bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Paralogons, Origin of the Vertebrate Karyotype, and Ancient Chromosomes Retained in Extant Species
Authors: Lamb Trevor D
Published: March 2021

A manually curated set of ohnolog families has been assembled, for seven species of bony vertebrates, that includes 255 four-member families and 631 three-member families, encompassing over 2,900 ohnologs. Across species, the patterns of chromosomes upon which the ohnologs reside fall into 17 distinct categories. These 17 paralogons reflect the 17 ancestral chromosomes that existed in our chordate ancestor immediately prior to the two rounds of whole-genome duplication (2R-WGD) that occurred around 600 Ma. Within each paralogon, it has now been possible to assign those pairs of ohnologs that diverged from each other at the first round of duplication, through analysis of the molecular phylogeny of four-member families. Comparison with another recent analysis has identified four apparently incorrect assignments of pairings following 2R, along with several omissions, in that study. By comparison of the patterns between paralogons, it has also been possible to identify nine chromosomal fusions that occurred between 1R and 2R, and three chromosomal fusions that occurred after 2R, that generated an ancestral bony-vertebrate karyotype comprising 47 chromosomes. At least 27 of those ancestral bony-vertebrate chromosomes can, in some extant species, be shown not to have undergone any fusion or fission events. Such chromosomes are here termed “archeochromosomes,” and have each survived essentially unchanged in their content of genes for some 400 Myr. Their utility lies in their potential for tracking the various fusion and fission events that have occurred in different lineages throughout the expansion of bony vertebrates.
Low-velocity impacts into granular material: application to small-body landing
Authors: Murdoch Naomi , Drilleau Melanie , Sunday Cecily , Thuillet Florian , Wilhelm Arnaud , Nguyen Gautier , Gourinat Yves
Published: March 2021

With the flourishing number of small body missions that involve surface interactions, understanding the mechanics of spacecraft – surface interactions is crucial for improving our knowledge about the landing phases of space missions, for preparing spacecraft operations, and for interpreting the results of measurements made during the surface interactions. Given their regolith-covered surfaces, the process of landing on a small body can be considered as an impact at low-velocity on to a granular material in reduced-gravity. In order to study the influence of the surface material, projectile shape, and gravity on the collision dynamics, we used two experimental configurations (one for terrestrial gravity experiments and one for reduced-gravity experiments) to perform low-velocity collisions into different types of granular materials: quartz sand, and two different sizes of glass beads (1.5 and 5 mm diameter). Both a spherical and a cubic projectile (with varying impact orientation) were used. The experimental data support a drag model for the impact dynamics composed of both a hydrodynamic drag force and quasi-static resistance force. The hydrodynamic and quasi-static contributions are related to the material frictional properties, the projectile geometry, and the gravity. The transition from a quasi-static to a hydrodynamical regime is shown to occur at lower impact velocities in reduced-gravity trials than in terrestrial gravity trials, indicating that regolith has a more fluid-like behaviour in low-gravity. The reduced quasi-static regime of a granular material under low-gravity conditions leads to a reduction in the strength, resulting in a decreased resistance to penetration and larger penetration depths.
Dynamical evolution of voids with surrounding gravitational tidal field
Authors: Minoguchi Mutsumi , Nishizawa Atsushi J , Takeuchi Tsutomu T , Sugiyama Naoshi
Published: March 2021

The void ellipticity distribution today can be well explained by the tidal field. Going a step further from the overall distribution, we investigate individuality on the tidal response of void shape in non-linear dynamical evolution. We perform an N-body simulation and trace individual voids using particle ID. The voids are defined based on Voronoi tessellation and watershed algorithm, using public code vide. A positive correlation is found between the time variation of void ellipticity and tidal field around a void if the void maintains its constituent particles. Such voids tend to have smaller mass densities. Conversely, not a few voids significantly deform by particle exchange, rather than the tidal field. Those voids may prevent us from correctly probing a quadrupole field of gravity out of a void shape.
The neglected operculum: a revision of the opercular characters in river snails (Caenogastropoda: Viviparidae)
Authors: Zhang Le-Jia , von Rintelen Thomas
Published: March 2021

The morphological identification of many groups of gastropods is mostly based on shell morphology and genital structures. The value of opercular characters as taxonomic characters has so far been barely studied and evaluated. Here, the opercular characters of river snails (Viviparidae) have been revised systematically for the first time. Based on a morphological study of the opercula of 38 species of 25 viviparid genera, 16 newly defined opercular characters are shown to be useful for genus and species identification. A detailed diagnosis and description of opercular characters for each genus/species is given. One new generic assignment of a viviparid species is proposed based on this study, namely Cipangopaludina nagaensis n. comb.
A New Class of Fictional Truths
Authors: Kim Hannah H
Published: March 2021

It is widely agreed that more is true in a work of fiction than explicitly said. In addition to directly stipulated fictional content (explicit truth), inference and background assumptions give us implicit truths. However, this taxonomy of fictional truths overlooks an important class of fictional truth: those generated by literary formal features. Fictional works generate fictional content by both semantic and formal means, and content arising from formal features such as italics or font size are neither explicit nor implicit: not explicit since formal features don’t say anything; and not implicit since content generated from formal features doesn’t rely on other truths or background assumptions. In addition to showing that our current classification is incomplete, the new class of fictional truths provides four further upshots for definitions of fictional truth, story and work identity conditions, and the relationship between literary interpretation and fictional truth.
The role of social isolation in opioid addiction
Authors: Christie Nina C
Published: March 2021

Humans are social animals: social isolation hurts people both psychologically and physically. Strong, positive social bonds help people to live longer and healthier lives compared with their more isolated peers. Opioid use disorder is associated with feelings of social isolation, an increased risk of suicide and, at the community level, lower social capital. I propose a psychobiological mechanistic explanation that contributes to the association between opioid use and social isolation. The endogenous opioid system plays a central role in the formation and maintenance of social bonds across the life span and has been investigated primarily through the framework of the brain opioid theory of social attachment. In primates, maternal-infant bonding and social play are both impaired by the administration of naltrexone (an opioid antagonist), and in humans, the chronic use of opioids appears to be particularly (relative to other drugs) corrosive to close relationships. Social isolation may play a role in the development and exacerbation of opioid use disorder. Taken together, work on the brain’s opioid system suggests a possible mechanistic basis for bidirectional causal links between social isolation and opioid use disorder. Evaluation of this hypothesis would benefit from longitudinal psychosocial and neuropsychopharmacological investigations.
Risk factors and frequency of COVID-19 among healthcare workers at a tertiary care centre in India: a case–control study
Authors: Dev Nishanth , Meena Ramesh Chand , Gupta D K , Gupta Nitesh , Sankar Jhuma
Published: March 2021

Background

There is a paucity of data on risk factors for infection among healthcare workers (HCWs) from India. Our objective was to evaluate the risk factors and frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among HCWs.

Methods

We conducted this retrospective case–control study of 3100 HCWs between May and July 2020. HCWs positive for SARS-CoV-2 infection were the cases (n=506) and those negative for SARS-CoV-2 were the controls (n=253). Univariate analysis was followed by multivariate analysis of key demographic, clinical and infection control variables.

Results

SARS-CoV-2 infection was found in 16.32% of HCWs. Nearly 45% of infected HCWs were asymptomatic. The proportions of sanitation workers (24% vs 8%; p<0.0001) and technicians (10% vs 4%; p=0.0002) were higher and that of doctors was lower among cases as compared with controls (23% vs 43%; p<0.0001). On univariate analysis, the type of HCW, smoking, lack of training, inadequate personal protective equipment (PPE) use and taking no or fewer doses of hydroxychloroquine (HCQ) were found to be significant. On multivariate analysis, the type of HCW (risk ratio [RR] 1.67 [95% confidence interval {CI} 1.34 to 2.08], p<0.0001), inappropriate PPE use (RR 0.63 [95% CI 0.44 to 0.89], p=0.01) and taking fewer doses of HCQ (RR 0.92 [95% CI 0.86 to 0.99], p=0.03) were significant.

Conclusions

The frequency of SARS-CoV-2 infection was 16% among HCWs. Being a sanitation worker, inappropriate PPE use and lack of HCQ prophylaxis predisposed HCWs to SARS-CoV-2 infection.
Genome Sequence of Venturia carpophila, the Causal Agent of Peach Scab
Authors: Zhou Yang , Zhang Lei , Fan Fei , Wang Zuo-Qian , Huang Yue , Yin Liang-Fen , Yin Wei-Xiao , Luo Chao-Xi
Published: March 2021

Venturia carpophila, the causal agent of scab disease on peach, is a host-specific fungus that is widely distributed around the world, including China. In our previous study, samples were collected from 14 provinces in China, and 750 isolates were obtained by single-spore separation. Here, we reported the first highly contiguous whole-genome sequence (35.87 Mb) of the V. carpophila isolate ZJHZ1-1-1, which included 33 contigs with N50 value of 2.01 Mb and maximum contig length of 3.39 Mb. The high-quality genome sequence and annotation resource will be useful to study the fungal biology, pathogen-host interaction, fungicide resistance, characterization of important genes, population genetic diversity, and development of molecular markers for genotyping and species identification.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Measuring the Effect of Examiner Variability in a Multiple-Circuit Objective Structured Clinical Examination (OSCE)
Authors: Yeates Peter , Moult Alice , Cope Natalie , McCray Gareth , Xilas Eleftheria , Lovelock Tom , Vaughan Nicholas , Daw Dan , Fuller Richard , McKinley Robert K. (Bob)
Published: March 2021

Purpose

Ensuring that examiners in different parallel circuits of objective structured clinical examinations (OSCEs) judge to the same standard is critical to the chain of validity. Recent work suggests examiner-cohort (i.e., the particular group of examiners) could significantly alter outcomes for some candidates. Despite this, examiner-cohort effects are rarely examined since fully nested data (i.e., no crossover between the students judged by different examiner groups) limit comparisons. In this study, the authors aim to replicate and further develop a novel method called Video-based Examiner Score Comparison and Adjustment (VESCA), so it can be used to enhance quality assurance of distributed or national OSCEs.

Method

In 2019, 6 volunteer students were filmed on 12 stations in a summative OSCE. In addition to examining live student performances, examiners from 8 separate examiner-cohorts scored the pool of video performances. Examiners scored videos specific to their station. Video scores linked otherwise fully nested data, enabling comparisons by Many Facet Rasch Modeling. Authors compared and adjusted for examiner-cohort effects. They also compared examiners’ scores when videos were embedded (interspersed between live students during the OSCE) or judged later via the Internet.

Results

Having accounted for differences in students’ ability, different examiner-cohort scores for the same ability of student ranged from 18.57 of 27 (68.8%) to 20.49 (75.9%), Cohen’s d = 1.3. Score adjustment changed the pass/fail classification for up to 16% of students depending on the modeled cut score. Internet and embedded video scoring showed no difference in mean scores or variability. Examiners’ accuracy did not deteriorate over the 3-week Internet scoring period.

Conclusions

Examiner-cohorts produced a replicable, significant influence on OSCE scores that was unaccounted for by typical assessment psychometrics. VESCA offers a promising means to enhance validity and fairness in distributed OSCEs or national exams. Internet-based scoring may enhance VESCA’s feasibility.
Use of Surgical Simulation by Underrepresented High School Students to Address Diversity Gaps in Surgery
Authors: Mohan Navyatha , Hughes Byron , Williams Taylor , Perez Alexander , Tyler Douglas , Okereke Ikenna
Published: March 2021

Recent tragedies have displayed systemic inequities in our society. Our institution has created a program for underrepresented high school students in our surgical simulation lab. The students have responded very favorably, and their interest in a surgical career and self-confidence increased significantly.
Teaching Human Rights in Surgical Curriculum
Authors: Jindal Rahul M.
Published: March 2021

The relatively new academic discipline of health and human rights builds upon international efforts to support universal human rights education. I propose that teaching of human rights, both in domestic and international situations, could be part of a structured curriculum along with medical ethics, professionalism, role-modeling, and mentoring for surgeons in training. I suggest a pilot course of human rights be taught to global and humanitarian surgeons as an initial step before widespread inclusion for all surgeons.
A “Just Enough” Gross Proximal Margin Length Ensuring Pathologically Complete Resection in Distal Gastrectomy for Gastric Cancer
Authors: Hayami Masaru , Ohashi Manabu , Ida Satoshi , Kumagai Koshi , Sano Takeshi , Hiki Naoki , Nunobe Souya
Published: March 2021

Introduction:

The objective of this study is to determine a “just enough” gross proximal margin (PM) length to ensure a pathologically negative PM in distal gastrectomy for gastric cancer. There is a discrepancy between the gross and pathological proximal boundaries of gastric cancer. We must transect the stomach maintaining some safety margins to obtain a pathologically negative PM. However, we have no standard to indicate where to transect the stomach.

Methods:

Patients undergoing distal gastrectomy for gastric cancer were enrolled. A new parameter named ΔPM, which corresponded to the pathological extension proximal to the gross tumor boundary toward the resection stump, was evaluated. The number of patients was counted in each ΔPM range of 1-cm increments. The maximum ΔPM was defined as the first value at which the number of patients became 0, and it was determined as the recommended gross PM length for each disease type.

Results:

In cT1, 259 and 330 patients were assigned to differentiated (Dif) and undifferentiated types (Und), respectively. The maximum ΔPM was 20 mm for Dif and 40 mm for Und. In cT2–4, 194 and 490 patients were assigned to the expansive (Exp) and infiltrative (Inf) growth types. The maximum ΔPM was 30 mm for Exp. The maximum ΔPM was 50 mm for Inf of less than 80 mm and 60 mm for Inf of 80 mm or more.

Conclusions:

A newly recommended gross PM length to ensure pathologically negative PMs in distal gastrectomy for each gastric cancer type was determined.
Pediatric Orthopaedic Surgeon Time Utilization in Clinic: A Pilot Study
Authors: Patterson Melanie , Silver Jeremy , Armstrong Douglas , Hennrikus William
Published: March 2021

Background:

The purpose of this study is to quantify how pediatric orthopaedic surgeons spend time in clinic.

Methods:

Two pediatric orthopaedic surgeons were individually observed and activities were timed during 3 clinic sessions. One medical student observed and recorded the time using a data collection sheet and a watch. The duration of each clinic session was 4 hours and a new patient was seen every 20 minutes. Data was collected in 7 categories including: time with the patient; time with staff; time listening to the resident presentations, time teaching, time multitasking, time dictating, and time on the electronic medical record (EMR). The number of computer mouse clicks needed to complete each patient encounter was also recorded. The Cerner EMR system was used (Cerner Inc. North Kansas City, MO).

Results:

Thirty-six percent of the physician’s time was spent on the EMR. Thirty-five percent of time was spent with the patient, 7% was spent dictating, 7% teaching, 5% multitasking, 6% with staff, and 4% listening to resident presentations. Overall, during a 20-minute patient visit, 7.2 minutes was spent on the EMR. During a 4-hour clinic, 87 minutes was spent on the EMR. During a full day of clinic—two 4-hour sessions—173 minutes were spent on the EMR. The average number of computer mouse clicks to complete a patient encounter was 70 (range: 42 to 110). A total of 1680 clicks were needed to see 24 patients in a typical 2 session clinic.

Conclusion:

Pediatric orthopaedic surgeons spend more time on the EMR than with patients. About 70 computer mouse clicks are needed per patient encounter. The excessive computer time can diminish the patient-physician relationship. Click fatigue in physicians is real and needs to be resolved by improved EMR technology, utilization of medical scribes, or a return to partial use of paper.

Level of Evidence:

Level IV—an observational study.
Risk Factors of Postoperative Shoulder Imbalance in Adolescent Idiopathic Scoliosis
Authors: Moorthy Vikaesh , Goh Graham S. , Guo Chang-Ming , Tan Seang-Beng , Chen John Li-Tat , Soh Reuben Chee Cheong
Published: March 2021

Study Design:

This is a retrospective study.

Objective:

To determine (1) the independent risk factors of postoperative shoulder imbalance (PSI) after adolescent idiopathic scoliosis (AIS) correction surgery; and (2) whether the level of upper instrumented vertebrae (UIV) affects postoperative shoulder balance.

Summary of Background Data:

PSI is an important outcome of AIS correction surgery as it influences a patient’s appearance and satisfaction. However, risk factors for PSI remain controversial and there are currently no studies evaluating the effect of sagittal spinopelvic parameters on PSI. Previous studies on the relationship between the level of UIV and PSI have also reported conflicting results.

Materials and Methods:

Sixty-nine AIS patients undergoing correction surgery at a single institution were retrospectively reviewed. Radiographic parameters were measured on anteroposterior and lateral x-rays preoperatively, immediate postoperatively, and 12 months postoperatively. At 1 year follow-up, patients were divided into 2 groups based on their radiographic shoulder height (RSH): (1) PSI group (RSH ≥20 mm) and (2) non-PSI group (RSH <20 mm).

Results:

On multivariate regression analysis, a lower postoperative main thoracic curve (MTC) [odds ratio (OR): 0.702, 95% confidence interval (CI): 0.519–0.949, P=0.022], greater percentage correction of MTC (OR: 1.526, 95% CI: 1.049–2.220, P=0.027) and higher postoperative sacral slope (OR: 1.364, 95% CI: 1.014–1.834, P=0.040) were identified as independent risk factors of PSI. When preoperative, postoperative, and absolute change in shoulder parameters were compared across the level of UIV, no significant differences were found regardless of the radiographic shoulder parameter analyzed.

Conclusions:

Lower postoperative MTC, greater percentage correction of MTC and higher postoperative sacral slope were independent risk factors of PSI. Shoulder balance and symmetry were not affected by the level of UIV selected. Relative curve correction is a more important consideration than UIV to avoid PSI after AIS correction surgery.

Level of Evidence:

III.
Neuromodulatory therapies for patients with prolonged disorders of consciousness
Authors: Wu Yue-Hao , Yu Jie , Hong Li-Rong , Luo Ben-Yan
Published: March 2021

Background:

Reviving patients with prolonged disorders of consciousness (DOCs) has always been focused and challenging in medical research. Owing to the limited effectiveness of available medicine, recent research has increasingly turned towards neuromodulatory therapies, involving the stimulation of neural circuits. We summarised the progression of research regarding neuromodulatory therapies in the field of DOCs, compared the differences among different studies, in an attempt to explore optimal stimulation patterns and parameters, and analyzed the major limitations of the relevant studies to facilitate future research.

Methods:

We performed a search in the PubMed database, using the concepts of DOCs and neuromodulation. Inclusion criteria were: articles in English, published after 2002, and reporting clinical trials of neuromodulatory therapies in human patients with DOCs.

Results:

Overall, 187 published articles met the search criteria, and 60 articles met the inclusion criteria. There are differences among these studies regarding the clinical efficacies of neurostimulation techniques for patients with DOCs, and large-sample studies are still lacking.

Conclusions:

Neuromodulatory techniques were used as trial therapies for DOCs wherein their curative effects were controversial. The difficulties in detecting residual consciousness, the confounding effect between the natural course of the disease and therapeutic effect, and the heterogeneity across patients are the major limitations. Large-sample, well-designed studies, and innovations for both treatment and assessment are anticipated in future research.
Association between cumulative blood pressure and long-term risk of cardiovascular disease: findings from the 26-year Chinese Multi-provincial Cohort Study-Beijing Project
Authors: Liu Shuai , Zhao Dong , Wang Miao , Qi Yue , Sun Jia-Yi , Liu Jun , Li Yan , Liu Jing
Published: March 2021

Background:

Cumulative blood pressure (BP), a measure incorporating the level and duration of BP exposure, is associated with the risk of cardiovascular disease (CVD). However, the level at which cumulative BP could significantly increase the risk remains unclear. This study aimed to investigate the association of 15-year cumulative BP levels with the long-term risk of CVD, and to examine whether the association is independent of BP levels at one examination.

Methods:

Data from a 26-year follow-up of the Chinese Multi-provincial Cohort Study-Beijing Project were analyzed. Cumulative BP levels between 1992 and 2007 were calculated among 2429 participants free of CVD in 2007. Cardiovascular events (including coronary heart disease and stroke) occurring from 2007 to 2018 were registered. Adjusted hazard ratios (HRs) for CVD incidence associated with quartiles of cumulative systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated.

Results:

Of the 2429 participants, 42.9% (1042) were men, and the mean age in 2007 was 62.1 ± 7.9 years. Totally, 207 CVD events occurred during the follow-up from 2007 to 2018. Participants with higher levels of cumulative SBP or DBP exhibited a higher incidence rate of CVD (P < 0.001). Compared with the lowest quartile of cumulative SBP, the HR for CVD was 1.03 (95% confidence interval [CI]: 0.59–1.81), 1.69 (95% CI: 0.99–2.87), and 2.20 (95% CI: 1.21–3.98) for the second to the fourth quartile of cumulative SBP, and 1.46 (95% CI: 0.86–2.48), 1.99 (95% CI: 1.18–3.35), and 2.08 (95% CI: 1.17–3.71) for the second to the fourth quartile of cumulative DBP, respectively. In further cross-combined group analyses with BP measurements in 2007, 15-year cumulative BP levels higher than the median, that is, 1970.8/1239.9 mmHg·year for cumulative SBP/DBP, which were equivalent to maintaining SBP/DBP levels of 131/83 mmHg or above on average in 15 years, were associated with higher risk of CVD in subsequent years independent of BP measurements at one-time point.

Conclusion:

Cumulative exposure to moderate elevation of BP is independently associated with increased future cardiovascular risk.
Lower Levels of Trust in the Medical Profession Among White, Younger, and More-educated Individuals With Cancer
Authors: Grant Stephen , Liao Kaiping , Miller Christopher , Peterson Susan , Elting Linda , Guadagnolo B. Ashleigh
Published: March 2021

Introduction:

Levels of medical mistrust have historically been higher among racial/ethnic minority patients compared with whites, largely owing to societal and health system inequities and history of discrimination or experimentation. However, recently trust in physicians has declined in the United States in general. We investigated trust in physicians among a large cohort of cancer patients residing in Texas.

Methods:

A sample of recently diagnosed cancer patients in Texas were identified from the Texas Cancer Registry with 1344 patients returning surveys between March 2017 and March 2020. The multiscale inventory was mailed to each individual and included the Trust in the Medical Profession Scale which assesses levels of agreement with 11 trust-related statements. Multivariable linear regression models were constructed to assess the adjusted relationship between trust in the medical profession aggregate score and sociodemographic and clinical factors.

Results:

A total of 1250 surveys were evaluable for trust in the medical profession. The mean aggregate trust score for all patients was 37.3 (95% confidence interval: 36.8-37.7). Unadjusted trust scores were higher for Hispanic (40.5) and black (38.2) respondents compared with white (36.4) (P<0.001). Multivariable analyses showed white, younger, more-educated, or those with lower levels of self-reported health estimated toward lower adjusted scores for trust in the medical profession.

Conclusions:

We observed relatively higher levels of medical mistrust among white, younger, more-educated individuals with cancer or those with poorer health. While the relatively higher trust among minority individuals is encouraging, these findings raise the possibility that recent societal trends toward mistrust in science may have implications for cancer care.
Immunologic and Epidemiologic Drivers of Norovirus Transmission in Daycare and School Outbreaks
Authors: Havumaki Joshua , Eisenberg Joseph N. S. , Mattison Claire P. , Lopman Benjamin A. , Ortega-Sanchez Ismael R. , Hall Aron J. , Hutton David W. , Eisenberg Marisa C.
Published: March 2021

Background:

Norovirus outbreaks are notoriously explosive, with dramatic symptomology and rapid disease spread. Children are particularly vulnerable to infection and drive norovirus transmission due to their high contact rates with each other and the environment. Despite the explosive nature of norovirus outbreaks, attack rates in schools and daycares remain low with the majority of students not reporting symptoms.

Methods:

We explore immunologic and epidemiologic mechanisms that may underlie epidemic norovirus transmission dynamics using a disease transmission model. Towards this end, we compared different model scenarios, including innate resistance and acquired immunity (collectively denoted ‘immunity’), stochastic extinction, and an individual exclusion intervention. We calibrated our model to daycare and school outbreaks from national surveillance data.

Results:

Including immunity in the model led to attack rates that were consistent with the data. However, immunity alone resulted in the majority of outbreak durations being relatively short. The addition of individual exclusion (to the immunity model) extended outbreak durations by reducing the amount of time that symptomatic people contribute to transmission. Including both immunity and individual exclusion mechanisms resulted in simulations where both attack rates and outbreak durations were consistent with surveillance data.

Conclusions:

The epidemiology of norovirus outbreaks in daycare and school settings cannot be well described by a simple transmission model in which all individuals start as fully susceptible. More studies on how best to design interventions which leverage population immunity and encourage more rigorous individual exclusion may improve venue-level control measures. See video abstract at http://links.lww.com/EDE/B795.
Instability of Variable-selection Algorithms Used to Identify True Predictors of an Outcome in Intermediate-dimension Epidemiologic Studies
Authors: Cadiou Solène , Slama Rémy
Published: March 2021

Background:

Machine-learning algorithms are increasingly used in epidemiology to identify true predictors of a health outcome when many potential predictors are measured. However, these algorithms can provide different outputs when repeatedly applied to the same dataset, which can compromise research reproducibility. We aimed to illustrate that commonly used algorithms are unstable and, using the example of Least Absolute Shrinkage and Selection Operator (LASSO), that stabilization method choice is crucial.

Methods:

In a simulation study, we tested the stability and performance of widely used machine-learning algorithms (LASSO, Elastic-Net, and Deletion-Substitution-Addition [DSA]). We then assessed the effectiveness of six methods to stabilize LASSO and their impact on performance. We assumed that a linear combination of factors drawn from a simulated set of 173 quantitative variables assessed in 1,301 subjects influenced to varying extents a continuous health outcome. We assessed model stability, sensitivity, and false discovery proportion.

Results:

All tested algorithms were unstable. For LASSO, stabilization methods improved stability without ensuring perfect stability, a finding confirmed by application to an exposome study. Stabilization methods also affected performance. Specifically, stabilization based on hyperparameter optimization, frequently implemented in epidemiology, increased the false discovery proportion dramatically when predictors explained a low share of outcome variability. In contrast, stabilization based on stability selection procedure often decreased the false discovery proportion, while sometimes simultaneously lowering sensitivity.

Conclusions:

Machine-learning methods instability should concern epidemiologists relying on them for variable selection, as stabilizing a model can impact its performance. For LASSO, stabilization methods based on stability selection procedure (rather than addressing prediction stability) should be preferred to identify true predictors.
Lessons from COVID-19 mortality data across countries
Authors: Corrao Giovanni , Rea Federico , Blangiardo Gian Carlo
Published: March 2021

Objective:

Several online sources provide up-to-date open-access data on numbers, rates and proportions of COVID-19 deaths. Our article aims of comparing and interpreting between-country trends of mortality rate, case-fatality and all-cause excess mortality.

Methods:

We used data from open databases (Our World in Data mostly) for comparing mortality of eleven western countries (Austria, Belgium, Canada, France, Germany, Italy, Netherlands, Spain, Sweden, UK, USA). Between-country trends in mortality rate and case-fatality (both including deaths for COVID-19 as numerator and therefore labelled as COVID-19 mortality metrics) and all-cause excess mortality (i.e. observed deaths during the epidemic compared with those expected based on mortality in the same periods of previous years) were compared.

Results:

Although Belgium ranks first in mortality from COVID-19 (possibly due to the broadest criterion for attributing a death to COVID-19), it does not rank first for all-cause excess mortality. Conversely, compared with Belgium, the UK, Italy and Spain have reported lower COVID-19 mortality (possibly due to the narrower definitions for a COVID-19 death) but higher all-cause excess mortality. Germany and Austria are the unique countries for which COVID-19 mortality, case-fatality and all-cause excess mortality consistently exhibited the lowest rates.

Conclusion:

Between-country heterogeneity of COVID-19 mortality metrics could be largely explained by differences of criteria for attributing a death to COVID-19; in age/comorbidity structures; in policies for identifying asymptomatic people affected from SARS-CoV-2 infection. All-cause excess mortality is recommended as a more reliable metric for comparing countries.
How to Estimate QT Interval in Patients With Left or Right Bundle Branch Block
Authors: Fredholm Kristian , Højlund Mikkel , Bjerregaard Mads Rye , Nielsen Jens Cosedis , Fink-Jensen Anders , Correll Christoph U.
Published: March 2021

Purpose/Background

Prolonged QT interval related to psychopharmacological treatment is a risk factor for potentially life-threatening arrhythmias. Electrocardiographic measurements are recommended in patients with cardiovascular risk factors before initiating treatment with potentially QT-prolonging medications, such as certain antidepressants or antipsychotics. In patients with left bundle branch block (LBBB) or right bundle branch block (RBBB), conventional QT-estimation methods will lead to overestimation of the QT interval, as the conduction defect, reflected by the QRS duration, will increase the QT interval without representing longer repolarization as in drug-induced QT prolongation.

Methods/Procedures

We conducted a systematic review of methods to estimate QT interval in the presence of LBBB or RBBB. We searched electronic databases Embase and Medline (last search, August 12, 2020).

Findings/Results

We found 8 different methods, including linear correction formulae with and without correction for heart rate, or simpler formula correcting QRS duration with empirically derived modifiers. Only 3 of 8 methods were applicable in the presence of RBBB, whereas all 8 methods could be applied in the presence of LBBB.

Implications/Conclusions

The QT interval is overestimated in patients with LBBB or RBBB, when using conventional measurements. Several alternative correction formulae exist, which can be applied using standard measurements from ordinary electrocardiographic readings. However, it is currently unknown whether or not the QT prolongation observed in the presence of bundle branch block significantly increases the risk of arrhythmias, as these formulae have not been tested against patient-specific clinical outcomes.
Dermatology Assessment
Authors: Maghfour Jalal , Jacob Sharon E.
Published: March 2021

Dermatology Assessment represents a novel readership-based tutorial module. Each question links to the Journal of the Dermatology Nurses' Association articles (for members) and Journal of the American Academy of Dermatology article citations associated with the topic.
Nursing Leadership in COVID-19 Education—Chronologic Indexing of Information and Assurance of Receipt of Information
Authors: Baghchechi Mohsen , Saldana Irene , Jacob Sharon E.
Published: March 2021

In December 2019, a cluster of patients in Wuhan, Hubei Province, China, presented with severe atypical pneumonia. Because of the association with a novel coronavirus strain, the disease was coined COVID-19. Preventing the spread of the virus through extensive education became the primary intervention point in the containment of COVID-19. Resource and labor mapping shifted to adapt to the pandemic. Nurse practitioners have transitioned to frontline community health and prevention roles in safety education and regulatory resource management.
Pharmacotherapy of Transgender Children and Adolescents
Authors: Farrington Elizabeth
Published: March 2021

This article will review the pharmacology used for patients with gender dysphoria who wish to use puberty blockers or cross-sex hormonal support. Dosages, proper usage, adverse effects, and monitoring parameters for each treatment period are described.
Iron deficiency in infancy: current insights
Authors: Berglund Staffan K. , Domellöf Magnus
Published: March 2021

Purpose of review

Iron deficiency is the most common micronutrient deficiency and infants are at particular risk. The purpose of this review is to summarize recent studies that explored the metabolism of iron in infants as well as the risks and benefits of iron supplementation in different populations.

Recent findings

The ability of infants to regulate iron homeostasis is not fully known but most likely different from adults. Reducing iron deficiency has beneficial effects on neurodevelopment but iron overload may have adverse functional effects including diarrhea and even poor neurodevelopment. Recent studies have confirmed benefits of delayed cord clamping and supplementation of infants in risk groups while iron supplementation to pregnant women has shown limited effect in the offspring with regard to iron status and neurodevelopment. Further support is given to the recommendation that exclusive breast feeding, without supplementation, is safe for normal birth weight infants until 6 months whereafter an iron-rich diet should be given.

Iron deficiency negatively impacts global health but efforts to identify optimal interventions are progressing. Yet, questions remain, particularly regarding long-term risks, benefits and optimal interventions for low birth weight infants as well as the level of iron fortification in infant formula.
COVID-19 new diagnostics development: novel detection methods for SARS-CoV-2 infection and considerations for their translation to routine use
Authors: Huggett Jim F. , Moran-Gilad Jacob , Lee J. Eugene
Published: March 2021

Purpose of review

COVID-19 has put the in-vitro-diagnostic community under an unprecedented spotlight, with a global requirement for accurate SARS-CoV-2 tests. This review will outline technological responses to this need and the analytical considerations required for their translation to routine use.

Recent findings

SARS-CoV-2 diagnostic solutions directly detect the virus or measure host-derived surrogate markers of infection. With pressure upon supply chains for the ‘traditional’ molecular approaches, a wide variety of analytical tools spanning the molecular, serology, imaging and chemistry space are being developed, including high throughput solutions and simplified near-patient formats.

The unique genetic nature of SARS-CoV-2 means high analytical specificity is achievable by most diagnostic formats. However, clinical sensitivity assessment is complicated by wide discrepancies in analytical range and challenges associated with standardising these differences. When coupled with the acute nature of SARS-CoV-2 infection, reported precise metrics of test performance must be questioned. The response to SARS-CoV-2 has delivered considerable diagnostic innovation, but for a technology to be maximised, it must be demonstrably reproducible and fit for purpose. If novel diagnostic solutions for SARS-CoV-2 are to succeed, equally innovative mechanisms are needed to ensure widespread clinical and surveillance application, enabling agreed standards and metrics to ensure comparability.
A network meta-analysis protocol of efficacy and safety evaluation of different surgery regimens for varicocele patients with infertility
Authors: Zhao Xiao-dong , Ma Xiao-ling , Ma Peng-cheng , Wang Jian-wen
Published: March 2021

Background:

Surgical treatment of varicocele is still one of the most common important treatments for male infertility. Surgery regimens for varicocele (VC) is various, including high ligation, sub-inguinal, inguinal, retroperitoneal, laparoscopic, and microsurgery. The surgery regimens applied for VC patients are various in clinic, however, the significance, advantages, and disadvantages of different varicocelectomies for male infertility are still in controversial. Therefore, this network meta-analysis is mainly to assess the relative efficacy and safety of different surgery regimens for VC patients with infertility.

Methods:

To compare the relative efficacy and safety among different varicocelectomies for VC patients, we systematic searched randomized controlled trials (RCTs) and non-RCTs were in five electronic databases: Pubmed, Web of Science, EMBASE database, Clinical Trials, and Cochrane Library. Using R-3.4.1 software to process and analyze data. The bias risk of RCTs and non-RCTs will be evaluated through the tool of Cochrane Handbook version 5.1.0 and non-randomized studies of interventions (ROBINS-I), respectively.

Results and conclusion:

The result of this network meta-analysis aim is to evaluate the relative effectiveness and safety and rank the interventions among all surgery methods for VC patients and provide more evidence-based guidance in clinical practice.

Protocol registration number:

CRD42020162051.
Oral high dose vitamin D for the treatment of diabetic patients with COVID-19
Authors: Nie Xiaoya , Chen Jiaoxue , Ye Fang , Wang Hui , Tang Liang , Wang Lang
Published: March 2021

Background:

Type 2 diabetes mellitus patients complicated with infections experience severe vitamin D deficiency. High-dose vitamin D is applied to the treatment of corona virus disease 2019 (COVID-19) by some researchers, and good results have been achieved. However, the efficacy of vitamin D in the treatment of infections in COVID-19 patients with diabetes remains unclarified. This study aims to explore the effect of oral high-dose vitamin D in the treatment of diabetic patients with COVID-19.

Methods:

Randomized controlled trials about the application of high-dose vitamin D in the treatment of diabetic patients with COVID-19 will be retrieved from such electronic databases as Embase, PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure database, Chinese Wanfang database and Chinese Biomedical Literature database. The retrieval time is from their inception to December 2020. According to the pre-designed inclusion/exclusion criteria, the data will be extracted independently by two researchers. The risk of bias of the included studies will be assessed by the Cochrane collaboration's tool. Meta-analysis will be conducted by using Revman 5.3 software.

Results:

A high-quality and comprehensive evaluation of oral high-dose vitamin D for the treatment of diabetic patients with COVID-19 will be made.

Conclusion:

The article will provide more convincing evidence and evidence-based guidance for clinical practice.

Ethics and dissemination:

The private information of individuals will not be made public, and this systematic evaluation will also not infringe on the rights of participants. Ethical approval is not required. Research results may be published in a peer-reviewed journal or disseminated in relevant conferences.

PROSPERO Registration Number:

CRD42020214284.
Low back pain
Authors: Zuo Jianjian , Pan Xuming , Shen Weiqiang
Published: March 2021

Objective:

To establish whether early use of magnetic resonance imaging (MRI) or computed tomography (CT) influences treatment and outcome of patients with low back pain.

Methods:

This study will be implemented from March 2021 to March 2022 at Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University. The experiment was granted through the Research Ethics Committee of Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University (R609320987). Patients who have symptomatic lumbar spine disorders at presentation are eligible for the trial if there is clinical uncertainty about the need for imaging (MRI or CT). Patients are excluded who required immediate referral for imaging (those who had signs suggestive of serious abnormalities or disease or who required surgical intervention), who have undergone MR imaging or CT of the spine within 1 year, who do not need imaging, and who have pain of a nonspinal origin. The primary outcome measure is the Aberdeen Low Back Pain (ALBP) score. Other principal outcome measure is the Short Form 36.

Results:

Table 1 will show the quality of life outcome measures between groups.

Conclusion:

This study may guide the policy makers to develop an evidence-based protocol to assess the effect of early use of MRI or CT in the treatment of patients with low back pain.
The relationships among self-efficacy, social support, and self-care behavior in the elderly patients with chronic pain (a STROBE-compliant article)
Authors: Li Si-yi
Published: March 2021

The relationships among the self-efficacy, social support and self-care behavior in the elderly patients with chronic pain has not been reported. Therefore, we explored the relationships among self-efficacy, social support and self-care behavior in the elderly patients with chronic pain.

General data questionnaire, self-efficacy scale, social support scale and self-care behavior scale were performed in 1032 elderly patients with chronic pain from Shenyang city between February and December 2017. The relationships among self-efficacy, social support and self-care behavior, and self-efficacy as a mediator between the social support and self-care behavior were analyzed by Pearson correlation analysis and Bootstrap method.

In these elderly patients with chronic pain, the total scores of the self-efficacy, social support and self-care behavior were 35.59 ± 12.38, 65.64 ± 19.68 and 50.52 ± 15.26, respectively. The self-efficacy was positively correlated with the self-care behavior (r = 0.414, P < .001), the self-efficacy was positively correlated with the social support (r = 0.293, P < .001) and the social support was positively correlated with the self-care behavior (r = 0.322, P < .001). The mediating effect of self-efficacy was 0.121 which accounted for 27.31% of the total effects.

The self-efficacy plays a mediating effect between social support and self-care behavior in the elderly patients with chronic pain.
Fibrodysplasia ossificans progressiva in a young adult with genetic mutation
Authors: Wang Zhankui , Wang Xiuhua , Liu Baojin , Hou Yanfeng
Published: March 2021

Rationale:

Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disorder characterized by congenital skeletal deformities and soft tissue masses that progress into heterotopic ossification. Deformities of the great toes are distinctive and heterotrophic ossification usually begins in the first decade of the patient's life. Any invasive procedure could potentially trigger a flare and heterotopic calcification. The diagnosis is difficult and there is no effective treatment for FOP and the approximate life expectancy is 4 decades.

Patient concerns:

A 22-year-old male patient who had suffered from pain and movement limitations for 14 years. At the early stage of disease, the child underwent an operation on both thighs with a diagnosis of myophagism. He had serious stiffness and multiple bony masses with the characteristic bilateral hallux valgus deformity and microdactyly.

Diagnoses:

The patient was diagnosed with FOP by the help of characteristic great toe malformations and widespread heterotopic ossification throughout the body. Deoxyribonucleic acid sequencing demonstrated that the patient had a de novo heterozygous mutation (c.617G>A; p.R206H) in activin A receptor/activin-like kinase 2.

Interventions:

We administered a co-therapy of glucocorticoids, NSAIDs to relieve pain, and montelukast for 2 months. Bisphosphonate (5 mg, intravenous) was used once.

Outcomes:

At the follow-up 12 months later, the patient still felt low back pain sometimes and need take NSAIDs three times a week.

Lessons:

Clinicians and radiologists should realize the characteristic features of FOP and early diagnosis can prevent additional invasive harm to the patient.