bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrated displays to improve chronic disease management in ambulatory care: A SMART on FHIR application informed by mixed-methods user testing
Authors: Curran Rebecca L , Kukhareva Polina V , Taft Teresa , Weir Charlene R , Reese Thomas J , Nanjo Claude , Rodriguez-Loya Salvador , Martin Douglas K , Warner Phillip B , Shields David E , Flynn Michael C , Boltax Jonathan P , Kawamoto Kensaku
Published: May 2020

Objective

The study sought to evaluate a novel electronic health record (EHR) add-on application for chronic disease management that uses an integrated display to decrease user cognitive load, improve efficiency, and support clinical decision making.

Materials and Methods

We designed a chronic disease management application using the technology framework known as SMART on FHIR (Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources). We used mixed methods to obtain user feedback on a prototype to support ambulatory providers managing chronic obstructive pulmonary disease. Each participant managed 2 patient scenarios using the regular EHR with and without access to our prototype in block-randomized order. The primary outcome was the percentage of expert-recommended ideal care tasks completed. Timing, keyboard and mouse use, and participant surveys were also collected. User experiences were captured using a retrospective think-aloud interview analyzed by concept coding.

Results

With our prototype, the 13 participants completed more recommended care (81% vs 48%; P < .001) and recommended tasks per minute (0.8 vs 0.6; P = .03) over longer sessions (7.0 minutes vs 5.4 minutes; P = .006). Keystrokes per task were lower with the prototype (6 vs 18; P < .001). Qualitative themes elicited included the desire for reliable presentation of information which matches participants’ mental models of disease and for intuitive navigation in order to decrease cognitive load.

Discussion

Participants completed more recommended care by taking more time when using our prototype. Interviews identified a tension between using the inefficient but familiar EHR vs learning to use our novel prototype. Concept coding of user feedback generated actionable insights.

Conclusions

Mixed methods can support the design and evaluation of SMART on FHIR EHR add-on applications by enhancing understanding of the user experience.
Abbreviated Breast MRI: Road to Clinical Implementation
Authors: Heacock Laura , Reig Beatriu , Lewin Alana A , Toth Hildegard K , Moy Linda , Lee Cindy S
Published: May 2020

Breast MRI offers high sensitivity for breast cancer detection, with preferential detection of high-grade invasive cancers when compared to mammography and ultrasound. Despite the clear benefits of breast MRI in cancer screening, its cost, patient tolerance, and low utilization remain key issues. Abbreviated breast MRI, in which only a select number of sequences and postcontrast imaging are acquired, exploits the high sensitivity of breast MRI while reducing table time and reading time to maximize availability, patient tolerance, and accessibility. Worldwide studies of varying patient populations have demonstrated that the comparable diagnostic accuracy of abbreviated breast MRI is comparable to a full diagnostic protocol, highlighting the emerging role of abbreviated MRI screening in patients with an intermediate and high lifetime risk of breast cancer. The purpose of this review is to summarize the background and current literature relating to abbreviated MRI, highlight various protocols utilized in current multicenter clinical trials, describe workflow and clinical implementation issues, and discuss the future of abbreviated protocols, including advanced MRI techniques.
A novel method of quantifying sperm to determine the potential for sperm depletion in male American lobstersHomarus americanus(H. Milne Edwards, 1837) (Decapoda: Astacidea: Nephropidae)
Authors: Gutzler Benjamin C , Pugh Tracy L , Watson Winsor H
Published: May 2020

Sperm limitation is a concern for a number of heavily fished decapods; however, work to assess this concern is sometimes hampered by a lack of simple techniques to quantify sperm transferred during reproduction. Our primary goal was to determine if DNA measurements could be used to quantify the sperm content of spermatophores and thus facilitate investigations of sperm limitation in American lobsters (Homarus americanus H. Milne Edwards, 1837). This was achieved by measuring the amount of DNA in a sample and then calibrating those values by using flow cytometry to count the number of individual sperm present in the sample. Our results show that the DNA quantification technique provides a fast and accurate way to quantify sperm. We then demonstrated the utility of the method by using it to examine the rate at which males can produce sperm under simulated conditions of repeated mating events, a situation that might lead to a reduction in the number of sperm per spermatophore. While spermatophores obtained from male lobsters at three-day intervals varied substantially in the number of sperm they contained (range 427,090–5,028,996; mean 2,306,473), there was no clear decline in sperm count over time. These results suggest that male lobsters replenish their sperm supplies rapidly, and that sperm recharge rate is unlikely to be a factor that could lead to sperm limitation in American lobster populations.
Characterization of the complete mitochondrial genome of a coconut crab, Birgus latro (Linnaeus, 1767) (Decapoda: Anomura: Coenobitidae), from Okinawa, Japan
Authors: Veldsman Werner P , Wang Yaqin , Niu Jiaojiao , Baeza J Antonio , Chu Ka Hou
Published: May 2020

We present a full description and analysis of the complete mitochondrial genome of a Pacific Ocean specimen of the coconut crab Birgus latro (Linnaeus, 1767), the largest extant terrestrial arthropod in the world. Our de novo-assembled mitogenome has a massive 16,161 times organelle read coverage, a length of 16,411 bp, contains 22 tDNAs (20 unique), 13 protein-coding genes, two rDNAs, and a putative control region of length 1,381 bp. The control region contains three microsatellites and two pairs of inverted repeats. Contrary to the mitochondrial sentinel gene concept, two-dimensional nucleotide analysis reveals higher GC-content in cox gene families than in nadh gene families. Moreover, cox gene families are more conserved than nadh gene families among the species of Coenobitidae selected for comparison. Secondary structure prediction of the 22 tDNAs shows major deviations from the cloverleaf pattern, which points to a relatively high rate of mutation in these genes. We also present a repertoire of mitochondrial variation between our male Okinawan coconut crab and an Indian Ocean specimen that consists of one insertion, one deletion, 135 SNPs, three MNPs and nine complex polymorphisms. We provide confirmatory evidence that the superfamily Paguroidea, to which the coconut crab belongs, is polyphyletic, that all the protein-coding genes of B. latro are under purifying selection, and that a Pacific versus Indian Ocean coconut crab population divergence occurred during the Pleistocene.
X-Ray-Based Irradiation of Larvae and Pupae of the Navel Orangeworm (Lepidoptera: Pyralidae)
Authors: Haff Ronald , Ovchinnikova Inna , Liang Peishih , Mahoney Noreen , Gee Wai , Gomez Joseph , Toyofuku Natsuko , Jackson Eric , Hnasko Robert , Light Douglas
Published: May 2020

The suitability of adult male the navel orangeworm, Amyelois transitella (Walker) for Sterile Insect Technique (SIT) has been reported for both high energy gamma (>1 MeV) and low energy x-ray (90 keV) sterilization. However, research regarding sterilization of NOW larvae and pupae by gamma irradiation indicated nonsuitability due to high mortality. Here, NOW larvae and pupae were irradiated to doses up to 50 Gy with 90 keV x-rays, then paired with nonirradiated colony mates. Sterility of surviving insects was determined by the presence or absence of hatched neonates. While presence of offspring does not guarantee viability, the absence does guarantee sterility (as is appropriate for SIT) and was thus the measure used here. Early stage larvae experienced 77% mortality at a dose of 30 Gy, versus 20% for nonirradiated control. At 40 Gy, mortality reached 98%. Of surviving early stage larvae at 30 Gy, 29% of moth pairs produced offspring. For late stage larvae, no offspring were produced at 40 Gy, but mortality was 73%. For pupae, mortality reached 53% at 30 Gy with 13% still producing neonates, while mortality reached 98% at 40 Gy. These results are consistent with reported results for gamma irradiation of NOW larvae where sterility was observed somewhere between the 30 Gy and 60 Gy data points, but mortality was high. This further confirms the lack of suitability of NOW irradiated in the larval stage, whether by gamma or x-ray, and supports the hypothesis that x-ray and gamma treatments are biologically equivalent at equal doses.
A Simple, Inexpensive Method for Mark-Recapture of Ixodid Ticks
Authors: White Alexis , Minch Robin , Bidder Lindsey , Gaff Holly
Published: May 2020

Mark-recapture techniques have been widely used and specialized to study organisms throughout the field of biology. To mark-recapture ticks (Ixodida), we have created a simple method to mark ticks using nail polish applied with an insect pin secured in a pencil that allows for a variety of questions to be answered. For measuring tick control efficacy, estimating population estimates, or measuring movement of ticks, this inexpensive mark-recapture method has been easily applied in the field and in the lab to provide useful data to answer a variety of questions about ticks.
Training fails to elicit behavioral change in a marsupial suffering evolutionary loss of antipredator behaviors
Authors: Jolly Chris J , Webb Jonathan K , Gillespie Graeme R , Phillips Ben L
Published: May 2020

Attempts to reintroduce threatened species from ex situ populations (zoos or predator-free sanctuaries) regularly fail because of predation. When removed from their natural predators, animals may lose their ability to recognize predators and thus fail to adopt appropriate antipredator behaviors. Recently, northern quolls (Dasyurus hallucatus; Dasyuromorpha: Dasyuridae) conserved on a predator-free “island ark” for 13 generations were found to have no recognition of dingoes, a natural predator with which they had coevolved on mainland Australia for about 8,000 years. A subsequent reintroduction attempt using quolls acquired from this island ark failed due to predation by dingoes. In this study, we tested whether instrumental conditioning could be used to improve predator recognition in captive quolls sourced from a predator-free “island ark.” We used a previously successful scent-recognition assay (a giving-up density experiment) to compare predator-scent recognition of captive-born island animals before and after antipredator training. Our training was delivered by pairing live predators (dingo and domestic dog) with an electrified cage floor in repeat trials such that, when the predators were present, foraging animals would receive a shock. Our training methodology did not result in any discernible change in the ability of quolls to recognize and avoid dingo scent after training. We conclude either that our particular training method was ineffective (though ethically permissible); or that because these quolls appear unable to recognize natural predators, predator recognition may be extremely difficult to impart in a captive setting given ethical constraints. Our results point to the difficulty of reinstating lost behaviors, and to the value of maintaining antipredator behaviors in conservation populations before they are lost.
Acute appendicitis with four appendicoliths: a first case report in the English literature
Authors: Lafleche Patrick , Pillay Yagan
Published: May 2020

This is an extremely rare presentation of multiple appendicoliths in one appendix. Multiple appendicoliths as well as appendicoliths larger than 5 mm have been implicated in severe appendicitis as well as perforation and gangrene of the appendix. There is no known correlation with appendicular malignancy. The controversy arises in the surgical management of asymptomatic patients. There is emerging evidence that justifies an elective appendicectomy in asymptomatic patients.
Cystic lymphangioma in adult: a case report and a review of the literature
Authors: Colangeli Walter , Facchini Valerio , Kapitonov Aleksandr , Zappalà Marta , Bozza Fabrizio , Becelli Roberto
Published: May 2020

Cystic lymphangioma (CL) in adult is a very rare pathology. Its etiology remains unclear, but it is supposed to be congenital or to be a result of obstruction and lymph fluid retention of developing lymphatic vessels. It generally occurs in the head and neck region, probably because of the rich lymphatics in this area. It can be easily misdiagnosed with other cervicofacial masses. We present the case of a 56-year-old-female presented with a right-sided painless cervical swelling. Ultrasonography and magnetic resonance imaging were performed and a surgical complete removal was carried out. Histological examination revealed that the mass was composed by a variety of dilated lymph vessels involved in a fibrovascular stroma. Diagnose of CL was done. With this article, we want to highlight the features of CL and its role in the differential diagnoses of adults’ cervicofacial masses.
Weak CS emission in an extremely metal-poor galaxy DDO 70
Authors: Du Kaiyi , Shi Yong , Zhang Zhi-Yu , Wang Junzhi , Gao Yu
Published: May 2020

In most galaxies like the Milky Way, stars form in clouds of molecular gas. Unlike the CO emission that traces the bulk of molecular gas, the rotational transitions of HCN and CS molecules mainly probe the dense phase of molecular gas, which has a tight and almost linear relation with the far-infrared luminosity and star formation rate (SFR). However, it is unclear whether dense molecular gas exists at very low metallicity, and if exists, how it is related to star formation. In this work, we report ALMA observations of the CS J = 5 → 4 emission line of DDO 70, a nearby gas-rich dwarf galaxy with $\sim \!7{{\ \rm per\ cent}}$ solar metallicity. We did not detect CS emission from all regions with strong CO emission. After stacking all CS spectra from CO-bright clumps, we find no more than a marginal detection of CS J = 5 → 4 transition, at a signal-to-noise ratio of ∼3.3. This 3σ upper limit deviates from the $L^\prime _{\rm CS}$–LIR and $L^\prime _{\rm CS}$–SFR relationships found in local star-forming galaxies and dense clumps in the Milky Way, implying weaker CS emission at given infrared luminosity and SFR. We discuss the possible mechanisms that suppress CS emission at low metallicity.
MDM2’s dual mRNA binding domains co-ordinate its oncogenic and tumour suppressor activities
Authors: Gnanasundram Sivakumar Vadivel , Malbert-Colas Laurence , Chen Sa , Fusée Leila , Daskalogianni Chrysoula , Muller Petr , Salomao Norman , Fåhraeus Robin
Published: May 2020

Cell growth requires a high level of protein synthesis and oncogenic pathways stimulate cell proliferation and ribosome biogenesis. Less is known about how cells respond to dysfunctional mRNA translation and how this feeds back into growth regulatory pathways. The Epstein-Barr virus (EBV)-encoded EBNA1 causes mRNA translation stress in cis that activates PI3Kδ. This leads to the stabilization of MDM2, induces MDM2’s binding to the E2F1 mRNA and promotes E2F1 translation. The MDM2 serine 166 regulates the interaction with the E2F1 mRNA and deletion of MDM2 C-terminal RING domain results in a constitutive E2F1 mRNA binding. Phosphorylation on serine 395 following DNA damage instead regulates p53 mRNA binding to its RING domain and prevents the E2F1 mRNA interaction. The p14Arf tumour suppressor binds MDM2 and in addition to preventing degradation of the p53 protein it also prevents the E2F1 mRNA interaction. The data illustrate how two MDM2 domains selectively bind specific mRNAs in response to cellular conditions to promote, or suppress, cell growth and how p14Arf coordinates MDM2’s activity towards p53 and E2F1. The data also show how EBV via EBNA1-induced mRNA translation stress targets the E2F1 and the MDM2 - p53 pathway.
Tox21BodyMap: a webtool to map chemical effects on the human body
Authors: Borrel Alexandre , Auerbach Scott S , Houck Keith A , Kleinstreuer Nicole C
Published: May 2020

To support rapid chemical toxicity assessment and mechanistic hypothesis generation, here we present an intuitive webtool allowing a user to identify target organs in the human body where a substance is estimated to be more likely to produce effects. This tool, called Tox21BodyMap, incorporates results of 9,270 chemicals tested in the United States federal Tox21 research consortium in 971 high-throughput screening (HTS) assays whose targets were mapped onto human organs using organ-specific gene expression data. Via Tox21BodyMap's interactive tools, users can visualize chemical target specificity by organ system, and implement different filtering criteria by changing gene expression thresholds and activity concentration parameters. Dynamic network representations, data tables, and plots with comprehensive activity summaries across all Tox21 HTS assay targets provide an overall picture of chemical bioactivity. Tox21BodyMap webserver is available at https://sandbox.ntp.niehs.nih.gov/bodymap/.
The Galaxy platform for accessible, reproducible and collaborative biomedical analyses: 2020 update
Authors: Jalili Vahid , Afgan Enis , Gu Qiang , Clements Dave , Blankenberg Daniel , Goecks Jeremy , Taylor James , Nekrutenko Anton
Published: May 2020

Galaxy (https://galaxyproject.org) is a web-based computational workbench used by tens of thousands of scientists across the world to analyze large biomedical datasets. Since 2005, the Galaxy project has fostered a global community focused on achieving accessible, reproducible, and collaborative research. Together, this community develops the Galaxy software framework, integrates analysis tools and visualizations into the framework, runs public servers that make Galaxy available via a web browser, performs and publishes analyses using Galaxy, leads bioinformatics workshops that introduce and use Galaxy, and develops interactive training materials for Galaxy. Over the last two years, all aspects of the Galaxy project have grown: code contributions, tools integrated, users, and training materials. Key advances in Galaxy's user interface include enhancements for analyzing large dataset collections as well as interactive tools for exploratory data analysis. Extensions to Galaxy's framework include support for federated identity and access management and increased ability to distribute analysis jobs to remote resources. New community resources include large public servers in Europe and Australia, an increasing number of regional and local Galaxy communities, and substantial growth in the Galaxy Training Network.
Comparison of treatment options in adults with frequently relapsing or steroid-dependent minimal change disease
Authors: Heybeli Cihan , Erickson Stephen B , Fervenza Fernando C , Hogan Marie C , Zand Ladan , Leung Nelson
Published: May 2020

Background

Studies comparing all treatment options for frequently-relapsing/steroid-dependent (FR/SD) minimal change disease (MCD) in adults are lacking.

Methods

Medical records of 76 adults with FR/SD MCD who were treated with corticosteroids as the first-line therapy were reviewed. Treatment options were compared for the time to relapse, change of therapy and progression (relapse on full-dose treatment).

Results

Second-line treatments included rituximab (RTX; n = 13), mycophenolate mofetil (MMF; n = 12), calcineurin inhibitors (CNI; n = 26) and cyclophosphamide (CTX; n = 16). During the second-line treatments, 48 (71.6%) patients relapsed at median 17 (range 2–100)  months. The majority of relapses occurred during dose tapering or off drug. Twenty of 65 (30.8%) changed therapy after the first relapse. The median time to relapse after the second line was 66 versus 28 months in RTX versus non-RTX groups (P = 0.170). The median time to change of treatment was 66 and 44 months, respectively (P = 0.060). Last-line treatment options included RTX (n = 8), MMF (n = 4), CNI (n = 3) and CTX (n = 2). Seven (41.2%) patients had a relapse during the last-line treatment at median 39 (range 5–112)  months. The median time to relapse was 48 versus 34 months in the RTX versus non-RTX groups (P = 0.727). One patient in the RTX group died presumably of heart failure. No major adverse event was observed. During the median follow-up of 81 (range 9–355)  months, no patients developed end-stage renal disease.

Conclusions

Relapse is frequent in MCD in adults. Patients treated with RTX may be less likely to require a change of therapy and more likely to come off immunosuppressive drugs.
Comparison of Low-Profiled Visualized Intraluminal Support Stent-Assisted Coiling and Coiling Only for Acutely Ruptured Intracranial Aneurysms: Safety and Efficacy Based on a Propensity Score-Matched Cohort Study
Authors: Xue Gaici , Zuo Qiao , Tang Haishuang , Zhang Xiaoxi , Duan Guoli , Feng Zhengzhe , Li Qiang , Yang Pengfei , Fang Yibin , Zhao Kaijun , Dai Dongwei , Xu Yi , Hong Bo , Huang Qinghai , Zhao Rui , Liu Jianmin
Published: May 2020

BACKGROUND

Low-profiled visualized intraluminal support (LVIS) is suggested as a promising stent for complex intracranial aneurysms. However, the safety and efficacy of LVIS-assisted coiling of acutely ruptured wide-necked intracranial aneurysms have not been well reported.

OBJECTIVE

To evaluate the safety and efficacy of LVIS-assisted coiling of acutely ruptured wide-necked intracranial aneurysms compared with contemporary coiling-only strategy via propensity score matching in a high-volume center.

METHODS

A retrospective review of patients with acutely ruptured intracranial aneurysms who underwent LVIS stent placement or coiling only from November 2013 to October 2017 was performed. Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared.

RESULTS

All baseline characteristics were equivalent between the 2 groups except for neck size. The immediate angiographic results, procedure-related complications, procedure-related mortality, and clinical outcomes between the 2 groups demonstrated no significant differences (P = .087, P = .207, P = .685, and P = .865, respectively). The angiographic follow-up outcomes of the LVIS-assisted coiling group showed a significantly higher complete occlusion rate and lower recurrence rate compared with the coiling-only group (92.3% vs 59.9%, 4.8% vs 26.1%, P < .001). Multivariable analysis showed no significant predictors for the overall perioperative procedure-related complications, hemorrhagic complications, and ischemic complications.

CONCLUSION

The LVIS stent is a safe and effective device for stent-assisted coiling of acutely ruptured wide-necked intracranial aneurysms, with comparable procedure-related complication rates, higher complete occlusion rates, and lower recurrence rates at follow-up compared with coiling only.
The Ki-67 Proliferation Index as a Marker of Time to Recurrence in Intracranial Meningioma
Authors: Mirian Christian , Skyrman Simon , Bartek Jiri , Jensen Lasse Rehné , Kihlström Lars , Förander Petter , Orrego Abiel , Mathiesen Tiit
Published: May 2020

BACKGROUND

There are examples of incongruence between the WHO grade and clinical course in meningioma patients. This incongruence between WHO grade and recurrence has led to search for other prognostic histological markers.

OBJECTIVE

To study the correlation between the Ki-67 proliferative index (PI), risk of recurrence, and recurrence rates in meningioma patients.

METHODS

We prospectively collected pathological diagnosis of de novo consecutive meningiomas. In total, we followed 159 patients with clinical controls until recurrence, death, or emigration. We estimated the correlation between risk of recurrence and Ki-67 PI when adjusted for age at diagnosis, sex, WHO grade, extent of surgical resection, and tumor location. We estimated the cumulative incidence of recurrence when considering death without recurrence a competing risk. We report recurrence rates per 100 person-years.

RESULTS

A 1%-point increase of Ki-67 PI yielded a hazard ratio of 1.12 (95% CI: 1.01-1.24) in a multivariate analysis. The cumulative incidence of recurrence was 3% for Ki-67 0% to 4% vs 19% for Ki-67 > 4% meningiomas after 1 yr, but 24% vs 35%, respectively, after 10 yr. There was no significant difference in mean Ki-67 PI between nonrecurrent and recurrent meningioma in a 2-sample t-test (P = .08). The strongest relationship was detected between Ki-67 PI and time to recurrence: Ki-67 < 4% meningiomas recurred after median 4.8 yr, compared to 0.60 to 0.75 yr for patients with higher Ki-67 PI.

CONCLUSION

Ki-67 PI was a marker for time to recurrence rather than a predictor of recurrence. Ki-67 PI may be utilized for patient tailored follow-up.
Dissection of the Petrosal Presigmoid-Retrolabyrinthine Approach for the Petroclival Region on a Cadaver: 2-Dimensional Operative Video
Authors: Borba Moreira Leandro , Tayebi Meybodi Ali , Zhao Xiaochun , Almefty Kaith K , Lawton Michael T , Preul Mark C
Published: May 2020

Skull base epidermoid tumors, meningiomas, and schwannomas can be accessed by different techniques depending on the location and size of the lesion. Small lesions located anterior to the internal acoustic meatus (IAM) can be accessed via the subtemporal approach, and lesions located posterior to the IAM can be approached via retrosigmoid craniotomy. However, expansive lesions that are located anterior to the IAM and extend posteriorly toward the lower clivus can be accessed via the petrosal approach. The petrosal approach (presigmoid-retrolabyrinthine) is centered on the petrous ridge of the temporal bone and is mainly performed for intradural lesions located at the clivus and petroclivus junction area. Patients with intact hearing can benefit from this technique, as the labyrinth is untouched and yet the middle and posterior fossa compartments are connected. Additionally, extension of the lesion from the suprasellar area/cavernous sinus to the foramen magnum can be dissected and removed. There are variations of the petrosal approach, such as translabyrinthine, transotic, and transchoclear, with which hearing cannot be preserved, and the “transcrusal” approach, wherein posterior and superior semicircular canals are sacrificed yet hearing preserved. The endolymphatic duct is usually transected and not reapproximated. Neurotology input is always helpful when dealing with inner ear structures.

This complex approach demands exhaustive practice with temporal bone dissection in a cadaver laboratory. Although this approach can be extended anteriorly, combination with an anterior petrosal approach permits more rostral exposure. In this video, we demonstrate the stepwise dissection of the posterior petrosal approach only, showing procedure nuances in a cadaver.
1-8

Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Mind the social feedback: effects of tDCS applied to the left DLPFC on psychophysiological responses during the anticipation and reception of social evaluations
Authors: Allaert Jens , De Raedt Rudi , Sanchez-Lopez Alvaro , Baeken Chris , Vanderhasselt Marie-Anne
Published: May 2020

The left dorsolateral prefrontal cortex (lDLPFC) is implicated in anticipatory (i.e. during anticipation of emotional stimuli) and online (i.e. during confrontation with emotional stimuli) emotion regulatory processes. However, research that investigates the causal role of the lDLPFC in these processes is lacking. In this study, 74 participants received active or sham transcranial direct current stimulation (tDCS) over the lDLPFC. Participants were told strangers evaluated them. These (rigged) social evaluations were presented, and in 50% of the trials, participants could anticipate the valence (positive or negative) of the upcoming social feedback. Pupil dilation (a marker of cognitive resource allocation) and skin conductance responses (a marker of arousal) were measured. The results indicate that active (compared to sham) tDCS reduced arousal during the confrontation with anticipated feedback but only marginally during the confrontation with unanticipated feedback. When participants were given the opportunity to anticipate the social feedback, tDCS reduced arousal, irrespective of whether one was anticipating or being confronted with the anticipated feedback. Moreover, tDCS reduced cognitive resource allocation during anticipation, which was associated with resource allocation increases during the subsequent confrontation. Altogether, results suggest that the lDLPFC is causally implicated in the interplay between anticipatory and online emotion regulatory processes.
Catastrophic costs due to tuberculosis worsen treatment outcomes: a prospective cohort study in Indonesia
Authors: Fuady Ahmad , Houweling Tanja A J , Mansyur Muchtaruddin , Burhan Erlina , Richardus Jan Hendrik
Published: May 2020

Background

While the incidence of catastrophic costs due to tuberculosis (TB) remains high, there is little evidence about their impact on TB treatment outcomes and adherence. We assessed their effect on treatment outcomes and adherence in Indonesia.

Methods

We interviewed 282 adult TB patients who underwent TB treatment in urban, suburban and rural districts of Indonesia. One year after the interview, we followed up treatment adherence and outcomes. We applied multivariable analysis using generalized linear mixed models.

Results

Follow-up was complete for 252/282 patients. Eighteen (7%) patients had unsuccessful treatment and 40 (16%) had poor adherence. At a threshold of 30% of annual household income, catastrophic costs negatively impacted treatment outcomes (adjusted odds ratio [aOR] 4.15 [95% confidence interval {CI} 1.15 to 15.01]). At other thresholds, the associations showed a similar pattern but were not statistically significant. The association between catastrophic costs and treatment adherence is complex because of reverse causation. After adjustment, catastrophic costs negatively affected treatment adherence at the 10% and 15% thresholds (aOR 2.11 [95% CI 0.97 to 4.59], p = 0.059 and aOR 2.06 [95% CI 0.95 to 4.46], p = 0.07). There was no evidence of such an effect at other thresholds.

Conclusions

Catastrophic costs negatively affect TB treatment outcomes and treatment adherence. To eliminate TB, it is essential to mitigate catastrophic costs.
Odour reduction interventions for simple pit latrines in rural Ethiopia: a randomized study
Authors: Aragie Solomon , Wittberg Dionna M , Aiemjoy Kristen , Melo Jason S , Smith Meghan J , Nash Scott D , Tadesse Zerihun , Keenan Jeremy D
Published: May 2020

Pit latrines are promoted in resource-limited settings, but unpleasant odours may deter their use. In this study, latrines in rural Ethiopia were randomized to the addition of cooking ash, the addition of boiling water or neither. Study staff ranked odour on a 6-point scale before and approximately 24 h after intervention. Following intervention, odour grades were on average 0.2 points lower (95% confidence interval [CI] 0.7 lower to 0.3 higher) in ash-treated latrines and 0.4 points lower (95% CI 0.9 lower to 0.1 higher) in boiled water–treated latrines, although the difference between the three groups was not statistically significant (p = 0.21). Larger studies might detect a smaller difference.
Changing Gambling Behavior through Experiential Learning
Authors: Abel Martin , Cole Shawn , Zia Bilal
Published: May 2020

This paper tests experiential learning as a debiasing tool to reduce gambling in South Africa, through a randomized field experiment. The study implements a simple, interactive game that simulates the odds of winning the national lottery through dice rolling. Participants first roll one die until they obtain a six, followed by two dice until they roll 2 sixes. They are then informed that the probability of winning the lottery jackpot is equivalent to rolling all sixes with nine dice. The results show that individuals who need many attempts to roll 2 sixes play the lottery significantly less than the control group, while those who need fewer attempts adopt the opposite behavior. These findings provide practical guidance for designing interventions to give individuals brief experiences that correct biases in their beliefs.
Statistical aspects in adjuvant and neoadjuvant trials for gastrointestinal cancer in 2020: focus on time-to-event endpoints
Authors: Saad Everardo D. , Buyse Marc
Published: May 2020

Purpose of review

Clinical-trial design, analysis, and interpretation entails the use of efficient and reliable endpoints. Statistical issues related to endpoints warrant continued attention, as they may have a substantial impact on the conduct of clinical trials and on interpretation of their results.

Recent findings

We review concepts and discuss recent developments related to the use of time-to-event endpoints in studies on adjuvant and neoadjuvant therapy for colon, pancreatic, and gastric adenocarcinomas. The definition of endpoints has varied to a considerable extent in these settings. Although these variations are relevant in interpreting results from individual trials, they probably have a small impact when considered in aggregate. In terms of surrogacy, most published reports so far have used aggregated data. A few studies based on the preferred method of a metaanalysis of individual-patient data have shown that disease-free survival (DFS) is a surrogate for overall survival in the adjuvant therapy of stage III colon cancer and in gastric cancer, whereas DFS with a landmark of six months is a surrogate for overall survival in the neoadjuvant therapy of adenocarcinoma of the esophagus, gastroesophageal junction, or stomach.

Testing novel agents in gastrointestinal cancer requires continued attention to statistical issues related to endpoints.
Trends and characteristics in pre-hospital emergency care in Beijing from 2008 to 2017
Authors: Huang Wei , Wang Tian-Bing , He Ying-Dong , Zhang Huan , Zhou Xiao-Hua , Liu Hui , Zhang Jin-Jun , Tian Zhen-Biao , Jiang Bao-Guo
Published: May 2020

Background:

We aimed to describe and analyze the pre-hospital emergency medical service (EMS) in Beijing and provide information for the government and medical institutions to optimize EMS.

Methods:

We collected all pre-hospital emergency data in Beijing from 2008 to 2017. The chief complaint in each case was classified according to the Medical Priority Dispatch System (MPDS). The sites’ administrative districts were determined through geo-encoding of addresses and then classified into four functional regions. We analyzed the demand for EMS, emergency response times (ERT), and disease spectrum for Beijing as a whole, and for each functional region.

Results:

A total of 4,192,870 pre-hospital EMS cases met the inclusion criteria, with a significant increase (P < 0.001) of 51.60% from 2008 to 2017. EMS demand was positively associated with population (r = 0.946, P < 0.001). The pre-hospital EMS demand rate was 1907.05 in 2008 and 2172.23 in 2017 per 100,000, with no significant change (P = 0.57). ERT increased significantly (P = 0.001), from 19.18 min in 2008 to 24.51 min in 2016. According to MPDS classifications, the demand for pre-hospital care increased for 14 diseases, remained stable for 19, and decreased for only 1 disease. Cases of injury-related disease increased significantly from approximately 90,000 in 2017, accounting for 20% of all pre-hospital EMS cases, and the demand rate decreased in the core region but increased in the sub-urban regions. Cases of heart problems and stroke/transient ischemic attack also increased significantly in the four functional regions, with the highest demand rate in the Core Functional Region.

Conclusions:

More resources and effort should be devoted to pre-hospital EMS according to the increased pre-hospital EMS demand and prolonged ERT in Beijing over our 10-year study period. Changes in disease spectrum and differences between functional regions should also be considered.
Metagenomic Deep Sequencing to Investigate for an Infectious Etiology of Iridocorneal Endothelial Syndrome
Authors: Sutra Plern , Rose-Nussbaumer Jennifer , Gonzales John A. , Wang Kaidi , Hinterwirth Armin , Seitzman Gerami , Bloomer Michele , Acharya Nisha , Doan Thuy
Published: May 2020

Purpose:

Iridocorneal endothelial (ICE) syndrome is a group of rare ocular conditions that result from abnormal corneal endothelial cells, leading to secondary glaucoma, iris distortions, and corneal edema. The etiology of ICE is unknown, although it has been associated with viral infections, such as herpes simplex virus. In this study, we sought to identify an infectious etiology for ICE using advanced molecular techniques.

Methods:

Metagenomic RNA sequencing (MDS) is a high-throughput sequencing approach that can identify all pathogens in any clinical sample, including RNA viruses. Descemet membrane and aqueous fluid from patients with ICE syndrome were subjected to MDS testing.

Results:

Samples from 3 patients with ICE were analyzed. MDS was performed on the aqueous fluid of 3 patients and Descemet membrane and endothelial cell tissue from 1 patient. Viral pathogens were not identified in any of the samples.

Conclusions:

We were unable to identify a viral etiology in the tissues of patients with the Chandler variant of ICE syndrome, although this study was limited by sample size.
COVID-19 in Children, Pregnancy and Neonates: A Review of Epidemiologic and Clinical Features
Authors: Zimmermann Petra , Curtis Nigel
Published: May 2020

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has spread rapidly across the globe. In contrast to initial reports, recent studies suggest that children are just as likely as adults to become infected with the virus but have fewer symptoms and less severe disease. In this review, we summarize the epidemiologic and clinical features of children infected with SARS-CoV-2 reported in pediatric case series to date. We also summarize the perinatal outcomes of neonates born to women infected with SARS-CoV-2 in pregnancy. We found 11 case series including a total of 333 infants and children. Overall, 83% of the children had a positive contact history, mostly with family members. The incubation period varied between 2 and 25 days with a mean of 7 days. The virus could be isolated from nasopharyngeal secretions for up to 22 days and from stool for more than 30 days. Co-infections were reported in up to 79% of children (mainly mycoplasma and influenza). Up to 35% of children were asymptomatic. The most common symptoms were cough (48%; range 19%–100%), fever (42%; 11%–100%) and pharyngitis (30%; 11%–100%). Further symptoms were nasal congestion, rhinorrhea, tachypnoea, wheezing, diarrhea, vomiting, headache and fatigue. Laboratory test parameters were only minimally altered. Radiologic findings were unspecific and included unilateral or bilateral infiltrates with, in some cases, ground-glass opacities or consolidation with a surrounding halo sign. Children rarely needed admission to intensive care units (3%), and to date, only a small number of deaths have been reported in children globally. Nine case series and 2 case reports described outcomes of maternal SARS-CoV-2 infection during pregnancy in 65 women and 67 neonates. Two mothers (3%) were admitted to intensive care unit. Fetal distress was reported in 30% of pregnancies. Thirty-seven percent of women delivered preterm. Neonatal complications included respiratory distress or pneumonia (18%), disseminated intravascular coagulation (3%), asphyxia (2%) and 2 perinatal deaths. Four neonates (3 with pneumonia) have been reported to be SARS-CoV-2 positive despite strict infection control and prevention procedures during delivery and separation of mother and neonates, meaning vertical transmission could not be excluded.
Analytical performance evaluation of Sysmex CS-2500 and Stago STA Compact
Authors: Yis Ozgur M. , Bugdayci Guler , Pehlivan Mine B. , Yildiz Rabia N. , Alisik Murat
Published: May 2020

The Sysmex Coagulation System-2500 (CS-2500) is a fully automated coagulation analyzer that uses the optical reaction method. In this study, we aimed to evaluate performance characteristics of the CS-2500 in two coagulation tests [prothrombin time (PT) and activated partial thromboplastin time (aPTT)] at our hospital laboratory. PT and aPTT measurements were performed using the CS-2500 and STA-Compact Diagnostica Stago coagulometers (STA-Compact). Then, precision, accuracy, reference range verification, and method comparison statistics were performed. In the precision study, which was performed with normal and pathologic controls for the PT-international normalized ratio (INR) and aPTT tests, all coefficient of variation% were found less than 3.5%. In the comparison study, the Passing-Bablok regression analysis demonstrated the good agreement between each analyzer for PT-INR (y = −0.081 + 1.07x and r = 0.962) and for aPTT (y = 5.498 + 0.86x and r = 0.944). Both analyzers exhibited less than 9.9% bias in the accuracy study. The reference range verification analyses revealed that the manufacturer ranges were acceptable. The verification studies of the CS-2500 coagulation system were acceptable; however, in the comparison studies, there were small differences between STA-Compact. Overall, we propose that these differences could be eliminated in future standardization studies performed to use the same reference ranges for all systems.
Magnetic sphincter augmentation versus fundoplication for gastroesophageal reflux disease: pros and cons
Authors: Sterris Jason A. , Dunn Colin P. , Bildzukewicz Nikolai A. , Lipham John C.
Published: May 2020

Purpose of review

The purpose of this magnetic sphincter augmentation (MSA) year in review article is to provide a clear understanding for the current state of MSA literature in 2019, and contrast MSA outcomes with traditional fundoplication.

Recent findings

Continued work was performed in 2019 to expand patient populations eligible for MSA including those with hiatal hernia, post-bariatric patients, patients necessitating a thoracic approach, and patients with esophageal intestinal metaplasia. Additionally, a large systematic review reinforced earlier findings comparing laparoscopic fundoplication to MSA. This study demonstrated equivalency over many different operative outcomes, with MSA patients having less bloating while also retaining the ability to belch and vomit. Furthermore, independent research teams found a modest cost savings for MSA over laparoscopic fundoplication with budget analysis.

MSA is a safe and efficacious procedure originally approved for patients with medically refractory, uncomplicated gastroesophageal reflux disease. The accumulating body of evidence suggests patients with intestinal metaplasia or hiatal hernias can safely and effectively undergo MSA, whereas further research will be required before MSA is widely used for post-bariatric patients or for patients requiring a transthoracic surgical approach. MSA is equivalent or superior to laparoscopic fundoplication in all surgical outcomes measured thus far.
Approaches to diet therapy for eosinophilic esophagitis
Authors: Molina-Infante Javier , Lucendo Alfredo J.
Published: May 2020

Purpose of review

The aim of this review is to highlight recent advances in dietary therapy for eosinophilic esophagitis (EoE).

Recent findings

An empiric elimination diet step-up strategy is now well established as the initial approach for dietary treatment. The most common food triggers are by far cow's milk, followed by wheat and egg. Legumes seem to be important solely in Spain and other Mediterranean countries, where they are regularly consumed. Retrospective efficacy data on cow's milk elimination diet in children vary from 25 to 65%. The recently described esophageal prick test did not detect local reaction to the most common food triggers described for EoE.

Within the step-up approach, the specific food group or groups to be first eliminated and whether if it will depend on the geographical setting and food consumption habits remain unknown. Prospective studies on cow's milk elimination diet in children and adults are definitely warranted. Better food allergy testing, identifying specific antigens involved in each food group, should be developed for an individualized therapy. As for disease prevention, we undoubtedly need to understand why foods we have been consuming since the Neolithic age have caused EoE just over the past few decades.
In-vivo differentiation of adult hematopoietic stem cells from a single-cell point of view
Authors: Nazaraliyev Amal , Richard Elodie , Sawai Catherine M.
Published: May 2020

Purpose of review

Although hematopoietic stem cell (HSC) function has long been studied by transplantation assays, this does not reflect what HSCs actually do in their native context. Here, we review recent technologic advances that facilitate the study of HSCs in their native context focusing on inducible HSC-specific lineage tracing and inference of hematopoietic trajectories through single-cell RNA sequencing (scRNA-Seq).

Recent findings

Lineage tracing of HSCs at the population level using multiple systems has suggested that HSCs make a major contribution to steady-state hematopoiesis. Although several genetic systems and novel methods for lineage tracing individual hematopoietic clones have been described, the technology for tracking these cellular barcodes (in particular mutations or insertion sites) is still in its infancy. Thus, lineage tracing of HSC clones in the adult bone marrow remains elusive. Static snapshots of scRNA-Seq of hematopoietic populations have captured the heterogeneity of transcriptional profiles of HSCs and progenitors, with some cells displaying a unilineage signature as well as others with bi or multipotent lineage profiles. Kinetic analysis using HSC-specific lineage tracing combined with scRNA-Seq confirmed this heterogeneity of progenitor populations and revealed a rapid and early emergence of megakaryocytic progeny, followed by erythroid and myeloid lineages, whereas lymphoid differentiation emerged last.

New approaches to study HSCs both in vivo through lineage tracing and at a high-resolution molecular level through scRNA-Seq are providing key insight into HSC differentiation in the absence of transplantation. Recent studies using these approaches are discussed here. These studies pave the way for integration of in-vivo clonal analysis of HSC behavior over time with single-cell sequencing data, including but not limited to transcriptomic, proteomic, and epigenomic, to establish a comprehensive molecular and cellular map of hematopoiesis.
The Simulation Games
Authors: Besse Cheryl , Vogelsang Laura , Zdunich Jill
Published: May 2020

Background

Although nursing students practice skills in labs as part of the curriculum, many report feeling anxious and unprepared for their first clinical experience.

Purpose

A capstone lab, integrating gaming with simulation, was implemented to assimilate previous learning and promote critical thinking before beginning clinical experiences.

Methods

Second-year baccalaureate nursing students participated in a gamified lab with simulated scenarios working in teams in various roles to manage patient situations. Remediation opportunities throughout the lab and formal structured debriefing further maximized their learning.

Results

Students reported the lab was beneficial. Most students found the lab “stressful, but in a good way,” which challenged them to apply previous learning. Most students cited reduced anxiety and increased confidence for practice after the labs.

Conclusions

Integrating gaming with simulated scenarios maintained student engagement while encouraging critical thinking and knowledge synthesis to better prepare them for clinical experiences.