bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Hand, Finger, and Wrist Musculoskeletal Problems in Keyboard Instrumentalists: The University of North Texas Musician Health Survey
Authors: Pak Chong H , Chesky Kris
Published: February 2021

Musculoskeletal problems are considered significant health factors for performing artists, especially instrumentalists. Although numerous studies exist that document the extent to which musicians experience these problems, serious consideration has not been given to musicians who play
the keyboard, or the type of music played by each instrumentalist. Furthermore, although the Internet is an emerging tool for research, epidemiologists have been surprisingly slow in adapting to this novel way to conduct surveys. Using data derived from the University of North Texas Musician
Health Survey (UNT-MHS) conducted over the Internet, this study assessed the prevalence of upper-extremity musculoskeletal problems among 455 keyboard instrumentalists and the association with musician type, daily playing time, gender, and age. Age and gender were found to be significant risk
factors, while musician type and daily playing time did not show statistical significance.
Preaching to the Un-converted
Authors: Brandfonbrener Alice G
Published: February 2021

Members of the medical profession traditionally tend to be publicly supportive of their colleagues, which does not alter the fact that they may at the same time be privately critical. However, given current constraints on medical practice, it may now be more difficult not to forgive
sins of medical omission as well as of commission. In spite of the best intentions, it is increasingly difficult to practice medicine with the care to detail with which we were trained. That does not mean that the principles of the Hippocratic Oath should be abandoned, or that it is no longer
permissible to constructively criticize our own medical practices as well as those of our colleagues. Nor, I hasten to add, is it inappropriate to challenge regulations inconsistent with medical competency that interfere with fulfilling our obligations to our patients.
Embouchure Problems in Brass Instrumentalists
Authors: Lederman Richard J
Published: February 2021

In a series of 81 brass instrumentalists personally evaluated over the past 16 years, 43 had problems with embouchure. The 31 men and 12 women ranged in age from 16 to 74 years, averaging 35. Twenty-seven were professional performers at the onset of the embouchure problem and 12 others
were students, all but one in college or graduate-level music programs. There were 17 who played the French horn, 15 trombone, ten trumpet, and one tuba. Symptom duration varied from as little as one day to as long as 14 years. A diagnosis of dystonia involving the muscles of embouchure was
made in 18 cases. Symptoms in this group primarily consisted of impairment in lip control, problems of articulation or tone quality, and loss of seal. Eleven patients were diagnosed as having overuse phenomena and an additional six had evidence of soft-tissue injury. These patients reported
predominance of pain, swelling, or discoloration. Four patients had a sensory or motor disturbance of a lip segment, implying focal nerve injury. Treatment generally consisted of a period of rest followed by lip rehabilitation, including buzzing and gradual return to playing. Change in technique
was often required to prevent recurrence. In patients with dystonia, technical retraining appeared to be the preferred treatment method but remained unsatisfactory in most cases.
Upper Extremity Overuse in Instrumentalists
Authors: Dawson William J
Published: February 2021

Upper extremity problems related to overuse continue to plague instrumentalists and remain a staple of performing arts medicine practices. The author reports his 15-year experience with these problems, both music-related and from other causes. The criteria for inclusion include adherence
to a specific definition of overuse. The 329 patients reviewed for this series ranged in age from 9 to 89 years and included 48.6% males. Keyboard instruments and strings were the primary instruments of 79.6%. There were 63.7% who were professionals, conservatory or collegiate music students,
or dedicated amateurs; these were described as high-level performers. Strains of the muscle–tendon unit and inflammatory conditions were the most common diagnoses made, each comprising about 43% of the total series. Neurologic diagnoses were made in only 6.8% of patients. Music was the
cause of problems in 44.7% of the entire group; prevalence rates were higher in females, especially those from ages 10 to 13 years. Making music also was implicated in causing 62.9% of muscle strains, but only 26.3% of inflammatory diagnoses. Treatment generally followed conservative principles;
only 10.3% of all overuse-related problems necessitated surgical care, mostly for release of inflamed tendons or compressed nerves in the hand and wrist. The demographics of this group reflect those of a typical hand surgical practice.
Adaptations for Trombone Performance: Ergonomic Interventions
Authors: Quarrier Nicholas F , Norris Richard N
Published: February 2021

Performing arts health care practitioners need to be familiar with the ergonomic features of various musical instruments, many of which put the performer at increased risk for injury. An informed practitioner can advise regarding improving the fit between the musician and the musical
instrument, in order to reduce stresses due to compression of the instrument against the body or to supporting the weight of the instrument. These modifications may alter the instrument itself and/or provide external devices, such as splints, straps, or stands that disperse and minimize stress
on the performer. Various thermoplastic orthoses have been designed to reduce static loading on small body parts such as the right thumb in clarinetists and flutists. The purpose of the paper is to discuss the nature of instrumental modifications and present two case studies using a simple
moldable splint as well as adaptations to the trombone itself.
Kabuki Actors Study
Authors: Brodsky Marc
Published: February 2021

The Kabuki Actors Study set out to explore the health status of Kabuki actors, their performance-related medical problems, and the nature and extent of their health care. Two hundred sixteen Kabuki performers voluntarily completed an anonymous three-page survey addressing their health
issues. Thirty-eight percent of the actors reported a history of at least one significant medical condition, and 88% of them identified at least one musculoskeletal or nonmusculoskeletal problem associated with performance. Sixty-nine percent of the performers had visited a physician over
the preceding year, and 30% of them had consulted nonphysician medical practitioners. Kabuki actors, the Kabuki management, and physicians can use the findings of this study as a starting point to investigate why these injuries occur and how to prevent and treat them. Pain severity scales
or other measurable outcomes of therapy can be used to compare the efficacies of physician and nonphysician treatments.
Prevalence Rates for Medical Problems among Flautists: A Comparison of the UNT-Musician Health Survey and the Flute Health Survey
Authors: Spence Cari
Published: February 2021

The purpose of this study was to identify prevalence rates of medical problems among flautists. The Flute Health Survey (FHS), a questionnaire with items regarding musculoskeletal and nonmusculoskeletal problems, was distributed at the 1999 National Flute Association annual meeting
(n = 40). This questionnaire was pilot tested at the 1999 Texas Flute Festival, which is hosted by the Texas Flute Society. The University of North Texas has posted on the Internet a similar questionnaire regarding the medical problems of all musicians. Responses from the University of North
Texas Musician Health Survey (UNT-MHS) were filtered to include only those respondents who denoted flute as their primary instruments (n = 328). Data sets from both surveys were then processed using comparative statistics. Findings show that there was no significant difference between the
demographics of the two populations. Only one musculoskeletal site, the left hand, was found to be statistically significant between the two groups. Four nonmusculoskeletal items, depression, earache, headache, and sleep disturbances, were found to be different between the two groups. The
overall findings of this comparison show that there are many medical problems facing the flute playing community. Further investigation and observations of this population are necessary.
Tinnitus and the Performer
Authors: Lockwood Alan H , Salvi Richard J , Burkard Robert F
Published: February 2021

Tinnitus is a common and potentially disabling problem that is commonly associated with hearing loss. The loss of hearing may occur as a consequence of cochlear damage or other injury to the inner ear. Recent research suggests that tinnitus may be due to spontaneous neural activity
in central auditory pathways. These pathways appear to be altered as the consequence of deafferentation. These aberrant pathways may also link the auditory system with other elements of the central nervous system. Since the treatment for tinnitus is largely unsatisfactory, preventing tinnitus
by adopting measures designed to preserve hearing is appropriate and prudent. The prevention of hearing loss is an important goal for everyone, particularly musicians.
Prevalence of Medical Problems among Double Reed Performers
Authors: Thrasher Michael , Chesky Kris S
Published: February 2021

One aspect of double reed performance warranting consideration involves the biomechanical stress placed on the human body through the performance of these instruments. At present, inadequate information exists that can effectively answer questions regarding the types of physical problems
experienced by oboe and bassoon players and the percentages of players who suffer from such problems. The purpose of this study is to describe medical problems of double reed players utilizing data collected through the University of North Texas Musician Health Survey (UNT-MHS). Sixty survey
respondents identified oboe as their primary instrument. The majority of musculoskeletal problems reported by oboists related to the right wrist, right hand, right fingers, right forearm, right neck, and right lower back. In all areas, females reported higher percentages of problems than did
males. Among nonmusculoskeletal problems, oboists reported a high incidence of headaches, blackouts/dizziness, and stage fright. Seventy-five subjects identified bassoon as their primary instrument. The majority of musculoskeletal problems reported by bassoonists related to the left wrist,
left hand, right wrist, and left fingers. Among nonmusculoskeletal problems, bassoonists reported a high incidence of headaches, eyestrain, and fatigue. Since the lack of a truly randomized sample prevents generalization of these results to the total double-reed-playing population, these results
should be interpreted with caution. However, the high rates of right upper extremity dysfunction among oboists and left upper extremity dysfunction among bassoonists illustrated in this study warrant additional research.
Health Attitudes, Preventive Behavior, and Playing-related Health Problems among Music Students
Authors: Spahn Claudia , Richter Bernhard , Zschocke Ina
Published: February 2021

The goal of the present study was to survey music students regarding their health attitudes, their use of body-oriented training as a measure of preventive behavior, and their playing-related symptoms and consultation for these symptoms with health professionals. In the framework of
a cross-sectional study, the music students at the Freiburg Conservatory were investigated by means of questionnaires. One hundred ninety-seven students participated and were evaluated. It was shown that more students believe that health can be actively influenced by one’s own behavior
than have a fatalistic, passive attitude toward their health. One third of the music students use body-oriented training--increasingly during their studies. The close connection of this phenomenon with the presence of playing-related problems, and the fact that only a very small number of
music students indicating no physical problems use a body-oriented training method, suggests that body-oriented training was not practiced for preventive reasons, but was motivated by a need for therapy. Two thirds of the music students stated that they had suffered at least once from playing-related
problems; half of the music students felt psychologically affected by such difficulties. Half of the musicians had sought professional help due to playing-related health problems. All in all, it must be concluded that there is minimal consciousness regarding questions of health problems, so
that few music students have taken preventive measures up to the present time. Therefore, preventive courses should be offered in order to inculcate health consciousness that would enhance the music students’ motivation for proactive health-promoting behavior.
Physical Analysis as a Foundation for Pirouette Training
Authors: Sugano Arleen , Laws Kenneth
Published: February 2021

Learning to perform successful pirouettes is often a very repetitive process, which can lead to fatigue-related injury. Little use is made of scientific principles of motion that can make instruction more efficient. This study of the relationship between certain aspects of the pirouette
preparation position and the success of the movement relates the fundamental physical principles to experimental results with dancers. The results show that pirouettes are generally improved when the width of the fourth position preparation is increased, so long as the initial proportion of
weight on each foot is carefully controlled. Those results are demonstrably useful in enhancing the efficiency of instruction and lessening the potential for injury for students learning pirouettes.
The Influence of Neck–Shoulder Pain on Trapezius Muscle Activity among Professional Violin and Viola Players: An Electromyographic Study
Authors: Berque Patrice , Gray Heather
Published: February 2021

Work-related musculoskeletal disorders in the neck-shoulder area are common among violin and viola players. The aim of this study was to investigate the influence of playing-related musculoskeletal disorders (PRMDs) on muscle activity, by measuring electromyographic activity in the
upper trapezius (UT) muscles of violin and viola players under three experimental conditions: rest, performance of an easy piece, and performance of a difficult piece. Ten professional violin and viola players from a Scottish orchestra volunteered to take part in the study. Five subjects complained
of pain in the neck-shoulder region; five were pain-free. Bilateral surface electromyography (EMG) was used, following submaximal reference voluntary contractions, to record the muscle activity of the UT muscles during the three experimental conditions. Subjects were randomly allocated to
the conditions. A four-factor balanced analysis of variance (ANOVA) was performed. The results revealed that the pain-free subjects developed more UT muscle activity than subjects experiencing neck-shoulder pain (F = 4.07, df = 1, p = 0.05). Furthermore, the subjects developed significantly
more UT activity when progressing from the rest condition to performance of the difficult piece (F = 36.64, df = 2, p> < 0.001). The PRMD subjects developed more UT activity than the pain-free subjects at rest. The opposite tendency was observed for the playing conditions. However, the
results were not statistically significant for this interaction (F = 1.85, df = 2, p = 0.169). The results suggest that redistribution of the load to other synergistic muscles may be a strategy used by PRMD subjects to alleviate pain or discomfort at the nec-shoulder area. The voluntary monitoring
of shoulder muscle activity may be of great importance in the prevention of PRMDs in viola and violin players.
Determinants of Injuries in Young Dancers
Authors: Luke Anthony C , Kinney Susan A , D’Hemecourt Pierre A , Baum Jessica , Owen Michael , Micheli Lyle J
Published: February 2021

The epidemiology of dance injuries requires further study, in order to properly implement effective health interventions. This study aimed to pilot injury surveillance tools to assess the incidence of injuries in adolescent pre-professional dancers and identify the intrinsic and extrinsic
risk factors associated with dance injuries. The study involved a prospective, cohort design. A population of adolescent dancers at a liberal arts high school dance program in Natick, Massachusetts, was studied over the nine-month school year in 2000/2001. Intrinsic risk factors, including
anatomical characteristics, past medical history, menstrual history, and dance experience, were assessed with a pre-participation history and orthopedic physical exam. The extrinsic risk factors, including training, fatigue, stress, shoes, and calcium intake, were assessed with surveys completed
every two weeks by the dancers. Study outcomes were: 1) self-reported injuries (SRIs), 2) reported injuries (RIs) assessed by a physical therapist in the school clinic, 3) duration of injuries, and 4) severity of injuries. Descriptive statistics and univariate analyses were performed on each
risk factor. Thirty-nine of 55 dancers participated in the study. The average age was 15.3 years, and 85% of the dancers were female. The return rate for the biweekly surveys was 90%. Over one school year, there were 112 self-reported injuries, averaging 2.8 SRIs per dancer, and 71 reported
injuries assessed by the physical therapist, averaging 1.4 RIs per dancer. Consistent with other studies, the most common locations for injuries were ankles, lower leg/calf, and back, usually caused by overuse, muscle strains, and sprains. Although the female dancers reported dancing significantly
more hours (3.3 hours per day) than the males (2.7 hours/day), the males had a higher injury rate of SRIs (8.4 injuries/1,000 exposure hours of dancing vs. 4.1 injuries/1,000 hours) as well as RIs (5.5 injuries/1,000 hours vs. 2.6 injuries/1,000 hours). Older age and male sex were risk factors
associated with SRIs and RIs. Most risk factors were found not to be statistically associated with the number of SRIs or RIs. Self-reported injuries occur frequently in pre-professional student dancers, who seek medical care in more than half the cases. Health professionals involved with dancers
should be familiar with posterior ankle and low back problems. The rates of injuries appear almost twice as high in male dancers than female dancers. The main limitations to this study were small sample size and misclassification, recall, and reporting biases. With the information and tools
of this pilot study, a multi-center study can be carried out to better assess risk factors on a larger dance population. Further research should aim to standardize injury definitions and classifications.
Upper-extremity Problems in Musicians Related to Age
Authors: Warrington Joan , Winspur Ian , Steinwede Daniel
Published: February 2021

This is a review of 140 musicians referred to a specialist hand therapy department in London, England. Musicians are referred from different sources and represent a fair cross-section. The musicians were analyzed in three different age groups: under 25 years of age, 25–40 years
of age, and over 40 years of age; and by three different pathological groups: “trauma,” “degenerative,” and “non-specific arm and hand pain.” The results highlight three points: 1) Musicians of all ages are injured in coincidental accidents (“trauma”).
2) As musicians age, they are more likely to develop “degenerative” upper limb conditions such as Dupuytren’s contracture, nerve compression syndromes, or degenerative arthrosis in critical joints. 3) Non-specific arm and hand pain is overwhelmingly prevalent in young musicians
and music students but is much less prevalent in the older age groups. This last point is the most worrisome statistic and perhaps the most preventable.
Pain Disorders and Variations in Upper Limb Morphology in Music Students
Authors: Miller Gavin , Peck Fiona , Watson J Stewart
Published: February 2021

The aim of this study was to identify the incidence and prevalence of upper limb pain and dysfunction in music students and to see whether there was any relationship between upper limb pain and upper limb morphology. Ninety-two music students and 65 nonmusician controls were questioned
regarding upper limb pain and both groups were examined for upper limb abnormalities. The results of the study demonstrated that music students were five times more likely to report an upper limb pain syndrome than controls. Upper limb pain was not related to morphological variations such
as small, weak, or hypermobile hands or to the presence of an anomaly. Instead, the study showed that upper limb pain was associated with being a musician, the number of years playing an instrument, duration of practice periods, and previous injury.
Psychological Stresses Experienced by Dance Teachers: “How Can I Be a Role Model When I Never Had One?”
Authors: Robson Bonnie E , Book Angela , Wilmerding M Virginia
Published: February 2021

This paper reports on a survey of 69 dance teachers who may act as role models for their students. It explores the psychological stresses faced by dance teachers today and the measures they have employed to correct poor pedagogical practices of their past. Of the 78.8% of teachers who
felt unjustly criticized in their own training, 61.5% had consciously changed their method of teaching to be more supportive of their students. Similarly, the 53.1% of teachers who reported a chronic injury were found to empathize with the students similarly injured and more likely to provide
strength and conditioning courses and to refer injured students to a health care professional. The concept of the teacher as a role model is self-reported. Water was consumed in front of students by 92.8% of teachers, while 96.8% drank coffee, 75.4% warmed up, and 65.2% stretched, but only
2.9% reported smoking in front of students. The most stressful aspects of teaching were unmotivated students, 27.9%, too little time, 19.8%, and lack of administrative support, 16.4%. Current issues faced by the dance professional were reported to be: fostering talent, 20%, student health
issues, 20%, and lack of discipline in students, 13.3%. The implications of these results are discussed as they relate to current and future teaching practices.
Performing Arts Medicine in Britain
Authors: Winspur Ian
Published: February 2021

Britain provides universal health coverage free at the point of delivery for its citizens (and most visitors) provided by the National Health Service (NHS). The NHS was established in 1947 in the flush of post-World War II idealism and was planned and structured along contemporary socialist
economic and management principles--a large centrally funded and run government monopoly. It is huge, for it employs currently 1.5 million people and it remains one of the last and certainly the largest bastion of such economic thinking and planning in Britain and in Europe. In its 50 years
of existence, it has at times provided excellent care for the British nation. But at this point in time, top-heavy with management and administration, chronically underfunded and understaffed, unresponsive to the rapidly changing needs of society and of developing medical technology, it is
on the verge of crumbling. Inherent in such a system is the lack of recognition of individuality or of an individual patient’s special needs, and no group of patients feels this more acutely than performers.
Controlled ovarian stimulation should not be preferred for male infertility treated with intrauterine insemination: a retrospective study
Authors: Tang Yan , He Qian-Dong , Zhang Ting-Ting , Wang Jing-Jing , Huang Si-Chong , Ye Yun
Published: February 2021

Background: Some studies have stated that intrauterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the pregnancy rate, while others suggest that IUI in the natural cycle (NC) should be the first line of treatment. It remains unclear whether it is necessary to use COS at the same time when IUI is applied to treat isolated male factor infertility. Thus, we aimed to investigate efficacy of IUI with COS for isolated male factor infertility.Methods: A total of 601 IUI cycles from 307 couples who sought medical care for isolated male factor infertility between January 2010 and February 2020 were divided into two groups: NC-IUI and COS-IUI. The COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (one follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The IUI outcomes, including clinical pregnancy, live birth, spontaneous abortion, ectopic pregnancy, and multiple pregnancy rates were compared.Results: The clinical pregnancy, live birth, spontaneous abortion, and ectopic pregnancy rates were comparable between the NC-IUI and COS-IUI group. Similar results were also observed among the NC-IUI, one follicle, and ≥ 2 follicles groups. However, with respect to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared to the NC-IUI group (8.7% vs. 0, P=0.091), and a significant difference was found between the NC-IUI and ≥ 2 follicles group (0 vs. 16.7%, P=0.033).Conclusion: In COS cycles, especially in those with at least two pre-ovulatory follicles, the multiple pregnancy rate increased without a substantial gain in overall pregnancy rate; thus, COS should not be preferred in IUI for isolated male factor infertility. If COS is required, one stimulated follicle and one healthy baby should be the goal considering the safety of both mothers and foetuses.
Inequalities in cognitive impairment among older adults in China and the associated social determinants: a decomposition approach
Authors: Deng Qingwen , Liu Wenbin
Published: February 2021

BackgroundDespite there is growing evidence focusing on health inequalities in China, socioeconomic inequalities in cognitive impairment among older adults have received little attention. This study aims to measure socioeconomic inequalities in cognitive impairment among Chinese older adults, and determine the contributing social factors to the inequalities.MethodsA cross-sectional analysis was performed using data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), a total of 10556 older adults aged 65 and over were included in the study. The prevalence of cognitive impairment was measured by using the Chinese version of the Mini-Mental State Examination. The socioeconomic inequalities in cognitive impairment were illustrated and quantified by the concentration curve and normalized concentration index. Multivariate logistic regression was conducted to identify the associated factors of cognitive impairment. And decomposition analysis was further applied to decompose the contribution of each determinant to the observed inequalities in cognitive impairment. ResultsThe study indicated that the prevalence of cognitive impairment among Chinese older adults was 18.95%. The overall concentration index for cognitive impairment was − 0.046, which suggested a higher concentration of cognitive impairment among socioeconomically disadvantaged older adults. The results showed the prevalence of cognitive impairment was associated with sex, age, marital status, education level, occupation, economic status, emotional support, financial support, living arrangement, and participation in informal activities. Decomposition results further revealed the contributions of the determinants to the inequalities in cognitive impairment. Specifically, age (131.61%), marital status (85.68%), emotional support (84.85%), education level (39.73%), occupation (21.24%), sex (17.25%), financial support (− 4.19%), economic status (1.02%), living arrangement (0.88%), and informal activities (0.30%) have varying degrees of contributions to the inequality in cognitive impairment.ConclusionThis study sheds light on the pro-rich inequality in cognitive impairment among older adults in China. It suggests that policymakers should pay more attention to older adults who are female, old-old, widowed, illiterate, economically disadvantaged, have no social support, and are less socially involved. Also, more targeted interventions should be undertaken to improve the socioeconomic conditions of these vulnerable individuals and their ability to cope with the risk of cognitive impairment.
The PD-L1 metabolic interactome intersects with choline metabolism and inflammation
Authors: Pacheco-Torres Jesús , Penet Marie-France , Mironchik Yelena , Krishnamachary Balaji , Bhujwalla Zaver M
Published: February 2021

Background: Harnessing the power of the immune system by using immune checkpoint inhibitors has resulted in some of the most exciting advances in cancer treatment. The full potential of this approach has, however, not been fully realized for treating many cancers such as pancreatic and breast cancer. Cancer metabolism influences many aspects of cancer progression including immune surveillance. An expanded understanding of how cancer metabolism can directly impact immune checkpoints may allow further optimization of immunotherapy. We therefore investigated, for the first time, the relationship between the overexpression of choline kinase-α (Chk-α), an enzyme observed in most cancers, and expression of the immune checkpoint PD-L1. Methods: We used small interfering RNA to downregulate Chk-a, PD-L1 or both in two triple negative human breast cancer cell lines (MDA-MB-231 and SUM-149) and two human pancreatic ductal adenocarcinoma cell lines (Pa09C and Pa20C). The effects of the downregulation were studied at the genomic, proteomic and metabolomic levels. The findings were compared with results obtained by analysis of public data from The Cancer Genome Atlas Program.Results: We identified an inverse dependence between Chk-α and PD-L1 at the genomic, proteomic and metabolomic levels. We also found that prostaglandin-endoperoxide synthase 2 (COX-2) and transforming growth factor beta (TGF-β) play an important role in this relationship. We independently confirmed this relationship in human cancers by analyzing data from The Cancer Genome Atlas Program. Conclusions: Our data identified previously unknown roles of PD-L1 in cancer cell metabolic reprogramming, and revealed the immunosuppressive increased PD-L1 effect of Chk-α downregulation. These data suggest that PD-L1 regulation of metabolism may be mediated through Chk-α, COX-2 and TGF-β. The observations provide new insights that can be applied to the rational design of combinatorial therapies targeting immune checkpoints and cancer metabolism.
Child witchcraft confessions as an idiom of distress in Sierra Leone; results of a rapid qualitative inquiry and recommendations for mental health interventions.
Authors: Yoder Heleen , de Jong Joop T.V.M. , Tol Wietse Anton , Duncan Joshua Abioseh , Bayoh Amjata , Reis Ria
Published: February 2021

Background Reports about child witchcraft are not uncommon in sub-Saharan Africa. In this study we approach child witchcraft as an idiom of distress. In an environment that may prohibit children from openly expressing distress, the shared imagery of witchcraft can provide a cultural idiom to communicate about psychosocial suffering. We used an ecological approach to study how some children in distressing circumstances come to a witchcraft confession, with the aim to set out pathways for mental health interventions.Methods We employed rapid qualitative inquiry methodology, with an inductive and iterative approach, combining emic and etic perspectives. We conducted 37 interviews and 12 focus group discussions with a total of 127 participants in Freetown, Sierra Leone. Inductive analysis was used to identify risk and protective factors related to witchcraft accusations and confessions.Results We identified risk and protective factors related to the individual child, the family, peer relations, teachers and other professionals in a child’s life, traditional healers, pastors and the wider society. We found that in the context of a macrosystem that supports witchcraft, suspicions of witchcraft are formed at the mesosystem level, where actors from the microsystem interact with each other and the child. The involvement of a traditional healer or pastor often forms a tipping point that leads to a confession of witchcraft. Conclusions Child witchcraft is an idiom of distress, not so much owned by the individual child as well as by the systems around the child. Mental health interventions should be systemic and multi-sectoral, to prevent accusations and confessions, and address the suffering of both the child and the systems surrounding the child. Interventions should be contextually relevant and service providers should be helped to address conscious and subconscious fears related to witchcraft. Beyond mental health interventions, advocacy, peacebuilding and legislation is needed to address the deeper systemic issues of poverty, conflict and abuse.
Echocardiographic Parameters during Prolonged Targeted Temperature Management in Out-of-hospital Cardiac Arrest Survivors to Predict Neurological Outcome - a post-hoc analysis of the TTH48 trial
Authors: Jensen Thomas Hvid , Juhl-Olsen Peter , Nielsen Bent Roni Ranghøj , Heiberg Johan , Duez Christophe Henri Valdemar , Jeppesen Anni Nørgaard , Frederiksen Christian Alcaraz , Kirkegaard Hans , Grejs Anders Morten
Published: February 2021

Background: Transthoracic echocardiographic (TTE) indices of myocardial function among survivors of out-of-hospital cardiac arrest (OHCA) have been related to neurological outcome; however, results are inconsistent. We hypothesized that changes in average peak systolic mitral annular velocity (s’) from 24 hours (h) to 72 h following start of targeted temperature management (TTM) predict six-month neurological outcome in comatose OHCA survivors.Methods: We investigated the association between peak systolic velocity of the mitral plane (s’) and six-month neurological outcome in a population of 99 patients from a randomised controlled trial comparing TTM at 33±1°C for 24 hours (h) (n=47) vs. 48h (n=52) following OHCA (TTH48-trial). TTE was conducted at 24h, 48h, and 72h after reaching target temperature. The primary outcome was 180 days neurological outcome assessed by Cerebral Performance Category score (CPC180) and the primary TTE outcome measure was s’. Secondary outcome measures were left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), e’, E/e’ and tricuspid annular plane systolic excursion (TAPSE). Results: Across all three scan time points s’ was not associated with neurological outcome (ORs: 24 h: 1.0 (95%CI: 0.7-1.4, p=0.98), 48 h: 1.13 (95%CI: 0.9-1.4, p=0.34), 72 h: 1.04 (95%CI: 0.8-1.4, p=0.76)). LVEF, GLS, E/e’, and TAPSE recorded on serial TTEs following OHCA were neither associated with nor did they predict CPC180. Estimated median e’ at 48h following TTM was 5.74 cm/s (95%CI: 5.27-6.22) in patients with good outcome (CPC180 1-2) vs. 4.95 cm/s (95%CI: 4.37-5.54) in patients with poor outcome (CPC180 3-5) (p=0.04). Conclusions: s’ assessed on serial TTEs in comatose survivors of OHCA treated with TTM was not associated with CPC180. Our findings suggest that serial TTEs in the early post-resuscitation phase during TTM do not aid the prognostication of neurological outcome following OHCA.Trial registration: NCT02066753. Registered 14 February 2014 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02066753
Submarine Terraces reveal Late Quaternary Tectonic deformation in the Intermediate Zone between the Island Shelf and Rift Zone of the Middle Part of the Nanseishoto Islands, Southwest Japan
Authors: Goto Hideaki
Published: February 2021

Late Quaternary tectonic deformation of coastal areas is usually examined based on the height distribution of paleo-shorelines observed on marine terraces. However, it is difficult to examine deformation along the subduction zone, in which small, isolated islands are distributed. In this paper, the author focuses on the widespread shallow submarine terraces surrounding the Iheya-Izena islands in the middle part of the Nanseishoto islands, Southwest Japan, where crustal deformation is not known. The islands are located in the intermediate zone between island shelf uplifted during the Late Quaternary and the rift zone occurred to the northwest, along the Okinawa trough.
Detailed topographic anaglyph images and maps of the islands were produced using a digital elevation model (DEM) of the seafloor, which is stored by the Japan Coast Guard (JCG) and the Advanced Institute of Science and Technology (AIST). Topographic anaglyph images enabled us to identify the widespread distribution and deformation of the shallow seafloor above −200 m using red-cyan glasses.
Four terrace-like features divided by small steps were found on the shallow seafloor, which are named T1, T2, T3, and T4, in descending order. Topographic expressions of paleo-shoreline depths are preserved on submarine terraces formed during the last glacial period. The paleo-shoreline depths of terraces T2 and T3 are −60 m and −70 m on the west side and −70 m and −80 m, respectively, on the east side of Iheyajima island; this indicates southeastward tilting. The tilting ratio of T2 and T3 was calculated to approximately 1‰. The tilting rate is approximately 1×10^4/kyr, assuming that the T2 was formed in 10–11 kyr. This is much more rapid than that of the last inter-glacial marine terraces in the Muroto peninsula of Shikoku, Japan, with a tilting rate of 4×10^5/kyr, which formed by steep northward tilting against the Nankai subduction zone. The author suggests that this phenomenon is not related to mega-thrusting along the subduction zone, but rather to local deformation, probably caused by the reverse faulting of nearby active submarine faults along the west side of the islands.
Very broadband strain-rate measurements along a submarine fiber-optic cable off Cape Muroto, Nankai subduction zone, Japan
Authors: Ide Satoshi , Araki Eiichiro , Matsumoto Hiroyuki
Published: February 2021

Distributed acoustic sensing (DAS) is a new method that measures the strain change along a fiber-optic cable and has emerged as a promising geophysical application across a wide range of research and monitoring. Here we present the results of DAS observations from a submarine cable offshore Cape Muroto, Nankai subduction zone, western Japan. The observed signal amplitude varies widely among the DAS channels, even over short distances of only ~100 m, which is likely attributed to the differences in cable-seafloor coupling due to complex bathymetry along the cable route. Nevertheless, the noise levels at the well-coupled channels of DAS are almost comparable to those observed at nearby permanent ocean-bottom seismometers, suggesting that the cable has the ability to detect nearby micro earthquakes and even tectonic tremors. Many earthquakes were observed during the five-day observation period, with the minimum and maximum detectable events being a local M1.1 event 30–50 km from the cable and a teleseismic Mw7.7 event that occurred in Cuba, respectively. Temperature appears to exert a greater control on the DAS signal than real strain in the quasi-static, sub-seismic range, where we can regard our DAS record as distributed temperature sensing (DTS) record, and detected many rapid temperature change events migrating along the cable: a small number of large migration events (up to 10 km in 6 hours) associated with rapid temperature decreases, and many small-scale events (both rising and falling temperatures). These events may reflect oceanic internal surface waves and deep-ocean water mixing processes that are the result of ocean current–tidal interactions along an irregular seafloor boundary.
Coherently amplifying photon production from vacuum with a dense cloud of accelerating photodetectors
Authors: Wang Hui , Blencowe Miles
Published: February 2021

We consider N>>1 accelerating (i.e., oscillating) photodetectors modeled as two level systems (TLSs) that are contained within a microwave cavity and show that the resulting photon production from vacuum can be collectively enhanced such as to be measurable. The cavity-accelerating TLSs system maps onto a parametrically driven Dicke-type model and when the detector number N exceeds a certain critical value, the vacuum photon production undergoes a phase transition from a normal phase to an enhanced superradiant-like, inverted lasing phase. Such a model may be realized as a mechanical membrane with a dense concentration of optically active defects undergoing GHz flexural motion and contained within a 3D, superconducting microwave cavity. We show that recent related experimental devices are close to demonstrating this inverted, vacuum photon lasing phase.
Conditional Survival Probability of Non-Small Cell Lung Cancers, Based on The SEER Database
Authors: Fang Shixu , Zhai Kui , Ke Xixian , Han Hao , Lu Hongling , Xu Gang
Published: February 2021

Background: This study aims to explore the dynamic survival probability of lung cancers after resection based on those had survived several years, provide more precise monitoring and treatment information for non-metastatic non-small cell lung cancer (NSCLC) patients.Materials and Methods: In the Surveillance, Epidemiology, and End Results (SEER) database (2000–2016), 95531 eligible non-metastatic NSCLC patients after surgery were enrolled, TNM stage were reclassified, the methods of condition survival probability (CS) and actuarial overall survival (OS) were used to explore the relationship between clinicopathological characteristics and cancer prognosis.Results: The 1-, 3-, 5- and 10-year OS of included patients were 83.6% (95%CI: 83%-84%), 62.9% (95%CI: 62.6%-63.1%), 50.8% (95%CI: 50.6%-51.0%) and 33.1% (95%CI: 32.7%-33.6%) respectively. For those already survived 1, 2, 3, 4 and 5 years after diagnosis, the probability for surviving an additional 3 years were 67%, 71%, 73%, 75% and 77% respectively. Enrolled population were reclassified into 9 cohorts including T1aN0, T1bN0, T1cN0, T2aN0, T2bN0, T3N0, T4N0, T1-4N1, T1-4N2 according to 8th TNM staging. According to the conditional survival probability, patients with unfavorable tumor stage diagnosed initially at surgery had the significant improvement in CS over time. Analysis based on other clinical features demonstrated similar conclusion that the poorer the initial diagnosis, the more significant the benefit of conditional survival over time.Conclusion: The worse the patient's prognosis, the more significant the benefit of time-dependent conditional survival probability, long-lived cancer patients may have a better cancer prognosis.
Users’ Experiences With an Interactive Evidence to Decision (iEtD) Framework: A Qualitative Analysis
Authors: Meneses-Echavez Jose , Rosenbaum Sarah , Rada Gabriel , Flottorp Signe , Moberg Jenny , Alonso-Coello Pablo
Published: February 2021

Background

Evidence to Decision (EtD) frameworks bring clarity, structure and transparency to health care decision making. The interactive Evidence to Decision (iEtD) tool, developed in the context of the DECIDE project and published by Epistemonikos, is a stand-alone online solution for producing and using EtD frameworks. Since its development, little is known about how organizations have been using the iEtD tool and what characterizes users’ experiences with it.
Methods

This study aimed to describe users’ experiences with the iEtD and identify main barriers and facilitators related to use. We contacted all users registered in the iEtD via email and invited people who identified themselves as having used the solution to a semi-structured interview. Audio recordings were transcribed, and one researcher conducted a content analysis of the interviews guided by a user experience framework. Two researchers checked the content independently for accuracy.
Results

Out of 860 people contacted, 81 people replied to our introductory email (response rate 9.4%). Twenty of these had used the tool in a real scenario and were invited to an interview. We interviewed all eight users that accepted this invitation (from six countries, four continents). ‘Guideline development’ was the iEtD use scenario they most commonly identified. Most participants reported an overall positive experience, without major difficulties navigating or using the different sections. They reported having used most of the EtD framework criteria. Participants reported tailoring their frameworks, for instance by adding or deleting criteria, translating to another language, or rewording headings. Several people preferred to produce a Word version rather than working online, due to the burden of completing the framework, or lack of experience with the tool. Some reported difficulties working with the exportable formats, as they needed considerable editing.
Conclusion

A very limited number of guideline developers have used the iEtD tool published by Epistemonikos since its development. Although users’ general experiences are positive, our work has identified some aspects of the tool that need improvement. Our findings could be also applied to development or improvement of other solutions for producing or using EtD frameworks.
Medical imaging algorithms exacerbate biases in underdiagnosis
Authors: Seyyed-Kalantari Laleh , Liu Guanxiong , McDermott Matthew , Chen Irene , Ghassemi Marzyeh
Published: February 2021

Artificial intelligence (AI) systems have increasingly achieved expert-level performance, particularly in medical imaging (‎1). However, there is growing concern that AI systems will reflect and amplify human bias against under-served subpopulations (‎2-‎7). Such biases are especially troubling in the context of underdiagnosis: if AI systems falsely predict that patients are healthy, patients would be denied care when they need it most. This use case is particularly relevant in the context of existing health disparities where high underdiagnosis rates for under-served subgroups are well documented (‎8-‎11). Although bias in underdiagnosis can potentially delay access to medical treatment unequally, underdiagnosis due of AI has been relatively unexplored. In this work we examine algorithmic underdiagnosis in chest X-ray pathology classifiers and find that classifiers consistently and selectively underdiagnose under-served patients, actively amplifying the existing biases in clinical care. These effects are worse on intersectional subpopulations, e.g., Black females, and persist across three large and a multi-source chest X-ray dataset. Our work demonstrates that deploying AI systems risks exacerbating biases present in current care practices. Developers, clinical staff, and regulators must address the serious ethical concerns of -- and barriers to -- effective deployment of these models in the clinic.