bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Validation of a Risk Tool for Predicting Severe Toxicity in Older Adults Receiving Chemotherapy for Early-Stage Breast Cancer
Authors: Magnuson Allison , Sedrak Mina S. , Gross Cary P. , Tew William P. , Klepin Heidi D. , Wildes Tanya M. , Muss Hyman B. , Dotan Efrat , Freedman Rachel A. , O'Connor Tracey , Dale William , Cohen Harvey J. , Katheria Vani , Arsenyan Anait , Levi Abrahm , Kim Heeyoung , Mohile Supriya , Hurria Arti , Sun Can-Lan
Published: January 2021

PURPOSE

Limited tools exist to predict the risk of chemotherapy toxicity in older adults with early-stage breast cancer.

METHODS

Patients of age ≥ 65 years with stage I-III breast cancer from 16 institutions treated with neoadjuvant or adjuvant chemotherapy were prospectively evaluated for geriatric and clinical features predictive of grade 3-5 chemotherapy toxicity. Logistic regression with best-subsets selection was used to identify and incorporate independent predictors of toxicity into a model with weighted variable scoring. Model performance was evaluated using area under the ROC curve (AUC) and goodness-of-fit statistics. The model was internally and externally validated.

RESULTS

In 473 patients (283 in development and 190 in validation cohort), 46% developed grade 3-5 chemotherapy toxicities. Eight independent predictors were identified (each assigned weighted points): anthracycline use (1 point), stage II or III (3 points), planned treatment duration > 3 months (4 points), abnormal liver function (3 points), low hemoglobin (3 points), falls (4 points), limited walking (3 points), and lack of social support (3 points). We calculated risk scores for each patient and defined three risk groups: low (0-5 points), intermediate (6-11 points), or high (≥ 12 points). In the development cohort, the rates of grade 3-5 chemotherapy toxicity for these three groups were 19%, 54%, and 87%, respectively ( P < .01). In the validation cohort, the corresponding toxicity rates were 27%, 45%, and 76%. The AUC was 0.75 (95% CI, 0.70 to 0.81) in the development cohort and 0.69 (95% CI, 0.62 to 0.77) in the validation cohort. Risk groups were also associated with hospitalizations and reduced dose intensity ( P < .01).

CONCLUSION

The Cancer and Aging Research Group-Breast Cancer (CARG-BC) score was developed and validated to predict grade 3-5 chemotherapy toxicity in older adults with early-stage breast cancer.
Insights for Quantifying the Long-Term Benefit of Immunotherapy Using Quantile Regression
Authors: Mboup Bassirou , Le Tourneau Christophe , Latouche Aurélien
Published: January 2021

PURPOSE

Immunotherapy has been approved to treat many tumor types. However, one characteristic of this therapeutic class is that survival benefit is due to late immune response, which leads to a delayed treatment effect. Quantifying the benefit, if any, of such treatment, will thus require other metrics than the usual hazard ratio and different approaches have been proposed to quantify the long-term response of immunotherapy.

METHOD

In this paper, we suggest to use quantile regression for survival data to quantify the long-term benefit of immunotherapy. Our motivation is that this approach is not trial-specific and provides clinically understandable results without specifying arbitrary time points or the necessity to reach median survival, as is the case with other methods. We use reconstructed data from published Kaplan-Meier curves to illustrate our method.

RESULTS

On average, patients from the immunotherapy group have 60% chance to survive 5.46 months (95% CI, 2.57 to 9.02) more than patients in the chemotherapy group.
Demographic Trends From 2005 to 2015 Among Physicians With Accreditation Council for Graduate Medical Education–Accredited Anesthesiology Training and Active Medical Licenses
Authors: Zhou Yan , Sun Huaping , Wang Ting , Harman Ann E. , Keegan Mark T. , Macario Alex , Minhaj Mohammed M. , Chaudhry Humayun J. , Young Aaron , Warner David O.
Published: January 2021

BACKGROUND:

A temporary decrease in anesthesiology residency graduates that occurred around the turn of the millennium may have workforce implications. The aims of this study are to describe, between 2005 and 2015, (1) demographic changes in the workforce of physicians trained as anesthesiologists; (2) national and state densities of these physicians, as well as temporal changes in the densities; and (3) retention of medical licenses by mid- and later-career anesthesiologists.

METHODS:

Using records from the American Board of Anesthesiology and state medical and osteopathic boards, the numbers of licensed physicians aged 30–59 years who had completed Accreditation Council for Graduate Medical Education–accredited anesthesiology residency training were calculated cross-sectionally for 2005, 2010, and 2015. Demographic trends were then described. Census data were used to calculate national and state densities of licensed physicians. Individual longitudinal data were used to describe retention of medical licenses among older physicians.

RESULTS:

The number of licensed physicians trained as anesthesiologists aged 30–59 years increased from 32,644 in 2005 to 36,543 in 2010 and 36,624 in 2015, representing a national density of 1.10, 1.18, and 1.14 per 10,000 population in those years, respectively. The density of anesthesiologists among states ranged from 0.37 to 3.10 per 10,000 population. The age distribution differed across the years. For example, anesthesiologists aged 40–49 years predominated in 2005 (47%), but by 2015, only 31% of anesthesiologists were aged 40–49 years. The proportion of female anesthesiologists grew from 22% in 2005, to 24% in 2010, and to 28% in 2015, particularly among early-career anesthesiologists. For anesthesiologists with licenses in 2005, the number who still had active licenses in 2015 decreased by 9.6% for those aged 45–49 years, by 14.1% for those aged 50–54 years, and by 19.7% for those aged 55–59 years.

CONCLUSIONS:

The temporary decrease in anesthesiology residency graduates around the turn of the 21st century decreased the proportion of anesthesiologists who were midcareer as of 2015. This may affect the future availability of senior leaders as well as the future overall workforce in the specialty as older anesthesiologists retire. National efforts to plan for workforce needs should recognize the geographical variability in the distribution of anesthesiologists.
Perioperative Multidisciplinary Delirium Prevention: A Longitudinal Case Report
Authors: Hamlet Kristin M. , Pasternak Eliana , Rabai Ferenc , Mufti Mariam , Hernaiz Alonso Carlos , Price Catherine C.
Published: January 2021

Postoperative delirium is associated with accelerated cognitive decline, mortality, and high health care costs. The importance of perioperative risk identification is increasingly recognized but optimal prevention strategies are still evolving. We review the case of an at-risk 79-year-old who had 3 lumbar spine surgeries within a year, 2 of which were complicated by postoperative delirium and one which was not. We discuss how a comprehensive preoperative cognitive assessment successfully informed perioperative decision making, including anesthetic management and postoperative multimodal delirium prevention strategies by geriatric medicine. The case exemplifies how coordinated interdisciplinary team management may reduce postoperative delirium in high-risk individuals.
Postoperative Diaphragmatic Liver Herniation Diagnosed by Point-of-Care Ultrasound
Authors: Prayal-Brown Audrey , Eissa Mohamed S. , Tryphonopoulos Peter , Talab Hesham F. , McFaul Colleen M.
Published: January 2021

Point-of-care ultrasound (PoCUS) is a sensitive and specific tool in early identification of malignant pathologies in unstable patients leading to improved outcomes. Postoperative diaphragmatic rupture is rare, can be life-threatening, and is difficult to diagnose. This report describes a 62-year-old women undergoing thoracoscopic right hemidiaphragm plication with acute postoperative hemodynamic instability. Bedside PoCUS identified hepatic herniation into the thorax causing cardiac compression and lateral displacement, which lead to expedited imaging and surgical reexploration.
An Innovative Method of Delivering Nebulized Medications for Perioperative Bronchospasm
Authors: Dekel Alex M. , Price Ryan , Tsai Alexander C. , Kim Eugene
Published: January 2021

Perioperative bronchospasm is a common challenge to anesthetic care. The timely delivery of inhaled medications can be challenging, particularly in pediatric patients and in locations where dedicated resources and respiratory support teams are limited. The delivery of nebulized medication to an intubated patient in the operating room can be difficult. We present an innovative method for delivery of nebulized solutions, in which a jet nebulizer is paired with a Mapleson hyperinflation system.
Utilization of Magnesium in Opioid-Free Anesthesia for Peroral Endoscopic Myotomy: A Case Report
Authors: Kim Richard K. , Hwang Joo H. , Tsui Ban C.
Published: January 2021

Optimal anesthetic management has not been studied for peroral endoscopic myotomy (POEM). This case report documents 2 patients with esophageal motility disorders who underwent POEM with opioid-free, magnesium-based anesthesia. Both patients had no postoperative esophageal complications nor need for opioid therapy. We further describe the therapeutic potential of magnesium for management of esophageal pain.
War Frenzy
Authors: Thobani Sunera
Published: January 2021

Following a speech against the war on terror the author presented at a conference on Violence Against Women, she was publicly attacked and threatened for “hate-mongering.” This paper was written in the aftermath of the controversy that followed. The author’s speech highlighted the history of U.S. foreign policy and sought to mobilize feminist opposition to the invasion of Afghanistan. The war, she argued, was reviving the colonial/imperial global divide and would be catastrophic. The author explores here how a number of carefully considered words used in the speech were treated in the public controversy that followed as too “incendiary” and used to shut down political opposition to the invasion of Afghanistan. By publicly branding her an ungrateful and hate-filled immigrant woman, and an apologist for terrorism, the media provided a platform to shut down political opposition and advance the racist and Islamophobic political ideology of the war.
“All That You Can’t Leave Behind”
Authors: Brooks Daphne A.
Published: January 2021

As numerous scholars have shown, Hurricane Katrina exacerbated the already-ongoing precarity of African American communities in New Orleans. The crisis demanded a reckoning with the afterlives of slavery at the national and global level. This article focuses on the work of Black women popular music artists whose early twenty-first century recordings and stirring performances addressed the traumas, the challenges, and the spectacular subjugation of Black women who fell victim to brutal disenfranchisement in the midst of the disaster. Beyonce’s B-Day album and Mary J. Blige’s history-making Katrina telethon performance are central to this discussion. The original title of this article was “‘All That You Can’t Leave Behind’: Black Female Soul Singing and the Politics of Surrogation in the Age of Catastrophe.”
Queering Puerto Rican Women’s Narratives
Authors: Torres Lourdes
Published: January 2021

While in the last decades there has been a proliferation of writings by Latina lesbians who theorize issues of intersectionality, missing still are the voices and analyses of Puerto Rican lesbians who articulate the specificity of Puerto Rican sexual, racial, national, and class dynamics. It is within this context that the author examines Memoir of a Visionary (2002) by Antonia Pantoja and The Noise of Infinite Longing (2004) by Luisita López Torregrosa; the article considers how these recent memoirs engage with intersecting issues in the lives of Puerto Rican women and suggest how shame implicitly conditions the articulation of Puerto Rican identity.
Mel-han-cholia as Political Practice in Theresa Hak Kyung Cha’s Dictée
Authors: Cho Jennifer
Published: January 2021

Turning to extant theories of melancholy, this article uses Theresa Hak Kyung Cha’s Dictée to reevaluate the linear trajectory of Asian American identity formation in the United States. In particular, the author develops the term mel-han-choly—a hybrid form of melancholy and Korean han (a culturally specific grief)—to show how Cha uses it as a subversive political tool to defer historical closure and to refuse her quiet assimilation. Cha’s remembrance of the histories of Japanese colonialism in the Korean peninsula and the Korean War defies the expectation that minority populations somehow transcend their grievous pasts in becoming model American citizens. The author claims that Cha’s mel-han-cholic gestures disrupt the United States’ discursive power in narrating Korean history, especially as one contingent on accepting America’s “liberating” charge. This article also proposes that mel-han-choly serves a healing function within the diasporic Korean community, offering transnational connectivity through the shared experience of grief.
Refined tooth and pulp segmentation using U-Net in CBCT image
Authors: Duan Wei , Chen Yufei , Zhang Qi , Lin Xiang , Yang Xiaoyu
Published: January 2021

Objectives

The aim of this study was extracting any single tooth from a CBCT scan and performing tooth and pulp cavity segmentation to visualize and to have knowledge of internal anatomy relationships before undertaking endodontic therapy.

Methods:

We propose a two-phase deep learning solution for accurate tooth and pulp cavity segmentation. First, the single tooth bounding box is extracted automatically for both single-rooted tooth (ST) and multirooted tooth (MT). It is achieved by using the Region Proposal Network (RPN) with Feature Pyramid Network (FPN) method from the perspective of panorama. Second, U-Net model is iteratively performed for refined tooth and pulp segmentation against two types of tooth ST and MT, respectively. In light of rough data and annotation problems for dental pulp, we design a loss function with a smoothness penalty in the network. Furthermore, the multi-view data enhancement is proposed to solve the small data challenge and morphology structural problems.

Results:

The experimental results show that the proposed method can obtain an average dice 95.7% for ST, 96.2% for MT and 88.6% for pulp of ST, 87.6% for pulp of MT.

Conclusions

This study proposed a two-phase deep learning solution for fast and accurately extracting any single tooth from a CBCT scan and performing accurate tooth and pulp cavity segmentation. The 3D reconstruction results can completely show the morphology of teeth and pulps, it also provides valuable data for further research and clinical practice.
LA FINANCIACIÓN DE LA SANIDAD PÚBLICA ESPAÑOLA. ESPECIAL REFERENCIA A LA CRISIS SANITARIA GENERADA POR COVID-19.
Authors: Benítez Llamazares Nuria
Published: January 2021

Health population is considered as a fundamental right according to the Spanish Constitution, and public administrations have the duty to guarantee such benefits. National Health System in Spain is configurated by public structures and Health services at all levels of government. The definition of health care benefits as non-contributory implies that the most appropriate alternative is the tax financing of a high percentage of public health spending. Additionally, other financing mechanisms are possible, such as income from donations to the COVID-19 State, an alternative that has given good results to finance the costs associated with the management of the current pandemic.
Dispersal history of Miniopterus fuliginosus bats and their associated viruses in east Asia
Authors: Kimprasit Thachawech , Nunome Mitsuo , Iida Keisuke , Murakami Yoshitaka , Wong Min-Liang , Wu Chung-Hsin , Kobayashi Ryosuke , Hengjan Yupadee , Takemae Hitoshi , Yonemitsu Kenzo , Kuwata Ryusei , Shimoda Hiroshi , Si Lifan , Sohn Joon-Hyuk , Asakawa Susumu , Ichiyanagi Kenji , Maeda Ken , Oh Hong-Shik , Mizutani Tetsuya , Kimura Junpei , Iida Atsuo , Hondo Eiichi
Published: January 2021

In this study, we examined the role of the eastern bent-winged bat (Miniopterus fuliginosus) in the dispersion of bat adenovirus and bat alphacoronavirus in east Asia, considering their gene flows and divergence times (based on deep-sequencing data), using bat fecal guano samples. Bats in China moved to Jeju Island and/or Taiwan in the last 20,000 years via the Korean Peninsula and/or Japan. The phylogenies of host mitochondrial D-loop DNA was not significantly congruent with those of bat adenovirus (m2XY = 0.07, p = 0.08), and bat alphacoronavirus (m2XY = 0.48, p = 0.20). We estimate that the first divergence time of bats carrying bat adenovirus in five caves studied (designated as K1, K2, JJ, N2, and F3) occurred approximately 3.17 million years ago. In contrast, the first divergence time of bat adenovirus among bats in the 5 caves was estimated to be approximately 224.32 years ago. The first divergence time of bats in caves CH, JJ, WY, N2, F1, F2, and F3 harboring bat alphacoronavirus was estimated to be 1.59 million years ago. The first divergence time of bat alphacoronavirus among the 7 caves was estimated to be approximately 2,596.92 years ago. The origin of bat adenovirus remains unclear, whereas our findings suggest that bat alphacoronavirus originated in Japan. Surprisingly, bat adenovirus and bat alphacoronavirus appeared to diverge substantially over the last 100 years, even though our gene-flow data indicate that the eastern bent-winged bat serves as an important natural reservoir of both viruses.
Factors correlated with visual outcomes at two and four years after vitreous surgery for proliferative diabetic retinopathy
Authors: Nishi Katsuhiro , Nishitsuka Koichi , Yamamoto Teiko , Yamashita Hidetoshi
Published: January 2021

Proliferative diabetic retinopathy (PDR) is the most severe case of diabetic retinopathy that can cause visual impairment. This study aimed to reveal the factors correlated with better postoperative visual acuity after a long follow-up in patients who underwent vitrectomy for PDR. We retrospectively analyzed the data set including systemic findings, ocular findings, and surgical factors from registered patients who could be completely followed up for 2 or 4 years after vitrectomy. We ultimately enrolled 128 eyes from 100 patients who underwent vitrectomy for PDR between January 2008 and September 2012 and were followed up for >2 years. Among them, 91 eyes from 70 patients could be followed up for 4 years. Factors related to the postoperative visual acuity of ≥20/40 and ≥20/30 after 2 and 4 years were investigated by logistic regression analysis. Better postoperative visual acuity correlated with the following factors: no rubeosis iridis ([≥20/40 at 2 years; odds ratio {OR}, 0.068; 95% confidence interval {CI}, 0.012–0.39; P = 0.003], [≥20/30 at 2 years; OR, 0.07; 95% CI, 0.01–0.40; P = 0.03], [≥20/30 at 4 years; OR, 0.078; 95% CI, 0.006–0.96; P = 0.04]), no fibrovascular membrane [(≥20/40 at 2 years; OR, 0.22; 95% CI, 0.061–0.81; P = 0.02), (≥20/40 at 4 years; OR, 0.26; 95% CI, 0.07–0.94; P = 0.04), (≥20/30 at 4 years; OR, 0.14; 95% CI, 0.04–0.52; P = 0.004)], existing vitreous hemorrhage (≥20/30 at 2 years; OR, 9.55; 95% CI, 1.03–95.27; P = 0.04), and no reoperation ([≥20/40 at 4 years; OR, 0.15; 95% CI, 0.03–0.78; P = 0.02], [≥20/30 at 4 years; OR, 0.06; 95% CI, 0.07–0.54; P = 0.01]). Treatment provision before disease severity and treatment without complications were associated with good postoperative visual acuity.
Prevention of adhesions post-abdominal surgery: Assessing the safety and efficacy of Chitogel with Deferiprone in a rat model
Authors: Vediappan Rajan Sundaresan , Bennett Catherine , Cooksley Clare , Finnie John , Trochsler Markus , Quarrington Ryan D. , Jones Claire F. , Bassiouni Ahmed , Moratti Stephen , Psaltis Alkis J. , Maddern Guy , Vreugde Sarah , Wormald P. J.
Published: January 2021

Introduction

Adhesions are often considered to be an inevitable consequence of abdominal and pelvic surgery, jeopardizing the medium and long-term success of these procedures. Numerous strategies have been tested to reduce adhesion formation, however, to date, no surgical or medical therapeutic approaches have been successful in its prevention. This study demonstrates the safety and efficacy of Chitogel with Deferiprone and/or antibacterial Gallium Protoporphyrin in different concentrations in preventing adhesion formation after abdominal surgery.

Materials and methods

112 adult (8–10 week old) male Wistar albino rats were subjected to midline laparotomy and caecal abrasion, with 48 rats having an additional enterotomy and suturing. Kaolin (0.005g/ml) was applied to further accelerate adhesion formation. The abrasion model rats were randomized to receive saline, Chitogel, or Chitogel plus Deferiprone (5, 10 or 20 mM), together with Gallium Protoporphyrin (250μg/mL). The abrasion with enterotomy rats were randomised to receive saline, Chitogel or Chitogel with Deferiprone (1 or 5 mM). At day 21, rats were euthanised, and adhesions graded macroscopically and microscopically; the tensile strength of the repaired caecum was determined by an investigator blinded to the treatment groups.

Results

Chitogel with Deferiprone 5 mM significantly reduced adhesion formation (p<0.01) when pathologically assessed in a rat abrasion model. Chitogel with Deferiprone 5 mM and 1 mM also significantly reduced adhesions (p<0.05) after abrasion with enterotomy. Def-Chitogel 1mM treatment did not weaken the enterotomy site with treated sites having significantly better tensile strength compared to control saline treated enterotomy rats.

Conclusions

Chitogel with Deferiprone 1 mM constitutes an effective preventative anti-adhesion barrier after abdominal surgery in a rat model. Moreover, this therapeutic combination of agents is safe and does not weaken the healing of the sutured enterotomy site.
Comparative RNA-Seq analysis unfolds a complex regulatory network imparting yellow mosaic disease resistance in mungbean [Vigna radiata (L.) R. Wilczek]
Authors: Dasgupta Uttarayan , Mishra Gyan Prakash , Dikshit Harsh K. , Mishra Dwijesh C. , Bosamia Tejas , Roy Anirban , Bhati Jyotika , Priti  , Aski Muraleedhar , Kumar Ranjeet R. , Singh Amit Kumar , Kumar Atul , Sinha Subodh K. , Chaurasia Shiksha , Praveen Shelly , Nair Ramakrishnan M.
Published: January 2021

Yellow Mosaic Disease (YMD) in mungbean [Vigna radiata (L.) R. Wilczek] is one of the most damaging diseases in Asia. In the northern part of India, the YMD is caused by Mungbean Yellow Mosaic India Virus (MYMIV), while in southern India this is caused by Mungbean Yellow Mosaic Virus (MYMV). The molecular mechanism of YMD resistance in mungbean remains largely unknown. In this study, RNA-seq analysis was conducted between a resistant (PMR-1) and a susceptible (Pusa Vishal) mungbean genotype under infected and control conditions to understand the regulatory network operating between mungbean-YMV. Overall, 76.8 million raw reads could be generated in different treatment combinations, while mapping rate per library to the reference genome varied from 86.78% to 93.35%. The resistance to MYMIV showed a very complicated gene network, which begins with the production of general PAMPs (pathogen-associated molecular patterns), then activation of various signaling cascades like kinases, jasmonic acid (JA) and brassinosteroid (BR), and finally the expression of specific genes (like PR-proteins, virus resistance and R-gene proteins) leading to resistance response. The function of WRKY, NAC and MYB transcription factors in imparting the resistance against MYMIV could be established. The string analysis also revealed the role of proteins involved in kinase, viral movement and phytoene synthase activity in imparting YMD resistance. A set of novel stress-related EST-SSRs are also identified from the RNA-Seq data which may be used to find the linked genes/QTLs with the YMD resistance. Also, 11 defence-related transcripts could be validated through quantitative real-time PCR analysis. The identified gene networks have led to an insight about the defence mechanism operating against MYMIV infection in mungbean which will be of immense use to manage the YMD resistance in mungbean.
Economic model to examine the cost-effectiveness of FlowOx home therapy compared to standard care in patients with peripheral artery disease
Authors: Ezeofor Victory ‘Segun , Bray Nathan , Bryning Lucy , Hashmi Farina , Hoel Henrik , Parker Daniel , Edwards Rhiannon Tudor
Published: January 2021

Background

Critical limb ischaemia is a severe stage of lower limb peripheral artery disease which can lead to tissue loss, gangrene, amputation and death. FlowOx™ therapy is a novel negative-pressure chamber system intended for home use to increase blood flow, reduce pain and improve wound healing for patients with peripheral artery disease and critical limb ischaemia.

Methods

A Markov model was constructed to assess the relative cost-effectiveness of FlowOx™ therapy compared to standard care in lower limb peripheral artery disease patients with intermittent claudication or critical limb ischaemia. The model used data from two European trials of FlowOx™ therapy and published evidence on disease progression. From an NHS analysis perspective, various FlowOx™ therapy scenarios were modelled by adjusting the dose of FlowOx™ therapy and the amount of other care received alongside FlowOx™ therapy, in comparison to standard care.

Results

In the base case analysis, consisting of FlowOx™ therapy plus nominal care, the cost estimates were £12,704 for a single dose of FlowOx™ therapy per annum as compared with £15,523 for standard care. FlowOx™ therapy patients gained 0.27 additional quality adjusted life years compared to standard care patients. This equated to a dominant incremental cost-effectiveness ratio per QALY gained. At the NICE threshold WTP of £20,000 and £30,000 per QALY gained, FlowOx™ therapy in addition to standard care had a 0.80 and 1.00 probability of being cost-effectiveness respectively.

Conclusions

FlowOx™ therapy delivered as a single annual dose may be a cost-effective treatment for peripheral artery disease. FlowOx™ therapy improved health outcomes and reduced treatment costs in this modelled cohort. The effectiveness and cost-effectiveness of FlowOx™ therapy is susceptible to disease severity, adherence, dose and treatment cost. Research assessing the impact of FlowOx™ therapy on NHS resource use is needed in order to provide a definitive economic evaluation.
Non-readmission decisions in the intensive care unit: A qualitative study of physicians’ experience in a multicentre French study
Authors: Jacquier Marine , Meunier-Beillard Nicolas , Ecarnot Fiona , Large Audrey , Aptel François , Labruyère Marie , Dargent Auguste , Andreu Pascal , Roudaut Jean-Baptiste , Rigaud Jean-Philippe , Quenot Jean-Pierre
Published: January 2021

Purpose

Deciding not to re-admit a patient to the intensive care unit (ICU) poses an ethical dilemma for ICU physicians. We aimed to describe and understand the attitudes and perceptions of ICU physicians regarding non-readmission of patients to the ICU.

Materials and methods

Multicenter, qualitative study using semi-directed interviews between January and May 2019. All medical staff working full-time in the ICU of five participating centres (two academic and three general, non-academic hospitals) were invited to participate. Participants were asked to describe how they experienced non-readmission decisions in the ICU, and to expand on the manner in which the decision was made, but also on the traceability and timing of the decision. Interviews were recorded, transcribed and analyzed using textual content analysis.

Results

In total, 22 physicians participated. Interviews lasted on average 26±7 minutes. There were 14 men and 8 women, average age was 35±9 years, and average length of ICU experience was 7±5 years. The majority of respondents said that they regretted that the question of non-readmission was not addressed before the initial ICU admission. They acknowledged that the ICU stay did lead to more thorough contemplation of the overall goals of care. Multidisciplinary team meetings could help to anticipate the question of readmission within the patient’s care pathway. Participants reported that there is a culture of collegial decision-making in the ICU, although the involvement of patients, families and other healthcare professionals in this process is not systematic. The timing and traceability of non-readmission decisions are heterogeneous.

Conclusions

Non-readmission decisions are a major issue that raises ethical questions surrounding the fact that there is no discussion of the patient’s goals of care in advance. Better anticipation, and better communication with the patients, families and other healthcare providers are suggested as areas that could be targeted for improvement.
Impact of SARS-CoV-2 pandemic among health care workers in a secondary teaching hospital in Spain
Authors: Garralda Fernandez Javier , Molero Vilches Ignacio , Bermejo Rodríguez Alfredo , Cano Torres Isabel , Colino Romay Elda Isabel , García Arata Isabel , Jaqueti Aroca Jerónimo , Lillo Rodríguez Rosa , López Lacomba Daniel , Mazón Cuadrado Luis , Molina Esteban Laura , Morales García Luis Javier , Moratilla Monzo Laura , Nieto-Borrajo Elva , Pacheco Delgado María , Prieto Menchero Santiago , Sánchez Hernández Cristina , Sánchez Testillano Eva , García-Martínez Jesús
Published: January 2021

Background

The COVID-19 pandemic has posed a huge challenge to healthcare systems and their personnel worldwide. The study of the impact of SARS-CoV-2 infection among healthcare workers (HCW), through prevalence studies, will let us know viral expansion, individuals at most risk and the most exposed areas in healthcare organizations. The aim of this study is to gauge the impact of SARS-CoV-2 pandemic in our hospital workforce and identify groups and areas at increased risk.

Methods and findings

This is a cross-sectional and incidence study carried out on healthcare workers based on molecular and serological diagnosis of SARS-CoV-2 infection. Of the 3013 HCW invited to participate, 2439 (80.9%) were recruited, including 674 (22.4%) who had previously consulted at the Occupational Health Service (OHS) for confirmed exposure and/or presenting symptoms suggestive of COVID-19. A total of 411 (16.9%) and 264 (10.8%) healthcare workers were SARS-CoV-2 IgG and rRT-PCR positive, respectively. The cumulative prevalence considering all studies (IgG positive HCW and/or rRT-PCR positive detection) was 485 (19.9%). SARS-CoV-2 IgG-positive patients in whom the virus was not detected were 221 (9.1%); up to 151 of them (68.3%) did not report any compatible symptoms nor consult at the OHS for this reason. Men became more infected than women (25% vs 18.5%, p = 0.0009), including when data were also classified by age. COVID-19 cumulative prevalence among the HCW assigned to medical departments was higher (25.2%) than others, as well as among medical staff (25.4%) compared with other professional categories (p<0.01).

Conclusions

The global impact of the COVID-19 pandemic on HCW of our centre has been 19.9%. Doctors and medical services personnel have had the highest prevalence of SARS-CoV-2 infection, but many of them have not presented compatible symptoms. This emphasizes the performance of continuous surveillance methods of the most exposed health personnel and not only based on the appearance of symptoms.
The effect of antenatal care on perinatal outcomes in Ethiopia: A systematic review and meta-analysis
Authors: Shiferaw Kasiye , Mengiste Bizatu , Gobena Tesfaye , Dheresa Merga
Published: January 2021

Background

The estimated annual global perinatal and neonatal death is four million. Stillbirths are almost equivalent to neonatal mortality, yet they have not received the same attention. Antenatal care is generally thought to be an effective method of improving pregnancy outcomes, but its effectiveness as a means of reducing perinatal mortality has not been evaluated in Ethiopia. Therefore, we will identify the pooled effect of antenatal care on perinatal outcomes in Ethiopia.

Methods

Medline, Embase, Cinahl, African journal online and Google Scholar was searched for articles published in English language between January 1990 and May 2020. Two independent assessors selected studies and extracted data from eligible articles. The Risk of Bias Assessment tool for Non-Randomized Studies was used to assess the quality of each included study. Data analysis was performed using RevMan 5.3. Heterogeneity and publication bias were assessed using I2test statistical significance and Egger's test for small-study effects respectively. The random effect model was employed, and forest plot was used to present the risk ratio (RR) with 95% confidence interval (CI).

Results

Thirteen out of seventeen included studies revealed antenatal care utilization had a significant association with perinatal outcomes. The pooled risk ratio by the random-effects model for perinatal death was 0.42 (95% CI: 0.34, 0.52); stillbirth 0.34 (95% CI: 0.25, 0.46); early neonatal death 0.85 (95% CI: 0.21. 3.49).

Conclusion

Women who attended at least one antenatal care visit were more likely to give birth to an alive neonate that survives compared to their counterpart. Therefore, the Ethiopian Ministry of health and other stakeholders should design tailored interventions to increase antenatal care utilization since it has been shown to reduce perinatal mortality.
Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe
Authors: Mapangisana Tichaona , Machekano Rhoderick , Kouamou Vinie , Maposhere Caroline , McCarty Kathy , Mudzana Marceline , Munyati Shungu , Mutsvangwa Junior , Manasa Justen , Shamu Tinei , Bogoshi Mampedi , Israelski Dennis , Katzenstein David
Published: January 2021

Introduction

Maintaining virologic suppression of children and adolescents on ART in rural communities in sub-Saharan Africa is challenging. We explored switching drug regimens to protease inhibitor (PI) based treatment and reducing nevirapine and zidovudine use in a differentiated community service delivery model in rural Zimbabwe.

Methods

From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. Viral load testing was performed (2016) by Roche and at follow-up (2018) by a point of care viral load assay. Virologic failure was defined as viral load ≥1,000 copies/ml. A logistic regression model which included demographics, treatment regimens and caregiver’s characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU).

Results

At baseline in 2016, 296 of 306 children and adolescents (97%) were on first-line ART, and only 10 were receiving a PI-based regimen. The median age was 12 years (IQR 8–15) and 55% were female. Two hundred and nine (68%) had viral load suppression (<1,000 copies/ml) and 97(32%) were unsuppressed (viral load ≥1000). At follow-up in 2018, 42/306 (14%) were either transferred 23 (7%) or LTFU 17 (6%) and 2 had died. In 2018, of the 264 retained in care, 107/264 (41%), had been switched to second-line, ritonavir-boosted PI with abacavir as a new nucleotide analog reverse transcriptase inhibitor (NRTI). Overall viral load suppression increased from 68% in 2016 to 81% in 2018 (P<0.001).

Conclusion

Viral load testing, and switching to second-line, ritonavir-boosted PI with abacavir significantly increased virologic suppression among HIV-infected children and adolescents in rural Zimbabwe.
Covariance matrix filtering with bootstrapped hierarchies
Authors: Bongiorno Christian , Challet Damien
Published: January 2021

Cleaning covariance matrices is a highly non-trivial problem, yet of central importance in the statistical inference of dependence between objects. We propose here a probabilistic hierarchical clustering method, named Bootstrapped Average Hierarchical Clustering (BAHC), that is particularly effective in the high-dimensional case, i.e., when there are more objects than features. When applied to DNA microarray, our method yields distinct hierarchical structures that cannot be accounted for by usual hierarchical clustering. We then use global minimum-variance risk management to test our method and find that BAHC leads to significantly smaller realized risk compared to state-of-the-art linear and nonlinear filtering methods in the high-dimensional case. Spectral decomposition shows that BAHC better captures the persistence of the dependence structure between asset price returns in the calibration and the test periods.
The effects of laser displacement on femtosecond laser-assisted conjunctival autograft preparation for pterygium surgery
Authors: Foo Valencia Hui Xian , Liu Yu-Chi , Ong Hon Shing , Ang Marcus , Mehta Jodhbir S.
Published: January 2021

Aims

To evaluate the effects of no-suction femtosecond laser (FSL) stability on conjunctival autograft (CAG) dissection in pterygium surgery.

Methods

Prospective analysis of 35 eyes from 34 subjects who underwent femtosecond laser-assisted pterygium surgery with the Ziemer Z8 laser (Ophthalmic Systems AG, Switzerland). Intraoperative absolute FSL displacements were measured and correlated with the duration and ease of CAG peel, CAG thickness, measured with intraoperative optical coherence tomography, and deviation from intended graft thickness.

Results

The median absolute FSL displacement was 22 μm (interquartile range [IQR] 14.7 to 60.8), while median vertical FSL displacement was 14.7 μm (IQR 7.3 to 44) and median horizontal FSL displacement was 22.0 μm (IQR 14.7 to 44). 65.7% had a grade 1 peel, 11.4% had grade 2 peel, 14.3% had grade 3 peel and 8.6% had grade 4 peel. The median duration of CAG peel was 5.4 seconds (IQR 3 to 21.4). The median CAG thickness was 69 μm (IQR 60.3 to 78.5), and the median deviation from targeted graft thickness was 9 μm (IQR 1 to 16). Eyes with more difficult peels and longer duration of CAG peels had significantly greater vertical FSL displacements (p = 0.04 and 0.02 respectively), but not horizontal displacement, age, ethnicity, CAG thickness or deviation from original thickness, compared to those with better quality and shorter duration peels. 1 eye (2.9%) had an incomplete CAG peel with a buttonhole and 2 eyes had graft tears (5.7%).

Conclusion

Micro-displacements during the suction-free CAG preparation are common but they did not affect the quality of the CAG peel, duration of peel, or CAG thickness. However, vertical globe displacement during FSL-assisted CAG creation was significantly associated with a more difficult and longer CAG peel duration. This highlights the importance of the cornea traction suture fixation to ensure stability of the eye during FSL application.
Psychological, physical, and sleep comorbidities and functional impairment in irritable bowel syndrome: Results from a national survey of U.S. adults
Authors: Grover Madhusudan , Kolla Bhanu Prakash , Pamarthy Rahul , Mansukhani Meghna P. , Breen-Lyles Margaret , He Jian-Ping , Merikangas Kathleen R.
Published: January 2021

Background/Aims

Patients with irritable bowel syndrome (IBS) in referral practice commonly report mental disorders and functional impairment. Our aim was to determine the prevalence of mental, physical and sleep-related comorbidities in a nationally representative sample of IBS patients and their impact on functional impairment.

Methods

IBS was defined by modified Rome Criteria based on responses to the chronic conditions section of the National Comorbidity Survey-Replication. Associations between IBS and mental, physical and sleep disorders and 30-day functional impairment were examined using logistic regression models.

Results

Of 5,650 eligible responders, 186 met criteria for IBS {weighted prevalence 2.5% (SE = 0.3)}. Age >60 years was associated with decreased odds (OR = 0.3; 95% CI:.1-.6); low family income (OR = 2.4; 95% CI:1.2–4.9) and unemployed status (OR = 2.3; 95% CI:1.2–4.2) were associated with increased odds of IBS. IBS was significantly associated with anxiety, behavior, mood disorders (ORs 1.8–2.4), but not eating or substance use disorders. Among physical conditions, IBS was associated with increased odds of headache, chronic pain, diabetes mellitus and both insomnia and hypersomnolence related symptoms (ORs 1.9–4.0). While the association between IBS and patients’ role impairment persisted after adjusting for mental disorders (OR = 2.4, 95% CI 1.5–3.7), associations with impairment in self-care, cognition, and social interaction in unadjusted models (ORs 2.5–4.2) were no longer significant after adjustment for mental disorders.

Conclusion

IBS is associated with socioeconomic disadvantage, comorbidity with mood, anxiety and sleep disorders, and role impairment. Other aspects of functional impairment appear to be moderated by presence of comorbid mental disorders.
Insights into structure and dynamics of extracellular domain of Toll-like receptor 5 in Cirrhinus mrigala (mrigala): A molecular dynamics simulation approach
Authors: Rout Ajaya Kumar , Acharya Varsha , Maharana Diptimayee , Dehury Budheswar , Udgata Sheela Rani , Jena Rajkumar , Behera Bhaskar , Parida Pranaya Kumar , Behera Bijay Kumar
Published: January 2021

The toll-like receptor 5 (TLR5) is the most conserved important pattern recognition receptors (PRRs) often stimulated by bacterial flagellins and plays a major role in the first-line defense against invading pathogenic bacteria and in immune homeostasis. Experimental crystallographic studies have shown that the extracellular domain (ECD) of TLR5 recognizes flagellin of bacteria and functions as a homodimer in model organism zebrafish. However, no structural information is available on TLR5 functionality in the major carp Cirrhinus mrigala (mrigala) and its interaction with bacterial flagellins. Therefore, the present study was undertaken to unravel the structural basis of TLR5-flagellin recognition in mrigala using structural homodimeric TLR5-flagellin complex of zebrafish as reference. Integrative structural modeling and molecular dynamics simulations were employed to explore the structural and mechanistic details of TLR5 recognition. Results from structural snapshots of MD simulation revealed that TLR5 consistently formed close interactions with the three helices of the D1 domain in flagellin on its lateral side mediated by several conserved amino acids. Results from the intermolecular contact analysis perfectly substantiate with the findings of per residue-free energy decomposition analysis. The differential recognition mediated by flagellin to TLR5 in mrigala involves charged residues at the interface of binding as compared to the zebrafish complex. Overall our results shows TLR5 of mrigala involved in innate immunity specifically recognized a conserved site on flagellin which advocates the scientific community to explore host-specific differences in receptor activation.
A comprehensive assessment of physical image quality of five different scanners for head CT imaging as clinically used at a single hospital centre—A phantom study
Authors: Barca Patrizio , Paolicchi Fabio , Aringhieri Giacomo , Palmas Federica , Marfisi Daniela , Fantacci Maria Evelina , Caramella Davide , Giannelli Marco
Published: January 2021

Nowadays, given the technological advance in CT imaging and increasing heterogeneity in characteristics of CT scanners, a number of CT scanners with different manufacturers/technologies are often installed in a hospital centre and used by various departments. In this phantom study, a comprehensive assessment of image quality of 5 scanners (from 3 manufacturers and with different models) for head CT imaging, as clinically used at a single hospital centre, was hence carried out. Helical and/or sequential acquisitions of the Catphan-504 phantom were performed, using the scanning protocols (CTDIvol range: 54.7–57.5 mGy) employed by the staff of various Radiology/Neuroradiology departments of our institution for routine head examinations. CT image quality for each scanner/acquisition protocol was assessed through noise level, noise power spectrum (NPS), contrast-to-noise ratio (CNR), modulation transfer function (MTF), low contrast detectability (LCD) and non-uniformity index analyses. Noise values ranged from 3.5 HU to 5.7 HU across scanners/acquisition protocols. NPS curves differed in terms of peak position (range: 0.21–0.30 mm-1). A substantial variation of CNR values with scanner/acquisition protocol was observed for different contrast inserts. The coefficient of variation (standard deviation divided by mean value) of CNR values across scanners/acquisition protocols was 18.3%, 31.4%, 34.2%, 30.4% and 30% for teflon, delrin, LDPE, polystyrene and acrylic insert, respectively. An appreciable difference in MTF curves across scanners/acquisition protocols was revealed, with a coefficient of variation of f50%/f10% of MTF curves across scanners/acquisition protocols of 10.1%/7.4%. A relevant difference in LCD performance of different scanners/acquisition protocols was found. The range of contrast threshold for a typical object size of 3 mm was 3.7–5.8 HU. Moreover, appreciable differences in terms of NUI values (range: 4.1%-8.3%) were found. The analysis of several quality indices showed a non-negligible variability in head CT imaging capabilities across different scanners/acquisition protocols. This highlights the importance of a physical in-depth characterization of image quality for each CT scanner as clinically used, in order to optimize CT imaging procedures.
The validity of laser diffraction system to reproduce hydrometer results for grain size analysis in geotechnical applications
Authors: Al-Hashemi Hamzah M. Beakawi , Al-Amoudi Omar S. Baghabra , Yamani Zain H. , Mustafa Yassir M. , Ahmed Habib-ur-Rehman
Published: January 2021

The grain size analysis plays a significant role in any geotechnical study. The grain size analysis, by means of sieving, is usually used for coarse material of particle size > 75 μm. For the fine material; the sedimentation methods are frequently adopted (e.g., hydrometers). Other methods also exist such as electron microscopy, digital image analysis and laser diffraction. The fine geomaterials commonly undergo agglomeration which makes the recognition of individual grain size using digital image analysis or electron microscopy challenging. To facilitate and enhance the grain-size analysis, this study was conducted using the Laser Diffraction System (LDS). Seven samples with different nature (composition and texture) and sources were analyzed by hydrometer and LDS. For LDS, various factors were studied such as air pressure, sonication, dilution, refractive index, and distribution method (volume or number). The results were compared qualitatively and quantitatively based on soil classification systems, fractal dimensions, and other parameters. Furthermore, this study provided a novel criterion to determine which LDS distribution method (volume or number) is to be used depending on the Liquid Limit. A combined sieve-LDS system is recommended to obtain the entire grain size distribution. It is concluded that the LDS is a viable technique that can replace the time-consuming hydrometer method to assess the grain-size distribution.