bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive and Characterized Pulsar Evolution From its Optical Pulsation
Authors: Masong Rizchel
Published: August 2020

The measured and predicted variables of pulsar PSR B1937+21 were explored from the energetics obtained from the previous observation made. The target parameters such as the brightness, luminosities, and optical efficiency. A series of observations were analysed to determine the individual values of the parameters chosen. Within the extended area of optical pulsation, the values were plotted to determine the relation of it to synchrotron emission. The results were presented graphically to see whether PSR B1937+21 will remain consistent with the expected pulsar model. The researcher suggests that simulation and correlation of previous observation made together with a new one to explore the cause of optical pulsation from mass transfer and spectral evolution.
Galactic warp from the kinematics of OB stars
Authors: Nurhidayat Rizky Maulana , Arifyanto Mochamad Ikbal , Puspitarini Lucky
Published: August 2020

The warp in Milky Way seen through the young stellar disk shows the complex structures. Its spatial distribution reveals the asymmetry in the vertical distance to the galactic midplane, whereas the kinematics shows the os- cillating motion. We analyze the warp using about 25,000 OB stars from Gaia Data Release 2, with Galactocentric azimuth (φ) range from 135◦ to 225◦ . We detect the warp from two distinctive regions. First region (warp down) lies on 100◦ < l < 150◦ and second regions (warp up) lies on 150◦ < l < 220◦ . The vertical position towards the Galactic midplane (Z) from all samples shows the line-of-nodes of the warp is on φ = 174◦ ± 2◦ . The maximum deviation in warp down region reachs 0.1 kpc and 0.2 kpc in warp up region. The vertical velocity (VZ) from both regions are dominated by negative VZ . From the kinematics dis- tribution, it can be concluded that there is an oscillati1ng motion. Considering with the previous study, the oscillating motion was caused by the gravitational interaction with the Galaxy satellites. From this, we can constrain the origin of the warp is developing from the tidal interaction between Milky Way and its satellites.
Numerical solutions to Giovannini’s QCD parton branching processes
Authors: Ong Z. , Agarwal P. , Ang H.W. , Wang E. , Chan A.H. , Oh C.H.
Published: August 2020

In 1979, Giovannini [1] formulated multiparticle production as a manifestation of four QCD processes: A: g → gg (gluon bremsstrahlung), A-: q → qg (quark bremsstrahlung), B: g → qq (quark pair creation) and C: g → ggg (four-gluon vertex). At present, only approximate solutions exist, such as the Generalized Multiplicity Distribution (GMD) which excludes pro- cesses B and C [2, 3]. These approximate solutions have been very successful in describing charged particle multiplicities at lower energies, at least until the appearance of a shoulder-like structure at √s ≈ 200 GeV and 900 GeV first reported by the UA5 collaboration [4], also known as “KNO-scaling violation”. Here, we extend the work of Sakai [5] and attempt a numerical solution that incorporates all four QCD processes, and see if the addition of processes B and C can explain the shoulder-like structure.
Nonlinear Dirac Neutrino Oscillations
Authors: Quek Zhi Hao , Ng Wei Khim , Chan Aik Hui , Oh Choo Hiap
Published: August 2020

Neutrino oscillations are a possible way to probe beyond Standard Model physics. The propagation of Dirac neutrinos in a massive medium is governed by the Dirac equation modified with an effective Hamiltonian that de- pends on the number density of surrounding matter fields. At the same time, quantum nonlinearities may contribute to neutrino oscillations by further mod- ifying the Dirac equation. A possible nonlinearity is computationally studied using Mathematica at low energies. We find that the presence of a uniform, static background matter distribution may significantly alter the oscillation am- plitude and wavelength; the considered nonlinearity may further reduce both oscillation amplitude and wavelength. In addition, the presence of matter al- lows the effects of the nonlinearity to be more readily observed for the chosen background densities and neutrino energy.
Myopie de l’enfant
Authors: Bremond-Gignac Dominique
Published: August 2020

La myopie est une anomalie réfractive, enjeu mondial de santé publique, essentiellement due à une augmentation de longueur axiale du globe oculaire. La myopie est en forte augmentation dans le monde, revêtant un aspect « d’épidémie mondiale de la myopie ». Chez les enfants de moins de 6 ans, 20 % présentent des anomalies dont les plus fréquentes sont essentiellement les anomalies réfractives, suivies par le strabisme et l’amblyopie. La myopie présente des risques majeurs de complications, corrélée à sa sévérité, comme le décollement de rétine, les néovaisseaux rétiniens, la cataracte précoce et le glaucome. Une myopie syndromique doit être recherchée devant toute myopie forte. Il est essentiel de dépister précocement et de reconnaître la myopie évolutive de façon à mettre en place des stratégies de freination. Les traitements les plus prometteurs incluent les activités d’extérieur, les verres correcteurs ou les lentilles de contact défocalisants, l’orthokératologie et les traitements pharmacologiques par atropine faiblement dosée.
Jules Bordet, un homme de conviction
Authors: Cavaillon Jean-Marc , Sansonetti Philippe , Goldman Michel
Published: August 2020

Docteur en médecine, bénéficiant d’une bourse du gouvernement belge, Jules Bordet vint se former au sein du laboratoire du père de l’immunité cellulaire, Elie Metchnikoff, à l’Institut Pasteur. Paradoxalement, il va y déchiffrer certains des mécanismes clés de l’immunité humorale, initialement découverte par l’école allemande. Il y décrit notamment les mécanismes qui aboutissent à la bactériolyse et l’hémolyse par l’action d’immunsérums. Même s’il favorisa le terme d’alexine, créé par Hans Buchner, c’est bien le système du complément (terme inventé par Paul Ehrlich) dont il est un des pères fondateurs. C’est pour ces travaux qu’il se verra attribué en octobre 1920 le prix Nobel de physiologie ou médecine millésimé 1919. Il identifia aussi le bacille de la coqueluche, qui porte son nom Bordetella pertussis.
Strukturierte Diabetesschulung
Authors: Kronsbein Peter , Kuniß Nadine
Published: August 2020

Successful diabetes treatment requires a high degree of therapy-related competence and everyday coping from the patients. The necessary knowledge and skills are developed in diabetes education programs together with the diabetes health care team. This article presents history, structural components and methodological-didactic aspects, gives an up-to-date overview of existing programs in Germany and an outlook on future diabetes education in view of technological progress.
Gebärmuttererkrankungen des Rindes: mikrobiologische, molekularbiologische und immunologische Aspekte
Authors: Neubrand Lisa , Wagener Karen , Drillich Marc
Published: August 2020

Postpartale Gebärmutterentzündungen treten beim Rind in unterschiedlichen Ausprägungen als puerperale Metritis oder klinische Endometritis auf und können über 40 % der Kühe einer Herde betreffen. Unabhängig von ihrem klinischen Erscheinungsbild zählen sie zu den häufigsten Ursachen für Fruchtbarkeitsstörungen bei Rindern und verursachen erhebliche Einbußen in der Produktivität der Milchkühe und letztendlich in der Wirtschaftlichkeit der Betriebe. Obwohl Erkrankungen der Gebärmutter schon seit vielen Jahren Gegenstand der wissenschaftlichen Diskussion sind, fehlen weiterhin, trotz entsprechender Versuche zur Vereinheitlichung, einheitliche Definitionen der verschiedenen Ausprägungen uteriner Erkrankungen. Durch Anwendung neuer technischer Entwicklungen und Testverfahren konnte ein immenser Fortschritt hinsichtlich der Kenntnisse über physiologische Zusammenhänge und pathologische Mechanismen erreicht werden. Bovine (Endo)metritiden können als multifaktorielle Erkrankungen angesehen werden und resultieren aus dem Zusammenspiel einer mikrobiellen Infektion, einer Dysregulation des Immunsystems und einwirkenden Risikofaktoren. Dieses Zusammenspiel wird auf den Ebenen der Mikrobiologie und Molekularbiologie und auch mithilfe der Bioinformatik und Molekulargenetik intensiv erforscht. Im Ergebnis wurden unter anderem neue Bakterienspezies beschrieben, die zur Entstehung der Erkrankung beitragen können, Effekte von Entzündungsmediatoren erklärt sowie metabolische und genetische Einflüsse und Zusammenhänge zu nachfolgenden Fruchtbarkeitsstörungen beschrieben. Daraus ergeben sich nicht nur Grundlagen für mögliche neue Therapie- und Präventionsansätze, sondern auch Ansätze, die in der tierärztlichen Praxis heute schon genutzt werden können. Dieser Artikel soll eine Übersicht über den aktuellen Stand der Forschung zur bovinen Metritis und Endometritis mit einem Schwerpunkt auf mikrobiologischen, molekularbiologischen und immunologischen Studien liefern.
Analysis of puerperal metritis treatment records in a grazing dairy farm in Argentina
Authors: de la Sota Rodolfo Luzbel , Corva Santiago , Dominguez German , Madoz Laura Vanina , Jaureguiberry Maria , Giuliodori Mauricio
Published: August 2020

Objective To assess the efficacy of antibiotic usage for the treatment of puerperal metritis (PM) and its association with reproductive performance, a retrospective cohort study including a total of 9168 records of cows from a dairy farm in Argentina was run.

Material and methods Cows having a PM3 (metricheck, scale 0–3) and treated with ceftiofur (ceftiofur crystalline free acid, 6.6 mg/kg) at 0–21 days postpartum (p. p.) (n = 2688), and cows having a PM 1–2 and not treated with an antibiotic at 0–21 days p. p. (n = 6480) were included in the study. All cows were reexamined with metricheck to assess the clinical cure (vaginal discharge [VD] score 0), partial cure (VD score similar or lower than previous), no cure (VD score higher than previous). Cows with a metricheck VD1–3 after 0–21 days p. p. were diagnosed as clinical endometritis (CE) 1–3. The occurrence of PM1–3, cure rate, calving to conception interval, the hazard of pregnancy, odds for non-pregnancy, and odds for CE were analyzed using SAS software.

Results A total of 8876 PM1–3 records were included, 2435 records of PM3 treatments with ceftiofur (27.43 %), and 6441 records of PM1–2 (72.57 %) with no treatment. Cows having PM1 and PM2 became pregnant 14 and 12 days earlier than cows with PM3 (p < 0.001). The PM3 ceftiofur treated cows had a clinical cure of 24.85 % (PM0); 53.63 % had a partially cure; and 18.52 % no cure. Conversely, cows with PM1–2 had a 51.96 %, 20.70 %, and 24.53 % cure rate, respectively (p < 0.001). Cows having complete cure became pregnant 13 and 11 days earlier than cows having partial cure and no cure (p < 0.001). Cows that had PM3 during the first 21 days p. p. had twice the chances of developing CE compared to cows having PM1–2 (41.28 % vs. 24.14 %, p < 0.001). After 21 days p. p., less than 1 % of cows with clinical cure developed CE compared to 63.32 % that developed CE with partial cure, and 38.21 % with no cure (p < 0.001).

Conclusion and clinical relevance After ceftiofur treatment, 78 % of cows were cured when measured by disappearance of fetid VD but only 25 % of cows had clinical cure when measured by appearance of a clear VD. The cows that remained with clinical metritis had more chances of having CE after 21 days p. p. and had more days open than cows with clear normal VD.
Epidemiologie und Verletzungsprävention im Handball
Authors: Achenbach Leonard , Luig Patrick
Published: August 2020

Handball ist durch eine hohe Verletzungsrate gekennzeichnet. Aktuelle epidemiologische Studien, die die Charakteristik des Handballs besser berücksichtigen, zeichnen hierbei ein deutliches Bild des Verletzungsmusters und -risikos für Handballspielerinnen und -spieler. Während die Hälfte der Spieler nach einer akuten Verletzung mit einer medizinischen Behandlung weiterspielen und trainieren können, so geht die andere Hälfte der Verletzungen mit Verlust an Trainings- und Spielzeit einher. Zwar zeigen sich die erlittenen Verletzungen im Ligabetrieb häufig mit einem Kontaktmechanismus assoziiert, jedoch sind diese nur wenig mit Foulspiel verbunden, sodass im Handball ein hohes Präventionspotenzial vorhanden ist. Die Handballmedizin zeigt dabei große Bemühungen, das Verletzungsrisiko ihres Sports primär reduzieren zu wollen. Die bereits vorhandene Evidenz für Reduktionsmöglichkeiten von Knieverletzungen muss nun in den Trainingsalltag implementiert werden. Aufgrund der hohen Prävalenz von Überlastungsverletzungen der Wurfschulter wurden auch hier die ersten Erkenntnisse in ein Präventionsprogramm umgesetzt. Dieser Artikel wird dies im Detail beschreiben.
Distraction index and Norberg angle to distinguish dysplastic and non-dysplastic hips based on FCI score
Authors: Klever Julius , Brühschwein Andreas , Meyer-Lindenberg Andrea
Published: August 2020

Objective Radiographic hip scoring according to the Fédération Cynologique Internationale (FCI) and PennHIP (Pennsylvania Hip Improvement Program) method was performed with the purpose to compare the PennHIP and FCI results as well as coxofemoral joint laxity by correlation of Norberg angle and distraction index measurements.

Materials and methods A total of 167 dogs of various breeds presented for official screening examination in a veterinary teaching hospital in Germany were included. Using receiver operating characteristic analysis, the best Norberg angle and distraction index cut-off values to distinguish between dysplastic and non-dysplastic groups based on FCI grades and to distinguish between lax and tight hip joints according to the PennHIP proposal were calculated.

Results More than one third (38.2 %) of dogs that passed the breeding criterions according to FCI (grades A and B) were in the half of the population with lax hip joints and should not be used for breeding according to the PennHIP proposal. A cut-off value for the distraction index of 0.44 with sensitivity of 82.7 % and specificity of 84.2 % was superior to the best cut-off value for the Norberg angle at 101.8° with sensitivity of 82.7 % and specificity of 71.9 % to discriminate between non-dysplastic joints (A, B) and dysplastic joints (C, D, E).

Conclusions and clinical relevance Our results show a limited impact of laxity on the FCI grading. Breeding selection processes that are based on the FCI method could profit by an additional and complementary use of the distraction index.
Atraumatische Instabilität des vorderen Kreuzbandes durch eine intraligamentäre Zyste
Authors: Burchard René , Graw Jan A.
Published: August 2020

Ein 28-jähriger Mann wurde mit einem Instabilitätsgefühl im Knie beim Fußballspielen ohne vorhergehendes Unfallereignis vorstellig. Die klinische Untersuchung ergab sowohl einen pathologischen Lachmann- als auch einen pathologischen Pivot-Shift-Test. Die kernspintomografische Bildgebung zeigte eine intraligamentäre Zyste des vorderen Kreuzbandes (VKB). In der darauffolgenden Arthroskopie zeigte sich eine durch die Zyste verursachte subtotale Zerstörung des VKB. Nach einer VKB-Ersatzplastik mittels Semitendinosustransplantats war das Gelenk wieder stabil. Gelenkzysten sind selten und verursachen häufig unspezifische Schmerzen oder Bewegungseinschränkungen. Bislang wurden keine Zusammenhänge zwischen intraligamentären Zysten und einer Gelenkinstabilität beschrieben. Eine mögliche präventive Resektion auch asymptomatischer und zufällig gefundener Ligament-assoziierter Zysten ist zu diskutieren.
Factors Associated With Operatively Confirmed Adnexal Torsion Among Pregnant Women – A Multicenter Cohort Study
Authors: Rottenstreich Misgav , Moran Ido , Hirsch Ayala , Rotem Reut , Armon Shunit , benshushan Avi , Grisaru-Granovsky Sorina , Rottenstreich Amihai
Published: August 2020

Purpose The aim of this study was to investigate the association of clinical, laboratory, and ultrasound findings with the surgical diagnosis of adnexal torsion in a retrospective cohort of women operated for suspected torsion during pregnancy.

Materials and Methods A multicenter retrospective study of pregnant women who underwent urgent laparoscopy for suspected adnexal torsion during 2004–2019 in three tertiary medical centers.

Results Adnexal torsion was found in 143/208 (68.8 %) cases. Women with adnexal torsion had lower parity and lower rates of previous cesarean section, but higher rates of fertility treatments and multiple gestations, and were more likely to report right lower abdominal pain, with shorter duration of symptoms (< 24 hrs) and vomiting but not nausea. Women with adnexal torsion were found to have higher rates of sonographic findings suggestive of ovarian edema, while normal-appearing ovaries on ultrasound were more common in women without torsion. A multivariate logistic regression analysis showed that complaints of right abdominal pain were positively associated with adnexal torsion (aOR [95 % CI] 5.03 (1.45–17.49), while previous cesarean delivery and ultrasound findings of normal-appearing ovaries were negatively associated with adnexal torsion (aOR of 0.17 (0.05–0.52) and 0.10 (0.02–0.43), respectively).

Conclusion Clinical characteristics and ultrasound findings may be incorporated into the emergency room workup of pregnant women with suspected adnexal torsion.
Clinical Decision Support and Implications for the Clinician Burnout Crisis
Authors: Jankovic Ivana , Chen Jonathan H.
Published: August 2020

Objectives: This survey aimed to review aspects of clinical decision support (CDS) that contribute to burnout and identify key themes for improving the acceptability of CDS to clinicians, with the goal of decreasing said burnout.

Methods: We performed a survey of relevant articles from 2018-2019 addressing CDS and aspects of clinician burnout from PubMed and Web of Science™. Themes were manually extracted from publications that met inclusion criteria.

Results: Eighty-nine articles met inclusion criteria, including 12 review articles. Review articles were either prescriptive, describing how CDS should work, or analytic, describing how current CDS tools are deployed. The non-review articles largely demonstrated poor relevance and acceptability of current tools, and few studies showed benefits in terms of efficiency or patient outcomes from implemented CDS. Encouragingly, multiple studies highlighted steps that succeeded in improving both acceptability and relevance of CDS.

Conclusions: CDS can contribute to clinician frustration and burnout. Using the techniques of improving relevance, soliciting feedback, customization, measurement of outcomes and metrics, and iteration, the effects of CDS on burnout can be ameliorated.
Review of Clinical Research Informatics
Authors: Solomonides Anthony
Published: August 2020

Objectives: Clinical Research Informatics (CRI) declares its scope in its name, but its content, both in terms of the clinical research it supports—and sometimes initiates—and the methods it has developed over time, reach much further than the name suggests. The goal of this review is to celebrate the extraordinary diversity of activity and of results, not as a prize-giving pageant, but in recognition of the field, the community that both serves and is sustained by it, and of its interdisciplinarity and its international dimension.

Methods: Beyond personal awareness of a range of work commensurate with the author’s own research, it is clear that, even with a thorough literature search, a comprehensive review is impossible. Moreover, the field has grown and subdivided to an extent that makes it very hard for one individual to be familiar with every branch or with more than a few branches in any depth. A literature survey was conducted that focused on informatics-related terms in the general biomedical and healthcare literature, and specific concerns (“artificial intelligence”, “data models”, “analytics”, etc.) in the biomedical informatics (BMI) literature. In addition to a selection from the results from these searches, suggestive references within them were also considered.

Results: The substantive sections of the paper—Artificial Intelligence, Machine Learning, and “Big Data” Analytics; Common Data Models, Data Quality, and Standards; Phenotyping and Cohort Discovery; Privacy: Deidentification, Distributed Computation, Blockchain; Causal Inference and Real-World Evidence—provide broad coverage of these active research areas, with, no doubt, a bias towards this reviewer’s interests and preferences, landing on a number of papers that stood out in one way or another, or, alternatively, exemplified a particular line of work.

Conclusions: CRI is thriving, not only in the familiar major centers of research, but more widely, throughout the world. This is not to pretend that the distribution is uniform, but to highlight the potential for this domain to play a prominent role in supporting progress in medicine, healthcare, and wellbeing everywhere. We conclude with the observation that CRI and its practitioners would make apt stewards of the new medical knowledge that their methods will bring forward.
Contributions from the 2019 Literature on Bioinformatics and Translational Informatics
Authors: Smaïl-Tabbone Malika , Rance Bastien ,   Section Editors for the IMIA Yearbook Section on Bioinformatics and Translational Informatics
Published: August 2020

Objectives: Summarize recent research and select the best papers published in 2019 in the field of Bioinformatics and Translational Informatics (BTI) for the corresponding section of the International Medical Informatics Association Yearbook.

Methods: A literature review was performed for retrieving from PubMed papers indexed with keywords and free terms related to BTI. Independent review allowed the section editors to select a list of 15 candidate best papers which were subsequently peer-reviewed. A final consensus meeting gathering the whole Yearbook editorial committee was organized to finally decide on the selection of the best papers.

Results: Among the 931 retrieved papers covering the various subareas of BTI, the review process selected four best papers. The first paper presents a logical modeling of cancer pathways. Using their tools, the authors are able to identify two known behaviours of tumors. The second paper describes a deep-learning approach to predicting resistance to antibiotics in Mycobacterium tuberculosis. The authors of the third paper introduce a Genomic Global Positioning System (GPS) enabling comparison of genomic data with other individuals or genomics databases while preserving privacy. The fourth paper presents a multi-omics and temporal sequence-based approach to provide a better understanding of the sequence of events leading to Alzheimer’s Disease.

Conclusions: Thanks to the normalization of open data and open science practices, research in BTI continues to develop and mature. Noteworthy achievements are sophisticated applications of leading edge machine-learning methods dedicated to personalized medicine.
Notable Papers and Trends from 2019 in Sensors, Signals, and Imaging Informatics
Authors: Hsu William , Baumgartner Christian , Deserno Thomas M. ,   Section Editors for the IMIA Yearbook Section on Sensors, Signals, and Imaging Informatics
Published: August 2020

Objective: To highlight noteworthy papers that are representative of 2019 developments in the fields of sensors, signals, and imaging informatics.

Method: A broad literature search was conducted in January 2020 using PubMed. Separate predefined queries were created for sensors/signals and imaging informatics using a combination of Medical Subject Heading (MeSH) terms and keywords. Section editors reviewed the titles and abstracts of both sets of results. Papers were assessed on a three-point Likert scale by two co-editors, rated from 3 (do not include) to 1 (should be included). Papers with an average score of 2 or less were then read by all three section editors, and the group nominated top papers based on consensus. These candidate best papers were then rated by at least six external reviewers.

Results: The query related to signals and sensors returned a set of 255 papers from 140 unique journals. The imaging informatics query returned a set of 3,262 papers from 870 unique journals. Based on titles and abstracts, the section co-editors jointly filtered the list down to 50 papers from which 15 candidate best papers were nominated after discussion. A composite rating after review determined four papers which were then approved by consensus of the International Medical Informatics Association (IMIA) Yearbook editorial board. These best papers represent different international groups and journals.

Conclusions: The four best papers represent state-of-the-art approaches for processing, combining, and analyzing heterogeneous sensor and imaging data. These papers demonstrate the use of advanced machine learning techniques to improve comparisons between images acquired at different time points, fuse information from multiple sensors, and translate images from one modality to another.
Clinical Research Informatics
Authors: Daniel Christel , Kalra Dipak ,   Section Editors for the IMIA Yearbook Section on Clinical Research Informatics
Published: August 2020

Objectives: To summarize key contributions to current research in the field of Clinical Research Informatics (CRI) and to select best papers published in 2019.

Method: A bibliographic search using a combination of MeSH descriptors and free-text terms on CRI was performed using PubMed, followed by a double-blind review in order to select a list of candidate best papers to be then peer-reviewed by external reviewers. After peer-review ranking, a consensus meeting between the two section editors and the editorial team was organized to finally conclude on the selected three best papers.

Results: Among the 517 papers, published in 2019, returned by the search, that were in the scope of the various areas of CRI, the full review process selected three best papers. The first best paper describes the use of a homomorphic encryption technique to enable federated analysis of real-world data while complying more easily with data protection requirements. The authors of the second best paper demonstrate the evidence value of federated data networks reporting a large real world data study related to the first line treatment for hypertension. The third best paper reports the migration of the US Food and Drug Administration (FDA) adverse event reporting system database to the OMOP common data model. This work opens the combined analysis of both spontaneous reporting system and electronic health record (EHR) data for pharmacovigilance.

Conclusions: The most significant research efforts in the CRI field are currently focusing on real world evidence generation and especially the reuse of EHR data. With the progress achieved this year in the areas of phenotyping, data integration, semantic interoperability, and data quality assessment, real world data is becoming more accessible and reusable. High quality data sets are key assets not only for large scale observational studies or for changing the way clinical trials are conducted but also for developing or evaluating artificial intelligence algorithms guiding clinical decision for more personalized care. And lastly, security and confidentiality, ethical and regulatory issues, and more generally speaking data governance are still active research areas this year.
Pragmatic Considerations on Clinical Decision Support from the 2019 Literature
Authors: Duclos C. , Bouaud J. ,   Section Editors for the IMIA Yearbook Section on Decision Support
Published: August 2020

Objectives: To summarize significant research contributions published in 2019 in the field of computerized clinical decision support and select the best papers for the Decision Support section of the International Medical Informatics Association (IMIA) Yearbook.

Methods: Two bibliographic databases were searched for papers referring to clinical decision support systems (CDSSs) and computerized provider order entry (CPOE) systems. From search results, section editors established a list of candidate best papers, which were then peer-reviewed by external reviewers. The IMIA Yearbook editorial committee finally selected the best papers on the basis of all reviews including the section editors’ evaluation.

Results: A total of 1,378 articles were retrieved. Fifteen best paper candidates were selected, the reviews of which resulted in the selection of three best papers. One paper reports on a guideline modeling approach based on clinical decision trees, both clinically interpretable and suitable for implementation in CDSSs. In another paper, authors promote the use of extended Timed Transition Diagrams in CDSSs to formalize consistently recurrent medical processes for chronic diseases management. The third paper proposes a conceptual framework and a grid for assessing the performance of predictive tools based on the critical appraisal of published evidence.

Conclusions: As showed by the number and the variety of works related to decision support, research in the field is very active. This year’s selection highlighted pragmatic works that promote transparency and trust required by decision support tools.
Social Media, Research, and Ethics: Does Participant Willingness Matter?
Authors: Lau Annie Y. S. , Staccini Pascal ,   Section Editors for the IMIA Yearbook Section on Consumer Health Informatics and Education
Published: August 2020

Objective: To summarise the state of the art published in 2019 in consumer health informatics and education, with a special emphasis on “Ethics and Health Informatics”.

Methods: We conducted a systematic search of articles published in PubMed using a predefined set of queries, which identified 368 potential articles for review. These articles were screened according to topic relevance and 15 were selected for consideration of best paper candidates, which were then presented to a panel of international experts for full paper review and scoring. The top five papers according to the external reviewers’ ranking were discussed in a consensus meeting. Finally, the paper that received the highest score from four of the five experts was selected as the best paper on social media and ethics for patients and consumers of the year 2019.

Results: Despite using the terms “ethics” and “ethical” in the search query, we retrieved very few articles. The bibliometric analysis identified three major clusters centred on “social”, “health”, and “study”. Among the top five papers, one was a review where the authors identified ethical issues across four areas at the intersection of social media and health: 1) the impact of social networking sites on the doctor-patient relationship; 2) the development of e-health platforms to deliver care; 3) the use of online data and algorithms to inform health research; and 4) the broader public health consequences of widespread social media use. The other papers highlighted ethical concerns in using social media to interact with patients at different phases of a clinical research protocol, such as recruitment phase, participant engagement, data linkage, and detection and monitoring of adverse events.

Conclusions: Findings suggest that most users do not think that using social media for patient monitoring in clinical research, for example using Twitter for clinical trial recruitment, constitutes inappropriate surveillance or a violation of privacy. However, further research is needed to identify whether and how views on ethical concerns differed between social media platforms and across populations.
Vasopressor Therapy in the Intensive Care Unit
Authors: Russell James A. , Gordon Anthony C. , Williams Mark D. , Boyd John H. , Walley Keith R. , Kissoon Niranjan
Published: August 2020

After fluid administration for vasodilatory shock, vasopressors are commonly infused. Causes of vasodilatory shock include septic shock, post-cardiovascular surgery, post-acute myocardial infarction, postsurgery, other causes of an intense systemic inflammatory response, and drug -associated anaphylaxis. Therapeutic vasopressors are hormones that activate receptors—adrenergic: α1, α2, β1, β2; angiotensin II: AG1, AG2; vasopressin: AVPR1a, AVPR1B, AVPR2; dopamine: DA1, DA2. Vasopressor choice and dose vary widely because of patient and physician practice heterogeneity. Vasopressor adverse effects are excessive vasoconstriction causing organ ischemia/infarction, hyperglycemia, hyperlactatemia, tachycardia, and tachyarrhythmias. To date, no randomized controlled trial (RCT) of vasopressors has shown a decreased 28-day mortality rate. There is a need for evidence regarding alternative vasopressors as first-line vasopressors. We emphasize that vasopressors should be administered simultaneously with fluid replacement to prevent and decrease duration of hypotension in shock with vasodilation. Norepinephrine is the first-choice vasopressor in septic and vasodilatory shock. Interventions that decrease norepinephrine dose (vasopressin, angiotensin II) have not decreased 28-day mortality significantly. In patients not responsive to norepinephrine, vasopressin or epinephrine may be added. Angiotensin II may be useful for rapid resuscitation of profoundly hypotensive patients. Inotropic agent(s) (e.g., dobutamine) may be needed if vasopressors decrease ventricular contractility. Dopamine has fallen to almost no-use recommendation because of adverse effects; angiotensin II is available clinically; there are potent vasopressors with scant literature (e.g., methylene blue); and the novel V1a agonist selepressin missed on its pivotal RCT primary outcome. In pediatric septic shock, vasopressors, epinephrine, and norepinephrine are recommended equally because there is no clear evidence that supports the use of one vasoactive agent. Dopamine is recommended when epinephrine or norepinephrine is not available. New strategies include perhaps patients will be started on several vasopressors with complementary mechanisms of action, patients may be selected for particular vasopressors according to predictive biomarkers, and novel vasopressors may emerge with fewer adverse effects.
Cervicothoracic Fixation by Domino Connector in Cervicothoracic Junction Tuberculosis–A Case Report
Authors: Amin Md. Rezaul , Haque Moududul , Nath Haradhan Dev , Hossain ABM Manwar , Bari Mohammad Shahnawaz
Published: August 2020

Cervicothoracic junction tuberculosis involves the C7 to D3 levels of the spine which constitutes 5% of all spinal tuberculosis. As the cervicothoracic junction is transitional zone and a weight-bearing area, the anatomical considerations for treatment of cervicothoracic junction is very difficult. We did a lateral mass screw for C5, 6, and 7 and pedicle screw of D3 and 4 levels, and connected cervical 3.5 mm rod with thoracic 5.5 mm rod using a domino connector. We gave antituberculosis therapy for 18 months. We followed-up the patient routinely and she significantly improved.
Transorbital Endoscopic Surgery for Sphenoid Wing Meningioma: Long-Term Outcomes and Surgical Technique
Authors: Goncalves N. , Lubbe D.E.
Published: August 2020

Sphenoid wing meningiomas are benign tumors that can result in proptosis, visual impairment, and pain. Traditional open surgical approaches are associated with significant morbidity. Transorbital endoscopic surgery has been developed as a minimally invasive approach to gain access to these tumors and address the main presenting symptoms. Case series reporting transorbital endoscopic resection of sphenoid wing meningiomas using combined endonasal, pre-caruncular, and extended superior eyelid approaches have demonstrated stable and/or improved short- and medium-term visual outcomes. Earlier medial optic nerve decompression appears to result in more favorable long-term visual outcomes. Transorbital endoscopic surgery therefore represents an emerging minimally invasive alternative to deal with these challenging lesions.
Capnography in Pediatric Critical Care Unit and Correlation of End-Tidal and Arterial Carbon Dioxide in Ventilated Children
Authors: Krishnamoorthy Akhil , Meher Bijay Kumar , Damayanty Pradhan Deepti , Satpathy Saroj Kumar
Published: August 2020

Recording of end-tidal carbon dioxide (EtCO2) noninvasively reflects a real-time estimation of arterial carbon dioxide (PaCO2 [partial pressure of CO2]). However, as the EtCO2 is dependent on metabolism, perfusion, and ventilation, predicting PaCO2 from EtCO2 is not linear. The objective of the study was to find out the predictability of PaCO2 from EtCO2 in PICU and to evaluate the factors affecting the correlation of EtCO2 and PaCO2 in critically ill ventilated children. The design involved was prospective observational study. The setting discussed over here is that of pediatric intensive care unit (PICU) of tertiary care hospital. A total of 160 children between 1 month and 14 years received mechanical ventilation. EtCO2, PaCO2, PaO2/FiO2 (PF) ratio, oxygenation index (OI), and ventilation index (VI) are the factors involved in main outcome measures. A total of 535 pairs of EtCO2 and PaCO2 were recorded in 160 ventilated children during the stable hemodynamic state. Mean age and weight (Z-score) of patients were 31.15 ± 40.46 months and −2.10 ± 1.58, respectively. EtCO2 and PaCO2 differences were normal (2–5 mm of Hg) in 393 (73.5%) pairs. High gradient (>5 mm of Hg) was mostly found with children with pneumonia, prolonged ventilation, and pressure mode of ventilation (p < 0.05). EtCO2 had a strong positive correlation with PaCO2 (r = 0.723, 95% confidence interval [CI] = 0.68 and 0.76) and not significantly affected by PF ratio or OI. However, presence of pneumonia and high ventilation index (VI > 20) adversely affected the relationship with poor correlation coefficient (r = 0.449, 95% CI = 0.30, 0.58 and r = 0.227, 95% CI = 0.03, 0.41, respectively). EtCO2 reading showed good validity to predict PaCO2 and not affected by oxygenation parameters. The correlation was affected by the presence of pneumonia and high ventilation index; hence it is recommended to monitor PaCO2 invasively in these patients till a good correlation is established.
Diagnostic Accuracy in Acute Venous Thromboembolism: Comparing D-Dimer, Thrombin Generation, Overall Hemostatic Potential, and Fibrin Monomers
Authors: Farm Maria , Antovic Aleksandra , Schmidt David E. , Bark Niklas , Soutari Nida , Siddiqui Anwar J. , Holmström Margareta , Pruner Iva , Antovic Jovan P.
Published: August 2020

Introduction For acute venous thromboembolism (VTE), a biomarker with higher specificity than D-dimer would be of great clinical use. Thrombin generation and overall hemostatic potential (OHP) reflect the hemostatic balance by globally assessing multiple coagulation factors and inhibitors. These tests discriminate between healthy controls and patients with a prothrombotic tendency but have yet to be established as clinical biomarkers of VTE.

Objective This study compares endogenous thrombin potential (ETP) and OHP to D-dimer and fibrin monomers (FM) in outpatients with suspected VTE.

Methods A cross-sectional diagnostic study where 954 patients with suspected pulmonary embolism or deep venous thrombosis were recruited consecutively from the medical emergency department at Karolinska University Hospital. D-dimer, FM, OHP, and ETP were analyzed in a subpopulation of 60 patients with VTE and 98 matched controls without VTE. VTE was verified either by ultrasonography or computed tomography and clinical data were collected from medical records.

Results Compared with healthy controls, both VTE and non-VTE patients displayed prothrombotic profiles in OHP and ETP. D-dimer, FM, ETP area under the curve (AUC), and ETP Tlag were significantly different between patients with VTE and non-VTE. The largest receiver-operating characteristic AUCs for discrimination between VTE and non-VTE, were found in D-dimer with 0.94, FM 0.77, and ETP AUC 0.65. No useful cutoff could be identified for the ETP or the OHP assay.

Conclusion Compared with D-dimer, neither ETP nor OHP were clinically viable biomarkers of acute venous thrombosis. The data indicated that a large portion of the emergency patients with suspected VTE were in a prothrombotic state.
Stiff-Person Syndrome Outpatient Rehabilitation: Case Report
Authors: Khan Fayaz , Chevidikunnan Mohamed Faisal , Almalki Raghad Ahmad , Mirdad Mawada Khaled , Nimatallah Khadeeja Abdulaziz , Al-Zahrani Shahad , Alshareef Aysha Abdulmalek
Published: August 2020

Stiff-person syndrome (SPS) is a rare neurological disorder that causes muscle rigidity and stiffness of the trunk and proximal limb muscles, leading to movement difficulties and impaired function. Due to the rarity of the disease, studies on the benefit of rehabilitation for this disorder are quite limited. A 46-year-old female patient diagnosed with SPS complained of imbalance and movement difficulty. We prescribed therapeutic exercises aimed to reduce the stiffness of the trunk and proximal limbs and improve her function. Baseline measurement of the patient's range of motion, muscle power and tone, balance and functional abilities were taken pre- and post-program. Outcome measures showed a general improvement in the patient's muscle flexibility, balance, and functionality.
Neurodevelopmental Impairment As the Main Phenotypic Hallmark Associated with the Translocation t(7;10)(7p22.3;q26.11)
Authors: Mastrangelo Mario , Torres Barbara , De Vita Gloria , Goldoni Marina , De Giorgi Agnese , Bernardini Laura , Leuzzi Vincenzo
Published: August 2020

Reported here is a novel patient carrying an unbalanced t (10q26.11-q26.3; 7p22.3) and presenting with a severe intellectual disability with autistic features, abnormalities of muscle tone, and a drug-responsive epilepsy. The prominence of neurological and neurodevelopmental abnormalities in the clinical phenotype highlights a possible pathogenic role for different genes in the involved regions. Hypothetical mechanisms may include a possible gene dosage effect for DOCK1 and/or haploinsufficiency of PRKAR1B SUN1, ADAP1, and GPER1.
A Case of Right Apogeotropic Posterior Semicircular Canal BPPV that Initially Emulated as Left Anterior Semicircular Canal BPPV
Authors: Vats Ajay Kumar , Kothari Sudhir , Biswas Anirban
Published: August 2020

In any patient with a history of rotational vertigo triggered by changes in the position of head relative to the gravity, whose oculomotor patterns elicit a positional downbeating nystagmus (p-DBN), the localization could be either central in the brainstem, midline cerebellum, or at the craniocerebral junction; or else peripheral due to one of the rare variants of benign paroxysmal positional vertigo of vertical semicircular canals. Most serious causes of central vertigo in patients with p-DBN can be diagnosed by magnetic resonance imaging of the posterior fossa and craniovertebral junction. However, the peripheral p-DBN could be either due to anterior semicircular canal benign paroxysmal positional vertigo (ASC-BPPV) or a recently described apogeotropic variant of posterior semicircular canal BPPV (apo-PSC-BPPV) and the two are almost impossible to differentiate initially. The usual clinical scenario in apo-PSC-BPPV is diagnosing it initially as ASC-BPPV. However, following diagnostic or therapeutic positioning maneuvers for the purported ASC-BPPV, the positional oculomotor pattern changes to an upbeating nystagmus with the reversal in the direction of the torsion as well, localizing it to the contralateral PSC with respect to the ASC initially diagnosed. The initial oculomotor pattern observed on the right Dix–Hallpike test in this patient, of a short latency downbeating left torsional (from the patient’s perspective) positional nystagmus suggested a diagnosis of left ASC-BPPV, which was accordingly treated with multiple sessions of reverse Epley maneuvers daily for a week. At the end of the week, a verifying right Dix–Hallpike test elicited an upbeating right torsional (from the patient’s perspective) positional nystagmus. It is extremely unlikely that this patient had resolution of her initial left ASC-BPPV with the daily sessions of reverse Epley maneuvers carried over a week and immediately suffered from commoner geotropic variant of the right PSC-BPPV (geo-PSC-BPPV). It is plausible to interpret that this patient suffered from the right apo-PSC-BPPV from the very outset, and the reverse Epley maneuver performed for the ostensive left ASC-BPPV led to an intracanal shift of otoconial debris from its nonampullary to the ampullary arm resulting in right geo-PSC-BPPV. The reasons why situations like this outwit the clinician resulting in inaccurate localization as well as lateralization is discussed. The patient was successfully treated with right Epley maneuver after transformation to geo-PSC-BPPV and was asymptomatic at follow-up for 4 weeks. A peripheral p-DBN with torsional component in any patient with a history of positionally triggered vertigo can be either ASC-BPPV or apo-PSC-BPPV. A very close follow-up at a short interval of time with meticulously executed positional tests is the only definitive way to differentiate the two conditions.
Bone Cement Cranioplasty Reduces Cerebrospinal Fluid Leak Rate after Microvascular Decompression: A Single-Institutional Experience
Authors: Wolfson Daniel I. , Magarik Jordan A. , Godil Saniya S. , Shah Hamid M. , Neimat Joseph S. , Konrad Peter E. , Englot Dario J.
Published: August 2020

Background Microvascular decompression (MVD) is a common surgical treatment for cranial nerve compression, though cerebrospinal fluid (CSF) leak is a known complication of this procedure. Bone cement cranioplasty may reduce rates of CSF leak.

Objective To compare rates of CSF leak before and after implementation of bone cement cranioplasty for the reconstruction of cranial defects after MVD.

Methods Retrospective chart review was performed of patients who underwent MVD through retrosigmoid craniectomy for cranial nerve compression at a single institution from 1998 to 2017. Study variables included patient demographics, medical history, type of closure, and postoperative complications such as CSF leak, meningitis, lumbar drain placement, and ventriculoperitoneal shunt insertion. Cement and noncement closure groups were compared, and predictors of CSF leak were assessed using a multivariate logistic regression model.

Results A total of 547 patients treated by 10 neurosurgeons were followed up for more than 20 years, of whom 288 (52.7%) received cement cranioplasty and 259 (47.3%) did not. Baseline comorbidities were not significantly different between groups. CSF leak rate was significantly lower in the cement group than in the noncement group (4.5 vs. 14.3%; p < 0.001). This was associated with significantly fewer patients developing postoperative meningitis (0.7 vs. 5.2%; p = 0.003). Multiple logistic regression model demonstrated noncement closure as the only independent predictor of CSF leak (odds ratio: 3.55; 95% CI: 1.78–7.06; p < 0.001).

Conclusion CSF leak is a well-known complication after MVD. Bone cement cranioplasty significantly reduces the incidence of postoperative CSF leak and other complications. Modifiable risk factors such as body mass index were not associated with the development of CSF leak.