bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Watery Diarrhea Surveillance During the Rohingya Crisis 2017–2019 in Cox’s Bazar, Bangladesh
Authors: Islam Md Taufiqul , Khan Ashraful Islam , Khan Zahid Hasan , Tanvir Nabid Anjum , Ahmmed Faisal , Afrad Md Mokibul Hassan , Begum Yasmin Ara , Kim Minjoon , Hasan A S M Mainul , Vandenent Maya , Uzzaman M Salim , Shirin Tahmina , Clemens John D , Qadri Firdausi
Published: September 2021

Background

Forcibly Displaced Myanmar Nationals (FDMNs) fled into Cox’s Bazar, Bangladesh due to internal conflict. Considering the public health situation, a surveillance network was established to identify the enteric pathogens and early detection of cholera epidemics. The purpose of this manuscript is to report the clinical, epidemiological determinants of cholera and other enteric pathogens among hospitalized diarrheal patients from FDMNs and host community.

Methods

A total of 11 sentinel surveillance sites were established around the camps in Ukhia and Teknaf Upazila, Cox’s Bazar. Rapid diagnostic testing was conducted for immediate detection of cholera cases. Stool samples were transferred to the Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b) laboratory for culture.

Results

A total of 8134 participants with diarrhea were enrolled from 2017 to 2019: 4881 were FDMNs and 3253 were from the Bangladeshi host community. Among the FDMNs, the proportion of Vibrio cholerae was 0.7%, the proportion of enterotoxigenic Escherichia coli (ETEC) was 4.9%, and the proportion of Shigella was 1.5%. The distributions from host community were 1.2% V cholerae, 1.8% ETEC, and 1.1% Shigella. Similar risk factors have been identified for the diarrheal pathogens for both communities.

Conclusions

This surveillance helped to monitor the situation of diarrheal diseases including cholera in refugee camps as well as in the neighboring host community. These findings lead policymakers to take immediate preventive measures.
The Enemy of My Enemy Is Not My Friend: Arabic Twitter Sentiment toward ISIS and the United States
Authors: Romney David , Jamal Amaney A , Keohane Robert O , Tingley Dustin
Published: September 2021

A counter-intuitive finding emerges from an analysis of Arabic Twitter posts from 2014 to 2015: Twitter participants who are negative toward the Islamic State of Iraq and the Levant (ISIS) are also more likely to hold negative views of the United States. This surprising correlation is due to the interpretations of two sets of users. One set of users views the United States and ISIS negatively as independent interventionist powers in the region. The other set of users negatively links the United States with ISIS, often asserting a secretive conspiracy between the two. The intense negativity toward the United States in the Middle East seems conducive to views that, in one way or another, cause citizens to link the United States and ISIS in a conspiratorial manner.
Recent use of deep learning techniques in clinical applications based on gait: a survey
Authors: Matsushita Yume , Tran Dinh Tuan , Yamazoe Hirotake , Lee Joo-Ho
Published: September 2021

Gait analysis has been studied for a long time and applied to fields such as security, sport, and medicine. In particular, clinical gait analysis has played a significant role in improving the quality of healthcare. With the growth of machine learning technology in recent years, deep learning-based approaches to gait analysis have become popular. However, a large number of samples are required for training models when using deep learning, where the amount of available gait-related data may be limited for several reasons. This paper discusses certain techniques that can be applied to enable the use of deep learning for gait analysis in case of limited availability of data. Recent studies on the clinical applications of deep learning for gait analysis are also reviewed, and the compatibility between these applications and sensing modalities is determined. This article also provides a broad overview of publicly available gait databases for different sensing modalities.
Unraveling the role of epigenetic regulation in asymmetric cell division during plant development
Authors: Alejo-Vinogradova M Teresa , Ornelas-Ayala Diego , Vega-León Rosario , Garay-Arroyo Adriana , García-Ponce Berenice , R. Álvarez-Buylla Elena , Sanchez María de la Paz
Published: September 2021

Asymmetric cell divisions are essential to generate different cellular lineages. In plants, asymmetric cell divisions regulate the correct formation of the embryo, stomatal cells, apical and root meristems, and lateral roots. Current knowledge of regulation of asymmetric cell divisions suggests that, in addition to the function of key transcription factor networks, epigenetic mechanisms play crucial roles. Therefore, we highlight the importance of epigenetic regulation and chromatin dynamics for integration of signals and specification of cells that undergo asymmetric cell divisions, as well as for cell maintenance and cell fate establishment of both progenitor and daughter cells. We also discuss the polarization and segregation of cell components to ensure correct epigenetic memory or resetting of epigenetic marks during asymmetric cell divisions.
From giant clumps to clouds – I. The impact of gas fraction evolution on the stability of galactic discs
Authors: Renaud Florent , Romeo Alessandro B , Agertz Oscar
Published: September 2021

The morphology of gas-rich disc galaxies at redshift $\sim 1\!-\!3$ is dominated by a few massive clumps. The process of formation or assembly of these clumps and their relation to molecular clouds in contemporary spiral galaxies are still unknown. Using simulations of isolated disc galaxies, we study how the structure of the interstellar medium and the stability regime of the discs change when varying the gas fraction. In all galaxies, the stellar component is the main driver of instabilities. However, the molecular gas plays a non-negligible role in the interclump medium of gas-rich cases, and thus in the assembly of the massive clumps. At scales smaller than a few 100 pc, the Toomre-like disc instabilities are replaced by another regime, especially in the gas-rich galaxies. We find that galaxies at low gas fraction (10 per cent) stand apart from discs with more gas, which all share similar properties in virtually all aspects we explore. For gas fractions below $\approx 20{{\ \rm per\ cent}}$, the clump-scale regime of instabilities disappears, leaving only the large-scale disc-driven regime. Associating the change of gas fraction to the cosmic evolution of galaxies, this transition marks the end of the clumpy phase of disc galaxies, and allows for the onset of spiral structures, as commonly found in the local Universe.
Evaluation of the liver and blood micronucleus, and comet assay end points in a 14-day repeated-dose study with methyl carbamate and 1,3-propane sultone
Authors: Tu Honggang , Yu Chunrong , Tong Wen , Zhou Changhui , Li Ruowan , Huang Pengcheng , Wang Qingli , Chang Yan
Published: September 2021

The repeated-dose liver micronucleus (RDLMN) assay is a novel method for detecting genotoxic chemicals. Two carcinogens methyl carbamate (MC) and 1,3-propane sultone (PS) were evaluated for the liver micronucleus in a 14-day repeated-dose study with Crl: CD (SD) IGS rats. Additionally, micronucleated reticulocytes (MN-RET) in peripheral blood and DNA damage (alkaline comet assay) in the liver were also assessed in the same animals. Ten groups of five male Crl: CD (SD) IGS rats were treated once daily with MC (300, 600 or 1200 mg/kg/day), PS (37.5, 75 or 150 mg/kg/day), negative control or three positive controls by oral gavage for 15 days. Blood samples were collected at 3 h after the last administration for determining MN-RET frequencies (%MN-RET), and the livers were sampled for determining the frequency of micronuclei and DNA damage. MC was negative in the comet assay, liver micronucleus assay and reticulocyte micronucleus assay, while PS was positive in all three assays. These results are consistent with the previous genotoxic findings of MC and PS. Therefore, the liver micronucleus assay can be effectively integrated into repeated-dose studies in animals. Moreover, integration of multiple genotoxicity end points into one study can reduce the number of animals, boost the experimental efficiency, and provides a comprehensive evaluation of the genotoxic potential of chemicals.
Pathways of thymidine hypermodification
Authors: Lee Yan-Jiun , Dai Nan , Müller Stephanie I , Guan Chudi , Parker Mackenzie J , Fraser Morgan E , Walsh Shannon E , Sridar Janani , Mulholland Andrew , Nayak Krutika , Sun Zhiyi , Lin Yu-Cheng , Comb Donald G , Marks Katherine , Gonzalez Reyaz , Dowling Daniel P , Bandarian Vahe , Saleh Lana , Corrêa Ivan R , Weigele Peter R
Published: September 2021

The DNAs of bacterial viruses are known to contain diverse, chemically complex modifications to thymidine that protect them from the endonuclease-based defenses of their cellular hosts, but whose biosynthetic origins are enigmatic. Up to half of thymidines in the Pseudomonas phage M6, the Salmonella phage ViI, and others, contain exotic chemical moieties synthesized through the post-replicative modification of 5-hydroxymethyluridine (5-hmdU). We have determined that these thymidine hypermodifications are derived from free amino acids enzymatically installed on 5-hmdU. These appended amino acids are further sculpted by various enzyme classes such as radical SAM isomerases, PLP-dependent decarboxylases, flavin-dependent lyases and acetyltransferases. The combinatorial permutations of thymidine hypermodification genes found in viral metagenomes from geographically widespread sources suggests an untapped reservoir of chemical diversity in DNA hypermodifications.
Microsurgical Resection of a Parasellar Meningioma Invading the Cavernous Sinus, Bone, and Optic Canal: 2-Dimensional Operative Video
Authors: Ibn Essayed Walid , Tavanaiepour Daryoush , Abolfotoh Mohammad , Al-Mefty Ossama
Published: September 2021

Parasellar meningiomas, regardless of the initial origin, frequently involve the optic canal and cavernous sinus, leading to visual loss and ocular movement dysfunction.
1
Hyperostotic bony invasion to the surrounding skull base is common.
2
Visual acuity prognosis can be improved by surgical resection through different technical maneuvers, including opening the optic canal and the preservation of the visual apparatus vascular supply by developing the intra-arachnoidal dissection planes.
1,3,4
To achieve radical dissection and reduce recurrences, the extradural invaded bone is thoroughly resected. Likewise, the soft and nonadherent invasive tumor around the cavernous carotid can be extensively removed.
1,3,4
New or worsening of the ophthalmoplegia is frequent after cavernous sinus exploration and tumor resection. However, it is usually temporary and improves progressively in 80% of patients.
1,3,4
Safely approaching these lesions requires extensive anatomic knowledge through cadaveric dissection and training, allowing us to achieve tumor control, preserve or improve visual function, and avoid or delay irradiation therapy.
1,3,4
Pituitary function preservation is also possible in many patients through surgery, which is at higher risk with irradiation. We demonstrate the technical maneuvers through a case of a 49-yr-old woman who presented with a parasellar meningioma involving the cavernous sinus, both optic canals, and extensive bony invasion. The patient consented to the surgery and publication of her images.

 Image at 1:14 and middle and right image at 1:31 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, ©LWW, 1998. Left image at 1:31 reprinted from Arnautovic et al,
5
by permission from JNSPG.
Combined Microscopic-Endoscopic Transmastoid Resection of a Petrous Meningioma: 2-Dimensional Operative Video
Authors: Ibn Essayed Walid , Aboud Emad , Al-Mefty Ossama
Published: September 2021

Petrous meningiomas are defined as tumors with a basal dural attachment on the posterior surface of the petrous bone.
1
Their insertion can be anterior to the meatus (petrous apex meningiomas), or posterior to the meatus, with associated hyperostotic bony invasion either pre- or retro-meatal.
2
These meningiomas are amenable to curative surgical removal and have better surgical outcomes than more medially located true petroclival meningiomas that originate medial to the fifth nerve.
2-4
They, however, remain challenging because of their close relationship to critical neurovascular structures in the cerebellopontine angle.
5
The posterior petrous meningiomas might reach a significant size with compression of the cerebellum, the brainstem, and involvement of the cranial nerves, and extend posteriorly to the transverse sigmoid sinus.
2,6

 Transmastoid approach with skeletonization and lateral reflection of the transverse sigmoid sinus provides a superb exposure without cerebellar retraction.
6,7
The ease and complete resection of the tumor and invaded bone can be facilitated by combined microscopic-endoscopic techniques. We demonstrate these principles through the resection of a petrosal meningioma in a 56-yr-patient who presented with headaches, nystagmus, and mild cerebellar signs. The patient consented to the procedure.

 Image at 1:36 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, ©LWW, 1998.
Ant crickets and their secrets:Myrmecophilus acervorumis not always parthenogenetic (Insecta: Orthoptera: Myrmecophilidae)
Authors: Iorgu Ionuț Ştefan , Iorgu Elena Iulia , Stalling Thomas , Puskás Gellért , Chobanov Dragan , Szövényi Gergely , Moscaliuc Liviu Aurel , Motoc Rozalia , Tăuşan Ioan , Fusu Lucian
Published: September 2021

Previously considered as a thelytokous parthenogenetic species, the widespread ant cricket Myrmecophilus acervorum actually turns out to have a mixed reproductive system: our recent surveys in the central part of its distribution area has revealed the presence of both sexes. Detailed morphological and morphometric descriptions of the previously unknown males are here provided. New data on species distribution in south-eastern Europe are presented, including the first records of M. balcanicus in Bulgaria and of M. nonveilleri in Bulgaria and Hungary. Phylogenetic and phylogeographic analyses have revealed several haplotypes of M. acervorum in Europe, with six of them forming a parthenogenetic clade in populations distributed west of the Carpathians. We tested our samples for bacterial infection by Wolbachia and, surprisingly, Wolbachia was identified only in populations with both sexes and no amplification was obtained from parthenogenetic populations. Phylogenetic analyses performed with sequences pertaining to five nominal species related to M. acervorum, yielded topological congruent trees with four well-supported groups: one group with M. acervorum samples, the second group with M. nonveilleri samples, the third group with M. fuscus and M. gallicus samples, and the fourth group with samples of M. balcanicus. We performed species delineation tests on our sequences, which delimited between four to seven putative species.
CE: A Prone Positioning Protocol for Awake, Nonintubated Patients with COVID-19
Authors: Joseph Bridgid , Mackinson Lynn G. , Sokol-Hessner Lauge , Law Anica C. , DeSanto-Madeya Susan
Published: September 2021

Prone positioning of critically ill patients with acute respiratory distress syndrome is an accepted therapy done to improve oxygenation and promote weaning from mechanical ventilation. But there is limited information regarding its use outside of the ICU. At one Boston hospital, the influx of patients with suspected or confirmed COVID-19 strained its resources, requiring sweeping systems changes and inspiring innovations in clinical care. This article describes how an interdisciplinary team of clinicians developed a prone positioning protocol for use with awake, nonintubated, oxygen-dependent patients with suspected or confirmed COVID-19 on medical–surgical units, with the hope of hastening their recovery and avoiding deterioration and ICU transfer. A protocol implementation plan and staff educational materials were disseminated via the hospital incident command system and supported through daily leadership huddles. Patient eligibility criteria, including indications and contraindications, and a clear nursing procedure for the implementation of prone positioning with a given patient, were key elements. Nurses' feedback of their experiences with the protocol was elicited through an e-mailed survey. Nearly all respondents reported improvements in patients' oxygen saturation levels, while few respondents reported barriers to protocol implementation. The prone positioning protocol was found to be both feasible for and well tolerated by awake, nonintubated patients on medical–surgical units, and can serve as an example for other hospitals during this pandemic.
Injection Drug Use and Healthcare Utilization in Patients Newly Diagnosed With HIV
Authors: Fix Cecilia , Re Christopher , Roberts Brian , Salzman Matthew , Baston Kaitlan , Baxter John , Gorman Pamela , Salerno John , Haroz Rachel
Published: September 2021

Objectives

To determine recent trends in: (1) human immunodeficiency virus (HIV) diagnoses, (2) the proportion of patients newly diagnosed with HIV with injection drug use (IDU) and (3) patients’ patterns of healthcare utilization in the year before diagnosis at an urban, academic medical center.

Methods

We performed a cross sectional study of patients newly diagnosed with HIV at a healthcare system in southern New Jersey between January 1st, 2014 and December 31st, 2019. Patients 18 years or older with HIV diagnosed during the study period were included. Demographics, comorbidities, HIV test results, and healthcare utilization data were collected from the electronic medical record.

Results

Of 192 patients newly diagnosed with HIV, 36 (19%) had documented IDU. New HIV diagnoses doubled from 22 to 47 annual cases between 2014 and 2019. The proportion of patients with newly diagnosed HIV and documented IDU increased from 9% in 2014 to 32% in 2019, chi-square test for linear trend P value = 0.001. Eighty-nine percent of patients with IDU had at least one contact with the healthcare system in the year before diagnosis compared to 63% of patients without IDU, P value 0.003. The median (interquartile range IQR) number of healthcare visits was 7 [2 – 16] for patients with IDU versus 1 [0 – 3] for patients without IDU, P < 0.001.

Conclusions

We observed an increase in new HIV diagnoses with an increase in the proportion of newly diagnosed patients with IDU. Patients with newly diagnosed HIV and IDU had high rates of health care utilization in the year before diagnosis presenting an opportunity for intervention.
Causes of Death in the 12 Months After Hospital Discharge Among Patients With Opioid Use Disorder
Authors: King Caroline , Cook Ryan , Korthuis P. Todd , Morris Cynthia D. , Englander Honora
Published: September 2021

Background

Patients with substance use disorders are seven times more likely hospitalized than the general population. However, causes of death for recently hospitalized patients with Opioid Use Disorder (OUD) are not well described. This study describes causes of death in the year post-discharge among hospitalized patients with OUD.

Methods

We analyzed data from participants who were at least 18 years old, with Medicaid insurance, and had a diagnosis of OUD during a general hospital admission in Oregon between April 2015 and December 2017.

Results

During the study window, 6,654 Oregon Medicaid patients with an OUD diagnosis were hospitalized. Patients were predominately female (56.7%) and White (72.2%), an average age of 44.2 years (SD = 15.4 years) and average hospital length of stay of 6.5 days (SD = 10.9 days). In the 12 months post-discharge, 522 patients died (7.8%); 301 patients from a drug or substance related cause (4.5%), including 71 from drug overdose (1.1%). Stated another way, of those who died within 12 months, 58% of deaths were attributed to drug-related causes, including 13.6% of deaths attributed to overdose; 42% died of non-drug related causes. Drug-related death was the most frequent cause of mortality.

Conclusions

Hospitalized patients with OUD are at high risk of death, from drug and non-drug related causes, in the year after discharge. Future research should consider not only overdose, but a more comprehensive definition of drug-related death in understanding post-discharge mortality among hospitalized patients with OUD, and care systems should work to mitigate the risk of death in this population.
The Need for Multidisciplinary Hospital Teams for Injection Drug Use-related Infective Endocarditis
Authors: Weimer Melissa B. , Falker Caroline G. , Seval Nikhil , Golden Marjorie , Hull Sarah C. , Geirsson Arnar , Vallabhajosyula Prashanth
Published: September 2021

Injection drug use-related infective endocarditis (IDU-IE) is a complex disease with increasing incidence. Although universally recognized that IDU-IE requires antibiotics and often requires cardiac surgery, most patients do not receive addiction treatment which substantially increases their risk of recurrent IDU-IE from drug use recurrence. Accordingly, a multidisciplinary approach integrating addiction treatment may benefit patients with IDU-IE. We describe the format and structure of a team called the Multidisciplinary Endocarditis Evaluation Team (MEET) whose purpose is to optimize, formalize, and standardize the care of patients with IDUIE. Given the complexity of IDU-IE, MEET is comprised of addiction medicine, anesthesia, cardiology, cardiac surgery, infectious disease, case management, nursing, and social work. MEET strived to be acceptable to patients and families to support their preferences and values. MEET focused treatment of IDU-IE on the patient’s medical and surgical needs with attention to the patients’ underlying substance use disorder as an essential component.
An Interdisciplinary Approach to Reducing NEC While Optimizing Growth
Authors: Noonan Jane M.
Published: September 2021

Background:

Necrotizing enterocolitis (NEC) and postnatal growth restriction are significant clinical dilemmas that contribute to short- and long-term morbidities for the most premature infants.

Purpose:

After a rise in NEC rates in a regional neonatal intensive care unit (NICU), improvement practices were implemented by an interdisciplinary quality improvement (QI) work group whose focus was initially on nutrition and growth. QI work was refocused to address both NEC and growth concurrently.

Methods:

Through various QI initiatives and with evolving understanding of NEC and nutrition, the work group identified and implemented multiple practices changes over 2-decade time span. A standardized tool was used to review each case of NEC and outcomes were continually tracked to guide QI initiatives.

Local Findings:

Focused QI work contributed to a significant reduction in NEC rates from 16.2% in 2007 to 0% in 2018 for inborn infants. Exclusive human milk diet was a critical part of the success. Postnatal growth outcomes initially declined after initial NEC improvement work. Improvement work that focused jointly on NEC and nutrition resulted in improved growth outcomes without impacting NEC.

Implications for Practice:

Use of historical perspective along with evolving scientific understanding can guide local improvement initiatives. Work must continue to optimize lactation during NICU hospitalization. More research is needed to determine impact of care practices on gastrointestinal inflammation including medication osmolality, probiotics, and noninvasive respiratory support.
Proximal Humerus Geriatric Fracture Care: Fix, Replace, or Nonoperative Treatment?
Authors: O'Donnell Jeffrey A. , Gage Mark J.
Published: September 2021

Decision-making in the treatment of proximal humerus fractures can be challenging. A careful assessment of the patient's anticipated activity and specific fracture features can help determine which treatment strategy best aligns with an individual's goals. Treatment of geriatric proximal humerus fractures is dependent on these factors and an awareness of one's own technical ability.
Advances in Geriatric Hip Fractures: Pre-Operative Considerations and Tips to Optimize Outcome
Authors: Marenghi Natalie Marie , Tyler-Paris Pilson Holly , Halvorson Jason J.
Published: September 2021

Geriatric hip fractures are complicated by increased morbidity and mortality, and their incidence continues to rise around the world. Frequent considerations in treating geriatric hip fractures include optimal time to surgery, need for preoperative cardiac clearance, risks of operating through anticoagulation, utilization of regional anesthesia, and collaborative care between treatment teams. This article aims to summarize these factors as well as to provide some tips and tricks that can be helpful in their surgical management.
Modified Lumbopelvic Technique Using S1 Pedicle Screws for Spinopelvic Dissociation U-Type and H-Type Sacral Fractures With Kyphotic Deformity
Authors: Saiz Augustine M. , Shieh Alvin K. , Hideshima Kelsey , Wong Felix , Klineberg Eric O. , Eastman Jonathan G.
Published: September 2021

Spinopelvic dissociation injuries are complex injuries defined as discontinuity between the appendicular and axial skeleton. Fracture patterns are variable, but U-type and H-type fractures are common and often present with kyphotic deformity along with translational displacement and impaction. The ideal method of fixation has not been established for these injuries. The goals of treatment include restoration of alignment, stability, and neural decompression as needed. Traditional methods of lumbopelvic fixation have spanned the upper sacral fracture site. Our novel modified method of lumbopelvic fixation directly instruments the S1 body. This allows for direct manipulation of the fracture which we theorize improves reduction and increases stability across the fracture. This article characterizes the injury patterns, outlines the modified technique, and reports the clinical and radiographic outcomes of our modified lumbopelvic fixation technique and construct.
The Prognostic Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Melanoma Patients Receiving Immunotherapy
Authors: Li Yayun , Meng Yu , Sun Huiyan , Ye Lin , Zeng Furong , Chen Xiang , Deng Guangtong
Published: September 2021

Immunotherapy has revolutionized the treatment in metastatic melanoma, but alternative biomarkers that are economical, simple and reliable still need to be clarified. In this study, we aimed to comprehensively analyze the prognostic significance of baseline neutrophil-to-lymphocyte ratio (NLR) in melanoma patients with immunotherapy. We searched PubMed, Embase, and Cochrane Library until September 16, 2020. Hazard ratio (HR) and 95% confidence intervals (CIs) were pooled to investigate the association of baseline NLR with overall survival (OS) and progression-free survival (PFS). Sensitivity analysis, subgroup analyses, publication bias assessment, and the Duval and Tweedie trim-and-fill method were used to evaluate the stability of results. A total of 18 studies including 2054 patients were included in our analysis. Pooled data demonstrated that higher baseline NLR was associated with a poorer OS (HR=2.46, 95% CI=1.77, 3.43) and PFS (HR=2.38, 95% CI=1.95, 2.89) of melanoma patients receiving immunotherapy. Subgroup analysis according to immunotherapy type showed that the prognostic effects of baseline NLR existed in all the subtypes of immunotherapy, including anticytotoxic T lymphocyte-associated protein 4 therapy (OS HR=2.26, 95% CI=1.43, 3.59; PFS HR=2.68, 95% CI=1.79, 4.02), antiprogrammed cell death-1 therapy (OS HR=3.08, 95% CI=2.21, 4.27; PFS HR=2.01, 95% CI=1.64, 2.47), and combination therapy (OS HR=1.75, 95% CI=1.13, 2.72; PFS HR=3.13, 95% CI=1.63, 6.03). Conclusions were still consistent in subgroup analyses stratified by study year, region, study type, sample size, analysis of HR and cuttoff of baseline NLR. Altogether, baseline NLR is a promising prognostic biomarker for melanoma patients receiving immunotherapy.
Effectiveness of azithromycin mass drug administration on trachoma: a systematic review
Authors: Xiong Tao , Yue Yan , Li Wen-Xing , Choonara Imti , Qazi Shamim , Chen Hong-Ju , Tang Jun , Shi Jing , Wang Hua , Zeng Li-Nan , Xia Bin , Qiao Li-Na , Qu Yi , Mu De-Zhi
Published: September 2021

Backgrounds:

Azithromycin mass drug administration (MDA) is a key part of the strategy for controlling trachoma. This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma; provide an overview of the impact of azithromycin MDA on trachoma in different districts; and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts.

Methods:

PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov were searched up to February 2021 with no language restriction. Studies reporting the effect of azithromycin MDA on trachoma were included. Mathematical modeling studies, animal studies, case reports, and reviews were excluded. The trachomatous inflammation-follicular (TF) <5.0% was used to judge the effect of azithromycin MDA on eliminating trachoma as a public health problem. Two researchers independently conducted the selection process and risk of bias assessment.

Results:

A total of 1543 studies were screened, of which 67 studies including 13 cluster-randomized controlled trials and 54 non-randomized studies were included. The effect of azithromycin MDA on trachoma was closely related to the baseline prevalence in districts. For the districts with baseline prevalence between 5.0% and 9.9%, a single round of MDA achieved a TF <5.0%. For the districts with baseline between 10.0% and 29.9%, annual MDA for 3 to 5 years reduced TF <5.0%. However, for the districts with high level of baseline prevalence (TF >30.0%), especially with baseline TF >50.0%, annual MDA was unable to achieve the TF <5.0% even after 5 to 7 years of treatment. Quarterly MDA is more effective in controlling trachoma in these hyperendemic districts.

Conclusions:

Azithromycin MDA for controlling trachoma depends on the baseline prevalence. The recommendation by the World Health Organization that annual MDA for 3 to 5 years in the districts with TF baseline >10.0% is not appropriate for all eligible districts.
Racial, Ethnic, and Sociodemographic Disparities in Diagnosis of Children with Autism Spectrum Disorder
Authors: Aylward Brandon S. , Gal-Szabo Diana E. , Taraman Sharief
Published: September 2021

This special article uses a biosocial-ecological framework to discuss findings in the literature on racial, ethnic, and sociodemographic diagnostic disparities in autism spectrum disorder. We draw explanations from this framework on the complex and cumulative influences of social injustices across interpersonal and systemic levels.
Evaluation of Radiation Shielding Requirements and Self-shielding Characteristics for a Novel Radiosurgery System
Authors: Cao Qinjian , Tan Jun , Ren Yue , Xiong Wanchun , Wei Xiaofeng , Cheng Wei
Published: September 2021

In order to provide safe operating conditions for radiation workers and the public at large, the radiation shielding for radiotherapy treatment rooms will have to be determined by an expert physicist according to the applicable radiation control regulations. A new radiosurgery system with integrated self-shielding, called the Zap-X, obviates the need for costly and complex radiation bunkers. Radiation levels in the vicinity of the ZAP-X radiosurgery system were acquired for a number of different operating conditions, and a 3D radiation dose distribution was measured for better visualization of hot spots and the general dose distribution. The radiation shielding requirements were evaluated according to the International and Chinese standards, respectively. While the integral self-shielding of the Zap-X was designed in accordance with international standards, it was found to be insufficient for Chinese standards. In order to meet the needs of the growing new generation of radiotherapy equipment, several suggestions for improvement of Chinese standards are proposed.
A Comparison of Current Methods for the Determination of Ra-226 and Ra-228 in Water by a Modified Georgia Tech Gamma Method Vs. US Environmental Protection Agency Drinking Water Methodologies
Authors: Nguyen Dao M. , Moody W. Allen , Williamson John A.
Published: September 2021

Radium is a significant source of human radiation exposure both from natural sources (NORM, or Naturally Occurring Radioactive Material) and from technologically enhanced natural radioactive material (TENORM). Gamma analysis for 226Ra and 228Ra in water using high purity germanium (HPGe) detectors was compared with current methods from the US Environmental Protection Agency (EPA) using alpha scintillation and gas proportional counters. Extensive evaluations of a modified version of the original Georgia Tech HPGe method were performed. Known value 226Ra samples from the US Department of Energy (DOE) Mixed-Analyte Performance Evaluation Program (MAPEP) program, mixed 226Ra and 228Ra samples from the Environmental Resource Associates Quality Assurance Program (ERA), and mixed 226Ra and 228Ra samples from the Laboratory Proficiency Testing Program of the International Atomic Energy Agency (IAEA) were used for cross-check comparisons of the modified Georgia Tech method with other methodologies (EPA 903.1 and Ra-05 for 226Ra and 228Ra, respectively). Minimum counting times for our gamma instrumentation to reach a minimum detectable activity (MDA) of 0.04 Bq L−1 were also determined.
HYPERREFLECTIVE FOCI AS IMPORTANT PROGNOSTIC INDICATORS OF PROGRESSION OF RETINITIS PIGMENTOSA
Authors: Huang Chu-Hsuan , Yang Chang-Hao , Lai Ying-Ju , Hsiao Chuhsing Kate , Hou Yu-Chih , Yang Chung-May , Chen Ta-Ching
Published: September 2021

Purpose:

To investigate the presence and clinical relevance of hyperreflective foci (HRFs) in retinitis pigmentosa.

Methods:

Seventy seven retinitis pigmentosa cases were retrospectively reviewed. The 10-mm wide cross-line macular scans in optical coherence tomography were acquired. Hyperreflective foci were classified according to the location in optical coherence tomography: outer layers within the macula (HRF-outer-central), macular border beyond the central 3 mm (HRF-outer-perifoveal), and choroid (HRF-choroidal). The visual acuity at baseline, at 12 months, and other fundus characteristics were collected.

Results:

The mean logMAR best-corrected visual acuity decreased from 0.59 ± 0.66 (20/78 in Snellen) to 0.74 ± 0.81 (20/106 in Snellen) in 1 year. Sixty-six (42.9%), 105 (68.2%), and 98 (63.6%) eyes were classified to HRF-outer-central, HRF-outer-perifoveal, and HRF-choroidal group, respectively. Hyperreflective foci were positively correlated with poorer vision, central macular thinning, and ellipsoid zone disruption (allP< 0.001). Worse vision was associated with older age, macular involvement, and the coexistence of two or three HRF groups (P= 0.014, 0.047, 0.019, <0.001, respectively). Hyperreflective foci developed more frequently in patients with thick choroid than in those with thin choroid. The coexistence of three HRF groups was correlated with quicker visual deterioration (P= 0.034).

Conclusion:

Hyperreflective foci are common in retinitis pigmentosa and can be a negative prognostic indicator of macular thickness and visual preservation. Thick choroid was associated with all groups of HRFs, especially HRF-choroidal.
STRAWBERRY RETINA: SILICONE OIL–RETINA INTERFACE ON MULTIMODAL IMAGING
Authors: Pilli Suman , Murjaneh Salem
Published: September 2021

Purpose:

To report a new photographic macular feature identified on multimodal imaging in eyes with silicone oil in situ.

Methods:

Retrospective, observational case series of three eyes of three patients.

Results:

Two eyes had undergone initial vitrectomy for vitreous hemorrhage with fibrovascular membranes causing tractional retinal detachments secondary to retinovascular occlusion. One eye had further vitrectomy for rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy. All three eyes had multiple, discrete, coarse, hyperreflective deposits at the silicone oil–retina interface on optical coherence tomography macular scans, with increased reflectivity from the inner retinal layers. On multicolor and infrared images, these preretinal deposits produced hyporeflective darker spots giving a quasi-pitting appearance of the retinal surface against glossy bright reflection from silicone oil, thus simulating an appearance of ‟a strawberry.” These deposits are causing inverse pitting of the oil bubble. On blue autoflourescence imaging, the preretinal deposits caused hypoautoflourescence. Partial silicone oil emulsification was seen superiorly in two of these patients with a different clinical and optical coherence tomography appearance from these hyperreflective macular deposits.

Conclusion:

We describe a new distinctive ‟Strawberry Retina” appearance identified on multicolor and infrared macular images associated with hyperreflective, coarse deposits at the silicone oil–retina interface.
To tolerate weather and to tolerate pain: two sides of the same coin? The Tromsø Study 7
Authors: Farbu Erlend Hoftun , Rypdal Martin , Skandfer Morten , Steingrímsdóttir Ólöf Anna , Brenn Tormod , Stubhaug Audun , Nielsen Christopher Sivert , Höper Anje Christina
Published: September 2021

It is a common belief that weather affects pain. Therefore, we hypothesized that weather can affect pain tolerance. This study used data from over 18,000 subjects aged 40 years or older from the general population, who participated in the Tromsø Study 7. They underwent a one-time assessment of cuff algometry pressure pain tolerance (PPT) and cold pain tolerance (CPT), tested with a cold pressor test. The results showed a clear seasonal variation in CPT. The rate of withdrawal in the cold pressor test was up to 75% higher in months in the warmer parts of the year compared with January 2016. There was no seasonal variation in PPT. The study not only found a nonrandom short-term variation in PPT but also indications of such a variation in CPT. The intrinsic timescale of this short-term variation in PPT was 5.1 days (95% % confidence interval 4.0-7.2), which is similar to the observed timescales of meteorological variables. Pressure pain tolerance and CPT correlated with meteorological variables, and these correlations changed over time. Finally, temperature and barometric pressure predicted future values of PPT. These findings suggest that weather has a causal and dynamic effect on pain tolerance, which supports the common belief that weather affects pain.
Declines and regional variation in opioid distribution by U.S. hospitals
Authors: Eidbo Sarah A. , Kropp Lopez Amalie K. , Hagedorn Joseph D. , Mathew Varkey , Kaufman Daniel E. , Nichols Stephanie D. , McCall Kenneth L. , Piper Brian J.
Published: September 2021

The United States is enduring a preventable opioid crisis, particularly involving a population being treated in a hospital setting, a subset of whom may escalate to illicit opioids. This project analyzed trends in distribution of opioids by hospitals in the United States. Opioids monitored included buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, powdered opium, remifentanil, and tapentadol. The Automation of Reports and Consolidated Orders System (ARCOS) reports on substances controlled by the Drug Enforcement Administration. National data from ARCOS reports 5 and 7 from 2000 to 2019 were used for an observational study on hospital opioid distribution. Morphine milligram equivalents (MMEs) were calculated using oral conversion factors. The MME per person per state was calculated to compare data from the peak year, 2012, with data from 2019. Opioid use peaked in 2012, with a −46.6% decline from 2012 to 2019. Half (25) of the states have seen a decrease of −50% or greater. Of the opioid compounds observed, buprenorphine has seen increased (+122.5%) hospital use from 2012 to 2019. All other opioids have been experiencing a decline (≥50%), particularly hydromorphone (−49.9%), oxymorphone (−57.7%), methadone (−58.7%), morphine (−66.9%), codeine (−67.5%), and meperidine (−77.6%). There was a 6-fold difference in population-corrected use of opioids in 2019 between the lowest (6.8 MME/person in New Jersey) and highest (Alaska = 39.6) states. This study demonstrates the considerable progress made thus far by hospitals in curbing the U.S. opioid crisis.
Measurement properties of grimace scales for pain assessment in nonhuman mammals: a systematic review
Authors: Evangelista Marina C. , Monteiro Beatriz P. , Steagall Paulo V.
Published: September 2021

Facial expressions of pain have been identified in several animal species. The aim of this systematic review was to provide evidence on the measurement properties of grimace scales for pain assessment. The protocol was registered (SyRF#21-November-2019), and the study is reported according to the PRISMA guidelines. Studies reporting the development, validation, and the assessment of measurement properties of grimace scales were included. Data extraction and assessment were performed by 2 investigators, following the COnsensus-based Standards for the Selection of Health Measurement INstruments guidelines. Six categories of measurement properties were assessed: internal consistency, reliability, measurement error, criterion and construct validity, and responsiveness. Overall strength of evidence (high, moderate, and low) of each instrument was based on methodological quality, number of studies, and studies' findings. Twelve scales for 9 species were included (mice, rats, rabbits, horses, piglets, sheep or lamb, ferrets, cats, and donkeys). Considerable variability regarding their development and measurement properties was observed. The Mouse, Rat, Horse and Feline Grimace Scales exhibited high level of evidence. The Rabbit, Lamb, Piglet and Ferret Grimace Scales and Sheep Pain Facial Expression Scale exhibited moderate level of evidence. The Sheep Grimace Scale, EQUUS-FAP, and EQUUS-Donkey-FAP exhibited low level of evidence for measurement properties. Construct validity was the most reported measurement property. Reliability and other forms of validity have been understudied. This systematic review identified gaps in knowledge on the measurement properties of grimace scales. Further studies should focus on improving psychometric testing, instrument refinement, and the use of grimace scales for pain assessment in nonhuman mammals.
Benefit–risk assessment and reporting in clinical trials of chronic pain treatments: IMMPACT recommendations
Authors: Kleykamp Bethea A. , Dworkin Robert H. , Turk Dennis C. , Bhagwagar Zubin , Cowan Penney , Eccleston Christopher , Ellenberg Susan S. , Evans Scott R. , Farrar John T. , Freeman Roy L. , Garrison Louis P. , Gewandter Jennifer S. , Goli Veeraindar , Iyengar Smriti , Jadad Alejandro R. , Jensen Mark P. , Junor Roderick , Katz Nathaniel P. , Kesslak J. Patrick , Kopecky Ernest A. , Lissin Dmitri , Markman John D. , McDermott Michael P. , Mease Philip J. , O'Connor Alec B. , Patel Kushang V. , Raja Srinivasa N. , Rowbotham Michael C. , Sampaio Cristina , Singh Jasvinder A. , Steigerwald Ilona , Strand Vibeke , Tive Leslie A. , Tobias Jeffrey , Wasan Ajay D. , Wilson Hilary D.
Published: September 2021

Chronic pain clinical trials have historically assessed benefit and risk outcomes separately. However, a growing body of research suggests that a composite metric that accounts for benefit and risk in relation to each other can provide valuable insights into the effects of different treatments. Researchers and regulators have developed a variety of benefit–risk composite metrics, although the extent to which these methods apply to randomized clinical trials (RCTs) of chronic pain has not been evaluated in the published literature. This article was motivated by an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials consensus meeting and is based on the expert opinion of those who attended. In addition, a review of the benefit–risk assessment tools used in published chronic pain RCTs or highlighted by key professional organizations (ie, Cochrane, European Medicines Agency, Outcome Measures in Rheumatology, and U.S. Food and Drug Administration) was completed. Overall, the review found that benefit–risk metrics are not commonly used in RCTs of chronic pain despite the availability of published methods. A primary recommendation is that composite metrics of benefit–risk should be combined at the level of the individual patient, when possible, in addition to the benefit–risk assessment at the treatment group level. Both levels of analysis (individual and group) can provide valuable insights into the relationship between benefits and risks associated with specific treatments across different patient subpopulations. The systematic assessment of benefit–risk in clinical trials has the potential to enhance the clinical meaningfulness of RCT results.
Return to Work in Survivors With Occupational Cancers
Authors: Lim Zhu Wei , Wang Chung-Ching , Wu Wei-Te , Chen Wei-Liang
Published: September 2021

Objectives:

The aim of this study is to investigate the change in employment status in survivors with occupational cancers at the time of diagnosis until 2 years.

Methods:

In this study, we included 382 occupational cancer workers from Labor Insurance Database. After applying exclusion criteria, 86 workers in 2004 to 2015 were included. The mean age of cancer workers were 51.38 ± 9.1119 years old and the average salary of industry of NTD 31,492 ± 10,696.

Results:

Salary adjustment was the most change in the employment status in cancer survivors. Salary adjustment (37%), 28- to 45-year-old group (55%), male (30%), and Southern district (34%), had the most workers on day 730. Wholesale and Retail Trade had the most of percentage of cancer survivals remained on workplace.

Conclusions:

Change of employment status in cancer survivors are important to decrease the impact of economic burden on society.
A Review of Reported Adverse Events in MRI-Safe and MRI-Conditional Cochlear Implants
Authors: Bestourous Daniel E. , Davidson Lauren , Reilly Brian K.
Published: September 2021

Objectives:

This study looks to examine how the development of diametric magnet cochlear implant devices (CIDs) has affected observed magnetic resonance imaging (MRI)-related adverse events and MRI safety measures.

Methods:

A search of the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was conducted using the product code “MCM” for “Cochlear implants.” Reports were included for analysis if they involved MRI in recipients of cochlear implantation. Included reports were stratified into two cohorts by year: 2010 to 2014 and 2015 to 2020, reflecting the FDA approval of diametric magnet cochlear implants in 2015. Extracted event variables included implant manufacturer, adherence to MRI protocol, patient injuries, and device malfunctions.

Results:

The product code search query yielded a total of 27,305 reports, from which 584 reports were included for analysis. From 2010 to 2014, there were 109 adverse events and 30 pre-MRI explantations. Implant displacement was the most common device malfunction (n = 69, 87.3%), and pain was the most common patient injury (n = 16, 53.3%). From 2015 to 2020, there were 566 adverse events and 62 pre-MRI explantations. The most common device malfunction was implant displacement (n = 365, 94.6%) and pain was the most common patient injury (n = 114, 63.3%). Only 64/114 (56.1%) reports after 2015 reported adherence to the recommended MRI protocol. No adverse events occurred in patients with synchrony diametric-magnet CIDs.

Conclusion:

Despite the advent of FDA-approved MRI-safe diametric magnet devices, implanted patients are still experiencing injury, explantation, and device malfunction, and providers are reporting poor compliance with MRI safety protocols.