bluuebunny/crossref_metadata_2025 huggingface dataset:
Sampling type method combined with deep learning for inverse scattering with one incident wave
Authors: Le Thu , Nguyen Dinh-Liem , Nguyen Vu , Truong Trung
Published: April 2023

We consider the inverse problem of determining the geometry of penetrable objects from scattering data generated by one incident wave at a fixed frequency. We first study an orthogonality sampling type method which is fast, simple to implement, and robust against noise in the data. This sampling method has a new imaging functional that is applicable to data measured in near field or far field regions. The resolution analysis of the imaging functional is analyzed where the explicit decay rate of the functional is established. A connection with the orthogonality sampling method by Potthast is also studied. The sampling method is then combined with a deep neural network to solve the inverse scattering problem. This combined method can be understood as a network using the image computed by the sampling method for the first layer and followed by the U-net architecture for the rest of the layers. The fast computation and the knowledge from the results of the sampling method help speed up the training of the network. The combination leads to a significant improvement in the reconstruction results initially obtained by the sampling method. The combined method is also able to invert some limited aperture experimental data without any additional transfer training.
Fast numerical solutions to direct and inverse scattering for bi-anisotropic periodic Maxwell’s equations
Authors: Nguyen Dinh-Liem , Truong Trung
Published: April 2023

This paper is concerned with the numerical solution to the direct and inverse electromagnetic scattering problem for bi-anisotropic periodic structures. The direct problem can be reformulated as an integro-differential equation. We study the existence and uniqueness of solution to the latter equation and analyze a spectral Galerkin method to solve it. This spectral method is based on a periodization technique which allows us to avoid the evaluation of the quasiperiodic Green’s tensor and to use the fast Fourier transform in the numerical implementation of the method. For the inverse problem, we study the orthogonality sampling method to reconstruct the periodic structures from scattering data generated by only two incident fields. The sampling method is fast, simple to implement, regularization free, and very robust against noise in the data. Numerical examples for both direct and inverse problems are presented to examine the efficiency of the numerical solvers.
Concentration of the number of intersections of random eigenfunctions on flat tori
Authors: Nguyen Hoi
Published: April 2023

We show that in two dimensional flat torus the number of intersections between random eigenfunctions of general eigenvalues and a given smooth curve is almost exponentially concentrated around its mean, even when the randomness is not gaussian.
Rapid engineering of SARS-CoV-2 therapeutic antibodies to increase breadth of neutralization including BQ.1.1, CA.3.1, CH.1.1, XBB.1.16, and XBB.1.5
Authors: Entzminger Kevin C , Fleming Jonathan K , Entzminger Paul D , Espinosa Lisa Yuko , Samadi Alex , Hiramoto Yuko , Okumura Shigeru C J , Maruyama Toshiaki
Published: April 2023

SARS-CoV-2 Omicron variant XBB.1.5 has shown extraordinary immune escape even for fully vaccinated individuals. There are currently no approved antibodies that neutralize this variant, and continued emergence of new variants puts immunocompromised and elderly patients at high risk. Rapid and cost-effective development of neutralizing antibodies is urgently needed. Starting with a single parent clone that neutralized the Wuhan-Hu-1 strain, antibody engineering was performed in iterative stages in real time as variants emerged using a proprietary technology called STage-Enhanced Maturation. An antibody panel that broadly neutralizes currently circulating Omicron variants was obtained by in vitro affinity maturation using phage display. The engineered antibodies show potent neutralization of BQ.1.1, XBB.1.16, and XBB.1.5 by surrogate virus neutralization test and pM KD affinity for all variants. Our work not only details novel therapeutic candidates but also validates a unique general strategy to create broadly neutralizing antibodies to current and future SARS-CoV-2 variants.
The Effect of HIV Treatment Interruption on Subsequent Immunological Response
Authors: Thomadakis Christos , Yiannoutsos Constantin T , Pantazis Nikos , Diero Lameck , Mwangi Ann , Musick Beverly S , Wools-Kaloustian Kara , Touloumi Giota
Published: April 2023

Recovery of CD4-positive T lymphocyte count after initiation of antiretroviral therapy (ART) has been thoroughly examined among people with human immunodeficiency virus infection. However, immunological response after restart of ART following care interruption is less well studied. We compared CD4 cell-count trends before disengagement from care and after ART reinitiation. Data were obtained from the East Africa International Epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration (2001–2011; n = 62,534). CD4 cell-count trends before disengagement, during disengagement, and after ART reinitiation were simultaneously estimated through a linear mixed model with 2 subject-specific knots placed at the times of disengagement and treatment reinitiation. We also estimated CD4 trends conditional on the baseline CD4 value. A total of 10,961 patients returned to care after disengagement from care, with the median gap in care being 2.7 (interquartile range, 2.1–5.4) months. Our model showed that CD4 cell-count increases after ART reinitiation were much slower than those before disengagement. Assuming that disengagement from care occurred 12 months after ART initiation and a 3-month treatment gap, CD4 counts measured at 3 years since ART initiation would be lower by 36.5 cells/μL than those obtained under no disengagement. Given that poorer CD4 restoration is associated with increased mortality/morbidity, specific interventions targeted at better retention in care are urgently required.
EpiCompare: R package for the comparison and quality control of epigenomic peak files
Authors: Choi Sera , Schilder Brian M , Abbasova Leyla , Murphy Alan E , Skene Nathan G
Published: April 2023

EpiCompare combines a variety of downstream analysis tools to compare, quality control and benchmark different epigenomic datasets. The package requires minimal input from users, can be run with just one line of code and provides all results of the analysis in a single interactive HTML report. EpiCompare thus enables downstream analysis of multiple epigenomic datasets in a simple, effective and user-friendly manner.

Availability and implementation

EpiCompare is available on Bioconductor (≥ v3.15): https://bioconductor.org/packages/release/bioc/html/EpiCompare.html; all source code is publicly available via GitHub: https://github.com/neurogenomics/EpiCompare; documentation website https://neurogenomics.github.io/EpiCompare; and EpiCompare DockerHub repository: https://hub.docker.com/repository/docker/neurogenomicslab/epicompare.
Aortic cross-clamp time correlates with mortality in the mini-mitral international registry
Authors: Doenst Torsten , Berretta Paolo , Bonaros Nikolaos , Savini Carlo , Pitsis Antonios , Wilbring Manuel , Gerdisch Marc , Kempfert Jorg , Rinaldi Mauro , Folliguet Thierry , Yan Tristan , Stefano Pierluigi , Van Praet Frank , Salvador Loris , Lamelas Joseph , Nguyen Tom C , Dinh Nguyen Hoang , Färber Gloria , Di Eusanio Marco
Published: April 2023

OBJECTIVES

Minimally invasive access has become the preferred choice in mitral and/or tricuspid valve surgery. Reported outcomes are at least similar to classic sternotomy although aortic cross-clamp times are usually longer.

METHODS

We analysed the largest registry of mitral and/or tricuspid valve surgery patients (mini-mitral international registry (MMIR)) for the relationship between aortic cross-clamp times, mortality and other outcomes. From 2015 to 2021, 7513 consecutive patients underwent mini-mitral and/or tricuspid valve surgery in 17 international Heart-Valve-Centres. Data were collected according to Mitral Valve Academic Research Consortium (MVARC) definitions and 6878 patients with 1 cross-clamp period were analysed. Uni- and multivariable regression analyses were used to assess outcomes in relation to aortic cross-clamp times.

RESULTS

Median age was 65 years (57% male). Median EuroSCORE II was 1.3% (Inpatient Quality Reporting (IQR): 0.80–2.63). Minimally invasive access was either by direct vision (28%), video-assisted (41%) or totally endoscopic/robotic (31%). Femoral cannulation was used in 93%. Three quarters were repairs with 17% additional tricuspid valve surgery and 19% Atrial Fibrillation (AF)-ablation. Cardiopulmonary bypass and cross-clamp times were 135 min (IQR: 107–173) and 85 min (IQR: 64–111), respectively. Postoperative events were death (1.6%), stroke (1.2%), bleeding requiring revision (6%), low cardiac output syndrome (3.5%) and acute kidney injury (6.2%, mainly stage I). Statistical analyses identified significant associations between cross-clamp time and mortality, low cardiac output syndrome and acute kidney injury (all P < 0.001). Age, low ejection fraction and emergent surgery were risk factors, but variables of ‘increased complexity’ (redo, endocarditis, concomitant procedures) were not.

CONCLUSIONS

Aortic cross-clamp time is associated with mortality as well as postoperatively impaired cardiac and renal function. Thus, implementing measures to reduce cross-clamp time may improve outcomes.
Assessing the potential of mobile laser scanning for stand-level forest inventories in near-natural forests
Authors: Vatandaşlar Can , Seki Mehmet , Zeybek Mustafa
Published: April 2023

Recent advances in LiDAR sensors and robotic technologies have raised the question of whether handheld mobile laser scanning (HMLS) systems can allow for the performing of forest inventories (FIs) without the use of conventional ground measurement (CGM) techniques. However, the reliability of such an approach for forest planning applications, particularly in non-uniform forests under mountainous conditions, remains underexplored. This study aims to address these issues by assessing the accuracy of HMLS-derived data based on the calculation of basic forest attributes such as the number of trees, dominant height and basal area. To this end, near-natural forests of a national park (NE Türkiye) were surveyed using the HMLS and CGM techniques for a management plan renewal project. Taking CGM results as reference, we compared each forest attribute pair based on two datasets collected from 39 sample plots at the forest (landscape) scale. Diameter distributions and the influence of stand characteristics on HMLS data accuracy were also analyzed at the plot scale. The statistical results showed no significant difference between the two datasets for any investigated forest attributes (P > 0.05). The most and the least accurately calculated attributes were quadratic mean diameter (root mean square error (RMSE) = 1.3 cm, 4.5 per cent) and stand volume (RMSE = 93.7 m3 ha−1, 16.4 per cent), respectively. The stand volume bias was minimal at the forest scale (15.65 m3 ha−1, 3.11 per cent), but the relative bias increased to 72.1 per cent in a mixed forest plot with many small and multiple-stemmed trees. On the other hand, a strong negative relationship was detected between stand maturation and estimation errors. The accuracy of HMLS data considerably improved with increased mean diameter, basal area and stand volume values. Eventually, we conclude that many forest attributes can be quantified using HMLS at an accuracy level required by forest planning and management-related decision making. However, there is still a need for CGM in FIs to capture qualitative attributes, such as species mix and stem quality.
Whole-genome analysis of recombinant inbred rice lines reveals a quantitative trait locus on chromosome 3 with genotype-by-environment interaction effects
Authors: Sakai Toshiyuki , Fujioka Tomoaki , Uemura Toyokazu , Saito Shinichi , Terauchi Ryohei , Abe Akira
Published: April 2023

Elucidating genotype-by-environment interactions is fundamental for understanding the interplay between genetic and environmental factors that shape complex traits in crops. Genotype-by-environment interactions are of practical importance, as they determine the performance of cultivars grown in different environments, prompting the need for an efficient approach for evaluating genotype-by-environment interactions. Here, we describe a method for genotype-by-environment detection that involves comparing linear mixed models. This method successfully detected genotype-by-environment interactions in rice (Oryza sativa) recombinant inbred lines grown at 3 locations. We identified a quantitative trait locus (QTL) on chromosome 3 that was associated with heading date, grain number, and leaf length. The effect of this QTL on plant growth–related traits varied with environmental conditions, indicating the presence of genotype-by-environment interactions. Therefore, our method enables a powerful genotype-by-environment detection pipeline that should facilitate the production of high-yielding crops in a given environment.
Current outcomes of SARS-CoV-2 Omicron variant infection in high-risk haematological patients treated early with antivirals
Authors: Aiello Tommaso-Francesco , Puerta-Alcalde Pedro , Chumbita Mariana , Lopera Carlos , Monzó Patricia , Cortes Albert , Fernández-Avilés Francesc , Suárez-Lledó María , Correa Juan , Ortiz-Maldonado Valentín , Cuesta Genoveva , Martinez-Cibrian Nuria , Esteve Jordi , Marcos Maria Ángeles , Mensa Josep , Soriano Alex , Garcia-Vidal Carolina
Published: April 2023

Objectives

We aimed to describe the clinical outcomes and duration of viral shedding in high-risk patients with haematological malignancies hospitalized with COVID-19 during Omicron variant predominance who received early treatment with antivirals.

Methods

We conducted a prospective observational study on high-risk haematological patients admitted in our hospital between December 2021 and March 2022. We performed detection techniques on viral subgenomic mRNAs until negative results were obtained to document active, prolonged viral replication.

Results

This analysis included 60 consecutive adults with high-risk haematological malignancies and COVID-19. All of these patients underwent early treatment with remdesivir. Thirty-two (53%) patients received combined antiviral strategies, with sotrovimab or hyperimmune plasma being added to remdesivir. The median length of viral replication—as measured by real-time RT-PCR and/or subgenomic RNA detection—was 20 (IQR 14–28) days. Prolonged viral replication (6 weeks after diagnosis) was documented in six (10%) patients. Only two patients had prolonged infection for more than 2 months. Overall mortality was 5%, whereas COVID-19-related mortality was 0%.

Conclusions

Current outcomes of high-risk patients with haematological malignancies hospitalized with COVID-19 during Omicron variant predminance are good with the use of early antiviral strategies. Persistent viral shedding is uncommon.
Mapping 3 procedure coding systems to the International Classification of Health Interventions (ICHI): coverage and challenges
Authors: Fung Kin Wah , Xu Julia , Ameye Filip , Burelle Lisa , MacNeil Janice
Published: April 2023

Objective

To study the coverage and challenges in mapping 3 national and international procedure coding systems to the International Classification of Health Interventions (ICHI).

Materials and Methods

We identified 300 commonly used codes each from SNOMED CT, ICD-10-PCS, and CCI (Canadian Classification of Health Interventions) and mapped them to ICHI. We evaluated the level of match at the ICHI stem code and Foundation Component levels. We used postcoordination (modification of existing codes by adding other codes) to improve matching. Failure analysis was done for cases where full representation was not achieved. We noted and categorized potential problems that we encountered in ICHI, which could affect the accuracy and consistency of mapping.

Results

Overall, among the 900 codes from the 3 sources, 286 (31.8%) had full match with ICHI stem codes, 222 (24.7%) had full match with Foundation entities, and 231 (25.7%) had full match with postcoordination. 143 codes (15.9%) could only be partially represented even with postcoordination. A small number of SNOMED CT and ICD-10-PCS codes (18 codes, 2% of total), could not be mapped because the source codes were underspecified. We noted 4 categories of problems in ICHI—redundancy, missing elements, modeling issues, and naming issues.

Conclusion

Using the full range of mapping options, at least three-quarters of the commonly used codes in each source system achieved a full match. For the purpose of international statistical reporting, full matching may not be an essential requirement. However, problems in ICHI that could result in suboptimal maps should be addressed.
Bowel volvulus in the chest after an esophagectomy: an uncommon type IV hiatal hernia
Authors: Ludena Danny , Camillo Rodolfo , Machry Mayara , Solis-Pazmino Paola
Published: April 2023

Transverse colon volvulus is an uncommon cause of bowel obstruction. Moreover, a thoracic herniation into the thorax is still rare. An early diagnosis and treatment are critical to the patient since they can lead to bowel infarction, peritonitis and death. We reported a 55-year-old woman admitted to the emergency department at a hospital. She presented with severe abdominal pain, mainly in the epigastrium, associated with dyspnea, nausea and vomiting. An abdominal CT scan showed a large hiatal hernia in the thorax with signs of volvulus in the involved segment.
The diagnostic dilemma: Giant Mucocele of the appendix—challenging conventional thinking
Authors: Solis-Pazmino Paola , Cedillo Cynthia , Avila Augusta , Saldanha Luis Henrique , Doncatto Vitor , Hamaoui Mohamed
Published: April 2023

This article reports on a 76-year-old male patient diagnosed with a mucocele of the appendix. A mucocele of the appendix is a benign fluid-filled swelling caused by the accumulation of mucus in the appendix due to a blockage in its discharge route. The patient presented with symptoms of chronic constipation and rectal tenesmus and was diagnosed through physical examination, imaging studies and laboratory tests. The patient underwent an open ileocolectomy procedure to remove the affected appendix. The results of the histopathological analysis showed a confined low-grade appendiceal mucinous neoplasm. The overall survival rate after surgery for mucocele of the appendix is excellent, with a low recurrence rate.
Numerically studying the degeneracy problem in extreme finite-source microlensing events
Authors: Sajadian Sedighe
Published: April 2023

Most transit microlensing events due to very low mass lens objects suffer from extreme finite-source effects. While modelling their light curves, there is a known continuous degeneracy between their relevant lensing parameters, i.e. the source angular radius normalized to the angular Einstein radius ρ⋆, the Einstein crossing time tE, the lens impact parameter u0, the blending parameter, and the stellar apparent magnitude. In this work, I numerically study the origin of this degeneracy. I find that these light curves have five observational parameters (i.e. the baseline magnitude, the maximum deviation in the magnification factor, the full width at half-maximum $\rm {FWHM}=2 \mathit{ t}_{\rm {HM}}$, the deviation from a top-hat model, and the time of the maximum time derivative of microlensing light curves $T_{\rm {max}}=t_{\rm E}\sqrt{\rho _{\star }^{2}-u_{0}^{2}}$). For extreme finite-source microlensing events due to uniform source stars, we get tHM ≃ Tmax and the deviation from the top-hat model tends to zero, which both cause the known continuous degeneracy. When either ρ⋆ ≲ 10 or the limb-darkening effect is considerable, tHM and Tmax are two independent observational parameters. I use a numerical approach, i.e. random forests containing 100–120 decision trees, to study how these observational parameters are efficient in yielding the lensing parameters. These machine learning models find the mentioned five lensing parameters for finite-source microlensing events from uniform and limb-darkened source stars with the average R2-scores of 0.87 and 0.84, respectively. R2-score for evaluating the lens impact parameter gets worse on adding limb darkening, and for extracting the limb-darkening coefficient itself this score falls as low as 0.67.
Characterization of recurrence patterns and outcomes of medulloblastoma in adults: The University of Texas MD Anderson Cancer Center experience
Authors: Gregory Timothy A , Mastall Maximilian , Lin Heather , Hess Kenneth R , Yuan Ying , Martin-Bejarano Garcia Manuela , Fuller Gregory N , Alfaro Kristin D , Gule-Monroe Maria K , Huse Jason T , Khatua Soumen , Rao Ganesh , Sandberg David I , Wefel Jeffrey S , Yeboa Debra N , Paulino Arnold C , McGovern Susan L , Zaky Wafik , Mahajan Anita , Suki Dima , Weathers Shiao-Pei , Harrison Rebecca A , de Groot John F , Puduvalli Vinay K , Penas-Prado Marta , Majd Nazanin K
Published: April 2023

Background

Medulloblastoma in adults is rare and treatment decisions are largely driven from pediatric literature. We sought to characterize recurrent medulloblastoma in adults.

Methods

From a single-institution dataset of 200 adult patients diagnosed with medulloblastoma during 1978–2017, those with recurrence were analyzed for clinical features, treatment, and outcome.

Results

Of the 200 patients, 82 (41%) with median age of 29 years (18–59) had recurrence after a median follow-up time of 8.4 years (95% CI = 7.1, 10.3). Of these, 30 (37%) were standard-risk, 31 (38%) were high-risk, and 21 (26%) had unknown-risk diseases at the time of initial diagnosis. Forty-eight (58%) presented with recurrence outside the posterior fossa, of whom 35 (43%) had distant recurrence only. Median Progression-free survival (PFS) and OS from initial surgery were 33.5 and 62.4 months, respectively. Neither PFS nor OS from initial diagnosis differed between the standard-risk and high-risk groups in those who experience recurrence (P = .505 and .463, respectively). Median OS from first recurrence was 20.3 months, also with no difference between the standard-risk and high-risk groups (P = .518). Recurrences were treated with combinations of re-resection (20 patients; 25%), systemic chemotherapy (61 patients; 76%), radiation (29 patients; 36%), stem cell transplant (6 patients; 8%), and intrathecal chemotherapy (4 patients; 5%). Patients who received radiation at recurrence had better OS (32.9 months) than those who did not (19.2 months) (P = .034).

Conclusions

Recurrent medulloblastoma in adults has a poor prognosis irrespective of initial risk stratification. Recurrence commonly arises outside the posterior fossa years after initial diagnosis.
Feasibility of deep learning-based tumor segmentation for target delineation and response assessment in grade-4 glioma using multi-parametric MRI
Authors: Hannisdal Marianne H , Goplen Dorota , Alam Saruar , Haasz Judit , Oltedal Leif , Rahman Mohummad A , Rygh Cecilie Brekke , Lie Stein Atle , Lundervold Arvid , Chekenya Martha
Published: April 2023

Background

Tumor burden assessment is essential for radiation therapy (RT), treatment response evaluation, and clinical decision-making. However, manual tumor delineation remains laborious and challenging due to radiological complexity. The objective of this study was to investigate the feasibility of the HD-GLIO tool, an ensemble of pre-trained deep learning models based on the nnUNet-algorithm, for tumor segmentation, response prediction, and its potential for clinical deployment.

Methods

We analyzed the predicted contrast-enhanced (CE) and non-enhancing (NE) HD-GLIO output in 49 multi-parametric MRI examinations from 23 grade-4 glioma patients. The volumes were retrospectively compared to corresponding manual delineations by 2 independent operators, before prospectively testing the feasibility of clinical deployment of HD-GLIO-output to a RT setting.

Results

For CE, median Dice scores were 0.81 (95% CI 0.71–0.83) and 0.82 (95% CI 0.74–0.84) for operator-1 and operator-2, respectively. For NE, median Dice scores were 0.65 (95% CI 0.56–0,69) and 0.63 (95% CI 0.57–0.67), respectively. Comparing volume sizes, we found excellent intra-class correlation coefficients of 0.90 (P < .001) and 0.95 (P < .001), for CE, respectively, and 0.97 (P < .001) and 0.90 (P < .001), for NE, respectively. Moreover, there was a strong correlation between response assessment in Neuro-Oncology volumes and HD-GLIO-volumes (P < .001, Spearman’s R2 = 0.83). Longitudinal growth relations between CE- and NE-volumes distinguished patients by clinical response: Pearson correlations of CE- and NE-volumes were 0.55 (P = .04) for responders, 0.91 (P > .01) for non-responders, and 0.80 (P = .05) for intermediate/mixed responders.

Conclusions

HD-GLIO was feasible for RT target delineation and MRI tumor volume assessment. CE/NE tumor-compartment growth correlation showed potential to predict clinical response to treatment.
Prevalence and Correlates of Adverse Mental Health Outcomes among Male and Female Black Emerging Adults with a History of Exposure (Direct versus Indirect) to Police Use of Force
Authors: Motley Robert O , Chen Yu-Chih , Motley Jamie D
Published: April 2023

Anxiety, depression, and psychological distress are public health concerns for Black emerging adults ages 18–29, given their prevalence in this population. However, we have scant empirical research investigating the prevalence and correlates of negative mental outcomes among Black emerging adults with a history of exposure to police use of force. Thus, the current study examined the prevalence and correlates of depression, anxiety, and psychological well-being and how they vary among a sample of Black emerging adults with a history of direct or indirect exposure to police use of force. Computer-assisted surveys were administered to a sample of Black emerging adults (N = 300). Univariate, bivariate, and multiple linear regression analyses were conducted. Black women with a history of direct or indirect exposure to police use of force had significantly less favorable scores on the depression and anxiety scales compared with Black men. Study findings suggest that Black emerging adults, particularly women, with a history of exposure to police use of force are at risk of experiencing adverse mental health outcomes. Future research with a larger and ethnically diverse sample of emerging adults that examines the prevalence and correlates of adverse mental health outcomes and how they vary by gender, ethnicity, and exposure to police use of force is warranted.
Translation of a family-based behavioral intervention for adolescent obesity using the RE-AIM framework and common steps from adaptation frameworks
Authors: Biggs Bridget K , Rodgers Kristi V , Nayman Samuel J , Hofschulte Deanna R , Loncar Haylee , Kumar Seema , Lynch Brian A , Rajjo Tamim I , Wilson Dawn K
Published: April 2023

Interventions for adolescent weight management that are ready to use in clinical settings are needed to address the obesity epidemic and improve the health and wellbeing of affected adolescents. This report describes the systematic process our team followed to adapt an evidence-based intervention (EBI) for adolescent weight management from its randomized control trial protocol to a package for delivery in a group-based telehealth format within a medical center. The EBI adaptation was clinician initiated, prompted by identified practice needs, and involved collaboration of the clinical team with the EBI developer. The process was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and followed key steps for adapting EBIs to new contexts. RE-AIM-aligned adaptations included telehealth delivery and broader inclusion criteria, separate clinical and research evaluation batteries, adaptations to fit the clinical practice, practical fidelity checklists to guide and record session delivery, and continuous quality improvement processes aimed to facilitate program longevity and family engagement. The process culminated in a package of adapted intervention materials deemed by stakeholders as appropriate to the practice and congruent with the EBI model. This report provides a much-needed practical demonstration of the translation of an EBI for adolescent weight management from research protocol to group telehealth delivery in a medical center. Key lessons include the value of clinician-researcher collaboration, the breadth of resources needed to adapt EBIs for real-world delivery, and the importance of considering delivery context in implementation and evaluation decisions, including defining inclusion criteria, staffing, and outcomes assessments.
Functional relevance of the extrastriate body area for visual and haptic object recognition: a preregistered fMRI-guided TMS study
Authors: Atilgan Hicret , Koi J X Janice , Wong Ern , Laakso Ilkka , Matilainen Noora , Pasqualotto Achille , Tanaka Satoshi , Chen S H Annabel , Kitada Ryo
Published: April 2023

The extrastriate body area (EBA) is a region in the lateral occipito-temporal cortex (LOTC), which is sensitive to perceived body parts. Neuroimaging studies suggested that EBA is related to body and tool processing, regardless of the sensory modalities. However, how essential this region is for visual tool processing and nonvisual object processing remains a matter of controversy. In this preregistered fMRI-guided repetitive transcranial magnetic stimulation (rTMS) study, we examined the causal involvement of EBA in multisensory body and tool recognition. Participants used either vision or haptics to identify 3 object categories: hands, teapots (tools), and cars (control objects). Continuous theta-burst stimulation (cTBS) was applied over left EBA, right EBA, or vertex (control site). Performance for visually perceived hands and teapots (relative to cars) was more strongly disrupted by cTBS over left EBA than over the vertex, whereas no such object-specific effect was observed in haptics. The simulation of the induced electric fields confirmed that the cTBS affected regions including EBA. These results indicate that the LOTC is functionally relevant for visual hand and tool processing, whereas the rTMS over EBA may differently affect object recognition between the 2 sensory modalities.
Remote Provision of Medication Abortion and Contraception Through Telemedicine
Authors: Pearlman Shapiro Marit , Myo Melissa , Chen Tracy , Nathan Alexanna , Raidoo Shandhini
Published: April 2023

This Narrative Review describes the remote provision of family planning services, including medication abortion and contraception, through telemedicine. The coronavirus disease 2019 (COVID-19) pandemic was a catalyst to shift toward telemedicine to maintain and expand access to crucial reproductive health services when public health measures necessitated social distancing. There are legal and political considerations when providing medication abortion through telemedicine, along with unique challenges, even more so after the Dobbs decision starkly limited options for much of the country. This review includes the literature describing the logistics of telemedicine and modes of delivery for medication abortion and details special considerations for contraceptive counseling. Health care professionals should feel empowered to adopt telemedicine practices to provide family planning services to their patients.
Is There a Role for Anti-factor Xa Activity Assay in Venous Thromboembolism Prophylaxis Management Among Orthopaedic Trauma Patients? Systematic Review and Meta-analysis
Authors: Tischler Eric H. , Tsai Sung Huang Laurent , Wolfert Adam J. , von Keudell Arvind , Roudnitsky Valery , Gross Jonathan , Suneja Nishant
Published: April 2023

Objectives:

To determine the effect of anti-factor Xa assay dosing of low-molecular-weight heparin (LMWH) on rates of venous thromboembolism (VTE), deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding, and mortality among orthopaedic trauma patients.

Data Sources:

PubMed/MEDLINE, Embase, Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), clinicaltrials.gov, and Scopus were systematically searched from inception of the database to 2021.

Study Selection:

Prospective, retrospective, and randomized controlled trial studies were included if they compared rates of VTE, DVT, PE, bleeding, and/or mortality between orthopaedic trauma patients receiving anti-factor Xa–based LMWH dosing and those receiving standard dosing.

Data Extraction:

Two independent reviewers screened titles and abstracts for eligibility. Study characteristics including study design, inclusion criteria, and intervention were extracted.

Data Synthesis:

Meta-analysis was performed using pooled proportion of events (effect size) with 95% confidence intervals. A random-effects model was used. Heterogeneity was quantified by Higgins I2. Heterogeneity and variability between subgroups indicated differences in the pooled estimate represented by a P-value.

Results:

Six hundred eighty-five studies were identified, and 10 studies including 2870 patients were included. In total, 30.3% and 69.7% received an adjusted and nonadjusted dose of LMWH, respectively. The rate of VTE and DVT were significantly lower in the anti-factor Xa–adjusted cohort, whereas there was no statistically significant difference in rates of PE, bleeding, or mortality between the cohorts.

Conclusions:

This systematic review and meta-analysis demonstrates that anti-factor Xa activity assay dosing of LMWH among orthopaedic trauma patients leads to a reduction in overall DVT rates, although not PE rates, without an increased risk of bleeding events.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Agreement between cardiac output measurements by pulse wave analysis using the Pressure Recording Analytical Method and transthoracic echocardiography in patients with veno-venous extracorporeal membrane oxygenation therapy
Authors: Greiwe Gillis , Flick Moritz , Hapfelmeier Alexander , Winkler Martin S. , Nitzschke Rainer , Frings Daniel , Saugel Bernd
Published: April 2023

BACKGROUND

Measuring cardiac output (CO) is important in patients treated with veno-venous extracorporeal membrane oxygenation (vvECMO) because vvECMO flow and CO need to be balanced. Uncalibrated pulse wave analysis with the Pressure Recording Analytical Method (PRAM) may be suitable to measure CO in patients with vvECMO therapy.

OBJECTIVE

To assess the agreement between CO measured by PRAM (PRAM-CO; test method) and CO measured by transthoracic echocardiography (TTE-CO; reference method).

DESIGN

A prospective observational method comparison study.

SETTING

The ICU of a German university hospital between March and December 2021.

PATIENTS

Thirty one adult patients with respiratory failure requiring vvECMO therapy: 29 of the 31 patients (94%) were treated for COVID-19 related respiratory failure.

MAIN OUTCOME MEASURES

PRAM-CO and TTE-CO were measured simultaneously at two time points in each patient with at least 20 min between measurements. A radial or femoral arterial catheter-derived blood pressure waveform was used for PRAM-CO measurements. TTE-CO measurements were conducted using the pulsed wave Doppler-derived velocity time integral of the left ventricular outflow tract (LVOT) and the corresponding LVOT diameter. PRAM-CO and TTE-CO were compared using Bland–Altman analysis and the percentage error (PE). We defined a PE of <30% as clinically acceptable.

RESULTS

Mean ± SD PRAM-CO was 6.86 ± 1.49 l min−1 and mean TTE-CO was 6.94 ± 1.58 l min−1. The mean of the differences between PRAM-CO and TTE-CO was 0.09 ± 0.73 l min−1 with a lower 95% limit of agreement of −1.34 l min−1 and an upper 95% limit of agreement of 1.51 l min−1. The PE was 21%.

CONCLUSIONS

The agreement between PRAM-CO and TTE-CO is clinically acceptable in adult patients with vvECMO therapy.
Cardiac dysfunction in patients affected by subarachnoid haemorrhage affects in-hospital mortality
Authors: Messina Antonio , Longhitano Yaroslava , Zanza Christian , Calabrò Lorenzo , Villa Federico , Cammarota Gianmaria , Sanfilippo Filippo , Cecconi Maurizio , Robba Chiara
Published: April 2023

BACKGROUND

Subarachnoid haemorrhage (SAH) is a life-threatening condition with associated brain damage. Moreover, SAH is associated with a massive release of catecholamines, which may promote cardiac injury and dysfunction, possibly leading to haemodynamic instability, which in turn may influence a patient's outcome.

OBJECTIVES

To study the prevalence of cardiac dysfunction (as assessed by echocardiography) in patients with SAH and its effect on clinical outcomes.

DESIGN

Systematic review of observational studies.

DATA SOURCES

We performed a systematic search over the last 20 years on MEDLINE and EMBASE databases.

ELIGIBILITY CRITERIA

Studies reporting echocardiography findings in adult patients with SAH admitted to intensive care. Primary outcomes were in-hospital mortality and poor neurological outcome according to the presence or absence of cardiac dysfunction.

RESULTS

We included a total of 23 studies (4 retrospective) enrolling 3511 patients. The cumulative frequency of cardiac dysfunction was 21% (725 patients), reported as regional wall motion abnormality in the vast majority of studies (63%). Due to the heterogeneity of clinical outcome data reporting, a quantitative analysis was carried out only for in-hospital mortality. Cardiac dysfunction was associated with a higher in-hospital mortality [odds ratio 2.69 (1.64 to 4.41); P < 0.001; I
2 = 63%]. The GRADE of evidence assessment resulted in very low certainty of evidence.

CONCLUSION

About one in five patients with SAH develops cardiac dysfunction, which seems to be associated with higher in-hospital mortality. The consistency of cardiac and neurological data reporting is lacking, reducing the comparability of the studies in this field.
Identifying Kawasaki Disease With a Low Coronary Artery Aneurysm Risk
Authors: Iio Kazuki , Morikawa Yoshihiko , Miyata Koichi , Kaneko Tetsuji , Misawa Masahiro , Yamagishi Hiroyuki , Miura Masaru
Published: April 2023

Introduction:

Kawasaki disease (KD) patients with a high risk of coronary artery aneurysm (CAA) development are well characterized and targeted for intensified primary intravenous immunoglobulin (IVIG) treatment. However, the characteristics of KD patients with a low CAA risk are less well-known.

Methods:

The present study was a secondary analysis of Prospective Observational study on STRAtified treatment with Immunoglobulin plus Steroid Efficacy for Kawasaki disease (Post RAISE), a multicenter, prospective cohort study of KD patients in Japan. The target of the analysis was patients with a Kobayashi score <5 who were predicted to respond to IVIG. The incidence of CAA during the acute phase, the primary outcome, was assessed based on all echocardiographic evaluations performed between week 1 (days 5–9) and month 1 (days 20–50) after the start of primary treatment. Multivariable logistic regression was used to identify the independent risk factors of CAA during the acute phase, based on which a decision tree was created to identify a subpopulation of patients with KD with a low CAA risk.

Results:

Multivariate analysis found that a baseline maximum Z score >2.5, age <12 months at fever onset, nonresponsiveness to IVIG, low neutrophils, high platelets and high C-reactive protein were independent predictors of CAA during the acute phase. The decision tree created by using these risk factors identified 679 KD patients who had a low incidence of CAA during the acute phase (4.1%) and no medium or large CAA.

Conclusions:

The present study identified a KD subpopulation with a low CAA risk comprising around a quarter of the entire Post RAISE cohort.
The Influence of SARS-CoV-2 Variants B.1.1.7 and B.1.617.2 on a Different Clinical Course and Severity of COVID-19 in Children Hospitalized in 2021 Compared With 2020
Authors: Pokorska-Śpiewak Maria , Talarek Ewa , Pawłowska Małgorzata , Mania Anna , Hasiec Barbara , Żwirek-Pytka Elżbieta , Stankiewicz Magdalena , Stani Martyna , Frańczak-Chmura Paulina , Szenborn Leszek , Zaleska Izabela , Chruszcz Joanna , Majda-Stanisławska Ewa , Dryja Urszula , Gąsiorowska Kamila , Figlerowicz Magdalena , Mazur-Melewska Katarzyna , Faltin Kamil , Ciechanowski Przemysław , Peregrym Michał , Łasecka-Zadrożna Joanna , Rudnicki Józef , Szczepańska Barbara , Pałyga-Bysiecka Ilona , Rogowska Ewelina , Hudobska-Nawrot Dagmara , Domańska-Granek Katarzyna , Sybilski Adam , Kucharek Izabela , Franczak Justyna , Sobolewska-Pilarczyk Małgorzata , Kuchar Ernest , Wronowski Michał , Paryż Maria , Kalicki Bolesław , Toczyłowski Kacper , Sulik Artur , Niedźwiecka Sławomira , Gorczyca Anna , Marczyńska Magdalena
Published: April 2023

Background:

This study aimed to analyze the differences in the epidemiologic and clinical characteristics of coronavirus disease 2019 (COVID-19) in children hospitalized in 2021, when the severe acute respiratory syndrome coronavirus 2 variants B.1.1.7 (alpha) and B.1.617.2 (delta) dominated, compared with 2020.

Methods:

In this multicenter study based on the pediatric part of the national SARSTer register (SARSTer-PED), we included 2771 children (0–18 years) with COVID-19 diagnosed between March 1, 2020, and December 31, 2021, from 14 Polish inpatient centers. An electronic questionnaire, which addressed epidemiologic and clinical data, was used.

Results:

Children hospitalized in 2021 were younger compared with those reported in 2020 (mean 4.1 vs. 6.8 years, P = 0.01). Underlying comorbidities were reported in 22% of the patients. The clinical course was usually mild (70%). A significant difference in the clinical course assessment between 2020 and 2021 was found, with more asymptomatic patients in 2020 and more severely ill children in 2021. In total, 5% of patients were severely or critically ill, including <3% of the participants in 2020 and 7% in 2021. The calculated mortality rate was 0.1% in general and 0.2% in 2021.

Conclusion:

Infections with severe acute respiratory syndrome coronavirus 2 variants alpha and delta lead to a more severe course of COVID-19 with more pronounced clinical presentation and higher fatality rates than infection with an original strain. Most of the children requiring hospitalization due to COVID-19 do not have underlying comorbidities.
Pediatric intestinal rehabilitation
Authors: Kudo Hironori , Wada Motoshi
Published: April 2023

Purpose of review

The intestinal rehabilitation program (IRP) is a comprehensive treatment strategy that employs various approaches implemented by multidisciplinary teams to treat intestinal failure in children. This program has shown promising results, such as reducing complications and improving prognosis and quality of life (QOL). In this review, we discuss the current status of this program and relevant topics.

Recent findings

IRP includes the prevention and treatment of various complications such as intestinal failure associated liver disease, catheter-related bloodstream infection or sepsis, and venous thromboembolism. In addition, treatment strategies such as glucagon-like peptide-2 analogs, surgical interventions, and intestinal transplantation have evolved over time and have contributed to improved outcomes. In addition, the scope and regions for IRP activities have expanded.

IRP improves the prognosis and QOL of children with intestinal failure. The development of new drugs, surgical methods, and treatment strategies is expected to improve the current and future status of pediatric patients with intestinal failure. Furthermore, international institutions must collaborate, share knowledge, conduct joint research, and establish patient registries to advance IRP progress.
The Impact of Redlining on Modern-Day Firearm Injuries
Authors: Spitzer Sarabeth A. , Vail Daniel G. , Dey Tanujit , Salim Ali , Jarman Molly P.
Published: April 2023

Objectives:

To evaluate whether exposure to the United States discriminatory housing practice of redlining, which occurred in over 200 cities in the 1930s, is associated with modern-day, community-level incidence of firearm injury.

Background:

Firearm violence is a public health epidemic within the United States. Federal policies are crucial in both shaping and reducing the risk of firearm violence; identifying policies that might have contributed to risks also offers potential solutions. We analyzed whether 1930s exposure to the discriminatory housing practices that occurred in over 200 US cities was associated with the modern-day, community-level incidence of firearm injury.

Methods:

We performed a nationwide retrospective cohort study between 2014 and 2018. Urban Zip Code Tabulation Areas (ZCTAs) historically exposed to detrimental redlining (grades C and D) were matched to unexposed ZCTAs based on modern-day population-level demographic characteristics (ie, age, Gini index, median income, percentage Black population, and education level). Incidence of firearm injury was derived from the Gun Violence Archive and aggregated to ZCTA level counts. Our primary outcome was the incidence of firearm injury, modeled using zero-inflated negative binomial regression.

Results:

When controlling for urban firearm risk factors, neighborhoods with detrimental redlining were associated with 2.6 additional firearm incidents annually compared with nonredlined areas with similar modern-day risk factors. Over our study period, this accounts for an additional 23,000 firearm injuries.

Conclusions:

Historic, discriminatory Federal policies continue to impact modern-day firearm violence. Policies aimed at reversing detrimental redlining may offer an economic means to reduce firearm violence.
Diversity of the type VI secretion systems in the Neisseria spp
Authors: Calder Alan , Snyder Lori A.S.
Published: April 2023

Complete Type VI Secretion Systems were identified in the genome sequence data of

Neisseria subflava

isolates sourced from throat swabs of human volunteers. The previous report was the first to describe two complete Type VI Secretion Systems in these isolates, both of which were distinct in terms of their gene organization and sequence homology. Since publication of the first report, Type VI Secretion System subtypes have been identified in

Neisseria

spp. The characteristics of each type in

N. subflava

are further investigated here and in the context of the other

Neisseria

spp., including identification of the lineages containing the different types and subtypes. Type VI Secretion Systems use VgrG for delivery of toxin effector proteins; several copies of vgrG and associated effector / immunity pairs are present in

Neisseria

spp. Based on sequence similarity between strains and species, these core Type VI Secretion System genes, vgrG, and effector / immunity genes may diversify via horizontal gene transfer, an instrument for gene acquisition and repair in

Neisseria

spp.