provide new therapeutic and prognostic strategies for ovarian cancer treatment.
Complete Mitogenome of Endangered and Endemic Nicobar Treeshrew (Tupaia Nicobarica) and Comparison with Other Scandentians
Authors: Kundu Shantanu , Pakrashi Avas , Kamalakannan Manokaran , Singha Devkant , Tyagi Kaomud , Venkatraman Chinnadurai , Kumar Vikas
Published: September 2021

The Nicobar treeshrew (Tupaia nicobarica) is an endangered smaller mammal endemic to the Nicobar Island of the Andaman Sea, India regarded as an alternative experimental animal model in biomedical research. The present study aimed to assemble the first mitochondrial genome of T. nicobarica to elucidate evolutionary relationship. The structure and variation of the novel mitochondrial genome were analyzed and compared with other Scandentians. The complete mitogenome (17,164 bp) encodes 37 genes, including 13 protein-coding genes (PCGs), 22 transfer RNA (tRNAs), two ribosomal RNA (rRNAs), and one control region (CR). Most of the genes were encoded on majority strand, except nad6 and eight tRNAs. The nonsynonymous/synonymous ratio in all PCGs indicates strong negative selection among all Tupaiidae species. The comparative study of CRs revealed the occurrence of tandem repeats (CGTACA) found in T. nicobarica. The phylogenetic analyses (ML and BA) showed distinct clustering of T. nicobarica with high branch supports and depict a substantial divergence time (11.4 to 18.8 MYR) from the ancestor lineage of Tupaiidae. The 16S rRNA dataset corroborates the taxonomic rank of two subspecies of T. nicobarica from the Great and Little Nicobar Islands. The present study suggests the assembly of whole-genome to improve the understanding of evolutionary relationships of treeshrews and its implication in biomedical research.
Fire Can Reduce Thorn Damage by the Invasive Callery Pear Tree
Authors: Coyle David R. , Williams Brayden M. , Hagan Donald L.
Published: September 2021

Callery pear (Pyrus calleryana) is an invasive tree across much of the eastern United States that can form dense thickets, and tree branches and stems are often covered in sharp thorns. Landowners and land managers attempting to manage callery pear infestations are faced with the challenge of killing and/or removing the trees while also avoiding thorn damage to equipment, which can lead to wasted time and increased costs. We evaluated fire as management tool to reduce the likelihood of equipment damage from callery pear thorns. Branches were collected in the field from callery pear trees that were killed by herbicide, and also from untreated trees, and half the branches from each group were then burned with a propane garden torch to simulate a low-intensity prescribed fire. After treatment, all branches were returned either to an old field or forest floor for 1 year, after which thorn puncture strength was evaluated and compared with freshly cut thorns. Herbicide treatment and location did not affect thorn strength, but burning reduced the likelihood that thorns would puncture a tire. Fire increased tip width, which reduced thorn sharpness. Burning also reduced wood strength, and fungi proliferated on burned thorns after 1 year in the field or forest. Both factors likely contributed to decreasing thorn strength and probability of puncture. Our results show that using prescribed fire as a management tool can weaken callery pear thorns and dull their tips, reducing the chance of equipment damage and costs associated with clearing land of this invasive species. Leaving cut callery pear trees on the ground for 1 year increased fungal colonization, which may also reduce thorn damage. Prescribed fire can be part of an effective integrated management plan for this, and possibly other, thorny invasive flora.
Brand effects of omnichannel-based pickup service on consumption value and service satisfaction
Authors: Hee Lee Kyoung , Kim Boyoung
Published: September 2021

As an online and offline integrated service of refund, replacement, and after-sales service, omnichannel is placing itself as a major service used in the online shopping market, as efficiency and an integrated operation system develop according to channel integration due to ICT development. Centered on young people who have recently put importance on in-store experience and direct experience, offline pickup service is reinforced beyond online delivery. This study aims to analyze the effects of a distribution company’s brand factors on customer consumption value and satisfaction targeting the omnichannel-based pickup service. The research model was designed to find out whether brand image, identity, attachment, and trust factors affect consumption satisfaction factors through the intervention of emotional and functional consumption value factors. This study targeted 324 consumers using Korea’s omnichannel-based pickup service and carried out a questionnaire survey. According to the analysis result, the brand image and brand identity had a positive (+) effect on the emotional value and functional value. Brand attachment and brand trust positively affected emotional value but the hypothesis on functional value was rejected. Hence, brand factors were confirmed to work on improving a consumer’s emotional value effectively.
Liquidity, leverage, and solvency: What affects profitability of industrial enterprises the most?
Authors: D. Ayoush Maha , A. Toumeh Ahmad , I. Shabaneh Khaled
Published: September 2021

The purpose of this paper is to show the relative impact of liquidity, leverage, and solvency on profitability of industrial enterprises listed on the Amman Stock Exchange to ascertain which of them has the most effect on profitability. To reach the objectives of this study, 44 Jordanian industrial companies are examined from 2012 to 2018. Return on assets (ROA) and return on equity (ROE) are examined as measures of performance, current ratio and quick ratio as measures of liquidity, debt ratio and debt to equity ratio as measures of leverage, and the interest coverage ratio as a measure of financial solvency. Multiple regression analysis was used to check the hypotheses. A negative and statistically significant impact was found at the 1% level between financial leverage and profitability. At the same time, findings did not show the same for the effect of liquidity and solvency on profitability. In addition, leverage has the highest relative impact among independent variables on profitability, followed by solvency and then liquidity. Moreover, it is indicated that company size is a control variable of the effect between liquidity, leverage, and solvency on performance. Thus, it is concluded that management of industrial companies should reduce dependence on debt to finance companies to achieve the highest possible returns; it is recommended to maintain an acceptable level of liquidity to ensure the continuity of companies and attention to the level of solvency within companies to maintain a high financial performance.
Discovery of Antioxidant Peptides from Amphibians: A Review
Authors: Feng Guizhu , Wu Jing , Yang Hai-Long , Mu Lixian
Published: September 2021

In recent years, bioactive peptide drugs have attracted growing attention due to the increasing
difficulty in developing new drugs with novel chemical structures. In addition, many diseases
are linked to excessive oxidation in the human body. Therefore, the role of peptides with antioxidant
activity in counteracting diseases related to oxidative stress is worth exploring. Amphibians
are a major repository for bioactive peptides that protect the skin from biotic and abiotic
stresses, such as microbial infection and radiation injury. We characterized the first amphibian-
derived gene-encoded antioxidant peptides in 2008. Since then, a variety of antioxidant
peptides have been detected in different amphibian species. In this work, the physicochemical properties
of antioxidant peptides identified from amphibians are reviewed for the first time, particularly
acquisition methods, amino acid characteristics, antioxidant mechanisms, and application
prospects. This review should provide a reference for advancing the identification, structural analysis,
and potential therapeutic value of natural antioxidant peptides.
Anti-inflammatory Effects of Mesenchymal Stem Cells and their Secretomes
in Pneumonia
Authors: Li Zongjin , Hezam Kamal , Mo Rigen , Wang Chen , Liu Yue
Published: September 2021

:

Mesenchymal stem cells (MSCs) are multipotent progenitor cells that play crucial roles in the microenvironment of injured tissues. The potential therapeutics of MSCs have attracted extensive attention for several diseases such as acute respiratory distress syndrome (ARDS) and novel coronavirus disease 2019 (COVID-19) pneumonia. MSC-extracellular vesicles have been isolated from MSC-conditioned media (MSC-CM) with similar functional effects as parent MSCs. The therapeutic role of MSCs can be achieved through the balance between the inflammatory and regenerative microenvironments. Clinical settings of MSCs and their extracellular vesicles remain promising for many diseases, such as ARDS and pneumonia. However, their clinical applications remain limited due to the cost of growing and storage facilities of MSCs with a lack of standardized MSC-CM. This review highlights the proposed role of MSCs in pulmonary diseases and discusses the recent advances of MSC application for pneumonia and other lung disorders.
Access, Use, and Patient-Reported Experiences of Emergency Care During the COVID-19 Pandemic: Population-Based Survey
Authors: Gray Jodi , Partington Andrew , Karnon Jonathan
Published: September 2021

Background

An increase in the number of people presenting to emergency departments (EDs) is contributing to ED overcrowding. In the early stages of the COVID-19 pandemic, there was a significant reduction in the number of ED presentations in Australia, creating an opportunity to learn from patients’ experiences of alternative management options.

Objective

The aim of this study is to report on the use and experience of health services by Australian adults experiencing a health issue during the COVID-19 pandemic for which they would have presented at an ED prior to the pandemic.

Methods

An online survey was conducted in May 2020. Reported health issues were categorized using an existing classification system. Data collected included demographics, care pathways, levels of concern at times of health issue and survey completion, and patient-reported experiences with care.

Results

A total of 1289 eligible respondents completed the survey. Almost 25% (309/1289) of respondents avoided an ED presentation, of which 58% (179/309) used an alternative form of health care and 42% (130/309) self-managed. Respondents making face-to-face or telehealth appointments with their general practitioner (GP) reported high levels of ED avoidance (135/286, 47%) and mostly positive experiences of care provided by GPs. A high proportion of those who self-managed reported high levels of concern at the time of completing the survey (42/130, 32%).

Conclusions

Telehealth consultations with GPs may be a more promotable alternative to the ED beyond the COVID-19 pandemic, providing easier access to a doctor with access to patients’ medical histories than an appointment for a face-to-face consultation. GP telehealth consultations may also address barriers to accessing health care for those with potentially the greatest need. The reported use and positive experiences with GP telehealth appointments should inform further research on their appropriateness as an alternative to the ED.
Reducing Delays in Diagnosing Primary Immunodeficiency Through the Development and Implementation of a Clinical Decision Support Tool: Protocol for a Quality Improvement Project
Authors: Kumar Bharat , Zetumer Samuel , Swee Melissa , Endelman Ellen L Keyser , Suneja Manish , Davis Benjamin
Published: September 2021

Background

Primary immunodeficiencies (PIs) are a set of heterogeneous chronic disorders characterized by immune dysfunction. They are diagnostically challenging because of their clinical heterogeneity, knowledge gaps among primary care physicians, and continuing shortages of clinically trained immunologists. As a result, patients with undiagnosed PIs are at increased risk for recurrent infections, cancers, and autoimmune diseases.

Objective

The aim of this research is to develop and implement a clinical decision support (CDS) tool for the identification of underlying PIs.

Methods

We will develop and implement a CDS tool for the identification of underlying PIs among patients who receive primary care through a health care provider at the University of Iowa Hospitals and Clinics. The CDS tool will function through an algorithm that is based on the Immune Deficiency Foundation’s 10 Warning Signs for Primary Immunodeficiency. Over the course of a year, we will use Lean Six Sigma principles and the Define, Measure, Analyze, Improve, and Control (DMAIC) framework to guide the project. The primary measure is the number of newly diagnosed PI patients per month. Secondary measures include the following: (1) the number of new patients identified by the CDS as being at high risk for PI, (2) the number of new PI cases in which immunoglobulin replacement or rotating antibiotics are started, (3) the cost of evaluation of each patient identified by the CDS tool as being at high risk for PIs, (4) the number of new consults not diagnosed with a PI, and (5) patient satisfaction with the process of referral to the Immunology Clinic.

Results

This study was determined to not be Human Subjects Research by the Institutional Review Board at the University of Iowa. Data collection will begin in August 2021.

Conclusions

The development and implementation of a CDS tool is a promising approach to identifying patients with underlying PI. This protocol assesses whether such an approach will be able to achieve its objective of reducing diagnostic delays. The disciplined approach, using Lean Six Sigma and the DMAIC framework, will guide implementation to maximize opportunities for a successful intervention that meets the study’s goals and objectives as well as to allow for replication and adaptation of these methods at other sites.

International Registered Report Identifier (IRRID)

PRR1-10.2196/32635
User Experiences of the NZ COVID Tracer App in New Zealand: Thematic Analysis of Interviews (Preprint)
Authors: Tretiakov Alexei , Hunter Inga
Published: September 2021

BACKGROUND

For mobile app–based COVID-19 contact tracing to be fully effective, a large majority of the population needs to be using the app on an ongoing basis. However, there is a paucity of studies of users, as opposed to potential adopters, of mobile contact tracing apps and of their experiences. New Zealand, a high-income country with western political culture, was successful in managing the COVID-19 pandemic, and its experience is valuable for informing policy responses in similar contexts.

OBJECTIVE

This study asks the following research questions: (1) How do users experience the app in their everyday contexts? and (2) What drives the use of the app?

METHODS

Residents of New Zealand’s Auckland region, which encompasses the country’s largest city, were approached via Facebook, and 34 NZ COVID Tracer app users were interviewed. Interview transcripts were analyzed using thematic analysis.

RESULTS

Interviews ranged in duration from 15 to 50 minutes. Participants ranged in age from those in their late teens to those in their early sixties. Even though about half of the participants identified as White New Zealanders of European origin, different ethnicities were represented, including New Zealanders of South Pacific, Indian, Middle Eastern, South American, and Southeast Asian descent. Out of 34 participants, 2 (6%) identified as Māori (Indigenous New Zealanders). A broad range of careers were represented, from top-middle management to health support work and charity work. Likewise, educational backgrounds ranged broadly, from high school completion to master’s degrees. Out of 34 participants, 2 (6%) were unemployed, having recently lost their jobs because of the pandemic. The thematic analysis resulted in five major themes: perceived benefits, patterns of use, privacy, social influence, and need for collective action. Benefits of using the app to society in general were more salient to the participants than immediate health benefits to the individual. Use, however, depended on the alert level and tended to decline for many participants at low alert levels. Privacy considerations played a small role in shaping adoption and use, even though the participants were highly aware of privacy discourse around the app. Participants were aware of the need for high levels of adoption and use of the app to control the pandemic. Attempts to encourage others to use the app were common, although not always successful.

CONCLUSIONS

Appeals to civic responsibility are likely to drive the use of a mobile contact tracing app under the conditions of high threat. Under the likely scenario of COVID-19 remaining endemic and requiring ongoing vigilance over the long term, other mechanisms promoting the use of mobile contact tracing apps may be needed, such as offering incentives. As privacy is not an important concern for many users, flexible privacy settings in mobile contact tracing apps allowing users to set their optimal levels of privacy may be appropriate.
The Pandemic Year 2020: World Map of Coronavirus Research (Preprint)
Authors: Klingelhöfer Doris , Braun Markus , Brüggmann Dörthe , Groneberg David A
Published: September 2021

BACKGROUND

SARS-CoV-2 is one of the most threatening pandemics in human history. As of the date of this analysis, it had claimed about 2 million lives worldwide, and the number is rising sharply. Governments, societies, and scientists are equally challenged under this burden.

OBJECTIVE

This study aimed to map global coronavirus research in 2020 according to various influencing factors to highlight incentives or necessities for further research.

METHODS

The application of established and advanced bibliometric methods combined with the visualization technique of density-equalizing mapping provided a global picture of incentives and efforts on coronavirus research in 2020. Countries’ funding patterns and their epidemiological and socioeconomic characteristics as well as their publication performance data were included.

RESULTS

Research output exploded in 2020 with momentum, including citation and networking parameters. China and the United States were the countries with the highest publication performance. Globally, however, publication output correlated significantly with COVID-19 cases. Research funding has also increased immensely.

CONCLUSIONS

Nonetheless, the abrupt decline in publication efforts following previous coronavirus epidemics should demonstrate to global researchers that they should not lose interest even after containment, as the next epidemiological challenge is certain to come. Validated reporting worldwide and the inclusion of low-income countries are additionally important for a successful future research strategy.
Health Care Students’ Perspectives on Artificial Intelligence: Countrywide Survey in Canada (Preprint)
Authors: Teng Minnie , Singla Rohit , Yau Olivia , Lamoureux Daniel , Gupta Aurinjoy , Hu Zoe , Hu Ricky , Aissiou Amira , Eaton Shane , Hamm Camille , Hu Sophie , Kelly Dayton , MacMillan Kathleen M , Malik Shamir , Mazzoli Vienna , Teng Yu-Wen , Laricheva Maria , Jarus Tal , Field Thalia S
Published: September 2021

BACKGROUND

Artificial intelligence (AI) is no longer a futuristic concept; it is increasingly being integrated into health care. As studies on attitudes toward AI have primarily focused on physicians, there is a need to assess the perspectives of students across health care disciplines to inform future curriculum development.

OBJECTIVE

This study aims to explore and identify gaps in the knowledge that Canadian health care students have regarding AI, capture how health care students in different fields differ in their knowledge and perspectives on AI, and present student-identified ways that AI literacy may be incorporated into the health care curriculum.

METHODS

The survey was developed from a narrative literature review of topics in attitudinal surveys on AI. The final survey comprised 15 items, including multiple-choice questions, pick-group-rank questions, 11-point Likert scale items, slider scale questions, and narrative questions. We used snowball and convenience sampling methods by distributing an email with a description and a link to the web-based survey to representatives from 18 Canadian schools.

RESULTS

A total of 2167 students across 10 different health professions from 18 universities across Canada responded to the survey. Overall, 78.77% (1707/2167) predicted that AI technology would affect their careers within the coming decade and 74.5% (1595/2167) reported a positive outlook toward the emerging role of AI in their respective fields. Attitudes toward AI varied by discipline. Students, even those opposed to AI, identified the need to incorporate a basic understanding of AI into their curricula.

CONCLUSIONS

We performed a nationwide survey of health care students across 10 different health professions in Canada. The findings would inform student-identified topics within AI and their preferred delivery formats, which would advance education across different health care professions.
Computer-aided diagnosis of gastrointestinal protruded lesions using wireless capsule endoscopy: a systematic review and diagnostic test accuracy meta-analysis (Preprint)
Authors: Bang Chang Seok , Lee Jae Jun , Baik Gwang Ho
Published: September 2021

BACKGROUND

Wireless capsule endoscopy allows the identification of small intestinal protruded lesions, such as polyps, tumors, or venous structures. However, reading wireless capsule endoscopy images or movies is time-consuming, and minute lesions are easy to miss. Computer-aided diagnosis (CAD) has been applied to improve the efficacy of the reading process of wireless capsule endoscopy images or movies. However, there are no studies that systematically determine the performance of CAD models in diagnosing gastrointestinal protruded lesions.

OBJECTIVE

This aim of this study was to evaluate the diagnostic performance of CAD models for gastrointestinal protruded lesions using wireless capsule endoscopic images.

METHODS

Core databases were searched for studies based on CAD models for the diagnosis of gastrointestinal protruded lesions using wireless capsule endoscopy, and data on diagnostic performance were presented. A systematic review and diagnostic test accuracy meta-analysis were performed.

RESULTS

Twelve studies were included. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD models for the diagnosis of protruded lesions were 0.95 (95% confidence interval, 0.93–0.97), 0.89 (0.84–0.92), 0.91 (0.86–0.94), and 74 (43–126), respectively. Subgroup analyses showed robust results. Meta-regression found no source of heterogeneity. Publication bias was not detected.

CONCLUSIONS

CAD models showed a high performance for the optical diagnosis of gastrointestinal protruded lesions based on wireless capsule endoscopy.

CLINICALTRIAL

Prospero registration number: id 276623
Infection in Patients with Suspected Thrombotic Microangiopathy Based on Clinical Presentation
Authors: Thoreau Benjamin , von Tokarski Florent , Bauvois Adeline , Bayer Guillaume , Barbet Christelle , Cloarec Sylvie , Mérieau Elodie , Lachot Sébastien , Garot Denis , Bernard Louis , Gyan Emmanuel , Perrotin Franck , Pouplard Claire , Maillot François , Gatault Philippe , Sautenet Bénédicte , Rusch Emmanuel , Frémeaux-Bacchi Véronique , Vigneau Cécile , Fakhouri Fadi , Halimi Jean-Michel
Published: September 2021

Background and objectives

In contrast to shigatoxin-associated Escherichia coli (STEC) causing hemolytic uremic syndrome, STEC-unrelated infections associated with thrombotic microangiopathy are less characterized.

Design, setting, participants, & measurements

Our retrospective study in a four-hospital institution of 530 consecutive patients with adjudicated thrombotic microangiopathies during the 2009–2016 period studied STEC-unrelated infections’ epidemiology and major outcomes (death, acute dialysis, and major cardiovascular events).

Results

STEC-unrelated infection was present in 145 of 530 (27%) patients, thrombotic microangiopathies without infection were present in 350 of 530 (66%) patients, and STEC causing hemolytic and uremic syndrome was present in 35 of 530 (7%) patients. They (versus thrombotic microangiopathy without infection) were associated with age >60 years (36% versus 18%), men (53% versus 27%), altered consciousness (32% versus 11%), mean BP <65 mm Hg (21% versus 4%), lower hemoglobin and platelet count, and AKI (72% versus 49%). They were associated with more than one pathogen in 36 of 145 (25%) patients (either isolated [14%] or combined [86%] to other causes of thrombotic microangiopathy); however, no significant clinical or biologic differences were noted between the two groups. They were more frequently due to bacteria (enterobacteria [41%], Staphylococcus aureus [11%], and Streptococcus pneumonia [3%]) than viruses (Epstein–Barr [20%], cytomegalovirus [18%], influenza [3%], hepatitis C [1%], HIV [1%], and rotavirus [1%]). STEC-unrelated infections were independent risk factors for in-hospital death (odds ratio, 2.22; 95% confidence interval, 1.18 to 4.29), major cardiovascular event (odds ratio, 3.43; 95% confidence interval, 1.82 to 6.69), and acute dialysis (odds ratio, 3.48; 95% confidence interval, 1.78 to 7.03). Bacteria (versus other pathogens), and among bacteria, enterobacteria, presence of more than one bacteria, and E. coli without shigatoxin were risk factors for acute dialysis.

Conclusions

Infections are frequent thrombotic microangiopathy triggers or causes, and they are mostly unrelated to STEC. Infections convey a higher risk of death and major complications. The most frequent pathogens were enterobacteria, S. aureus, Epstein–Barr virus, and cytomegalovirus.

Podcast

This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_09_07_CJN17511120.mp3
Ventajas de la mediación en el ámbito sanitario y su ampliación a otros tópicos
Authors: Riveros Ferrada Carolina , Villarroel Toro Gabriela , Olivares Ramírez Maximiliano
Published: September 2021

La Ley núm. 19.996, también conocida como Ley AUGE, consagró un régimen de garantías de salud y estableció, específicamente en su artículo 43, la mediación obligatoria para poder ejercer acciones de carácter indemnizatorias en contra de prestadores públicos y privados. Es muy interesante evaluar cómo ha funcionado la aplicación de la mediación obligatoria en el ámbito de la salud. Lo anterior, considerando que es un tema muy sensible entre la población y, en concreto, entre el personal de salud que ejerce su actividad, tanto en hospitales públicos como en clínicas privadas. También se evalúa si existen nuevas esferas donde la mediación pudiera ser considerada.
El delito de tráfico de migrantes. Un análisis comparado a los tipos penales español y chileno
Authors: Salinero Echeverría Sebastián
Published: September 2021

El presente trabajo realiza un análisis jurídico comparado del delito de tráfico de migrantes, previsto y sancionado en el artículo 318 Bis y 411 Bis de los códigos penales español y chileno, respectivamente. En particular, se atiende a poder establecer el bien jurídico tutelado por esta figura, inclinándose a por qué se trata de un delito pluriofensivo en el que están en juego intereses individuales y colectivos. Por otro lado, se ocupa de poder delimitar el sujeto pasivo que es protegido por la norma penal. Finalmente, se reflexiona sobre los verbos rectores de la conducta criminal.
Checking of the robustness of precast structural systems based on the energy balance method
Authors: Tur Viktor V. , Tur Andrei V. , Lizahub Aliaksandr A.
Published: September 2021

Introduction. The robustness requirements should be fulfilled already at the stage of conceptual design of the structural system, taking into account the use of various strategies for its protection from progressive collapse. Compared to monolithic reinforced concrete structural systems, precast concrete systems are more susceptible to the effects of accidental actions. To ensure the integrity of the damaged system in the original prefabricated structural system, it is necessary to provide (reserve) a sufficient number of horizontal (internal and perimetric) and vertical ties with the required degree of continuity and plastic deformability.

Materials and methods. Analytical models of the resistance of horizontal ties based on the equations of the energy balance of the system.

Results. On a real example of a prefabricated floor, calculations of the required parameters of horizontal ties were performed according to the proposed dependencies, based on the model of the energy balance of the system and the design models included in the standards of various countries. Comparison of the results obtained showed that the calculation models of the norms in a number of cases can give an unsafe result, underestimating the required cross-sectional area of horizontal ties. This is due to the fact that all dependencies for calculating the tie forces are based on constant values of the ultimate deflection (usually from 1/6 to 1/10 of the span) without checking the limiting deformability of horizontal ties.

Conclusions. Deformability of ties is one of the basic parameters that should be monitored when checking the robustness of structural systems made of precast concrete. The proposed method, based on the provisions of the energy balance, makes it possible to take into account the limiting deformability of horizontal ties when determining the membrane (chain) forces and calculate the maximum dynamic response of the damaged structural system.