bluuebunny/crossref_metadata_2025 huggingface dataset:
Machine Learning and Cochlear Implantation—A Structured Review of Opportunities and Challenges
Authors: Crowson Matthew G. , Lin Vincent , Chen Joseph M. , Chan Timothy C. Y.
Published: October 2019

Objective:

The use of machine learning technology to automate intellectual processes and boost clinical process efficiency in medicine has exploded in the past 5 years. Machine learning excels in automating pattern recognition and in adapting learned representations to new settings. Moreover, machine learning techniques have the advantage of incorporating complexity and are free from many of the limitations of traditional deterministic approaches. Cochlear implants (CI) are a unique fit for machine learning techniques given the need for optimization of signal processing to fit complex environmental scenarios and individual patients’ CI MAPping. However, there are many other opportunities where machine learning may assist in CI beyond signal processing. The objective of this review was to synthesize past applications of machine learning technologies for pediatric and adult CI and describe novel opportunities for research and development.

Data Sources:

The PubMed/MEDLINE, EMBASE, Scopus, and ISI Web of Knowledge databases were mined using a directed search strategy to identify the nexus between CI and artificial intelligence/machine learning literature.

Study Selection:

Non-English language articles, articles without an available abstract or full-text, and nonrelevant articles were manually appraised and excluded. Included articles were evaluated for specific machine learning methodologies, content, and application success.

Data Synthesis:

The database search identified 298 articles. Two hundred fifty-nine articles (86.9%) were excluded based on the available abstract/full-text, language, and relevance. The remaining 39 articles were included in the review analysis. There was a marked increase in year-over-year publications from 2013 to 2018. Applications of machine learning technologies involved speech/signal processing optimization (17; 43.6% of articles), automated evoked potential measurement (6; 15.4%), postoperative performance/efficacy prediction (5; 12.8%), and surgical anatomy location prediction (3; 7.7%), and 2 (5.1%) in each of robotics, electrode placement performance, and biomaterials performance.

Conclusion:

The relationship between CI and artificial intelligence is strengthening with a recent increase in publications reporting successful applications. Considerable effort has been directed toward augmenting signal processing and automating postoperative MAPping using machine learning algorithms. Other promising applications include augmenting CI surgery mechanics and personalized medicine approaches for boosting CI patient performance. Future opportunities include addressing scalability and the research and clinical communities’ acceptance of machine learning algorithms as effective techniques.
Anxiety and depression predict unfavorable survival in acute myeloid leukemia patients
Authors: Ding Ting , Wang Xin , Fu Adan , Xu Liwen , Lin Jing
Published: October 2019

This study aimed to investigate the prevalence/severity of anxiety and depression, and also their correlations with clinical characteristics and survival profiles in acute myeloid leukemia (AML) patients.

In all, 208 AML patients and 200 age and sex-matched healthy controls (HCs) were recruited in this study. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS) in AML patients before initiating therapy and in HCs after being enrolled. Treatment response was assessed, and event-free survival (EFS), and also the overall survival (OS) were calculated.

The HADS-anxiety score (P < .001), anxiety prevalence (P < .001), and anxiety severity (P < .001) were increased in AML patients than those in HCs. The HADS-depression score (P < .001), depression prevalence (P < .001), and also depression severity (P < .001) were higher in AML patients compared with HCs. No correlation of anxiety or depression with clinical characteristics was found in AML patients (all P > .05). Moreover, the anxiety (P = .178) and depression (P = .512) rates were similar between complete remission (CR) patients and non-CR patients. Additionally, the EFS was worse in anxiety patients compared with nonanxiety patients (P = .013). The OS was shorter in anxiety patients compared with nonanxiety patients (P = .015) and was also worse in depression patients compared with nondepression patients (P = .007).

Anxiety and depression are much more frequent and severe in AML patients compared to HCs, and both of them predict unfavorable survival profiles in AML patients.
A prioritization regimen of the acupuncture treatment for simple obesity
Authors: Zhou Rui , Wang Zhijie , Chen Wanwei , Huang Chushuan , Liu Chang , Zhuang Lixing , Xie Xiaoyan , Hong Haidu
Published: October 2019

Background:

Patients with simple obesity suffer from poor quality of life, as well as high risk of hypertension, diabetes, cardiovascular, and cerebrovascular accidents. Lots of Clinical trials suggested that acupuncture is beneficial for simple obesity, and it aims to gather solid evidence in order to provide reliable reference in establishing guidelines for acupuncture treatment of simple obesity in this study.

Methods:

Relevant databases including Cochrane Library, PubMed, Cochrane Central Register of Controlled Trials, Medline University Resource Center, Chinese Biomedical Literature Service System, and China National Knowledge Infrastructure will be retrieved from January 1950 to November 2018. Two authors will screen studies independently according to the inclusion and exclusion criteria and extract the data in a form of sheet. Quality evaluations and bias risk assessments will be performed for the methodology of included studies. Dichotomous data will be analyzed using odds ratio (OR), and continuous data using mean differences. Network meta-analysis will be conducted by using Stata 14.0. The Development and Evaluation approach will be used to rate the certainty of the evidence of estimates derived from meta-analysis. The primary outcome is body mass index (BMI), and the secondary outcomes are triglycerides, total cholesterol, low-density lipoprotein-cholesterol, effective rate, adverse effects, and recurrence rate. Trial registration number is CRD42019117387.

Results:

Based on current evidence, this review will rank the efficacy and safety of the various acupuncture regimen in decreasing BMI, triglycerides, total cholesterol of patients with simple obesity, and to summarize a prioritization regimen.

Conclusion:

This evidence may be useful for clinicians, patients, and guideline-makers to select the optimum proposal of acupuncture for the simple obesity treatment.
Neutrophil-to-lymphocyte ratio as a predictive marker of metabolic syndrome
Authors: Liu Chuan-Chuan , Ko Hung-Ju , Liu Wan-Shan , Hung Chung-Lieh , Hu Kuang-Chun , Yu Lo-Yip , Shih Shou-Chuan
Published: October 2019

Neutrophil-to-lymphocyte ratio (NLR) serves as a strong prognostic indicator for patients suffering from various diseases. Neutrophil activation promotes the recruitment of a number of different cell types that are involved in acute and chronic inflammation and are associated with cancer treatment outcome. Measurement of NLR, an established inflammation marker, is cost-effective, and it is likely that NLR can be used to predict the development of metabolic syndrome (MS) at an early stage. MS scores range from 1 to 5, and an elevated MS score indicates a greater risk for MS. Monitoring NLR can prevent the risk of MS.

A total of 34,013 subjects were enrolled in this study. The subjects (score 0–5) within the 6 groups were classified according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria, and all anthropometrics, laboratory biomarkers, and hematological measurements were recorded. For the 6 groups, statistical analysis and receiver operating characteristic (ROC) curves were used to identify the development of MS.

Analysis of the ROC curve indicated that NLR served as a good predictor for MS. An MS score of 1 to 2 yielded an acceptable discrimination rate, and these rates were even higher for MS scores of 3 to 5 (P < .001), where the prevalence of MS was 30.8%.

NLR can be used as a prognostic marker for several diseases, including those associated with MS.
Efficacy of ulinastatin for the treatment of patients with severe acute pancreatitis
Authors: Yao Jian-hui , Li Wei-min
Published: October 2019

Background:

The aim of this study is to explore the efficacy and safety of ulinastatin for the treatment of patients with severe acute pancreatitis (SAP).

Methods:

We will search randomized controlled trials which assess the efficacy and safety of ulinastatin for patients with SAP from the electronic databases of Cochrane Library, MEDILINE, EMBASE, CINAHL, PsycINFO, Scopus, CBM, Wangfang, VIP, and CNKI. All electronic databases will be searched from inception to the present with no limitations of language and publication status. Two researchers will carry out study selection, data extraction, and study quality assessment independently. Another researcher will help to resolve any disagreements between 2 researchers.

Results:

The outcomes include overall mortality, time of hospital stay, complications of systematic or local infection, multiple organ deficiency syndrome, health related quality of life (as measured as the 36-Item Short Form Health Survey), and adverse events related to nutrition.

Conclusion:

This study will provide evidence to evaluate the efficacy and safety of ulinastatin in the treatment of patients with SAP.

Systematic review registration:

PROSPERO CRD42019149566.
Individual opioids, and long- versus short-acting opioids, for chronic noncancer pain
Authors: Noori Atefeh , Busse Jason W. , Sadeghirad Behnam , Siemieniuk Reed A. , Wang Li , Couban Rachel , Juurlink David N. , Thabane Lehana , Guyatt Gordon H.
Published: October 2019

Background:

Opioids are frequently prescribed for the management of patients with chronic non-cancer pain (CNCP). Previous meta-analyses of efficacy and harms have combined treatment effects across all opioids; however, specific opioids, pharmacokinetic properties (ie, long acting vs short acting), or the type of formulation (ie, immediate vs extended release) may be a source of heterogeneity for pooled effects.

Methods:

We will conduct a network meta-analysis (NMA) of randomized controlled trials evaluating opioids for CNCP. We will acquire eligible studies through systematic searches of EMBASE, MEDLINE, CINAHL, AMED, PsycINFO, and the Cochrane Central Registry of Controlled Trials (CENTRAL). Eligible studies will have randomly allocated adult CNCP patients to an oral or transdermal opioid versus another type of opioid (or formulation) or placebo, and follow patients for ≥ 4 weeks. We will collect outcome data for pain intensity, physical function, nausea, vomiting, and constipation. Pairs of reviewers will, independently and in duplicate, abstract data from eligible trials and assess risk of bias using a modified Cochrane tool. We will assess coherence of our networks through both a global test, and by comparing direct and indirect evidence for each comparison with node-splitting.

Results:

Using a frequentist approach, we will conduct random effects multiple treatment meta-analysis to establish treatment effects of individual opioids for each outcome. The certainty of evidence for pooled treatment effects will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. We will categorize interventions from most to least effective based on the effect estimates obtained from NMAs and their associated certainty of evidence, as follows: superior to both placebo and alternatives; superior to placebo, but inferior to alternatives; and no better than placebo.

Conclusion:

This NMA will determine the relative effectiveness and adverse effects of individual opioids among patients with CNCP. Our results will help inform the appropriateness of assuming similar beneficial and adverse effects of varying opioid formulations.

Systematic review registration:

This systematic review is registered with Prospective Register of Systematic Reviews, an international prospective register of systematic reviews (registration no.: CRD42018110331), available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=110331.
A systematic review and meta-analysis approach on diagnostic value of MLH1 promoter methylation for head and neck squamous cell carcinoma
Authors: Li Qun , Hong Jinjiong , Shen Zhisen , Deng Hongxia , Shen Yi , Wu Zhenhua , Zhou Chongchang
Published: October 2019

Background:

Head and neck squamous cell carcinoma (HNSCC) is the leading histological type among head and neck cancers. Several studies have explored an association between aberrant methylation of MutL homolog-1 (MLH1) promoter and HNSCC risk. We aimed to explore the associations between MLH1 promoter methylation and HNSCC by using a meta-analysis.

Methods:

Systematic literature search was conducted among PubMed, Google Scholar, Web of Science, and China National Knowledge Infrastructure, and Wanfang databases to retrieve relevant articles published up to June 30, 2018. A total of 12 studies were included in this meta-analysis (including 717 HNSCC and 609 controls).

Results:

The results demonstrated that MLH1 promoter methylation was notably higher in patients with HNSCC than in controls (odds ratios [ORs] = 2.52, 95% confidence intervals [CIs] = 1.33–4.79). Besides, MLH1 promoter methylation was not associated with tumor stage, lymph node status, smoking behavior, age, clinical stage, gender, and differentiation grade (all P > .05). The pooled sensitivity and specificity rates of MLH1 methylation for HNSCC were 0.23 (95% CI = 0.12–0.38) and 0.95 (95% CI, 0.82–0.99), respectively. The area under the receiver operating characteristic (ROC) curve was presented as 0.64 (95% CI = 0.60-0.68).

Conclusion:

The results of this meta-analysis suggested that hypermethylation of MLH1 promoter was associated with HNSCC. Methylated MLH1 could be a potential diagnostic biomarker for diagnose of HNSCC.
Ulcerative intestinal tuberculosis case as a complication of treatment by infliximab for intestinal Behçet's disease
Authors: Shen Yan , Ma Hai-fen , Yang Yan-li , Guan Jian-long
Published: October 2019

Rationale:

Intestinal Behçet's disease (BD) is characterized by intestinal ulcerations and gastrointestinal symptoms. Ulcerative intestinal tuberculosis (TB) is usually with dyspepsia, abdominal pain, vomiting, and weight loss. The 2 diseases exhibit similar clinical manifestations, but the most critical aspects of their clinical courses and required treatments are not at all similar.

Patient concerns:

We present a case in which a patient with intestinal Behçet's disease developed a de novo ulcerative intestinal TB infection after the start of anti-tumor necrosis factor-α treatment. This was despite histopathologic examination without caseous necrosis granuloma and negative for acid-fast staining and latent TB screen.

Diagnoses:

Intestinal Behçet's disease and intestinal TB.

Interventions:

The patient was treated with quadruple antituberculous chemotherapy, comprising rifapentine, isoniazid, ethambutol, and pyrazinamide.

Outcomes:

At follow-up about 3 months, the therapy of oral antituberculous drugs and thalidomide was continued and the patient's condition had stabilized.

Lessons:

This case illustrates the importance of closely monitoring patients who are on infliximab for possible onset of TB, even without abdominal symptoms, and with negative screening results for latent TB.
Rationale and design to assess the efficacy and safety of HT047 in patients with acute ischemic stroke
Authors: Heo Sung Hyuk , Song Jungbin , Kim Bum Joon , Kim Hocheol , Chang Dae-Il
Published: October 2019

Background:

Though several neuroprotective agents have been evaluated as potential treatments for acute ischemic stroke, none have demonstrated a definitive treatment efficacy, which remains elusive. HT047 is an herbal extract of Scutellaria baicalensis and Pueraria lobata, both of which have been widely used to treat ischemic stroke in traditional Korean medicine. The aims of this trial are to investigate whether HT047 can improve neurologic status, particularly motor function, in acute ischemic stroke patients, and to determine the safety of HT047.

Methods:

A multicenter, double-blind, randomized, placebo-controlled, 3-arm parallel group, phase II trial will be conducted in patients who have had an acute ischemic stroke within the past 14 days. The participating patients must have a Fugl-Meyer assessment (FMA) motor score ≤55, with arm or leg weakness, and Korean version of the National Institutes of Health Stroke scale (K-NIHSS) score of ≥4 and ≤15. Seventy-eight participants will be randomized in a 1:1:1 ratio and given high-dose HT047 (750 mg 3 times a day), low-dose HT047 (500 mg 3 times a day), or a placebo for 12 weeks. The primary endpoint is the change in FMA motor score between baseline and week 12. Secondary endpoints are as follows: the change in FMA motor score at weeks 4 and 8 from baseline; the change in FMA motor score at weeks 4, 8, and 12 from baseline according to the timing of treatment initiation (either within 1 week, or 1–2 weeks), or according to the presence of prognostic risk factors (hypertension, diabetes, dyslipidemia, etc); the change in K-NIHSS and Korean versions of the modified Rankin scale (K-mRS) and the modified Barthel index at weeks 4 and 12 from baseline; and the proportion of subjects at week 12 with a K-NIHSS score of 0 to 2, or with K-mRS scores of 0, ≤1, and ≤2.

Discussion:

This study is a 1st-in-human trial of HT047 to explore the efficacy and safety in acute ischemic stroke patients. The results will provide the appropriate dosage and evidence of therapeutic benefit of HT047 for stroke recovery.

Trial registration:

ClinicalTrials.gov (NCT02828540) Registered July 11, 2016.
Type-A aortic dissection manifesting as acute inferior myocardial infarction
Authors: Wang Wenjun , Wu Jiahong , Zhao Xin , You Beian , Li Chuanbao
Published: October 2019

Rationale:

Acute Type-A aortic dissection (AD) is a challenging clinical emergency. Despite advances in diagnosis and surgical techniques, the high surgical mortality rate of the condition persists. As a result of similarities in clinical symptoms, AD can mimic acute myocardial infarction (AMI). In this paper, we report 2 cases of patients with acute AD manifesting as inferior AMI.

Patient concerns:

Two patients with undetected AD were misdiagnosed with AMI; in such patients, the administration of thrombolytic therapy has disastrous consequences.

Diagnoses:

The patients were initially diagnosed with AMI in the emergency room, and then diagnosed with AD during catheterization.

Interventions:

The patients were transferred to the cardiac catheterization laboratory for primary coronary angiography. The initial attempt to selectively engage the coronary ostium was unsuccessful. Subsequent computed tomography angiography (CTA) confirmed AD from the aortic root to the abdominal aorta and dissection violations of the coronary ostium. The patients underwent emergency aortic root replacement.

Outcomes:

One patient recovered and was discharged 2 weeks later. At a 1-year follow-up examination, CTA indicated that this patient had made a full recovery. The other patient died 6 days after surgery.

Lessons:

As a result of similarities in clinical symptoms, AD can mimic AMI. Rapid diagnosis and treatment of AD is crucial. Difficulty during catheter engagement should raise the suspicion of acute Type-A AD.
The immunity features and defects against primary cytomegalovirus infection post-splenectomy indicate an immunocompromised status
Authors: Liatsos George Dimitrios
Published: October 2019

Background:

To evaluate if splenectomy results in severely impaired immune responses against primary cytomegalovirus (CMV) infection compared to the general immunocompetent population.

Methods:

We performed a systemic literature review to study CMV infections in splenectomized individuals, a special population group presently considered immunocompetent to viral infections. We retrieved 30 cases with established CMV infection post-splenectomy and we recorded their disease manifestations, laboratory findings, immunological studies, and histopathology reports. In addition, we retrieved numerous multidisciplinary articles in view of post-splenectomy immunology defects, as well as of immune responses to primary invading CMV in the absence of the spleen. Two clinical studies directly comparing splenectomized with nonsplenectomized individuals under severe iatrogenic immunosuppression as well as the numerically largest review articles of CMV infections in immunocompetent were retained.

Results:

Splenectomy results in the loss of spleen's ability to fend-off blood-borne pathogens and impairs the link between innate and adaptive immunity. The major post-splenectomy immune-defects against CMV are: weakened, delayed or absent anti-CMV IgM, and compensatory marked IgG response; severely impaired B-cell and CD4+, CD8+ T-cells function responses; and post-splenectomy, bone marrow compensates for the absence of spleen's immune responses against CMV, mimicking a monoclonal T-cell lymphoproliferative process.

Conclusion:

The puzzled diagnosis of the CMV syndrome post-splenectomy is of the most challenging and misleading, resulting in risky and costly interventions and a subsequent prolonged hospitalization (2 months). The mounting multi-disciplinary literature evidence renders us to suggest that splenectomized individuals are not only prone to encapsulated bacteria but also behave as immunocompromised to CMV.
Does night work affect age at which menopause occurs?
Authors: Stock David , Schernhammer Eva
Published: October 2019

Purpose of review

To delineate the current state of evidence on the impact of night shift work on age at natural menopause.

Recent findings

The only direct evidence is from a single observational study, which indicates that women who work night shifts are at moderately higher risk for earlier menopause and that this risk is more pronounced among younger women. Underlying biological mechanisms have yet to be sufficiently substantiated. A long-held line of inquiry, most strongly propagated by the observed link between night shift work and female breast cancer, is the ‘Light at Night’ hypothesis, which suggests melatonin-mediated circadian disruption as a potential regulator of reproductive signaling in women. Supporting evidence is found from observations of changes in endogenous melatonin production among night working women or in response to light exposure, and corresponding changes in endogenous ovarian hormone levels and modulated menstrual patterns, among other indications of altered central ovulation-governing processes. Susceptibility to night shift work may be modified by chronotype.

This review summarizes the literature related to night work and ovulatory regulation in humans, prioritizing population-based evidence to provide motivation for the study of circadian disruption and night shift work as a regulator of menopausal timing.
Efficacy and Safety of Sodium Benzoate in The Management of Hyperammonemia in Decompensated Chronic Liver Disease of the Childhood—A Double‐blind Randomized Controlled Trial
Authors: Snehavardhan Pandey , Lal Bikrant B. , Sood Vikrant , Khanna Rajeev , Alam Seema
Published: October 2019

Objective:

The objective was to evaluate the efficacy and safety of sodium benzoate in the management of hyperammonemia and hepatic encephalopathy (HE) in decompensated chronic liver disease.

Methods:

It was a prospective, interventional, double‐blinded randomized controlled trial conducted from August 2017 to December 2018. Children with decompensated chronic liver disease and hyperammonemia were included in the study. Those with ammonia >400 μg/dL, already receiving sodium benzoate or with grade III ascites were excluded. Group A received sodium benzoate (400 mg/kg loading dose followed by 200 mg · kg−1 · day−1maintenance for 5 days) along with the standard medical therapy. Group B received standard medical therapy with placebo.

Results:

A total of 108 episodes of hyperammonemia occurred in 86 patients of whom 16 were excluded. The final analysis included 46 episodes in each group. The median decrease in ammonia from baseline to day 5 was 52 μg/dL in group A versus 42 μg/dL in group B (P = 0.321). There was a significant decrease in ammonia on days 1 and 2 in group A as compared to group B, but not on subsequent days. There was no significant difference in the resolution of HE (57.1% vs 50%; P = 1), but there was higher, albeit insignificant increase in ascites in group A (15.9% vs 4.5%).

Conclusions:

Addition of sodium benzoate significantly reduced the ammonia levels on the first 2 days of therapy but the effect was not sustained till day 5. The effect of sodium benzoate would probably be more sustained, if higher dosage (400 mg · kg−1 · day−1) could be used under monitoring of benzoate levels. There was no effect on resolution of HE. Sodium benzoate caused an increasing trend of adverse events with no effect on short‐term survival.
A Typology of Innovations in Nursing
Authors: Joseph M. Lindell , Huber Diane L. , Bair Heather , Moorhead Sue , Hanrahan Kirsten
Published: October 2019

OBJECTIVE

The purposes of this project were to identify innovations conceived from nurse faculty at a college of nursing and nurses in an academic medical center, examine their characteristics, and create a typology of nursing innovations.

BACKGROUND

Innovation is a crucial component for progress in healthcare. Jobs to Be Done Theory suggests that to make progress in nursing, workers must be solution focused to answer problems.

METHODS

This qualitative study used directed content analysis to evaluate survey responses of nurses in 1 university's academic and practice setting about solutions or innovations to achieve progress in their jobs.

RESULTS

Fifty-seven examples of situations needing an innovative solution were coded and categorized by challenges to yield an 8 characteristic typology in nursing innovation.

CONCLUSIONS

These findings serve as a guide for nurse executives to understand and leverage how innovations are conceptualized and translated in academia and practice.
A Scoping Review of Validated Tools to Measure Incivility in Healthcare Settings
Authors: Harris Whitney C. , Usseglio John , Chapman-Rodriguez Rose , Licursi Maureen , Larson Elaine
Published: October 2019

OBJECTIVE

To identify and compare validated tools used to assess incivility in healthcare settings.

BACKGROUND

Incivility in the workforce is associated with poor quality outcomes, increased employee turnover, and decreased job satisfaction. Validated tools are essential for accurate measurement of incivility. The aim of this study was to compare characteristics of validated tools for use in a busy clinical setting.

METHODS

In a scoping review, English language research studies using incivility tools published in PubMed or CINAHL between March 1, 2013, and March 14, 2018, were assessed for sound psychometric properties and feasibility of use (eg, short, easy to administer).

RESULTS

After screening 869 articles and full text review of 244, 5 identified tools met the criteria; the Short Negative Acts Questionnaire seemed best suited for use in a busy healthcare setting.

CONCLUSION

Adoption of a standardized and validated incivility tool makes it possible to compare across clinical settings and track progress over time.
Getting to Know the Magnet Recognition Program® Staff and Services
Authors: Lal M. Maureen
Published: October 2019

In this month's Magnet Perspectives column, the director of the Magnet Recognition Program® highlights the program staff and leadership at ANCC responsible for the Magnet® Program.
Increase in Gonorrhea Incidence Associated With Enhanced Partner Notification Strategy
Authors: Schleihauf Emily , Leonard Erin , Phillips Carrie , Hatchette Todd , Haldane David , Arnason Trevor , Martin Irene , Whelan Noella
Published: October 2019

Objectives

Partner notification services for reportable sexually transmitted infections vary based on jurisdiction, resources, type of infection, and whether an outbreak has been reported. The objective of this study was to determine whether case finding increased after implementation of enhanced notification and follow-up activities for contacts of cases of Neisseria gonorrhoeae in Central Zone, the largest health authority in Nova Scotia, Canada.

Methods

Enhanced contact tracing by public health professionals was implemented in May 2015. N. gonorrhoeae multiantigen sequence typing (NG-MAST) was conducted on all positive specimens. Epidemiologic and NG-MAST information for reported gonorrhea cases were captured and analyzed. Case numbers, rates, and NG-MAST results in the preintervention and postintervention periods were compared. Laboratory testing data were extracted and analyzed for association with reported incidence.

Results

There was a significant increase in the number of reported gonorrhea cases per month when comparing the preintervention and postintervention periods. The reported gonorrhea rate in 2016 was 2.9 times that in 2014. This increase was not associated with changes in testing rates and was more pronounced among women than men. Larger groups of cases sharing the same NG-MAST profiles were detected postintervention.

Conclusions

The implementation of an enhanced contact tracing program for N. gonorrhoeae resulted in increased case finding and a notable increase in the reported rate of cases per 100,000 population. Owing to these findings, the practice of enhanced partner notification was continued as standard public health practice in Central Zone. An understanding of case finding efforts is required when interpreting observed trends in rates of N. gonorrhoeae, as early infection is highly asymptomatic in women and can be asymptomatic in men.
Does Racial Disparity in Kidney Transplant Waitlisting Persist After Accounting for Social Determinants of Health?
Authors: Ng Yue-Harn , Pankratz V. Shane , Leyva Yuridia , Ford C. Graham , Pleis John R. , Kendall Kellee , Croswell Emilee , Dew Mary Amanda , Shapiro Ron , Switzer Galen E. , Unruh Mark L. , Myaskovsky Larissa
Published: October 2019

Background.

African Americans (AA) have lower rates of kidney transplantation (KT) compared with Whites (WH), even after adjusting for demographic and medical factors. In this study, we examined whether the racial disparity in KT waitlisting persists after adjusting for social determinants of health (eg, cultural, psychosocial, and knowledge).

Methods.

We prospectively followed a cohort of 1055 patients who were evaluated for KT between 3 of 10 to 10 of 12 and followed through 8 of 18. Participants completed a semistructured telephone interview shortly after their first KT evaluation appointment. We used the Wilcoxon rank-sum and Pearson chi-square tests to examine race differences in the baseline characteristics. We then assessed racial differences in the probability of waitlisting while accounting for all predictors using cumulative incidence curves and Fine and Gray proportional subdistribution hazards models.

Results.

There were significant differences in the baseline characteristics between non-Hispanic AA and non-Hispanic WH. AA were 25% less likely (95% confidence interval, 0.60-0.96) to be waitlisted than WH even after adjusting for medical factors and social determinants of health. In addition, being older, having lower income, public insurance, more comorbidities, and being on dialysis decreased the probability of waitlisting while having more social support and transplant knowledge increased the probability of waitlisting.

Conclusions.

Racial disparity in kidney transplant waitlisting persisted even after adjusting for medical factors and social determinants of health, suggesting the need to identify novel factors that impact racial disparity in transplant waitlisting. Developing interventions targeting cultural and psychosocial factors may enhance equity in access to transplantation.
Pediatric Montages in Clinical Practice
Authors: San Juan Daniel O. , Ordóñez Mario Ulises Ávila , Montufar Juan Pablo Muñoz , Hortiales Sabino Suárez , Anschel David J.
Published: October 2019

The montages in clinical EEG recordings in neonates, infants, and children follow some basic principles of adolescent or adult EEG recordings; however, special considerations are needed to obtain optimal diagnostic yield in pediatric patients. The aim of this review is to summarize the pediatric montages recommended in clinical practice in the standard clinical neurophysiology laboratory and in special situations.
A new varanopid synapsid from the early Permian of Oklahoma and the evolutionary stasis in this clade
Authors: Maho Sigi , Gee Bryan M. , Reisz Robert R.
Published: October 2019

Varanopids are a basal clade of small- to medium-sized non-therapsid synapsids, whose range extends from the late Pennsylvanian to the late middle Permian, and are found in North America, Russia, Europe and South Africa. The greatest varanopid diversity is observed at the fossiliferous cave deposits near Richards Spur, Oklahoma, well known for the preservation of a complex early Permian upland community. Two previously described varanopids,MycterosaurusandVaranops, are known only from fragmentary disarticulated material at Richards Spur. A third putative varanopid,Basicranodon fortsillensis, represented by a partial parasphenoid, has been synonymized withMycterosaurus longiceps. This study reports on a new varanopid taxon, represented by substantially more complete material, including three nearly complete skulls. Such comprehensive cranial material allows for a detailed study of the taxon and its relationship to other varanopids. This new varanopid bears great morphological similarity toMesenosaurus romerifrom the middle Permian Mezen River Basin of northern Russia. Phylogenetic analysis recovers a sister relationship between this taxon andMe. romeri. This relationship, in conjunction with a detailed morphological comparison, supports the placement of this taxon withinMesenosaurus, as a new species,Me. efremovi. These results reveal an unexpected extension of the geographical and temporal range ofMesenosaurus, contributing to our understanding of varanopid dispersal. The extended persistence of this basal clade of predatory synapsids, underscored by the apparent evolutionary stasis of this genus, is unusual among Palaeozoic tetrapods. This phenomenon implies an exceptionally high degree of extended ecological resilience across major faunal and environmental transitions.
Ice sheet flow with thermally activated sliding. Part 1: the role of advection
Authors: Mantelli E. , Haseloff M. , Schoof C.
Published: October 2019

Flow organization into systems of fast-moving ice streams is a well-known feature of ice sheets. Fast motion is frequently the result of sliding at the base of the ice sheet. Here, we consider how this basal sliding is first initiated as the result of changes in bed temperature. We show that an abrupt sliding onset at the melting point, with no sliding possible below that temperature, leads to rapid drawdown of cold ice and refreezing as the result of the increased temperature gradient within the ice, and demonstrate that this result holds regardless of the mechanical model used to describe the flow of ice. Using this as a motivation, we then consider the possibility of a region of ‘subtemperate sliding’ in which sliding at reduced velocities occurs in a narrow range of temperatures just below the melting point. We confirm that this prevents the rapid drawdown of ice and refreezing of the bed, and construct a simple numerical method for computing steady-state ice sheet profiles that include a subtemperate region. The stability of such an ice sheet is analysed in a companion paper.
Rapid and positive responses of plants to lower precipitation predictability
Authors: March-Salas Martí , van Kleunen Mark , Fitze Patrick S.
Published: October 2019

Current climate change is characterized by an increase in weather variability, which includes altered means, variance and predictability of weather parameters, and which may affect an organism's ecology and evolution. Few studies have experimentally manipulated the variability of weather parameters, and very little is known about the effects of changes in the intrinsic predictability of weather parameters on living organisms. Here, we experimentally tested the effects of differences in intrinsic precipitation-predictability on two herbaceous plants (
Onobrychis viciifolia
and
Papaver rhoeas
). Lower precipitation-predictability led to phenological advance and to an increase in reproductive success, and population growth. Both species exhibited rapid transgenerational responses in phenology and fitness-related traits across four generations that mitigated most effects of precipitation-predictability on fitness proxies of ancestors. Transgenerational responses appeared to be the result of changes in phenotypic plasticity rather than local adaptation. They mainly existed with respect to conditions prevailing during early, but not during late growth, suggesting that responses to differences in predictability during late growth might be more difficult. The results show that lower short-term predictability of precipitation positively affected fitness, rapid transgenerational responses existed and different time scales of predictability (short-term, seasonal and transgenerational predictability) may affect organisms differently. This shows that the time scale of predictability should be considered in evolutionary and ecological theories, and in assessments of the consequences of climate change.
Genetic coupling of signal and preference facilitates sexual isolation during rapid speciation
Authors: Xu Mingzi , Shaw Kerry L.
Published: October 2019

The divergence of sexual signals is ultimately a coevolutionary process: while signals and preferences diverge between lineages, they must remain coordinated within lineages for matings to occur. Divergence in sexual signals makes a major contribution to evolving species barriers. Therefore, the genetic architecture underlying signal–preference coevolution is essential to understanding speciation but remains largely unknown. InLaupalacrickets where male song pulse rate and female pulse rate preferences have coevolved repeatedly and rapidly, we tested two contrasting hypotheses for the genetic architecture underlying signal–preference coevolution: linkage disequilibrium between unlinked loci and genetic coupling (linkage disequilibrium resulting from pleiotropy of a shared locus or tight physical linkage). Through selective introgression and quantitative trait locus (QTL) fine mapping, we estimated the location of QTL underlying interspecific variation in both female preference and male pulse rate from the same mapping populations. Remarkably, map estimates of the pulse rate and preference loci are as close as 0.06 cM apart, the strongest evidence to date for genetic coupling between signal and preference loci. As the second pair of colocalizing signal and preference loci in theLaupalagenome, our finding supports an intriguing pattern, pointing to a major role for genetic coupling in the quantitative evolution of a reproductive barrier and rapid speciation inLaupala. Owing to its effect on suppressing recombination, a coupled, quantitative genetic architecture offers a powerful and parsimonious genetic mechanism for signal–preference coevolution and the establishment of positive genetic covariance on which the Fisherian runaway process of sexual selection relies.
Post-copulatory sexual selection allows females to alleviate the fitness costs incurred when mating with senescing males
Authors: Vuarin Pauline , Bouchard Alice , Lesobre Loïc , Levêque Gwènaëlle , Chalah Toni , Jalme Michel Saint , Lacroix Frédéric , Hingrat Yves , Sorci Gabriele
Published: October 2019

Male senescence has detrimental effects on reproductive success and offspring fitness. When females mate with multiple males during the same reproductive bout, post-copulatory sexual selection that operates either through sperm competition or cryptic female choice might allow females to skew fertilization success towards young males and as such limit the fitness costs incurred when eggs are fertilized by senescing males. Here, we experimentally tested this hypothesis. We artificially inseminated female North African houbara bustards with sperm from dyads of males of different (young and old) or similar ages (either young or old). Then, we assessed whether siring success was biased towards young males and we measured several life-history traits of the progeny to evaluate the fitness costs due to advanced paternal age. In agreement with the prediction, we found that siring success was biased towards young males, and offspring sired by old males had impaired hatching success, growth and post-release survival (in females). Overall, our results support the hypothesis that post-copulatory sexual selection might represent an effective mechanism allowing females to avoid the fitness costs of fertilization by senescing partners.
Beyond drugs: the evolution of genes involved in human response to medications
Authors: Fuselli Silvia
Published: October 2019

The genetic variation of our species reflects human demographic history and adaptation to diverse local environments. Part of this genetic variation affects individual responses to exogenous substances, such as food, pollutants and drugs, and plays an important role in drug efficacy and safety. This review provides a synthesis of the evolution of loci implicated in human pharmacological response and metabolism, interpreted within the theoretical framework of population genetics and molecular evolution. In particular, I review and discuss key evolutionary aspects of different pharmacogenes in humans and other species, such as the relationship between the type of substrates and rate of evolution; the selective pressure exerted by landscape variables or dietary habits; expected and observed patterns of rare genetic variation. Finally, I discuss how this knowledge can be translated directly or after the implementation of specific studies, into practical guidelines.
Tensor Factorization-based Prediction with an Application to Estimating the Risk of Chronic Diseases
Authors: Wang Haolin , Zhang Qingpeng , Chen Frank Youhua , Man Leung Eman Yee , Yi Wong Eliza Lai , Yeoh Eng-Kiong
Published: October 2019

Tensor factorization has emerged as a powerful method to address the challenges of high dimensionality regarding disease development and comorbidity. Chronic diseases have a high likelihood to co-occur, making patients suffering from one chronic disease to have an elevated risk for the other diseases in the course of aging. Individualized prediction of chronic diseases can help patients prevent new diseases and reduce the healthcare costs. Despite rich results of risk assessment models for chronic diseases, individualized risk prediction considering the complex mechanisms of disease development and comorbidity remains to be under-researched. This research aims to develop tensor factorization-based machine learning models to predict the onset of new chronic diseases for individual patients through incorporating the comorbidity patterns with the clinical and sequential factors revealed in the electronic health records (EHR) data. We propose two tensor factorization-based methods to incorporate the clinical and sequential factors to reveal the latent patterns of co-occurring chronic diseases. The efficacy of the proposed methods was validated through predicting the onset of new chronic diseases for individual patients using the EHR data for 23 years from a major hospital in Hong Kong. The proposed methods consistently outperform benchmark predictive models. The top 10 predictions of new chronic diseases have approximately 60% recall. Tensor factorization is an appropriate method for predicting the onset of chronic diseases at the individual level. The proposed predictive models could inform proactive health management programs for at-risk patients with different chronic conditions at discharge.

Author summary

The existing risk assessment models mainly focused on the prediction of single diseases in the population base. Chronic disease risk prediction considering the complex mechanisms of disease development and comorbidity is under-researched. To support and inform clinical decision making for healthcare professionals in the aging society, this study provides an innovative approach to mapping an interconnected web of chronic illnesses and investigated the performance of chronic disease prediction using 2 years’ worth of patient assessment records and 23 years’ admission history data from a major hospital in Hong Kong. We proposed matrix and tensor-based methods to represent the high-order interrelations of patients, chronic diseases and additional features, which can reveal the latent patterns of co-occurring chronic diseases to enable more effective prediction. The proposed methods exhibit state-of-the-art performance in predicting the onset of new chronic diseases for individual patients.
Suppressor mutations in Mecp2-null mice reveal that the DNA damage response is key to Rett syndrome pathology
Authors: Enikanolaiye Adebola , Ruston Julie , Zeng Rong , Taylor Christine , Shrock Marijke , Buchovecky Christie M. , Shendure Jay , Acar Elif , Justice Monica J.
Published: October 2019

Mutations in X-linked methyl-CpG-binding protein 2 (MECP2) cause Rett syndrome (RTT). We carried out a genetic screen for secondary mutations that improved phenotypes in Mecp2/Y mice after mutagenesis with N-ethyl-N-nitrosourea (ENU), aiming to identify potential therapeutic entry points. Here we report the isolation of 106 founder animals that show suppression of Mecp2-null traits from screening 3,177 Mecp2/Y genomes. Using exome sequencing, genetic crosses and association analysis, we identify 33 candidate genes in 30 of the suppressor lines. A network analysis shows that 61% of the candidate genes cluster into the functional categories of transcriptional repression, chromatin modification or DNA repair, delineating a pathway relationship with MECP2. Many mutations lie in genes that are predicted to modulate synaptic signaling or lipid homeostasis. Surprisingly, mutations in genes that function in the DNA damage response (DDR) also improve symptoms in Mecp2/Y mice. The combinatorial effects of multiple loci can be resolved by employing association analysis. One line, which was previously reported to carry a suppressor mutation in a gene required for cholesterol synthesis, Sqle, carries a second mutation in retinoblastoma binding protein 8 (Rbbp8 or CtIP), which regulates a DDR choice in double stranded break (DSB) repair. Cells from Mecp2/Y mice have increased DSBs, so this finding suggests that the balance between homology directed repair and non-homologous end joining is important for neuronal cells. In this and other lines, the presence of two suppressor mutations confers better symptom improvement than one locus alone, suggesting that combination therapies could be effective in RTT.