bluuebunny/crossref_metadata_2025 huggingface dataset:
The Paternal Transition Entails Neuroanatomic Adaptations that are Associated with the Father’s Brain Response to his Infant Cues
Authors: Paternina-Die María , Martínez-García Magdalena , Pretus Clara , Hoekzema Elseline , Barba-Müller Erika , Martín de Blas Daniel , Pozzobon Cristina , Ballesteros Agustín , Vilarroya Óscar , Desco Manuel , Carmona Susanna
Published: November 2020

The transition into fatherhood is a life-changing event that requires substantial psychological adaptations. In families that include a father figure, sensitive paternal behavior has been shown to positively impact the infant’s development. Yet, studies exploring the neuroanatomic adaptations of men in their transition into fatherhood are scarce. The present study used surface-based methods to reanalyze a previously published prospective magnetic resonance imaging dataset comprised of 20 first-time fathers (preconception-to-postpartum) and 17 childless men. We tested if the transition into fatherhood entailed changes in cortical volume, thickness, and area and whether these changes were related to 2 indicators of paternal experience. Specifically, we tested if such changes were associated with (1) the baby’s age and/or (2) the fathers’ brain activity in response to pictures of their babies compared with an unknown baby. Results indicated that first-time fathers exhibited a significant reduction in cortical volume and thickness of the precuneus. Moreover, higher volume reduction and cortical thinning were associated with stronger brain responses to pictures of their own baby in parental brain regions. This is the first study showing preconception-to-postpartum neuroanatomical adaptations in first-time fathers associated with the father’s brain response to cues of his infant.
Reading the Self: Medical Students’ Experience of Reflecting on Their Writing Over Time
Authors: Cunningham Hetty , Taylor Delphine S. , Desai Urmi A. , Ender Katherine L. , Glickstein Julie , Krishnan Usha S. , Richards Boyd F. , Charon Rita , Balmer Dorene F.
Published: November 2020

Purpose

To investigate students’ experience (over time) with meta-reflection writing exercises, called Signature Reflections. These exercises were used to strengthen reflective capacity, as part of a 4-year reflective writing portfolio curriculum that builds on a recognized strategy for reflection (narrative medicine) and employs longitudinal faculty–mentors.

Method

In 2018, the authors conducted 5 focus groups with 18 third-year students from the Columbia University Vagelos College of Physicians and Surgeons class of 2019 to examine students’ experience with Signature Reflections. Using an iterative, thematic approach, they developed codes to reflect common patterns in the transcripts, distilled conceptually similar codes, and assembled the code categories into themes.

Results

Three core themes (safe space, narrative experience, mirror of self) and 1 overarching theme (moving through time) were identified. Students frequently experienced relief at having a safe reflective space that promoted grappling with their fears or vulnerabilities and highlighted contextual factors (e.g., trusted faculty–mentors, protected time) that fostered a safe space for reflection and exploration. They often emphasized the value of tangible documentation of their medical school journey (narrative experience) and reported using Signature Reflections to examine their emerging identity (mirror of self). Overlapping with the core themes was a deep appreciation for the temporal perspective facilitated by the Signature Reflections (moving through time).

Conclusions

A longitudinal narrative medicine-based portfolio curriculum with pauses for meta-reflection allowed students, with faculty support, to observe their trajectory through medical school, explore fears and vulnerabilities, and narrate their own growth. Findings suggest that narrative medicine curricula should be required and sufficiently longitudinal to facilitate opportunities to practice the skill of writing for insight, foster relationships with faculty, and strengthen students’ temporal perspectives of their development.
Tolerance for Ambiguity Among Medical Students: Patterns of Change During Medical School and Their Implications for Professional Development
Authors: Geller Gail , Grbic Douglas , Andolsek Kathyrn M. , Caulfield Marie , Roskovensky Lindsay
Published: November 2020

Purpose

Tolerance for ambiguity (TFA) is important for physicians, with implications for ethical behavior and patient care. This study explores how medical students’ TFA changes from matriculation to graduation and how change in empathy and openness to diversity are associated with this change.

Method

Data for students who took the Matriculating Student Questionnaire (MSQ) in 2013 or 2014 and the Medical School Graduation Questionnaire (GQ) in 2017 or 2018 were drawn from the Association of American Medical Colleges (n = 17,221). Both the MSQ and GQ included a validated TFA scale and a shortened version of the Interpersonal Reactivity Index; the MSQ also included an openness to diversity scale. Tercile groups were used to assess how TFA changed from the MSQ to GQ, and regression analyses were used to assess associations between change in TFA and openness to diversity and between change in TFA and change in empathy.

Results

Mean TFA scores decreased (d = −.67) among students with the highest TFA at matriculation but increased (d = .60) among students with the lowest TFA at matriculation. Regression results showed that change in TFA was significantly and positively associated with change in empathy (beta = .05, P < .001) and that openness to diversity (as reported at matriculation) was significantly and positively associated with TFA at graduation (beta = .05, P < .001).

Conclusions

This is the first nationally representative study to suggest that medical students’ TFA changes over time, but in different directions depending on TFA at matriculation. TFA over time was also associated with change in empathy and openness to diversity. Medical schools should consider strategies to assess TFA in their admissions processes and for cultivating TFA throughout the learning process.
Effects of a Clonidine Taper on Dexmedetomidine Use and Withdrawal in Adult Critically Ill Patients—A Pilot Study
Authors: Bhatt Krupa , Thompson Quan Ashley , Baumgartner Laura , Jia Shawn , Croci Rhiannon , Puntillo Kathleen , Ramsay James , Bouajram Rima H
Published: November 2020

Objectives:

Prolonged use of dexmedetomidine has become increasingly common due to its favorable sedative and anxiolytic properties. Hypersympathetic withdrawal symptoms have been reported with abrupt discontinuation of prolonged dexmedetomidine infusions. Clonidine has been used to transition patients off dexmedetomidine infusions for ICU sedation. The objective of this study was to compare the occurrence of dexmedetomidine withdrawal symptoms in ICU patients transitioning to a clonidine taper versus those weaned off dexmedetomidine alone after prolonged dexmedetomidine infusion.

Design:

This was a single-center, prospective, double cohort observational study conducted from November 2017 to December 2018.

Setting:

Medical-surgical, cardiothoracic, and neurosurgical ICUs in a tertiary care hospital.

Patients:

We included adult ICU patients being weaned off dexmedetomidine after receiving continuous infusions for at least 3 days.

Interventions:

Patients were either weaned off dexmedetomidine alone or with a clonidine taper at the discretion of the providers.

Measurements and Main Results:

The primary outcome was the incidence of at least two dexmedetomidine withdrawal symptoms during a single assessment within 24 hours of dexmedetomidine discontinuation. Time on dexmedetomidine after wean initiation and difference in medication cost were also evaluated. Forty-two patients were included in this study: 15 received clonidine (Group C) and 27 weaned off dexmedetomidine alone (Group D). There was no significant difference in the incidence of two or more withdrawal symptoms between groups (73% in Group C vs 59% in Group D; p = 0.51). Patients in Group C spent less time on dexmedetomidine after wean initiation compared with patients in Group D (19 vs 42 hr; p = 0.02). An average cost savings of $1,553.47 per patient who received clonidine was observed. No adverse effects were noted.

Conclusions:

Our study demonstrated that patients receiving clonidine were able to wean off dexmedetomidine more rapidly, with a considerable cost savings and no difference in dexmedetomidine withdrawal symptoms, compared with patients weaned off dexmedetomidine alone. Clonidine may be a safe, effective, and practical option to transition patients off prolonged dexmedetomidine infusions.
Incidence, Risk Factors, and Clinical Consequence of Enteral Feeding Intolerance in the Mechanically Ventilated Critically Ill: An Analysis of a Multicenter, Multiyear Database
Authors: Heyland Daren K. , Ortiz Alfonso , Stoppe Christian , Patel Jayshil J. , Yeh D. Dante , Dukes George , Chen Yaozhu J. , Almansa Cristina , Day Andrew G.
Published: November 2020

OBJECTIVES:

To determine the incidence of enteral feed intolerance, identify factors associated with enteral feed intolerance, and assess the relationship between enteral feed intolerance and key nutritional and clinical outcomes in critically ill patients.

DESIGN:

Analysis of International Nutrition Survey database collected prospectively from 2007 to 2014.

SETTING:

Seven-hundred eighty-five ICUs from around the world.

PATIENTS:

Mechanically ventilated adults with ICU stay greater than or equal to 72 hours and received enteral nutrition during the first 12 ICU days.

INTERVENTIONS:

None.

MEASUREMENT AND MAIN RESULTS:

We defined enteral feed intolerance as interrupted feeding due to one of the following reasons: high gastric residual volumes, increased abdominal girth, distension, subjective discomfort, emesis, or diarrhea. The current analysis included 15,918 patients. Of these, 4,036 (24%) had at least one episode of enteral feed intolerance. The enteral feed intolerance rate increased from 1% on day 1 to 6% on days 4 and 5 and declined daily thereafter. After controlling for site and patient covariates, burn (odds ratio 1.46; 95% CIs, 1.07–1.99), gastrointestinal (odds ratio 1.45; 95% CI, 1.27–1.66), and sepsis (odds ratio 1.34; 95% CI, 1.17–1.54) admission diagnoses were more likely to develop enteral feed intolerance, as compared to patients with respiratory-related admission diagnosis. enteral feed intolerance patients received about 10% less enteral nutrition intake, as compared to patients without enteral feed intolerance after controlling for important covariates including severity of illness. Enteral feed intolerance patients had fewer ventilator-free days and longer ICU length of stay time to discharge alive (all p < 0.0001). The daily mortality hazard rate increased by a factor of 1.5 (1.4–1.6; p < 0.0001) once enteral feed intolerance occurred.

CONCLUSIONS:

Enteral feed intolerance occurs frequently during enteral nutrition delivery in the critically ill. Burn and gastrointestinal patients had the highest risk of developing enteral feed intolerance. Enteral feed intolerance is associated with lower enteral nutrition delivery and worse clinical outcomes. Identification, prevention, and optimal management of enteral feed intolerance may improve nutrition delivery and clinical outcomes in important “at risk” populations.
CHARACTERIZING THE NATURAL HISTORY OF FOVEAL-SPARING ATROPHIC LATE-ONSET RETINAL DEGENERATION
Authors: Borooah Shyamanga , Papastavrou Vasileios T. , Lando Leonardo , Moghimi Sasan , Lin Tiezhu , Dans Kunny , Motevasseli Tahmineh , Cameron James R. , Freeman William R. , Dhillon Baljean , Browning Andrew C.
Published: November 2020

Purpose:

To identify quantifiable markers of disease progression in patients with foveal-sparing atrophic late-onset retinal degeneration using fundus autofluorescence and spectral-domain optical coherence tomography imaging.

Methods:

Natural history study evaluating patients within a 3-year interval. Disease progression was assessed based on the area of retinal atrophy, macular topographic distribution of lesions, retinal and choroidal thickness and volume, and choroidal vascularity index.

Results:

Twenty-four eyes (12 individuals) were included for fundus autofluorescence, and 31 eyes (16 individuals) for spectral-domain optical coherence tomography studies. Measurements were symmetrical between eyes of the same patient. The area of atrophy significantly enlarged (P = 0.002), with a growth rate of 2.67 mm2/year (SD: 2.13; square rooted: 0.57 mm/year, SD = 0.34). Baseline area of atrophy and progression both correlated with age. Most atrophic lesions were found in the temporal macula and progressed nasally at follow-up. Central choroidal and retinal thicknesses and volume in late-onset retinal degeneration cases were significantly reduced compared with controls, but only central retinal thickness decreased significantly at follow-up.

Conclusion:

This study identifies the area of atrophy and central retinal thickness, but not chorioretinal volume or choroidal thickness, as markers of short-term progression in late-onset retinal degeneration. These findings may be useful for disease monitoring and late-onset retinal degeneration interventional studies.
RETINAL PIGMENT EPITHELIAL LESIONS ASSOCIATED WITH A SPORADIC CASE OF FAMILIAL ADENOMATOUS POLYPOSIS
Authors: Alsberge Joseph B. , Peng Michelle Y. , Agarwal Anita , McDonald H. Richard
Published: November 2020

Purpose:

To report a sporadic case of a familial adenomatous polyposis (FAP) discovered in a patient with bilateral retinal pigment epithelial lesions.

Methods:

Case report.

Results:

A 30-year-old Asian woman presented for evaluation of bilateral pigmented lesions at the level of the retinal pigment epithelium. She had no personal or family history of colonic polyps or colon cancer. Colonoscopy revealed innumerable adenomatous polyps and genetic testing revealed a mutation in the adenomatous polyposis coli gene consistent with FAP. She subsequently underwent prophylactic total colectomy.

Conclusion:

The pigmented retinal pigment epithelium lesions of FAP have a characteristic appearance and it is vital for the retinal specialist to be familiar with them. De novo mutations in the APC gene are responsible for 20% to 30% of FAP cases. In the presence of the characteristic retinal pigment epithelium lesions, it is important to send the patient for work up of FAP even in the absence of family history of FAP.
Impact of Invasive Quantitative Respiratory Cultures on Antimicrobial Therapy for Suspected Pneumonia in Trauma
Authors: Allen Lauren , Minson Quentin , Burke Christopher
Published: November 2020

Background:

Invasive quantitative respiratory cultures are generally not recommended because of a lack of demonstrated benefit. There is insufficient literature regarding specific populations such as trauma. The objective of this study was to evaluate the effect of invasive quantitative respiratory sampling on de-escalation to targeted antimicrobial therapy for the management of pneumonia in a trauma population.

Methods:

This was a single-center retrospective cohort study conducted at an American College of Surgeons-verified Level II Trauma Center in Nashville, TN. Adult patients admitted to the trauma service and diagnosed with pneumonia from July 2013 to August 2018 were divided into 2 groups: invasive quantitative respiratory sampling versus noninvasive respiratory sampling. The primary endpoint was rate of targeted antimicrobial therapy. Secondary endpoints included in-hospital mortality, antibiotic days of therapy, and frequency of discontinuation of antibiotics when quantitative cultures were below the diagnostic threshold.

Results:

A total of 88 patients were sampled, with 27 in the invasive quantitative group and 66 in the noninvasive group. There was no difference in rates of targeted therapy in patients with invasive quantitative sampling (17 [63%] vs. 35 [57%]; relative risk = 1.10; 95% confidence interval [0.76, 1.57]). No statistically significant differences were observed for in-hospital mortality (8 patients vs. 6 patients, p = .35) or antimicrobial days of therapy (10.3 ± 8.8 vs. 7.8 ± 3.6, p = .161). Only 2 patients (17%) had antibiotics withheld when below the diagnostic threshold.

Conclusions:

Invasive quantitative respiratory sampling did not result in significant changes in targeted antibiotic therapy in a trauma population.
Center Donor Refusal Rate Is Associated With Worse Outcomes After Listing in Pediatric Heart Transplantation
Authors: Butts Ryan J. , Baez Hernandez Nathanya , Kirk Richard , Bano Maria , Davies Ryan
Published: November 2020

Background.

Pediatric donor heart acceptability differs among transplant centers. However, the impact of center donor acceptance on waitlist and posttransplant outcomes has not been investigated. The aim of our study was to investigate associations between transplant center refusal rate (RR) and outcomes after listing.

Methods.

Retrospective analysis was performed using United Network for Organ Sharing/Organ Procurement and Transplant Network pediatric (<18 y) heart transplant data from 2007 to 2017. Center RR was defined as the median number of refusals per listed patient. Associations between RR center quartile and waitlist time, waitlist removal for death or clinical deterioration, posttransplant survival, and survival after listing were investigated.

Results.

There were 5552 listed patients in 59 centers who met inclusion criteria. The lowest quartile RR centers had a median RR of ≤1 per listed patient, and highest RR centers percentile had a median RR of ≥4. Highest RR centers had shorter time to first offer (19 versus 38 d; P < 0.001), with longer waitlist times (203 versus 145 d; P < 0.001), were more likely to remove patients from the waitlist due to death or deterioration (24.1% versus 14.6%; P < 0.001), less likely to transplant listed patients (63.1% versus 77.6%; P < 0.001), and had a lower likelihood of survival 1 year after listing (79.2% versus 91.6%; odds ratio, 1.6; 95% confidence interval, 1.2-2.0; P < 0.001) compared with low RR centers.

Conclusions.

Patients listed at high RR centers had worse survival from listing despite having shorter times to first offer.
PO2of the metathoracic ganglion in response to progressive hypoxia in an insect
Authors: Harrison Jon F. , Waser Wolfgang , Hetz Stefan K.
Published: November 2020

Mammals regulate their brain tissuePO2tightly, and only small changes in brainPO2are required to elicit compensatory ventilation. However, unlike the flow-through cardiovascular system of vertebrates, insect tissues exchange gases through blind-ended tracheoles, which may involve a more prominent role for diffusive gas exchange. We tested the effect of progressive hypoxia on ventilation and thePO2of the metathoracic ganglion (neural site of control of ventilation) using microelectrodes in the American locust,Schistocerca americana. In normal air (21 kPa),PO2of the metathoracic ganglion was 12 kPa. ThePO2of the ganglion dropped as airPO2dropped, with ventilatory responses occurring when ganglionPO2reached 3 kPa. Unlike vertebrates, insects tolerate relatively high resting tissuePO2levels and allow tissuePO2to drop during hypoxia, activity and discontinuous gas exchange before activating convective or spiracular gas exchange. Tracheated animals, and possibly pancrustaceans in general, seem likely to generally experience wide spatial and temporal variation in tissue PO2compared with vertebrates, with important implications for physiological function and the evolution of oxygen-using proteins.
Preparation and application of pH-responsive composite hydrogel beads as potential delivery carrier candidates for controlled release of berberine hydrochloride
Authors: Gao Jiande , Fan Dongying , Song Ping , Zhang Shudan , Liu Xiong
Published: November 2020

For improving the effective concentration of berberine hydrochloride (BH) in the gastrointestinal tract, a series of pH-responsive hydrogel beads were prepared based on carboxymethylstarch-g-poly (acrylic acid)/palygorskite/starch/sodium alginate (CMS-g-PAA/PGS/ST/SA) in the present work. The developed hydrogel beads were characterized by Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD) and thermogravimetric analysis (TG). Effect of palygorskite (PGS) content on the swelling properties of hydrogel beads and BH cumulative release were discussed. The pH responsiveness of hydrogel beads was also investigated in different media. Results illustrated that swelling of hydrogel beads and BH cumulative release from hydrogel beads were obviously affected by PGS content. The swelling ratio and BH cumulative release of composite hydrogel beads remarkably slowed down with PGS content increasing in the range from 10 to 40 wt%. The composite hydrogel beads were pH-responsive. At pH 7.4, the swelling ratio and BH cumulative release from composite hydrogel beads were the fastest among the dissolution media of pH 1.2, pH 6.8 and pH 7.4. The BH cumulative release from hydrogel beads was related to the swelling and relaxation of composite hydrogel beads and could be fitted better by the Higuchi model. The obtained composite hydrogel beads could be potentially used for the development of BH pharmaceutical dosage forms.
Network comparison and the within-ensemble graph distance
Authors: Hartle Harrison , Klein Brennan , McCabe Stefan , Daniels Alexander , St-Onge Guillaume , Murphy Charles , Hébert-Dufresne Laurent
Published: November 2020

Quantifying the differences between networks is a challenging and ever-present problem in network science. In recent years, a multitude of diverse,
ad hoc
solutions to this problem have been introduced. Here, we propose that simple and well-understood ensembles of random networks—such as Erdős–Rényi graphs, random geometric graphs, Watts–Strogatz graphs, the configuration model and preferential attachment networks—are natural benchmarks for network comparison methods. Moreover, we show that the expected distance between two networks independently sampled from a generative model is a useful property that encapsulates many key features of that model. To illustrate our results, we calculate this
within-ensemble graph distance
and related quantities for classic network models (and several parameterizations thereof) using 20 distance measures commonly used to compare graphs. The within-ensemble graph distance provides a new framework for developers of graph distances to better understand their creations and for practitioners to better choose an appropriate tool for their particular task.
Heterogeneous node responses to multi-type epidemics on networks
Authors: Moore S. , Rogers T.
Published: November 2020

Having knowledge of the contact network over which an infection is spreading opens the possibility of making individualized predictions for the likelihood of different nodes to become infected. When multiple infective strains attempt to spread simultaneously we may further ask which strain, or strains, are most likely to infect a particular node. In this article we investigate the heterogeneity in likely outcomes for different nodes in two models of multi-type epidemic spreading processes. For models allowing co-infection we derive message-passing equations whose solution captures how the likelihood of a given node receiving a particular infection depends on both the position of the node in the network and the interaction between the infection types. For models of competing epidemics in which co-infection is impossible, a more complicated analysis leads to the simpler result that node vulnerability factorizes into a contribution from the network topology and a contribution from the infection parameters.
Parallels, differences and lessons: a comparison of the management of foot-and-mouth disease and COVID-19 using UK 2001/2020 as points of reference
Authors: Sumption Keith , Knight-Jones Theodore J. D. , McLaws Melissa , Paton David J.
Published: November 2020

Foot-and-mouth disease (FMD) is an extremely infectious viral infection of cloven-hoofed animals which is highly challenging to control and can give rise to national animal health crises, especially if there is a lack of pre-existing immunity due to the emergence of new strains or following incursions into disease-free regions. The 2001 FMD epidemic in the UK was on a scale that initially overwhelmed the national veterinary services and was eventually controlled by livestock lockdown and slaughter on an unprecedented scale. In 2020, the rapid emergence of COVID-19 has led to a human pandemic unparalleled in living memory. The enormous logistics of multi-agency control efforts for COVID-19 are reminiscent of the 2001 FMD epidemic in the UK, as are the use of movement restrictions, not normally a feature of human disease control. The UK experience is internationally relevant as few countries have experienced national epidemic crises for both diseases. In this review, we reflect on the experiences and lessons learnt from UK and international responses to FMD and COVID-19 with respect to their management, including the challenge of preclinical viral transmission, threat awareness, early detection, different interpretations of scientific information, lockdown, biosecurity behaviour change, shortage of testing capacity and the choices for eradication versus living with infection. A major lesson is that the similarity of issues and critical resources needed to manage large-scale outbreaks demonstrates that there is benefit to a ‘One Health’ approach to preparedness, with potential for greater cooperation in planning and the consideration of shared critical resources.
Fitness outcomes in relation to individual variation in constitutive innate immune function
Authors: Roast Michael J. , Aranzamendi Nataly Hidalgo , Fan Marie , Teunissen Niki , Hall Matthew D. , Peters Anne
Published: November 2020

Although crucial for host survival when facing persistent parasite pressure, costly immune functions will inevitably compete for resources with other energetically expensive traits such as reproduction. Optimizing, but not necessarily maximizing, immune function might therefore provide net benefit to overall host fitness. Evidence for associations between fitness and immune function is relatively rare, limiting our potential to understand ultimate fitness costs of immune investment. Here, we assess how measures of constitutive immune function (haptoglobin, natural antibodies, complement activity) relate to subsequent fitness outcomes (survival, reproductive success, dominance acquisition) in a wild passerine (Malurus coronatus). Surprisingly, survival probability was not positively linearly predicted by any immune index. Instead, both low and high values of complement activity (quadratic effect) were associated with higher survival, suggesting that different immune investment strategies might reflect a dynamic disease environment. Positive linear relationships between immune indices and reproductive success suggest that individual heterogeneity overrides potential resource reallocation trade-offs within individuals. Controlling for body condition (size-adjusted body mass) and chronic stress (heterophil-lymphocyte ratio) did not alter our findings in a sample subset with available data. Overall, our results suggest that constitutive immune components have limited net costs for fitness and that variation in immune maintenance relates to individual differences more closely.
Morphological divergence in giant fossil dormice
Authors: Hennekam Jesse J. , Benson Roger B. J. , Herridge Victoria L. , Jeffery Nathan , Torres-Roig Enric , Alcover Josep Antoni , Cox Philip G.
Published: November 2020

Insular gigantism—evolutionary increases in body size from small-bodied mainland ancestors—is a conceptually significant, but poorly studied, evolutionary phenomenon. Gigantism is widespread on Mediterranean islands, particularly among fossil and extant dormice. These include an extant giant population of
Eliomys quercinus
on Formentera, the giant Balearic genus †
Hypnomys
and the exceptionally large †
Leithia melitensis
of Pleistocene Sicily. We quantified patterns of cranial and mandibular shape and their relationships to head size (allometry) among mainland and insular dormouse populations, asking to what extent the morphology of island giants is explained by allometry. We find that gigantism in dormice is not simply an extrapolation of the allometric trajectory of their mainland relatives. Instead, a large portion of their distinctive cranial and mandibular morphology resulted from the population- or species-specific evolutionary shape changes. Our findings suggest that body size increases in insular giant dormice were accompanied by the evolutionary divergence of feeding adaptations. This complements other evidence of ecological divergence in these taxa, which span predominantly faunivorous to herbivorous diets. Our findings suggest that insular gigantism involves context-dependent phenotypic modifications, underscoring the highly distinctive nature of island faunas.
Thermal effects vary predictably across levels of organization: empirical results and theoretical basis
Authors: Bozinovic Francisco , Cavieres Grisel , Martel Sebastián I. , Alruiz José M. , Molina Andrés N. , Roschzttardtz Hannetz , Rezende Enrico L.
Published: November 2020

Thermal performance curves have provided a common framework to study the impact of temperature in biological systems. However, few generalities have emerged to date. Here, we combine an experimental approach with theoretical analyses to demonstrate that performance curves are expected to vary predictably with the levels of biological organization. We measured rates of enzymatic reactions, organismal performance and population viability in
Drosophila
acclimated to different thermal conditions and show that performance curves become narrower with thermal optima shifting towards lower temperatures at higher levels or organization. We then explain these results on theoretical grounds, showing that this pattern reflects the cumulative impact of asymmetric thermal effects that piles up with complexity. These results and the proposed framework are important to understand how organisms, populations and ecological communities might respond to changing thermal conditions.
Predicting Self-harm Incidents Following Inpatient Visits using Disease Comorbidity Network
Authors: Xu Zhongzhi , Zhang Qingpeng , Fai Yip Paul Siu
Published: November 2020

Self-harm is serious but preventable, particularly if the risk can be identified early. But the early detection of self-harm individuals is so far not satisfied. This study aims to develop and test a comorbidity network-enhanced deep learning framework to improve the prediction of individual self-harm within 12 months after hospital discharge. Between January 1, 2007, and December 31, 2010, we obtained 2,323 patients with self-harm clinical record from 1,764,094 inpatients across 44 public hospitals in Hong Kong and 46,460 randomly sampled population controls from those same hospitals. Eighty percent (80%) of the study sample was randomly selected for model training, and the remaining 20% was set aside for model testing. The proposed comorbidity network-enhanced model was compared with a baseline deep learning model for self-harm prediction. The C-statistic, precision and sensitivity were used to evaluate the prediction accuracy of the proposed model and the baseline model. Experiments demonstrated that the proposed comorbidity network-enhanced model outperformed baseline model in identifying patients who would self-harm within 12 months (C-statistic of proposed model 0.89). The precision was 0.54 for positive cases and 0.98 for negative cases, whilst the sensitivity was 0.72 for positive cases and 0.96 for negative cases. Results indicated that it is critical to consider the general disease comorbidity patterns in self-harm screening and prevention programs. The model also extracted the most predictive diagnoses, and pairs of comorbid diagnoses which provide medical professionals with an effective screening strategy.
Creatine Kinase during Non-ST-Segment Elevation Acute Coronary Syndromes is Associated with Major Bleeding
Authors: Brewster Lizzy M. , Fernand Jim D.
Published: November 2020

Background

It was recently reported that highly elevated plasma activity of the ADP-scavenging enzyme creatine kinase (CK), to >10 times the upper reference limit (URL), is independently associated with fatal or non-fatal bleeding during treatment for ST-segment elevation myocardial infarction (OR 2.6 [95% CI, 1.8 to 2.7]/log CK increase). Evidence indicates that CK attenuates ADP-dependent platelet aggregation. This study investigates whether moderately elevated CK in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is associated with major bleeding.

Methods

The Thrombolysis In Myocardial Ischemia (TIMI) 3B trial compared rt-PA (35 to 80 mg) with placebo, and early catheterization with conservative management in patients with NSTE-ACS. Main outcomes of the current study are the independent association of peak plasma CK (CKmax) with adjudicated fatal or non-fatal major bleeding (primary), and with combined major bleeding, stroke, and all-cause mortality (secondary) in multivariable binomial logistic regression analysis, with co-variables including age, sex, BMI, SBP, creatinine, and treatment assignment. Discrimination was assessed with C-statistics.

Results

The study included 1473 patients (66% men, 80% white, mean age 59 y, SE 0.3). CKmax ranged between 15 and 19045 IU/L (mean (SE), 450(24) IU/L; i.e. 2 times URL). Major bleeding occurred in 2.0% (mean age 65(1.3) y; mean CKmax 1015(318) IU/L; 6 times URL), and the combined outcome in 4.3% of the patients, adjusted OR per log CK increase respectively 3.1 [1.6 to 5.8] for major bleeding, and 3.9 [2.5 to 6.1] for the combined outcome; C-index 0.8 for both outcomes.

Discussion

The presented data add to the existing evidence that proportionate to its plasma activity, the ADP-binding enzyme CK is strongly and independently associated with non-fatal and fatal major bleeding during ACS treatment. CK might increase the accuracy of prediction models for major bleeding in patients treated with antithrombotic or thrombolytic drugs for ACS.

ClinicalTrials.gov identifier

NCT00000472
SARS-CoV-2 Seroprevalence in a Cohort of Asymptomatic, RT-PCR Negative Croatian First League Football Players
Authors: Vince Adriana , Zadro Renata , Šostar Zvonimir , Sternak Sunčanica Ljubin , Vraneš Jasmina , Škaro Vedrana , Projić Petar , Molnar Vilim , Matišić Vid , Baršić Bruno , Lauc Gordan , Lovrić-Makarić Zvjezdana , Bahtijarević Zoran , Vlahović Tomislav , Šikić Sandra , Polašek Ozren , Primorac Dragan
Published: November 2020

Background

During the COVID-19 pandemic the Croatian Football Federation has launched a new model of pre-season systematic examination of football players, emphasizing the diagnosis of asymptomatic SARS-CoV-2 infection and preventing further spread among the players.

Objectives

The aim of this study was to assess the prevalence and dynamics of SARS-CoV-2 IgA and IgG antibodies in the cohort of asymptomatic and SARS-CoV-2 PCR negative professional football players in the Croatian First Football League by using a commercial ELISA antibody assay in the paired serum samples taken 2 months apart.

Methods

Serology testing was performed from May till July 2020 in a cohort of 305 asymptomatic football players and club staff members. RT-PCR for detection of SARS-CoV-2 from nasopharyngeal swabs was performed on three occasions, and Euroimmun ELISA for detection of IgA and IgG (S1 and NCP) antibodies was tested in paired serum samples in May and July.

Results

All RT-PCR results were negative. Sixty-one (20%) participants were reactive in one or two classes of antibodies at baseline and/or follow-up serology testing. IgA reactivity was found in 41 (13.4% [95% CI=10.7-17.7]) baseline sera and 42 (13.8% [95% CI=10.3-18.9]) follow-up sera. IgG to S1 protein was found in 6 (2% [95% CI=0.9-4.2]) participants at baseline and 1 (0.33% [95% CI=0.0006-1.83]) at follow-up. IgG to NCP was found in 2 (0.7% [95% CI=0.2-2.4]) participants at baseline and 8 (2.6% (95% CI=1.3-5.1]) participants at follow-up. Noticeable dynamics in the paired sera was observed in 18 (5.9%) participants (excluding borderline IgA results) or 32 (10.5%) (including IgA borderline results).

Conclusion

Various patterns of IgA and IgG reactivity were found in the paired serum samples. Based on serology dynamics we estimate that in 5.9%-10.5% of PCR negative football players asymptomatic exposure to SARS-CoV-2 during pandemics could not be excluded.
SARS-CoV-2 Innate Effector Associations and Viral Load in Early Nasopharyngeal Infection
Authors: Liou Theodore G , Adler Frederick R , Cahill Barbara C , Cox David R , Cox James E , Grant Garett J , Hanson Kimberly E , Hartsell Stephen C , Hatton Nathan D , Helms My N , Jensen Judy L , Kartsonaki Christiana , Li Yanping , Leung Daniel T , Marvin James E , Middleton Elizabeth A , Osburn-Staker Sandra M , Packer Kristyn A , Shakir Salika M , Sturrock Anne B , Tardif Keith D , Warren Kristi Jo , Waddoups Lindsey J , Weaver Lisa J , Zimmerman Elizabeth , Paine Robert
Published: November 2020

To examine innate immune responses in early SARS-CoV-2 infection that may change clinical outcomes, we compared nasopharyngeal swab data from 20 virus-positive and 20 virus-negative individuals. Multiple innate immune-related and ACE-2 transcripts increased with infection and were strongly associated with increasing viral load. We found widespread discrepancies between transcription and translation. Interferon proteins were unchanged or decreased in infected samples suggesting virally-induced shut-off of host anti-viral protein responses. However, IP-10 and several interferon-stimulated gene proteins increased with viral load. Older age was associated with modifications of some effects. Our findings may characterize the disrupted immune landscape of early disease.
A household case evidences shorter shedding of SARS-CoV-2 in naturally infected cats compared to their human owners
Authors: Neira Víctor , Brito Bárbara , Agüero Belén , Berrios Felipe , Valdés Valentina , Gutierrez Alberto , Ariyama Naomi , Espinoza Patricio , Retamal Patricio , Holmes Edward C. , Gonzalez-Reiche Ana S. , Khan Zenab , van de Guchte Adriana , Dutta Jayeeta , Miorin Lisa , Kehrer Thomas , Galarce Nicolás , Almonacid Leonardo I. , Levican Jorge , van Bakel Harm , García-Sastre Adolfo , Medina Rafael A.
Published: November 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in domestic and wild cats. However, little is known about natural viral infections of domestic cats, although their importance for modeling disease spread, informing strategies for managing positive human-animal relationships and disease prevention. Here, we describe the SARS-CoV-2 infection in a household of two human adults and sibling cats (one male and two females) using real-time RT-PCR, an ELISA test, viral sequencing, and virus isolation. On May 2020, the cat- owners tested positive for SARS-CoV-2. Two days later, the male cat showed mild respiratory symptoms and tested positive. Four days after the male cat, the two female cats became positive, asymptomatically. Also, one human and one cat showed antibodies against SARS-CoV-2. All cats excreted detectable SARS-CoV-2 RNA for a shorter duration than humans and viral sequences analysis confirmed human-to-cat transmission. We could not determine if cat-to-cat transmission also occurred.

Article Summary Line

SARS-CoV-2 in naturally infected cats present a shorter shedding pattern compared to their owners.
Difference of brain cortical thickness and area of different lobes between fetuses with intrauterine growth restriction and control group assessed by 3 Tesla MRI
Authors: Moradi Behnaz , Shirazi Mahboobeh , nezhad Zohreh Alibeigi , Saadat Nazanin Seyed , Hashemi Hassan , Kazemi Mohammad Ali , Gity Masoumeh , Rahmani Maryam , Ghanaati Hossein
Published: November 2020

Background

Intrauterine growth restricted (IUGR) is a major factor of perinatal and long-term morbidity and is associated with abnormal fetal brain development but its pattern of brain involvement is still unknown.

Materials and Methods

42 women with IUGR pregnancy and 28 women with normally-grown fetuses between 28-38 weeks underwent 3Tesla MRI. Cortical thickness was assessed in 4 regions and was corrected by biparietal diameter/2. Also, whole brain surface area (WBA) and areas of 6 brain regions were included and corrected by WBA.

Results

IUGR fetuses had significantly thinner cortical thickness in the insula and temporal lobes compared to the control group (0.034 vs 0.043 and 0.036 vs 0.047 respectively, P value of < 0.05). They had significantly reduced WBA (P value: 0.028). The corrected brain areas were not significantly different between groups except for the corrected areas of cerebellum and hippocampus which were increased in IUGR fetuses compared to the control group (0.147vs 0.130,0.017vs 0.0125 respectively, P value of < 0.05).

Conclusion

IUGR fetuses had significantly thinner insular and temporal lobe cortex and smaller WBA compared to the control group. Among different brain regions, cerebellum and hippocampus were less affected by growth restriction in utero period.
The ratio of BRAFV600E alleles can be used to assess the biological behavior of papillary thyroid carcinoma
Authors: Luo Dingcun , Ni Yeqin , Zhang Shirong , Xun Yanping , Zhao Pan , Wu Fan , Zhou Tianhan , Shi Jingjing , Lu Si , Sun Sihan , Lu Kaining
Published: November 2020

Background

The BRAFV600E mutations is an important molecular event in the occurrence and development of papillary thyroid carcinoma (PTC). A qualitative detection of the BRAFV600E mutation is still insufficient to explain the biological behavior of PTC. Though quantitative detection of the BRAFV600E mutation can reflect certain characteristics of PTC, its clinical value is still controversial. We aimed to investigate the association between the ratio of BRAFV600E alleles and clinicopathological parameters in PTC patients.

Methods

Genomic DNA was extracted from specimens obtained from 329 PTC patients undergoing thyroidectomy. The ratio of BRAFV600E alleles was determined by amplification refractory mutation system (ARMS) and droplet digital polymerase chain reaction (ddPCR). Inconsistent results were further verified by next-generation sequencing (NGS). The clinicopathologic features, clinical tumor stage, and tumor recurrence risk stratification of all patients were correlated with the ratio of BRAFV600E alleles.

Results

The sensitivity of ddPCR was superior to that of ARMS and almost the same as that of NGS. In total, 275 of 329 patients had the BRAFV600E mutation as determined by ARMS, ddPCR and NGS. The ratio of BRAFV600E alleles ranged from 0.17%-48.0%, with a median ratio of 12.58%, and significantly correlated with tumor size (p<0.001), capsule or extrathyroidal invasion (p<0.001), the number or rate of lymph node metastases (p<0.001), tumor stage (p=0.006) and tumor recurrence risk (p<0.001) but not with sex, age or multifocality. The ratio of BRAFV600E alleles was much lower in PTC patients with Hashimoto’s thyroiditis than in those without (p<0.001).

Conclusions

The ratio of BRAFV600E alleles can reliably reflect the biological behavior of PTC, making it a molecular-based stratification index of recurrence risk. The quantitative detection of BRAFV600E has the potential to guide the clinical diagnosis and treatment of PTC.
A service user evaluation of eConsult use by Defence Primary Healthcare Primary Care Clinicians using a mixed-method approach
Authors: Willman Antony S
Published: November 2020

Introduction

eConsult has been recently introduced into Defence Primary Healthcare to allow patients electronic access to healthcare. Using mixed methods, this service evaluation sought the views of primary care clinicians using eConsult.

Methods

A two-phase sequential exploratory mixed-method approach was used. An inductive thematic analysis of feedback from primary care clinicians in the Salisbury Plain Area identified themes around eConsult use. These were used to construct an 18-item survey instrument. This was then distributed to primary care clinicians in Defence Primary Healthcare to assess the broader applicability of the themes.

Results

Four themes were identified: the impact on accessibility, the effects on working practices, the impact on the dynamics of the consultation and the effect of training and administrative support. eConsult did not save time for clinicians but was generally more convenient for patients. eConsult was often used in conjunction with telephone and face to face follow up, forming a ‘blended consult’. Accessibility was improved, but cultural factors may affect some patients engaging.

Conclusions

eConsult improves accessibility and can reduce telephone and face to face consultations but does not reduce workload. It should be used alongside conventional access methods, not instead of. It is useful for straightforward clinical and administrative problems but is less useful for more complex cases unless part of a ‘blended consult’. Future use could be modified to provide greater data gathering for occupational health and chronic disease monitoring and should be monitored to ensure it is inclusive of all demographic groups.

KEY MESSAGES

The increased accessibility to a clinician that eConsult offered for patients was positive.

There was no workload saving for clinicians using eConsult.

EConsult was often the first part of a ‘blended consult’ which subsequently involved telephone and face to face consults.

While the dynamics of the consultation were changed, this was generally perceived as positive.

EConsult should exist alongside current systems for accessing primary care.

The efficiency of the eConsult system could be improved with better administrative support and training.
Modelling the impact of COVID-19-related control programme interruptions on progress towards the WHO 2030 target for soil-transmitted helminths
Authors: Malizia Veronica , Giardina Federica , Vegvari Carolin , Bajaj Sumali , McRae-McKee Kevin , Anderson Roy M , de Vlas Sake J , Coffeng Luc E
Published: November 2020

Background

On the 1st of April 2020, the World Health Organization (WHO) recommended an interruption of all neglected tropical disease control programmes, including soil-transmitted helminths (STH), in response to the COVID-19 pandemic. This paper investigates the impact of this disruption on the achieved progress towards the WHO 2030 target for STH.

Methods

We used two stochastic individual-based models to simulate the impact of missing one or more preventive chemotherapy (PC) rounds in different endemicity settings. We also investigate the extent to which the impact can be lessened by mitigation strategies, such as semi-annual or community-wide PC.

Results

Both models show that even without a mitigation strategy, control programmes will catch up by 2030. The catch-up time is limited to a maximum of 4.5 years after the interruption. Mitigations strategies may reduce this catch-up time by up to two years and can even increase the probability of achieving the 2030 target.

Conclusions

Though a PC interruption will only temporarily impact the progress towards the WHO 2030 target, programmes are encouraged to restart as soon as possible to minimise the impact on morbidity. The implementation of suitable mitigation strategies can turn the interruption into an opportunity to accelerate the progress toward reaching the target.