bluuebunny/crossref_metadata_2025 huggingface dataset:
Lactococcus lactisbacteraemia in a patient on probiotic supplementation therapy
Authors: Gurley Amelia , O'Brien Thomas , Garland Joseph M , Finn Arkadiy
Published: July 2021

A 59-year-old woman presented with fever and malaise and was found to haveLactococcus lactisbacteraemia.L. lactisinfection is rare in humans with few reported cases, with most associated with dairy food product ingestion. The patient reported use of a multistrain over-the-counter probiotic supplement. After isolation ofL. lactisfrom blood culture, the patient was treated empirically with ertapenem and amoxicillin and displayed clinical improvement. She remained well after completion of antibiotic regimen and discontinued probiotic supplementation use. We review the clinical presentation ofL. lactisinfection including diagnosis, identification and treatment.
Deep learning-assisted (automatic) diagnosis of glaucoma using a smartphone
Authors: Nakahara Kenichi , Asaoka Ryo , Tanito Masaki , Shibata Naoto , Mitsuhashi Keita , Fujino Yuri , Matsuura Masato , Inoue Tatsuya , Azuma Keiko , Obata Ryo , Murata Hiroshi
Published: July 2021

Background/aims

To validate a deep learning algorithm to diagnose glaucoma from fundus photography obtained with a smartphone.

Methods

A training dataset consisting of 1364 colour fundus photographs with glaucomatous indications and 1768 colour fundus photographs without glaucomatous features was obtained using an ordinary fundus camera. The testing dataset consisted of 73 eyes of 73 patients with glaucoma and 89 eyes of 89 normative subjects. In the testing dataset, fundus photographs were acquired using an ordinary fundus camera and a smartphone. A deep learning algorithm was developed to diagnose glaucoma using a training dataset. The trained neural network was evaluated by prediction result of the diagnostic of glaucoma or normal over the test datasets, using images from both an ordinary fundus camera and a smartphone. Diagnostic accuracy was assessed using the area under the receiver operating characteristic curve (AROC).

Results

The AROC with a fundus camera was 98.9% and 84.2% with a smartphone. When validated only in eyes with advanced glaucoma (mean deviation value < −12 dB, N=26), the AROC with a fundus camera was 99.3% and 90.0% with a smartphone. There were significant differences between these AROC values using different cameras.

Conclusion

The usefulness of a deep learning algorithm to automatically screen for glaucoma from smartphone-based fundus photographs was validated. The algorithm had a considerable high diagnostic ability, particularly in eyes with advanced glaucoma.
Metagenomics of the lacrimal sac in primary acquired nasolacrimal duct obstruction: the Lacriome paper 1
Authors: Ali Mohammad Javed
Published: July 2021

Background

The purpose is to study the metagenomics of the microbes isolated from the lacrimal sac of patients with primary acquired nasolacrimal duct obstruction (PANDO).

Methods

A prospective study was performed on ten consecutive lacrimal sac samples obtained for the metagenomic analysis from the patients with PANDO, who underwent endoscopic dacryocystorhinostomy at a tertiary care Dacryology service. The samples were collected intraoperatively soon after a full-length lacrimal sac marsupialisation and immediately transported on ice to the laboratory. Following DNA extraction and library preparation, a whole shotgun metagenome sequencing was performed on the Illumina platform. The downstream processing and bioinformatics of the samples were performed using multiple software packaged in the SqueezeMeta pipeline and MG-RAST pipeline.

Results

The taxonomic hit distribution across the samples showed that bacteria were the most common isolates (mean—97.56%), followed by viruses (mean—0.29%), archaea (0.04%) and others. The five major phyla identified across the samples of PANDO were proteobacteria, Bacteroidetes, Fusobacteria, Actinobacteria and Firmicutes. The prevalent organisms includeAcinetobacter johnsonii, Porphyromonas catoniae, Cutibacterium acnes, Pseudomonas alcaliphila, Escherichia coli, Haemophilus influenzae, Enhydrobacter aerosaccus, Fusobacterium nucleatum, Moraxella osloensis, Butyricimonas virosaandVariovorax paradoxus,among few others. The alpha diversity of the ten sample datasets ranged from 60 to 175 species.

Conclusion

This is the first whole metagenome sequencing of the lacrimal sac contents from PANDO patients. Lacrimal sacs harbour diverse microbial communities, including bacteria, viruses, and archaea. Further Lacriome studies may provide clues for a better understanding of the disease aetiopathogenesis.
Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy
Authors: Bagepally Bhavani Shankara , Haridoss Madhumitha , Sasidharan Akhil , Jagadeesh Kayala Venkata , Oswal Nikhil Kumar
Published: July 2021

Background

The effectiveness of early cholecystectomy for gallstone diseases treatment is uncertain compared with conservative management/delayed cholecystectomy.

Aims

To synthesise treatment outcomes of early cholecystectomy versus conservative management/delayed cholecystectomy in terms of its safety and effectiveness.

Design

We systematically searched randomised control trials investigating the effectiveness of early cholecystectomy compared with conservative management/delayed cholecystectomy. We pooled the risk ratios with a 95% CI, also estimated adjusted number needed to treat to harm.

Results

Of the 40 included studies for systematic review, 39 studies with 4483 patients are included in meta-analysis. Among the risk ratios of gallstone complications, pain (0.38, 0.20 to 0.74), cholangitis (0.52, 0.28 to 0.97) and total biliary complications (0.33, 0.20 to 0.55) are significantly lower with early cholecystectomy. Adjusted number needed to treat to harm of early cholecystectomy compared with conservative management/delayed cholecystectomy are, for pain 12.5 (8.3 to 33.3), biliary pancreatitis >1000 (50–100), common bile duct stones 100 (33.3 to 100), cholangitis (100 (25–100), total biliary complications 5.9 (4.3 to 9.1) and mortality >1000 (100 to100 000).

Conclusions

Early cholecystectomy may result in fewer biliary complications and a reduction in reported abdominal pain than conservative management.

PROSPERO registration number

2020 CRD42020192612.
How medical dominance and interprofessional conflicts undermine patient-centred care in hospitals: historical analysis and multiple embedded case study in Morocco
Authors: Belrhiti Zakaria , Van Belle Sara , Criel Bart
Published: July 2021

Background

In Morocco’s health systems, reforms were accompanied by increased tensions among doctors, nurses and health managers, poor interprofessional collaboration and counterproductive power struggles. However, little attention has focused on the processes underlying these interprofessional conflicts and their nature. Here, we explored the perspective of health workers and managers in four Moroccan hospitals.

Methods

We adopted a multiple embedded case study design and conducted 68 interviews, 8 focus group discussions and 11 group discussions with doctors, nurses, administrators and health managers at different organisational levels. We analysed what health workers (doctors and nurses) and health managers said about their sources of power, perceived roles and relationships with other healthcare professions. For our iterative qualitative data analysis, we coded all data sources using NVivo V.11 software and carried out thematic analysis using the concepts of ‘negotiated order’ and the four worldviews. For context, we used historical analysis to trace the development of medical and nursing professions during the colonial and postcolonial eras in Morocco.

Results

Our findings highlight professional hierarchies that counterbalance the power of formal hierarchies. Interprofessional interactions in Moroccan hospitals are marked by conflicts, power struggles and daily negotiated orders that may not serve the best interests of patients. The results confirm the dominance of medical specialists occupying the top of the professional hierarchy pyramid, as perceived at all levels in the four hospitals. In addition, health managers, lacking institutional backing, resources and decision spaces, often must rely on soft power when dealing with health workers to ensure smooth collaboration in care.

Conclusion

The stratified order of care professions creates hierarchical professional boundaries in Moroccan hospitals, leading to partitioning of care and poor interprofessional collaboration. More attention should be placed on empowering health workers in delivering quality care by ensuring smooth interprofessional collaboration.
Development and validation of the Oxford Pandemic Attitude Scale-COVID-19 (OPAS-C): an internet-based cross-sectional study in the UK and USA
Authors: Kantor Bella Nichole , Kantor Jonathan
Published: July 2021

Objectives

To develop and validate the Oxford Pandemic Attitude Scale-COVID-19 (OPAS-C), a multidimensional scale that addresses seven domains over 20 items including stress, fear, loneliness, sense of community, belief that the pandemic is a hoax or exaggerated, the use of and attitude to non-pharmaceutical interventions and vaccine hesitancy, in a single measure.

Design

Cross-sectional validation study.

Setting

Internet based with respondents in the USA and UK.

Participants

General community respondents using the Prolific Academic platform.

Main outcome measures

Exploratory factor analyses with promax oblique rotation and confirmatory factor analysis including goodness of fit indices: root mean square error of approximation (RMSEA), standardised root mean square residual (SRMR) and comparative fit index (CFI). Reliability as internal consistency using Cronbach’s alpha. Convergent and discriminant validity using Pearson correlation coefficients.

Results

The sample included 351 respondents in the USA and the factorial structure was confirmed using a separate set of 348 respondents in the UK. The OPAS-C had excellent goodness of fit characteristics, with an RMSEA of 0.047 (90% CI 0.037 to 0.056), SRMR of 0.043 and CFI of 0.962. Reliability was excellent, demonstrating Cronbach’s alpha of 0.87 in both the US and UK samples. Convergent validity showed correlation coefficients of 0.54 and 0.49 in the US and UK samples, respectively. Discriminant validity demonstrated correlations of 0.21 and 0.26 in the US and UK samples, respectively.

Conclusions

The OPAS-C represents the first validated scale that addresses mental health measures and public health-relevant responses to COVID-19, and may be a useful measure for use in future longitudinal and cross-sectional studies. Further international validation beyond the USA and UK may be helpful.
Electronic Health Records, Interoperability and Patient Safety in Health Systems of High-income Countries: A Systematic Review Protocol
Authors: Li Edmond , Clarke Jonathan , Neves Ana Luisa , Ashrafian Hutan , Darzi Ara
Published: July 2021

Introduction

The availability and routine use of electronic health records (EHRs) have become commonplace in healthcare systems of many high-income countries. While there is an ever-growing body of literature pertaining to their use, evidence surrounding the importance of EHR interoperability and its impact on patient safety remains less clear. There is, therefore, a need and opportunity to evaluate the evidence available regarding this relationship so as to better inform health informatics development and policies in the years to come. This systematic review aims to evaluate the impact of EHR interoperability on patient safety in health systems of high-income countries.

Methods and analysis

A systematic literature review will be conducted via a computerised search through four databases: PubMed, Embase, Health Management Information Consortium and PsycInfo for relevant articles published between 2010 and 2020. Outcomes of interest will include impact on patient safety and the broader effects on health systems. Quality of the randomised quantitative studies will be assessed using Cochrane Risk of Bias Tool. Non-randomised papers will be evaluated with the Risk of Bias In Non-Randomised Studies—of Interventions tool. Drummond’s Checklist will be used for publications pertaining to economic evaluation. The National Institute for Health and Care Excellence quality appraisal checklist will be used to assess qualitative studies. A narrative synthesis will be conducted for included studies, and the body of evidence will be summarised in a summary of findings table.

Ethics and dissemination

This review will summarise published studies with non-identifiable data and, thus, does not require ethical approval. Findings will be disseminated through preprints, open access peer-reviewed publications, and conference presentations.

PROSPERO registration number

CRD42020209285.
EXperienceS and aTtitudes towards Agitated behaviours in Traumatic brain injury in the Intensive Care unit patients (EXSTATIC): a protocol for an interprofessional mixed-method study
Authors: Saavedra-Mitjans Mar , David Pierre-Marie , Frenette Anne-Julie , Arbour Caroline , Perreault Marc , Williams Virginie , Bernard Francis , Williamson David
Published: July 2021

Introduction

Agitation and violent behaviours are common conditions developed by patients with acute traumatic brain injury (TBI) in intensive care units (ICUs). Healthcare professionals caring for these patients have various tools to manage these behaviours, but lack of a formal protocol to assess and manage them makes caring for these patients a challenge. Moreover, safety may often be compromised for both ICU professionals and patients encountering such situations. The EXperienceS and aTtitudes towards Agitated behaviours in Traumatic brain injury in the Intensive Care unit patients (EXSTATIC) study aims to explore the experiences and attitudes of ICU nurses and other ICU healthcare professionals on the management of agitated behaviours in patients with acute TBI.

Methods and analysis

EXSTATIC is a multicenter mixed methods convergent study exploring experiences and attitudes of ICU healthcare professionals caring of agitated patients with TBI. The study includes three qualitative methods (observation, semistructured interviews and focus groups) and one quantitative method (retrospective cohort). The integration of the different methods will be done using sequential steps of the research and by the integration of results for each step. Qualitative data will be evaluated following a thematic analysis derived from a grounded theory approach. Quantitative data will be analysed using descriptive statistics. Qualitative and quantitative results will be combined in a convergent interactive interpretative design. Gender and race perspective will be integrated in collection, analysis and interpretation of data.

Ethics and dissemination

This study has been approved by the Centre intégré universitaire de santé et de services sociaux du nord de l’île de Montréal (CIUSSS-NÎM) Research Ethics Board. The findings will be disseminated locally with ICU staff and health managers, international peer-reviewed journals, a PhD dissertation, and national and international conferences. The knowledge derived from this study is key in the development of clinical protocols to manage agitation and related behaviours in patients with TBI and designing further interventional studies targeting this specific problematic.

Trial registration number

NCT04741399.
Cohort profile: SCREEN-RA: design, methods and perspectives of a Swiss cohort study of first-degree relatives of patients with rheumatoid arthritis
Authors: Gilbert Benoit Thomas P , Lamacchia Céline , Mongin Denis , Lauper Kim , Trunk Eric , Studer Olivia , Courvoisier Delphine S , Rubbert-Roth Andrea , Kyburz Diego , Moeller Burkhard , Finckh Axel
Published: July 2021

Purpose

Rheumatoid arthritis (RA) is an insidious autoimmune disease, with an immunological onset years before diagnosis. Early interventions in preclinical stages could prevent or minimise the progression towards irreversible joint damage. The SCREEN-RA cohort (Evaluation of a SCREENing strategy for Rheumatoid Arthritis) aims to characterise the preclinical stages of the disease, to identify environmental risk factors, and to discover or validate novel biomarkers predictive for RA development.

Participants

SCREEN-RA includes an at-risk population for RA, namely first-degree relatives of patients with established RA.

Findings to date

The cohort started in 2009 is composed of mostly asymptomatic healthy individuals (total n=1458, 7262 person-years), with a mean age of 44 years at enrolment, 74% female and 91% Caucasian ethnicity. During the study period, 16 participants have developed RA. All participants provide baseline serum, DNA and RNA samples, and in a subset, stool samples and oral examination are performed for microbiota assessment. At enrolment, 10% of participants had asymptomatic autoimmunity associated with RA (n=147), 10% presented ‘clinically suspect arthralgias’ (n=143) and 3% reported arthralgias in conjunction with autoimmunity or high genetic risk (n=51). Studies with this cohort have uncovered risk factors for RA development, such as female hormonal factors, poor oral health or intestinal dysbiosis.

Future plans

Future directions include immunological and ‘multiomics’ approaches to discover new biological markers of progression towards RA, as well as testing preventive interventions in ‘high-risk’ population.
Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study
Authors: Pereira Filipa , Verloo Henk , Taushanov Zhivko , Di Giovanni Saviana , Meyer-Massetti Carla , von Gunten Armin , Martins Maria Manuela , Wernli Boris
Published: July 2021

Objectives

The present study analysed 4 years of a hospital register (2015–2018) to determine the risk of 30-day hospital readmission associated with the medical conditions and drug regimens of polymedicated, older inpatients discharged home.

Design

Registry-based cohort study.

Setting

Valais Hospital—a public general hospital centre in the French-speaking part of Switzerland.

Participants

We explored the electronic records of 20 422 inpatient stays by polymedicated, home-dwelling older adults held in the hospital’s patient register. We identified 13 802 hospital stays by older adults who returned home involving 8878 separate patients over 64 years old.

Outcome measures

Sociodemographic characteristics, medical conditions and drug regimen data associated with risk of readmission within 30 days of discharge.

Results

The overall 30-day hospital readmission rate was 7.8%. Adjusted multivariate analyses revealed increased risk of hospital readmission for patients with longer hospital length of stay (OR=1.014 per additional day; 95% CI 1.006 to 1.021), impaired mobility (OR=1.218; 95% CI 1.039 to 1.427), multimorbidity (OR=1.419 per additional International Classification of Diseases, 10th Revision condition; 95% CI 1.282 to 1.572), tumorous disease (OR=2.538; 95% CI 2.089 to 3.082), polypharmacy (OR=1.043 per additional drug prescribed; 95% CI 1.028 to 1.058), and certain specific drugs, including antiemetics and antinauseants (OR=3.216 per additional drug unit taken; 95% CI 1.842 to 5.617), antihypertensives (OR=1.771; 95% CI 1.287 to 2.438), drugs for functional gastrointestinal disorders (OR=1.424; 95% CI 1.166 to 1.739), systemic hormonal preparations (OR=1.207; 95% CI 1.052 to 1.385) and vitamins (OR=1.201; 95% CI 1.049 to 1.374), as well as concurrent use of beta-blocking agents and drugs for acid-related disorders (OR=1.367; 95% CI 1.046 to 1.788).

Conclusions

Thirty-day hospital readmission risk was associated with longer hospital length of stay, health disorders, polypharmacy and drug regimens. The drug regimen patterns increasing the risk of hospital readmission were very heterogeneous. Further research is needed to explore hospital readmissions caused solely by specific drugs and drug–drug interactions.
‘Do not attempt cardiopulmonary resuscitation’ (DNACPR)—difficulty in discussions with older medical inpatients and their families: a survey of hospital doctors
Authors: Walker Jane , Burke Katy , Magill Nicholas , van Niekerk Maike , Wanat Marta , Hobbs Harriet , Rocroi Isabelle , Frost Chris , Sharpe Michael
Published: July 2021

Objectives

To determine, for doctors looking after older medical inpatients: (1) how difficult they find discussions about ‘do not attempt cardiopulmonary resuscitation’ (DNACPR); (2) whether difficulty is associated with doctors’ personal and professional characteristics; (3) how frequently DNACPR discussions are made more difficult by practical issues and by doctors’ uncertainties.

Methods

Survey of hospital doctors working on the acute medical wards of a UK NHS teaching hospital.

Results

171/200 (86%) of eligible doctors participated. 165 had experience of DNACPR discussions with older inpatients and/or their families and were included in our analysis. ‘Difficulty’ (defined as finding discussions ‘fairly difficult’ or ‘difficult’) was experienced by 52/165 (32%) for discussions with patients and 60/165 (36%) for discussions with families. Doctors with specific training in DNACPR discussions were less likely to have difficulty in discussions with patients. Older, more experienced doctors were less likely to have difficulty in discussions with families. Lack of time and place, and uncertainty about prognosis were the most frequently reported causes of difficulty.

Conclusions

Many doctors have difficulty in DNACPR discussions. Training needs to include managing discussions with families, as well as with patients, and doctors need time and space to deliver this important part of their job.
Impact of the COVID-19 pandemic on emergency medical service response to out-of-hospital cardiac arrests in Taiwan: a retrospective observational study
Authors: Yu Jiun-Hao , Liu Chien-Yu , Chen Wei-Kung , Yu Shao-Hua , Huang Fen-Wei , Yang Ming-Tzu , Chen Chih-Yu , Shih Hong-Mo
Published: July 2021

Background

Emergency medical service (EMS) personnel have high COVID-19 risk during resuscitation. The resuscitation protocol for patients with out-of-hospital cardiac arrest (OHCA) was modified in response to the COVID-19 pandemic. However, how the adjustments in the EMS system affected patients with OHCA remains unclear.

Methods

We analysed data from the Taichung OHCA registry system. We compared OHCA outcomes and rescue records for 622 cases during the COVID-19 outbreak period (1 February to 30 April 2020) with those recorded for 570 cases during the same period in 2019.

Results

The two periods did not differ significantly with respect to patient age, patient sex, the presence of witnesses or OHCA location. Bystander cardiopulmonary resuscitation and defibrillation with automated external defibrillators were more common in 2020 (52.81% vs 65.76%, p<0.001%, and 23.51% vs 31.67%, p=0.001, respectively). The EMS response time was longer during the COVID-19 pandemic (445.8±210.2 s in 2020 vs 389.7±201.8 s in 2019, p<0.001). The rate of prehospital return of spontaneous circulation was lower in 2020 (6.49% vs 2.57%, p=0.001); 2019 and 2020 had similar rates of survival discharge (5.96% vs 4.98%). However, significantly fewer cases had favourable neurological function in 2020 (4.21% vs 2.09%, p=0.035).

Conclusion

EMS response time for patients with OHCA was prolonged during the COVID-19 pandemic. Early advanced life support by EMS personnel remains crucial for patients with OHCA.
Reverse translation approach generates a signature of penetrating fibrosis in Crohn’s disease that is associated with anti-TNF response
Authors: Xiong Shanshan , Whitehurst Charles E , Li Li , Heo Gyu Seong , Lai Chin-Wen , Jain Umang , Muegge Brian D , Espenschied Scott T , Musich Ryan J , Chen Minhu , Liu Yongjian , Liu Ta-Chiang , Stappenbeck Thaddeus S
Published: July 2021

Objective

Fibrosis is a common feature of Crohn’s disease (CD) which can involve the mesenteric fat. However, the molecular signature of this process remains unclear. Our goal was to define the transcriptional signature of mesenteric fibrosis in CD subjects and to model mesenteric fibrosis in mice to improve our understanding of CD pathogenesis.

Design

We performed histological and transcriptional analysis of fibrosis in CD samples. We modelled a CD-like fibrosis phenotype by performing repeated colonic biopsies in mice and analysed the model by histology, type I collagen-targeted positron emission tomography (PET) and global gene expression. We generated a gene set list of essential features of mesenteric fibrosis and compared it to mucosal biopsy datasets from inflammatory bowel disease patients to identify a refined gene set that correlated with clinical outcomes.

Results

Mesenteric fibrosis in CD was interconnected to areas of fibrosis in all layers of the intestine, defined as penetrating fibrosis. We found a transcriptional signature of differentially expressed genes enriched in areas of the mesenteric fat of CD subjects with high levels of fibrosis. Mice subjected to repeated colonic biopsies showed penetrating fibrosis as shown by histology, PET imaging and transcriptional analysis. Finally, we composed a composite 24-gene set list that was linked to inflammatory fibroblasts and correlated with treatment response.

Conclusion

We linked histopathological and molecular features of CD penetrating fibrosis to a mouse model of repeated biopsy injuries. This experimental system provides an innovative approach for functional investigations of underlying profibrotic mechanisms and therapeutic concepts in CD.
Effects of non-surgical treatment of chronic periodontitis on insulin resistance and glucose tolerance in subjects without diabetes (PARODIA 2 study)
Authors: Nana Nana Arnel Redon , Tsobgny Tsague Nadia-Flore , Lontchi-Yimagou Eric , Bengondo Messanga Charles , Tankeu Aurel , Katte Jean-Claude , Balti Vounsia Eric , Dehayem Mesmin , Sobngwi Eugene
Published: July 2021

This study aimed to assess the effects of non-surgical periodontal treatment (NSPT) of chronic periodontitis on insulin sensitivity, glucose tolerance, and serum C reactive protein (CRP) level in individuals without diabetes. Twenty individuals without diabetes with chronic periodontitis underwent NSPT, which consisted of complete scaling, polishing, root planing, and irrigation of the periodontal pockets with a 10% povidone-iodine solution. Periodontal indices (plaque index, gingival bleeding index, pocket depth, and clinical attachment loss), insulin sensitivity using the Short Insulin Tolerance Test index (KITT), glucose tolerance derived from oral glucose tolerance test, and serum CRP level were measured before and 3 months after the intervention. This study was carried out at the National Obesity Center of Yaoundé Central Hospital, Cameroon. After 3 months, we observed significant improvement in periodontal parameters (all p<0.001) and insulin sensitivity (3.72 (2.99–4.17) %/min before treatment vs 4.04 (3.67–4.78) %/min after treatment, p=0.001) and significant decrease in serum CRP level (2.35 (1.46–4.18) mg/L before vs 1.53 (1.03–2.12) mg/L after, p=0.033). There was a trend toward improvement in glucose tolerance, although not statistically significant after the intervention. This study suggests that NSPT of chronic periodontitis in individuals without diabetes is associated with increased insulin sensitivity and decreased serum CRP levels.

Trial registration number NCT02830113.
Borderline personality disorder, therapeutic privilege, integrated care: is it ethical to withhold a psychiatric diagnosis?
Authors: Sims Erika , Nelson Katharine J , Sisti Dominic
Published: July 2021

Once common, therapeutic privilege—the practice whereby a physician withholds diagnostic or prognostic information from a patient intending to protect the patient—is now generally seen as unethical. However, instances of therapeutic privilege are common in some areas of clinical psychiatry. We describe therapeutic privilege in the context of borderline personality disorder, discuss the implications of diagnostic non-disclosure on integrated care and offer recommendations to promote diagnostic disclosure for this patient population.
Engagement without entanglement: a framework for non-sexual patient–physician boundaries
Authors: Appel Jacob M
Published: July 2021

The integrity of the patient–physician relationship depends on maintaining professional boundaries. While ethicists and professional organisations have devoted significant consideration to the subject of sexual boundary transgressions, the subject of non-sexual boundaries, especially outside the mental health setting, has been largely neglected. While professional organisations may offer guidance on specific subjects, such as accepting gifts or treating relatives, as well as general guidance on transparency and conflict of interest, what is missing is a principle-based method that providers can use to assess non-sexual interactions with patients that transcend norms of practice. This paper attempts to offer an operational model for such assessment that considers not only the traditional emphasis on beneficence, but also incorporates concerns over entanglement and concordance.
Inconsistency arguments still do not matter
Authors: Blackshaw Bruce Philip , Colgrove Nicholas , Rodger Daniel
Published: July 2021

William Simkulet has recently criticised Colgroveet al’s defence against what they have called inconsistency arguments—arguments that claim opponents of abortion (OAs) act in ways inconsistent with their underlying beliefs about human fetuses (eg, that human fetuses are persons at conception). Colgroveet alpresented three objections to inconsistency arguments, which Simkulet argues are unconvincing. Further, he maintains that OAs who hold that the fetus is a person at conception fail to act on important issues such as the plight of frozen embryos, poverty and spontaneous abortion. Thus, they are morally negligent. In response, we argue that Simkulet has targeted a very narrow group of OAs, and so his criticisms are inapplicable to most OAs. We then explain why his responses to each of Colgroveet al’sobjections do not succeed, even for this restricted group. Finally, we note that Simkulet fails to provide evidence for his claims regarding OAs’ supposed failures to act, and we show that OAs veritably do invest resources into these important issues. We conclude that Colgroveet al’s reasons for rejecting inconsistency arguments (en masse) remain intact.
Ethical issues in two parallel trials of personalised criteria for implantation of implantable cardioverter defibrillators for primary prevention: the PROFID project—a position paper
Authors: Willems Dick , Bak Marieke , Tan Hanno , Lindinger Georg , Kocar Ayca , Seperhi Shamloo Alireza , Schmidt Georg , Hindricks Gerhard , Dagres Nikolaos
Published: July 2021

Aim

To discuss ethical issues related to a complex study (PROFID) involving the development of a new, partly artificial intelligence-based, prediction model to enable personalised decision-making about the implantation of an implantable cardioverter defibrillator (ICD) in postmyocardial infarction patients, and a parallel non-inferiority and superiority trial to test decision-making informed by that model.

Method

The position expressed in this paper is based on an analysis of the PROFID trials using concepts from high-profile publications in the ethical literature.

Results

We identify ethical issues related to the testing of the model in the treatment setting, and to both the superiority and the non-inferiority trial. We underline the need for ethical-empirical studies about these issues, also among patients, as a parallel to the actual trials. The number of ethics committees involved is an organisational, but also an ethical challenge.

Conclusion

The PROFID trials, and probably other studies of similar scale and complexity, raise questions that deserve dedicated parallel ethics and social science research, but do not constitute a generic obstacle. A harmonisation procedure, comparable to the Voluntary Harmonization Procedure (VHP) for medication trials, could be needed for this type of trials.
Ecological responses to elevated water temperatures across invasive populations of the round goby (Neogobius melanostomus) in the Great Lakes basin
Authors: Reid Heather Bauer , Ricciardi Anthony
Published: July 2021

Climate warming is expected to alter the distribution, abundance, and impact of non-native species in aquatic ecosystems. In laboratory experiments, we measured the maximum feeding rate and critical thermal maximum (CTmax) of an invasive Eurasian fish, the round goby (Neogobius melanostomus), acclimated to a range of temperatures (18–28 °C) reflecting current and projected future thermal conditions for the nearshore Great Lakes. Fish were collected from four distinct populations along a latitudinal gradient from the western basin of Lake Erie to Hamilton Harbour (Lake Ontario) and the upper St. Lawrence River. Thermal tolerance increased with acclimation temperature for populations in Lakes Erie and Ontario. However, the St. Lawrence River populations had lower acclimation capacity and exhibited an unexpected decline in CTmax at the highest acclimation temperature. Maximum feeding rates peaked at 18–24 °C and declined with temperatures above 24 °C. Northern populations in the basin appear poorly adapted to elevated temperatures such that their performance and impact could be reduced by climate warming. Thermal response data from latitudinally distributed populations are needed to inform invasive species risk assessment.
Competitive Caching with Machine Learned Advice
Authors: Lykouris Thodoris , Vassilvitskii Sergei
Published: July 2021

Traditional online algorithms encapsulate decision making under uncertainty, and give ways to hedge against all possible future events, while guaranteeing a nearly optimal solution, as compared to an offline optimum. On the other hand, machine learning algorithms are in the business of extrapolating patterns found in the data to predict the future, and usually come with strong guarantees on the expected generalization error.

In this work, we develop a framework for augmenting online algorithms with a machine learned predictor to achieve competitive ratios that provably improve upon unconditional worst-case lower bounds when the predictor has low error. Our approach treats the predictor as a complete black box and is not dependent on its inner workings or the exact distribution of its errors.

We apply this framework to the traditional caching problem—creating an eviction strategy for a cache of size
k
. We demonstrate that naively following the oracle’s recommendations may lead to very poor performance, even when the average error is quite low. Instead, we show how to modify the Marker algorithm to take into account the predictions and prove that this combined approach achieves a competitive ratio that both (i) decreases as the predictor’s error decreases and (ii) is always capped by
O
(log
k
), which can be achieved without any assistance from the predictor. We complement our results with an empirical evaluation of our algorithm on real-world datasets and show that it performs well empirically even when using simple off-the-shelf predictions.
Quit When You Can: Efficient Evaluation of Ensembles by Optimized Ordering
Authors: Wang Serena , Gupta Maya , You Seungil
Published: July 2021

Given a classifier ensemble and a dataset, many examples may be confidently and accurately classified after only a subset of the base models in the ensemble is evaluated. Dynamically deciding to classify early can reduce both mean latency and CPU without harming the accuracy of the original ensemble. To achieve such gains, we propose jointly optimizing the evaluation order of the base models and early-stopping thresholds. Our proposed objective is a combinatorial optimization problem, but we provide a greedy algorithm that achieves a 4-approximation of the optimal solution under certain assumptions, which is also the best achievable polynomial-time approximation bound. Experiments on benchmark and real-world problems show that the proposed
Quit When You Can (QWYC)
algorithm can speed up average evaluation time by 1.8–2.7 times on even jointly trained ensembles, which are more difficult to speed up than independently or sequentially trained ensembles. QWYC’s joint optimization of ordering and thresholds also performed better in experiments than previous fixed orderings, including gradient boosted trees’ ordering.
Robot-Delivered Cognitive Stimulation Games for Older Adults
Authors: Gasteiger Norina , Ahn Ho Seok , Gasteiger Chiara , Lee Christopher , Lim Jongyoon , Fok Christine , Macdonald Bruce A. , Kim Geon Ha , Broadbent Elizabeth
Published: July 2021

Cognitive stimulation games delivered on robots may be able to improve cognitive functioning and delay decline in older adults. However, little is known about older adults’ in-depth opinions of robot-delivered games, as current research primarily focuses on technical development and one-off use. This article explores the usability, acceptability, and perceptions of community-dwelling older adults towards cognitive games delivered on a robot that incorporated movable interactive blocks. Semi-structured interviews were conducted with participants at the end of a 12-week cognitive stimulation games intervention delivered entirely on robots. Participants were 10 older adults purposively sampled from two retirement villages. A framework analysis approach was used to code data to predefined themes related to technology acceptance (perceived benefits, satisfaction, and preference), and usability (effectiveness, efficiency, and satisfaction). Results indicated that cognitive games delivered on a robot may be a valuable addition to existing cognitive stimulation activities. The robot was considered easy to use and useful in improving cognitive functioning. Future developments should incorporate interactive gaming tools, the use of social anthropomorphic robots, contrasting colour schemes to accommodate macular degeneration, and cultural-specific imagery and language. This will help cater to the preferences and age-related health needs of older adults, to ultimately enhance usability and acceptability.
Data-Driven Imitation Learning for a Shopkeeper Robot with Periodically Changing Product Information
Authors: Doering Malcolm , Brščić Dražen , Kanda Takayuki
Published: July 2021

Data-driven imitation learning enables service robots to learn social interaction behaviors, but these systems cannot adapt after training to changes in the environment, such as changing products in a store. To solve this, a novel learning system that uses neural attention and approximate string matching to copy information from a product information database to its output is proposed. A camera shop interaction dataset was simulated for training/testing. The proposed system was found to outperform a baseline and a previous state of the art in an offline, human-judged evaluation.
Cookie Banners and Privacy Policies: Measuring the Impact of the GDPR on the Web
Authors: Kretschmer Michael , Pennekamp Jan , Wehrle Klaus
Published: July 2021

The General Data Protection Regulation (GDPR) is in effect since May of 2018. As one of the most comprehensive pieces of legislation concerning privacy, it sparked a lot of discussion on the effect it would have on users and providers of online services in particular, due to the large amount of personal data processed in this context. Almost three years later, we are interested in revisiting this question to summarize the impact this new regulation has had on actors in the World Wide Web. Using Scopus, we obtain a vast corpus of academic work to survey studies related to changes on websites since and around the time the GDPR went into force. Our findings show that the emphasis on privacy increased w.r.t. online services, but plenty potential for improvements remains. Although online services are on average more transparent regarding data processing practices in their public data policies, a majority of these policies still either lack information required by the GDPR (e.g., contact information for users to file privacy inquiries) or do not provide this information in a user-friendly form. Additionally, we summarize that online services more often provide means for their users to opt out of data processing, but regularly obstruct convenient access to such means through unnecessarily complex and sometimes illegitimate interface design. Our survey further details that this situation contradicts the preferences expressed by users both verbally and through their actions, and researchers have proposed multiple approaches to facilitate GDPR-conform data processing without negatively impacting the user experience. Thus, we compiled reoccurring points of criticism by privacy researchers and data protection authorities into a list of four guidelines for service providers to consider.
RNA sequencing and immunofluorescence of the myotendinous junction of mature horses and humans
Authors: Jakobsen Jens R. , Schjerling Peter , Svensson Rene B. , Buhl Rikke , Carstensen Helena , Koch Manuel , Krogsgaard Michael R. , Kjær Michael , Mackey Abigail L.
Published: July 2021

The myotendinous junction (MTJ) is a specialized interface for transmitting high forces between the muscle and tendon and yet the MTJ is a common site of strain injury with a high recurrence rate. The aim of this study was to identify previously unknown MTJ components in mature animals and humans. Samples were obtained from the superficial digital flexor (SDF) muscle-tendon interface of 20 horses, and the tissue was separated through a sequential cryosectioning approach into muscle, MTJ (muscle tissue enriched in myofiber tips attached to the tendon), and tendon fractions. RT-PCR was performed for genes known to be expressed in the three tissue fractions and t-distributed stochastic neighbor embedding (t-SNE) plots were used to select the muscle, MTJ, and tendon samples from five horses for RNA sequencing. The expression of previously known and unknown genes identified through RNA sequencing was studied by immunofluorescence on human hamstring MTJ tissue. The main finding was that RNA sequencing identified the expression of a panel of 61 genes enriched at the MTJ. Of these, 48 genes were novel for the MTJ and 13 genes had been reported to be associated with the MTJ in earlier studies. The expression of known [COL22A1 (collagen XXII), NCAM (neural cell adhesion molecule), POSTN (periostin), NES (nestin), OSTN (musclin/osteocrin)] and previously undescribed [MNS1 (meiosis-specific nuclear structural protein 1), and LCT (lactase)] MTJ genes was confirmed at the protein level by immunofluorescence on tissue sections of human MTJ. In conclusion, in muscle-tendon interface tissue enriched with myofiber tips, we identified the expression of previously unknown MTJ genes representing diverse biological processes, which may be important in the maintenance of the specialized MTJ.
Repetitive amiodarone administration causes liver damage via adipose tissue ER stress-dependent lipolysis, leading to hepatotoxic free fatty acid accumulation
Authors: Hubel Einav , Fishman Sigal , Holopainen Minna , Käkelä Reijo , Shaffer Ortal , Houri Inbal , Zvibel Isabel , Shibolet Oren
Published: July 2021

AMD chronic administration induces hepatic lipid accumulation by several mechanisms, including induction of hepatic ER stress, impairment of β-oxidation, and inhibition of triacylglycerol secretion. Our study shows that repetitive AMD treatment induces not only hepatic ER stress but also adipose tissue ER stress and lipolysis and hepatic accumulation of free fatty acids and enrichment of palmitate in the total lipids. Understanding the toxicity mechanisms of AMD would help devise ways to limit liver damage.
l-Citrulline supplementation during pregnancy improves perinatal and postpartum maternal vascular function in a mouse model of preeclampsia
Authors: Gemmel Mary , Sutton Elizabeth F. , Brands Judith , Burnette Lauren , Gallaher Marcia J. , Powers Robert W.
Published: July 2021

Preeclampsia is a spontaneously occurring pregnancy complication diagnosed by new-onset hypertension and end-organ dysfunction with or without proteinuria. This pregnancy-specific syndrome contributes to maternal morbidity and mortality and can have detrimental effects on fetal outcomes. Preeclampsia is also linked to increased risk of maternal cardiovascular disease throughout life. Despite intense investigation of this disorder, few treatment options are available. The aim of this study was to investigate the potential therapeutic effects of maternal l-citrulline supplementation on pregnancy-specific vascular dysfunction in the male C57BL/6J × female C57BL/6J C1q−/− preeclampsia-like mouse model. l-Citrulline is a nonessential amino acid that is converted to l-arginine to promote smooth muscle and blood vessel relaxation and improve nitric oxide (NO)-mediated vascular function. To model a preeclampsia-like pregnancy, female C57BL/6J mice were mated to C1q−/− male mice, and a subset of dams was supplemented with l-citrulline throughout pregnancy. Blood pressure, systemic vascular glycocalyx, and ex vivo vascular function were investigated in late pregnancy, and postpartum at 6 and 10 mo of age. Main findings show that l-citrulline reduced blood pressure, increased vascular glycocalyx volume, and rescued ex-vivo vascular function at gestation day 17.5 in this preeclampsia-like model. The vascular benefit of l-citrulline also extended postpartum, with improved vascular function and glycocalyx measures at 6 and 10 mo of age. l-Citrulline-mediated vascular improvements appear, in part, attributable to NO pathway signaling. Taken together, l-citrulline supplementation during pregnancy appears to have beneficial effects on maternal vascular health, which may have translational implications for improved maternal cardiovascular health.
Influence of ischemia-reperfusion injury on endothelial function in men and women with similar serum estradiol concentrations
Authors: Lalande Sophie , Hemingway Holden W. , Jarrard Caitlin P. , Moore Amy M. , Olivencia-Yurvati Albert H. , Richey Rauchelle E. , Romero Steven A.
Published: July 2021

Prior data suggest that, relative to the early follicular phase, women in the late follicular phase are protected against endothelial ischemia-reperfusion (I/R) injury when estradiol concentrations are highest. In addition, endothelial I/R injury is consistently observed in men with naturally low endogenous estradiol concentrations that are similar to those of women in the early follicular phase. Therefore, the purpose of this study was to determine whether the vasodeleterious effect of I/R injury differs between women in the early follicular phase of the menstrual cycle and age-matched men. We tested the hypothesis that I/R injury would attenuate endothelium-dependent vasodilation to the same extent in women and age-matched men with similar circulating estradiol concentrations. Endothelium-dependent vasodilation was assessed via brachial artery flow-mediated dilation (duplex ultrasound) in young healthy men ( n = 22) and women ( n = 12) before (pre-I/R) and immediately after (post-I/R) I/R injury, which was induced via 20 min of arm circulatory arrest followed by 20-min reperfusion. Serum estradiol concentrations did not differ between sexes (men 115.0 ± 33.9 pg·mL−1 vs. women 90.5 ± 40.8 pg·mL−1; P = 0.2). The magnitude by which I/R injury attenuated endothelium-dependent vasodilation did not differ between men (pre-I/R 5.4 ± 2.4% vs. post-I/R 3.0 ± 2.7%) and women (pre-I/R 6.1 ± 2.8% vs. post-I/R 3.7 ± 2.7%; P = 0.9). Our data demonstrate that I/R injury similarly reduces endothelial function in women in the early follicular phase of the menstrual cycle and age-matched men with similar estradiol concentrations.