bluuebunny/crossref_metadata_2025 huggingface dataset:
510 Artificial Intelligence Tutoring Compared with Expert Instruction in Neurosurgical Simulation Training: A Randomized Controlled Trial
Authors: Fazlollahi Ali , Bakhaidar Mohamad , Alsayegh Ahmad , Yilmaz Recai , Winkler-Schwartz Alexander , Langleben Ian , Mirchi Nykan , Ledwos Nicole , Harley Jason , Del Maestro Rolando
Published: March 2022

INTRODUCTION:

Resection of subpial tumors adjacent to critical brain areas is one of the most high-stakes surgical procedures that lacks opportunities for safe deliberate practice. Furthermore, performance-based assessment in neurosurgical apprenticeship is inefficient and vulnerable to subjectivity. Utilizing Artificial Intelligence (AI) to classify neurosurgical psychomotor expertise, we developed the first AI-powered tutor in neurosurgical simulation training, known as the Virtual Operative Assistant (VOA), to augment technical skills acquisition training by providing intelligent feedback.

METHODS:

A multi-institutional randomized controlled trial compared VOA’s automated audiovisual metric-based feedback vs remote verbal debriefing with expert instruction and no-feedback controls. Medical students performed six simulated subpial brain tumor resections: five practice attempts followed with feedback and one complex realistic attempt evaluated skill retention and transfer. A deep learning model, Intelligent Continuous Expertise Monitoring System (ICEMS Expertise Score), and blinded Objective Structured Assessment of Technical Skills (OSATS) evaluated performance. Participants reported emotions before, during and after training and completed a cognitive load questionnaire following training.

RESULTS:

Seventy medical students from four institutions were randomly assigned to VOA (n=23), Instructor (n=24), and Control (n=23) Groups. 350 practice attempts were assessed by ICEMS, and 70 realistic attempts were evaluated by ICEMS and OSATS. During practice, VOA training resulted in a significant improvement of participants’ Expertise Scores that was on average 0.66 (95% CI 0.55-0.77) and 0.65 (95% CI 0.54-0.77) points higher than Instructor and Control Groups (p<.001). Realistic attempt’s average Expertise Score was significantly higher in the VOA Group compared to Instructor and Control Groups (mean difference 0.53; 0.49, respectively, p<.001). VOA and Instructor Group’s realistic attempt OSATS ratings were not significantly different. OSATS ratings demonstrated that VOA feedback resulted in significantly higher Respect for Tissue and Economy of Movement compared to Control while expert instruction significantly improved Instrument Handling compared to Control. There was no significant between-groups difference in cognitive load, positive-, and negative-activating emotions.

CONCLUSION:

VOA’s quantitative automated benchmark feedback demonstrated superior performance outcome, improved skill transfer, with equivalent OSATS ratings and similar cognitive and affective responses compared to remote expert instruction.
515 Serious Illness Communication Practices in Glioblastoma Care: An Institutional Perspective
Authors: Miranda Stephen , Reed-Guy Lauren , Alexander Tyler , Biggiani Gregory , Grady M. Sean , Jones Joshua , Bagley Stephen , Kumar Pallavi , O'Connor Nina
Published: March 2022

INTRODUCTION:

Serious illness (SI) communication about goals, prognosis, and advance care planning is essential for supporting goal-concordant care among glioblastoma patients, however clinicians may fail to elicit patients’ preferences while they have decision-making capacity.

METHODS:

The electronic medical records of 240 glioblastoma patients who died between 2017 and 2019 were systematically reviewed for documented SI conversations about four domains (prognosis, goals, end-of-life planning, and code status) using published criteria. Patient outcomes and SI conversation characteristics were analyzed using descriptive statistics. Standardized interviews about glioblastoma care were held with five clinicians. Interview transcripts were analyzed using grounded-theory coding to identify emergent themes.

RESULTS:

Nearly all patients (96%) had at least one documented SI conversation (median: 4; interquartile range: 2-7), mostly outpatient with oncology physicians. Median timing of first SI conversation was 360 days before death. Prognosis (92% of patients) and goals (89%) were the domains discussed most frequently. SI conversations were not significantly associated with patient outcomes, including inpatient death and hospice enrollment. Seven themes emerged from clinician interviews: balancing hope and reality, anticipatory guidance, neglect of the “big picture,” need for earlier conversations, care coordination, the role of clinical expertise, and communication training.

CONCLUSION:

SI conversations were documented earlier and more often in our sample than has been previously reported, but their quality was difficult to assess. Contrary to chart review findings, interviewees reported that SI conversations were late, infrequent, and fragmented across specialties, failing to explore issues such as functional prognosis and anticipatory guidance.
516 Artificial Neural Networks Predict the Need for Permanent CSF Diversion After Posterior Fossa Tumor Surgery
Authors: Bray David P. , Saad Hassan , Douglas James A. M. , Grogan Dayton , Dawoud Reem , Nduom Edjah K. , Pradilla Gustavo , Olson Jeffrey , Alawieh Ali M. , Hoang Kimberly B.
Published: March 2022

INTRODUCTION:

Resection of posterior fossa tumors (PFTs) can result in hydrocephalus that requires permanent CSF diversion. Clinicians need a durable method to predict occurrence of CSF diversion in this population.

METHODS:

We collected pre-operative and post-operative variables on 510 patients that underwent PFT surgery at our center in a retrospective fashion to train several statistical classifiers to predict the need for permanent CSF diversion as a binary class. A total of 62 classifiers relevant to our data structure were surveyed including regression models, decision trees, Bayesian models, and multilayer perceptron artificial neural networks (ANN). Models were trained using the (N=510) retrospective data using 10-fold cross validation to obtain accuracy metrics. Given the low incidence of our positive outcome (12%), we used the true positive rate along with the area under the receiver operating characteristic curve (AUC) to compare models. The best performing model was then prospectively validated on a set of 90 patients.

RESULTS:

12% of patients in our dataset required permanent CSF diversion after PFT surgery. Of the trained models, 8 classifiers had an AUC greater than 0.5 on prospective testing. Artificial neural networks (ANN) demonstrated the highest AUC of 0.902 with a true positive rate of 83.3%. Despite comparable AUC, the remaining classifiers had a true positive rate below 35% (compared to ANN, P<0.0001). The negative predictive value of the ANN model was 98.8%.

CONCLUSION:

ANN-based models can reliably predict the need for ventriculoperitoneal shunt after PFT surgery.
800 Patient Frailty Predicts Cerebral Arteriovenous Malformation Microsurgical Outcomes: An Analysis of 16,721 Nationwide Admissions
Authors: Tang Oliver Young , Bajaj Ankush , Zhao Kevin , Liu James K.
Published: March 2022

INTRODUCTION:

Earlier research has demonstrated that patient frailty is associated with higher morbidity and mortality for several neurosurgical procedures. However, the comparative accuracy between different frailty metrics for cerebral arteriovenous malformation (AVM) outcomes is poorly understood.

METHODS:

We identified all adult AVM admissions undergoing microsurgery in the National Inpatient Sample from 2002-2017. Three frailty measures were analyzed: mFI-5 (range=0-5), mFI-11 (range=0-11), and Charlson Comorbidity Index (CCI) (range=0-29). We generated receiver operating characteristic (ROC) curves to compare accuracy and determine the optimal cutoff of “high frailty” for each score (=2 for all three scores). Analyzed endpoints included in-hospital mortality, routine discharge, complications, length of stay (LOS), and hospitalization costs. We used survey-weighted multivariate regression to analyze the associations between frailty and outcomes, adjusting for twelve confounding variables, including patient demographics, hospital characteristics, ruptured status, hydrocephalus or epilepsy on admission, and treatment modality. Statistical significance was maintained at P<0.05.

RESULTS:

We analyzed 16,271 total AVM admissions nationwide. 3,515 patients (21.0%) presented with ruptured AVMs. Patients were treated via microsurgery alone (81.7%) or combined microsurgical and endovascular management (18.3%). High frailty status in the mFI-5, mFI-11, and CCI were all predictive of lower rates of routine discharge disposition (CCI: odds ratio [OR]=0.25, P=0.001), increased perioperative complications (CCI: OR=2.35, P=0.001), and elevated postoperative (CCI: +60%, P=0.001) and total LOS (CCI: +56%, P=0.001). The mFI-11 (+8%, P=0.001) and CCI (+30%, P=0.001) also predicted higher hospital costs. However, only the CCI remained significantly associated with all of the aforementioned outcomes following stratification by ruptured status (unruptured vs. ruptured) and treatment modality (microsurgery vs. combined). On ROC analysis, the CCI significantly outperformed age, mFI-5, and mFI-11 in predicting routine discharge for microsurgical, combined, and unruptured AVM admissions (all P<0.01). However, the CCI had comparable predictive ability to age for ruptured AVMs (P=0.449).

CONCLUSIONS:

Patient frailty was predictive of lower routine hospital discharge rates and higher complications, LOS, and costs for AVM admissions undergoing microsurgery, with the CCI outperforming the mFI-5 and mFFI-11.
803 Extracorporeal Filtration of Blood and Blood Breakdown Products from CSF via Spinal Catheter (PILLAR-XT) Following Aneurysmal Subarachnoid Hemorrhage
Authors: Blackburn Spiros L. , Babi Marc , Grande Andrew W. , Choudhri Omar , Hauck Erik F. , Kellner Christopher P.
Published: March 2022

INTRODUCTION:

Delayed cerebral ischemia (DCI) is a secondary injury of aneurysmal subarachnoid hemorrhage (aSAH), and is considered to be related to blood and blood breakdown products (BBPs) in the CSF. Previously, bulk drainage of CSF post-aSAH via lumbar drain appeared to result in decreased DCI. If inflammation related to BBPs plays a role in DCI, accelerating removal of BBPs following aSAH could be of significant therapeutic benefit. This study evaluated a system designed to accelerate removal by rapidly filtering BBPs from CSF while returning filtered CSF to the patient via a dual lumen catheter and extracorporeal filtration system (Neurapheresis™ System).

METHODS:

Patients with aSAH had a dual lumen lumbar, intrathecal catheter placed after aneurysm securement and received up to 72±4 hours Neurapheresis therapy. The catheter aspirated blood-contaminated CSF from the lumbar cistern and returned filtered CSF to the thoracic subarachnoid space, routing BBPs to a waste bag.

RESULTS:

Of 7 males (24.1%) and 22 females (75.9%), a catheter was successfully placed in 27 subjects out of 29 attempts (93.1% success rate. The mean duration of treatment was 34:18 hrs [3:39 – 62:17] (n=27), and the system maintained its expected, controlled, safe drainage rate, mean 6.5 ml/hr [2.1 – 12.5] (n=27). Mean paired RBC values in CSF (106/mm3) declined by 84.5±22.3% (n=21) by the end of treatment. Mean paired total protein (mg/dL) declined by 85.3±8.3% (n=21) to within normal range. Paired Hijdra Sum Scores (sum of ten cistern blood fullness scores - maximum score: 30) declined by 60.1±24.1% (n=25); the largest decline was noted between catheter placement and catheter removal.

CONCLUSIONS:

In this feasibility study, Neurapheresis was associated with a decline in RBC and protein concentration in CSF, and improvement in blood clearance as measured by Hijdra Sum Scores. The procedure was safe and well tolerated in this study.
806 Do Robotic Procedures Have Improved Perioperative Outcomes After a Learning Curve Period?
Authors: Passias Peter G. , Krol Oscar , Ahmad Salman , Passfall Lara , Kummer Nicholas , Imbo Bailey , Tretiakov Peter S. , Joujon-Roche Rachel , Moattari Kevin , Williamson Tyler , Vira Shaleen
Published: March 2022

INTRODUCTION:

Robot-assisted surgical techniques are being increasingly implemented to increase surgeon accuracy and stamina; however, the effects of surgeon learning curve on outcomes have not been well studied.

METHODS:

Robotic cases were isolated from single center multi surgeon database. Single surgeon cases were ranked by DOS into 3 quartiles. 1st Quartile (Group I) was analyzed against the 3rd Quartile (Group II). Univariate analysis was used to assess differences between quartiles. A propensity score matched (PSM) cohort of patients undergoing identical surgical procedures was included as a control group.

RESULTS:

281 patients undergoing robotic surgery met inclusion criteria (Age: 56±12.5, BMI: 30±6, 42% female) with an average of 1.6 levels fused. Group I had 95 patients and Group II had 94. Group II had a lower EBL (314 vs 492, p<0.05), shorter LOS (3.8 vs 4.7, p=.1), greater amount of levels fused (2 vs 1.4, p=.021), greater amount of decompressions (2.5 vs 1, p=.003), with less return to the OR within 30 days (7% vs 14%, p=.2), and a lower rate of overall post-operative complications (34% vs 54%, p=.04). In a PSM cohort, the mean EBL was 411±790, LOS 3.7±2.7, overall post-operative complication rate 58%, and rate to return to OR within 30 days was 8%.

CONCLUSIONS:

There is a substantial learning curve that exists in order to capture the potential benefits of robotic surgery. Performing more robotic cases over time can potentially result in a surgeon lowering length of stay, EBL, and complication rate. Furthermore, this study shows that progressing through this learning curve allows a surgeon to become more comfortable performing larger surgeries in the form of greater levels of decompression.
808 Metastatic Breast Cancer to the Spine: Outcomes After the Introduction of Small Molecule Inhibitors
Authors: Rabah Nicholas M. , Khan Hammad A. , Jarmula Jakub , Hamza Omar , Chakravarthy Vikram , Wright Christina , Wright James Monroe , Steinmetz Michael P. , Krishnaney Ajit A.
Published: March 2022

INTRODUCTION:

Over the past decade, with the development of small molecule inhibitors and immunotherapies, expanded attention is being paid to the somatic mutations expressed within a patient’s individual breast tumor, especially in the case of advanced or metastatic disease. A number of mutations have been found to occur most commonly in patients with metastatic breast cancer, including TP53, PI3K, CDH1, and MAP3K. Specifically, with regards to patients with metastases to bone, PIK3 mutations have been found to increase in frequency.

METHODS:

This is a retrospective study of patients who underwent treatment (surgery/radiation) at a tertiary care center for their diagnosis of breast cancer metastatic to the spine between 2010 and 2020. Review of peripheral sample gene sequencing reports was conducted to calculate the prevalence of different somatic gene mutations within our population. The use of small molecule inhibitors in the post-treatment period was determined and patient post-treatment mortality was calculated in order to elucidate the effect of systemic therapy on overall survival.

RESULTS:

77 patients were included in our final analysis. Within our population of spine metastases patients, 44 (57%) were found to have a PI3K mutation, followed by 20 (26%) with a TP53 mutation. Furthermore, those patients given targeted molecular therapies in the post-treatment period were found to have a median overall survival of 1356 days. In comparison, those who did not receive targeted molecular therapies were found to have a median overall survival of 503 days (p<0.001).

CONCLUSIONS:

The results of the present study demonstrate that not only is there an increased prevalence of PI3K mutations within spine metastases in comparison to the general metastatic breast cancer population, there is also a significant mortality benefit with adding targeted molecular therapies to the patient’s post-operative treatment plan.
809 Comparison of Intraoperative Indocyanine Green Videoangiography Versus Postoperative Catheter Angiography to Confirm Microsurgical Occlusion of Dorsal Intradural Arteriovenous Fistulas
Authors: Karahalios Katherine , Srinivasan Visish M. , Scherschinski Lea , DiDomenico Joseph D. , Catapano Joshua , Safaee Michael , Lawton Michael T.
Published: March 2022

INTRODUCTION:

Dorsal intradural arteriovenous fistulas (DI-AVFs) represent 70% of all spinal vascular malformations and 80% of all spinal AVFs. Microsurgical clip occlusion is a durable treatment for DI-AVFs and includes pre- and postoperative digital subtraction angiography (DSA) as the standard practice. Intraoperative indocyanine green videoangiography (ICG-VA) has become a valuable intraoperative adjunct in these cases. Results with intraoperative ICG-VA have not been compared to postoperative DSA.

METHODS:

A multi-institutional database of vascular malformations was queried for all surgically managed cases of DI-AVFs. Patients with both intraoperative ICG-VA and postoperative DSA were included. Demographic, radiologic, intraoperative findings, and surgical outcomes data were obtained and retrospectively analyzed.

RESULTS:

Forty-five cases of DI-AVFs were identified. Patients had a mean age of 61.9 years old (range 26-85), including 32 males and 13 females. Except for one asymptomatic patient, all other patients presented with leg numbness and weakness, gait instability, bowel and/or bladder incontinence, back pain, paresthesias, paraplegia, upper extremity discoordination, erectile dysfunction, and/or general weakness. The majority of lesions were diagnosed in the thoracic spine (72%). All DI-AVFs were treated with interruption of the fistula with clip occlusion of the draining vein. Intraoperative ICG-VA confirmed complete obliteration in all patients. Postoperative spinal angiography was performed on 40 patients confirming complete obliteration in all patients. More patients had clinical improvement compared to their preoperative state than stayed the same (47.4% vs. 42.1%).

CONCLUSIONS:

ICG-VA is useful for both intraoperative identification of DI-AVFs and confirmation of complete microsurgical occlusion. Perfect correlation between intraoperative ICG-VA and postoperative DSA demonstrates the diagnostic power of the former. This finding suggests that postoperative DSA is not necessary when intraoperative ICG-VA confirms complete occlusion of the DI-AVF, which will spare patients the procedural risk and cost of this invasive procedure.
820 New Insights into the Genomic Landscape of Skull Base Meningiomas
Authors: Alsahlawi Aysha , Abedalthagafi Malak
Published: March 2022

INTRODUCTION:

The management of skull base meningiomas is challenging due to their complexity and proximity to crucial nearby structures. The identification of oncogenic mutations has provided further insights into the tumorigenesis of meningioma and the possibility of targeted therapy.

METHODS:

Tissue samples were collected from 71 patients diagnosed with meningioma from 2008 to 2016. Tissues were treated and archived as formalin-fixed paraffin-embedded (FFPE). Samples were subjected to targeted sequencing using a customized gene panel.

RESULTS:

The study cohort comprised 71 patients with histologically proven meningioma (grades I, II, and III) .The median patient age was 54.8 years (range 27-96 years). Most of the patients were female (51/71, 72.82%), while 19/71 (27.14%) were male. 56/71 patients had grade I (80.0%), 13/71 (18.57%) had grade II and 1/71 (1.428%) had grade III tumors. A total of 51/71 of the tumors were found in the skull base (72.82%). 22/71 (31.42%) of the tumors were meningothelial, 6/71 (8.57%) were atypical, 6/71 (8.57%) were transitional, 3/71 (4.28) were secretory, and 2/71 (2.86%) were chordoid. We detected an average of 1.56 ± 1.07 genomic alterations (GAs) per patient. the most common mutations were in NF2 (52/71), PIK3CA (22/71), FGFR3 (13/71), SMO (11/71) and AKT1 (10/71), with Tertp (1/71) mutations being the least frequent. The NF2-positive tumors were predominantly of grade I 43/52 (82.69%) with lower rates of recurrence (7/52, 13.41%) in tumors harboring NF2 mutations compared to tumor harboring non-NF2 mutations (8/18, 44.44%). Single FGFR3 mutations reported in three patients, all had WHO grade I tumors, with no recurrence in our cohort.

CONCLUSIONS:

This cohort focusing skull base meningiomas, highlights a range of mutations outside the known cancer driver NF2 that may be linked to meningioma prognosis. Among our findings were the identification of a rare TERTp mutation and the first report of FGFR3 mutations that may represent biomarkers for the identification of skull base meningioma patients with a favorable prognosis. Taken together, these findings highlight how genetic profiling can guide optimal treatment strategies, prognostic prediction, and patient management for skull meningioma.
827 Trends of In-patient Use of Patient-provider Video Recording During COVID19 Era and its Effects on HCAHPS Scores
Authors: Naeem Komal , Bhargava Malika , Porter Randall W.
Published: March 2022

INTRODUCTION:

Visitation restriction during COVID19 hindered the provision of optimal care provision. The presence of attendants with the family has proven to be beneficial for the patient’s recovery. The family of unconscious patients also liked to be updated periodically. We introduced the facility of video recording the patient and healthcare provider interaction that were made readily available for the patient and their family member.

METHODS:

We analyzed the number of videos recorded from July 2020 to Nov 2020. We also studied the change in the hospitals’ HCAHPs scores during the time.

RESULTS:

In total, 34,603 videos were recorded for the admitted patients, providing the details of daily progress. These videos received 44,981 (129%) views and 13,704 videos (39.6%) were shared with a total watch time of 1,081.5 hours. From 7/20 to 11/20 an increasing trend was seen in HCAHPS scores for the hospital and an R2 of 0.26 was calculated. A qualitative analysis of patients comments about their care revealed that they found the videos “comforting”, “communicate effectively”, “helpful”, “I do not need to call”.

CONCLUSIONS:

This study shows the benefits of providing a video recording of daily follow-up of hospitalized patients. We report an increasing trend in the HCAHPS scores. Not only patients/caregivers were able to watch the videos but they were shared with loved ones as well.
837 Shunt-dependent Post Traumatic Hydrocephalus in Pediatric Patients with Moderate to Severe Traumatic Brain Injury (TBI)
Authors: Asemota Anthony O. , Schneider Eric
Published: March 2022

INTRODUCTION:

Post-traumatic hydrocephalus (PTH) is a sequela of traumatic brain injury (TBI) causing significant morbidity among patients and treatment often requires placement of ventriculoperitoneal (VP) shunts. It is especially concerning in children given the often-lifelong dependency and quality-of-life issues over their life course.

METHODS:

The Nationwide Inpatient Sample 2000-2014 was queried and patients =18 years with moderate-severe TBI identified using ICD-9-CM codes. Weighted-data was analyzed and outcomes examined.

RESULTS:

A total 328,971 pediatric TBI cases were identified. Most patients were male (67.26%). The mean patient age was 9.74 years (SD=6.63), median 12 years (IQR=3-16). Age-group categories were: <1-year (14.58%), 1-9 years (30.14%), 10-19 years (55.28%). Majority of cases were treated at teaching hospitals (81.98%). The most common injury-causes were falls (20.35%) followed by motor-vehicle accidents (18.47%). Approximately 1.47% developed PTH requiring VP-shunt placement. By age-group, VP-shunt placement occurred in <1-year (3.69%), 1-9 years (1.14%), 10-19 years (1.07%), P<0.001. The mean age of patients developing shunt-dependent PTH was 6.95 years (SD=7.08), median age 4 years (IQR=0-14). After multivariate regression, patients with shunt-dependent PTH demonstrated higher odds of inpatient mortality (OR=1.29; 95%CI=1.02-1.62, P<0.001), tracheostomy (OR=5.93; 95%CI=4.75-7.40, P<0.001) and PEG-placement (OR=5.54; 95%CI=4.40-6.96, P<0.001), and also demonstrated significantly higher odds of medical complications including pulmonary insufficiency (OR=2.36; 95%CI=1.98-2.81, P<0.001), acute respiratory failure (OR=2.58; 95%CI=2.15-3.10, P<0.001), deep-vein thrombosis (OR=5.42; 95%CI=3.57-8.21, P<0.001), pulmonary embolism (OR=3.31; 95%CI=1.01-10.82, P=0.04), ventilator associated pneumonia (OR=2.20; 95%CI=1.07-4.52, P<0.001), congestive cardiac failure (OR=4.64; 95%CI=1.81-11.90, P<0.001), acute renal failure (OR=2.57; 95%CI=1.45-4.56, P<0.001), sepsis (OR=2.87; 95%CI=1.49-5.52, P<0.001), and severe sepsis (OR=4.12; 95%CI=1.89-8.97, P<0.001).

CONCLUSIONS:

Pediatric TBI patients developing shunt-dependent PTH have significantly higher inpatient morbidity and mortality. Research to better understand factors associated with post-traumatic hydrocephalus in pediatric patients are warranted.
The power of Drosophila in modeling human disease mechanisms
Authors: Verheyen Esther M.
Published: March 2022

Six years ago, DMM launched a subject collection called ‘Drosophila as a Disease Model’. This collection features Review-type articles and original research that highlight the power of Drosophila research in many aspects of human disease modeling. In the ensuing years, Drosophila research has further expanded to capitalize on genome editing, development of resources, and further interest in studying rare disease mechanisms. In the current issue of DMM, we again highlight the versatility, breadth, and scope of Drosophila research in human disease modeling and translational medicine. While many researchers have embraced the power of the fly, many more could still be encouraged to appreciate the strengths of Drosophila and how such research can integrate across species in a multi-pronged approach. Only when we truly acknowledge that all models contribute to our understanding of human biology, can we take advantage of the scope of current research endeavors.
Random attention can explain apparent object choice behavior in free-walking blowflies
Authors: Monteagudo José , Egelhaaf Martin , Lindemann Jens Peter
Published: March 2022

Flies are often observed to approach dark objects. To a naive observer they seem to pay selective attention to one out of several objects although previous research identified as a possible underlying mechanism a reflex-like fixation behavior integrating responses to all objects. In a combination of behavioral experiments and computational modelling, we investigated the choice behavior of flies freely walking towards an arrangement of two objects placed at a variable distance from each other. The walking trajectories were oriented towards one of the objects much earlier than predicted by a simple reactive model. We show that object choice can be explained by a continuous control scheme in combination with a mechanism randomly responding to the position of each object according to a stochastic process. This may be viewed as a special form of an implicit attention-like mechanism, for which the model does not require an explicit decision mechanism or a memory for the drawn decision.
Embryonal tumor with multilayered rosettes: a report of a rare case
Authors: Alshoabi Sultan A. , Abdu Ali M. , Alkhalidi Hisham M. , Jhaveri Miral D , Hamid Abdullgabbar
Published: March 2022

The authors report a case of an embryonal tumor with multilayered rosettes (ETMR) in an 18-month-old female infant who presented with gait imbalance and progressive left-sided weakness for 2 months. ETMR is a rare small round blue cell aggressive tumor of the central nervous system characterized by the amplification of the C19MC region on chromosome 19 (Chr19q13.42). This report in detail the clinical–radiologic and histopathological workup and diagnosis. Because ETMRs are newly described rare pediatric central nervous system tumors with only a few reported cases, we aim to document this typical case to add to the existing data on these tumors.
ZFC3H1 and U1-70K promote the nuclear retention of mRNAs with 5′ splice site motifs within nuclear speckles
Authors: Lee Eliza S. , Smith Harrison W. , Wolf Eric J. , Guvenek Aysegul , Wang Yifan E. , Emili Andrew , Tian Bin , Palazzo Alexander F.
Published: March 2022

Quality control of mRNA represents an important regulatory mechanism for gene expression in eukaryotes. One component of this quality control is the nuclear retention and decay of misprocessed RNAs. Previously, we demonstrated that mature mRNAs containing a 5′ splice site (5′SS) motif, which is typically found in misprocessed RNAs such as intronic polyadenylated (IPA) transcripts, are nuclear retained and degraded. Using high-throughput sequencing of cellular fractions, we now demonstrate that IPA transcripts require the zinc finger protein ZFC3H1 for their nuclear retention and degradation. Using reporter mRNAs, we demonstrate that ZFC3H1 promotes the nuclear retention of mRNAs with intact 5′SS motifs by sequestering them into nuclear speckles. Furthermore, we find that U1-70K, a component of the spliceosomal U1 snRNP, is also required for the nuclear retention of these reporter mRNAs and likely functions in the same pathway as ZFC3H1. Finally, we show that the disassembly of nuclear speckles impairs the nuclear retention of reporter mRNAs with 5′SS motifs. Our results highlight a splicing independent role of U1 snRNP and indicate that it works in conjunction with ZFC3H1 in preventing the nuclear export of misprocessed mRNAs by sequestering them into nuclear speckles.
Case Report: Bocavirus Infection Radiologically Resembling a Congestive Heart Failure in a Patient with Metastatic Castration-Resistant Prostate Cancer
Authors: Benitez Fuentes Javier David , de Luna Aguilar Alicia , Flores Navarro Paloma , Lopez de Sa Lorenzo Alfonso , Toledano Rojas Carmen , Laguna Fonseca Berta , Shah Richa , Frick Clara , Jimenez Ortega Alejandro Francisco , Rocha Iñigo Tania , Vidal Cassinello Natalia
Published: March 2022

Background: Human bocavirus (HBoV) is a viral pathogen from the genus Bocaparvovirus (family Parvoviridae, subfamily Parvovirinae) discovered in 2005. Most of available literature is about HBoV in children and adults with hematological malignancies and in otherwise healthy children with respiratory infections. Information regarding infection in the adult population with solid tumors is scarce.

Case Report: We report the case of a 51-year-old male with metastatic castration resistant prostate cancer undergoing chemotherapy treatment who presented with fever, dyspnea, dry cough, and pleuritic pain. Imaging techniques showed signs of congestive heart failure. Symptoms, laboratory tests and echocardiography revealed a more probable infectious etiology. Antibiotic therapy was started. A polymerase chain reaction (PCR) test of nasopharyngeal exudate for respiratory viruses was positive for HBoV. The rest of the microbiological tests were negative. Bronchoalveolar lavage (BAL) was performed. Bacterial culture of BAL was negative while respiratory virus PCR confirmed positivity for HBoV. Antibiotic therapy was discontinued. The patient gradually recovered.

Conclusions: Emerging infectious diseases are a notorious threat for immunocompromised populations such as solid tumor patients. This case is unique because to our knowledge this is the first case report article of HBoV in a solid tumor patient and because imaging techniques exhibited signs of congestive heart failure that did not correlate with the rest of the tests. It shows that unusual pathogens should be considered when managing serious clinical complications with uncommon presentations in cancer patients. Notable diagnostic efforts should be made to reach a diagnosis in these cases.
The stock market reaction to COVID-19 vaccination in ASEAN
Authors: Herlina Marizsa , Mafruhat Ade Yunita , Kurniati Eti , Wildan Wildan , Salsabila Hilwa Gifty
Published: March 2022

Previous studies have shown that the confirmed cases drive investor sentiment, reflecting the stock's return. Based on this, the vaccination growth is also expected to drive the investor’s sentiment, which can be reflected in the return of the stock market in ASEAN.  Therefore, this study explores the vaccination impact on stock returns in ASEAN countries. This study contributes to the gap of taking the COVID-19 vaccination impact to the stock return into account by using the panel regression model with HC and Driscoll and Kraay robust covariance matrix estimator, which addresses the cross-dependency and heterogeneity problems. This study is one of the early studies of the topic, especially in ASEAN. The panel regression model with HC and Driscoll and Kraay robust covariance matrix estimator uses three variables: the daily stocks return, vaccine growth, and cases growth. It is a balanced panel data that includes six countries and 117 daily series data, making 702 observations used in the study.  The results show conflicting results where daily vaccination growth negatively affects the stock return. This problem can arise for several reasons, such as the uncertainty in the financial market and cross-dependency and heterogeneity detected in the model. We can see that the investors still have a negative sentiment because COVID-19 has resulted in uncertainty on the financial market in ASEAN. This gives us practical implications that the ASEAN country members’ government needs to push vaccination policy more aggressively.
CLASSIC RUSSIAN MASSAGE IN 15 DAYS
Authors: Ogui Victor
Published: March 2022

Данная книга предназначена для всех, кто так или иначе связан с областью массажных технологий или интересуется данными вопросами. Каждый - и новичок, и профессионал - найдет в ней для себя что-то, что позволит ему отметить или освоить еще одну грань искусства массажа! Срок 15 дней не случайно отмечен в заголовке. Используя данную книгу и дополнительную литературу, приведенную в ней, можно получить представление о теории и практике массажа, освоить базовую технику классического русского массажа, что позволит использовать массаж в домашних условиях, при работе в фитнес-клубах, кабинетах и салонах красоты. Книга рассчитана на лиц, изучающих массаж самостоятельно или на курсах повышения квалификации, специалистов индустрии красоты и фитнес-услуг, на врачей, медицинских сестер по массажу, инструкторов лечебной физкультуры, персональных тренеров по фитнесу и бодибилдингу, преподавателей физической культуры и т.д. Т.е. всех тех, кто использует массаж в повседневной жизни, профессиональной деятельности, лечебной практике или только собирается освоить и применять это искусство. Богатые иллюстрации позволят не только освоить технику выполнения приемов массажа, но и получить основные знания об анатомии и физиологии жизнедеятельности человека.
¡Ay ay ay! ¡Ya llegó tu ratoncito! El ratón cantor
Authors: Martín-Regalado Natalia
Published: March 2022

Aunque para muchas personas los ratones son considerados animales desagradables, éstos son organismos muy importantes en los ecosistemas donde viven, ya que dispersan semillas, forman parte de la alimentación de serpientes, búhos y felinos, e incluso hay especies muy particulares que se alimentan de insectos y “dan serenata”.
Feline pancytopenia: a review of causes, investigation and treatment
Authors: Parton Sophie , Titmarsh Helen
Published: March 2022

Pancytopenia refers to a decrease in circulating levels of erythrocytes, neutrophils and platelets. These changes typically occur as a result of reduced production within the bone marrow or from peripheral cell destruction. A variety of causes have been reported in the literature, including primary bone marrow disorders, neoplasia, infectious diseases and toxins. When presented with a case of feline pancytopenia, it is important to take a thorough history, including travel history and any recent husbandry changes. Treatment and prognosis are dependent on the underlying cause, with favourable outcomes more commonly reported in cases of toxicity and certain infectious diseases. This article summarises the reported causes of pancytopenia, and provides a structured approach to managing these cases in practice.
Group inverses of matrices associated with certain graph classes
Authors: McDonald Judith , Nandi Raju , Sivakumar K. C.
Published: March 2022

We obtain formulae for group inverses of matrices that are associated with a new class of digraphs obtained from stars. This new class contains both bipartite and non-bipartite graphs. Expressions for the group inverse of matrices corresponding to double star digraphs and the adjacency matrix of certain undirected multi-star graphs are also proven. A blockwise representation of the inverse or group inverse of the adjacency matrix of the Dutch windmill graph is presented.
Investigating spray flames for nanoparticle synthesis via tomographic imaging using multi-simultaneous measurements (TIMes) of emission
Authors: Foo Cheau Tyan , Unterberger Andreas , Martins Fabio J. W. A. , Prenting Markus M. , Schulz Christof , Mohri Khadijeh
Published: March 2022

Tomographic imaging using multi-simultaneous measurements (TIMes) of spontaneous light emission was performed on various operating conditions of the SpraySyn burner to analyse the flame morphology and its potential impact on spray flame pyrolysis. Concurrent instantaneous and time-averaged three-dimensional measurements of CH* chemiluminescence (flame front indicator) and atomic Na emission from NaCl dissolved in the injected combustible liquid (related to hot burnt products of the spray flame) were reconstructed employing a 29-camera setup. Overlapping regions of CH* and Na are presented using isosurface visualisation, local correlation coefficient fields and joint probability distributions. The instantaneous results reveal the complex nature of the reacting flow and regions of interaction between the flame front with the hot gases that originate from the spray stream. The averaged reconstructions show that the spray flames tested are slightly asymmetric near the burner exit but develop into symmetric bell-shaped distributions at downstream locations. The changes in the flame structure for different operating conditions are analysed in light of previous studies, helping in the better understanding of the nanoparticle synthesis process. Furthermore, the importance of using measurements from two views for significantly improved alignment of the burner based on the originally proposed procedure are discussed in light of the reconstructions. This is an important aspect since the SpraySyn is intended for use as a well-defined standardised burner for nanoparticle synthesis, which is being investigated numerically and experimentally across different research groups.
Personalized image enhancement method for color deficient observers
Authors: Xu Lihao , Li Qixin , Li Qinyuan , Liu Xiaoxuan , Xu Qiang , Luo Ming Ronnier
Published: March 2022

A personalized image enhancement method is proposed to improve color vision in hereditary color vision deficiency (CVD). It is divided into two stages: evaluation of CVD and gamut mapping for image enhancement. These two separate stages are connected via a psychophysical experiment, through which the deficiency test result expressed using the C-index can be further transformed into a physical parameter, namely the wavelength shift of the cone fundamental. Experiments conducted by the color-deficient observers (CDOs) validated this proposed method, and it is emphasized that the proposed method is just serving as a template for image enhancement. A more advanced simulation model, a more accurate assessment method, or a more sophisticated gamut mapping algorithm can yield a better result.
Arbitrary amplitude and phase control in visible by dielectric metasurface
Authors: Jiang Qiang , Hu Leyong , Geng Guangzhou , Li Junjie , Wang Yongtian , Huang Lingling
Published: March 2022

Metasurfaces have been widely studied for arbitrary manipulation of the amplitude, phase and polarization of a field at the sub-wavelength scale. However, realizing a high efficiency metasurface with simultaneous and independent control of the amplitude and phase in visible remains a challenge. In this work, an ultrathin single-cell dielectric metasurface which can modulate arbitrary complex amplitude in transmission mode is proposed. The amplitude is controlled by adjusting the dipoles and quadrupoles by tuning the geometric size, while the phase is manipulated based on the Pancharatnam-Berry phase by rotating the meta-atom. Complex amplitude fields for generating holographic images and structure light are utilized to verify the reliability of the proposed structure. It has been experimentally demonstrated that the quality of holographic image of complex-amplitude hologram encoded on the proposed metasurface is better than that of phase-only holograms and verified by simulation that complex structure light can be generated by the proposed structure. Our work expands the superior limits of various applications, including arbitrary beam shaping, 3D biological imaging, optical computing, and optics-on-chip devices.
Multifocal confocal microscopy using a volume holographic lenslet array illuminator
Authors: Suresh Surag Athippillil , Vyas Sunil , Chen Wen-Pin , Yeh J. Andrew , Luo Yuan
Published: March 2022

Multifocal illumination can improve image acquisition time compared to single point scanning in confocal microscopy. However, due to an increase in the system complexity, obtaining uniform multifocal illumination throughout the field of view with conventional methods is challenging. Here, we propose a volume holographic lenslet array illuminator (VHLAI) for multifocal confocal microscopy. To obtain uniform array illumination, a super Gaussian (SG) beam has been incorporated through VHLAI with an efficiency of 43%, and implemented in a confocal microscope. The design method for a photo-polymer based volume holographic beam shaper is presented and its advantages are thoroughly addressed. The proposed system can significantly improve image acquisition time without sacrificing the quality of the image. The performance of the proposed multifocal confocal microscopy was compared with wide-field images and also evaluated by measuring optically sectioned microscopic images of fluorescence beads, florescence pollen grains, and biological samples. The proposed multifocal confocal system generates images faster without any changes in scanning devices. The present method may find important applications in high-speed multifocal microscopy platforms.
First population norms for the EQ-5D-3L in the Russian Federation
Authors: Khabibullina Alina , Aleksandrova Ekaterina , Gerry Christopher J. , Vlassov Vasily
Published: March 2022

Purpose

The EQ–5D survey instrument is routinely applied to general and patient specific populations in many countries, as a means of measuring Health Related Quality of Life (HRQOL) and/or informing Health Technology Assessment. The instrument is the subject of growing interest in the Russian Federation, as too is Health Technology Assessment. This research is the first to systematically present the EQ–5D–3L nationally representative population norms and to examine the socioeconomic and socio-demographic characteristics of the instrument among a representative sample of the Russian population.

Methods

Based on a nationally representative health and well-being survey of the Russian population, conducted in November 2017, we establish the descriptive results, including the EQ-VAS and the EQ-5D Index, by age and gender, examine the correspondence between the EQ–5D health classifications and the separate EQ-VAS scores, and draw on a set of augmented logistic regressions to evaluate the association between the presence of problems in each dimension and various socio-economic and health-related characteristics.

Results

We find strong evidence that the EQ-5D instrument is sensitive to underlying observed and latent health experiences, that it mirrors many of the characteristics familiar from other settings but that there are Russian specificities which merit further research, particularly with respect to the anxiety/depression dimension of the instrument.

Conclusion

This research represents an important landmark for HRQOL studies in Russia as well as for the prospects of continuing to develop the scholarly and practical infrastructure necessary for Russian Health Technology Assessment to advance.
Computational mining of MHC class II epitopes for the development of universal immunogenic proteins
Authors: Saylor Kyle , Donnan Ben , Zhang Chenming
Published: March 2022

The human leukocyte antigen (HLA) gene complex, one of the most diverse gene complexes found in the human genome, largely dictates how our immune systems recognize pathogens. Specifically, HLA genetic variability has been linked to vaccine effectiveness in humans and it has likely played some role in the shortcomings of the numerous human vaccines that have failed clinical trials. This variability is largely impossible to evaluate in animal models, however, as their immune systems generally 1) lack the diversity of the HLA complex and/or 2) express major histocompatibility complex (MHC) receptors that differ in specificity when compared to human MHC. In order to effectively engage the majority of human MHC receptors during vaccine design, here, we describe the use of HLA population frequency data from the USA and MHC epitope prediction software to facilitate the in silico mining of universal helper T cell epitopes and the subsequent design of a universal human immunogen using these predictions. This research highlights a novel approach to using in silico prediction software and data processing to direct vaccine development efforts.
Interval forecasts of weekly incident and cumulative COVID-19 mortality in the United States: A comparison of combining methods
Authors: Taylor Kathryn S. , Taylor James W.
Published: March 2022

Background

A combined forecast from multiple models is typically more accurate than an individual forecast, but there are few examples of studies of combining in infectious disease forecasting. We investigated the accuracy of different ways of combining interval forecasts of weekly incident and cumulative coronavirus disease-2019 (COVID-19) mortality.

Methods

We considered weekly interval forecasts, for 1- to 4-week prediction horizons, with out-of-sample periods of approximately 18 months ending on 8 January 2022, for multiple locations in the United States, using data from the COVID-19 Forecast Hub. Our comparison involved simple and more complex combining methods, including methods that involve trimming outliers or performance-based weights. Prediction accuracy was evaluated using interval scores, weighted interval scores, skill scores, ranks, and reliability diagrams.

Results

The weighted inverse score and median combining methods performed best for forecasts of incident deaths. Overall, the leading inverse score method was 12% better than the mean benchmark method in forecasting the 95% interval and, considering all interval forecasts, the median was 7% better than the mean. Overall, the median was the most accurate method for forecasts of cumulative deaths. Compared to the mean, the median’s accuracy was 65% better in forecasting the 95% interval, and 43% better considering all interval forecasts. For all combining methods except the median, combining forecasts from only compartmental models produced better forecasts than combining forecasts from all models.

Conclusions

Combining forecasts can improve the contribution of probabilistic forecasting to health policy decision making during epidemics. The relative performance of combining methods depends on the extent of outliers and the type of models in the combination. The median combination has the advantage of being robust to outlying forecasts. Our results support the Hub’s use of the median and we recommend further investigation into the use of weighted methods.