bluuebunny/crossref_metadata_2025 huggingface dataset:
Measuring and Preventing COVID-19 Using the SIR Model and Machine Learning in Smart Health Care
Authors: Alanazi Saad Awadh , Kamruzzaman M. M. , Alruwaili Madallah , Alshammari Nasser , Alqahtani Salman Ali , Karime Ali
Published: November 2020

COVID-19 presents an urgent global challenge because of its contagious nature, frequently changing characteristics, and the lack of a vaccine or effective medicines. A model for measuring and preventing the continued spread of COVID-19 is urgently required to provide smart health care services. This requires using advanced intelligent computing such as artificial intelligence, machine learning, deep learning, cognitive computing, cloud computing, fog computing, and edge computing. This paper proposes a model for predicting COVID-19 using the SIR and machine learning for smart health care and the well-being of the citizens of KSA. Knowing the number of susceptible, infected, and recovered cases each day is critical for mathematical modeling to be able to identify the behavioral effects of the pandemic. It forecasts the situation for the upcoming 700 days. The proposed system predicts whether COVID-19 will spread in the population or die out in the long run. Mathematical analysis and simulation results are presented here as a means to forecast the progress of the outbreak and its possible end for three types of scenarios: “no actions,” “lockdown,” and “new medicines.” The effect of interventions like lockdown and new medicines is compared with the “no actions” scenario. The lockdown case delays the peak point by decreasing the infection and affects the area equality rule of the infected curves. On the other side, new medicines have a significant impact on infected curve by decreasing the number of infected people about time. Available forecast data on COVID-19 using simulations predict that the highest level of cases might occur between 15 and 30 November 2020. Simulation data suggest that the virus might be fully under control only after June 2021. The reproductive rate shows that measures such as government lockdowns and isolation of individuals are not enough to stop the pandemic. This study recommends that authorities should, as soon as possible, apply a strict long-term containment strategy to reduce the epidemic size successfully.
Macroglossia in Beckwith-Wiedemann Syndrome Is Attributed to Skeletal Muscle Hyperplasia
Authors: Oyama Yuzo , Nishida Haruto , Kobayashi Osamu , Kawano Kenji , Ihara Kenji , Daa Tsutomu
Published: November 2020

Macroglossia is a common feature in patients with Beckwith-Wiedemann syndrome (BWS). The underlying cause of macroglossia in BWS remains unknown, and further histological studies are required to uncover its etiology. We present the case of a 5-year-old girl who was diagnosed with BWS and underwent partial tongue resection for difficulties in articulation and aesthetics. The keyhole-shaped partial resection revealed a harder posterior side than the anterior. Microscopically, the posterior side consisted of dense subepithelial eosinophilic areas composed of an abundance of tightly packed skeletal muscle fibers that were arranged in a fascicular or storiform pattern. BWS-associated macroglossia results from skeletal muscle hyperplasia, consistent with true macroglossia. Therefore, tongue resection may be beneficial for such patients. Further studies are required to develop personalized surgical interventions for each patient with BWS.
An Integrating Immune-Related Signature to Improve Prognosis of Hepatocellular Carcinoma
Authors: Zhu Rui , Guo Wenna , Xu Xin-Jian , Zhu Liucun
Published: November 2020

Growing evidence suggests that the superiority of long noncoding RNAs (lncRNAs) and messenger RNAs (mRNAs) could act as biomarkers for cancer prognosis. However, the prognostic marker for hepatocellular carcinoma with high accuracy and sensitivity is still lacking. In this research, a retrospective, cohort-based study of genome-wide RNA-seq data of patients with hepatocellular carcinoma was carried out, and two protein-coding genes (GTPBP4, TREM-1) and one lncRNA (LINC00426) were sorted out to construct an integrative signature to predict the prognosis of patients. The results show that both the AUC and the C-index of this model perform well in TCGA validation dataset, cross-platform GEO validation dataset, and different subsets divided by gender, stage, and grade. The expression pattern and functional analysis show that all three genes contained in the model are associated with immune infiltration, cell proliferation, invasion, and metastasis, providing further confirmation of this model. In summary, the proposed model can effectively distinguish the high- and low-risk groups of hepatocellular carcinoma patients and is expected to shed light on the treatment of hepatocellular carcinoma and greatly improve the patients’ prognosis.
Streptococcus mitis Chorioamnionitis after Dental Scaling and Oral Sex
Authors: Hosseini Boshra Sara , Hunt Jennifer
Published: November 2020

Background. Oral sex is postulated to be a risk factor for the introduction of bacteria into the amniotic cavity. Common oropharyngeal bacteria have been implicated in reports of second trimester chorioamnionitis via ascending vaginal transmission following oral sex. Dental scaling can also introduce these pathogens into the blood stream, allowing hematogenous spread of oral pathogens to the fetoplacental unit in pregnant patients. Case. We report a case of Streptococcus mitis chorioamnionitis at 21 weeks and 5 days’ gestation in a patient whose only risk factors were recent dental scaling and recent oral sex with a partner known to have periodontal disease. Conclusion. Bacterial chorioamnionitis should be considered in the differential diagnosis of preterm labour. Oral sex and dental procedures may be risk factors for chorioamnionitis.
[Retracted] Analysis on the Expression and Prognostic Value of LncRNA FAF in Patients with Coronary Heart Disease
Authors: Xu Hai , Zhang Xiwen , Yu Kun , Zhang Gang , Shi Yafei , Jiang Yicheng
Published: November 2020

Objective. To investigate the expression and prognostic value of LncRNA FAF in patients with coronary heart disease. Patients and Methods. 97 patients with coronary heart disease who came to our hospital were selected as the research group (RG), and 97 healthy people who came to our hospital for physical examination during the same period were selected as the control group (CG). The serum LncRNA FAF, plasma homocysteine (HCY), lipoprotein A (Lp‐a), serum tumor necrosis factor α (TNF‐α), and high‐sensitivity C‐reactive protein (hsCRP) in the two groups of patients were detected, and their correlations were analyzed. Then, the predictive value and risk factors of FAF for poor prognosis of patients with coronary heart disease were analyzed. Results. The expression of LncRNA FAF in the serum of patients in the RG was significantly lower than that in the CG, and the expressions of HCY, Lp‐a, TNF‐α, and hsCRP were significantly higher than those in the CG (p <0.05). The AUC of FAF in the diagnosis of coronary heart disease was more than 0.9. FAF was negatively correlated with the coronary lesion vessels, HCY, Lp‐a, TNF‐α, and hsCRP expressions in patients with coronary heart disease (p < 0.05). The ROC of FAF for predicting poor prognosis in patients with coronary heart disease was greater than 0.9. Low expression of FAF; high expressions of HCY, Lp‐a, and hsCRP; and increase of coronary lesion vessels were independent risk factors for poor prognosis in patients with coronary heart disease. Conclusions. LncRNA FAF was lowly expressed in the serum of patients with coronary heart disease, and it was of high value in the diagnosis and prediction of poor prognosis of coronary heart disease. It was also an independent risk factor for poor prognosis of patients with coronary heart disease and may be a potential target for diagnosis and treatment of coronary heart disease.
Turning Up the Heat on the Pancreatic Tumor Microenvironment by Epigenetic Priming
Authors: Nephew Kenneth P.
Published: November 2020

The study by Gonda and colleagues, in this issue of Cancer Research, represents the first combinatorial approach based on epigenetic therapy priming to overcome resistance to immunotherapy in pancreatic cancer. The authors show that treatment with a DNA hypomethylating agent causes profound changes in the pancreatic cancer microenvironment, including increased numbers of tumor-infiltrating T cells, elevated IFN signaling, and immune checkpoint expression, as well as increased antigen presentation in tumor cells. Accordingly, they show that the combination of decitabine plus immune checkpoint blockade effectively restores antitumor immunity and results in a significant survival benefit in a widely accepted mouse model of pancreatic cancer. The study provides evidence for a new therapeutic approach for pancreatic cancer having antitumor efficacy through modulation of the immune suppressive microenvironment, leading to an increased response to immune checkpoint inhibitors. As the incidence of pancreatic cancer continues to increase, new treatment strategies for this devastating disease are urgently needed. Gonda and colleagues provide preclinical proof of concept for a new therapeutic strategy and address an unmet need for this difficult to treat disease.

See related article by Gonda et al., p. 4754
Setting the Pick: Can PI3K Inhibitors Circumvent CDK4/6 Inhibitor Resistance?
Authors: Clark Amy S. , Makhlin Igor , DeMichele Angela
Published: November 2020

PI3K and CDK4/6 inhibitors (CDK4/6i) are targeted therapies approved to treat advanced breast cancer; CDK4/6is are more widely used. Here, we discuss trials that examine PI3K inhibitors with novel drug combinations, including a CDK4/6i, given data implicating the pathway in CDK 4/6 resistance.

See related articles by Lu et al., p. 408, and Tolaney et al., p. 418
A Patient with Limbic Encephalitis, Ear Perichondritis, and Episcleritis – An Unusual Presentation of Relapsing Polychondritis
Authors: Angkodjojo Stanley , Yeo Crystal Jing Jing
Published: November 2020

Relapsing polychondritis (RPC) is a rare autoimmune disease that is characterized by recurrent inflammation and destruction of cartilaginous tissues. Limbic encephalitis is a rare central nervous system manifestation of RPC that has been mentioned in case reports. Recognition of this association, and reliable methods of diagnosis, including the utility of neuroimaging modalities such as positron emission tomography/computed tomography (PET/CT) can be useful in the evaluation of this diagnostic challenge. We report a patient with limbic encephalitis associated with RPC, where PET/CT was effectively used in the diagnosis, and monitoring of response to treatment. We also demonstrate that it can be a useful modality in certain situations when brain magnetic resonance imaging cannot be done.
Abnormal Functional Connectivity Density in Patients with Dysthyroid Optic Neuropathy
Authors: Tu Yunhai , Huang Pingping , Mao Chuanwan , Liu Xiaozheng , Gao Jianlu
Published: November 2020

Objective: Functional connectivity density (FCD) mapping was used to investigate abnormalities and factors related to brain functional connectivity in cortical regions of patients with dysthyroid optic neuropathy (DON) and to analyze the pathogenesis of DON further. Methods: Patients diagnosed with thyroid-associated opthalmology (TAO) in the Eye Hospital were enrolled. All patients underwent comprehensive eye examinations and best-corrected visual acuity, visual field (VF) test. MRI data collection and analysis were completed in the 2nd Affiliated Hospital of Wenzhou Medical University. The patients were divided into 2 groups: the DON group, with an average VF, mean deviation (MD) of both eyes < −5 dB, and the non-DON group (nDON group), with an average VF MD of both eyes ≥ −2 dB. Results: A total of 30 TAO patients (14 men, 16 women) with complete data who met the experimental requirements were enrolled. The average age was 48.79 (40–57) years. There were 16 patients in the DON group and 14 patients in the nDON group. No significant differences in age, gender, education level, and the maximum horizontal diameter of either medial rectus muscle were found between the 2 groups. The difference of brain FCD between the 2 groups showed significant abnormal connectivity in the right orbital gyri of the frontal lobe (Frontal_Inf_Orb_R) and the left precuneus in the DON group compared with the nDON group. As demonstrated by decreased FCD values in the right inferior frontal gyrus/orbital part, the relevant brain regions were the left middle temporal gyrus, left precuneus, left middle frontal gyrus, right postcentral gyrus, and brain gyri (excluding the supramarginal gyrus and angular gyrus) below the left parietal bone. The FCD associated with the left precuneus was increased, and the relevant brain areas were the left middle temporal gyrus, right cuneus, superior occipital gyrus, and right fusiform gyrus. A significant correlation was identified between the MD of the binocular VF and brain FCD. Conclusion: The abnormal FCD in the cortex of DON patients suggests that a central nervous system mechanism may be related to the pathogenesis of the DON.
Multimodal Imaging in Choroidal Metastasis
Authors: Cennamo Gilda , Montorio Daniela , Carosielli Marianna , Romano Mario R. , Cennamo Giovanni
Published: November 2020

Background: Choroidal metastasis represents the most common malignant intraocular tumours. Objectives: The objective of this study is to detect the structural and vascular features of choroidal metastasis by multimodal imaging. Methods: Sixteen eyes of 16 patients with choroidal metastasis were enrolled in this prospective study. The multimodal imaging was performed in all patients: fluorescein angiography, indocyanine green angiography, enhanced depth imaging optical coherence tomography (EDI-OCT), OCT angiography (OCTA), and ultrasonography. Results: The choroidal metastasis was located in the macula region in 9 eyes (57%) and in the extramacular region in 7 eyes (43%). EDI-OCT showed a mean thickness of 950 ± 246 µm, a smooth anterior tumour surface in 5 eyes (31%), and a lumpy bumpy appearance in 11 eyes (69%). The most frequent EDI-OCT features were represented by choriocapillaris thinning (100%), shaggy photoreceptors (82%), subretinal fluid with speckles (69%), subretinal lipofuscin pigment (6%), absence of drusen (100%), optical shadowing (94%), low-internal optical reflectivity (75%), and retinal pigment epithelium alterations (43%). OCTA revealed an absence of intratumoral vascular network in all cases. Conclusions: The multimodal imaging contributed to greater insights into the anatomical and vascular features of choroidal metastasis. It allows for the collection of useful information to establish an appropriate diagnosis and follow-up.
Metabolomic Effects of Hormone Therapy and Associations With Coronary Heart Disease Among Postmenopausal Women
Authors: Balasubramanian Raji , Demler Olga , Guasch-Ferré Marta , Paynter Nina P. , Sheehan Ryan , Liu Simin , Manson JoAnn E. , Salas-Salvadó Jordi , Martínez-Gonzalez Miguel Á. , Hu Frank B. , Clish Clary , Rexrode Kathryn M.
Published: November 2020

Background:

In the WHI-HT trials (Women’s Health Initiative Hormone Therapy), treatment with oral conjugated equine estrogens and medroxyprogesterone acetate (CEE+MPA) resulted in increased risk of coronary heart disease (CHD), whereas oral conjugated equine estrogens (CEE) did not.

Methods:

Four hundred eighty-one metabolites were measured at baseline and at 1-year in 503 and 431 participants in the WHI CEE and CEE+MPA trials, respectively. The effects of randomized HT on the metabolite profiles at 1-year was evaluated in linear models adjusting for baseline metabolite levels, age, body mass index, race, incident CHD, prevalent hypertension, and diabetes. Metabolites with discordant effects by HT type were evaluated for association with incident CHD in 944 participants (472 CHD cases) in the WHI-OS (Women’s Health Initiative Observational Study), with replication in an independent cohort of 980 men and women at high risk for cardiovascular disease.

Results:

HT effects on the metabolome were profound; 62% of metabolites significantly changed with randomized CEE and 52% with CEE+MPA (false discovery rate–adjusted
P
value<0.05) in multivariable models. Concerted increases in abundance were seen within various metabolite classes including triacylglycerols, phosphatidylethanolamines, and phosphatidylcholines; decreases in abundance was observed for acylcarnitines, lysophosphatidylcholines, quaternary amines, and cholesteryl/cholesteryl esters. Twelve metabolites had discordant effects by HT type and were associated with incident CHD in the WHI-OS; a metabolite score estimated in a Least Absolute Shrinkage and Selection Operator regression was associated with CHD risk with an odds ratio of 1.47 per SD increase (95% CI, 1.27–1.70,
P
<10
-6
). All twelve metabolites were altered in the CHD protective direction by CEE treatment. One metabolite (lysine) was significantly altered in the direction of increased CHD risk by CEE+MPA; the remaining 11 metabolites were not significantly changed by CEE+MPA. The CHD associations of a subset of 4 metabolites including C58:11 triacylglycerol, C54:9 triacylglycerol, C36:1 phosphatidylcholine and sucrose replicated in an independent dataset of 980 participants in the PREDIMED trial (Prevención con Dieta Mediterránea).

Conclusions:

Randomized treatment with oral HT resulted in large metabolome shifts that generally favored CEE alone over CEE+MPA in term of CHD risk. Discordant metabolite effects between HT regimens may partially mediate the differences in CHD risk between the 2 WHI-HT trials.
Impact of the COVID-19 Pandemic on Percutaneous Coronary Intervention in England
Authors: Kwok Chun Shing , Gale Chris P. , Curzen Nick , de Belder Mark A. , Ludman Peter , Lüscher Thomas F. , Kontopantelis Evangelos , Roebuck Chris , Denwood Tom , Burton Tony , Hains Julian , Deanfield John E. , Mamas Mamas A.
Published: November 2020

Background:

The objective of the study was to evaluate changes in percutaneous coronary intervention (PCI) practice in England by analyzing procedural numbers, changes in the clinical presentation, and characteristics of patients and their clinical outcomes during the coronavirus disease 2019 (COVID-19) pandemic.

Methods:

We conducted a retrospective cohort study of all patients who underwent PCI in England between January 2017 and April 2020 in the British Cardiovascular Intervention Society database.

Results:

Forty-four hospitals reported PCI procedures for 126 491 patients. There were ≈700 procedures performed each week before the lockdown. After the March 23, 2020 lockdown (11th/12th week in 2020), there was a 49% fall in the number of PCI procedures after the 12th week in 2020. The decrease was greatest in PCI procedures performed for stable angina (66%), followed by non–ST-segment–elevation myocardial infarction (45%), and ST-segment–elevation myocardial infarction (33%). Patients after the lockdown were younger (64.5 versus 65.5 years,
P
<0.001) and less likely to have diabetes (20.4% versus 24.6%,
P
<0.001), hypertension (52.0% versus 56.8%,
P
=0.001), previous myocardial infarction (23.5% versus 26.7%,
P
=0.008), previous PCI (24.3% versus 28.3%,
P
=0.001), or previous coronary artery bypass graft (4.6% versus 7.2%,
P
<0.001) compared with before the lockdown.

Conclusions:

The lockdown in England has resulted in a significant decline in PCI procedures. Fewer patients underwent PCI for stable angina. This enabled greater capacity for urgent and emergency cases, and a reduced length of stay was seen for such patients. Significant changes in the characteristics of patients towards a lower risk phenotype were observed, particularly for non–ST-segment–elevation myocardial infarction, reflecting a more conservative approach to this cohort.
Ischemic Cerebral Endothelial Cell–Derived Exosomes Promote Axonal Growth
Authors: Zhang Yi , Qin Yi , Chopp Michael , Li Chao , Kemper Amy , Liu Xianshuang , Wang Xinli , Zhang Li , Zhang Zheng Gang
Published: November 2020

Background and Purpose:

Cerebral endothelial cells (CECs) and axons of neurons interact to maintain vascular and neuronal homeostasis and axonal remodeling in normal and ischemic brain, respectively. However, the role of exosomes in the interaction of CECs and axons in brain under normal conditions and after stroke is unknown.

Methods:

Exosomes were isolated from CECs of nonischemic rats and is chemic rats (nCEC-exos and isCEC-exos), respectively. A multicompartmental cell culture system was used to separate axons from neuronal cell bodies.

Results:

Axonal application of nCEC-exos promotes axonal growth of cortical neurons, whereas isCEC-exos further enhance axonal growth than nCEC-exos. Ultrastructural analysis revealed that CEC-exos applied into distal axons were internalized by axons and reached to their parent somata. Bioinformatic analysis revealed that both nCEC-exos and isCEC-exos contain abundant mature miRNAs; however, isCEC-exos exhibit more robust elevation of select miRNAs than nCEC-exos. Mechanistically, axonal application of nCEC-exos and isCEC-exos significantly elevated miRNAs and reduced proteins in distal axons and their parent somata that are involved in inhibiting axonal outgrowth. Blockage of axonal transport suppressed isCEC-exo–altered miRNAs and proteins in somata but not in distal axons.

Conclusions:

nCEC-exos and isCEC-exos facilitate axonal growth by altering miRNAs and their target protein profiles in recipient neurons.
Is Phasmarhabditis papillosa (Nematoda: Rhabditidae) a possible biological control agent against the Spanish slug, Arion vulgaris (Gastropoda: Arionidae)?
Authors: Laznik Žiga , Majić Ivana , Trdan Stanislav , Malan Antoinette P. , Pieterse Annika , Ross Jenna L.
Published: November 2020

In the period from August to October 2018, 140 specimens of the Spanish slug, Arion vulgaris, were collected from Podbrezje, Slovenia. Slugs were dissected and examined for the presence of parasitic nematodes within the cadavers. Identification of the nematodes was conducted using morphological and molecular techniques and confirmed the presence of Phasmarhabditis papillosa. This is the first record of P. papillosa from the mollusc host, A. vulgaris. Laboratory experiments aimed at testing the efficacy of P. papillosa against A. vulgaris were conducted using nematodes grown in vivo. Nematodes were applied at concentration rates of 50, 100 and 200 nematodes slug−1, respectively. Three weeks following treatment, the mortality of slugs was confirmed in all treatments (50 nematodes slug−1, 37.4 ± 2.7%; 100 nematodes slug−1, 48.4 ± 2.7%; 200 nematodes slug−1, 50.6 ± 2.7%). However, the pathogenesis of P. papillosa was observed first in the treatments with the lowest nematode dose at 4 days after treatments, while a decrease in the feeding behaviour of slugs was noted first in the treatments with the highest nematode dose. Future opportunities for the potential use of P. papillosa as a biological control agent against slugs are discussed. This is the first report of P. papillosa from Slovenia, and of its virulence against A. vulgaris.
Environmental adaptation in language
Authors: Hansen Magnus Pharao , O’Meara Carolyn
Published: November 2020

We argue that the human ability to linguistically describe spatial locations, relations and paths is likely to contribute importantly to human survival, and that consequently the relation between linguistic elements and structures used in spatial reference, and the environment in which humans navigate, ought to be of concern for evolutionary studies of language. We make the case for systematically studying the correspondences between the structures of human spatial language and the spatially structured practices of human groups within specific landscapes, and for considering this relation within a diachronic framework, as a process of cultural and linguistic adaptation to the physical environment. The last section presents the research design of the Nahuatl Space Project, which investigates the possibility of environmental adaptation of spatial language in four varieties of the Nahuan languages of Mexico.
Cantharellus albus, a striking new species from Southwest China

Authors: JIAN SI-PENG , DAI RONG , GAO JUN , FENG BANG
Published: November 2020

A new species, Cantharellus albus, was collected from southwestern China and described with both morphological and molecular characters. It differs from other species of Cantharellus by its smooth white pileus, white hymenophore, and white stipe, the latter turning yellow after bruising. The phylogenetic tree inferred from the combined dataset of three DNA fragments, namely large subunit ribosomal RNA gene (LSU), RNA polymerase II second largest subunit (rpb2), and translation elongation factor 1-alpha gene (tef1), indicated that the new species is distinct from other species of Cantharellus and is a member of sect. Flavobrunnei within the subgenus Parvocantharellus.
A new species of Cerroneuroterus Melika & Pujade-Villar from the Eastern Palaearctic (Hymenoptera, Cynipidae, Cynipini)
Authors: PUJADE-VILLAR JULI , WANG YIPING , GUO RUI , SALA-NISHIKAWA ALBA , CUESTA-PORTA VICTOR , ARNEDO MIQUEL A. , MELIKA GEORGE
Published: November 2020

A new gall wasp species, Cerroneuroterus yukawamasudai Pujade-Villar & Melika sp. nov., is described from China. The asexual generation induces leaf lenticular galls, and the sexual generation induces catkin galls on Q. acutissima and Q. variabilis. Sexual females and males are not described yet. Data on the diagnosis, distribution, and biology of the new species are provided, including a key to sexual and asexual females of all described Cerroneuroterus species. Previous misidentifications of host galls recorded in Japan are commented on. Molecular analyses were performed to assess the validity of the genus Cerroneuroterus and the affiliation of the new species.
Radiative Relaxation Time Scales Quantified from Sudden Stratospheric Warmings
Authors: Bloxam Kevin , Huang Yi
Published: November 2020

Sudden stratospheric warmings (SSWs) are impressive events that occur in the winter hemisphere’s polar stratosphere and are capable of producing temperature anomalies upward of +50 K within a matter of days. While much work has been dedicated toward determining how SSWs occur and their ability to interact with the underlying troposphere, one underexplored aspect is the role of radiation, especially during the recovery phase of SSWs. Using a radiative transfer model and a heating rate analysis for distinct layers of the stratosphere averaged over the 60°–90°N polar region, this paper accounts for the radiative contribution to the removal of the anomalous temperatures associated with SSWs. In total 17 events are investigated over the 1979–2016 period. This paper reveals that in the absence of dynamical heating following major SSWs, longwave radiative cooling dominates and often results in a strong negative temperature anomaly. The polar winter stratospheric temperature change driven by the radiative cooling is characterized by an exponential decay of temperature with an increasing e-folding time of 5.7 ± 2.0 to 14.6 ± 4.4 days from the upper to middle stratosphere. The variability of the radiative relaxation rates among the SSWs was determined to be most impacted by the initial temperature of the stratosphere and the combined dynamic and solar heating rates following the onset of the events. We also found that trace-gas anomalies have little impact on the radiative heating rates and the temperature evolution during the SSWs in the mid- to upper stratosphere.
Women, Wells, and Springs: Water Rights and Hagar’s Tribulations
Authors: Copeland Rebecca L.
Published: November 2020

The theological problem underlying environmental and gender injustice is the pathological assumption that “the rest of” creation is available for use and commodification by a select group of privileged image bearers. An adequate response to this assumption requires re-examining appropriate relationships between creatures. The story of Hagar’s relationship to water provides the foundation for such a response. An ecomimetic interpretation of Genesis 16:1–16 and 21:8–21, focused on the character of water in these passages, uncovers the basis for an appropriate human relationship to water that challenges the ways in which both water and women have been commodified.
Josiah at Bethel and the “Monument” to the Unnamed Prophet from Judah
Authors: Matthews Victor H.
Published: November 2020

In a reexamination of the narrative in which Josiah travels to Bethel and desacralizes the shrine originally constructed by King Jeroboam, special attention is given to issues of spatiality, sensory criticism, and memory studies. By focusing on the sighting of a monument standing in the cemetery at Bethel, the storyteller uses this mnemonic device to evoke a memory that would further vilify Jeroboam and justify Josiah’s centralization of worship in Jerusalem.
Tracheostomy During the COVID‐19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries
Authors: Bier‐Laning Carol , Cramer John D. , Roy Soham , Palmieri Patrick A. , Amin Ayman , Añon José Manuel , Bonilla‐Asalde Cesar A. , Bradley Patrick J. , Chaturvedi Pankaj , Cognetti David M. , Dias Fernando , Di Stadio Arianna , Fagan Johannes J. , Feller‐Kopman David J. , Hao Sheng‐Po , Kim Kwang Hyun , Koivunen Petri , Loh Woei Shyang , Mansour Jobran , Naunheim Matthew R. , Schultz Marcus J. , Shang You , Sirjani Davud B. , St. John Maie A. , Tay Joshua K. , Vergez Sébastien , Weinreich Heather M. , Wong Eddy W. Y. , Zenk Johannes , Rassekh Christopher H. , Brenner Michael J.
Published: November 2020

Objective

The coronavirus disease 2019 (COVID‐19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID‐19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID‐19 pandemic.

Data Sources

Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low‐ and middle‐income countries, 23 published or society‐endorsed protocols, and 36 institutional protocols.

Review Methods

The comparative document analysis involved cross‐sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management.

Conclusions

Timing of tracheostomy varied from 3 to >21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID‐19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to >30 days postoperatively, sometimes contingent on negative COVID‐19 test results.

Implications for Practice

Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence‐based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.
Hormonal Outcomes Following Hemithyroidectomy
Authors: Buehler Lauren Anne , Madhun Nabil Zuhayr , Bena James , Nasr Christian , Scharpf Joseph , Zhou Keren
Published: November 2020

Objective

To assess hormonal outcomes and thyroid hormone (TH) replacement after hemithyroidectomy (HT).

Study Design

Retrospective chart review.

Setting

Quaternary care hospital system.

Methods

A retrospective analysis was performed on patients who had an HT at Cleveland Clinic between 2000 and 2010 with outcomes assessed up to 5 years post‐HT. Patients with overt hypothyroidism (OH; thyroid‐stimulating hormone [TSH] >10 mIU/L, TSH >4.2 mIU/L on thyroid hormone [TH]), subclinical hypothyroidism (SH; TSH >4.2‐10 mIU/L, no TH), or euthyroidism (EU; TSH 0.4‐4.2 mIU/L, no TH) were compared. Patients with SH who returned to EU were compared to those who continued to have SH. For immediate start on TH, a receiver operating characteristic analysis was performed to determine dosage of TH above which suppression of TSH <0.4 mIU/L was predicted.

Results

We identified 335 patients (average age 51 years, 78% female, median follow‐up of 50 months). Of the 210 not immediately started on TH, 32.4% were OH, 13.3% were SH, and 54.3% were EU. EU patients were younger (48 years), had more remaining gland, were less likely to have lymphocytic infiltrate, and had a lower preoperative TSH (1.2 mIU/L). In the SH group, 58.3% of patients normalized their TSH. With immediate TH start, 45% developed suppressed TSH. Those on LT4 >1.05 mcg/kg/d were more likely to suppress (sensitivity 89%).

Conclusion

Most patients post‐HT will remain EU, and immediate start of TH may lead to TSH suppression. Those with SH may ultimately normalize TSH. These findings together suggest that observation may be a better option than TH replacement after HT.
Coagulation States in Patients With Sudden Sensorineural Hearing Loss Evaluated by Thromboelastography
Authors: Li Chunyan , Zhou Huiqun , Feng Yanmei , Zhao Yan , Wang Jingjing , Chen Zhengnong , Yin Shankai
Published: November 2020

Objective

The state of coagulation is controversial in patients with sudden sensorineural hearing loss (SSNHL). We used thromboelastography (TEG) to explore the relationships between blood coagulation parameters and SSNHL pathogenesis and recovery.

Study Design

Prospective study.

Setting

Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University.

Methods

A total of 104 newly diagnosed patients with SSNHL and 29 matched healthy controls were recruited. Hearing assessments, TEG, and conventional coagulation tests (CCTs) were performed, followed by standard treatments and follow‐up.

Results

The TEG parameters of patients with SSNHL were in the normal range, but the group exhibited a significantly prolonged kinetic time (K; P =. 004) and a smaller angle (P =. 003) as compared with the controls. After grouping the patients with SSNHL according to audiograms and comparing them in pairs, we found that the differences were significant only when controls were compared with patients with low‐frequency SSNHL (K, P =. 023; angle, P =. 04) and flat‐type SSNHL (K, P =. 017; angle, P =. 014). Logistic regression analysis showed that neither TEG nor CCT parameters significantly affected hearing improvement after SSNHL treatment.

Conclusions

Although the K value and angle were significantly increased and significantly reduced, respectively, in the test group as compared with the control group, the state of coagulation in patients with SSNHL was still within the normal range. No CCT or TEG coagulation parameters (except the angle) differed significantly among patients in each group according to hearing recovery status, which suggested that the coagulation status does not determine the prognosis of patients with SSNHL.
Revisiting the Recommendation for Contralateral Tonsillectomy in HPV‐Associated Tonsillar Carcinoma
Authors: Parhar Harman S. , Shimunov David , Brody Robert M. , Cannady Steven B. , Newman Jason G. , O’Malley Bert W. , Chalian Ara A. , Rassekh Christopher H. , Weinstein Gregory S. , Rajasekaran Karthik
Published: November 2020

Objective

Despite epidemiologic evidence that second primaries occur infrequently in HPV (human papillomavirus)–associated oropharyngeal squamous cell carcinoma, recent recommendations advocate for elective contralateral palatine tonsillectomy. We aimed to study this discordance and define the necessary extent of up‐front surgery in a large contemporary cohort with long‐term follow‐up treated with unilateral transoral robotic surgery. We hypothesized that second primaries are discovered exceedingly rarely during follow‐up and that survival outcomes are not compromised with a unilateral surgical approach.

Study Design

Retrospective cohort analysis.

Setting

Tertiary care academic center between 2007 and 2017.

Methods

Records for patients with p16‐positive oropharyngeal squamous cell carcinoma of the tonsil and workup suggestive of unilateral disease who underwent ipsilateral transoral robotic surgery were analyzed for timing and distribution of locoregional recurrence, distant metastases, and second primary occurrence as well as survival characteristics.

Results

Among 295 included patients, 21 (7.1%) had a locoregional recurrence; 17 (5.8%) had a distant recurrence; and 3 (1.0%) had a second primary during a median follow‐up of 48.0 months (interquartile range, 29.5‐62.0). Only 1 (0.3%) had a second primary found in the contralateral tonsil. The 2‐ and 5‐year estimates of overall survival were 95.5% (SE, 1.2%) and 90.1% (SE, 2.2%), respectively, while the 2‐ and 5‐year estimates of disease‐free survival were 90.0% (SE, 1.8%) and 84.7% (SE, 2.3%).

Conclusion

Second primary occurrence in the contralateral tonsil was infrequent, and survival outcomes were encouraging with unilateral surgery. This provides a rationale for not routinely performing elective contralateral tonsillectomy in patients whose workup suggests unilateral disease.
Search Trends and Quality of Online Resources Regarding Thyroidectomy
Authors: Chen Lena W. , Harris Vandra Chatrice , Jia Justin Lee , Xie Deborah Xingchun , Tufano Ralph Patrick , Russell Jonathon Owen
Published: November 2020

Objective

Thyroidectomy is one of the most common procedures performed in head and neck surgery. The quality of online resources for thyroidectomy is unknown. We aim to evaluate search trends and online resource quality regarding thyroidectomy.

Study Design

Cross‐sectional analysis.

Setting

Websites appearing on Google search.

Methods

The first 30 Google websites for thyroidectomy were reviewed, excluding research, video, and restricted sites. Search patterns were obtained with Google Trends. Quality was measured by readability (Flesch Reading Ease and Flesch‐Kinkaid Grade Level), understandability and actionability (Patient Education Materials Assessment Tool), and clinical practice guideline (CPG) compatibility. Fleiss kappa interrater reliability analysis was performed for 2 raters.

Results

Twenty‐one sites were evaluated. Search popularity for thyroidectomy has increased since 2004. Median reading ease was 42.2 (range, 15.4‐62.7) on a scale from 1 to 100, with 100 indicating maximum readability. Median reading grade level was 12 (range, 7‐16). Thyroidectomy resources were poorly understandable (median, 66%; range, 21%‐88%) and actionable (median, 10%; range, 0%‐60%). Median CPG compatibility was 4 out of 5 (range, 0‐5). Interrater reliability ranged from substantial to moderate for understandability (0.78), actionability (0.57), and CPG compatibility (0.58), with P <. 05 for all results.

Conclusion

Online resources about thyroidectomy vary in quality and reliability and are written at grade levels above the average reading level of the public. Providers should be aware of existing resources and work to create education resources that meet universal health literacy guidelines. The framework provided in this article may also serve as a guide and provide tangible steps that providers can take to help patients access care.
Biomarkers as predictors of renal damage in neonates undergoing cardiac surgery
Authors: Borchert Evelyn , de la Fuente René , Guzmán Ana María , González Katia , Rolle Augusto , Morales Karina , González Rodrigo , Jalil Roberto , Lema Guillermo
Published: November 2020

Background:

Acute Kidney Injury is a complication in children with heart disease undergoing cardiac surgery with cardiopulmonary bypass. The aim of this study is to describe the behavior of KIM-1 (Kidney Injury Molecule) and NGAL (Neutrophil Gelatinase Associated Lipocalin) as early predictors of renal damage, comparing them with serum creatinine and creatinine clearance, in neonates undergoing cardiac surgery.

Methods:

Twenty-one (21) neonates, under 4 kg, with complex congenital heart diseases, RACHS-1 > 3, without preoperative renal failure, were studied. Serum creatinine and creatinine clearance were measured preoperatively and at 24, 48, 72, 96 hours postoperatively. Urinary samples of KIM-1(pg/ml) and NGAL (ng/ml) were collected after induction of anesthesia at 24 and 48 hours post-operatively.

Results:

nRIFLE criteria were used to divide cohorts in “NO AKI” (12 patients) and “AKI” (nine patients). In the AKI group, serum creatinine increased significantly and creatinine clearance decreased significantly at 24, 48, and 72 hours compared with their respective baseline values. There was no difference in KIM-1 and NGAL values between patients who developed AKI and those who did not at any measured time.

Conclusions:

The deterioration of renal function continues to be one of the most frequent complications in this population. In our study, biomarkers did not show any correlation with the appearance of AKI. It remains to be seen whether this behavior of the biomarkers is linked with the non-consistent release of these types of molecules in immature kidneys. It is likely that a larger panel of biomarkers together with other glomerular filtration rate assessment methods will provide more information about AKI diagnosis.
Radiological Society of North America (RSNA) Expert Consensus Statement Related to Chest CT Findings in COVID-19 Versus CO-RADS: Comparison of Reporting System Performance Among Chest Radiologists and End-User Preference
Authors: O’ Neill Siobhan B. , Byrne Danielle , Müller Nestor L. , Jalal Sabeena , Parker William , Nicolaou Savvas , Bilawich Ana-Maria
Published: November 2020

Purpose:

The RSNA expert consensus statement and CO-RADS reporting system assist radiologists in describing lung imaging findings in a standardized manner in patients under investigation for COVID-19 pneumonia and provide clarity in communication with other healthcare providers. We aim to compare diagnostic performance and inter-/intra-observer among chest radiologists in the interpretation of RSNA and CO-RADS reporting systems and assess clinician preference.

Methods:

Chest CT scans of 279 patients with suspected COVID-19 who underwent RT-PCR testing were retrospectively and independently examined by 3 chest radiologists who assigned interpretation according to the RSNA and CO-RADS reporting systems. Inter-/intra-observer analysis was performed. Diagnostic accuracy of both reporting systems was calculated. 60 clinicians participated in a survey to assess end-user preference of the reporting systems.

Results:

Both systems demonstrated almost perfect inter-observer agreement (Fleiss kappa 0.871, P < 0.0001 for RSNA; 0.876, P < 0.0001 for CO-RADS impressions). Intra-observer agreement between the 2 scoring systems using the equivalent categories was almost perfect (Fleiss kappa 0.90-0.92, P < 0.001). Positive predictive values were high, 0.798-0.818 for RSNA and 0.891-0.903 CO-RADS. Negative predictive value were similar, 0.573-0.585 for RSNA and 0.573-0.58 for CO-RADS. Specificity differed between the 2 systems, 68-73% for CO-RADS and 52-58% for RSNA with superior specificity of CO-RADS. Of 60 survey participants, the majority preferred the RSNA reporting system rather than CO-RADS for all options provided (66.7-76.7%; P < 0.05).

Conclusions:

RSNA and CO-RADS reporting systems are consistent and reproducible with near perfect inter-/intra-observer agreement and excellent positive predictive value. End-users preferred the reporting language in the RSNA system.
“I Did It to Save My Children”: Parenting Strengths and Fears of Women Exposed to Intimate Partner Violence
Authors: Scrafford Kathryn E. , Miller-Graff Laura E. , Umunyana Aimee Gladys , Schwartz Laura E. , Howell Kathryn H.
Published: November 2020

Intimate partner violence (IPV) is experienced by one in four women in the United States, and a wealth of quantitative research has underscored its detrimental effects on women’s mental health and parenting practices. Little research, however, has considered ways in which women exposed to IPV retain and foster parenting strengths and ways in which motherhood serves as a source of resilience for these women. The objective of the current study was to conduct a thematic analysis of IPV-exposed women’s parenting strengths and concerns as reported through focus groups conducted with IPV-exposed women ( n = 22) and service providers ( n = 31) in two urban areas in the Mid-West and Mid-South. Results of the thematic analysis indicated the emergence of three core themes: resilience and challenges of parenting in the context of IPV, leaving the violent partner, and intergenerational processes. Overall, service providers recognized far fewer strengths in parenting on all dimensions than did women, suggesting that service providers may be conceptualizing parenting in the context of IPV from a deficit model that underestimates the resilience demonstrated by these women. This has important consequences for the extent to which women may feel stigmatized or blamed when receiving resources and services critical to their families. Future research on parenting among women experiencing IPV would be enhanced by capturing the dynamic interplay between women’s parenting strengths and challenges, and the ways in which these capacities are affected by resource access within and across social ecological contexts.
Do High-Risk Parents Use More Aggression During Competitive Play With Children?
Authors: Crouch Julie L. , Skowronski John J. , Davila America L. , Milner Joel S.
Published: November 2020

The present study examined the extent to which the aggressive tendencies of parents at risk for perpetrating child physical abuse (CPA) generalize to situations other than discipline-related encounters (e.g., a competitive gaming interaction). Participants included parents who were either low ( n = 90) or high ( n = 75) risk for CPA. Parents were led to believe that they were playing a game against a child opponent with whom they exchanged sound blasts of varying intensities. Parental sound blast selections served as a proxy for aggressive behavior. Parents were randomly assigned to high or low loss conditions. The fictitious child opponent’s responses were pre-programed so that sound blasts received by parents became louder (i.e., more provocative) over time. As predicted, high CPA risk parents exhibited higher levels of aggression than low CPA risk parents. Moreover, high-risk parents reported having higher levels of aggressive motives during the game than low-risk parents; and aggressive motives explained the link between parental CPA risk and parents’ aggressive behavior. With one exception, higher levels of child provocation during the game prompted parents to send higher levels of sound blasts. The exception to this pattern occurred among low-risk parents who experienced high rates of loss during the game. Specifically, low-risk parents in the high loss condition continued to send low levels of sound blasts even as their child opponent became more provocative. Aggressive motives (and the ability to change motives as situations change) may help explain differences in aggressive tendencies evinced by parents with varying levels of CPA risk.