bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the state of the art in missing data imputation for clinical data
Authors: Luo Yuan
Published: October 2021

Clinical data are increasingly being mined to derive new medical knowledge with a goal of enabling greater diagnostic precision, better-personalized therapeutic regimens, improved clinical outcomes and more efficient utilization of health-care resources. However, clinical data are often only available at irregular intervals that vary between patients and type of data, with entries often being unmeasured or unknown. As a result, missing data often represent one of the major impediments to optimal knowledge derivation from clinical data. The Data Analytics Challenge on Missing data Imputation (DACMI) presented a shared clinical dataset with ground truth for evaluating and advancing the state of the art in imputing missing data for clinical time series. We extracted 13 commonly measured blood laboratory tests. To evaluate the imputation performance, we randomly removed one recorded result per laboratory test per patient admission and used them as the ground truth. DACMI is the first shared-task challenge on clinical time series imputation to our best knowledge. The challenge attracted 12 international teams spanning three continents across multiple industries and academia. The evaluation outcome suggests that competitive machine learning and statistical models (e.g. LightGBM, MICE and XGBoost) coupled with carefully engineered temporal and cross-sectional features can achieve strong imputation performance. However, care needs to be taken to prevent overblown model complexity. The challenge participating systems collectively experimented with a wide range of machine learning and probabilistic algorithms to combine temporal imputation and cross-sectional imputation, and their design principles will inform future efforts to better model clinical missing data.
Case report: ventricular fibrillation and cardiac arrest provoked by forward bending in adolescent with severe pectus excavatum
Authors: Moossdorff Martine , Maesen Bart , den Uijl Dennis W , Lenderink Timo , Franssen Fleur A R , Vissers Yvonne L J , de Loos Erik R
Published: October 2021

Background

Life-threatening arrhythmias have been reported in patients with severe pectus excavatum in absence of other cardiac abnormalities. Literature is scarce regarding diagnosis, cause and management of this problem, particularly regarding the question as to whether the placement of an implantable cardioverter-defibrillator (ICD) is necessary.

Case summary

A 19-year-old male patient with severe pectus excavatum was scheduled for elective surgical correction. During forward bending for epidural catheter placement, syncope and ventricular fibrillation (VF) occurred resulting in cardiac arrest. After successful cardiopulmonary resuscitation, extensive analysis was performed and showed no cause for VF other than cardiac compression (particularly of the left atrium, right atrium, and ventricle to a lesser degree) due to severe pectus excavatum. Postponed correction by modified Ravitch was performed without ICD placement, with an uneventful post-operative recovery. Eighteen months after surgery, the patient remains well. Upon specific request, he did remember dizzy spells when tying shoelaces. He always considered this unremarkable.

Discussion

In severe pectus excavatum with cardiac compression, forward bending can decrease central venous return and cardiac output, causing hypotension, arrhythmia, and cardiac arrest. In absence of structural or electric abnormalities, cardiac compression by severe pectus excavatum was considered a reversible cause of VF and ICD placement unnecessary. Patients with cardiac compression due to severe pectus excavatum may report pre-existing postural symptoms upon specific request. When these postural symptoms are present, extreme and prolonged forward bending postures should be avoided.
“How I Can Help Me”: Self-Care Priorities and Structural Pressures Among Black Older Adults With Diabetes
Authors: Chard Sarah , Henderson Loren , Wallace Brandy H , Roth Erin G , Girling Laura , Eckert J Kevin
Published: October 2021

Background and Objectives

Disparities in type 2 diabetes mellitus (diabetes) represent an ongoing public health challenge. Black older adults are at high risk of diabetes and diabetes’ complications. Diet, physical activity, and medication can control these risks, yet disease rates remain elevated. Utilizing an intersectionality framework, we seek to extend understanding of the social dimensions of diabetes through an examination of the diabetes self-care process from the perspective of Black older adults.

Research Design and Methods

This project involved a thematic analysis of diabetes illness narrative interviews with Black participants (N = 41) in our National Institute on Aging-funded study of diabetes. In a narrative approach, the participant communicates the significance of actions and events.

Results

The findings suggest that diabetes self-care involves interconnected struggles across four domains of care: (1) multimorbidity management, (2) financial well-being, (3) family support, and (4) formal health care.

Discussion and Implications

Black older adult self-care reflects an active process of pursuing meaningful social goals and critical health needs. An intersectional framework, however, reveals the ongoing histories of inequity that shape this process. Further intervention to address the racist policies and practices found in Black older adults’ communities and clinical care is needed to make true progress on diabetes disparities.
Well-log facies classification using an active semi-supervised algorithm with pairwise constraints
Authors: Xie Wei , Spikes Kyle T
Published: October 2021

We present a technique for lithofacies classification of well-log data using an active semi-supervised algorithm. This method considers both the input of domain experts and the distribution characteristics of well-log properties. It aims to obtain lithofacies that are more geologically meaningful and seismically interpretable than the conventional clustering methods. We impose guidance from experts (e.g. geologist, petrophysicist and seismic interpreter) as pairwise constraints. The acquired constraints were incorporated into facies classification in two ways: modification of the objective function and optimization of the classification subspace. An iterative expectation-maximization (EM) algorithm was used to minimize the objective function. We applied the method to a set of well logs from the Glitne field, North Sea, where six lithofacies had been defined initially. Classification results illustrated that facies predicted with the semi-supervised approach achieved good matches with true labels. Comparisons among different methods (semi-supervised method, quadratic determinant analysis and expectation-maximization with Gaussian mixture model algorithm) also demonstrated that the proposed method significantly outperformed the others. We also tested a scenario with five facies, where we combined silty shale and shale into one group due to significant overlap in the elastic domain. Results demonstrated that the semi-supervised approach produced facies that were more consistent with expert intention, and they were more geologically interpretable. The techniques and results illustrated here could be performed in different types of reservoir facies classification, and the facies classified using semi-supervised algorithm honours the input of the users and data characteristics.
The Canonical Dimension of a Semisimple Group and the Unimodular Degree of a Root System
Authors: Zainoulline Kirill
Published: October 2021

We produce a short and elementary algorithm to compute an upper bound for the canonical dimension of a spit semisimple linear algebraic group. Using this algorithm we confirm previously known bounds by Karpenko [6–9] and Devyatov [5] as well as we produce new bounds (e.g., for groups of types $F_4$, adjoint $E_6$, for some semisimple groups).
Technical contribution: use of continuous recording video monitoring of maintenance and pain behaviors in piglets after surgical castration to validate six continuous time sampling periods for behavior scoring
Authors: Robles Ivelisse , Park Rachel M , Cramer Catie M , Wagner Brooklyn K , Moraes Luis E , Viscardi Abbie V , Coetzee Johann F , Pairis-Garcia Monique D
Published: October 2021

Castration is a painful procedure routinely performed on piglets. Specific periods relative to castration and time sampling rules are used widely to quantify deviations in piglet’s behavior associated with castration rather than assessing behavior for the entire trial period. However, very limited work has evaluated time sampling recording rules to quantify behavioral changes to piglets undergoing castration. Therefore, the objective of this study was to validate the accuracy of six continuous time sampling periods (5, 10, 15, 20, 30, and 45 min), to quantify piglet behavior post-castration when compared with a full 60-min observation period. Sixteen Yorkshire-Landrace x Duroc piglets were surgically castrated. Data were collected using continuous observation (recording rule) of each individual male piglet per litter for 60-min post-castration. The 60-min continuous behavioral data set was then subdivided into six data subsets for each defined continuous time sampling period (5, 10, 15, 20, 30, and 45 min). Data from each continuous time sampling period and the full period data were analyzed using both a generalized linear mixed model and linear regression analysis. For the generalized linear mixed model, 30- and 45-min continuous time sampling periods were not different (P > 0.05) when compared with the full observation period data for all behaviors. For the linear regression analysis, affiliative interaction, sitting, walking, huddled up, prostrated, scratching, spasms, and trembling behaviors met the pairwise comparison accuracy criteria: [1) the coefficient of determination (R2) was > 0.90, 2) the intercept did not differ from 0 (P > 0.05), and 3) the slope did not differ from 1 (P > 0.05)] at the 45-min continuous time sampling period compared to full observation period. Results from this study suggest that a 45-min continuous time sampling period would be necessary to accurately investigate piglet behavior during the acute pain sensitivity time post-castration when considering both maintenance and pain-associated behaviors.
Physiological response of weaned piglets to two transport durations observed in a Canadian commercial setting
Authors: Golightly Hannah R , Brown Jennifer , Bergeron Renée , Poljak Zvonimir , Roy R Cyril , Seddon Yolande M , O’Sullivan Terri L
Published: October 2021

Observational studies describing the impact of transport duration on weaned piglet welfare are limited. Current Canadian transport regulations are heavily informed by studies involving market hogs. Due to physiological differences between weaned piglets and market hogs, additional data on their response to transport are needed for age-specific evidence-based recommendations. A cohort study was conducted to describe and compare mortality, injury, weight change, hematological or biochemical changes in hydration, muscle injury and stress response observed in weaned piglets undergoing short duration (SD, <3 h), or long duration (LD, >30 h) commercial summertime transport events. Data collection on 440 of 11,434 transported piglets occurred the morning of the day before transport (T0), at arrival (T1) and approximately 3 to 4 d (78 to 93 h) after arrival at the nursery barn (T2). Low mortality occurred over all transport events (0.06%) with no association observed between transport duration and odds of death during transport (P = 0.62). The incidence of lameness between T0 and T1 was low (1.84% of the 435 focal piglets scored) with all lameness cases identified as mild in severity. Lesions on ears and skin were more prevalent than other injury types after transport (T1) and may have been related to mixing aggression associated with weaning rather than transport alone. LD piglets weighed 0.39 kg less than SD piglets at T1 (P < 0.01), but no difference in group weight was observed at T2 (P = 0.17). Hematological and biochemical differences were present between groups at T1. LD piglets had increased hematocrit levels compared with SD piglets (P = 0.01), suggesting increased body water losses. SD piglets showed greater levels of muscle injury compared with LD piglets including elevated aspartate aminotransferase (P < 0.01) and creatine kinase (P < 0.01). However, these parameters were within normal reference ranges for piglets of this age group. Indicators of physiological stress response including cortisol and neutrophil to lymphocyte ratios were elevated in SD piglets compared with LD piglets (P = 0.02 and P < 0.01, respectively). The results of this study demonstrate that both short and long transport durations can result in detectable physiological changes in weaned piglets. The overall impact of these durations on piglet welfare should be further explored by analyzing behavioral time budgets during and after transport.
Parotid gland dose reduction in the hippocampus avoidance whole-brain radiotherapy using helical tomotherapy
Authors: Shimizu Hidetoshi , Sasaki Koji , Aoyama Takahiro , Tachibana Hiroyuki , Koide Yutaro , Iwata Tohru , Kitagawa Tomoki , Kodaira Takeshi
Published: October 2021

The present study aimed to reduce the parotid gland dose in the hippocampus avoidance with whole-brain radiotherapy (HA-WBRT) using the helical tomotherapy (HT). Ten patients who had previously undergone WBRT were randomly selected and enrolled in this study. During the treatment planning, two different techniques to the jaw were applied for each patient, namely, 1.0 cm fixed jaw and 2.5 cm dynamic jaw. To efficiently reduce the dose in the bilateral parotid glands, directional block (DB) mode was set. The DB is a function of a treatment planning system for the dose reduction in organs at risk. The standard HA-WBRT plan which did not reduce the parotid gland dose was also designed to compare the plan quality. Compared with the standard HA-WBRT plan, the parotid gland dose could be reduced by approximately 70% without extending the delivery time by adding the parotid gland on the DB mode to the dose constraint. In addition, the differences in dosimetric parameters observed between the plans employing the 1.0 cm fixed jaw and 2.5 cm dynamic jaw were almost negligible. Moreover, delivery time in the 2.5 cm dynamic jaw could be greatly reduced by 60% compared with that in the 1.0 cm fixed jaw.
Differential rotation in a 3D simulation of oxygen shell burning
Authors: McNeill Lucy O , Müller Bernhard
Published: October 2021

We study differential rotation in late-stage shell convection in a 3D hydrodynamic simulation of a rapidly rotating $16\, {\rm M}_{\odot }$ helium star with a particular focus on the convective oxygen shell. We find that the oxygen shell develops a quasi-stationary pattern of differential rotation that is described neither by uniform angular velocity as assumed in current stellar evolution models of supernova progenitors, nor by uniform specific angular momentum. Instead, the oxygen shell develops a positive angular velocity gradient with faster rotation at the equator than at the pole by tens of per cent. We show that the angular momentum transport inside the convection zone is not adequately captured by a diffusive mixing-length flux proportional to the angular velocity or angular momentum gradient. Zonal flow averages reveal stable large-scale meridional flow and an entropy deficit near the equator that mirrors the patterns in the angular velocity. The structure of the flow is reminiscent of simulations of stellar surface convection zones and the differential rotation of the Sun, suggesting that similar effects are involved; future simulations will need to address in more detail how the interplay of buoyancy, inertial forces, and turbulent stresses shapes differential rotation during late-stage convection in massive stars. If convective regions develop positive angular velocity gradients, angular momentum could be shuffled out of the core region more efficiently, potentially making the formation of millisecond magnetars more difficult. Our findings have implications for neutron star birth spin periods and supernova explosion scenarios that involve rapid core rotation.
SDSS-IV DR17: final release of MaNGA PyMorph photometric and deep-learning morphological catalogues
Authors: Domínguez Sánchez H , Margalef B , Bernardi M , Huertas-Company M
Published: October 2021

We present the MaNGA PyMorph photometric Value Added Catalogue (MPP-VAC-DR17) and the MaNGA Deep Learning Morphological VAC (MDLM-VAC-DR17) for the final data release of the MaNGA survey, which is part of the SDSS Data Release 17 (DR17). The MPP-VAC-DR17 provides photometric parameters from Sérsic and Sérsic+Exponential fits to the two-dimensional surface brightness profiles of the MaNGA DR17 galaxy sample in the g, r, and i bands (e.g. total fluxes, half-light radii, bulge-disc fractions, ellipticities, position angles, etc.). The MDLM-VAC-DR17 provides deep-learning-based morphological classifications for the same galaxies. The MDLM-VAC-DR17 includes a number of morphological properties, for example, a T-Type, a finer separation between elliptical and S0, as well as the identification of edge-on and barred galaxies. While the MPP-VAC-DR17 simply extends the MaNGA PyMorph photometric VAC published in the SDSS Data Release 15 (MPP-VAC-DR15) to now include galaxies that were added to make the final DR17, the MDLM-VAC-DR17 implements some changes and improvements compared to the previous release (MDLM-VAC-DR15): Namely, the low end of the T-Types is better recovered in this new version. The catalogue also includes a separation between early or late type, which classifies the two populations in a complementary way to the T-Type, especially at the intermediate types (−1 < T-Type < 2), where the T-Type values show a large scatter. In addition, k-fold-based uncertainties on the classifications are also provided. To ensure robustness and reliability, we have also visually inspected all the images. We describe the content of the catalogues and show some interesting ways in which they can be combined.
CircleBase: an integrated resource and analysis platform for human eccDNAs
Authors: Zhao Xiaolu , Shi Leisheng , Ruan Shasha , Bi Wenjian , Chen Yifan , Chen Lin , Liu Yifan , Li Mingkun , Qiao Jie , Mao Fengbiao
Published: October 2021

Rapid advances in high-throughput sequencing technologies have led to the discovery of thousands of extrachromosomal circular DNAs (eccDNAs) in the human genome. Loss-of-function experiments are difficult to conduct on circular and linear chromosomes, as they usually overlap. Hence, it is challenging to interpret the molecular functions of eccDNAs. Here, we present CircleBase (http://circlebase.maolab.org), an integrated resource and analysis platform used to curate and interpret eccDNAs in multiple cell types. CircleBase identifies putative functional eccDNAs by incorporating sequencing datasets, computational predictions, and manual annotations. It classifies them into six sections including targeting genes, epigenetic regulations, regulatory elements, chromatin accessibility, chromatin interactions, and genetic variants. The eccDNA targeting and regulatory networks are displayed by informative visualization tools and then prioritized. Functional enrichment analyses revealed that the top-ranked cancer cell eccDNAs were enriched in oncogenic pathways such as the Ras and PI3K-Akt signaling pathways. In contrast, eccDNAs from healthy individuals were not significantly enriched. CircleBase provides a user-friendly interface for searching, browsing, and analyzing eccDNAs in various cell/tissue types. Thus, it is useful to screen for potential functional eccDNAs and interpret their molecular mechanisms in human cancers and other diseases.
Smoking and risk of fractures requiring hospitalization in haemodialysis patients: a nationwide cohort study in Japan
Authors: Wakasugi Minako , Kazama Junichiro James , Nitta Kosaku , Narita Ichiei
Published: October 2021

Background

Smoking is a well-established lifestyle risk factor for fractures in the general population, but evidence specific to haemodialysis populations is lacking. This nationwide cohort study used data from the Japanese Society for Dialysis Therapy Renal Data Registry to examine the association between smoking status and fractures.

Methods

A total of 154 077 patients (64.2% men; mean age 68 years) aged ≥20 years undergoing maintenance haemodialysis thrice weekly at the end of 2016 were followed for 1 year. Among these, 19 004 (12.3%) patients were current smokers. Standardized incidence rate ratios of hospitalization due to any fracture were calculated and analysed by multivariable logistic regression analysis, controlling for potential confounders. Propensity score (PS) matching and subgroup analyses were also performed as sensitivity analyses.

Results

During the 1-year follow-up period, 3337 fractures requiring hospitalization (1201 hip, 479 vertebral and 1657 other fractures) occurred in 3291 patients. The age- and sex-standardized incidence ratio for current smokers was 1.24 (95% confidence interval 1.12–1.39) relative to non-smokers. Standardized incidence ratios were similar after stratification by age group and sex. Multivariable logistic regression analysis revealed a 1.25-fold higher risk of any fracture requiring hospitalization (95% confidence interval 1.10–1.42) in current smokers relative to non-smokers in a fully adjusted model. PS matching showed similar results (odds ratio 1.25; 95% confidence interval 1.05–1.48). Subgroup analyses for baseline covariates revealed no significant interactions.

Conclusions

Smoking is a significant risk factor for any fracture requiring hospitalization in haemodialysis patients.
Economic evaluations of interventions against influenza at workplaces: systematic review
Authors: Ofori S K , Hung Y W , Schwind J S , Diallo K , Babatunde D , Nwaobi S O , Hua X , Sullivan K L , Cowling B J , Chowell G , Fung I C H
Published: October 2021

Background

The burden of influenza is mostly felt by employees and employers because of increased absenteeism rates, loss of productivity and associated direct costs. Even though interventions against influenza among working adults are effective, patronage and compliance to these measures especially vaccination are low compared to other risk groups.

Aims

This study was aimed to assess evidence of economic evaluations of interventions against influenza virus infection among workers or in the workplace setting.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline for systematic reviews was followed. Three databases, PubMed, Web of Science and EconLit, were searched using keywords to identify relevant articles from inception till 25 October 2020. Original peer-reviewed papers that conducted economic evaluations of influenza interventions using cost–benefit, cost–effectiveness or cost–utility analysis methods focused on working-age adults or work settings were eligible for inclusion. Two independent teams of co-authors extracted and synthesized data from identified studies.

Results

Twenty-four articles were included: 21 were cost–benefit analyses and 3 examined cost–effectiveness analyses. Two papers also presented additional cost–utility analysis. Most of the studies were pharmaceutical interventions (n = 23) primarily focused on vaccination programs while one study was a non-pharmaceutical intervention examining the benefit of paid sick leave. All but two studies reported that interventions against influenza virus infection at the workplace were cost-saving and cost-effective regardless of the analytic approach.

Conclusions

Further cost–effectiveness research in non-pharmaceutical interventions against influenza in workplace settings is warranted. There is a need to develop standardized methods for reporting economic evaluation methods to ensure comparability and applicability of future research findings.
Multi-layered Regulation of Plant Cell Wall Thickening
Authors: Zhu Yingying , Li Laigeng
Published: October 2021

Plants need to develop thickened cell walls with appropriate localization through precise regulation during the process of growth and development in order to support their body weight and to build long distance transportation systems. Wall thickening is achieved through a multitude of regulatory networks in various tissues under changeable environments. In this mini-review, we summarize current understanding of the regulatory pathways and mechanisms involved in cell wall thickening. Regulation of cell wall thickening is not only mechanistically essential to understand the plant structure accretion but also has applicable significance to plant cell wall biomass utilization.
The yellowhornAGLtranscription factor geneXsAGL22contributes to ABA biosynthesis and drought tolerance in poplar
Authors: Bian Zhan , Wang Xiaoling , Lu Junkun , Wang Dongli , Zhou Yangyan , Liu Yunshan , Wang Shengkun , Yu Zequn , Xu Daping , Meng Sen
Published: October 2021

Regulation of abscisic acid (ABA) biosynthesis helps plants adapt to drought stress, but the underlying molecular mechanisms are largely unclear. Here, a drought-induced transcription factor XsAGL22 was isolated from yellowhorn (Xanthoceras sorbifolium Bunge). Yeast one-hybrid and electrophoretic mobility shift assays indicated that XsAGL22 can physically bind to the promoters of the ABA biosynthesis-related genes XsNCED6 and XsBG1, and a dual-luciferase assay showed that XsAGL22 activates the promoters of the later two genes. Transient overexpression of XsAGL22 in yellowhorn leaves also increased the expression of XsNCED6 and XsBG1 and increased cellular ABA levels. Finally, heterologous overexpression of XsAGL22 in poplar increased ABA content, reduced stomatal aperture and increased drought resistance. Our results suggest that XsAGL22 is a powerful regulator of ABA biosynthesis and plays a critical role in drought resistance in plants.
Spatiotemporal Changes in Varietal Resistance to Wheat Yellow Rust in France Reveal an Increase in Field Resistance Level During the Period 1985–2018
Authors: Perronne Rémi , Dubs Florence , de Vallavieille-Pope Claude , Leconte Marc , du Cheyron Philippe , Cadot Valérie , Vidal Tiphaine , Enjalbert Jérôme
Published: October 2021

Monitoring spatiotemporal changes in varietal resistance and understanding its drivers seem essential to managing plant diseases but require having access to the genetic basis of disease resistance and to its deployment. In this study, we focused on yellow rust (Puccinia striiformis f. sp. tritici) for three decades in France, by using field adult plant resistance levels, Yr race-specific resistance genes of varieties, presence of Puccinia striiformis f. sp. tritici pathotypes and their virulence profiles, and systematic surveys of the acreages of bread wheat varieties available at a yearly survey time and at a district level. Based on these data, we studied spatiotemporal changes in varietal resistance over the period from 1985 to 2018 in 54 French administrative districts (hereafter “departments”) by using a set of relevant indicators weighted by the relative acreage proportion of the varieties sown at the department level. Our analyses revealed an increase in varietal resistance over decades that would be due to the accumulation of both quantitative resistance and different race-specific resistance genes. We suggest that, beyond breeders, several actors, including examination offices, agricultural advisory services, and farmers, may have had a substantial influence on these spatiotemporal changes, promoting more resistant varieties and the rapid replacement of newly susceptible varieties by still resistant ones at the beginning of each epidemic.
Machine Learning-based Prediction of Prolonged Intensive Care Unit Stay for Critical Patients with Spinal Cord Injury
Authors: Fan Guoxin , Yang Sheng , Liu Huaqing , Xu Ningze , Chen Yuyong , He Jie , Su Xiuyun , Pang Mao , Liu Bin , Han Lanqing , Rong Limin
Published: October 2021

Study Design.

A retrospective cohort study.

Objective.

The objective of the study was to develop machine-learning (ML) classifiers for predicting prolonged intensive care unit (ICU)-stay and prolonged hospital-stay for critical patients with spinal cord injury (SCI).

Summary of Background Data.

Critical patients with SCI in ICU need more attention. SCI patients with prolonged stay in ICU usually occupy vast medical resources and hinder the rehabilitation deployment.

Methods.

A total of 1599 critical patients with SCI were included in the study and labeled with prolonged stay or normal stay. All data were extracted from the eICU Collaborative Research Database and the Medical Information Mart for Intensive Care III-IV Database. The extracted data were randomly divided into training, validation and testing (6:2:2) subdatasets. A total of 91 initial ML classifiers were developed, and the top three initial classifiers with the best performance were further stacked into an ensemble classifier with logistic regressor. The area under the curve (AUC) was the main indicator to assess the prediction performance of all classifiers. The primary predicting outcome was prolonged ICU-stay, while the secondary predicting outcome was prolonged hospital-stay.

Results.

In predicting prolonged ICU-stay, the AUC of the ensemble classifier was 0.864 ± 0.021 in the three-time five-fold cross-validation and 0.802 in the independent testing. In predicting prolonged hospital-stay, the AUC of the ensemble classifier was 0.815 ± 0.037 in the three-time five-fold cross-validation and 0.799 in the independent testing. Decision curve analysis showed the merits of the ensemble classifiers, as the curves of the top three initial classifiers varied a lot in either predicting prolonged ICU-stay or discriminating prolonged hospital-stay.

Conclusion.

The ensemble classifiers successfully predict the prolonged ICU-stay and the prolonged hospital-stay, which showed a high potential of assisting physicians in managing SCI patients in ICU and make full use of medical resources.

Level of Evidence: 3
Cryoballoon atrial fibrillation ablation experience in Japan
Authors: Miyazaki Shinsuke
Published: October 2021

Purpose of review

In Japan, cryoballoon ablation has been widely accepted and more than 70 000 patients have undergone pulmonary vein isolation using this novel technology since the introduction. This review focused on the current status of cryoballoon ablation in Japan and clarified the characteristics as compared to Europe and the United States.

Recent findings

The number of atrial fibrillation patients undergoing cryoballon ablation has rapidly increased over the last 6 years. Most of the Japanese physicians consider the indication of cryoballoon ablation based on the anatomy of the pulmonary veins and left atrium evaluated on preprocedural computed tomography, and often perform adjunctive radiofrequency ablation after the pulmonary vein isolation. The reported overall efficacy and safety were similar to that in Europe and the United States; however, there are some distinctive complications of the cryoballoon procedure in Japan, such as air embolisms, gastric hypomotility and coronary artery spasms.

Currently, the cryoballoon pulmonary vein isolation is widely accepted in Japan owing to the low incidence of lethal complications, shorter procedure time and acceptable single procedure atrial fibrillation freedom.
Skin Organoid Research Progress and Potential Applications
Authors: Li Hong-Yang , Ren Kun , Wang Cheng , Bu Wen-Bo
Published: October 2021

Skin diseases were characterized by various types and high incidence, which seriously affect people's health. At present, skin pathogenesis research and the therapeutic drug development for skin diseases are limited by the lack of reasonable research models that recapitulate the development of skin diseases. Organoids are three-dimensionally cultured cell populations derived from skin stem cells, which exhibits the ability of multicell assembly and the similar histological characteristics with the living tissues and organs. This article reviews the establishment of normal skin organoids and skin tumor organoids, and summarizes the application of skin organoids in the evaluation of drug sensitivity, pathological mechanism research, and individualized treatment. In addition, the advantages and limitations of organoids in skin disease research are also discussed, which provides a basis for revealing the pathogenesis of skin diseases and developing preventive and therapeutic drugs for skin diseases.
Development and Evaluation of a Teamwork Improvement Program for Perioperative Patient Safety
Authors: AHN Shinae , LEE Nam-Ju
Published: October 2021

Background

Effective teamwork in healthcare teams improves quality of care, which positively impacts on patient safety. Teamwork is especially crucial for perioperative nurses because they provide care as a team in the operating room. Previous research on teamwork training has principally addressed the general aspects of healthcare settings and focused on interdisciplinary teamwork and has rarely considered operative settings and nursing teamwork.

Purpose

The aim of this study was to develop a teamwork improvement program for perioperative patient safety and to evaluate the effectiveness of this program.

Methods

A quasi-experimental design was applied. We developed a teamwork improvement program based on teamwork competencies that focused on the perioperative nursing practice. This research was conducted at two operating centers in a tertiary hospital in South Korea, and a total of 60 perioperative nurses participated, including 28 nurses from the cancer operating center (experimental group) and 32 nurses from the main operating center (control group). The program consisted of four sessions and was delivered to the experimental group for a period of 2 weeks. Following the intervention, the effectiveness of the intervention was measured using a self-report questionnaire, focus group interviews, and program evaluation survey. Data were analyzed using chi-square test, t test, Fisher’s exact test, and content analysis.

Results

Nearly all (96.4%) of the participants were satisfied with the overall content of the teamwork improvement program. Statistically significant differences were found between the experimental and control groups with regard to teamwork knowledge, teamwork attitudes, communication self-efficacy, and teamwork skills and behaviors. Three themes were elicited from the qualitative analysis, including “recognizing the importance and content of teamwork,” “improving teamwork competencies,” and “contributing to safe surgery.” No significant difference in the incidence of surgical nursing errors was identified between the experimental and control groups within a 4-week period.

Conclusions/Implications for Practice

The teamwork improvement program developed in this study was demonstrated as effective in improving perioperative nurses' utilization of teamwork competencies in nursing practice and positively changing teamwork. The findings of this study provide evidence that teamwork training increases nurses’ teamwork competencies. The clinical application of teamwork tools using competency-based teamwork training may contribute to patient safety and safe nursing practice.
Abnormal Pulmonary Function Testing as an Independent Risk Factor for Procedural Complications During Transthoracic Needle Biopsies
Authors: Rothman Adam , Lim Steven , Hasegawa Daisuke , Steiger David , Patel Rajesh , Lee Young Im
Published: October 2021

Background:

Computed tomography (CT)-guided transthoracic needle biopsy is an important diagnostic tool for pulmonary nodules, offering a less invasive alternative to surgical procedures. This study aims to better risk stratify patients undergoing this procedure by analyzing the pulmonary function testing (PFT), imaging characteristics, and patient demographics most associated with complications.

Patients and Methods:

This retrospective study involved 254 patients undergoing transthoracic needle biopsies at 3 hospitals between October 2016 and December 2019. Demographic data, extent of emphysema, and target lesion characteristics were recorded. Complications were defined as minor (small pneumothorax, mild hemoptysis, or pulmonary hemorrhage) and major (pneumothorax requiring chest tube, hemothorax, rapid atrial fibrillation, or postprocedure hypotension or hypoxia).

Results:

There were 50 minor (20%) and 18 major complications (7%). As seen with prior studies, older age, increased distance to pleura, and smaller nodule size correlated with an increased risk of complications. Uniquely to our study, emphysema severity, seen on CT (P=0.008) and with decreased forced expiratory volume/forced vital capacity ratio, conferred an increased risk (62.94 vs. 68.74, P=0.05) of complications. Decreased Hounsfield unit of surrounding lung (a surrogate measure of emphysema) and decreased diffusion capacity (11.81 vs. 14.93, P=0.05) were associated with increased risk of major complications. Interestingly, body mass index and comorbidities had no correlation with complications.

Conclusion:

In addition to previous well-described characteristics, we described physiological data (abnormal PFTs), imaging findings, and nodule location as risk factors of procedural complications. Obtaining preprocedural PFT, in addition to reviewing CT imaging and demographic data, may aid clinicians in better risk stratifying patients undergoing transthoracic needle biopsies.
Outcomes of out-of-hospital cardiac arrest in patients with SARS-CoV-2 infection: a systematic review and meta-analysis
Authors: Scquizzato Tommaso , Landoni Giovanni , Scandroglio Anna Mara , Franco Annalisa , Calabrò Maria Grazia , Paoli Andrea , D’Amico Filippo , Yavorovskiy Andrey , Zangrillo Alberto
Published: October 2021

Introduction

Out-of-hospital cardiac arrests increased during the COVID-19 pandemic and a direct mechanism of cardiac arrest in infected patients was hypothesized. Therefore, we conducted a systematic review and meta-analysis to assess outcomes of SARS-CoV-2 patients with out-of-hospital cardiac arrest.

Methods

PubMed and EMBASE were searched up to April 05, 2021. We included studies comparing out-of-hospital cardiac arrests patients with suspected or confirmed SARS-CoV-2 infection versus noninfected patients. The primary outcome was survival at hospital discharge or at 30 days. Secondary outcomes included return of spontaneous circulation, cardiac arrest witnessed and occurring at home, bystander-initiated cardiopulmonary resuscitation, proportion of nonshockable rhythm and resuscitation attempted, and ambulance arrival time.

Results

In the ten included studies, 18% (1341/7545) of out-of-hospital cardiac arrests occurred in patients with SARS-CoV-2 infection. Patients with out-of-hospital cardiac arrest and SARS-CoV-2 infection had reduced rates of survival (16/856 [1.9%] vs. 153/2344 [6.5%]; odds ratio (OR) = 0.33; 95% confidence interval (CI), 0.17–0.65; P = 0.001; I

2
= 28%) and return of spontaneous circulation (188/861 [22%] vs. 640/2403 [27%]; OR = 0.75; 95% CI, 0.65–0.86; P < 0.001; I

2
= 0%) when compared to noninfected patients. Ambulance arrived later (15 ± 10 vs. 13 ± 7.5 min; mean difference = 1.64; 95% CI, 0.41–2.88; P = 0.009; I

2
= 61%) and nonshockable rhythms (744/803 [93%] vs. 1828/2217 [82%]; OR = 2.79; 95% CI, 2.08–3.73; P < 0.001; I

2
= 0%) occurred more frequently. SARS-CoV-2 positive patients suffered a cardiac arrest at home more frequently (1186/1263 [94%] vs. 3598/4055 [89%]; OR = 1.86; 95% CI, 1.45–2.40; P<0.001; I

2
= 0%) but witnessed rate (486/890 [55%] vs. 1385/2475 [56%]; OR = 0.97; 95% CI, 0.82–1.14; P = 0.63; I

2
= 0%) and bystander-initiated cardiopulmonary resuscitation rate (439/828 [53%] vs. 1164/2304 [51%]; OR = 0.95; 95% CI, 0.73–1.24; P = 0.70; I

2
= 53%) were similar.

Conclusions

One-fifth of out-of-hospital cardiac arrest patients had SARS-CoV-2 infection. These patients had low rates of return of spontaneous circulation and survival and were characterized by higher nonshockable rhythms but similar bystander-initiated cardiopulmonary resuscitation rate.

Review registration:

PROSPERO - CRD42021243540.
Neurodevelopmental Outcomes in Children With Inherited Liver Disease and Native Liver
Authors: Leung Daniel H. , Sorensen Lisa G. , Ye Wen , Hawthorne Kieran , Ng Vicky L. , Loomes Kathleen M. , Fredericks Emily M. , Alonso Estella M. , Heubi James E. , Horslen Simon P. , Karpen Saul J. , Molleston Jean P. , Rosenthal Philip , Sokol Ronald J. , Squires Robert H. , Wang Kasper S. , Kamath Binita M. , Magee John C. ,   Childhood Liver Disease Research Network (ChiLDReN)
Published: October 2021

Objective:

To evaluate neurodevelopmental status among children with inherited cholestatic liver diseases with native liver and variables predictive of impairment.

Methods:

Participants with Alagille syndrome (ALGS), progressive familial intrahepatic cholestasis (PFIC), and alpha 1 antitrypsin deficiency (A1AT) enrolled in a longitudinal, multicenter study and completed the Wechsler Preschool and Primary Scale of Intelligence‐III or Intelligence Scale for Children‐IV. Full Scale Intelligence Quotient (FSIQ) was analyzed continuously and categorically (>100, 85–99, 70–84, <70). Univariate linear regression was performed to study association between FSIQ and risk factors, stratified by disease.

Results:

Two hundred and fifteen completed testing (ALGS n = 70, PFIC n = 43, A1AT n = 102); median age was 7.6 years (3.0–16.9). Mean FSIQ in ALGS was lower than A1AT (94 vs 101, P = 0.01). Frequency of FSIQ < 85 (>1 standard deviation [SD] below average) was highest in ALGS (29%) versus 18.6% in PFIC and 12.8% in A1AT, and was greater than expected in ALGS based on normal distribution (29% vs 15.9%, P = 0.003). ALGS scored significantly lower than test norms in almost all Wechsler composites; A1AT scored lower on Working Memory and Processing Speed; PFIC was not different from test norms. Total bilirubin, alkaline phosphatase, albumin, hemoglobin, and parental education were significantly associated with FSIQ.

Conclusions:

Patients with ALGS are at increased risk of lower FSIQ, whereas our data suggest A1AT and PFIC are not. A1AT and ALGS appear vulnerable to working memory and processing speed deficits suggestive of attention/executive function impairment. Malnutrition, liver disease severity, and sociodemographic factors appear related to FSIQ deficits, potentially identifying targets for early interventions.
Chief Nursing Officer Perspectives on Nursing Theory-Guided Practice
Authors: Turkel Marian , Smith Marlaine C. , Tappen Ruth , Hansell Phyllis , Fawcett Jacqueline , Alanbry Toqa , Drenkard Karen
Published: October 2021

OBJECTIVE

The purpose of this study was to identify what guides nursing practice.

BACKGROUND

Change occurred when the Magnet Recognition Program® no longer required a nursing theory.

METHODS

This was a mixed-methods study to identify the process used to implement nursing theory-guided practice and the relationship to professional practice recognition. Deidentified quantitative data were collected from 36 chief nursing officers (CNOs). Seventeen CNOs participated in the qualitative interview.

RESULTS

Thirteen CNOs were from a Magnet®-designated facility. Ten CNOs were on the Magnet journey, and 2 had no intent to seek Magnet recognition. Two CNOs were from a Pathway to Excellence®–designated facility. One CNO was on the Pathway to Excellence journey. The majority of respondents who were Magnet® recognized who participated in the survey used Watson's Theory of Human Caring. Themes were identified that share the benefits and strategies to integrate nursing-guided theory into nursing processes, structures, and outcomes.

CONCLUSION

Findings will benefit CNOs as they make decisions related to pursuing Magnet status recognition.
Content comparison of four commonly used amputee mobility assessment scales in the literature by linking to the International Classification of Functioning, Disability, and Health
Authors: Ekinci Yasin , Yaşaroğlu Ömer Faruk , Düger Tülin
Published: October 2021

Background:

Despite the fact that there are a number of studies revealing the linkage of scales with the World Health Organization's international classification of functioning, disability, and health (ICF), there is a need for comprehensive studies examining the relationship between amputee mobility scales and ICF.

Objective:

To analyze the content of four amputee mobility scales at the item level using the ICF.

Methods:

The Locomotor Capacity Index, Rivermead Mobility Index, Amputee Mobility Predictor, and Prosthetic Limb Users Survey of Mobility were analyzed by two health professionals for content comparison according to the ICF categories. Kappa statistic was used to calculate the degree of agreement between the two investigators.

Results:

A total of 62 items in the scales were analyzed and linked with ICF codes. The scale questions were linked with 27 different ICF codes as follows: 1 (3.7%) “body function”, 23 (85.1%) “activity and participation”, 2 (7.5%) “environmental factors,” and 1 (3.7%) “not definable. The estimated kappa values ranged from 0.83 to 0.90 for ICF codes.

Conclusion:

As a result of the study, the ICF is a highly effective resource that can be used in the analysis of amputee mobility scales. Because the scale items are more concentrated on the mobility chapter, it was seen that the scales generally served their purposes. In the light of the findings obtained, it is thought that the diversity of the scales in the concept distribution will guide clinicians and researchers in choosing scales according to their target groups.
Antifungal hypersensitivity reactions and cross-reactivity patterns
Authors: Copaescu Ana M. , Phillips Elizabeth J. , Trubiano Jason A.
Published: October 2021

Purpose of review

The goal of this article is to provide an updated understanding and evidence-based approach where possible for antifungal hypersensitivity. This includes recognition of clinical phenotype, implications for cross-reactivity and diagnostic, and management strategy for immediate and delayed hypersensitivity reactions.

Recent findings

Antifungal hypersensitivity reactions can be classified according to their latency (immediate or delayed) and clinical phenotype. The majority of the cases described in the literature are delayed T-cell mediated reactions of various severities but immediate reactions consistent with non-Immunoglobulin E (IgE)-mediated mast cell activation and IgE-mediated reactions have also been described. Ancillary information such as skin testing, drug challenge and ex vivo experimental approaches can aid causality assessments and inform antifungal class cross-reactivity, which help optimize antifungal prescribing and stewardship.

This review will update the clinician on mechanisms of drug hypersensitivity as well as providing a structured approach to the recognition, diagnosis and management of antifungal hypersensitivity reaction.
An Evanishing Thyroid During Immune Checkpoint Inhibitor Therapy
Authors: Cuzzocrea Marco , Paone Gaetano , Ceriani Luca , Giovanella Luca
Published: October 2021

In recent years, a large number of articles have described the endocrine-related adverse events associated with immune checkpoint inhibitors, especially affecting the thyroid. A 37-year-old man affected by nasopharyngeal carcinoma (stage IVb) underwent serial 18F-FDG PET/CT evaluations during treatment with nivolumab (480 mg every 4 weeks) after first-line chemoradiotherapy. The patient had no history of thyroid disease and before starting immunotherapy the thyroid-stimulating hormone value was normal at 0.9 mU/L (reference range, 0.27–4.2 mIU/L). FDG PET/CT studies revealed involution of the thyroid gland following immune checkpoint inhibitor–induced thyroiditis.