bluuebunny/crossref_metadata_2025 huggingface dataset:
How Does Seasonal Forecast Performance Influence Decision-Making? Insights from a Serious Game
Authors: Crochemore Louise , Cantone Carolina , Pechlivanidis Ilias G. , Photiadou Christiana S.
Published: May 2021

In a context that fosters the evolution of hydroclimate services, it is crucial to support and train users in making the best possible forecast-based decisions. Here, we analyze how decision-making is influenced by the seasonal forecast performance based on the Call For Water serious game in which participants manage a water supply reservoir. The aim is twofold: 1) train participants in the concepts of forecast sharpness and reliability, and 2) collect participants’ decisions to investigate the levels of forecast sharpness and reliability needed to make informed decisions. In the first game round, participants are provided with forecasts of varying reliability and sharpness, while in the second round, they have the possibility to pay for systematically reliable and sharp forecasts (improved forecasts). Exploitable answers were collected from 367 participants, predominantly researchers, forecasters, and consultants in the water resources and energy sectors. Results show that improved forecasts led to better decisions, enabling participants to step out of purely conservative strategies and successfully take risks. Reliability levels of 60% are necessary for decision-making while both reliability levels above 70% and sharpness are required for informed risk-prone strategies. Improved forecasts are judged more valuable in extreme years, for instance, when hedging against water shortage risks. Additionally, participants working in the energy, air quality, and agriculture sectors, as well as traders, decision-makers, and forecasters, invested the most in forecasts. Finally, we discuss the potential of serious games to foster capacity development in hydroclimate services and provide recommendations for forecast-based service development.
Emergent Constraints on the Large-Scale Atmospheric Circulation and Regional Hydroclimate: Do They Still Work in CMIP6 and How Much Can They Actually Constrain the Future?
Authors: Simpson Isla R. , McKinnon Karen A. , Davenport Frances V. , Tingley Martin , Lehner Flavio , Al Fahad Abdullah , Chen Di
Published: May 2021

An emergent constraint (EC) is a statistical relationship, across a model ensemble, between a measurable aspect of the present-day climate (the predictor) and an aspect of future projected climate change (the predictand). If such a relationship is robust and understood, it may provide constrained projections for the real world. Here, models from phase 6 of the Coupled Model Intercomparison Project (CMIP6) are used to revisit several ECs that were proposed in prior model intercomparisons with two aims: 1) to assess whether these ECs survive the partial out-of-sample test of CMIP6 and 2) to more rigorously quantify the constrained projected change than previous studies. To achieve the latter, methods are proposed whereby uncertainties can be appropriately accounted for, including the influence of internal variability, uncertainty on the linear relationship, and the uncertainty associated with model structural differences, aside from those described by the EC. Both least squares regression and a Bayesian hierarchical model are used. Three ECs are assessed: (i) the relationship between Southern Hemisphere jet latitude and projected jet shift, which is found to be a robust and quantitatively useful constraint on future projections; (ii) the relationship between stationary wave amplitude in the Pacific–North American sector and meridional wind changes over North America (with extensions to hydroclimate), which is found to be robust but improvements in the predictor in CMIP6 result in it no longer substantially constraining projected change in either circulation or hydroclimate; and (iii) the relationship between ENSO teleconnections to California and California precipitation change, which does not appear to be robust when using historical ENSO teleconnections as the predictor.
Data assimilation challenges posed by nonlinear operators: A comparative study of ensemble and variational filters and smoothers
Authors: Kurosawa Kenta , Poterjoy Jonathan
Published: May 2021

The ensemble Kalman Filter (EnKF) and the 4D variational method (4DVar) are the most commonly used filters and smoothers in atmospheric science. These methods typically approximate prior densities using a Gaussian and solve a linear system of equations for the posterior mean and covariance. Therefore, strongly nonlinear model dynamics and measurement operators can lead to bias in posterior estimates. To improve the performance in nonlinear regimes, minimization of the 4DVar cost function typically follows multiple sets of iterations, known as an “outer loop”, which helps reduce bias caused by linear assumptions. Alternatively, “iterative ensemble methods” follow a similar strategy of periodically re-linearizing model and measurement operators. These methods come with different, possibly more appropriate, assumptions for drawing samples from the posterior density, but have seen little attention in numerical weather prediction (NWP) communities. Lastly, particle filters (PFs) present a purely Bayesian filtering approach for state estimation, which avoids many of the assumptions made by the above methods. Several strategies for applying localized PFs for NWP have been proposed very recently. The current study investigates intrinsic limitations of current data assimilation methodology for applications that require nonlinear measurement operators. In doing so, it targets a specific problem that is relevant to the assimilation of remotely-sensed measurements, such as radar reflectivity and all-sky radiances, which pose challenges for Gaussian-based data assimilation systems. This comparison includes multiple data assimilation approaches designed recently for nonlinear/non-Gaussian applications, as well as those currently used for NWP.
Perceptions, barriers, and attitudes toward research among in-training physicians in Saudi Arabia: A multicenter survey
Authors: Saud AlEnazi Abdulaziz , Alamri Abdullah Saeed , AlGhamdi Abdullah Saeed , Almansour Abdulelah Hassan , Rubaian Nouf Faihan Bin , Al-Otaibi Futoon Khaled , Alreshaid Farouk Tawfiq , Saad Alaftan Mohammed , Esam Himdy Ziyad , Makhdom Rawan Abdulrahman , Alshahrani Mohammed
Published: May 2021

The outcomes of patient care are improved by adequate knowledge, practical skills, and positive attitude. Currently, there is a lack of data on medical research activities among resident doctors in Saudi Arabia. This study aimed to evaluate the perception, barriers, and research attitudes among various residency programs running in different cities of Saudi Arabia. A total of 434 surgical and medical residents participated in the current study. A cross-sectional study encompassing multiple training centers in the eastern province of Saudi. Convenient sampling technique was used to include all the working training residents. A self-administered questionnaire was formulated for data collection. Descriptive statistics were employed to analyze the data. The mean age of the residents with various specialties was 27.83 ± 2.41 years. Approximately 61.7% had participated in research, while 38.3% had never participated in any research. A total of 26% of junior and 44% of senior residents have one publication only. While 11% of junior and 9% of senior residents have three publications or more. Inadequate facilities for research, lack of baseline research skills, and personal commitments were the reasons which over 60% of respondents had agreed on. Institutional reasons: lack of professional supervisor support and lack of research curriculum in the training program was reported by 308 (71%) and 305(70.3%) residents, respectively. A lack of interest for research was prevailed more in males (19%) compared to females (14%) (OR 1.43, 95% CI: 0.86–2.38, p-value 0.17). A subset of residents had one or three publications, while some had none. A lack of baseline research skills and inadequate facilities for scientific explorations, time, and funds were the main constraints among training residents. However, several residents had a positive attitude toward research but fewer publications. Thus, training in medical research methodology should be obligatory in the residency curriculum in all specialties. Further research is needed.
Efficacy of High Temporal Frequency Photoacoustic Guidance of Laser Ablation Procedures
Authors: Yan Yan , John Samuel , Meiliute Jurgita , Kabbani Loay , Mehrmohammadi Mohammad
Published: May 2021

Inaccurate placement of the ablation catheter and the inability to monitor the real-time temperature within the tissue of interest such as veins curbs the treatment efficacy of laser ablation procedures during thermal therapies. Our previous studies have validated the efficacy of photoacoustic (PA) imaging during endovenous laser ablation (EVLA) procedures. However, the PA-guided therapies suffer from low temporal resolution, due to the low pulse repetition rates of pulsed lasers, which could cause a problem during fast catheter motion and rapid temperature changes. Herein, to enhance the accuracy and sensitivity for tracking the ablation catheter tip and temperature monitoring, we proposed to develop a high frame rate (500 Hz), combined ultrasound (US), and PA-guided ablation system. The proposed PA-guided ablation system was evaluated in a set of ex vivo tissue studies. The developed system provides a 2 ms temporal resolution for tracking and monitoring the ablation catheter tip’s location and temperature, which is 50 times higher temporal resolution compared to the previously proposed 10 Hz system. The proposed system also provided more accurate feedback about the temperature variations during rapid temperature increments of 10°C per 250 ms. The co-registered US and PA images have an imaging resolution of about 200 μm and a field of view of 45 × 40 mm2. Tracking the ablation catheter tip in an excised tissue layer shows higher accuracy during a relatively fast catheter motion (0.5–3 mm/s). The fast US/PA-guided ablation system will potentially enhance the outcome of ablation procedures by providing location and temperature feedback.
Sonic Metaphors: Music, Sound, and Ecofeminist Theology
Authors: Ursic Elizabeth
Published: May 2021

This article explores the relationship between music and ecofeminist theology and investigates how music and sound can advance the development of ecofeminist thought. On a physical level, the act of breathing connects humankind with the earth’s atmosphere and the element of air produces music and sound. On a theological level, traditional church teachings about the power and danger of music have reflected similar warnings about women and nature. Ecofeminist theologian Sally McFague made a persuasive case for metaphorical theology that supported the arts being included in theological development. Religious Studies scholar Heidi Epstein engaged McFague’s metaphorical theology to develop a feminist theology of music and featured female composers including Hildegard of Bingen. I propose that metaphorical theology and music can also connect through the development of sonic metaphors. Sonic metaphors are created with pitch, rhythm, and sound. While most metaphors rely on the eyes to process written text and visual art, sonic metaphors are processed through the ears and offer different pathways for cognition. Sonic metaphors have been underutilized in theology and they offer potential for exploring theological concepts that can be challenging to comprehend through textual or visual means. These metaphors are particularly applicable for developing ecofeminist theology because sound and music can connect our bodies with nature in illuminating ways. I include examples from my own musical background, and I offer suggestions for non-musicians and ecofeminist theologians who want to incorporate sonic metaphors into their own creative theological reflection.
Molecular Alterations in Pediatric Fibroblastic/Myofibroblastic Tumors: An Appraisal of a Next Generation Sequencing Assay in a Retrospective Single Centre Study
Authors: Slack Jonathan C , Bründler Marie-Anne , Nohr Erik , McIntyre John B , Kurek Kyle C
Published: May 2021

Background

Pediatric fibroblastic/myofibroblastic tumors (PFMTs) can be challenging to definitively classify. Large case series or diagnostic updates have not been recently published despite identification of molecular alterations that could improve diagnostic accuracy. Our review of the literature found that over two-thirds of the more than 30 types of PFMTs harbor recurrent molecular alterations. We performed an institutional review of PFMTs to highlight limitations of a predominantly morphological classification, and evaluated the utility of a next-generation sequencing assay to aid diagnosis.

Methods

PFMTs identified over a period of 12 years were reviewed, categorized per the new WHO classification, and tested using the Oncomine Childhood Cancer Research Assay.

Results

Eighty-seven specimens from 58 patients were reviewed; 50 were chosen for molecular analysis, 16 (32%) lacking definitive classification. We identified alterations, some novel, in 33% of assayed cases. Expected alterations were identified for most known diagnoses and mutations were identified in 6 of 16 tumors (38%) that were initially unclassified.

Conclusion

We confirmed a significant subset of PFMTs remain difficult to classify using current criteria, and that a combined DNA/RNA assay can identify alterations in many of these cases, improving diagnostic certainty and suggesting a clinical utility for challenging cases.
Application of OSNA Nomogram in Patients With Macrometastatic Sentinel Lymph Node: A Retrospective Assessment of Accuracy
Authors: Combi Francesca , Andreotti Alessia , Gambini Anna , Palma Enza , Papi Simona , Biroli Alice , Zaccarelli Stefania , Ficarra Guido , Tazzioli Giovanni
Published: May 2021

Introduction:

Almost 50% to 70% of patients who undergo axillary lymph node dissection (ALND) because of a single metastatic sentinel lymph node (SLN) have no further metastatic nodes at the axillary histology. On these grounds, the one-step nucleic acid amplification (OSNA) nomogram was designed and validated. As a mathematical model, calculated through tumor size (expressed in millimeters) and CK19 mRNA copy number, it is thought to predict nonsentinel lymph node (NSLN) status. The aim of the study is to verify the diagnostic accuracy of the OSNA nomogram in a group of patients with macrometastatic SLN, with a retrospective analysis.

Methods:

The OSNA nomogram was retrospectively applied to a group of 66 patients with macrometastatic SLN who underwent ALND. The result of the final histology of the axillary cavity was compared to the nomogram prediction. We calculated the prevalence of NSLN metastasis in patients who underwent ALND, sensitivity and specificity, negative and positive predictive value of the nomogram.

Results:

In patients with macrometastasis in SLN, the prevalence of patients with metastatic NSLN was 45%. The sensitivity of the nomogram was excellent (90%). The specificity was low (36%). Positive predictive value amounted to 54%, while negative predictive value was good (81%).

Conclusions:

These results suggest that the OSNA nomogram is a valid instrument that can help choose the best surgical strategy for the treatment of axillary cavity. The mathematical model is useful to avoid surgery in a selected group of patients because it accurately predicts NSLN status.
Patient Feedback Systems at the Primary Level of Health Care Centres in Bangladesh: A Mixed Methods Study
Authors: Huque Rumana , Al Azdi Zunayed , Ebenso Bassey , Nasreen Shammi , Chowdhury Ayesha Afroz , Elsey Helen , Mirzoev Tolib
Published: May 2021

This paper documents, and reflects on key strengths and weaknesses of, existing patient feedback management systems at primary health care in Bangladesh and proposes key implications for future policy and practice. A mixed-method study was conducted in two Upazila (sub-district) Health Complexes (UHC) within one district in Bangladesh. It reports qualitative data from thematic analysis of in-depth interviews ( n = 15) with key stakeholders; non-participant observations of feedback environment at UHCs; document review; and a stakeholder workshop. Patient feedback data from publicly available web portals were also analyzed. Multiple parallel patient feedback systems exist at health facilities. Key strengths across all systems included common goals of ensuring accountability and patient voice and high-level commitment. Common weaknesses included lack of documented processes, limited awareness of available channels among patients and a lack of documented actions following feedback. The findings helped to provide a few implications for future policy and practice on patient feedback management.
Shoulder Arthroscopy Simulator Training Improves Surgical Procedure Performance: A Controlled Laboratory Study
Authors: Hauschild Jordan , Rivera Jessica C. , Johnson Anthony E. , Burns Travis C. , Roach Christopher J.
Published: May 2021

Background:

Previous simulation studies evaluated either dry lab (DL) or virtual reality (VR) simulation, correlating simulator training with the performance of arthroscopic tasks. However, these studies did not compare simulation training with specific surgical procedures.

Purpose/Hypothesis:

To determine the effectiveness of a shoulder arthroscopy simulator program in improving performance during arthroscopic anterior labral repair. It was hypothesized that both DL and VR simulation methods would improve procedure performance; however, VR simulation would be more effective based on the validated Arthroscopic Surgery Skill Evaluation Tool (ASSET) Global Rating Scale.

Study Design:

Controlled laboratory study.

Methods:

Enrolled in the study were 38 orthopaedic residents at a single institution, postgraduate years (PGYs) 1 to 5. Each resident completed a pretest shoulder stabilization procedure on a cadaveric model and was then randomized into 1 of 2 groups: VR or DL simulation. Participants then underwent a 4-week arthroscopy simulation program and completed a posttest. Sports medicine–trained orthopaedic surgeons graded the participants on completeness of the surgical repair at the time of the procedure, and a single, blinded orthopaedic surgeon, using the ASSET Global Rating Scale, graded participants’ arthroscopy skills. The procedure step and ASSET grades were compared between simulator groups and between PGYs using paired t tests.

Results:

There was no significant difference between the groups in pretest performance in either the procedural steps or ASSET scores. Overall procedural step scores improved after combining both types of simulator training ( P = .0424) but not in the individual simulation groups. The ASSET scores improved across both DL ( P = .0045) and VR ( P = .0003), with no significant difference between the groups.

Conclusion:

A 4-week simulation program can improve arthroscopic skills and performance during a specific surgical procedure. This study provides additional evidence regarding the benefits of simulator training in orthopaedic surgery for both novice and experienced arthroscopic surgeons. There was no statistically significant difference between the VR and DL models, which disproved the authors’ hypothesis that the VR simulator would be the more effective simulation tool.

Clinical Relevance:

There may be a role for simulator training in the teaching of arthroscopic skills and learning of specific surgical procedures.
Episodes of fissure formation in the Alps: connecting quartz fluid inclusion, fissure monazite age, and fissure orientation data
Authors: Gnos Edwin , Mullis Josef , Ricchi Emmanuelle , Bergemann Christian A. , Janots Emilie , Berger Alfons
Published: May 2021

Fluid assisted Alpine fissure-vein and cleft formation starts at prograde, peak or retrograde metamorphic conditions of 450–550 °C and 0.3–0.6 GPa and below, commonly at conditions of ductile to brittle rock deformation. Early-formed fissures become overprinted by subsequent deformation, locally leading to a reorientation. Deformation that follows fissure formation initiates a cycle of dissolution, dissolution/reprecipitation or new growth of fissure minerals enclosing fluid inclusions. Although fissures in upper greenschist and amphibolite facies rocks predominantly form under retrograde metamorphic conditions, this work confirms that the carbon dioxide fluid zone correlates with regions of highest grade Alpine metamorphism, suggesting carbon dioxide production by prograde devolatilization reactions and rock-buffering of the fissure-filling fluid. For this reason, fluid composition zones systematically change in metamorphosed and exhumed nappe stacks from diagenetic to amphibolite facies metamorphic rocks from saline fluids dominated by higher hydrocarbons, methane, water and carbon dioxide. Open fissures are in most cases oriented roughly perpendicular to the foliation and lineation of the host rock. The type of fluid constrains the habit of the very frequently crystallizing quartz crystals. Open fissures also form in association with more localized strike-slip faults and are oriented perpendicular to the faults. The combination of fissure orientation, fissure quartz fluid inclusion and fissure monazite-(Ce) (hereafter monazite) Th–Pb ages shows that fissure formation occurred episodically (1) during the Cretaceous (eo-Alpine) deformation cycle in association with exhumation of the Austroalpine Koralpe-Saualpe region (~ 90 Ma) and subsequent extensional movements in association with the formation of the Gosau basins (~ 90–70 Ma), (2) during rapid exhumation of high-pressure overprinted Briançonnais and Piemontais units (36–30 Ma), (3) during unroofing of the Tauern and Lepontine metamorphic domes, during emplacement and reverse faulting of the external Massifs (25–12 Ma; except Argentera) and due to local dextral strike-slip faulting in association with the opening of the Ligurian sea, and (4) during the development of a young, widespread network of ductile to brittle strike-slip faults (12–5 Ma).
Association between suicidal risks and medication-overuse headache in chronic migraine: a cross-sectional study
Authors: Wang Yen-Feng , Yu Chia-Chun , Kuan Ai Seon , Chen Shih-Pin , Wang Shuu-Jiun
Published: May 2021

Background

Behaviors of substance dependence are common among patients with medication-overuse headache (MOH). Whether MOH, like other substance use disorders, is associated with an increased risk for suicide is unknown.

Methods

In this cross-sectional study, newly diagnosed chronic migraine (CM) patients with or without coexisting MOH were enrolled prospectively. Headache diagnoses were made through face-to-face interviews by headache specialists, and a specifically designed questionnaire was used to collect demographics, headache profiles, Migraine Disability Assessment, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, etc. Suicidal ideation and prior suicide attempt were specifically questioned.

Results

In total, 603 CM patients (485F/118M, mean age 42.03 ± 12.18 years) were recruited, including 320 with MOH (257F/63M, mean age 42.8 ± 11.7 years) (53.1%), and 214 (35.5%) and 81 (13.4%) had suicidal ideation and prior suicide attempt, respectively. Among CM patients, the presence of MOH increased the risks of suicidal ideation (odds ratio [OR] = 1.75 [95% CI = 1.20–2.56], p = 0.004) and prior suicide attempt (OR = 1.88 [1.09–3.24], p = 0.024), after controlling for demographics, headache profile, disabilities, symptoms of anxiety and depression, and sleep quality.

Conclusions

In CM patients, MOH is associated with an increased risk for suicidal ideation and prior suicide attempt, which deserves attention for clinicians taking care of headache patients. However, further studies are needed to determine the causal relationship, as well as the underlying pathophysiology.
DR2S: an integrated algorithm providing reference-grade haplotype sequences from heterozygous samples
Authors: Klasberg Steffen , Schmidt Alexander H. , Lange Vinzenz , Schöfl Gerhard
Published: May 2021

Background

High resolution HLA genotyping of donors and recipients is a crucially important prerequisite for haematopoetic stem-cell transplantation and relies heavily on the quality and completeness of immunogenetic reference sequence databases of allelic variation.

Results

Here, we report on , an R package that leverages the strengths of two sequencing technologies—the accuracy of next-generation sequencing with the read length of third-generation sequencing technologies like PacBio’s SMRT sequencing or ONT’s nanopore sequencing—to reconstruct fully-phased high-quality full-length haplotype sequences. Although optimised for HLA and KIR genes, is applicable to all loci with known reference sequences provided that full-length sequencing data is available for analysis. In addition, integrates supporting tools for easy visualisation and quality control of the reconstructed haplotype to ensure suitability for submission to public allele databases.

Conclusions

is a largely automated workflow designed to create high-quality fully-phased reference allele sequences for highly polymorphic gene regions such as HLA or KIR. It has been used by biologists to successfully characterise and submit more than 500 HLA alleles and more than 500 KIR alleles to the IPD-IMGT/HLA and IPD-KIR databases.
Identification of the conserved long non-coding RNAs in myogenesis
Authors: Bhattacharya Anupam , Champramary Simang , Tripathi Tanya , Thakur Debajit , Ioshikhes Ilya , Singh Satyendra Kumar , Nandi Soumyadeep
Published: May 2021

Background

Our understanding of genome regulation is ever-evolving with the continuous discovery of new modes of gene regulation, and transcriptomic studies of mammalian genomes have revealed the presence of a considerable population of non-coding RNA molecules among the transcripts expressed. One such non-coding RNA molecule is long non-coding RNA (lncRNA). However, the function of lncRNAs in gene regulation is not well understood; moreover, finding conserved lncRNA across species is a challenging task. Therefore, we propose a novel approach to identify conserved lncRNAs and functionally annotate these molecules.

Results

In this study, we exploited existing myogenic transcriptome data and identified conserved lncRNAs in mice and humans. We identified the lncRNAs expressing differentially between the early and later stages of muscle development. Differential expression of these lncRNAs was confirmed experimentally in cultured mouse muscle C2C12 cells. We utilized the three-dimensional architecture of the genome and identified topologically associated domains for these lncRNAs. Additionally, we correlated the expression of genes in domains for functional annotation of these trans-lncRNAs in myogenesis. Using this approach, we identified conserved lncRNAs in myogenesis and functionally annotated them.

Conclusions

With this novel approach, we identified the conserved lncRNAs in myogenesis in humans and mice and functionally annotated them. The method identified a large number of lncRNAs are involved in myogenesis. Further studies are required to investigate the reason for the conservation of the lncRNAs in human and mouse while their sequences are dissimilar. Our approach can be used to identify novel lncRNAs conserved in different species and functionally annotated them.
Variations in volume of emergency surgeries and emergency department access at a third level hospital in Milan, Lombardy, during the COVID-19 outbreak
Authors: Castoldi Laura , Solbiati Monica , Costantino Giorgio , Casiraghi Elena
Published: May 2021

Background

During the recent outbreak of COVID-19 (coronavirus disease 2019), Lombardy was the most affected region in Italy, with 87,000 patients and 15,876 deaths up to May 26, 2020. Since February 22, 2020, well before the Government declared a state of emergency, there was a huge reduction in the number of emergency surgeries performed at hospitals in Lombardy. A general decrease in attendance at emergency departments (EDs) was also observed. The aim of our study is to report the experience of the ED of a third-level hospital in downtown Milan, Lombardy, and provide possible explanations for the observed phenomena.

Methods

This retrospective, observational study assessed the volume of emergency surgeries and attendance at an ED during the course of the pandemic, i.e. immediately before, during and after a progressive community lockdown in response to the COVID-19 pandemic. These data were compared with data from the same time periods in 2019. The results are presented as means, standard error (SE), and 95% studentized confidence intervals (CI). The Wilcoxon rank signed test at a 0.05 significance level was used to assess differences in per-day ED access distributions.

Results

Compared to 2019, a significant overall drop in emergency surgeries (60%, p < 0.002) and in ED admittance (66%, p ≅ 0) was observed in 2020. In particular, there were significant decreases in medical (40%), surgical (74%), specialist (ophthalmology, otolaryngology, traumatology, and urology) (92%), and psychiatric (60%) cases. ED admittance due to domestic violence (59%) and individuals who left the ED without being seen (76%) also decreased. Conversely, the number of deaths increased by 196%.

Conclusions

During the COVID-19 outbreak the volume of urgent surgeries and patients accessing our ED dropped. Currently, it is not known if mortality of people who did not seek care increased during the pandemic. Further studies are needed to understand if such reductions during the COVID-19 pandemic will result in a rebound of patients left untreated or in unwanted consequences for population health.
Measurement of fasting breath hydrogen concentration as a simple diagnostic method for pancreatic exocrine insufficiency
Authors: Uetsuki Kota , Kawashima Hiroki , Ohno Eizaburo , Ishikawa Takuya , Iida Tadashi , Yamamoto Kenta , Furukawa Kazuhiro , Nakamura Masanao , Honda Takashi , Ishigami Masatoshi , Hirooka Yoshiki , Fujishiro Mitsuhiro
Published: May 2021

Background

Pancreatic exocrine insufficiency (PEI) is associated with the outcome of pancreatic disease. However, there is no method for assessing PEI that can be used noninvasively and easily for outpatient. It has been reported that changes in intestinal bacteria caused by PEI may increase breath hydrogen concentration (BHC) levels during glucose or lactose loading. We have evaluated the usefulness of fasting breath hydrogen concentration (FBHC) measurement without glucose loading for the evaluation of PEI.

Methods

Sixty patients underwent FBHC measurement, BT-PABA testing, and microbiome analysis. They were classified into PEI group (PABA excretion rate < 73.4%, n = 30) and non-PEI group (n = 30). The FBHC of the two groups were compared, and the diagnostic ability of PEI by them was evaluated. The 16 s rRNA (V3–V4) from fecal samples was analyzed by MiSeq.

Results

FBHC levels was higher in the PEI group 15.70 (1.4 to 77.0) ppm than in the non-PEI group 2.80 (0.7 to 28.2) ppm (P < 0.0001). FBHC was negatively correlated with PABA excretion rate (r =  − 0.523, P < 0.001). The cutoff value of FBHC of 10.7 ppm (95% CI: 0.678–0.913, P < 0.001) showed a sensitivity of 73.3% and specificity of 83.3% for PEI diagnosis. In the PEI group, there was a significant increase of relative abundance of phylum Firmicutes (P < 0.05) and the genus Clostridium (P < 0.05).

Conclusion

FBHC shows good potential as a simple and repeatable test for the diagnosis of PEI. The elevated FBHC levels may be caused by hydrogen-producing bacteria such as Clostridium.
Prevalence of and risk factors for metabolic associated fatty liver disease in an urban population in China: a cross-sectional comparative study
Authors: Chen Yu-ling , Li Hao , Li Shu , Xu Zhou , Tian Shen , Wu Juan , Liang Xin-yu , Li Xin , Liu Zi-li , Xiao Jun , Wei Jia-ying , Ma Chen-yu , Wu Kai-nan , Ran Liang , Kong Ling-quan
Published: May 2021

Background

Metabolic associated fatty liver disease (MAFLD) is a new definition for liver disease associated with known metabolic dysfunction. Based on new diagnostic criteria, we aimed to investigate its prevalence and risk factors in Chinese population.

Methods

We conducted this study in a health examination population who underwent abdominal ultrasonography in China. The diagnosis of MAFLD was based on the new diagnostic criteria. The characteristics of the MAFLD population, as well as the associations between MAFLD and metabolic abnormalities, were explored. Mann–Whitney U test and chi-square test were performed to compare different variables. Binary logistic regression was used to determine the risk factors for MAFLD.

Results

Among 139,170 subjects, the prevalence of MAFLD was 26.1% (males: 35.4%; females: 14.1%). The prevalence based on female menopausal status, that is, premenopausal, perimenopausal, and postmenopausal, was 6.1%, 16.8%, and 30.2%, respectively. In different BMI groups (underweight, normal, overweight and obese), the prevalence was 0.1%, 4.0%, 27.4% and 59.8%, respectively. The proportions of abnormal metabolic features in the MAFLD group were significantly higher than those in the non-MAFLD group, as was the proportion of elevated alanine aminotransferase (ALT) (42.5% vs. 11%, P < 0.001). In nonobese individuals with MAFLD, the proportions of abnormal metabolic features were also all significantly higher than those in nonobese individuals without MAFLD. The prevalence of metabolic syndrome (MS), dyslipidaemia, and hyperuricaemia, respectively, in the MAFLD group (53.2%, 80.0%, and 45.0%) was significantly higher than that in the non-MAFLD group (10.1%, 41.7%, and 16.8%). Logistic regression revealed that age, BMI, waist circumference, ALT, triglycerides, fasting glucose, uric acid and platelet count were associated with MAFLD.

Conclusions

MAFLD is prevalent in China and varies considerably among different age, sex, BMI, and female menopausal status groups. MAFLD is related to metabolic disorders, especially obesity, while metabolic disorders also play important roles in the occurrence of MAFLD in nonobese individuals. MAFLD patients exhibit a high prevalence of MS, dyslipidaemia, hyperuricaemia, and elevated liver enzymes. MAFLD tends to coexist with systemic metabolic disorders, and a deep inner relationship may exist between MAFLD and MS. Metabolic disorders should be considered to improve the management of MAFLD.
Normalization of γ-glutamyl transferase levels is associated with better metabolic control in individuals with nonalcoholic fatty liver disease
Authors: Ma Qianqian , Liao Xianhua , Shao Congxiang , Lin Yansong , Wu Tingfeng , Sun Yanhong , Feng Shi-Ting , Ye Junzhao , Zhong Bihui
Published: May 2021

Background

The normalization of liver biochemical parameters usually reflects the histological response to treatment for nonalcoholic fatty liver disease (NAFLD). Researchers have not clearly determined whether different liver enzymes exhibit various metabolic changes during the follow-up period in patients with NAFLD.

Methods

We performed a retrospective analysis of patients with NAFLD who were receiving therapy from January 2011 to December 2019. Metabolism indexes, including glucose levels, lipid profiles, uric acid levels and liver biochemical parameters, were measured. Magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) and liver ultrasound were used to evaluate steatosis. All patients received recommendations for lifestyle modifications and guideline-recommended pharmacological treatments with indications for drug therapy for metabolic abnormalities.

Results

Overall, 1048 patients with NAFLD were included and received lifestyle modification recommendations and pharmaceutical interventions, including 637 (60.7%) patients with abnormal GGT levels and 767 (73.2%) patients with abnormal ALT levels. Patients with concurrent ALT and GGT abnormalities presented higher levels of metabolism indexes and higher liver fat content than those in patients with single or no abnormalities. After 12 months of follow-up, the cumulative normalization rate of GGT was considerably lower than that of ALT (38% vs. 62%, P < 0.001). Greater weight loss resulted in higher cumulative normalization rates of GGT and ALT. Weight loss (OR = 1.21, 95% CI 1.11–1.32, P < 0.001), ALT normalization (OR = 2.75, 95% CI 1.41–5.36, P = 0.01) and lower TG and HOMA-IR values (OR = 2.03, 95% CI 1.11–3.71, P = 0.02; OR = 2.04, 95% CI 1.07–3.89, P = 0.03) were independent protective factors for GGT normalization. Elevated baseline GGT (OR = 0.99, 95% CI 0.98–0.99, P = 0.01) was a risk factor.

Conclusions

For NAFLD patients with concurrently increased ALT and GGT levels, a lower normalization rate of GGT was observed, rather than ALT. Good control of weight and insulin resistance was a reliable predictor of GGT normalization.
Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey of women in Switzerland
Authors: Oelhafen Stephan , Trachsel Manuel , Monteverde Settimio , Raio Luigi , Cignacco Eva
Published: May 2021

Background

In many countries, the increase in facility births is accompanied by a high rate of obstetric interventions. Lower birthrates or elevated risk factors such as women’s higher age at childbirth and an increased need for control and security cannot entirely explain this rise in obstetric interventions. Another possible factor is that women are coerced to agree to interventions, but the prevalence of coercive interventions in Switzerland is unknown.

Methods

In a nationwide cross-sectional online survey, we assessed the prevalence of informal coercion during childbirth, women’s satisfaction with childbirth, and the prevalence of women at risk of postpartum depression. Women aged 18 years or older who had given birth in Switzerland within the previous 12 months were recruited online through Facebook ads or through various offline channels. We used multivariable logistic regression to estimate the risk ratios associated with multiple individual and contextual factors.

Results

In total, 6054 women completed the questionnaire (a dropout rate of 16.2%). An estimated 26.7% of women experienced some form of informal coercion during childbirth. As compared to vaginal delivery, cesarean section (CS) and instrumental vaginal birth were associated with an increased risk of informal coercion (planned CS risk ratio [RR]: 1.52, 95% confidence interval [1.18,1.96]; unplanned CS RR: 1.92 [1.61,2.28]; emergency CS RR: 2.10 [1.71,2.58]; instrumental vaginal birth RR: 2.17 [1.85,2.55]). Additionally, migrant women (RR: 1.45 [1.26,1.66]) and women for whom a self-determined vaginal birth was more important (RR: 1.15 [1.06,1.24]) more often reported informal coercion. Emergency cesarean section (RR: 1.32 [1.08,1.62]), being transferred to hospital (RR: 1.33 [1.11,1.60]), and experiencing informal coercion (RR: 1.35 [1.19,1.54]) were all associated with a higher risk of postpartum depression. Finally, women who had a non-instrumental vaginal birth reported higher satisfaction with childbirth while women who experienced informal coercion reported lower satisfaction.

Conclusions

One in four women experience informal coercion during childbirth, and this experience is associated with a higher risk of postpartum depression and lower satisfaction with childbirth. To prevent traumatic after-effects, health care professionals should make every effort to prevent informal coercion and to ensure sensitive aftercare for all new mothers.
Development and validation of a survival nomogram for patients with Siewert type II/III adenocarcinoma of the esophagogastric junction based on real-world data
Authors: Chen Jian , Xia Yu-Jian , Liu Tian-Yu , Lai Yuan-Hui , Yu Ji-Shang , Zhang Tian-Hao , Ooi Shiyin , He Yu-Long
Published: May 2021

Background

The clinical staging systems for adenocarcinoma of the esophagogastric junction (AEG) are controversial. We aimed to propose a prognostic nomogram based on real-world data for predicting survival of Siewert type II/III AEG patients after surgery.

Methods

A total of 396 patients with Siewert type II/III AEG diagnosed and treated at the Center for Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-sen University, from June 2009 to June 2017 were enrolled. The original data of 29 variables were exported from the electronic medical records system. The nomogram was established based on multivariate Cox regression coefficients, and its performance was measured using Harrell’s concordance index (C-index), receiver operating characteristic (ROC) curve analysis and calibration curve.

Results

A nomogram was constructed based on nine variables. The C-index for overall survival (OS) prediction was 0.76 (95% CI, 0.72 to 0.80) in the training cohort, in the validation-1 cohort was 0.79 (95% CI, 0.72 to 0.86), and 0.73 (95% CI, 0.67 to 0.80) in the validation-2 cohort. Time-dependent ROC curves and calibration curves in all three cohorts showed good prognostic predictive accuracy. We further proved the superiority of the nomogram in predictive accuracy for OS to pathological TNM (pTNM) staging system and other independent prognostic factors. Kaplan-Meier survival curves demonstrated the pTNM stage, grade of differentiation, positive lymph node, log odds of positive lymph node and organ invasion were prognostic factors with good discriminative ability.

Conclusion

The established nomogram demonstrated a more precise prognostic prediction for patients with Siewert type II/III AEG.
Modeling the impact of COVID-19 on Retina Clinic Performance
Authors: Sethi Karan , Levine Emily S. , Roh Shiyoung , Marx Jeffrey L. , Ramsey David J.
Published: May 2021

Background

COVID-19, a highly contagious respiratory virus, presents unique challenges to ophthalmology practice as a high-volume, office-based specialty. In response to the COVID-19 pandemic, many operational changes were adopted in our ophthalmology clinic to enhance patient and provider safety while maintaining necessary clinical operations. The aim of this study was to evaluate how measures adopted during the pandemic period affected retina clinic performance and patient satisfaction, and to model future clinic flow to predict operational performance under conditions of increasing patient and provider volumes.

Methods

Clinic event timestamps and demographics were extracted from the electronic medical records of in-person retina encounters from March 15 to May 15, 2020 and compared with the same period in 2019 to assess patient flow through the clinical encounter. Patient satisfaction was evaluated by Press Ganey patient experience surveys obtained from randomly selected outpatient encounters. A discrete-events simulation was designed to model the clinic with COVID-era restrictions to assess operational performance under conditions of increasing patient and provider volumes.

Results

Retina clinic volume declined by 62 % during the COVID-19 health emergency. Average check-in-to-technician time declined 79 %, total visit length declined by 46 %, and time in the provider phase of care declined 53 %. Patient satisfaction regarding access nearly doubled during the COVID-period compared with the prior year (p < 0.0001), while satisfaction with overall care and safety remained high during both periods. A model incorporating COVID-related changes demonstrated that wait time before rooming reached levels similar to the pre-COVID era by 30 patients-per-provider in a 1-provider model and 25 patients-per-provider in a 2-provider model (p < 0.001). Capacity to maintain distancing between patients was exceeded only in the two 2-provider model above 25 patients-per-provider.

Conclusions

Clinic throughput was optimized in response to the COVID-19 health emergency. Modeling these clinic changes can help plan for eventual volume increases in the setting of limits imposed in the COVID-era.
Employment and retirement impacts on health and wellbeing among a sample of rural Australians
Authors: Handley Tonelle E. , Lewin Terry J. , Butterworth Peter , Kelly Brian J.
Published: May 2021

Background

In Australia, it is projected that one in four individuals will be at the nominal retirement age of 65 or over by 2056; this effect is expected to be especially pronounced in rural areas. Previous findings on the effects of retirement on wellbeing have been mixed. The present study explores the effects of employment and retirement on health and wellbeing among a sample of rural Australians.

Methods

Australian Rural Mental Health Study participants who were aged 45 or over (N = 2013) were included in a series of analyses to compare the health and wellbeing of individuals with differing employment and retirement circumstances. Self-reported outcome variables included perceived physical health and everyday functioning, financial wellbeing, mental health, relationships, and satisfaction with life.

Results

Across the outcomes, participants who were employed or retired generally reported better health and wellbeing than those not in the workforce. Retired participants rated more highly than employed participants on mental health, relationships, and satisfaction with life. There was also a short-term benefit for perceived financial status for retired participants compared to employed participants, but this effect diminished over time.

Conclusions

While retirement is a significant life transition that may affect multiple facets of an individual’s life, the direction and magnitude of these effects vary depending on the retirement context, namely the pre-retirement and concurrent circumstances within which an individual is retiring. Personal perceptions of status changes may also contribute to an individual’s wellbeing more so than objective factors such as income. Policies that promote rural work/retirement opportunities and diversity and address rural disadvantage are needed.