bluuebunny/crossref_metadata_2025 huggingface dataset:
Soft labeling with quasi-Gaussian structure for training samples of deep classification trackers
Authors: Peng Yan , Gao Jiantao , Liu Chang , Li Xiaomao , Fan Baojie , Chen Jiahong , Luo Jun , Xie Shaorong , Pu Huayan
Published: April 2020

Deep classification tracking aims at classifying the candidate samples into target or background by a classifier generally trained with a binary label. However, the binary label merely distinguishes samples of different classes, while inadvertently ignoring the distinction among the samples belonging to the same class, which weakens the classification and locating ability. To cope with this problem, this article proposes a soft labeling with quasi-Gaussian structure instead of the binary labeling, which distinguishes the samples belonging to different classes and the same class simultaneously. Like as the binary label, the signs of labels for target and background samples are set to be plus and minus respectively to distinguish samples of different classes. Further, to exploit the difference among samples in the same class, the label values of samples in the same class are designed as a monotonically decreasing quasi-Gaussian function about Intersection over Union. Therefore, the corresponding response function is a two-piecewise monotonically increasing quasi-Gaussian combination function about Intersection over Union. Due to such response function, deep classification tracking trained with this proposed soft labeling achieves better classification and location performance. To validate this, the proposed soft labeling is integrated into the pipeline of the deep classification tracker SiamFC. Experimental results on OTB-2015 and VOT benchmark show that our variant achieves significant improvement to the baseline tracker while maintaining real-time tracking speed and acquires comparable accuracy as recent state-of-the-art trackers.
Renal replacement anticoagulant management: Protocol and analysis plan for an observational comparative effectiveness study of linked data sources
Authors: Gould Doug W , Doidge James , Zia Sadique M , Borthwick Mark , Caskey Fergus J , Forni Lui , Lawrence Robert F , MacEwen Clare , Mouncey Paul R , Ostermann Marlies , Harrison David A , Rowan Kathryn M , Duncan Young J , Watkinson Peter J
Published: April 2020

Acute kidney injury is common in critical illness. In patients with severe acute kidney injury, renal replacement therapy is needed to prevent harm from metabolic and electrolyte disturbances and fluid overload. In the UK, continuous renal replacement therapy (CRRT) is the preferred modality, which requires anticoagulation. Over the last decade, conventional systemic heparin anticoagulation has started being replaced by regional citrate anticoagulation for CRRT, which is now used in approximately 50% of ICUs. This shift towards regional citrate anticoagulation for CRRT is occurring with little evidence of safety or longer term effectiveness. Renal replacement anticoagulant management (RRAM) is an observational comparative effectiveness study, utilising existing data sources to address the clinical and cost-effectiveness of the change to regional citrate anticoagulation for CRRT in UK ICUs. The study will use data from approximately 85,000 patients who were treated in adult, general ICUs participating in the case mix programme national clinical audit between 1 April 2009 and 31 March 2017. A survey of health service providers’ anticoagulation practices will be combined with treatment and hospital outcome data from the case mix programme and linked with long-term outcomes from the Civil Registrations (deaths), Hospital Episodes Statistics for England, Patient Episodes Data for Wales, and the UK Renal Registry datasets. The primary clinical effectiveness outcome is all-cause mortality at 90-days. The study will incorporate an economic evaluation with micro-costing of both regional citrate anticoagulation and systemic heparin anticoagulation.

Study registration: NCT03545750
Investigating the Gap between Newspaper Journalists’ Role Conceptions and Role Performance in Nine European, Asian, and Latin American Countries
Authors: Mellado Claudia , Mothes Cornelia , Hallin Daniel C. , Humanes María Luisa , Lauber Maria , Mick Jacques , Silke Henry , Sparks Colin , Amado Adriana , Davydov Sergey , Olivera Dasniel
Published: April 2020

Based on a standardized operationalization of the watchdog, civic, interventionist, loyal-facilitator, infotainment, and service roles, this study combines survey ( N = 643) and content analysis data ( N = 19,908) to explain gaps between newspaper journalists’ role conceptions and the performance of their press organizations in nine countries from Latin America, Western Europe, and Asia. Taking an institutional approach by focusing on institutional influences on the conception–performance gap at three levels (individual, organizational, societal), our results show that these gaps are largest for the two roles most connected with the public functions of journalism, the civic, and the watchdog roles. Multilevel analyses offer significant evidence on that, across all six analyzed roles, the size of the gaps differed more clearly between journalists and between media organizations, than among countries. Although influences on an individual level (i.e., perceived autonomy) have some explanatory power, influences on the organizational level and, more specifically, ownership and codified editorial policies are the factors that best explain conception–performance gaps. The implications of these findings are discussed in light of the public skepticism about the performance of journalism and the media.
2D perfusion-angiography during endovascular intervention for critical limb threatening ischemia – A feasibility study
Authors: Pärsson Håkan N , Lundin Niklas , Lindgren Hans
Published: April 2020

Purpose

Two-dimensional perfusion angiography is a new method to quantify and evaluate tissue perfusion during endovascular intervention. The aim was to evaluate time-patterns and dynamics of contrast arrival and distribution before and after endovascular intervention in patients with critical limb threatening ischemia.

Methods

Data were collected from 37 patients with critical limb threatening ischemia due to infra-inguinal occlusive disease having a successful endovascular procedure. two-dimensional perfusion angiography was used as a post-processing software with analysis of numeric parameters related to arrival and distribution patterns of contrast.

Results

Thirty-three patients were successfully analysed whereas four patients were excluded due to motion artefacts. All patients were successfully treated with recanalization of the superficial femoral, popliteal, below the knee-vessels or a combination. Short-term improvement at 30-day follow-up was noted both clinically and by ankle-brachial index and toe pressure measurements. A significant reduction in contrast arrival time between pre-and post-angioplasty runs was noted as measured by arrival time median 3.2 and interquartile range (2.5–4.2) vs. 2.6 (1.6–3.4) and time-to-peak 4.1 (3.6–5.0) vs. 3.1 (2.3–3.9) p = 0.009. An increased wash-in rate was also observed 18.3 (12.6–21) vs. 30.1 (22–30.5) p = 0.001 between pre-and post-angioplasty runs.

Conclusions

The use of perfusion angiography for evaluation of foot-circulation during endovascular interventions provides new information regarding quantitative assessment of contrast inflow before and after endovascular intervention without the need for extra contrast or runs. No selective catheterisation is necessary. The technique is easily adopted in a clinical setting. Further studies are necessary to create robust clinical endpoints.
Platformed Interactions: How Social Media Platforms Relate to Candidate–Constituent Interaction During Finnish 2015 Election Campaigning
Authors: Nelimarkka Matti , Laaksonen Salla-Maaria , Tuokko Mari , Valkonen Tarja
Published: April 2020

Interaction between candidates and constituents via social media is a well-studied domain. The article takes this research further through a synthesis with platform studies, emerging scholarship that applies a critical perspective to the role of digital platforms in society. Examination of candidate–constituent interaction via Twitter and Facebook during the 2015 Finnish parliamentary elections revealed that the types of interaction differ between the two platforms: Facebook was used for formal campaigning and for praising and expressing support, while Twitter was utilized for information and for seeking and sharing opinions. An additional finding is that interaction approaches may be platform-specific, with socio-emotional functions being employed more often by candidates than constituents on Facebook while no such difference existed for Twitter. On the basis of the implication that platforms have a critical role in the nature of candidate–constituent social media interaction, we discuss the implications of platformed interaction for the democratic process, suggesting that campaign strategy may exploit it in ways that may even necessitate regulation. Furthermore, scholars of social media interaction might need to consider the broader ramifications of the findings, and contributions to theory that acknowledge platforms’ part in interaction may be needed.
Layers of Marginality: An Exploration of Visibility, Impressions, and Cultural Context on Geospatial Apps for Men Who Have Sex With Men in Mumbai, India
Authors: Birnholtz Jeremy , Rawat Shruta , Vashista Richa , Baruah Dicky , Dange Alpana , Boyer Anne-Marie
Published: April 2020

Some social technologies can reduce marginality by enabling access to individuals and resources through increased visibility and opportunities for social connection, but visibility carries risks that may be outsized for some marginalized populations. This article reports on a study of location-based social apps (LBSA) used by men who have sex with men (MSM) in Mumbai, India, a legally and socially marginalized population. LBSAs, which facilitate interaction and social connection between physically proximate individuals would seem at first to be a valuable resource in reducing marginality for MSM by connecting otherwise isolated individuals with each other. We explored this from a socio-technical perspective through a qualitative study of MSM in Mumbai, India, who use LBSAs. Results suggest that, as in other contexts, using LBSAs presented formidable risks and challenges such as information security and identification by others, but also could serve as a valuable resource for connecting MSM to each other.
Two-Year Clinical and Radiological Outcomes in Patients With Diabetes Undergoing Single-Level Anterior Cervical Discectomy and Fusion
Authors: Arnold Paul M. , Vaccaro Alexander R. , Sasso Rick C. , Goulet Benoit , Fehlings Michael G. , Heary Robert F. , Janssen Michael E. , Kopjar Branko
Published: April 2020

Study Design:

Secondary analysis of data from the multicenter, randomized, parallel-controlled Food and Drug Administration (FDA) investigational device exemption study.

Objective:

Studies on outcomes following anterior cervical discectomy and fusion (ACDF) in individuals with diabetes are scarce. We compared 24-month radiological and clinical outcomes in individuals with and without diabetes undergoing single-level ACDF with either i-FACTOR or local autologous bone.

Methods:

Between 2006 and 2013, 319 individuals with single-level degenerative disc disease (DDD) and no previous fusion at the index level underwent ACDF. The presence of diabetes determined the 2 cohorts. Data collected included radiological fusion evaluation, neurological outcomes, Neck Disability Index (NDI), Visual Analog Scale (VAS) scores, and the 36-Item Short Form Survey Version 2 (SF-36v2) Physical and Mental component summary scores.

Results:

There were 35 individuals with diabetes (11.1%; average body mass index [BMI] = 32.99 kg/m2; SD = 5.72) and 284 without (average BMI = 28.32 kg/m2; SD = 5.67). The number of nondiabetic smokers was significantly higher than diabetic smokers: 73 (25.70%) and 3 (8.57%), respectively. Preoperative scores of NDI, VAS arm pain, and SF-36v2 were similar between the diabetic and nondiabetic participants at baseline; however, VAS neck pain differed significantly between the cohorts at baseline ( P = .0089). Maximum improvement for NDI, VAS neck and arm pain, and SF-36v2 PCS and MCS scores was seen at 6 months in both cohorts and remained stable until 24 months.

Conclusions:

ACDF is effective for cervical radiculopathy in patients with diabetes. Diabetes is not a contraindication for patients requiring single-level surgery for cervical DDD.
Corporate Governance and Working Capital Policy: An Unobserved Influence
Authors: Coleman Martha , Wu Mengyun , Baidoo Mark
Published: April 2020

This study examines the effect of corporate governance on working capital policy; Aggressive and Conservative of 103 firms listed on Nigeria and Ghana Stock Exchange from 2012 to 2016. This study used a panel data of nonfinancial companies listed on Nigeria and Ghana stock exchange for the period 2012–2016. Data extracted from the annual financial report. Companies with missing data were dropped given a total of 103 companies from both countries (Nigeria and Ghana) with total observation of 510. We discovered that corporate governance on implemented aggressive/conservative working capital policy by firms produced a mixed result. Aggressive working capital policy implementation calls for strict control mechanism to ensure less investment in current assets. Therefore, there is strong corporate governance influence on working capital management of firms that operate aggressive working policy than firms which have implemented conservative working capital policy.
Effect of total dissolved gas supersaturation on the tolerance of grass carp (Ctenopharyngodon idellus)
Authors: Fan Zequn , Deng Yuxuan , Yuan Quan , Liu Xiaoqing , Shi Haoran , Feng Cuixia , Yang Yao , Xu Liangfang
Published: April 2020

Background

Total dissolved gas (TDG) caused by the rapid outflow of water from dams may threaten the survival of fish. However, few studies have assessed the impact of fish size on their tolerance to TDG supersaturation in the Yangtze River. To investigate the influences of fish size on the TDG supersaturation tolerance of fish, juvenile grass carp (Ctenopharyngodon idellus) of two sizes were subjected to TDG-supersaturated water at high levels (125%, 130%, 135% and 140%). Furthermore, varying flood flows may cause different TDG levels during the flood season. Fish may be subjected to low, chronic exposure to TDG before peak flooding occurs. However, TDG tolerance in fish subjected to high levels of TDG-supersaturated water after chronic exposure is rare. To further investigate the tolerance of juvenile grass carp subjected to acute exposure after chronic TDG exposure, juvenile grass carp were exposed to high levels of TDG-supersaturated water (125–140%) after receiving 96 h of chronic exposure (115% TDG).

Results

In the single acute exposure and multiple exposures (acute exposure after chronic exposure), similar abnormal behaviours and symptoms of gas bubble disease (GBD) were observed in the juvenile grass carp subjected to the TDG-supersaturated water. No abnormal behaviour or mortality was observed in fish in the first chronic exposure of the multiple-exposure treatment. As the TDG level increased, the mortality of the large and small juvenile grass carp increased. The median lethal time (LT50) for the large juvenile grass carp was 36.55, 21.75 and 6.37 h at 130%, 135% and 140% TDG levels, respectively, while the LT50 value of the small juvenile grass carp was 88.13, 61.49 and 35.88 h at the same TDG levels, respectively. In addition, the LT50 value of juvenile grass carp during acute TDG exposure after chronic exposure was 26.22, 7.54 and 5.34 h at 130%, 135% and 140% TDG levels, respectively.

Conclusion

The tolerance of juvenile grass carp decreased with increasing TDG levels. The large juvenile grass carp had weaker tolerance to TDG-supersaturated water than the small juvenile grass carp. In addition, compared with juvenile grass carp subjected to single acute exposure, juvenile grass carp subjected to multiple exposures exhibited lower tolerance and were more vulnerable to the adverse effects of TDG.
A novel virtual barcode strategy for accurate panel-wide variant calling in circulating tumor DNA
Authors: Wu Leilei , Deng Qinfang , Xu Ze , Zhou Songwen , Li Chao , Li Yi-Xue
Published: April 2020

Background

Hybrid capture-based next-generation sequencing of DNA has been widely applied in the detection of circulating tumor DNA (ctDNA). Various methods have been proposed for ctDNA detection, but low-allelic-fraction (AF) variants are still a great challenge. In addition, no panel-wide calling algorithm is available, which hiders the full usage of ctDNA based ‘liquid biopsy’. Thus, we developed the VBCALAVD (Virtual Barcode-based Calling Algorithm for Low Allelic Variant Detection) in silico to overcome these limitations.

Results

Based on the understanding of the nature of ctDNA fragmentation, a novel platform-independent virtual barcode strategy was established to eliminate random sequencing errors by clustering sequencing reads into virtual families. Stereotypical mutant-family-level background artifacts were polished by constructing AF distributions. Three additional robust fine-tuning filters were obtained to eliminate stochastic mutant-family-level noises. The performance of our algorithm was validated using cell-free DNA reference standard samples (cfDNA RSDs) and normal healthy cfDNA samples (cfDNA controls). For the RSDs with AFs of 0.1, 0.2, 0.5, 1 and 5%, the mean F1 scores were 0.43 (0.25~0.56), 0.77, 0.92, 0.926 (0.86~1.0) and 0.89 (0.75~1.0), respectively, which indicates that the proposed approach significantly outperforms the published algorithms. Among controls, no false positives were detected. Meanwhile, characteristics of mutant-family-level noise and quantitative determinants of divergence between mutant-family-level noises from controls and RSDs were clearly depicted.

Conclusions

Due to its good performance in the detection of low-AF variants, our algorithm will greatly facilitate the noninvasive panel-wide detection of ctDNA in research and clinical settings. The whole pipeline is available at https://github.com/zhaodalv/VBCALAVD.
Re-annotation of the Theileria parva genome refines 53% of the proteome and uncovers essential components of N-glycosylation, a conserved pathway in many organisms
Authors: Tretina Kyle , Pelle Roger , Orvis Joshua , Gotia Hanzel T. , Ifeonu Olukemi O. , Kumari Priti , Palmateer Nicholas C. , Iqbal Shaikh B. A. , Fry Lindsay M. , Nene Vishvanath M. , Daubenberger Claudia A. , Bishop Richard P. , Silva Joana C.
Published: April 2020

Background

The apicomplexan parasiteTheileria parvacauses a livestock disease called East coast fever (ECF), with millions of animals at risk in sub-Saharan East and Southern Africa, the geographic distribution ofT. parva. Over a million bovines die each year of ECF, with a tremendous economic burden to pastoralists in endemic countries. Comprehensive, accurate parasite genome annotation can facilitate the discovery of novel chemotherapeutic targets for disease treatment, as well as elucidate the biology of the parasite. However, genome annotation remains a significant challenge because of limitations in the quality and quantity of the data being used to inform the location and function of protein-coding genes and, when RNA data are used, the underlying biological complexity of the processes involved in gene expression. Here, we apply our recently published RNAseq dataset derived from the schizont life-cycle stage ofT. parvato update structural and functional gene annotations across the entire nuclear genome.

Results

The re-annotation effort lead to evidence-supported updates in over half of all protein-coding sequence (CDS) predictions, including exon changes, gene merges and gene splitting, an increase in average CDS length of approximately 50 base pairs, and the identification of 128 new genes. Among the new genes identified were those involved in N-glycosylation, a process previously thought not to exist in this organism and a potentially new chemotherapeutic target pathway for treating ECF. Alternatively-spliced genes were identified, and antisense and multi-gene family transcription were extensively characterized.

Conclusions

The process of re-annotation led to novel insights into the organization and expression profiles of protein-coding sequences in this parasite, and uncovered a minimal N-glycosylation pathway that changes our current understanding of the evolution of this post-translational modification in apicomplexan parasites.
Are interventions effective at improving driving in older drivers?: A systematic review
Authors: Castellucci H. I. , Bravo G. , Arezes P. M. , Lavallière M.
Published: April 2020

Background

With the aging of the population, the number of older drivers is on the rise. This poses significant challenges for public health initiatives, as older drivers have a relatively higher risk for collisions. While many studies focus on developing screening tools to identify medically at-risk drivers, little research has been done to develop training programs or interventions to promote, maintain or enhance driving-related abilities among healthy individuals. The purpose of this systematic review is to synopsize the current literature on interventions that are tailored to improve driving in older healthy individuals by working on components of safe driving such as: self-awareness, knowledge, behaviour, skills and/or reducing crash/collision rates in healthy older drivers.

Methods

Relevant databases such as Scopus and PubMed databases were selected and searched for primary articles published in between January 2007 and December 2017. Articles were identified using MeSH search terms: (“safety” OR “education” OR “training” OR “driving” OR “simulator” OR “program” OR “countermeasures”) AND (“older drivers” OR “senior drivers” OR “aged drivers” OR “elderly drivers”). All retrieved abstracts were reviewed, and full texts printed if deemed relevant.

Results

Twenty-five (25) articles were classified according to: 1) Classroom settings; 2) Computer-based training for cognitive or visual processing; 3) Physical training; 4) In-simulator training; 5) On-road training; and 6) Mixed interventions. Results show that different types of approaches have been successful in improving specific driving skills and/or behaviours. However, there are clear discrepancies on how driving performance/behaviours are evaluated between studies, both in terms of methods or dependent variables, it is therefore difficult to make direct comparisons between these studies.

Conclusions

This review identified strong study projects, effective at improving older drivers’ performance and thus allowed to highlight potential interventions that can be used to maintain or improve older drivers’ safety behind the wheel. There is a need to further test these interventions by combining them and determining their effectiveness at improving driving performance.
Altered Achilles tendon morphology in individuals with chronic post-stroke hemiparesis: a case report
Authors: Liang Jing Nong , Ho Kai-Yu
Published: April 2020

Background

Individuals post-stroke walk slowly and with more effort, which puts them at higher risks for falls. The slow walking speed results from insufficient propulsive forces generated by the paretic leg. Current rehabilitative efforts to improve walking function target increasing propulsive forces, but overlook the muscle-tendon unit.

Case presentations

Two individuals with chronic post-stroke hemiparesis are presented. In both individuals post-stroke, paretic ankle plantarflexors presented with increased muscle tone. Gait kinetics revealed asymmetric propulsive forces, specifically, insufficient propulsive forces by the paretic legs, consistent with previous literature. Sonography revealed increased thickness of paretic Achilles tendon at the calcaneal insertion, in both stroke cases, in contrast to comparable Achilles tendon thickness between limbs in the non-neurologically impaired controls.

Conclusion

Tendon unit integrity should be considered in individuals post-stroke who demonstrate abnormal muscle tone and insufficient propulsion during gait.
Exons deletion of CNKSR2 gene identified in X-linked syndromic intellectual disability
Authors: Daoqi Mei , Guohong Chen , Yuan Wang , Zhixiao Yang , Kaili Xu , Shiyue Mei
Published: April 2020

Background

The Houge type of X-linked syndromic mental retardation is an X-linked intellectual disability (XLID) recently recorded in the Online Mendelian Inheritance in Man (OMIM) and only 8 cases have been reported in literature thus far.

Case presentation

We present two brothers with intractable seizures and syndromic intellectual disability with symptoms consisting of delayed development, intellectual disability, and speech and language delay. The mother was a symptomatic carrier with milder clinical phenotype. Whole exome sequencing identified a small fragment deletion spanning four exons, about 9.5 kilobases (kb) in length in the CNKSR2 gene in the patients. The mutation co-segregation revealed that exon deletions occurred de novo in the proband’s mother.

Conclusion

Although large deletions have been reported, no small deletions have yet been identified. In this case report, we identified a small deletion in the CNKSR2 gene. This study enhances our knowledge of the CNKSR2 gene mutation spectrum and provides further information about the phenotypic characteristics of X-linked syndromic intellectual disability.
Prevalence and risk factors of chronic kidney disease and diabetic kidney disease in a central Chinese urban population: a cross-sectional survey
Authors: Duan Jia-Yu , Duan Guang-Cai , Wang Chong-Jian , Liu Dong-Wei , Qiao Ying-Jin , Pan Shao-Kang , Jiang Deng-Ke , Liu Yong , Zhao Zi-Hao , Liang Lu-Lu , Tian Fei , Liu Zhang-Suo
Published: April 2020

Background

This study was conducted to evaluate and update the current prevalence of and risk factors for chronic kidney disease (CKD) and diabetic kidney disease (DKD) in a central Chinese urban population.

Methods

From December 2017 to June 2018, a total of 5231 subjects were randomly enrolled from 3 communities in 3 districts of Zhengzhou. CKD was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min.1.73m2 or urinary albumin to creatinine ratio ≥ 30 mg/g (albuminuria). Diabetic subjects with systolic blood pressure > 140 mmHg, albuminuria or an eGFR less than 60 mL/min/1.73 m2 were classified as having DKD. Participants completed a questionnaire assessing lifestyle and relevant medical history, and blood and urine specimens were taken. Serum creatinine, uric acid, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein and urinary albumin were assessed. The age- and sex-adjusted prevalences of CKD and DKD were calculated, and risk factors associated with the presence of reduced eGFR, albuminuria, DKD, severity of albuminuria and progression of reduced renal function were analyzed by binary and ordinal logistic regression.

Results

The overall adjusted prevalence of CKD was 16.8% (15.8–17.8%) and that of DKD was 3.5% (3.0–4.0%). Decreased renal function was detected in 132 participants (2.9, 95% confidence interval [CI]: 2.5–3.2%), whereas albuminuria was found in 858 participants (14.9, 95% CI: 13.9–15.9%). In all participants with diabetes, the prevalence of reduced eGFR was 6.3% (95% CI = 3.9–8.6%) and that of albuminuria was 45.3% (95% CI = 40.4–50.1%). The overall prevalence of CKD in participants with diabetes was 48.0% (95% CI = 43.1–52.9%). The results of the binary and ordinal logistic regression indicated that the factors independently associated with a higher risk of reduced eGFR and albuminuria were older age, sex, smoking, alcohol consumption, overweight, obesity, diabetes, hypertension, dyslipidemia and hyperuricemia.

Conclusions

Our study shows the current prevalence of CKD and DKD in residents of Central China. The high prevalence suggests an urgent need to implement interventions to relieve the high burden of CKD and DKD in China.
Assessment of viral RNA in idiopathic pulmonary fibrosis using RNA-seq
Authors: Yin Qinyan , Strong Michael J. , Zhuang Yan , Flemington Erik K. , Kaminski Naftali , de Andrade Joao A. , Lasky Joseph A.
Published: April 2020

Background

Numerous publications suggest an association between herpes virus infection and idiopathic pulmonary fibrosis (IPF). These reports have employed immunohistochemistry, in situ hybridization and/or PCR, which are susceptible to specificity artifacts.

Methods

We investigated the possible association between IPF and viral RNA expression using next-generation sequencing, which has the potential to provide a high degree of both sensitivity and specificity. We quantified viral RNA expression for 740 viruses in 28 IPF patient lung biopsy samples and 20 controls. Key RNA-seq results were confirmed using Real-time RT-PCR for select viruses (EBV, HCV, herpesvirus saimiri and HERV-K).

Results

We identified sporadic low-level evidence of viral infections in our lung tissue specimens, but did not find a statistical difference for expression of any virus, including EBV, herpesvirus saimiri and HERV-K, between IPF and control lungs.

Conclusions

To the best of our knowledge, this is the first publication that employs RNA-seq to assess whether viral infections are linked to the pathogenesis of IPF. Our results do not address the role of viral infection in acute exacerbations of IPF, however, this analysis patently did not support an association between herpes virus detection and IPF.
Daily fluctuating temperatures decrease growth and reproduction rate of a lethal amphibian fungal pathogen in culture
Authors: Lindauer Alexa L. , Maier Paul A. , Voyles Jamie
Published: April 2020

Background

Emerging infectious diseases (EIDs) are contributing to species die-offs worldwide. We can better understand EIDs by using ecological approaches to study pathogen biology. For example, pathogens are exposed to variable temperatures across daily, seasonal, and annual scales. Exposure to temperature fluctuations may reduce pathogen growth and reproduction, which could affect pathogen virulence, transmission, and environmental persistence with implications for disease. We examined the effect of a variable thermal environment on reproductive life history traits of the fungal pathogen Batrachochytrium dendrobatidis (Bd). Bd causes chytridiomycosis, an emerging infectious disease of amphibians. As a pathogen of ectothermic hosts, Bd can be exposed to large temperature fluctuations in nature. To determine the effect of fluctuating temperatures on Bd growth and reproduction, we collected temperature data from breeding pools of the Yosemite toad (Anaxyrus canorus), a federally threatened species that is susceptible to chytridiomycosis. We cultured Bd under a daily fluctuating temperature regime that simulated Yosemite toad breeding pool temperatures and measured Bd growth, reproduction, fecundity, and viability.

Results

We observed decreased Bd growth and reproduction in a diurnally fluctuating thermal environment as compared to cultures grown at constant temperatures within the optimal Bd thermal range. We also found that Bd exhibits temperature-induced trade-offs under constant low and constant high temperature conditions.

Conclusions

Our results provide novel insights on variable responses of Bd to dynamic thermal conditions and highlight the importance of incorporating realistic temperature fluctuations into investigations of pathogen ecology and EIDs.
Elastography for the diagnosis of high-suspicion thyroid nodules based on the 2015 American Thyroid Association guidelines: a multicenter study
Authors: Hairu Li , Yulan Peng , Yan Wang , Hong Ai , Xiaodong Zhou , Lichun Yang , Kun Yan , Ying Xiao , Lisha Liu , Baoming Luo , Qiang Yong , Shuzhen Cong , Shuangquan Jiang , Xin Fu , Buyun Ma , Yi Li , Xixi Zhang , Xue Gong , Haitao Chen , Wenying Liu , Ling Tang , Xiaoyu Lv , Xinbao Zhao , Liang Li , Kehong Gan , Jiawei Tian
Published: April 2020

Background

An accurate diagnosis for high-suspicion nodules based on the 2015 American Thyroid Association (ATA) guidelines would reduce unnecessary invasive examinations. Elastography is a useful tool for discriminating benign and malignant thyroid nodules. The aim of this study is to investigate the diagnostic efficiency of elastography for high-suspicion thyroid nodules based on the 2015 ATA guidelines in the Chinese population.

Methods

Thyroid nodules with high-suspicion characteristics based on the 2015 ATA guidelines were subjected to conventional ultrasound (US) and ultrasound strain elastography (USE) examinations at 12 hospitals from 4 geographic regions across China. Cytology/histology of thyroid nodules was used as a reference method. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic performance of the elasticity score (ES) and strain ratio (SR). Logistic regression analysis was used to determine the predictors of malignancy.

Results

Overall, a total of 1445 thyroid nodules (834 malignant, 611 benign) from 12 centers were included in the final analysis. The areas under the curve of the ES and SR were 0.828 and 0.732, respectively. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the ES were 92.4, 60.7, 79.0, 76.3 and 85.5%, respectively, and those of the SR were 81.1, 50.1, 68.9, 65.9 and 67.9%, respectively. The combination of the Thyroid Imaging Reporting and Data System (TI-RADS) and ES led to a significant increase in the sensitivity and NPV (97.1 and 91.9%, respectively) compared with the TI-RADS alone. Logistic regression analysis showed that microcalcifications (OR = 5.290), taller than wide (OR = 12.710), irregular margins (OR = 10.117), extrathyroidal extension (ETE; OR = 6.412), the ES (OR = 3.741) and the SR (OR = 1.083) were independent predictors of malignant thyroid nodules. The sensitivity, specificity, accuracy, PPV and NPV of the ES were all superior in nodules ≥1 cm than in those < 1 cm (95.0% vs 90.4, 68.8% vs 56.8, 85.9% vs 74.4, 85.2% vs 69.9, and 87.8% vs 84.2%, respectively).

Conclusions

Elastography combined with the ES is a valuable tool for the assessment of high-suspicion thyroid nodules based on the 2015 ATA guidelines, especially in nodules ≥1 cm.
Concurrent müllerianosis of the urinary bladder and the umbilicus presenting with umbilical bleeding: a rare case report and review of the literature
Authors: Jhang Syu , Chen Marcelo , Chen Li-Chen
Published: April 2020

Background

Müllerianosis is a very rare neoplasm composed of two or three Müllerian derived tissues (endosalpinx, endometrium and endocervix). We report the first case of concurrent müllerianosis of the urinary bladder and the umbilicus presenting with umbilical bleeding.

Case presentation

A 43-year-old Asian premesopausal female, gravida 1, para 1, presented with intermittent umbilical bleeding. An umbilical nodule and a bladder tumor on the posterior wall of the urinary bladder were identified. She underwent transurethral resection of the bladder tumor and excision of the umbilical nodule successively. Diagnosis of müllerianosis was confirmed by the histological and immunological features. No tumor recurrence was noted at 6 months of follow-up.

Conclusions

Müllerianosis is extremely rare and mainly reported in the urinary bladder, and generally affects women of reproductive age. Despite the common presentations of müllerianosis of the urinary bladder including irritative voiding symptoms, abdominal/pelvic pain and gross hematuria, our rare case had no symptom except umbilical bleeding. The possibility of concurrent bladder müllerianosis should be considered when müllerianosis is found at other location. We suggest a surgical intervention to establish the correct pathological diagnosis because it is essential to exclude malignant neoplasms of the urinary bladder. The majority of patients have a favorable prognosis.
Evaluating users’ experiences of electronic prescribing systems in relation to patient safety: a mixed methods study
Authors: Aufegger Lisa , Serou Naresh , Chen Shiping , Franklin Bryony Dean
Published: April 2020

Background

User interface (UI) design features such as screen layout, density of information, and use of colour may affect the usability of electronic prescribing (EP) systems, with usability problems previously associated with medication errors. To identify how to improve existing systems, our aim was to explore prescribers’ perspectives of UI features of a commercially available EP system, and how these may affect patient safety.

Methods

Two studies were conducted, each including ten participants prescribing a penicillin for a test patient with a penicillin allergy. In study 1, eye-gaze tracking was used as a means to explore visual attention and behaviour during prescribing, followed by a self-reported EP system usability scale. In study 2, a think-aloud method and semi-structured interview were applied to explore participants’ thoughts and views on prescribing, with a focus on UI design and patient safety.

Results

Study 1 showed high visual attention toward information on allergies and patient information, allergy pop-up alerts, and medication order review and confirmation, with less visual attention on adding medication. The system’s usability was rated ‘below average’. In study 2, participants highlighted EP design features and workflow, including screen layout and information overload as being important for patient safety, benefits of EP systems such as keeping a record of relevant information, and suggestions for improvement in relation to system design (colour, fonts, customization) and patient interaction.

Conclusions

Specific UI design factors were identified that may improve the usability and/or safety of EP systems. It is suggested that eye-gaze tracking and think-aloud methods are used in future experimental research in this area. Limitations include the small sample size; further work should include similar studies on other EP systems.
Understanding the association between caregiver sex and HIV infection among orphans and vulnerable children in Tanzania: learning from the USAID Kizazi Kipya project
Authors: Exavery Amon , Charles John , Kuhlik Erica , Barankena Asheri , Koler Alison , Kikoyo Levina , Jere Elizabeth
Published: April 2020

Background

Tanzania has met only 50.1% of the 90% target for diagnosing HIV in children. The country’s pediatric case finding strategy uses global best practices of index testing, provider-initiated counselling and testing, and targeted community testing of at-risk populations to find about 50,000 children living with HIV (CLHIV) who are undiagnosed. However, context-specific strategies are necessary to find the hidden children to meet the full 90% target. This study assesses whether sex of the caregiver is associated with HIV status of orphans and vulnerable children (OVC) as a valuable strategy for enhanced pediatric case findings.

Methods

Data originate from the community-based, United States Agency for International Development (USAID)-funded Kizazi Kipya Project, which works towards increasing OVC’s and their caregivers’ uptake of HIV/AIDS and other health and social services in Tanzania. Included in this study are 39,578 OVC ages 0–19 years who the project enrolled during January through March 2017 in 18 regions of Tanzania and who voluntarily reported their HIV status. Data analysis involved multi-level logistic regression, with OVC HIV status as the outcome of interest and caregiver’s sex as the main independent variable.

Results

Three-quarters (74.3%) of the OVC included in the study had female caregivers, and their overall HIV prevalence was 7.1%. The prevalence was significantly higher (p < 0.001) among OVC with male caregivers (7.8%) than among OVC with female caregivers (6.8%), and indeed, multivariate analysis showed that OVC with male caregivers were significantly 40% more likely to be HIV-positive than those with female caregivers (OR = 1.40, 95% CI 1.08–1.83). This effect was the strongest among 0–4 year-olds (OR = 4.02, 95% CI 1.61–10.03), declined to 1.72 among 5–9 year-olds (OR = 1.72, 95% CI 1.02–2.93), and lost significance for children over age 9 years. Other significant factors included OVC age and nutritional status; caregiver HIV status and marital status; household health insurance status, and family size; and rural versus urban residence.

Conclusions

OVC in Tanzania with male caregivers have a 40% higher likelihood of being HIV-positive than those with female caregivers. HIV risk assessment activities should target OVC with male caregivers, as well as OVC who have malnutrition, HIV-positive caregivers, or caregivers who do not disclose their HIV status to community volunteers. Further, younger HIV-positive OVC are more likely to live in rural areas, while older HIV-positive OVC are more likely to live in urban areas. These factors should be integrated in HIV risk assessment algorithms to enhance HIV testing yields and pediatric case-finding in the OVC population in Tanzania.
Practice, perceived barriers and motivating factors to medical-incident reporting: a cross-section survey of health care providers at Mbarara regional referral hospital, southwestern Uganda
Authors: Naome Turyahabwe , James Mwesigwa , Christine Atuhairwe , Mugisha Taremwa Ivan
Published: April 2020

Background

Medical-incident reporting (MIR) ensures patient safety and delivery of quality of care by minimizing unintentional harm among health care providers. We explored medical-incident reporting practices, perceived barriers and motivating factors among health care providers at Mbarara Regional Referral Hospital (MRRH).

Methods

We conducted a cross-sectional descriptive study on 158 health provider at Mbarara Regional Referral Hospital (MRRH), Western Uganda. Data was gathered using a structured questionnaire and analyzed with SPSS. The chi-square was used to determine factors associated with MIR at MRRH.

Results

The results showed that there was no formal incident reporting structure. However the medical-incidences identified were: medication errors (89.9%), diagnostic errors (71.5%), surgical errors (52.5%) and preventive error (47.7%). The motivating factors of MIR were: establishment of a good communication system, instituting corrective action on the reported incidents and reinforcing health workers knowledge on MIR (p-value 0.004); presence of effective organizational systems like: written guidelines, practices of open door policy, no blame approach, and team work were significantly associated with MIR (p-value 0.000). On the other hand, perceived barriers to MIR were: lack of knowledge on incidents and their reporting, non-existence of an incident reporting team and fear of being punished (p- value 0.669).

Conclusion

Medical Incident Reporting at MRRH was sub-optimal. Therefore setting up an incident management team and conducting routine training MIR among health care workers will increase patient safety.
Trends in anticoagulant prescribing: a review of local policies in English primary care
Authors: Ho Katherine H. , van Hove Maria , Leng Gillian
Published: April 2020

Background

Oral anticoagulants are prescribed for stroke prophylaxis in patients with atrial fibrillation, which is the most common heart arrhythmia worldwide. The vitamin K antagonist (VKA) warfarin is a long-established anticoagulant. However, newer direct oral anticoagulants (DOACs) have been recently introduced as an alternative. Given the prevalence of atrial fibrillation, anticoagulant choice has substantial clinical and financial implications for healthcare systems. In this study, we explore trends and geographic variation in anticoagulant prescribing in English primary care. Because national guidelines in England do not specify a first-line anticoagulant, we investigate the association between local policies and prescribing data.

Methods

Primary care prescribing data of anticoagulants for all NHS practices from 2014 to 2019 in England was obtained from the ePACT2 database. Public formularies were accessed online to obtain local anticoagulation prescribing policies for 89.5% of clinical commissioning groups (CCGs). These were categorized according to their recommendations: no local policies, warfarin as first-line, or identification of a preferred DOAC (but not a preferred anticoagulant). Local policies were cross-tabulated with pooled prescribing data to measure the strength of association with Cramér’s V.

Results

Nationally, prescribing of DOACs increased from 9% of all anticoagulants in 2014 to 74% in 2019, while that of warfarin declined accordingly. Still, there was significant local variation. Across geographical regions, DOACs ranged from 53 to 99% of all anticoagulants. Most CCGs (73%) did not specify a first-line choice, and 16% recommended warfarin first line. Only 11% designated a preferred DOAC. Policies with a preferred DOAC indeed correlated with increased prescribing of that DOAC (Cramér’s V = 0.25, 0.27, 0.38 for rivaroxaban, apixaban, edoxaban respectively). However, local policies showed a negligible relationship with the classes of anticoagulants prescribed—DOAC or VKA (Cramér’s V = 0.01).

Conclusions

Nationally, the use of DOACs to treat atrial fibrillation has increased rapidly. Despite this, significant geographical variation in uptake remains. This study provides insights on how local policies relate to this variation. Our findings suggest that, in the absence of a nationally recommended first-line anticoagulant, local prescribing policies may aid in deciding between individual DOACs, but not in adjudicating between DOACs and vitamin K antagonists (i.e. warfarin) as general classes.