bluuebunny/crossref_metadata_2025 huggingface dataset:
PatientExploreR: an extensible application for dynamic visualization of patient clinical history from electronic health records in the OMOP common data model
Authors: Glicksberg Benjamin S , Oskotsky Boris , Thangaraj Phyllis M , Giangreco Nicholas , Badgeley Marcus A , Johnson Kipp W , Datta Debajyoti , Rudrapatna Vivek A , Rappoport Nadav , Shervey Mark M , Miotto Riccardo , Goldstein Theodore C , Rutenberg Eugenia , Frazier Remi , Lee Nelson , Israni Sharat , Larsen Rick , Percha Bethany , Li Li , Dudley Joel T , Tatonetti Nicholas P , Butte Atul J
Published: June 2019

Motivation

Electronic health records (EHRs) are quickly becoming omnipresent in healthcare, but interoperability issues and technical demands limit their use for biomedical and clinical research. Interactive and flexible software that interfaces directly with EHR data structured around a common data model (CDM) could accelerate more EHR-based research by making the data more accessible to researchers who lack computational expertise and/or domain knowledge.

Results

We present PatientExploreR, an extensible application built on the R/Shiny framework that interfaces with a relational database of EHR data in the Observational Medical Outcomes Partnership CDM format. PatientExploreR produces patient-level interactive and dynamic reports and facilitates visualization of clinical data without any programming required. It allows researchers to easily construct and export patient cohorts from the EHR for analysis with other software. This application could enable easier exploration of patient-level data for physicians and researchers. PatientExploreR can incorporate EHR data from any institution that employs the CDM for users with approved access. The software code is free and open source under the MIT license, enabling institutions to install and users to expand and modify the application for their own purposes.

Availability and implementation

PatientExploreR can be freely obtained from GitHub: https://github.com/BenGlicksberg/PatientExploreR. We provide instructions for how researchers with approved access to their institutional EHR can use this package. We also release an open sandbox server of synthesized patient data for users without EHR access to explore: http://patientexplorer.ucsf.edu.

Supplementary information

Supplementary data are available at Bioinformatics online.
Asymmetries in reproductive anatomy: insights from promiscuous songbirds
Authors: Calhim Sara , Pruett-Jones Stephen , Webster Michael S , Rowe Melissah
Published: June 2019

Directional asymmetry in gonad size is commonly observed in vertebrates and is particularly pronounced in birds, where the left testis is frequently larger than the right. The adaptive significance of directional asymmetry in testis size is poorly understood, and whether it extends beyond the testes (i.e. side-correspondent asymmetry along the reproductive tract) has rarely been considered. Using the Maluridae, a songbird family exhibiting variation in levels of sperm competition and directional testis asymmetry, yet similar in ecology and life history, we investigated the relative roles of side-correspondence and sperm competition on male reproductive tract asymmetry at both inter- and intraspecific levels. We found some evidence for side-correspondent asymmetry. Additionally, sperm competition influenced directional asymmetry at each end of the reproductive tract: species experiencing higher levels of sperm competition had a relatively larger right testis and relatively more sperm in the right seminal glomerus. Within red-backed fairy-wrens (Malurus melanocephalus), auxiliary males had relatively more sperm in the left seminal glomerus, in contrast to a right-bias asymmetry throughout the reproductive tract in breeding males. Given that the number of sperm is important for competitive fertilization success, our results suggest that sperm competition shapes reproductive asymmetries beyond testis size, with likely functional consequences for male reproductive success.
The histone methyltransferase EZH2 is required for normal uterine development and function in mice†
Authors: Nanjappa Manjunatha K , Mesa Ana M , Medrano Theresa I , Jefferson Wendy N , DeMayo Francesco J , Williams Carmen J , Lydon John P , Levin Ellis R , Cooke Paul S
Published: June 2019

Enhancer of zeste homolog 2 (EZH2) is a rate-limiting catalytic subunit of a histone methyltransferase, polycomb repressive complex, which silences gene activity through the repressive histone mark H3K27me3. EZH2 is critical for epigenetic effects of early estrogen treatment, and may be involved in uterine development and pathologies. We investigated EZH2 expression, regulation, and its role in uterine development/function. Uterine epithelial EZH2 expression was associated with proliferation and was high neonatally then declined by weaning. Pre-weaning uterine EZH2 expression was comparable in wild-type and estrogen receptor 1 knockout mice, showing neonatal EZH2 expression is ESR1 independent. Epithelial EZH2 was upregulated by 17β-estradiol (E2) and inhibited by progesterone in adult uteri from ovariectomized mice. To investigate the uterine role of EZH2, we developed a EZH2 conditional knockout (Ezh2cKO) mouse using a cre recombinase driven by the progesterone receptor (Pgr) promoter that produced Ezh2cKO mice lacking EZH2 in Pgr-expressing tissues (e.g. uterus, mammary glands). In Ezh2cKO uteri, EZH2 was deleted neonatally. These uteri had reduced H3K27me3, were larger than WT, and showed adult cystic endometrial hyperplasia. Ovary-independent uterine epithelial proliferation and increased numbers of highly proliferative uterine glands were seen in adult Ezh2cKO mice. Female Ezh2cKO mice were initially subfertile, and then became infertile by 9 months. Mammary gland development in Ezh2cKO mice was inhibited. In summary, uterine EZH2 expression is developmentally and hormonally regulated, and its loss causes aberrant uterine epithelial proliferation, uterine hypertrophy, and cystic endometrial hyperplasia, indicating a critical role in uterine development and function.
Cortical Structure and Cognition in Infants and Toddlers
Authors: Girault Jessica B , Cornea Emil , Goldman Barbara D , Jha Shaili C , Murphy Veronica A , Li Gang , Wang Li , Shen Dinggang , Knickmeyer Rebecca C , Styner Martin , Gilmore John H
Published: June 2019

Cortical structure has been consistently related to cognitive abilities in children and adults, yet we know little about how the cortex develops to support emergent cognition in infancy and toddlerhood when cortical thickness (CT) and surface area (SA) are maturing rapidly. In this report, we assessed how regional and global measures of CT and SA in a sample (N = 487) of healthy neonates, 1-year-olds, and 2-year-olds related to motor, language, visual reception, and general cognitive ability. We report novel findings that thicker cortices at ages 1 and 2 and larger SA at birth, age 1, and age 2 confer a cognitive advantage in infancy and toddlerhood. While several expected brain–cognition relationships were observed, overlapping cortical regions were also implicated across cognitive domains, suggesting that infancy marks a period of plasticity and refinement in cortical structure to support burgeoning motor, language, and cognitive abilities. CT may be a particularly important morphological indicator of ability, but its impact on cognition is relatively weak when compared with gestational age and maternal education. Findings suggest that prenatal and early postnatal cortical developments are important for cognition in infants and toddlers but should be considered in relation to other child and demographic factors.
Impact of preoperative atrial fibrillation on thromboembolic events and pump thrombosis in long-term left ventricular assist device therapy
Authors: Pedde David , Soltani Sajjad , Stein Julia , Tsyganenko Dmytro , Müller Markus , Schönrath Felix , Falk Volkmar , Potapov Evgenij V
Published: June 2019

OBJECTIVES

Pump thrombosis (PT) and thromboembolic events (TEs) remain major adverse events in left ventricular assist device (LVAD) therapy at an annual rate of 6–8% supported with the HeartWare HVAD and HeartMate II. PT and TEs are multifactorial events. Understanding the predisposing risk factors for PT and TE is paramount to define preventive strategies. Preoperative atrial fibrillation (AF) is considered a significant and potentially modifiable risk factor. This study investigates whether LVAD patients with AF exhibit a higher rate of PT and TE than those in sinus rhythm (SR).

METHODS

We evaluated medical records of consecutive patients who underwent implantation of the HeartMate II (n = 195; 25.4%) and HeartWare HVAD (n = 574; 74.6%) at our institution between 2006 and 2015. Only visually confirmed PT was included in the study. TE was defined as any peripheral embolism or cerebral embolism according to the INTERMACS definitions.

RESULTS

SR was documented preoperatively in 211 patients (SR group) and AF in 558 patients (AF group). The median duration of support was 0.78 years in the AF group and 1.03 years in the SR group. The mean age was 60.27 years in the AF group and 52.04 years in the SR group. In the AF group, 83.0% of the patients were male, compared to 77.3% in the SR group. The cumulative incidence of PT in the SR group was 2.5% [95% confidence interval (CI) 0.3–4.7%] after 1 year and 5.7% (95% CI 2.2–9.2%) after 2 years, and in the AF group 4.9% (95% CI 3.0–6.7%) and 7.8% (95% CI 5.4–10.2%), respectively (P = 0.129). TEs were recorded in the SR group in 4.4% (95% CI 1.6–7.2%) after 1 year and in 6.3% (95% CI 2.8–9.8%) after 2 years, and occurred after a median support time of 214 days (range 120–768). In the AF group, the cumulative incidence was 8.4% (95% CI 6.0–10.7%) and 10.7% (95% CI 8.0–13.4%), respectively, after a median support time of 116 days (range 37–375), P-value = 0.163. In the multivariate analysis, event-free survival was not influenced by the preoperative SR [hazard ratio (HR) 0.86, 95% CI 0.68–1.1; P = 0.19].

CONCLUSIONS

Our study showed that the preoperative rhythm has no impact on survival, PT and TEs despite different preoperative risk factor profiles in the AF and SR group. Thus, the effect of a maze procedure, catheter ablation or left atrial appendage closure on PT and TE’s for AF patients during LVAD implantation is questionable. However, to obtain a definitive answer, a prospective study would be of value.
Challenges with quality of race and ethnicity data in observational databases
Authors: Polubriaginof Fernanda C G , Ryan Patrick , Salmasian Hojjat , Shapiro Andrea Wells , Perotte Adler , Safford Monika M , Hripcsak George , Smith Shaun , Tatonetti Nicholas P , Vawdrey David K
Published: June 2019

Objective

We sought to assess the quality of race and ethnicity information in observational health databases, including electronic health records (EHRs), and to propose patient self-recording as an improvement strategy.

Materials and Methods

We assessed completeness of race and ethnicity information in large observational health databases in the United States (Healthcare Cost and Utilization Project and Optum Labs), and at a single healthcare system in New York City serving a racially and ethnically diverse population. We compared race and ethnicity data collected via administrative processes with data recorded directly by respondents via paper surveys (National Health and Nutrition Examination Survey and Hospital Consumer Assessment of Healthcare Providers and Systems). Respondent-recorded data were considered the gold standard for the collection of race and ethnicity information.

Results

Among the 160 million patients from the Healthcare Cost and Utilization Project and Optum Labs datasets, race or ethnicity was unknown for 25%. Among the 2.4 million patients in the single New York City healthcare system’s EHR, race or ethnicity was unknown for 57%. However, when patients directly recorded their race and ethnicity, 86% provided clinically meaningful information, and 66% of patients reported information that was discrepant with the EHR.

Discussion

Race and ethnicity data are critical to support precision medicine initiatives and to determine healthcare disparities; however, the quality of this information in observational databases is concerning. Patient self-recording through the use of patient-facing tools can substantially increase the quality of the information while engaging patients in their health.

Conclusions

Patient self-recording may improve the completeness of race and ethnicity information.
The Impact of Resource Scarcity on Price-Quality Judgments
Authors: Park Hanyong , Lalwani Ashok K , Silvera David H
Published: June 2019

Consumers routinely encounter situations in which they perceive that resources are scarce. However, little is known about how this perception influences consumers’ use of price in their purchase decisions. The present research seeks to fill this gap by examining the link between scarcity and the tendency to use price to judge product quality, and the mechanisms underlying that link. Six studies (and five more reported in the web appendix) using multiple product categories and a variety of operationalizations of both scarcity and price-quality judgments show that scarcity decreases consumers’ tendency to use price to judge product quality. This occurs because scarcity induces a desire to compensate for the shortage and seek abundance, and thereby reduces an individual’s general categorization tendency (because categorizing brings about a feeling of reduction); this, in turn, hinders consumers from viewing products as belonging to different price-tier groups, and thus lowers their tendency to use price as a basis for judging product quality. Boundary conditions for the proposed effect are also identified. The current research makes fundamental contributions to the literatures on scarcity, price-quality judgments, and categorization.
The absence of [C ii] 158 $\mu$m emission in spectroscopically confirmed galaxies at z > 8
Authors: Laporte N , Katz H , Ellis R S , Lagache G , Bauer F E , Boone F , Inoue A K , Hashimoto T , Matsuo H , Mawatari K , Tamura Y
Published: June 2019

The scatter in the relationship between the strength of [C ii] 158 $\mu$m emission and the star formation rate at high redshift has been the source of much recent interest. Although the relationship is well established locally, several intensely star-forming galaxies have been found whose [C ii] 158 $\mu$m emission is either weak, absent, or spatially offset from the young stars. Here we present new ALMA data for the two most distant gravitationally lensed and spectroscopically confirmed galaxies, A2744_YD4 at z = 8.38 and MACS1149_JD1 at z = 9.11, both of which reveal intense [O iii] 88 $\mu$m emission. In both cases we provide stringent upper limits on the presence of [C ii] 158 $\mu$m with respect to [O iii] 88 $\mu$m. We review possible explanations for this apparent redshift-dependent [C ii] deficit in the context of our recent hydrodynamical simulations. Our results highlight the importance of using several emission line diagnostics with ALMA to investigate the nature of the interstellar medium in early galaxies.
Introduction
Authors: Giardini Francesca , Wittek Rafael
Published: June 2019

This introductory chapter sketches the contours of an emerging multidisciplinary and interdisciplinary research program on the conceptual foundations, antecedents, dynamics, and consequences of gossip and reputation. It argues that this research agenda should be developed along three interrelated dimensions. First, gossip and reputation are multifaceted theoretical constructs that share at least six key characteristics. Both are relational and triadic, morally laden, multifunctional, and context-dependent social phenomena that have an evolutionary base and are subject to strategic behavior. Each of the chapters in this Handbook touches upon at least one of these facets. Second, in order to adequately capture this complexity, a multidisciplinary and eventually interdisciplinary approach is needed. Intradisciplinary progress is a precondition for high-quality multidisciplinary scholarship. Third, the frontier of much current research crystallizes around six substantive problem domains, capturing different levels of analysis and their interplay.
Gossip and Emotion
Authors: Martinescu Elena , Janssen Onne , Nijstad Bernard A.
Published: June 2019

This chapter proposes that emotions are strongly involved in the functioning of gossip as a mechanism that regulates interpersonal behavior. Emotions may both shape and result from the transmission of gossip, because gossip is associated with any events relevant to individuals’ need and goal fulfillment, and thus fundamentally related to their adaptive success and well-being. First, emotions motivate people to engage in gossip behavior, thereby operating as antecedents of gossip. Second, emotions are experienced by gossip senders and receivers as an intrinsic aspect of the gossiping activity, and therefore emotions are endogenous to gossip. Third, emotions arise in reaction to gossip and may function to prepare behavioral responses for gossip receivers and targets; thus, emotions are important consequences of gossip. The chapter concludes that people’s understanding of gossip may be substantially enhanced when emotions are taken into consideration.
What is Foreign Relations Law?
Authors: Bradley Curtis A.
Published: June 2019

This chapter considers what is potentially encompassed by the term “foreign relations law,” and what it means to think about it as a distinct field of law that can be compared and contrasted across national jurisdictions. The term “foreign relations law” encompasses the domestic law of each nation that governs how that nation interacts with the rest of the world. Many issues of foreign relations law concern allocations of authority between political actors, such as the authority to represent the nation in diplomacy, to conclude and terminate international agreements, to recognize foreign governments and their territories, and to initiate or end the use of military force. But foreign relations law also encompasses issues relating to the role of the courts in transnational cases, such as whether certain issues are “nonjusticiable” and thus subject entirely to political branch determination, whether courts should take into account considerations of international comity when interpreting and applying domestic law, and whether and to what extent courts can apply international law directly to decide a particular case. The chapter describes the historical development of foreign relations law as a field of study within the United States and considers why it has not been treated as a field in many other countries. The chapter concludes by highlighting a central question for foreign relations law, which is the extent to which it should be treated differently than other types of domestic law—referred to in the United States as a debate over “foreign affairs exceptionalism.”
The Belief View of Assertion
Authors: Siebel Mark
Published: June 2019

This article discusses the belief view of assertion, which considers assertion to be basically the expression of a belief. Let “S” stand for the asserter and “p” be a placeholder for a declarative sentence providing the content of the assertion. Then the belief view, in its purest form, takes “S asserts that p” to mean that S expresses the belief that p. The article proceeds as follows. It first introduces three general worries threatening variants of the belief view. Afterwards, it deals with Green’s disjunctive analysis, which utilizes a factive concept of belief expression for delineating sincere assertions and then provides conditions for insincere assertions. The remaining sections turn to Bach and Harnish’s, Davis’s, and Kemmerling’s variants of the belief view. They are connected by applying a nonfactive concept of belief expression to both sincere and insincere assertions. It is shown that these accounts face a common problem. The involved notion of indicating a belief has to be weak enough to allow for obviously insincere assertions, that is, cases in which it is evident to all eyes that the utterer does not believe what she asserts. But then it appears to be too weak to exclude utterances by which an assertion is simulated but not performed.
Protection of the Health of Newborns
Authors: Van Howe Robert
Published: June 2019

Infants lack capacity, so the state assigns parents the authority to grant permission on behalf of their child for interventions that are routine, non-emergent interventions, or emergent/life-preserving. For the infant who is severely compromised medically and for whom any intervention would be considered futile, a dialectic between preserving “life at all costs” and the infant’s interest in avoiding unnecessary suffering emerges, prompting potential schisms between parents, physicians, the medical facility, and the state—each of which brings its own biases. Physicians are charged with compassionately providing accurate disclosure that is free of bias and refraining from exerting coercive influence. Parents need to be allowed the space and support to thoughtfully deliberate. Medical facilities, through ethics committees, can provide a path to resolving conflicts without resorting to adjudication in courts. Deliberation should focus on the principles of the infant’s best interests and substitute judgment.
How Federal Laws Pertaining to Foster Care Financing Shape Child Welfare Services
Authors: Duerr Berrick Jill , Heimpel Daniel
Published: June 2019

This chapter examines federal child welfare policy in historical perspective with close attention to the financial inducements used to encourage state policy and practice. The authors show that rather than setting a single child welfare policy for all fifty states, the US approach relies heavily on the budgeting process as a mechanism for shaping the field. Examples include the structure for accepting and responding to child maltreatment referrals; the design of foster care services; the approach to reunification and permanency services; extension of foster care beyond age eighteen; and, most recently, adoption of foster care prevention services to reduce reliance on out-of-home care. The result is similar system goals across states, with ample opportunities for disparate system designs and likely different experiences for families.
Conspiracy Theories
Authors: Uscinski Joseph E.
Published: June 2019

Conspiracy theories have become a more prominent part of political discourse in recent years. But, social scientists are only beginning to learn about their role in political persuasion. This chapter considers some important questions regarding them: Can conspiracy theories, or a worldview shaped by conspiracy thinking, change attitudes, alter behavior, or generate collective action? Who uses conspiracy theories to persuade and for what purposes? Are such attempts successful? It first reviews what social scientists have learned about conspiracy theories and the people who believe them and then advocates for a research agenda which better situates conspiracy theories within the literature addressing political persuasion.
Cellular Signalling Systems
Authors: Le Duc Diana , Schöneberg Torsten
Published: June 2019

Effective reception, delivery, and processing of information is fundamental to all life forms. Physical and chemical signals are perceived from both outside and inside an organism. The nature, duration, and intensity of signals are processed into information, mainly encoded as concentration differences of ions and molecules that ultimately lead to a reaction of the organism. Although the advent of the first and most primitive signalling system will remain unknown, it probably existed already in the first hours of life. Disturbances of well-orchestrated signalling systems are often the basis of diseases. Understanding the complexity of signalling networks is required for rational intervention in different disease stages. Understanding the evolutionary history of signalling systems can help us unveil the requirements for proper functioning of a given signalling network. This chapter provides an overview of how cellular communication evolved, works, and contributes to our understanding of human diseases in the light of evolution.
Concluding remarks on the Handbook of the Archaeology of Roman Germany
Authors: Fischer Thomas
Published: June 2019

This chapter summarizes the contributions to this handbook. It notes the limitations a book conceived from a perspective on Roman Germany that emphasizes unilaterally the provinces of Germania Inferior and Germania Superior as well as Germania Magna. However, it acknowledges that the handbook has successfully dealt with current trends in German scholarly research on these areas in a comprehensive way, especially for northern and western Germany. It further suggests that this German scholarship has attracted much less attention in Britain in recent years. Were the reciprocal interest in new results obtained in the respective provinces in Britain and Germany to increase, then comparative studies on all aspects of life in the imperial period of the British and Germanic provinces would once again offer great research opportunities.
Germanies, Britains, and the Roman World
Authors: Haynes Ian
Published: June 2019

This chapter offers a British perspective on the rich array of contributions by German scholars that make up the present volume. The stories told of Roman Germany and Roman Britain are entwined both in their detail and in the manner of their telling. A mass of data attests to the movement of objects, people, and ideas between these areas. It is argued that comparative archaeological studies of different parts of the Roman Empire are necessary in order to illuminate the entangled history of that empire. Analogy is a powerful weapon at the heart of most archaeological analyses, but our dependence upon it seldom receives the consideration it demands. Moreover, the importance of Roman Britain to the archaeology of the Roman Empire is out of all proportion to Britannia’s importance in the Roman World.
Rules of the Game: Exponential Random Graph Models of a Gang Homicide Network
Authors: Lewis Kevin , Papachristos Andrew V
Published: June 2019

Gang members frequently refer to street life as a “game” (or “The Game”): a social milieu in which status is lost or won by the way individuals and groups manage their reputations. Like other games, successfully participating in the street game may demand adherence to certain rules, such as the willingness to violently redress threats, the avoidance of “weak” behaviors, and the protection of one’s allies. This paper draws on detailed police records of violent exchanges among gangs in Chicago to ascertain which rules of the game in fact contribute to the relative social standing of groups. Specifically, we use exponential random graph models to identify the underlying micro-arrangements among gangs that collectively generate macro-level patterns of homicide. Findings illuminate a large and diverse array of generative mechanisms based on gangs’ attributes and structural positions. However, these mechanisms vary depending on which two gangs are at hand; provide evidence of a contested hierarchy with few intergroup alliances; and are surprisingly inconsistent over time. As all gangs engage in local and ongoing struggles for dominance—and as the rules constantly change—the street game is continually played but never truly won.
Characterization of the sleep disorder of anti-IgLON5 disease
Authors: Gaig Carles , Iranzo Alex , Cajochen Christian , Vilaseca Isabel , Embid Cristina , Dalmau Josep , Graus Francesc , Santamaria Joan
Published: June 2019

Study Objective

To characterize the sleep disorder of anti-IgLON5 disease.

Methods

We reviewed 27 video-polysomnographies (V-PSG), 6 multiple sleep latency tests (MSLT), 2 videsomnoscopies with dexmedetomidine, and 10 actigraphies recorded during the disease course of five patients. Due to severe sleep architecture abnormalities, we used a novel modified sleep scoring system combining conventional stages with a descriptive approach in which two additional stages were identified: undifferentiated-NREM (UN-NREM) and poorly structured N2 (P-SN2) sleep that were characterized by abnormal motor activation and absence or sparse elements of conventional NREM sleep.

Results

Sleep-related vocalizations, movements, behaviors, and respiratory abnormalities were reported by bed-partners. In all patients, NREM sleep onset and sleep reentering after an awakening occurred as UN-NREM (median: 29.8% of total sleep time [TST]) and P-SN2 sleep (14.5% TST) associated with vocalizations and simple and quasi-purposeful movements. Sleep initiation was normalized in one patient with a high dose of steroids, but NREM sleep abnormalities reappeared in subsequent V-PSG. In all patients, if sleep continued uninterrupted, there was a progressive normalization with normal N2 (11.7% TST) and N3 (22.3% TST) sleep but stridor and obstructive apnea emerged. REM sleep behavior disorder (RBD) occurred in four patients. Sleep initiation was also altered in MSLT and dexmedetomidine-induced sleep. Actigraphy showed a 10-fold increase of nocturnal activity compared with controls. Sleep abnormalities remained stable during the disease.

Conclusions

The sleep disorder of anti-IgLON5 disease presents as a complex sleep pattern characterized by abnormal sleep initiation with undifferentiated NREM sleep, RBD, periods of normal NREM sleep, stridor, and obstructive apnea.
Molecular phylogeny and systematics of cestodes with rudimentary rostellum (Cestoda: Hymenolepididae) from Holarctic Sorex shews (Eulipotyphla: Soricidae)
Authors: Kornienko Svetlana A , Binkienė Rasa , Dokuchaev Nikolai E , Tkach Vasyl V
Published: June 2019

We analyse the phylogenetic relationships and taxonomic status of hymenolepidid cestodes with rudimentary rostellum, parasitic in Holarctic shrews of the genus Sorex. These cestodes were previously termed as a ‘Ditestolepis clade’ and encompass eight genera: Diorchilepis, Ditestolepis, Ecrinolepis, Gulyaevilepis, Mathevolepis, Novobrachylepis, Spalania and Spasskylepis. Representatives of seven of these were available for molecular study, including type species of all seven genera. Phylogenetic analysis based on partial sequences of the 28S rRNA gene supports this group of genera as monophyletic. The ‘Ditestolepis clade’ consists of two subclades. One of these includes genera containing cestodes having suckers positioned inside bothrium-like depressions (Ditestolepis, Gulyaevilepis and Spasskylepis). The second subclade contains cestodes with suckers expanding far beyond the margins of the scolex (Mathevolepis, Ecrinolepis, Spalania and Novobrachylepis). The relative taxonomic value of several additional morphological characters is discussed. Genetic data convincingly demonstrate that Ditestolepis diaphana, Spasskylepis ovaluteri and Mathevolepis macyi represent complexes of morphologically similar species. Based on the phylogenetic analysis, we resurrect the genus Spalania. Amended generic diagnoses and keys to identification of the genera in the Ditestolepis clade, as well as keys to the known species, are provided.
Caring Models in Geriatric Rehabilitation
Authors: da Rocha Rodrigues Maria Goreti , Séchaud Laurence
Published: June 2019

To promote excellence in care, person centered care based on humanistic values are essential. This integrative literature review summarizes the current research on the use of a caring model or approach in rehabilitation wards for elderly and explores the issues or benefits on patient's care or on patient-nurse interactions.
Hemodynamic Aspects of Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiac Support: A Worldwide Survey
Authors: Siriwardena Maithri , Dozois Matthew , Fan Eddy , Billia Filio
Published: June 2019

There is limited data available to guide management of patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). An international cross-sectional survey of medical directors/program coordinators from Extracorporeal Life Support Organization centers was conducted. A hierarchical clustering on principle components was used. A total of 243 (55%) centers responded and were divided into three clusters: Cluster 1 (n = 102) had few high volumes and low specialized heart failure (HF) involvement; Cluster 2 (n = 75) had few high volumes and moderate HF involvement; Cluster 3 (n = 66) contained the majority of centers with >50 annual cases and high HF involvement. The most divergent responses were observed between Clusters 1 and 3 wherein Cluster 1 centers were less likely to change management based on pulse pressure (77% vs. 100%; p < 0.001) and would rather avoid inotropes to “rest the heart” (28%). Cluster 3 centers were more likely to perform daily echocardiograms (50% vs. 24%, p < 0.001), which were less likely to be exclusively performed by cardiologist (36% vs. 58%, p < 0.046) and base weaning on echocardiographic findings, when compared to Cluster 1 (3.97/5 vs. 3.56, p < 0.001). Responses were variable in management reflecting the lack of evidence for hemodynamic care for those supported with VA-ECMO.
Trends, Outcomes, and Readmissions Among Left Ventricular Assist Device Recipients with Acute Kidney Injury Requiring Hemodialysis
Authors: Adegbala Oluwole , Olakanmi Olagoke , Akintoye Emmanuel , Inampudi Chakradhari , Pahuja Mohit , Alvarez Paulino , Briasoulis Alexandros
Published: June 2019

Although renal function may improve after left ventricular assist devices (LVAD) implantation, acute kidney injury (AKI) requiring hemodialysis (HD) therapy can occur postoperatively. We used data from the National Readmissions Database to calculate annual rates of in-hospital outcomes and readmissions among patients who underwent implantation and developed acute kidney injury (AKI) requiring hemodialysis (HD) for years 2012–2015. We identified 178 (weighted 469) patients with AKI requiring HD after LVAD implantation. In-hospital mortality was significantly higher among LVAD recipients who required HD for AKI compared with those who did not (42.38% vs. 8.38%, p < 0.001). Rates of in-hospital mortality (from 52.1% in 2012 to 33.9% in 2014, p = 0.046) and length of stay (from 60.3 days in 2012 to 47.1 days in 2014, p = 0.003) decreased significantly, whereas there was a trend toward reduced hospital cost (from $320,414 in 2012 to $267,285 in 2014, p = 0.076) during the study period. However, postoperative bleeding increased significantly (p = 0.01). Acute kidney injury requiring HD after implantation was not associated with significantly higher rates of readmissions compared with LVAD recipients without AKI on HD, after adjustment for clinical and hospital characteristics (41.4% vs. 30.5%; odds ratio 1.28; 95% confidence interval [CI]: 0.85–1.95; P = 0.239). However, 5.42% of these patients required maintenance hemodialysis in readmissions. In-hospital mortality and length of stay are decreasing but remain unacceptably high in patients requiring HD for AKI after LVAD implantation but remain higher than LVAD recipients without AKI on HD. A minority of these patients who survive hospital discharge require maintenance hemodialysis.
Systemic and prophylactic intrathecal chemotherapy for primary adrenal lymphoma
Authors: Yuan Lei , Sun Lu , Bo Jian , Wang Quanshun , Zhao Yu
Published: June 2019

Primary adrenal lymphoma (PAL) is a rare entity of lymphoma with dismal prognosis using systemic chemotherapy. More clinical reports are needed to guide the treatment for PAL.

We performed a retrospective analysis of 20 patients diagnosed with PAL who presented to our center between January 2005 and January 2014.

Median age at presentation was 48 years (range: 27–73) with a male-to-female ratio of 7:3. Bilateral and right-sided adrenal involvement were seen in 11 of 20 and 7 of 20 patients, respectively. Adrenal insufficiency (AI) was seen in 6 of 10 evaluated patients. Diffuse large B cell lymphoma (DLBCL) was the most common immunophenotype (85.0%). Two patients died due to rapid disease progression before treatment. Two patients received autologous stem cell transplantation as consolidation therapy. All patients received prophylactic intrathecal chemotherapy. The estimated 5-year overall survival (OS) and progression-free survival (PFS) were 52.5% [95% confidence interval (95% CI: 28.2–72.0)] and 53.2% (95% CI: 29.0–72.5), respectively.

These findings suggest that PAL should always be considered in differential diagnosis of adrenal mass with AI. Despite the contrasting previous reports, long-term prognosis of PAL is not necessarily inferior to that of non-Hodgkin lymphoma in general.
The value of biomarkers in colorectal cancer
Authors: Wang Jun , Liang Wenjia , Wang Xiangwen , Min Guangtao , Chen Wei , Wang Hongpeng , Yao Nan , Wang Jiancheng
Published: June 2019

Background:

Colorectal cancer (CRC) is the third most common cancer in the world, with 694,000 deaths each year. Despite improvements in treatment strategies in recent years, the overall survival rate of CRC is still very low and the survival rate is highly dependent on the stage at the time of diagnosis. Some biomarkers have shown great potential for early screening of CRC and some have been tested in systematic reviews (SRs). However, the quality of these SRs remains unclear and these SRs did not clarify which biomarker is the optimal diagnostic test. This overview will evaluate the methodological quality of available SRs and compare the diagnostic value of different biomarkers in order to find the best biomarker for diagnosing CRC.

Methods:

A comprehensive literature search for SRs published before February 2019 was conducted in the PubMed, Embase.com, Cochrane Library, and Web of Science without any language restrictions. We will use the assessment of multiple systematic reviews-2 instrument to assess the methodological quality of each SR. Bubble plots will be used to summarize the main characteristics and quality of SRs. Standard pairwise meta-analysis and adjusted indirect comparison will be conducted to compare the diagnostic value of different biomarkers.

Results:

The results of this overview will be submitted to a peer-reviewed journal for publication.

Conclusion:

The findings of this project will provide a general overview and evidence of the diagnostic value of biomarkers in detecting CRC.

PROSPERO registration number:

CRD42019125880.
Patient-centered Involvement in Decision-Making
Authors: Perkins Henry S. , Freed Alisa A. , Cortez Josie D. , Hazuda Helen P.
Published: June 2019

Background/Objectives:

Ideally, doctors ask each patient’s current views about involvement in decision-making, but inquiries prove inconclusive with some inpatients. Doctors may then need indirect indicators of those views. We, therefore, explored ethnic group and sex as cultural indicators of patients’ current preferences and perceptions about such involvement.

Methods:

In open-response interviews, we asked those preferences and perceptions of 26 Mexican American (MA), 18 Euro-American (EA), and 14 African American (AA) adult inpatients. We content-analyzed responses blindly to identify themes and linked those themes to ethnic group and sex.

Results:

Only sex indicated patients’ current preferences. Regardless of ethnic group, most men preferred decision-making by the doctor (with or without the patient); most women, decision-making by the patient (with or without the doctor). But both ethnic group and sex together indicated patients’ current perceptions. Specifically, each ethnic group as a whole most often perceived decision-making by the doctor alone and the patient alone on separate occasions, but the sexes within ethnic groups differed. For MAs roughly equal numbers of men and women perceived such decision making, for EAs more men than women did so, and for AAs more women than men did so. In addition, no EA men but some EA women perceived decision-making by the doctor alone, and some MA men and women—but no EAs or AAs—perceived decision-making by the patient alone. Primarily ethnic group indicated matches between current preferences and perceptions: Most EAs had matches; most MAs and AAs did not.

Conclusions:

Whenever direct inquiries fail, ethnic group and sex may indicate adult inpatients’ current preferences and perceptions about involvement in decision-making. Yet matching those preferences and perceptions, especially for minority patients, remains difficult.
Brief Report: Outcome of Acute Hepatitis B Virus Infection in HIV-1–Infected Patients: Possible Factors Associated With Resolution or Chronicity
Authors: Morsica Giulia , Galli Laura , Bossolasco Simona , Bagaglio Sabrina , Vercesi Riccardo , Salpietro Stefania , Hasson Hamid , Messina Emanuela , Castagna Antonella , Uberti-Foppa Caterina
Published: June 2019

Background:

HIV-1 infection impairs cellular immunity, causing a detrimental effect on the natural course of hepatitis B virus (HBV) infection. HBV vaccination is less effective in HIV-1–infected patients. This study aimed to gain insight into HIV-1 infection with persistence of hepatitis B surface antigen (HBsAg) defining chronic hepatitis B infection (CBI) after a primary infection and the possible associated factors.

Setting:

Division of Infectious Diseases, San Raffaele Hospital, Italy.

Methods:

This retrospective study analyzed HIV-1–infected patients diagnosed with acute hepatitis B infection (AHB) based on clinical or laboratory records. CBI was defined as a positive HBsAg result recorded >6 months after an AHB diagnosis. Multivariate logistic regression was applied to assess factors (evaluated at AHB diagnosis) that were associated with CBI.

Results:

Of 63 HIV-1–infected patients with AHB, 23 (36.5%) developed CBI. On multivariate analysis, CBI risk was less likely in patients with HIV-RNA of >50 copies/mL (adjusted odds ratio = 0.03, 95% confidence interval: 0.001 to 0.58, P = 0.021). Dually acting antiretroviral treatment, including one or more drugs active against HIV/HBV (lamivudine, emtricitabine, and tenofovir), seemed to be protective in terms of the clinical outcome of CBI (adjusted odds ratio = 0.07, 95% confidence interval: 0.01 to 1.02, P = 0.050). Among the 23 patients with CBI, 15 (65.2%) lost the hepatitis B e-antigen, while 11 (47.8%) had HBsAg seroclearance during follow-up.

Conclusions:

In HIV-1–infected subjects with AHB, the persistence of HBsAg seemed to occur frequently. Factors associated with a lower CBI risk were detectable HIV load and the use of dually acting antiretroviral treatment during AHB.
Novel simulations to determine the impact of superficial perineal structures on vaginal delivery
Authors: Routzong Megan R. , Moalli Pamela A. , Maiti Spandan , De Vita Raffaella , Abramowitch Steven D.
Published: June 2019

This study's aim was to determine whether the inclusion of superficial perineal structures in a finite-element simulation of vaginal delivery impacts the pubovisceral muscle and perineal body, two common sites of birth-related injury. The hypothesis, inferred from prevailing literature, was that these structures would have minimal influence (differences less than ±10%). Two models were made using the Visible Human Project's female cadaver to create a rigid, fixed pelvis, musculature held by spring attachments to that pelvis, and a rigid, ellipsoidal fetal head prescribed with an inferior displacement to simulate delivery. Injury site stretch ratios and fetal head and perineal body displacements and angles of progression were compared between the Omitted Model (which excluded the superficial perineal structures as is common practice) and the Included Model (which included them). Included Model stretch ratios were +107%, −9.84% and −14.6% compared to Omitted Model perineal body and right and left pubovisceral muscles, respectively. Included Model peak perineal body inferior displacement was +72.5% greater while similar anterior–posterior displacements took longer to reach. These results refute our hypothesis, suggesting superficial perineal structures impact simulations of vaginal delivery by inhibiting perineal body anterior–posterior displacement, which stretches and inferiorly displaces the perineal body.
Managing female pelvic floor disorders: a medical device review and appraisal
Authors: Powers Shelby A. , Burleson Lindsey K. , Hannan Johanna L.
Published: June 2019

Pelvic floor disorders (PFDs) will affect most women during their lifetime. Sequelae such as pelvic organ prolapse, stress urinary incontinence, chronic pain and dyspareunia significantly impact overall quality of life. Interventions to manage or eliminate symptoms from PFDs aim to restore support of the pelvic floor. Pessaries have been used to mechanically counteract PFDs for thousands of years, but do not offer a cure. By contrast, surgically implanted grafts or mesh offer patients a more permanent resolution but have been in wide use within the pelvis for less than 30 years. In this perspective review, we provide an overview of the main theories underpinning PFD pathogenesis and the animal models used to investigate it. We highlight the clinical outcomes of mesh and grafts before exploring studies performed to elucidate tissue level effects and bioengineering considerations. Considering recent turmoil surrounding transvaginal mesh, the role of pessaries, an impermanent method, is examined as a means to address patients with PFDs.
An automated computational biomechanics workflow for improving breast cancer diagnosis and treatment
Authors: Babarenda Gamage Thiranja Prasad , Malcolm Duane T. K. , Maso Talou Gonzalo , Mîra Anna , Doyle Anthony , Nielsen Poul M. F. , Nash Martyn P.
Published: June 2019

Clinicians face many challenges when diagnosing and treating breast cancer. These challenges include interpreting and co-locating information between different medical imaging modalities that are used to identify tumours and predicting where these tumours move to during different treatment procedures. We have developed a novel automated breast image analysis workflow that integrates state-of-the-art image processing and machine learning techniques, personalized three-dimensional biomechanical modelling and population-based statistical analysis to assist clinicians during breast cancer detection and treatment procedures. This paper summarizes our recent research to address the various technical and implementation challenges associated with creating a fully automated system. The workflow is applied to predict the repositioning of tumours from the prone position, where diagnostic magnetic resonance imaging is performed, to the supine position where treatment procedures are performed. We discuss our recent advances towards addressing challenges in identifying the mechanical properties of the breast and evaluating the accuracy of the biomechanical models. We also describe our progress in implementing a prototype of this workflow in clinical practice. Clinical adoption of these state-of-the-art modelling techniques has significant potential for reducing the number of misdiagnosed breast cancers, while also helping to improve the treatment of patients.