bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of hypertension and other risk factors on the onset of sublingual varices
Authors: Accardo Agostino , Pascazio Lorenzo , Costantinides Fulvia , Gorza Fabio , Silveri Giulia
Published: May 2021

Background

Sublingual varices (SV) are dilatations of tortuous veins that increased with age. Previous studies showed that this pathology could be correlated to some risk factors such as hypertension, age, gender and diabetes mellitus. In this study we evaluated, on a large number of subjects, the relationship between SV and different grades of hypertension as well as some risk factors extending the analysis to new risk factors such as dyslipidemia, obesity and antihypertensive therapy, modelling a possible dependence of SV on all these factors.

Methods

In the study 1008 subjects, 284 with and 724 without SV, were examined. The blood pressure was measured in office condition and, to exclude subjects with white coat syndrome or masked hypertension, also using a 24 h Holter pressure monitor. Hypertensive subjects were divided in resistant, drugs controlled (compensated) and patients with prior unknown hypertension (new diagnosed) groups. The presence or absence of SV as well as of the risk factors was assessed clinically. We tested the influence of age on the presence of SV by using the chi-square test and the relation between each risk factor and SV by the Cochran–Mantel–Haenszel test. Finally, we carried out a multivariate regression tree analysis in order to predict the presence of SV.

Results

We confirmed the influence of age on SV and found a significant relationship between SV and both the compensated and resistant hypertension grades. We highlighted a relationship between SV and dyslipidemia in subjects with new diagnosed hypertension, and between SV and smoking in subjects with compensated hypertension grade. The regression tree showed a classification accuracy of about 75% using as variables hypertension grades, age and antihypertensive treatment.

Conclusions

We confirmed the SV dependence on age, resistant hypertension and smoking, highlighting a new association with dyslipidemia in new diagnosed hypertensive subjects and new relations depending on the hypertension grades. Thus, the SV inspection could be used to suggest a lipidologist as well as a hypertension specialist visit for a pharmacological and pressure check particularly in subjects presenting SV and dyslipidemia. However, further parameters are to be considered to improve the sensitivity of the prognostic tree model.
A filter approach for feature selection in classification: application to automatic atrial fibrillation detection in electrocardiogram recordings
Authors: Michel Pierre , Ngo Nicolas , Pons Jean-François , Delliaux Stéphane , Giorgi Roch
Published: May 2021

Background

In high-dimensional data analysis, the complexity of predictive models can be reduced by selecting the most relevant features, which is crucial to reduce data noise and increase model accuracy and interpretability. Thus, in the field of clinical decision making, only the most relevant features from a set of medical descriptors should be considered when determining whether a patient is healthy or not. This statistical approach known as feature selection can be performed through regression or classification, in a supervised or unsupervised manner. Several feature selection approaches using different mathematical concepts have been described in the literature. In the field of classification, a new approach has recently been proposed that uses the$$\gamma$$γ-metric, an index measuring separability between different classes in heart rhythm characterization. The present study proposes a filter approach for feature selection in classification using this$$\gamma$$γ-metric, and evaluates its application to automatic atrial fibrillation detection.

Methods

The stability and prediction performance of the$$\gamma$$γ-metric feature selection approach was evaluated using the support vector machine model on two heart rhythm datasets, one extracted from the PhysioNet database and the other from the database of Marseille University Hospital Center, France (Timone Hospital). Both datasets contained electrocardiogram recordings grouped into two classes: normal sinus rhythm and atrial fibrillation. The performance of this feature selection approach was compared to that of three other approaches, with the first two based on the Random Forest technique and the other on receiver operating characteristic curve analysis.

Results

The$$\gamma$$γ-metric approach showed satisfactory results, especially for models with a smaller number of features. For the training dataset, all prediction indicators were higher for our approach (accuracy greater than 99% for models with 5 to 17 features), as was stability (greater than 0.925 regardless of the number of features included in the model). For the validation dataset, the features selected with the$$\gamma$$γ-metric approach differed from those selected with the other approaches; sensitivity was higher for our approach, but other indicators were similar.

Conclusion

This filter approach for feature selection in classification opens up new methodological avenues for atrial fibrillation detection using short electrocardiogram recordings.
Changing the eligibility criteria for welfare payments at the end of life – a budget impact analysis for England and Wales
Authors: Webb Edward J. D. , Meads David , Gardiner Clare
Published: May 2021

Background

Terminal illness can cause a financial burden for many households. In England and Wales, fast-track access to welfare payments is available through special rules for the terminally ill (SRTI). Individuals are eligible for SRTI if they are judged to have 6 months or less to live. This criterion has been criticised as lacking a clinical basis, and being unfair for people with conditions where life-expectancy is difficult to accurately assess.

Aim

To conduct a budget impact analysis on the possible increase in expenditure of personal independence payments (PIP) following a change in England and Wales to SRTI so that everyone with a terminal illness is eligible.

Methods

The fraction of individuals with a given long-term condition was estimated by combining data from the Health Survey for England, the Office for National Statistics (ONS) and the Department for Work and Pensions. Logistic growth modelling and ONS population projections were used to project PIP expenditure from 2020 to 2025. The increased expenditure was calculated for hypothetical scenarios which may occur following an SRTI regime change, specifically an increase of 1, 2 and 3 percentage points in the fraction of individuals claiming PIP under SRTI. Data from the literature on the projected prevalence of mild, moderate and severe dementia was used to calculate the cost if everyone with a given severity of dementia claimed PIP under SRTI.

Results

Under the current SRTI regime, PIP expenditure under SRTI was projected to increase from £0.231bn in 2020 to £0.260bn in 2025, compared to equivalent figures of £11.1bn and £12.7bn under non-SRTI. Expenditure in 2025 following an increase in the fraction claiming of 1, 2 and 3 percentage points was projected to be £1.1bn, £1.9bn and £2.7bn respectively. In 2025, PIP expenditure was estimated to be £7.4bn if everyone with dementia claimed under SRTI, compared to £6.4bn if only individuals with moderate and severe dementia claimed, and £4.7bn if only individuals with severe dementia claimed.

Conclusion

Changes in SRTI are projected to lead to increases in PIP expenditure. However, the increased cost is small compared to expenditure under non-SRTI, especially as the highest costs were associated with extreme scenarios.
Barriers to responding to reproductive coercion and abuse among women presenting to Australian primary care
Authors: Wellington Molly , Hegarty Kelsey , Tarzia Laura
Published: May 2021

Background

Reproductive coercion and abuse is defined as any behaviour that seeks to control a woman’s reproductive autonomy. In Australia, women often access reproductive health care through a primary care clinician, however, little is known about clinicians’ experiences responding to reproductive coercion and abuse. This study aims to address this gap by exploring the barriers to responding to reproductive coercion and abuse in Australian primary care.

Methods

In this qualitative study, twenty-four primary care clinicians from diverse clinical settings in primary care across Australia were recruited to participate in a semi-structured interview. Data were analysed thematically.

Results

Through analysis, three themes were developed: It’s not even in the frame; which centred around clinicians lack of awareness around the issue. There’s not much we can do, where clinicians described a lack of confidence in responding correctly as well as a lack of services to refer on to. Lastly There’s no one to help us, explaining the disconnect between referral services and primary care as well as the impacts of lack of abortion on women experiencing reproductive coercion and abuse.

Conclusions

Clinicians expressed similar experiences of barriers to respond to reproductive coercion and abuse. Many clinicians felt ill-equipped to identify and respond to reproductive coercion and abuse. Some clinicians hadn’t received any formal training, others were trained but had nowhere to refer women. Further complicating responses was a lack of support from referral services. This study highlights the need for more training and a streamlined referral pathways for women who experience reproductive coercion and abuse, as well as better access to reproductive health services in rural areas.
The impact of child health interventions and risk factors on child survival in Kenya, 1993–2014: a Bayesian spatio-temporal analysis with counterfactual scenarios
Authors: Macharia Peter M. , Joseph Noel K. , Snow Robert W. , Sartorius Benn , Okiro Emelda A.
Published: May 2021

Background

During the millennium development goals period, reduction in under-five mortality (U5M) and increases in child health intervention coverage were characterised by sub-national disparities and inequities across Kenya. The contribution of changing risk factors and intervention coverage on the sub-national changes in U5M remains poorly defined.

Methods

Sub-national county-level data on U5M and 43 factors known to be associated with U5M spanning 1993 and 2014 were assembled. Using a Bayesian ecological mixed-effects regression model, the relationships between U5M and significant intervention and infection risk ecological factors were quantified across 47 sub-national counties. The coefficients generated were used within a counterfactual framework to estimate U5M and under-five deaths averted (U5-DA) for every county and year (1993–2014) associated with changes in the coverage of interventions and disease infection prevalence relative to 1993.

Results

Nationally, the stagnation and increase in U5M in the 1990s were associated with rising human immunodeficiency virus (HIV) prevalence and reduced maternal autonomy while improvements after 2006 were associated with a decline in the prevalence of HIV and malaria, increase in access to better sanitation, fever treatment-seeking rates and maternal autonomy. Reduced stunting and increased coverage of early breastfeeding and institutional deliveries were associated with a smaller number of U5-DA compared to other factors while a reduction in high parity and fully immunised children were associated with under-five lives lost. Most of the U5-DA occurred after 2006 and varied spatially across counties. The highest number of U5-DA was recorded in western and coastal Kenya while northern Kenya recorded a lower number of U5-DA than western. Central Kenya had the lowest U5-DA. The deaths averted across the different regions were associated with a unique set of factors.

Conclusion

Contributions of interventions and risk factors to changing U5M vary sub-nationally. This has important implications for targeting future interventions within decentralised health systems such as those operated in Kenya. Targeting specific factors where U5M has been high and intervention coverage poor would lead to the highest likelihood of sub-national attainment of sustainable development goal (SDG) 3.2 on U5M in Kenya.
Day time, night time, over time: geographic and temporal uncertainty when linking event and contextual data
Authors: Folch David C. , Fowler Christopher S. , Mikaelian Levon
Published: May 2021

Background

The growth of geolocated data has opened the door to a wealth of new research opportunities in the health fields. One avenue of particular interest is the relationship between the spaces where people spend time and their health outcomes. This research model typically intersects individual data collected on a specific cohort with publicly available socioeconomic or environmental aggregate data. In spatial terms: individuals are represented as points on map at a particular time, and context is represented as polygons containing aggregated or modeled data from sampled observations. Uncertainty abounds in these kinds of complex representations.

Methods

We present four sensitivity analysis approaches that interrogate the stability of spatial and temporal relationships between point and polygon data. Positional accuracy assesses the significance of assigning the point to the correct polygon. Neighborhood size investigates how the size of the context assumed to be relevant impacts observed results. Life course considers the impact of variation in contextual effects over time. Time of day recognizes that most people occupy different spaces throughout the day, and that exposure is not simply a function residential location. We use eight years of point data from a longitudinal study of children living in rural Pennsylvania and North Carolina and eight years of air pollution and population data presented at 0.5 mile (0.805 km) grid cells. We first identify the challenges faced for research attempting to match individual outcomes to contextual effects, then present methods for estimating the effect this uncertainty could introduce into an analysis and finally contextualize these measures as part of a larger framework on uncertainty analysis.

Results

Spatial and temporal uncertainty is highly variable across the children within our cohort and the population in general. For our test datasets, we find greater uncertainty over the life course than in positional accuracy and neighborhood size. Time of day uncertainty is relatively low for these children.

Conclusions

Spatial and temporal uncertainty should be considered for each individual in a study since the magnitude can vary considerably across observations. The underlying assumptions driving the source data play an important role in the level of measured uncertainty.
Coronary lesion complexity in patients with heterozygous familial hypercholesterolemia hospitalized for acute myocardial infarction: data from the RICO survey
Authors: Yao Hermann , Farnier Michel , Tribouillard Laura , Chague Frédéric , Brunel Philippe , Maza Maud , Brunet Damien , Rochette Luc , Bichat Florence , Cottin Yves , Zeller Marianne
Published: May 2021

Background

Although patients with familial heterozygous hypercholesterolemia (FH) have a high risk of early myocardial infarction (MI), the coronary artery disease (CAD) burden in FH patients with acute MI remains to be investigated.

Methods

The data for all consecutive patients hospitalized in 2012–2019 for an acute MI and who underwent coronary angiography were collected from a multicenter database (RICO database). FH (n = 120) was diagnosed using Dutch Lipid Clinic Network criteria (score ≥ 6). We compared the angiographic features of MI patients with and without FH (score 0–2) (n = 234) after matching for age, sex, and diabetes (1:2).

Results

Although LDL-cholesterol was high (208 [174–239] mg/dl), less than half of FH patients had chronic statin treatment. When compared with non-FH patients, FH increased the extent of CAD (as assessed by SYNTAX score; P = 0.005), and was associated with more frequent multivessel disease (P = 0.004), multiple complex lesions (P = 0.022) and significant stenosis location on left circumflex and right coronary arteries. Moreover, FH patients had more multiple lesions, with an increased rate of bifurcation lesions or calcifications (P = 0.021 and P = 0.036, respectively). In multivariate analysis, LDL-cholesterol levels (OR 1.948; 95% CI 1.090–3.480, P = 0.024) remained an independent estimator of anatomical complexity of coronary lesions, in addition to age (OR 1.035; 95% CI 1.014–1.057, P = 0.001).

Conclusions

FH patients with acute MI had more severe CAD, characterized by complex anatomical features that are mainly dependent on the LDL-cholesterol burden. Our findings reinforce the need for more aggressive preventive strategies in these high-risk patients, and for intensive lipid-lowering therapy as secondary prevention.
Motivations, dating app relationships, unintended consequences and change in sexual behaviour in dating app users at an Australian music festival
Authors: Garga Shirali , Thomas Meryl T. , Bhatia Ashneet , Sullivan Aidan , John-Leader Franklin , Pit Sabrina W.
Published: May 2021

Background

Despite the popularity of dating apps, there remain scarce data on the motivations, consequences and their influence on sexual behaviour change in the Australian population.

Objective

To explore motivations, dating app relationships, unintended consequences and change in sexual behaviour in dating app users at an Australian music festival.

Methods

A cross-sectional study design was used. Festival patrons aged 18–30 at a major Australian music festival completed a paper-based survey. Logistic regression was used to identify which factors were associated with an increase in sexual partners since using dating apps.

Results

The primary reasons for dating app use (N = 437) were boredom (59.7%), casual sex (45.1%) and casual dating (42.8%). A third of users used them at music festivals (33.8%, n = 432). A third of participants had used dating apps for more than 2 years (33.3%) and a third (33.0%) of users claimed to have changed their sexual behaviour after app use, including increased frequency of sexual activity (70.0%), number of sexual partners (57.1%) and sexual experimentation (42.1%). Dating app users tended not to discuss sexually transmitted infections (STI) status with a sexual partner regardless of whether they had met them on an app or not: 38.5% would ‘never’ and 36.9% would ‘sometimes’ have safe sex discussions with partners met via apps. Condoms were ‘always’ used for 36.9% of dating app users when meeting partners via dating apps, compared to 29.9% met by other means. 8.6% of dating app users reported having contracted STIs, and 2.8% had unwanted pregnancies with those met on dating apps. After adjusting for socio-demographics, those who had an STI after engaging in sexual activity with a person met via a dating app had 2.4 times the odds of reporting an increase in sexual partners, and those who had used a dating app for over 2 years had twice the odds of reporting an increase in sexual partners. When condom use was entered into the model, those that ‘often’ or ‘sometimes’ used a condom with a new dating app partner were twice as likely to report an increase in sexual partners since using dating apps, compared to those who ‘always’ used a condom with a new dating app partner. Sexual orientation and STI discussions with a new sexual dating app partner were not associated with an increase in dating app partners.

Conclusion

Dating app usage is common and users report increased sexual activity, sexual partners and experimentation. STI discussions with potential partners and condom use remained low regardless of how partners were met and despite an increase in sexual partners since using dating apps. Given the high-risk nature of individuals that utilise dating apps, safe sex discussion, including STIs, pregnancies and condom use should be promoted to improve sexual health outcomes.
CMV infection, CD19+ B cell depletion, and Lymphopenia as predictors for unexpected admission in the institutionalized elderly
Authors: Chen Liang-Yu , Hwang An-Chun , Huang Chung-Yu , Chen Liang-Kung , Wang Fu-Der , Chan Yu-Jiun
Published: May 2021

Background

Chronic infections played a detrimental role on health outcomes in the aged population, and had complex associations with lymphocyte subsets distribution. Our study aimed to explore the predictive roles of chronic infections, lymphopenia, and lymphocyte subsets on unexpected admission and mortality in the institutionalized oldest-old during 3 year follow-up period.

Results

There were 163 participants enrolled prospectively with median age of 87.3 years (IQR: 83.1–90.2), male of 88.3%, and being followed for 156.4 weeks (IQR: 136.9–156.4 weeks). The unexpected admission and mortality rates were 55.2 and 24.5% respectively. The Cox proportional hazards models demonstrated the 3rd quartile of cytomegalovirus IgG (OR: 3.26, 95% CI: 1.55–6.84), lymphopenia (OR: 2.85, 95% CI: 1.2–6.74), and 1st quartile of CD19+B cell count (OR: 2.84, 95% CI: 1.29–6.25) predicted elevated risks of unexpected admission after adjusting for potential confounders; while the 3rd quartile of CD3+T cell indicated a reduced risk of mortality (OR: 0.19, 95% CI: 0.05–0.71). Negative association between CMV IgG and CD19+B cell count suggested that CMV infection might lead to B cell depletion via decreasing memory B cells repertoire.

Conclusions

CMV infection, lymphopenia, and CD19+B cell depletion might predict greater risk of unexpected admission, while more CD3+T cell would suggest a reduced risk of mortality among the oldest-old population. A non-linear or U-shaped relationship was supposed between health outcomes and CMV infection, CD3+T cell, or CD19+B cell counts. Further prospective studies with more participants included would be needed to elucidate above findings.
Benefit of replanning in MR-guided online adaptive radiation therapy in the treatment of liver metastasis
Authors: Mayinger Michael , Ludwig Roman , Christ Sebastian M. , Dal Bello Riccardo , Ryu Alex , Weitkamp Nienke , Pavic Matea , Garcia Schüler Helena , Wilke Lotte , Guckenberger Matthias , Unkelbach Jan , Tanadini-Lang Stephanie , Andratschke Nicolaus
Published: May 2021

Purpose

To assess the effects of daily adaptive MR-guided replanning in stereotactic body radiation therapy (SBRT) of liver metastases based on a patient individual longitudinal dosimetric analysis.

Methods

Fifteen patients assigned to SBRT for oligometastatic liver metastases underwent daily MR-guided target localization and on-table treatment plan re-optimization. Gross tumor volume (GTV) and organs at risk (OARs) were adapted to the anatomy-of-the-day. A reoptimized plan (RP) and a rigidly shifted baseline plan (sBP) without re-optimization were generated for each fraction. After extraction of DVH parameters for GTV, planning target volume (PTV), and OARs (stomach, duodenum, bowel, liver, heart) plans were compared on a per-patient basis.

Results

Median pre-treatment GTV and PTV were 14.9 cc (interquartile range (IQR): 7.7–32.9) and 62.7 cc (IQR: 42.4–105.5) respectively. SBRT with RP improved PTV coverage (V100%) for 47/75 of the fractions and reduced doses to the most proximal OARs (D1cc, Dmean) in 33/75 fractions compared to sBP. RP significantly improved PTV coverage (V100%) for metastases within close proximity to an OAR by 4.0% (≤ 0.2 cm distance from the edge of the PTV to the edge of the OAR; n = 7; p = 0.01), but only by 0.2% for metastases farther away from OAR (> 2 cm distance; n = 7; p = 0.37). No acute grade 3 treatment-related toxicities were observed.

Conclusions

MR-guided online replanning SBRT improved target coverage and OAR sparing for liver metastases with a distance from the edge of the PTV to the nearest luminal OAR < 2 cm. Only marginal improvements in target coverage were observed for target distant to critical OARs, indicating that these patients do not benefit from daily adaptive replanning.
Improving metagenomic binning results with overlapped bins using assembly graphs
Authors: Mallawaarachchi Vijini G. , Wickramarachchi Anuradha S. , Lin Yu
Published: May 2021

Background

Metagenomic sequencing allows us to study the structure, diversity and ecology in microbial communities without the necessity of obtaining pure cultures. In many metagenomics studies, the reads obtained from metagenomics sequencing are first assembled into longer contigs and these contigs are then binned into clusters of contigs where contigs in a cluster are expected to come from the same species. As different species may share common sequences in their genomes, one assembled contig may belong to multiple species. However, existing tools for binning contigs only support non-overlapped binning, i.e., each contig is assigned to at most one bin (species).

Results

In this paper, we introduce GraphBin2 which refines the binning results obtained from existing tools and, more importantly, is able to assign contigs to multiple bins. GraphBin2 uses the connectivity and coverage information from assembly graphs to adjust existing binning results on contigs and to infer contigs shared by multiple species. Experimental results on both simulated and real datasets demonstrate that GraphBin2 not only improves binning results of existing tools but also supports to assign contigs to multiple bins.

Conclusion

GraphBin2 incorporates the coverage information into the assembly graph to refine the binning results obtained from existing binning tools. GraphBin2 also enables the detection of contigs that may belong to multiple species. We show that GraphBin2 outperforms its predecessor GraphBin on both simulated and real datasets. GraphBin2 is freely available at https://github.com/Vini2/GraphBin2.
COVID-19 in conflict border regions: a case of South Kordofan, Sudan
Authors: Sserwanja Quraish , Adam Mohammed Bashir , Kawuki Joseph , Olal Emmanuel
Published: May 2021

The novel coronavirus disease (COVID-19) was first reported in Sudan on 13 March 2020. Since then, Sudan has experienced one of the highest rates of COVID-19 spread and fatalities in Africa. One year later, as per 22 March 2021, Sudan had registered 29,661 confirmed cases and 2,028 deaths with a case fatality rate (CFR) of 6.8 %. By 12 December 2020, of the 18 states in Sudan, South Kordofan had the fifth highest CFR of 17.4 %, only surpassed by the other conflict affected North (57.5 %), Central (50.0 %) and East (31.8 %) Darfur States. By late March 2021, just three months from December 2020, the number of cases in South Kordofan increased by 100 %, but with a significant decline in the CFR from 17.4 to 8.5 %. South Kordofan is home to over 200,000 poor and displaced people from years of destructive civil unrests. To date, several localities such as the Nubba mountains region remain under rebel control and are not accessible. South Kordofan State Ministry of Health in collaboration with the federal government and non-governmental organizations set up four isolation centres with 40 total bed capacity, but with only two mechanical ventilators and no testing centre. There is still need for further multi-sectoral coalition and equitable allocation of resources to strengthen the health systems of rural and conflict affected regions. This article aims at providing insight into the current state of COVID-19 in South Kordofan amidst the second wave to address the dearth of COVID-19 information in rural and conflict affected regions.
Role of epigenetics in unicellular to multicellular transition in Dictyostelium
Authors: Wang Simon Yuan , Pollina Elizabeth Ann , Wang I-Hao , Pino Lindsay Kristina , Bushnell Henry L. , Takashima Ken , Fritsche Colette , Sabin George , Garcia Benjamin Aaron , Greer Paul Lieberman , Greer Eric Lieberman
Published: May 2021

Background

The evolution of multicellularity is a critical event that remains incompletely understood. We use the social amoeba, Dictyostelium discoideum, one of the rare organisms that readily transits back and forth between both unicellular and multicellular stages, to examine the role of epigenetics in regulating multicellularity.

Results

While transitioning to multicellular states, patterns of H3K4 methylation and H3K27 acetylation significantly change. By combining transcriptomics, epigenomics, chromatin accessibility, and orthologous gene analyses with other unicellular and multicellular organisms, we identify 52 conserved genes, which are specifically accessible and expressed during multicellular states. We validated that four of these genes, including the H3K27 deacetylase hdaD, are necessary and that an SMC-like gene, smcl1, is sufficient for multicellularity in Dictyostelium.

Conclusions

These results highlight the importance of epigenetics in reorganizing chromatin architecture to facilitate multicellularity in Dictyostelium discoideum and raise exciting possibilities about the role of epigenetics in the evolution of multicellularity more broadly.
The effect of automated audit and feedback on data completeness in the electronic health record of the general physician: protocol for a cluster randomized controlled trial
Authors: Van den Bulck Steve , De Burghgraeve Tine , Raat Willem , Mamouris Pavlos , Coursier Patrick , Vankrunkelsven Patrik , Goderis Geert , Hermens Rosella , Van Pottelbergh Gijs , Vaes Bert
Published: May 2021

Background

The electronic health record (EHR) of the general physician (GP) is an important tool that can be used to assess and improve the quality of healthcare. However, there are some problems when (re) using the data gathered in the EHR for quality assessments. One problem is the lack of data completeness in the EHR. Audit and feedback (A&F) is a well-known quality intervention that can improve the quality of healthcare. We hypothesize that an automated A&F intervention can be adapted to improve the data completeness of the EHR of the GP, more specifically, the number of correctly registered diagnoses of type 2 diabetes and chronic kidney disease.

Methods

This study is a pragmatic cluster randomized controlled trial with an intervention at the level of GP practice. The intervention consists of an audit and extended electronically delivered feedback with multiple components that will be delivered 4 times electronically to general practices over 12 months. The data will be analyzed on an aggregated level (per GP practice). The primary outcome is the percentage of correctly registered diagnoses of type 2 diabetes. The key secondary outcome is the registration of chronic kidney disease. Exploratory secondary outcomes are the registration of heart failure, biometric data and lifestyle habits, and the evolution of 4 different EHR-extractable quality indicators.

Discussion

This cluster randomized controlled trial intends to primarily improve the registration of type 2 diabetes in the EHR of the GP and to secondarily improve the registration of chronic kidney disease. In addition, the registration of heart failure, lifestyle parameters, and biometric data in the EHR of the GP are explored together with 4 EHR-extractable quality indicators. By doing so, this study aims to improve the data completeness of the EHR, paving the way for future quality assessments.

Trial registration

ClinicalTrials.gov NCT04388228. Registered on May 14, 2020.
Single-cell sequencing of the small and AT-skewed genome of malaria parasites
Authors: Liu Shiwei , Huckaby Adam C. , Brown Audrey C. , Moore Christopher C. , Burbulis Ian , McConnell Michael J. , Güler Jennifer L.
Published: May 2021

Single-cell genomics is a rapidly advancing field; however, most techniques are designed for mammalian cells. We present a single-cell sequencing pipeline for an intracellular parasite, Plasmodium falciparum, with a small genome of extreme base content. Through optimization of a quasi-linear amplification method, we target the parasite genome over contaminants and generate coverage levels allowing detection of minor genetic variants. This work, as well as efforts that build on these findings, will enable detection of parasite heterogeneity contributing to P. falciparum adaptation. Furthermore, this study provides a framework for optimizing single-cell amplification and variant analysis in challenging genomes.
Existence and multiplicity of solutions for Kirchhof-type problems with Sobolev–Hardy critical exponent
Authors: Fan Hongsen , Deng Zhiying
Published: May 2021

In this paper, we discuss a class of Kirchhof-type elliptic boundary value problem with Sobolev–Hardy critical exponent and apply the variational method to obtain one positive solution and two nontrivial solutions to the problem under certain conditions.
Percolation-Based Image Processing for the Plastic Viscosity of Cementitious Mortar with Super Absorbent Polymer
Authors: Aryanfar Asghar , Şanal Irem , Marian Jaime
Published: May 2021

Super absorbent polymers (SAP) are the recent promising chemical admixtures with the potential for reducing the shrinkage, cracking, freeze/thaw and increasing the durability of the concrete. These polymers are classified as hydrogels when cross-linked and can retain exceptionally high amount of liquid solutions of their own weight. In this paper, the flowability of the concrete is quantified by means of developing a percolation-based image processing method and the transient behavior of the viscosity of the SAP-contained mortar mixture is characterized via numerical solution of Navier–Stokes relationship. In addition, rheological measurements and the analytical development has been carried out for complementary verification of the viscosity trends. Controlling the flow within such relatively short period of time is essential for tuning the functionality of concrete during the construction as well as it’s respective resilience during the extended period of application.
From information experiences to consumer engagement on brand’s social media accounts
Authors: Park Jee-Sun , Ha Sejin
Published: May 2021

The purpose of this paper is to propose and empirically validate a model that explains user experiences with information interactions on fashion brand pages, leading to consumer engagement on social media. Specifically, this study tests whether values involved in information interactions prompt positive emotions, which in turn foster experiential states contributing to customer engagement intentions. The moderating role of curiosity is also examined. Data from 290 users of fashion brand page in South Korea were collected using a web-based survey method. Structural equation modeling and the PROCESS macro were used to test the research hypotheses. The results revealed that the perceived values involved in information interactions (usefulness, enjoyment) elicit positive emotions, which foster experiential states (satisfaction, cognitive engagement, elaboration) that lead to engagement intentions with brand pages. The results also showed the moderating effect of curiosity on the relationship between perceived values and positive emotions. Theoretical and practical contributions are discussed.
Consumer store experience through virtual reality: its effect on emotional states and perceived store attractiveness
Authors: Jin Byoungho , Kim Gwia , Moore Marguerite , Rothenberg Lori
Published: May 2021

Based on the stimuli-organism-response model, this study aims to examine whether consumers’ store experience through virtual reality (VR), compared to website experience, can attract them enough to perceive the online store as appealing. Two types of stimuli were developed for the experiments: consumers’ VR store experience (106 data) (i.e., having respondents experience 360-degree-based VR store videos recorded at a fashion retailer) and store website experience (107 data) (i.e., having respondents experience the same store’s website). The results revealed that relative to an ordinary store website, consumers’ VR store experience evoked positive emotions and increased perceived store attractiveness. This study also discovered that store familiarity does not moderate the relationship between the two store experience types and evoked emotions, implying that VR technology is effective regardless of consumers’ familiarity with a store. Text analytics were also utilized, providing additional insights about their VR store experiences. This study suggests an effective method for online retailers to emulate an attractive store environment and entice consumers through VR, regardless of the retailers’ fame. Specifically, it demonstrates the effectiveness of VR over website in enhancing store attractiveness, an under-studied area.
National Trends in Pediatric Admissions for Diabetic Ketoacidosis, 2006–2016
Authors: Everett Estelle M , Copeland Timothy P , Moin Tannaz , Wisk Lauren E
Published: May 2021

Background and Objectives

Diabetic ketoacidosis (DKA) rates in the United States are rising. Prior studies suggest higher rates in younger populations, but no studies have evaluated national trends in pediatric populations and differences by subgroups. As such, we sought to examine national trends in pediatric DKA.

Methods

We used the 2006, 2009, 2012, and 2016 Kids’ Inpatient Database to identify pediatric DKA admissions among a nationally representative sample of admissions of youth ≤20 years old. We estimate DKA admission per 10 000 admissions and per 10 000 population, charges, length of stay (LOS), and trends over time among all hospitalizations and by demographic subgroups. Regression models were used to evaluate differences in DKA rates within subgroups overtime.

Results

Between 2006 and 2016, there were 149 535 admissions for DKA. Unadjusted DKA rate per admission increased from 120.5 (95% CI, 115.9-125.2) in 2006 to 217.7 (95% CI, 208.3-227.5) in 2016. The mean charge per admission increased from $14 548 (95% CI, $13 971-$15 125) in 2006 to $20 997 (95% CI, $19 973-$22 022) in 2016, whereas mean LOS decreased from 2.51 (95% CI, 2.45-2.57) to 2.28 (95% CI, 2.23-2.33) days. Higher DKA rates occurred among 18- to 20-year-old females, Black youth, without private insurance, with lower incomes, and from nonurban areas. Young adults, men, those without private insurance, and from nonurban areas had greater increases in DKA rates across time.

Conclusions

Pediatric DKA admissions have risen by 40% in the United States and vulnerable subgroups remain at highest risk. Further studies should characterize the challenges experienced by these groups to inform interventions to mitigate their DKA risk and to address the rising DKA rates nationally.
Peptide Receptor Radionuclide Therapy With 177Lu-DOTATATE for Symptomatic Control of Refractory Carcinoid Syndrome
Authors: Zandee Wouter T , Brabander Tessa , Blažević Anela , Minczeles Noémie S , Feelders Richard A , de Herder Wouter W , Hofland Johannes
Published: May 2021

Context

Peptide receptor radionuclide therapy (PRRT) with [Lutetium-177-DOTA0-Tyr3]octreotate (177Lu-DOTATATE) results in an increase of progression-free survival and quality of life in patients with progressive, well-differentiated neuroendocrine neoplasms (NENs).

Objective

To study the effect of 177Lu-DOTATATE in patients with carcinoid syndrome and radiologically stable or newly diagnosed disease treated solely for the purpose of symptom reduction.

Design

Retrospective cohort study.

Setting

Tertiary care hospital.

Patients

Twenty-two patients with a metastatic midgut NEN, elevated urinary 5-hydroxyindolacetic acid excretion, and flushing and/or diarrhea despite treatment with a somatostatin analog, without documented disease progression.

Intervention

PRRT with 177Lu-DOTATATE (intended cumulative dose: 29.6 GBq) with a primary aim to reduce symptoms.

Results

After PRRT, mean bowel movement frequency (BMF) decreased from 6.1 ± 3.4 to 4.6 ± 3.6 per day (P = 0.009). Flushes decreased from 4.3 ± 2.9 to 2.4 ± 2.7 flushes per day (P = 0.002). A decrease of BMF of more than 30% occurred in 47% of patients with baseline BMF of 4 or more (n = 17). In patients with ≥2 episodes of flushing a day (n = 15), 67% of patients had more than 50% decrease of daily flushing. A decrease in urinary 5-hydroxyindolacetic acid excretion of more than 30% was seen in 56% of patients. The European Organization for Research and Treatment of Cancer–Core Module diarrhea subscale score showed a trend toward improvement by an average of 16.7 ± 33.3 points (P = 0.11).

Conclusion

PRRT with 177Lu-DOTATATE effectively reduced diarrhea and flushing in patients with carcinoid syndrome and can be considered for symptomatic treatment of carcinoid syndrome insufficiently controlled with somatostatin analogs.
“Did Emmett Till Die in Vain? Organized Labor Says No!”: The United Packinghouse Workers and Civil Rights Unionism in the Mid-1950s
Authors: Nichter Matthew F.
Published: May 2021

Emmett Till's mangled face is seared into our collective memory, a tragic epitome of the brutal violence that upheld white supremacy in the Jim Crow South. But Till's murder was more than just a tragedy: it also inspired an outpouring of protest, in which labor unions played a prominent role. The United Packinghouse Workers of America (UPWA) campaigned energetically, from the stockyards of Chicago to the sugar refineries of Louisiana. The UPWA organized the first mass meeting addressed by Till's mother, Mamie Bradley; packinghouse workers petitioned, marched, and rallied to demand justice; and an interracial group of union activists traveled to Mississippi to observe the trial of Till's killers firsthand, flouting segregation inside and outside the courtroom. Analysis of antiracist unions like the UPWA can help rectify a weakness in the “whiteness” literature by illuminating the contexts and strategies that have fostered durable interracial working-class solidarity. The UPWA, which managed to survive the Red Scare of the late 1940s and early 1950s relatively unscathed, represents an important link between the “civil rights unionism” of the 1930s and 1940s and the civil rights movement of the mid-1950s and 1960s.
The biomechanical basis of biased epithelial tube elongation in lung and kidney development
Authors: Conrad Lisa , Runser Steve Vincent Maurice , Fernando Gómez Harold , Lang Christine Michaela , Dumond Mathilde Sabine , Sapala Aleksandra , Schaumann Laura , Michos Odyssé , Vetter Roman , Iber Dagmar
Published: May 2021

During lung development, epithelial branches expand preferentially in a longitudinal direction. This bias in outgrowth has been linked to a bias in cell shape and in the cell division plane. How this bias arises is unknown. Here, we show that biased epithelial outgrowth occurs independent of the surrounding mesenchyme, of preferential turnover of the extracellular matrix at the bud tips and of FGF signalling. There is also no evidence for actin-rich filopodia at the bud tips. Rather, we find epithelial tubes to be collapsed during early lung and kidney development, and we observe fluid flow in the narrow tubes. By simulating the measured fluid flow inside segmented narrow epithelial tubes, we show that the shear stress levels on the apical surface are sufficient to explain the reported bias in cell shape and outgrowth. We use a cell-based vertex model to confirm that apical shear forces, unlike constricting forces, can give rise to both the observed bias in cell shapes and tube elongation. We conclude that shear stress may be a more general driver of biased tube elongation beyond its established role in angiogenesis.

This article has an associated ‘The people behind the papers’ interview.
Lewis Wolpert (1929-2021)
Authors: Smith J. C.
Published: May 2021

Lewis Wolpert, who died on 28 January 2021, was an inspirational figure to generations of developmental biologists, and a man whose influence extended far beyond his subject. By seeing significance in the commonplace, and by identifying and re-framing research questions, he inspired new ways of thinking about embryonic development. As a teacher and as a lecturer he was nonpareil, and his ideas were brilliantly distilled in his textbook Principles of Development, which will continue to imbue students with his clarity of thought. In writing about his depression, Wolpert reduced the stigma associated with the disease and provided scientific understanding, solace and hope. An open, kind and generous man, he went out of his way to support young scientists.
Sickness behaviors across vertebrate taxa: proximate and ultimate mechanisms
Authors: Lopes Patricia C. , French Susannah S. , Woodhams Douglas C. , Binning Sandra A.
Published: May 2021

There is nothing like a pandemic to get the world thinking about how infectious diseases affect individual behavior. In this respect, sick animals can behave in ways that are dramatically different from healthy animals: altered social interactions and changes to patterns of eating and drinking are all hallmarks of sickness. As a result, behavioral changes associated with inflammatory responses (i.e. sickness behaviors) have important implications for disease spread by affecting contacts with others and with common resources, including water and/or sleeping sites. In this Review, we summarize the behavioral modifications, including changes to thermoregulatory behaviors, known to occur in vertebrates during infection, with an emphasis on non-mammalian taxa, which have historically received less attention. We then outline and discuss our current understanding of the changes in physiology associated with the production of these behaviors and highlight areas where more research is needed, including an exploration of individual and sex differences in the acute phase response and a greater understanding of the ecophysiological implications of sickness behaviors for disease at the population level.
Opposing effects of dopamine on agonistic behaviour in crayfish
Authors: Ibuchi Kengo , Nagayama Toshiki
Published: May 2021

The effects of dopamine on the agonistic behaviour of crayfish were analysed. When dopamine concentrations of 1 μmol l−1 were injected into large crayfish, individuals were beaten by smaller opponents, despite their physical advantage. Injection of 10 μmol l−1 dopamine into small animals increased their rate of winning against larger opponents. Injection of a D1 receptor antagonist prohibited the onset of a ‘loser’ effect in subordinate animals, suggesting that the inhibitory effect of dopamine on larger animals is mediated by D1 receptors. Similarly, injection of a D2 receptor antagonist prohibited the onset of a ‘winner’ effect in dominant animals, suggesting that the facilitating effect of dopamine on small animals is mediated by D2 receptors. Since the inhibitory effect of 1 μmol l−1 dopamine was similar to that seen with 1 μmol l−1 octopamine and the facilitating effect of 10 μmol l−1 dopamine was similar to that of 1 μmol l−1 serotonin, functional interactions among dopamine, octopamine and serotonin were analyzed by co-injection of amines with their receptor antagonists in various combinations. The inhibitory effect of 1 μmol l−1 dopamine disappeared when administered with D1 receptor antagonist, but remained when combined with octopamine receptor antagonist. Octopamine effects disappeared when administered with either D1 receptor antagonist or octopamine receptor antagonist, suggesting that the dopamine system is downstream of octopamine. The facilitating effect of 10 μmol l−1 dopamine disappeared when combined with serotonin 5HT1 receptor antagonist or D2 receptor antagonist. Serotonin effects also disappeared when combined with D2 receptor antagonist, suggesting that dopamine and serotonin activate each other through parallel pathways.