bluuebunny/crossref_metadata_2025 huggingface dataset:
To Predict or Not to Predict: The Case of the Emergency Department
Authors: Somanchi Sriram , Adjerid Idris , Gross Ralph
Published: September 2021

Coupling healthcare datasets with advanced statistical methods has the potential to improve the efficiency and quality of healthcare dramatically. However, data used for predictive decision making in healthcare delivery has significant variable costs. We offer a novel and generalizable framework that helps reduce the costs associated with the use of data for healthcare analytics while maintaining high predictive accuracy. We utilize this approach in the emergency department (ED) context and specifically in predicting whether a patient will be admitted to an interior hospital unit or discharged from the ED. Data used to generate this prediction are available at different times, introducing a time‐cost associated with different data used in the prediction. We focus on minimizing the time‐cost of prediction without sacrificing accuracy. Using our approach, we are able to reduce the time‐cost of prediction by more than two‐thirds and significantly reduce the need to use privacy‐sensitive features. Yet, we still maintain high accuracy of prediction that is comparable to standard approaches which do not reduce data costs (area under the ROC curve of 0.86). Our work has significant potential value to healthcare entities and contributes to a growing stream of work on how to realize the value of healthcare analytics efforts.
Measuring Prediction Accuracy in a Maritime Accident Warning System
Authors: Merrick Jason R. W. , Dorsey Claire A. , Wang Bo , Grabowski Martha , Harrald John R.
Published: September 2021

Advances in machine learning methods and the availability of new data sources show promise for improving prediction of operational risk. Maritime transportation is the backbone of global supply chains and maritime accidents can lead to costly disruptions. We describe a case study performed for the United States Coast Guard (USCG) to develop a prototype risk prediction system to provide early alerts of elevated risk levels to vessel traffic managers and operators in the Lower Mississippi River, the second largest port of entry in the United States. Integrating incident and accident data from the USCG with environmental and traffic data sources, we tested existing machine learning algorithms in their predictive ability. We found poor accident prediction accuracy in cross‐validation using the traditional measures of precision and sensitivity. In this specific operational context, however, such single‐class accuracy metrics can be misleading. We define action precision and action sensitivity metrics that measure the accuracy of predictions in engendering the correct behavioral response (actions) among vessel operators, rather than getting the specific event classification correct. We use these operationally appropriate measures for maritime risk prediction to choose an algorithm for our prototype system. While the traditional metrics indicated that none of the algorithms would perform sufficiently well to use in the early warning system, the modified metrics show that the top performing algorithm will perform well in this operational context.
Association between novel variants in BMPR1B gene and litter size in Mongolia and Ujimqin sheep breeds
Authors: Gao Yuanyuan , Hao Qi , Cang Ming , Wang Jianguo , Yu Haiquan , Liu Yongbin , Zhang Wenguang , Tong Bin
Published: September 2021

Prolificacy is an important trait of animals, specifically for sheep. The Bone morphogenetic protein receptor 1B (BMPR1B) is a major gene affecting the litter size of many sheep breeds. The well‐known FecB mutation (Q249R) was associated fully with the hyper prolific phenotype of Booroola Merino. However, the identification of variation in all exonic regions of BMPR1B was rare. In this study, we sequenced all exonic regions of BMPR1B gene of Mongolia sheep breed, and ten novel variants were detected by direct sequencing. Among them, the litter size of the Mongolia ewes with the CC genotype was significantly higher (0.34 additional lambs, p < .05) than those with the TT genotype of the g.29346567C>T single nucleotide polymorphism (SNP). The litter size of the Mongolia ewes with the TT genotype was significantly higher (0.19 additional lambs, p < .05 and .31 additional lambs, p < .01, respectively) than those with the GT and GG genotypes of the c.1470G>T SNP. The silent c.1470G>T mutation is predicted to increase the stability of the mRNA secondary structure through reducing minimum free energy and is predicted to change the mRNA secondary structure of BMPR1B. Our findings may give potentially useful genetic markers for increasing litter size in sheep.
Healthcare professionals’ experiences with practice for managing disease‐related malnutrition in general practice and proposals for improvement: A qualitative study
Authors: Mikkelsen Sabina , Geisler Lea , Holst Mette
Published: September 2021

Background & Aim

Disease‐related malnutrition is prevalent in all healthcare settings, including general practice, and is associated with negative consequences for the individual and the community. The aim of this study was to investigate general practitioners and general practice nurses’ perceptions of how they manage disease‐related malnutrition, and their view on introducing an early intervention against disease‐related malnutrition.

Methods

Content analysis was used to analyse individual semi‐structured interviews with the general practitioners (n = 9) and five focus group interviews with the general practice nurses (n = 21) from five general practices in Denmark.

Results

General practice has no tradition for detection of disease‐related malnutrition and find that they rarely see patients with unintended weight loss. Nutritional guidance is to a low degree and only randomly performed. Furthermore, most of the health professionals do not have access to nutritional guidance material for patients and lack information about patients’ nutrition, when patients when patients receive treatment in the hospital. Suggestions for improvement were handouts with pictures and including nutritional status as a standard in the communication from hospital to general practice. An early intervention against unintended weight loss in specific groups was found feasible. Barriers and facilitators were seen as lack of time, lack of educational opportunities and skills. A financial incentive from the health authorities, and interventions adapted to the individual general practice were among suggested facilitators.

Conclusion

Disease‐related malnutrition was rarely recognised and managed in general practice. The health professionals found they lacked means to perform nutritional guidance to patients with unintended weight loss. However, the health professionals had suggestions for improvement for an early intervention including handouts for patients. Further research on implementation of early intervention against unintended weight loss in general practice is needed.
Clinical decision making is improved by BioFire Pneumonia Plus in suspected lower respiratory tract infection after lung transplantation: Results of the prospective DBATE‐IT* study
Authors: Kayser Moritz Z. , Seeliger Benjamin , Valtin Christina , Fuge Jan , Ziesing Stefan , Welte Tobias , Pletz Mathias W. , Chhatwal Patrick , Gottlieb Jens
Published: September 2021

Background

Lower respiratory tract infections (LRTIs) are a significant cause of morbidity and mortality in lung transplant (LTx) recipients. Timely and precise pathogen detection is vital to successful treatment. Multiplex PCR kits with short turnover times like the BioFire Pneumonia Plus (BFPPp) (manufactured by bioMérieux) may be a valuable addition to conventional tests.

Methods

We performed a prospective observational cohort study in 60 LTx recipients with suspected LRTI. All patients received BFPPp testing of bronchoalveolar lavage fluid in addition to conventional tests including microbiological cultures and conventional diagnostics for respiratory viruses. Primary outcome was time‐to‐test‐result; secondary outcomes included time‐to‐clinical‐decision and BFPPp test accuracy compared to conventional tests.

Results

BFPPp provided results faster than conventional tests (2.3 h [2–2.8] vs. 23.4 h [21–62], p < 0.001), allowing for faster clinical decisions (2.8 [2.2–44] vs. virology 28.1 h [23.1–70.6] and microbiology 32.6 h [4.6–70.9], both p < 0.001). Based on all available diagnostic modalities, 26 (43%) patients were diagnosed with viral LRTI, nine (15 %) with non‐viral LRTI, and five (8 %) with combined viral and non‐viral LRTI. These diagnoses were established by BFPPp in 92%, 78%, and 100%, respectively. The remaining 20 patients (33 %) received a diagnosis other than LRTI. Preliminary therapies based on BFPPp results were upheld in 90% of cases. There were six treatment modifications based on pathogen‐isolation by conventional testing missed by BFPPp, including three due to fungal pathogens not covered by the BFPPp.

Conclusion

BFPPp offered faster test results compared to conventional tests with good concordance. The absence of fungal pathogens from the panel is a potential weakness in a severely immunosuppressed population.
Population growth rates of weed species in response to herbicide programme intensity and their impact on weed community
Authors: Oreja Fernando H. , Inman Matthew D. , Jordan David L. , Leon Ramon G.
Published: September 2021

The adoption of dicamba‐tolerant crops has reduced the challenge of controlling glyphosate‐resistantAmaranthus palmeriin these crops. However, introducing herbicide programmes with new mechanisms of action and different intensities can favour major shifts in weed communities. This can affect not only the functionality of the agroecosystem, but also resource availability to the most problematic species. The objectives of this work were to evaluate how herbicide programme structure and intensity affect (a) weed diversity, (b) population growth rate (λ) of weed species and (c) weed community structure based on λ dynamics in a dicamba‐tolerant cotton monoculture. To achieve these objectives, a cotton field experiment was established to compare four herbicide programmes from 2011 to 2018. The herbicide programmes differed in the first 4 years (i.e. glyphosate every year, alternating glyphosate and glyphosate plus dicamba every other year, glyphosate plus dicamba every year, and residual herbicide and glyphosate plus dicamba every year). During the last 4 years, all programmes received glyphosate plus dicamba. The weed seedbank was evaluated every spring and λ calculated. Environmental variation from year to year was more important in determining weed richness than herbicide programmes, which exhibited similar richness across all treatments during the eight years of the study. Regardless of herbicide programme, most species maintained λ between zero and one. Only a few species were the exception with λ values above one, such asA.palmeri,Mollugo verticillataandEleusine indica. Although glyphosate plus dicamba reduced λ for several species, this herbicide mix was less effective in reducing λ for other weeds compared with glyphosate alone, suggesting a potential antagonism that could change weed community composition. The limited changes in λ for most species suggest the capacity of weeds to adjust reproduction and survival to overcome changes in mortality rates caused by increases in herbicide use intensity.
Mechanical ventilation in COVID‐19: A physiological perspective
Authors: Cronin John N. , Camporota Luigi , Formenti Federico
Published: September 2021

New Findings

What is the topic of this review?

This review presents the fundamental concepts of respiratory physiology and pathophysiology, with particular reference to lung mechanics and the pulmonary phenotype associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and subsequent coronavirus disease 2019 (COVID‐19) pneumonia.

What advances does it highlight?

The review provides a critical summary of the main physiological aspects to be considered for safe and effective mechanical ventilation in patients with severe COVID‐19 in the intensive care unit.

Severe respiratory failure from coronavirus disease 2019 (COVID‐19) pneumonia not responding to non‐invasive respiratory support requires mechanical ventilation. Although ventilation can be a life‐saving therapy, it can cause further lung injury if airway pressure and flow and their timing are not tailored to the respiratory system mechanics of the individual patient. The pathophysiology of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection can lead to a pattern of lung injury in patients with severe COVID‐19 pneumonia typically associated with two distinct phenotypes, along a temporal and pathophysiological continuum, characterized by different levels of elastance, ventilation‐to‐perfusion ratio, right‐to‐left shunt, lung weight and recruitability. Understanding the underlying pathophysiology, duration of symptoms, radiological characteristics and lung mechanics at the individual patient level is crucial for the appropriate choice of mechanical ventilation settings to optimize gas exchange and prevent further lung injury. By critical analysis of the literature, we propose fundamental physiological and mechanical criteria for the selection of ventilation settings for COVID‐19 patients in intensive care units. In particular, the choice of tidal volume should be based on obtaining a driving pressure < 14 cmH2O, ensuring the avoidance of hypoventilation in patients with preserved compliance and of excessive strain in patients with smaller lung volumes and lower lung compliance. The level of positive end‐expiratory pressure (PEEP) should be informed by the measurement of the potential for lung recruitability, where patients with greater recruitability potential may benefit from higher PEEP levels. Prone positioning is often beneficial and should be considered early. The rationale for the proposed mechanical ventilation settings criteria is presented and discussed.
Living Standards and Material Culture in English Rural Households 1300-1600. Data Paper
Authors:   Cardiff University, Jervis Ben , Forward Alice , Briggs Chris ,   Allen Archaeology,   University of Cambridge,   University of Leicester, Dyer Chris
Published: September 2021

The data in the related digital archive was collected to examine the archaeological and historical evidence for material culture in English medieval rural households, with the aim of gaining a fuller picture than what might be attainable by looking only at objects or documents in isolation. The digital archive provides a starting point for anyone wishing to research aspects of medieval rural settlement.
Factores que facilitan y dificultan los procesos de reintegración de excombatientes y sus familias
Authors: Giovanni Irene , Durán Alicia del Socorro , Aponte Diego Mauricio , Laverde Diana Janneth
Published: September 2021

El presente artículo se propone como objetivo describir factores que facilitan y dificultan los procesos de reintegración de excombatientes desmovilizados  de Grupos Armados Organizados (GAO) en Colombia, al igual que los de sus familias, vinculados a la Agencia Colombiana para la Reincorporación y Normalización (ARN), con el fin de generar información que permita ampliar la comprensión de sus características y necesidades, dadas las complejidades del conflicto armado del que provienen. Esta es una investigación cualitativa que utilizó el método de teoría fundamentada. Dentro de los resultados más significativos se encontraron la necesidad de acompañar procesos de crianza para evitar la repetición de patrones intergeneracionales violentos, así como la importancia de fortalecer procesos comunicacionales dentro del sistema familiar. Así mismo, se hizo evidente lo fundamental de abordar la sensación de estigmatización y desarraigo de los excombatientes y  sus familias durante todo el proceso de reintegración. Finalmente, la investigación resaltó la necesidad del trabajo con las comunidades receptoras, pues estas son un elemento esencial para el proceso de ajuste de los excombatientes y sus familias y la necesidad de construir el sentido de la reintegración con sus participantes.
Task-Level Dexterous Manipulation With Multifingered Hand Under Modeling Uncertainties
Authors: Caldas Alex , Grossard Mathieu , Makarov Maria , Rodriguez-Ayerbe Pedro
Published: September 2021

This article presents an approach to efficiently control grippers/multifingered hands for dexterous manipulation according to a task, i.e., a predefined trajectory in the object space. The object motion is decomposed using a basis of predefined object motions equivalent to object-level coordinate couplings and leading to the definition of the task-level space. In the proposed approach, the decomposition of the motion in the task space is associated with a robust control design based on linear matrix inequalities (LMIs) and bilinear matrix inequalities (BMIs). Eigenvalue placement ensures the robustness of the system to geometric uncertainties and eigenvector placement decouples the system according to task specifications. A practical evaluation of the proposed control strategy is provided with a two-fingers' and six degrees-of-freedom robotic system manipulating an object in the horizontal plane. Results show a better trajectory tracking and the robustness of the control law according to geometric uncertainties and the manipulation of various objects.
Electroforming and threshold switching characteristics of NbOx films with crystalline NbO2 phase
Authors: Lee Jimin , Kim Jaeyeon , Jeong Juyoung , Sohn Hyunchul
Published: September 2021

Threshold switching (TS) and negative differential resistance (NDR) characteristic of niobium oxide (NbOx) films have been actively studied for neuromorphic computing. Generally, the electroforming process is required for TS and NDR in NbOx films. However, different electroforming and TS properties have been reported for NbOx films with different crystallinities or chemical compositions. This study investigates the effect of thermal annealing on the microstructures of NbOx films and compares the electroforming, TS, and NDR characteristics of amorphous, partially crystallized, and fully crystallized films. The distributions of crystalline NbO2 phase in NbOx films annealed at various temperatures were analyzed using transmission electron microscopy dark-field imaging, and it was observed that the distribution of crystalline NbO2 phase influenced the electroforming process. Moreover, TS characteristics improved in the thermally annealed NbOx films with crystalline NbO2 phases.
Optical theorems and symmetry relations in scattering problems
Authors: Apresyan L. A.
Published: September 2021

A generalized form of the optical theorem (GOT), equivalent to the energy conservation law, is derived for an absorbing scatterer in a homogeneous lossless medium. The derivation is based on the symmetry of the scatterer's internal parameters, associated with the separation of the corresponding operators into conservative and dissipative components. It leads to the GOT as a constraint on the Green's function, while the conventional optical theorem follows as a specific case of the GOT.
Hip Abductor Rate of Torque Development as Opposed to Isometric Strength Predicts Peak Knee Valgus During Landing: Implications for Anterior Cruciate Ligament Injury
Authors: Stearns-Reider Kristen M. , Straub Rachel K. , Powers Christopher M.
Published: September 2021

Peak knee valgus has been shown to predict anterior cruciate ligament injury. The purpose of the current study was to compare peak rate of torque development (RTD) to peak isometric torque as a predictor of peak knee valgus during landing. Twenty-three healthy females participated. Hip abductor muscle performance was quantified using 2 types of isometric contractions: sustained and rapid. Peak isometric torque was calculated from the sustained isometric contraction. Peak RTD was calculated from the rapid isometric contraction (0–50 and 0–200 ms after force initiation). Kinematic data were collected during the deceleration phase of a double-leg drop jump task. Linear regression was used to assess the ability of hip abductor muscle performance variables to predict peak knee valgus. Increased peak RTD during the 0 to 50 milliseconds window after force initiation was found to significantly predict lower peak knee valgus (P = .011, R2 = .32). In contrast, neither peak RTD from 0 to 200 milliseconds after force initiation window (P = .45, R2 = .03) nor peak isometric torque (P = .49, R2 = .03) predicted peak knee valgus. The inability of the hip abductors to rapidly generate muscular force may be more indicative of “at-risk” movement behavior in females than measures of maximum strength.
Injury-Related Fear in Individuals With and Without Chronic Ankle Instability: A Systematic Review
Authors: Suttmiller Ashley M.B. , McCann Ryan S.
Published: September 2021

Context: Injury-related fear has recently been recognized to exist in ankle sprain populations. It is unclear, however, if injury-related fear levels differ between those who develop chronic ankle instability (CAI) and those who do not and the best tools for assessing these differences. Objective: The purpose of this study was to conduct a comprehensive systematic review investigating differences in injury-related fear between individuals with and without CAI. Evidence Acquisition: Relevant studies from CINAHL Plus with full text, PubMed, and SPORTDiscus through November 2020 were included. All studies used the Tampa Scale of Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, or Athlete Fear Avoidance Questionnaire as either a descriptor or a main outcome and provided comparison data between a CAI group and ankle sprain copers (COP) or controls (CON). The authors independently assessed methodological quality using the modified Downs and Black Quality Index. Studies were then grouped by between-group comparisons including CAI and CON, CAI and COP, and COP and CON. The authors calculated Hedge g effect sizes and 95% confidence intervals to examine group differences. Evidence Synthesis: A total of 11 studies were included in this review. In total, 8 studies provided data for the CAI and CON comparison, 7 for CAI and COP comparisons, and 4 for COP and CON comparisons. Methodological quality scores ranged from 60.0% to 86.7%, with 2 high-, and 9 moderate-quality studies. Overall, the evidence suggests that physically active individuals with CAI report higher levels of injury-related fear when compared with both COP and CON. Although limited, ankle sprain COP do not seem to differ from CON. Conclusion: Available evidence emphasizes the importance of injury-related fear in individuals who develop chronicity after ankle sprain injury. The Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia are useful for the identification of injury-related fear in individuals after sustaining an ankle sprain and should be used to inform rehabilitation strategies and to monitor efficacy in fear reduction.
Expertise- and Tempo-Related Performance Differences in Unimanual Drumming
Authors: Buck Bryony , Beveridge Scott , Breaden Madden Gerard , Jabusch Hans-Christian
Published: September 2021

Background: High-speed drumming requires precise control over the timing, velocity, and magnitude of striking movements. Aim: To examine effects of tempo and expertise on unaccented repetitive drumming performance using 3D motion capture. Methods: Expert and amateur drummers performed unimanual, unaccented, repetitive drum strikes, using their dominant right hand, at five different tempi. Performance was examined with regard to timing variability, striking velocity variability, the ability to match the prescribed tempo, and additional variables. Results: Permutated multivariate analysis of variance (PERMANOVA) revealed significant main effects of tempo (p < .001) and expertise (p <.001) on timing variability and striking velocity variability; low timing variability and low striking velocity variability were associated with low/medium tempo as well as with increased expertise. Individually, improved precision appeared across an optimum tempo range. Precision was poorest at maximum tempo (400 hits per minute) for precision variables. Conclusions: Expert drummers demonstrated greater precision and consistency than amateurs. Findings indicate an optimum tempo range that extends with increased expertise.
The Changing Nature of Gay Rugby Clubs in the United Kingdom
Authors: Muir Ken , Anderson Eric , Parry Keith D. , Letts David
Published: September 2021

Rugby has traditionally existed as a leading definer of masculinity in British culture, which has included overt homophobia. However, cultural attitudes toward homosexuality have improved rapidly in the 21st century. To assess the impact of wider societal change on gay rugby teams, we employed a multiple methods investigation across five gay rugby teams in England. Results show that, whereas athletes once played for these teams to escape homophobia in broader rugby culture, this is no longer true. Affiliation with gay clubs is now primarily for social purposes, and gay rugby clubs now protect the physical safety of gay men from being less prepared to play the game, whereas before it was safety from homophobia. This research shows that gay rugby clubs have undergone an organizational shift in response to the increased social acceptance of sexual minorities.
Linezolid Population Pharmacokinetics in South African Adults with Drug-Resistant Tuberculosis
Authors: Abdelwahab Mahmoud Tareq , Wasserman Sean , Brust James C. M. , Dheda Keertan , Wiesner Lubbe , Gandhi Neel R. , Warren Robin M. , Sirgel Frederick A. , Meintjes Graeme , Maartens Gary , Denti Paolo
Published: September 2021

Linezolid is widely used for drug-resistant tuberculosis (DR-TB) but has a narrow therapeutic index. To inform dose optimization, we aimed to characterize the population pharmacokinetics of linezolid in South African participants with DR-TB and explore the effect of covariates, including HIV coinfection, on drug exposure.
Functional Properties of Oligomeric and Monomeric Forms of Helicobacter pylori VacA Toxin
Authors: Caso Georgia C. , McClain Mark S. , Erwin Amanda L. , Truelock Mandy D. , Campbell Anne M. , Leasure Catherine S. , Nagel Marcus , Schey Kevin L. , Lacy D. Borden , Ohi Melanie D. , Cover Timothy L.
Published: September 2021

Helicobacter pylori
VacA is a secreted toxin that assembles into water-soluble oligomeric structures and forms anion-selective membrane channels. Acidification of purified VacA enhances its activity in cell culture assays.
Profiling
Myxococcus xanthus
Swarming Phenotypes through Mutation and Environmental Variation
Authors: Ritchie Linnea J. , Curtis Erin R. , Murphy Kimberly A. , Welch Roy D.
Published: September 2021

Myxococcus xanthus
grows on surfaces as a predatory biofilm called a swarm. In nature, a feeding swarm expands by moving over and consuming prey bacteria.
Propagating uplift controls on high-elevation, low-relief landscape formation in the southeast Tibetan Plateau
Authors: Yuan X.P. , Huppert K.L. , Braun J. , Shen X. , Liu-Zeng J. , Guerit L. , Wolf S.G. , Zhang J.F. , Jolivet M.
Published: September 2021

High-elevation, low-relief surfaces are widespread in many mountain belts. However, the origin of these surfaces has long been debated. In particular, the southeast Tibetan Plateau has extensive low-relief surfaces perched above deep valleys and in the headwaters of three of the world's largest rivers (Salween, Mekong, and Yangtze Rivers). Various geologic data and geodynamic models show that many mountain belts grow first to a certain height and then laterally in an outward propagation sequence. By translating this information into a kinematic propagating uplift function in a landscape evolution model, we propose that the high-elevation, low-relief surfaces in the southeast Tibetan Plateau are simply a consequence of mountain growth and do not require a special process to form. The propagating uplift forms an elongated river network geometry with broad high-elevation, low-relief headwaters and interfluves that persist for tens of millions of years, consistent with the observed geochronology. We suggest that the low-relief interfluves can be long-lived because they lack the drainage networks necessary to keep pace with the rapid incision of the large main-stem rivers. The propagating uplift also produces spatial and temporal exhumation patterns and river profile morphologies that match observations. Our modeling therefore reconciles geomorphic observations with geodynamic models of uplift of the southeast Tibetan Plateau, and it provides a simple mechanism to explain the low-relief surfaces observed in several mountain belts on Earth.
Activity of Energy and Carbohydrate Metabolism Enzymes in the Juvenile Pink Salmon Oncorhynchus gorbuscha (Walb.) during the Transition from Freshwater to a Marine Environment
Authors: Churova M. V. , Shulgina N. S. , Krupnova M. Yu. , Efremov D. A. , Nemova N. N.
Published: September 2021

Biochemical adaptations of energy metabolism and some pathways of glucose oxidation during a change in salinity of the environment in larvae and smolts of the pink salmonOncorhynchus gorbuscha(Walb.) inhabiting the White Sea were studied. We assayed the activity of energy and carbohydrate metabolism enzymes (cytochromecoxidase (COХ), lactate dehydrogenase (LDH), glucose-6-phosphate dehydrogenase (G6PDH), 1-glycerophosphate dehydrogenase (1-GPDH), and aldolase) in pink salmon larvae in a short-term aquarium experiment and in pink salmon smolts in a long-term cage experiment simulating the transition of juveniles from freshwater to a marine environment. A decrease in the activity of COX, LDH, 1‑GPDH, and aldolase already in the first hour after the transfer of larvae to seawater was shown. Smolts kept in the estuary and in the sea had low levels of activity of 1-GPDH and aldolase in comparison with individuals from the river. Most likely, in the salmon juveniles studied, there was a redistribution of carbohydrates between the reactions of aerobic and anaerobic metabolism in favor of anaerobic ATP synthesis. No changes in the enzyme activity of the pentose phosphate pathway, G-6-PDH, were found in either larvae or smolts compared with the individuals kept in freshwater. Maintenance of the required levels of anaerobic metabolism and of the pentose phosphate pathway is probably one of the mechanisms of biochemical adaptation of pink salmon to changes in salinity.
Giant cell tumour of EHL tendon sheath in young: a rare case report and review of the literature
Authors: Pathak Subodh Kumar , Salunke Abhijeet Ashok , Virk Jagandeep Singh , Kumar Naveen
Published: September 2021

Giant cell tumour of tendon sheath also known as benign synovioma is a slow-growing benign tumour originating from tendon sheath, ligaments or bursa. We present a case of swelling over the left foot of 7-month duration in 11-year-old boy diagnosed as giant cell tumour of tendon sheath. There was an extensive pressure effect of tumour mass on the second metatarsal evident by scalloping. Local excision was planned and executed, and reduction in scalloping was evident at 26-month follow-up with no recurrence. We conclude that en bloc resection of tumour with a hydrogen peroxide lavage may result in a favourable prognosis without recurrence.
Diagnosis and management of temporomandibular joint dysfunction before surgery: a case report
Authors: Tateno Ken , Mieda Tsutomu , Doi Katsushi
Published: September 2021

We present a case of colorectal cancer with temporomandibular joint dysfunction and discuss the management of the case. Type IIIb temporomandibular disorder involves anterior dislocation of the articular disk, trismus and difficult intubation. A 68-year-old woman was scheduled for colectomy. The day before surgery, the patient had temporomandibular pain. On examination, the mouth opening was 13 mm. We diagnosed type IIIb temporomandibular disorder. A simple splint was fabricated with gauze and she bit it. The mouth opening was 55 mm on the day of surgery. The pain disappeared, and intubation was uneventful. Temporomandibular disorders are generally treated by dentists. It is beneficial for general hospitals without a dentistry department to employ a dental anaesthesiologist to assist in potentially difficult intubations in patients with temporomandibular disorders.
Hepatopulmonary syndrome as the first and only manifestation of cirrhosis in a patient with hypopituitarism
Authors: Alabsawy Eman , Serry Yassen , Kotha Sreelakshmi , Berry Philip , Tritto Giovanni
Published: September 2021

Hepatopulmonary syndrome (HPS) is characterised by the development of intrapulmonary arteriovenous blood shunts and vascular dilatation with consequent hypoxaemia, usually in the context of end-stage liver disease (ESLD). The estimated incidence of HPS in ESLD has been reported to be 13%–47%. Chronic liver disease has been described in patients with hypothalamic–pituitary dysfunction, mainly in the form of non-alcoholic fatty liver disease due to metabolic syndrome, with occasional progression to cirrhosis. We report a challenging case of a 27-year-old man with a background of hypopituitarism with no known liver disease who presented with progressive dyspnoea and hypoxaemia and was eventually diagnosed with severe HPS.
Endoluminal management of benign bronchoesophageal fistula
Authors: Wahi Jessica E , Rocco Diana , Williams Roy , Safdie Fernando M
Published: September 2021

The ideal management of bronchoesophageal fistulas is a debated topic. While open surgical repair remains the most definitive treatment, not all patients are fit for surgery. In this communication, we present a patient who developed a bronchoesophageal fistula 1 year after an Ivor Lewis esophagectomy that involved the native oesophagus and right mainstem bronchus. Endoluminal vacuum therapy was successful at closing this benign bronchoesophageal fistula.
Patient and caregiver factors in ambulatory incident reports: a mixed-methods analysis
Authors: Sharma Anjana E , Huang Beatrice ,   Stakeholder Research Advisory Council, Del Rosario Jan Bing , Yang Janine , Boscardin W John , Sarkar Urmimala
Published: September 2021

Objectives

Patients and caregivers are the primary stakeholders in ambulatory safety, given they perform daily chronic disease self-management, medication administration and outpatient follow-up. However, little attention has been given to their role in adverse events. We identified themes related to patient and caregiver factors and challenges in ambulatory safety incident reports from a Patient Safety Organization.

Methods

We conducted a mixed-methods analysis of ambulatory incident reports submitted to the Collaborative Healthcare Patient Safety Organization, including 450 hospitals or clinic members in 13 US states. We included events that had patient and/or caregiver behavioural, socioeconomic and clinical factors that may have contributed to the event. Two members of the team independently coded patient/caregiver factors, with dual coding of 20% of events. We then conducted a ‘frequent item set’ analysis to identify which factors most frequently co-occurred. We applied inductive analysis to the most frequent sets to interpret themes. Our team included a diverse stakeholder advisory council of patients, caregivers and healthcare staff.

Results

We analysed 522 incident reports and excluded 73 for a final sample of 449 events. Our co-occurrence analysis found the following three themes: (1) clinical advice may conflict with patient priorities; (2) breakdowns in communication and patient education cause medication adverse events and (3) patients with disabilities are vulnerable to the external environment.

Conclusions

Ambulatory safety reports capture both structural and behavioural factors contributing to adverse events. Actionable takeaways include the following: improving clinician counselling of patients to convey medical advice to elicit priorities, enhanced education regarding medication adverse events and expanding safety precautions for patients with disabilities at home. Ambulatory safety reporting must include patients in reporting and event review for better mitigation of future harm.
COVID-19 is associated with distinct myopathic features in the diaphragm of critically ill patients
Authors: Shi Zhonghua , Bogaards Sylvia J P , Conijn Stefan , Onderwater Yeszamin , Espinosa Pedro , Bink Diewertje I , van den Berg Marloes , van de Locht Martijn , Bugiani Marianna , van der Hoeven Hans , Boon Reinier A , Heunks Leo , Ottenheijm Coen A C
Published: September 2021

Introduction

The diaphragm is the main muscle of inspiration, and its dysfunction contributes to adverse clinical outcomes in critically ill patients. We recently reported the infiltration of SARS-CoV-2, and the development of fibrosis, in the diaphragm of critically ill patients with COVID-19. In the current study, we aimed to characterise myofiber structure in the diaphragm of critically ill patients with COVID-19.

Methods

Diaphragm muscle specimens were collected during autopsy from patients who died of COVID-19 in three academic medical centres in the Netherlands in April and May 2020 (n=27). We studied diaphragm myofiber gene expression and structure and compared the findings obtained to those of deceased critically ill patients without COVID-19 (n=10).

Results

Myofibers of critically ill patients with COVID-19 showed on average larger cross-sectional area (slow-twitch myofibers: 2441±229 vs 1571±309 µm2; fast-twitch myofibers: 1966±209 vs 1225±222 µm2). Four critically ill patients with COVID-19 showed extremely large myofibers, which were splitting and contained many centralised nuclei. RNA-sequencing data revealed differentially expressed genes involved in muscle regeneration.

Conclusion

Diaphragm of critically ill patients with COVID-19 has distinct myopathic features compared with critically ill patients without COVID-19, which may contribute to the ongoing dyspnoea and fatigue in the patients surviving COVID-19 infection.
Prognostic value of admission high-sensitivity troponin in patients with ST-elevation myocardial infarction
Authors: Coelho-Lima Jose , Georgiopoulos Georgios , Ahmed Javed , Adil Syeda E R , Gaskin David , Bakogiannis Constantinos , Sopova Kateryna , Ahmed Fareen , Ahmed Haaris , Spray Luke , Richardson Gavin , Bagnall Alan J , Stellos Konstantinos , Stamatelopoulos Kimon , Spyridopoulos Ioakim
Published: September 2021

Background and aim

Although the diagnostic usefulness of high-sensitivity cardiac troponin T (hs-cTnT) is well established in ST-segment elevation myocardial infarction (STEMI), its prognostic relevance in risk stratification of patients with STEMI remains obscure. This study sought to determine the prognostic value of pre-reperfusion (admission) and post-reperfusion (12-hour) hs-cTnT in patients with STEMI treated with primary percutaneous coronary intervention (PPCI).

Methods

Retrospective observational longitudinal study including consecutive patients with STEMI treated with PPCI at a university hospital in the northeast of England. hs-cTnT was measured at admission to the catheterisation laboratory and 12 hours after PPCI. Clinical, procedural and laboratory data were prospectively collected during patient hospitalisation (June 2010–December 2014). Mortality data were obtained from the UK Office of National Statistics. The study endpoints were in-hospital and overall mortality.

Results

A total of 3113 patients were included. Median follow-up was 53 months. Admission hs-cTnT >515 ng/L (fourth quartile) was independently associated with in-hospital mortality (HR=2.53 per highest to lower quartiles; 95% CI: 1.32 to 4.85; p=0.005) after multivariable adjustment for a clinical model of mortality prediction. Likewise, admission hs-cTnT >515 ng/L independently predicted overall mortality (HR=1.27 per highest to lower quartiles; 95% CI: 1.02 to 1.59; p=0.029). Admission hs-cTnT correctly reclassified risk for in-hospital death (net reclassification index (NRI)=0.588, p<0.001) and overall mortality (NRI=0.178, p=0.001). Conversely, 12-hour hs-cTnT was not independently associated with mortality.

Conclusion

Admission, but not 12-hour post-reperfusion, hs-cTnT predicts mortality and improves risk stratification in the PPCI era. These results support a prognostic role for admission hs-cTnT while challenge the cost-effectiveness of routine 12-hour hs-cTnT measurements in patients with STEMI.
Role of genetics in amyotrophic lateral sclerosis: a large cohort study in Chinese mainland population
Authors: Chen Yong-Ping , Yu Shi-Hui , Wei Qian-Qian , Cao Bei , Gu Xiao-Jing , Chen Xue-Ping , Song Wei , Zhao Bi , Wu Ying , Sun Ming-Ming , Liu Fei-Fei , Hou Yan-Bing , Ou Ru-Wei , Zhang Ling-Yu , Liu Kun-Cheng , Lin Jun-Yu , Xu Xin-Ran , Li Chun-Yu , Yang Jing , Jiang Zheng , Liu Jiao , Cheng Yang-Fan , Xiao Yi , Chen Ke , Feng Fei , Cai Ying-Ying , Li Shi-Rong , Hu Tao , Yuan Xiao-Qin , Guo Xiao-Yan , Liu Hui , Han Qing , Zhou Qing-Qing , Shao Na , Li Jian-Peng , Pan Ping-Lei , Ma Sha , Shang Hui-Fang
Published: September 2021

Background

A large number of new causative and risk genes for amyotrophic lateral sclerosis (ALS) have been identified mostly in patients of European ancestry. In contrast, we know relatively little regarding the genetics of ALS in other ethnic populations. This study aims to provide a comprehensive analysis of the genetics of ALS in an unprecedented large cohort of Chinese mainland population and correlate with the clinical features of rare variants carriers.

Methods

A total of 1587 patients, including 64 familial ALS (FALS) and 1523 sporadic ALS (SALS), and 1866 in-house controls were analysed by whole-exome sequencing and/or testing for G4C2 repeats in C9orf72. Forty-one ALS-associated genes were analysed.

Findings

155 patients, including 26 (40.6%) FALS and 129 (8.5%) SALS, carrying rare pathogenic/likely pathogenic (P/LP) variants of ALS causative genes were identified. SOD1 was the most common mutated gene, followed by C9orf72, FUS, NEK1, TARDBP and TBK1. By burden analysis, rare variants in SOD1, FUS and TARDBP contributed to the collective risk for ALS (p<2.5e-6) at the gene level, but at the allelic level TARDBP p.Gly294Val and FUS p.Arg521Cys and p.Arg521His were the most important single variants causing ALS. Clinically, P/LP variants in TARDBP and C9orf72 were associated with poor prognosis, in FUS linked with younger age of onset, and C9orf72 repeats tended to affect cognition.

Conclusions

Our data provide essential information for understanding the genetic and clinical features of ALS in China and for optimal design of genetic testing and evaluation of disease prognosis.
Stent-assisted coiling of dural sinus diverticula: a case series
Authors: Keshary Sanjeev Raj , Everett Travis , Alvarado Anthony Michael , Abraham Michael G
Published: September 2021

Background

Dural sinus diverticula are a rare vascular etiology of pulsatile tinnitus. Patients typically present with disabling symptoms and undergo an extensive workup for common causes of pulsatile tinnitus. Endovascular treatment has been shown to be effective in several case reports. We present the largest case series of eight patients treated with endovascular therapy using stent-assisted coiling and describe the unique details of intervention.

Methods

A retrospective chart review was performed on all patients who underwent endovascular dural sinus stenting.

Results

One-hundred-twenty patients underwent dural sinus stetnting from August 2012 to February 2020. Eight of these had symptomatic pulsatile tinnitus secondary to a dural sinus diverticulum and were successfully treated with stent-assisted coil embolization. No complications occurred.

Conclusion

Our case series demonstrates that endovascular dural sinus stent-assisted coil embolization for symptomatic dural sinus diverticula is a safe and effective treatment.
Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a meta-analysis
Authors: Deng Gang , Xiao Jun , Yu Haihan , Chen Man , Shang Ke , Qin Chuan , Tian Dai-Shi
Published: September 2021

Background

Despite successful recanalization after endovascular treatment, many patients with acute ischemic stroke due to large vessel occlusion still show functional dependence, namely futile recanalization.

Methods

PubMed and Embase were searched up to April 30, 2021. Studies that reported risk factors for futile recanalization following endovascular treatment of acute ischemic stroke were included. The mean difference (MD) or odds ratio (OR) and 95% confidence interval (95% CI) of each study were pooled for a meta-analysis.

Results

Twelve studies enrolling 2138 patients were included. The pooled analysis showed that age (MD 5.81, 95% CI 4.16 to 7.46), female sex (OR 1.40, 95% CI 1.16 to 1.68), National Institutes of Health Stroke Scale (NIHSS) score (MD 4.22, 95% CI 3.38 to 5.07), Alberta Stroke Program Early CT Score (ASPECTS) (MD −0.71, 95% CI −1.23 to –0.19), hypertension (OR 1.73, 95% CI 1.43 to 2.09), diabetes (OR 1.78, 95% CI 1.41 to 2.24), atrial fibrillation (OR 1.24, 95% CI 1.01 to 1.51), admission systolic blood pressure (MD 4.98, 95% CI 1.87 to 8.09), serum glucose (MD 0.59, 95% CI 0.37 to 0.81), internal carotid artery occlusion (OR 1.85, 95% CI 1.17 to 2.95), pre-treatment intravenous thrombolysis (OR 0.67, 95% CI 0.55 to 0.83), onset-to-puncture time (MD 16.92, 95% CI 6.52 to 27.31), puncture-to-recanalization time (MD 12.37, 95% CI 7.96 to 16.79), and post-treatment symptomatic intracerebral hemorrhage (OR 6.09, 95% CI 3.18 to 11.68) were significantly associated with futile recanalization.

Conclusion

This study identified female sex, comorbidities, admission systolic blood pressure, serum glucose, occlusion site, non-bridging therapy, and post-procedural complication as predictors of futile recanalization, and also confirmed previously reported factors. Further large-scale prospective studies are needed.
Cost-effectiveness analysis of endovascular coiling and neurosurgical clipping for aneurysmal subarachnoid hemorrhage in Thailand
Authors: Duangthongphon Pichayen , Kitkhuandee Amnat , Munkong Waranon , Limwattananon Phumtham , Waleekhachonloet Onanong , Rattanachotphanit Thananan , Limwattananon Supon
Published: September 2021

Background

For patients with aneurysmal subarachnoid hemorrhage (aSAH), the Universal Coverage Scheme in Thailand covers the full costs of surgical and endovascular procedures except for those of embolization coils and assisting devices. Costs and effectiveness were compared between endovascular coiling and neurosurgical clipping to inform reimbursement policy decisions.

Methods

Costs and quality-adjusted life years (QALYs) were compared between coiling and clipping using the decision tree and Markov models. Mortality and functional outcomes of clipping were derived from national and hospital databases, and relative efficacies of coiling were obtained from meta-analyses of randomized controlled trials. Risks of rebleeding were abstracted from the International Subarachnoid Aneurysm Trial. Costs of the primary treatments, retreatments and follow-up care as well as utilities were obtained from hospital-based data. Non-health and indirect costs were abstracted from standard cost lists.

Results

Coiling and clipping contributed 10.59 and 9.28 QALYs to patients aged in their 50s. Under the societal and healthcare perspectives, the incremental costs incurred by coiling compared with clipping were US$1923 and $4343, respectively, which were equal to the incremental cost-effectiveness ratio of US$1470 and $3321 per QALY gained, respectively. Coiling became a cost-saving option when the costs of coil devices were reduced by 65.7%. At the country’s cost-effectiveness threshold of US$5156, the probability of coiling being cost-effective was 71.3% and 65.6%, under the societal and healthcare perspectives, respectively.

Conclusion

Endovascular treatment for aSAH is cost-effective and this evidence supports coverage by national insurance.