bluuebunny/crossref_metadata_2025 huggingface dataset:
HEMORRHOIDS AGAIN?
Authors: López J , Quinto S , López de Lerma C , López-Rodríguez F , Sánchez L , Oller I , Arroyo A , Lacueva J
Published: January 2023

Introduction

Anal cancer represents 4% of digestive tract tumors, although its incidence is increasing due to the growing number of patients with HPV infection, who are immunosuppressed or who practice anal sex. The most common histological type is carcinoma and the usual standard treatment is the combination of radiotherapy with chemotherapy. Survival at 5 years exceeds 50% even in patients with nodal disease.

Clinical case

We present the case of a 54-year-old man, with a history of anal intercourse, referred to General Surgery for hemorrhoids. During the examination in consultation, an ulcerated excrescent anal lesion was observed. A rectal swab was taken for sexually transmitted diseases and a biopsy of the lesion was HPV+, genotype 16. In the pathology study, anal squamous cell carcinoma was diagnosed. An extension study was performed, objectifying bilateral inguinal lymphadenopathies (N1a) and treatment with radiochemotherapy was started after a decision made by the multidisciplinary tumor committee.

Discussion

Anal squamous cell carcinoma is the most frequent histological variety of malignant tumors of the anus. The first-line treatment is radiotherapy (which must be to the inguinal region) associated with chemotherapy (5-FU and mitomycin C). A clinical follow-up should be carried out in all cases at 8–12 weeks and, in addition, an annual extension radiological study in locally advanced cases. Rescue surgery will be reserved for those patients with confirmed locoregional recurrence, with abdominoperineal amputation being the indicated technique in most cases.
CASES' DIAGNOSED WITH SPONDYLODISCITIS DURING THE YEARS 2010–2020. DIAGNOSIS, TREATMENT AND COMPLICATIONS
Authors: González-Herráez Fernández P , Rodríguez Dopazo M , Adeba García M , Adeba García A , Meneses Gutiérrez A , García Arias A , Cabria Fernández J , Mateo Negreira J
Published: January 2023

Introduction

Spondylodiscitis is a rare infectious pathology with high morbidity and mortality that affects the intervertebral disc and adjacent vertebrae. It is most commonly found in the lumbar spine. It is mainly caused by haematogenous dissemination. It is a diagnostic challenge because its main manifestation, low back pain, is a prevalent symptom in the population.

Methods

A retrospective study of patients diagnosed with spondylodiscitis between 2010–2020 (n=60) was carried out. Exclusion criteria (n=14): follow-up less than one year, previous spinal surgery, first year mortality. Measurements made in plain radiology. Statistical analysis STATA 15.2. Statistical significance p<0,05.

Results

Average age: 68.17 years, 55% were males, 45% were females. Risk factors analyzed: 26.09% of the patients had diabetes, 8.70% kidney disease, 6.52% rheumatism, 6.52% were PVDA; about smoking 10.87% were smokers, 17.39% ex-smokers and the 71.74% were non-smokers; 8.70% had prescriptions of immunosuppressants and 19.57% had cancer before or during this episode. 50% had previous infection (n=23); 34.78% had urinary infection, 13.04% had knee prosthesis, 8.69% had respiratory infection, endocarditis the 30.43%, 17.36% had another sort of infection. The average delay to diagnosis was 40.36 days (SD 37.68). Total duration of antibiotic therapy, including days of hospital stay and those which were ambulatory: 134 days (SD 129.96); duration of hospitalization: 43 days. Surgical treatment was performed in 15.56% of the patients. a spacer was the technique used in the 14.29% of the patients; although the fixation was used in the 71.42% of the patients, the majority was a posterior fixation with the 57.14%, the anterior fixation was only used in the 14.29%. The acute complications found in this study were in this order, abscess with nearly half of the patients (n=22), phlegmon (n=3), vertebral destruction (n=2) and meningitis (n=1). No differences were obtained in the angle of kyphosis after pathology (p. 052), no increase in complications due to surgery (p=0.62), no difference in the cure of patients with targeted treatment (p=0.57), nor with surgical treatment (p=0.95), nor in the percentage of cure with diagnostic delay (p=0.76).

Conclusions

Spondylodiscitis is a pathology with non-specific symptoms, which leads to diagnostic delay. The cure rate with medical treatment is high, but it is essential to identify the causal germ in order to initiate targeted antibiotherapy and avoid the appearance of complications and long-term sequelae.
LATE HAEMOPHILLUS ENDOCARDITIS AFTER SEPTAL CLOSURE BY AMPLATZER
Authors: Vázquez Alarcón de la Lastra I , Bustamante Munguira J , Fernández Gutiérrez M , Segura Méndez B , Sánchez Torralvo C , Velasco García E , Feliz Pérez D , Bernal Esteban R
Published: January 2023

Introduction

Atrial septal defects are the second most frequent congenital heart diseases and their treatment of choice is the percutaneous approach. Complications associated are infrequent and are mainly related with the puncture. Other complications such as embolism or endocarditis are uncommon.

Clinical case

A 17-year-old woman whose only medical history of interest was an ostium secundum-type atrial septal defect that was treated percutaneously implanting a 24-mm Amplatzer septal occlude. 15 months after the procedure she came to the emergency room presenting 40°C fever and a headache. Physical examination and tests results were normal, being discharged with antibiotic treatment. She returned 24 hours later due to persistence of the same symptoms. An echocardiogram was performed, revealing an endocarditic growth and uncomplete endothelization of the amplatzer. Following 10 days of antibiogram-guided therapy with good response, she underwent surgery. The device was extracted and the defect closed. PCR was positive for H. Parainfluenzae. The patient was discharged on the 7th day with antibiotic therapy.

Discussion

This case is relevant due to the late presentation of IE, incomplete endothelization and to being caused by infrequent IE germ source with a negative blood culture. Despite the low prevalence of these complications, it is necessary to rule them out through imaging tests as well as microbiological tests. Appropriate length of bacterial coverage usually extends from 6 months to 1 year after implantation. Documented cases of prosthetic IE related to incorrect endothelial coverage can lead to reassessing the time period during which prophylaxis should be maintained.
TUMORAL MASS AS CAUSE OF RIGHT CARDIAC INSUFFICENCY
Authors: Vázquez Alarcón de la Lastra I , Bustamante Munguira J , Fernéndez Gutiérrez M , Segura Méndez B , Sánchez Torralvo C , Velasco García E , Feliz Pérez D , Bernal Esteban R
Published: January 2023

Introduction

The most frequent cardiac primary tumors are Mixomas, typically being located in the left atrium. They are usually incidental findings, but probable symptoms include constitutional syndrome, syncope, congestive symptoms, or embolism. The diagnosis is based upon clinical imaging tests (with the TEE being the test of choice) which define the characteristics of the chosen treatment, surgery.

Clinical case

A 79-year-old female with a medical history of HTA and Diabetes with retinopathy nephropathy. She was hospitalized 2 months earlier with a constitutional syndrome being diagnosed of a Giant cell arteritis. Then she came to the emergency room presenting with oliguria, edema and dyspnea with a 10 kg weight loss. The tests performed showed low voltajes in the EKG, anemization and the TTE showed a mass inside the right atrium. Then she was hospitalized and a CT scan confirmed the presence of an aparent Mixoma. The patient was treated with surgery and the diagnosis was confirmed by pathology.

Discussion

We are describing the case of a pluripathological patient with congestive symptoms due to cardiac insuffciency, so the differential diagnosis must include thromboembolisms, valvulopathies and pulmonary hypertension. The constitutional syndrome can be explained due to the relation of the Mixoma with IL-6 and the anemization could be caused by the hemolyisis of the tumor. After two years of the surgery no further symptoms appeared, and no evidence of the mass where it had been seen in the imaging tests.
PREOPERATIVE ANALYTICAL PREDICTORS OF COMPLICATED ACUTE APPENDICITIS MYTH OR REALITY OF PREDICTIVE SCORES?
Authors: García González L A , Merayo M , Michi Campos J L , Carrasco Beatriz , Rodicio Miravalles J L , Granero Trancon J E
Published: January 2023

Introduction

Acute appendicitis (AA) is the most frequent surgical emergency. Clinical and analytical parameters are the diagnostic basis. We analyze the predictive value of inflammatory markers (IM) and their relationship with complicated appendicitis (cAA), identifying a predictive SCORE.

Methods

Retrospective observational analysis of 484 patients > 14 years operated on for AA at a tertiary center between 2017–2019. 2 groups according to intraoperative findings in complicated and uncomplicated appendicitis (ncAA). Univariate logistic regression analysis was performed to evaluate the predictive ability of leukocyte count (LC), percentage of neutrophils (PN), CRP and polyglobulia) creating a multivariable predictive model.

Results

83.7% <65 years, with ultrasonography being the most frequent diagnostic study and laparoscopy the preferred route of approach. 43.30% (207) complicated vs 54.81% (262) uncomplicated. Both LC and PN and CRP present statistically significant associations with complicated appendicitis, with a cut-off point of LC >18,990, PN >61.8% and CRP >5.05 respectively, while polyglobulia is related to less complication OR 0.63% (p 0.01402). According to the multivariable model 1/ [1 + e - (- 4.45–0.000003 * leukocytes + 0.043 * neutrophil percentage + 0.138 * CRP - 0.028 (if red series anemia) - 1.031 (if red series polyglobulia))] good predictive capacity is evidenced. Harrel's C corrected index of 0.743 CI95% (0.69%-0.78%).

Conclusions

Elevation of IM is associated with cAA. The predictive ability of the described SCORE is acceptable, and useful in surgical planning. Prospective validation is needed.
What Can a Few Make of Mankind?
Authors: Derrig Ríán
Published: January 2023

Harlan Grant Cohen and Timothy Meyer present International Law as Behavior as a collection that aspires to exemplify and set an agenda for an interdisciplinary movement of scholars studying the ‘behavioral roots of international law’. This review essay places the book within a larger context of interactions between behavioural psychology and social sciences. Identifying the origins of contemporary behavioural international law scholarship in behavioural economics, and especially the 1970s work of the psychologists Amos Tversky and Daniel Kahneman, this essay questions the plausibility of the model of human motivation theorized in International Law as Behavior. Moreover, detailed analysis of the consequences of explaining international law phenomena using behavioural concepts demonstrates that responsibility is systematically under-attributed to the powerful and over-attributed to the vulnerable. Ultimately, this essay contends that viewing legal and social phenomena through behavioural psychology offers little explanatory power, while inuring us to a condition of passivity and control, seeking to replace politics with technique.
The Pitfalls of Ineffective Conceptualization: The Case of the Distinction between Procedure and Substance
Authors: Mayer Benoit
Published: January 2023

This review essay explores the distinction that judges and scholars have occasionally made between legal norms that they consider to be procedural and those considered to be substantive in nature. Approaching the issue from different angles, the three books under review all struggle to define procedure and substance as concepts informing a decontextualized distinction among international norms. Overall, they fail to show how this distinction is useful, either to understand what the law is or to account for its evolution. The essay argues that the concepts of ‘procedure’ and ‘substance’ hinder the clarity and, often, the soundness of the analysis presented in these books. At times, this ineffective conceptualization is an intellectual detour that hinders the development of more useful distinctions – for instance, between ‘principal’ and ‘accessory’ obligations, to determine when the breach of an obligation implies the breach of another obligation. Through this case study focused on recent publications on the distinction between procedure and substance, this essay reflects on the capacity of ineffective concepts to hinder the analysis of international law when their relevance and usefulness is too readily taken for granted.
Musical instruments in the Venetian home: contextualizing Marietta Robusti’s self-portrait
Authors: Hurley Bláithín
Published: January 2023

In her self-portrait of c.1578, Marietta Robusti, daughter of Tintoretto, and a successful artist in her own right, represented herself not with the tools of her chosen profession but with a keyboard instrument and holding a music book. Much has been written about how this painting, and others like it, reflect the necessity for well-bred 16th-century young women to promote their musical skills. However, little effort has so far been made to connect the world this image represents with the documentary evidence available in Venetian domestic household inventories. The current article analyses post-mortem and other inventories in order to establish the musical instruments found in 16th-century Venetian homes, and the rooms in which they were found and potentially used. Such inventories, through their employment of simple language and stock descriptive adjectives, offer strong insights into ordinary lives in Renaissance Venice, including the domestic lives of the otherwise invisible musical women of the Venetian household.
Orientation of conduction velocity vectors on cardiac mapping surfaces
Authors: Padilla Jairo Rodriguez , Anderson Robert D , Joens Christian , Masse Stephane , Bhaskaran Abhishek , Niri Ahmed , Lai Patrick , Azam Mohammed Ali , Lee Geoffrey , Vigmond Edward , Nanthakumar Kumaraswamy
Published: January 2023

Aims

Electroanatomical maps using automated conduction velocity (CV) algorithms are now being calculated using two-dimensional (2D) mapping tools. We studied the accuracy of mapping surface 2D CV, compared to the three-dimensional (3D) vectors, and the influence of mapping resolution in non-scarred animal and human heart models.

Methods and results

Two models were used: a healthy porcine Langendorff model with transmural needle electrodes and a computer stimulation model of the ventricles built from an MRI-segmented, excised human heart. Local activation times (LATs) within the 3D volume of the mesh were used to calculate true 3D CVs (direction and velocity) for different pixel resolutions ranging between 500 μm and 4 mm (3D CVs). CV was also calculated for endocardial surface-only LATs (2D CV). In the experimental model, surface (2D) CV was faster on the epicardium (0.509 m/s) compared to the endocardium (0.262 m/s). In stimulation models, 2D CV significantly exceeded 3D CVs across all mapping resolutions and increased as resolution decreased. Three-dimensional and 2D left ventricle CV at 500 μm resolution increased from 429.2 ± 189.3 to 527.7 ± 253.8 mm/s (P < 0.01), respectively, with modest correlation (R = 0.64). Decreasing the resolution to 4 mm significantly increased 2D CV and weakened the correlation (R = 0.46). The majority of CV vectors were not parallel (<30°) to the mapping surface providing a potential mechanistic explanation for erroneous LAT-based CV over-estimation.

Conclusion

Ventricular CV is overestimated when using 2D LAT-based CV calculation of the mapping surface and significantly compounded by mapping resolution. Three-dimensional electric field-based approaches are needed in mapping true CV on mapping surfaces.
Improved prediction of sudden cardiac death in patients with heart failure through digital processing of electrocardiography
Authors: Shiraishi Yasuyuki , Goto Shinichi , Niimi Nozomi , Katsumata Yoshinori , Goda Ayumi , Takei Makoto , Saji Mike , Sano Motoaki , Fukuda Keiichi , Kohno Takashi , Yoshikawa Tsutomu , Kohsaka Shun
Published: January 2023

Aims

Available predictive models for sudden cardiac death (SCD) in heart failure (HF) patients remain suboptimal. We assessed whether the electrocardiography (ECG)-based artificial intelligence (AI) could better predict SCD, and also whether the combination of the ECG-AI index and conventional predictors of SCD would improve the SCD stratification among HF patients.

Methods and results

In a prospective observational study, 4 tertiary care hospitals in Tokyo enrolled 2559 patients hospitalized for HF who were successfully discharged after acute decompensation. The ECG data during the index hospitalization were extracted from the hospitals’ electronic medical record systems. The association of the ECG-AI index and SCD was evaluated with adjustment for left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, and competing risk of non-SCD. The ECG-AI index plus classical predictive guidelines (i.e. LVEF ≤35%, NYHA Class II and III) significantly improved the discriminative value of SCD [receiver operating characteristic area under the curve (ROC-AUC), 0.66 vs. 0.59; P = 0.017; Delong’s test] with good calibration (P = 0.11; Hosmer–Lemeshow test) and improved net reclassification [36%; 95% confidence interval (CI), 9–64%; P = 0.009]. The Fine–Gray model considering the competing risk of non-SCD demonstrated that the ECG-AI index was independently associated with SCD (adjusted sub-distributional hazard ratio, 1.25; 95% CI, 1.04–1.49; P = 0.015). An increased proportional risk of SCD vs. non-SCD with an increasing ECG-AI index was also observed (low, 16.7%; intermediate, 18.5%; high, 28.7%; P for trend = 0.023). Similar findings were observed in patients aged ≤75 years with a non-ischaemic aetiology and an LVEF of >35%.

Conclusion

To improve risk stratification of SCD, ECG-based AI may provide additional values in the management of patients with HF.
Feasibility and safety of a three-dimensional anatomic map–guided transseptal puncture for left-sided catheter ablation procedures
Authors: Bohnen Marius , Minners Jan , Eichenlaub Martin , Weber Reinhold , Allgeier Hans-Jürgen , Jadidi Amir , Neumann Franz-Josef , Westermann Dirk , Arentz Thomas , Lehrmann Heiko
Published: January 2023

Aims

Transseptal puncture (TP) for left-sided catheter ablation procedures is routinely performed under fluoroscopic or echocardiographic guidance [transoesophageal echocardiography (TEE) or intracardiac echocardiography (ICE)], although three-dimensional (3D) mapping systems are readily available in most electrophysiology laboratories. Here, we sought to assess the feasibility and safety of a right atrial (RA) 3D map–guided TP.

Methods and results

In 104 patients, 3D RA mapping was performed to identify the fossa ovalis (FO) using the protrusion technique. The radiofrequency transseptal needle was visualized and navigated to the desired potential FO-TP site. Thereafter, the interventionalist was unblinded to TEE and the potential FO-TP site was reassessed regarding its convenience and safety. After TP, the exact TP site was documented using a 17-segment-FO model. Reliable identification of the FO was feasible in 102 patients (98%). In these, 114 3D map–guided TP attempts were performed, of which 96 (84%) patients demonstrated a good position and 18 (16%) an adequate position after TEE unblinding. An out-of-FO or dangerous position did not occur. A successful 3D map–guided TP was performed in 110 attempts (97%). Four attempts (3%) with adequate positions were aborted in order to seek a more convenient TP site. The median time from RA mapping until the end of the TP process was 13 (12–17) min. No TP-related complications occurred. Ninety-eight TP sites (85.1%) were in the central portion or in the inner loop of the FO.

Conclusion

A 3D map–guided TP is feasible and safe. It may assist to decrease radiation exposure and the need for TEE/ICE during left-sided catheter ablation procedures.
Two clinical case reports of embryonic mosaicism identified with PGT-A persisting during pregnancy as true fetal mosaicism
Authors: Greco Ermanno , Yakovlev Pavel , Kornilov Nikolay , Vyatkina Svetlana , Bogdanova Daria , Ermakova Marina , Tarasova Yulia , Tikhonov Andrei , Pendina Anna , Biricik Anil , Sessa Maria Teresa , Listorti Ilaria , Ronsini Carlo , Greco Pier Francesco , Victor Andrea , Barnes Frank , Zouves Christo , Spinella Francesca , Viotti Manuel
Published: January 2023

The health risks associated with transferring embryos classified as mosaic by preimplantation genetic testing for aneuploidies (PGT-A) are currently unknown. Such embryos produce PGT-A results indicating the presence of both euploid and aneuploid cells and have historically been deselected from transfer and grouped with uniformly aneuploid embryos as ‘abnormal’. In recent years, numerous groups have reported the intentional transfer of mosaic embryos in the absence of uniformly euploid embryos, largely observing births of seemingly healthy babies. However, it remains to be understood whether the embryonic mosaicism invariably becomes resolved during the ensuing pregnancy, or whether the placenta and/or fetal tissues retain aneuploid cells, and if so to what potential clinical effect. Here, we report two cases of mosaicism persisting from the embryonic stage to the established pregnancy. Case 1 involved an embryonic low-level segmental mosaic loss in Chromosome (Chr) 1, which was confirmed in amniocentesis as well as in brain tissue of the products of conception. This pregnancy was terminated due to the chromosomal pathologies associated with 1p36 deletion syndrome, such as severe intellectual disability. Case 2 involved a low-level mosaic Chr 21 trisomy, which was confirmed with chorionic villus sampling and amniocentesis. The ensuing pregnancy was terminated after ultrasound identification of severe abnormalities in the placenta and fetus. Together, these two cases should be taken into account for risk-benefit assessments of prospective mosaic embryo transfers.
Older Adults’ Concurrent and Retrospective Think-Aloud Verbalizations for Identifying User Experience Problems of VR Games
Authors: Fan Mingming , Tibdewal Vinita , Zhao Qiwen , Cao Lizhou , Peng Chao , Shu Runxuan , Shan Yujia
Published: January 2023

While virtual reality (VR) games are beneficial for older adults to improve their physical functions and cognitive abilities, VR research often does not include older adults. Our review of the proceedings of major HCI conferences (i.e. ASSETS, CHI, CHI PLAY, CSCW and DIS) between 2016 and 2020 shows that only three out of 352 VR-related papers involved older adults. Consequently, older adults tend to encounter user experience (UX) problems with VR. One common way to identify UX problems is to conduct usability testing with think-aloud (TA) protocols. As VR games tend to be perceptually and physically demanding, older adults might need to allocate more resources to VR content and interaction and thus have fewer resources for thinking aloud. This raises the question of whether TA protocols are still a viable approach to detecting UX problems of VR games for older adult participants. To answer this question, we conducted usability testing with older adults who played two common types of VR games (i.e. the exergame and experience game) using concurrent and retrospective TA protocols (i.e. CTA and RTA), which are widely used in the industry. We analyzed participants’ TA verbalizations and uncovered how different categories of verbalizations indicate UX problems. We further show how older adults perceived the effects of thinking aloud on their game experiences in two TA protocols and offer design implications.
Development of a Machine Learning Algorithm for Drug Screening Analysis on High-Resolution UPLC-MSE/QTOF Mass Spectrometry
Authors: Hao Ying , Lynch Kara , Fan Pengcheng , Jurtschenko Christopher , Cid Maria , Zhao Zhen , Yang He S
Published: January 2023

Background

Ultra-performance liquid chromatography (UPLC)-MSE/quadrupole time-of-flight (QTOF) high-resolution mass spectrometry employs untargeted, data-independent acquisition in a dual mode that simultaneously collects precursor ions and product ions at low and ramped collision energies, respectively. However, algorithmic analysis of large-scale multivariate data of comprehensive drug screening as well as the positivity criteria of drug identification have not been systematically investigated. It is also unclear whether ion ratio (IR), the intensity ratio of a defined product ion divided by the precursor ion, is a stable parameter that can be incorporated into the MSE/QTOF data analysis algorithm.

Methods

IR of 91 drugs were experimentally determined and variation of IR was investigated across 5 concentrations measured on 3 different days. A data-driven machine learning approach was employed to develop multivariate linear regression (MLR) models incorporating mass error, retention time, number of detected fragment ions and IR, accuracy of isotope abundance, and peak response using drug-supplemented urine samples. Performance of the models was evaluated in an independent data set of unknown clinical urine samples in comparison with the results of manual analysis.

Results

IR of most compounds acquired by MSE/QTOF were low and concentration-dependent (i.e., IR increased at higher concentrations). We developed an MLR model with composite score outputs incorporating 7 parameters to predict positive drug identification. The model achieved a mean accuracy of 89.38% in the validation set and 87.92% agreement in the test set.

Conclusions

The MLR model incorporating all contributing parameters can serve as a decision-support tool to facilitate objective drug identification using UPLC-MSE/QTOF.
Estimation of Reference Intervals from Routine Data Using the refineR Algorithm—A Practical Guide
Authors: Ammer Tatjana , Schützenmeister André , Rank Christopher M , Doyle Kelly
Published: January 2023

Background

Accurate reference intervals are essential for the interpretation of laboratory test results. Typically, they are determined by the central 95% range of test results from a predefined reference population. As these direct studies can face practical and ethical challenges, indirect methods using routine measurements offer an alternative approach.

Methods

We provide step-by-step guidance on how to apply an indirect method in practice using refineR, the most recently published indirect method, and showcase the application by evaluating real-world data of 12 prespecified analytes. Measurements were retrieved from ARUP Laboratories’ data warehouse, and were obtained from routine patient testing on cobas c502 or e602 analyzers. Test results were prefiltered and cleaned and, if necessary, physiologically partitioned prior to estimating reference intervals using refineR. Estimated reference intervals were then compared to established intervals provided by the manufacturer.

Results

For most analytes, the reference intervals estimated by refineR were comparable to those provided by the manufacturer, shown by overlapping confidence intervals at both reference limits, or only the upper or lower limit. For thyroid-stimulating hormone, refineR estimated higher reference limits, while estimates for prealbumin were lower compared to the established reference interval.

Conclusions

We applied the refineR algorithm to a variety of real-world data sets resulting in reference intervals similar to intervals previously established by direct methods. We further provide practical guidance and a code example on how to apply an indirect method in a real-world scenario facilitating their access and thus their use in laboratory settings.
End-to-End Data Automation for Pooled Sample SARS-CoV-2 Using R and Other Open-Source Tools
Authors: Mobini Mahdi , Matic Nancy , Gugten J Grace Van Der , Ritchie Gordon , Lowe Christopher F , Holmes Daniel T
Published: January 2023

Background

Due to supply chain shortages of reagents for real-time (RT)-PCR for SARS-CoV-2 and increasing demand on technical staff, an end-to-end data automation strategy for SARS-CoV-2 sample pooling and singleton analysis became necessary in the summer of 2020.

Methods

Using entirely open source software tools—Linux, bash, R, RShiny, ShinyProxy, and Docker—we developed a modular software application stack to manage the preanalytical, analytical, and postanalytical processes for singleton and pooled testing in a 5-week time frame.

Results

Pooling was operationalized for 81 days, during which time 64 pooled runs were performed for a total of 5320 sample pools and approximately 21 280 patient samples in 4:1 format. A total of 17 580 negative pooled results were released in bulk. After pooling was discontinued, the application stack was used for singleton analysis and modified to release all viral RT-PCR results from our laboratory. To date, 236 109 samples have been processed avoiding over 610 000 transcriptions.

Conclusions

We present an end-to-end data automation strategy connecting 11 devices, one network attached storage, 2 Linux servers, and the laboratory information system.
Cybersecurity and Information Assurance for the Clinical Laboratory
Authors: Patel Ankush U , Williams Christopher L , Hart Steven N , Garcia Christopher A , Durant Thomas J S , Cornish Toby C , McClintock David S
Published: January 2023

Background

Network-connected medical devices have rapidly proliferated in the wake of recent global catalysts, leaving clinical laboratories and healthcare organizations vulnerable to malicious actors seeking to ransom sensitive healthcare information. As organizations become increasingly dependent on integrated systems and data-driven patient care operations, a sudden cyberattack and the associated downtime can have a devastating impact on patient care and the institution as a whole. Cybersecurity, information security, and information assurance principles are, therefore, vital for clinical laboratories to fully prepare for what has now become inevitable, future cyberattacks.

Content

This review aims to provide a basic understanding of cybersecurity, information security, and information assurance principles as they relate to healthcare and the clinical laboratories. Common cybersecurity risks and threats are defined in addition to current proactive and reactive cybersecurity controls. Information assurance strategies are reviewed, including traditional castle-and-moat and zero-trust security models. Finally, ways in which clinical laboratories can prepare for an eventual cyberattack with extended downtime are discussed.

The future of healthcare is intimately tied to technology, interoperability, and data to deliver the highest quality of patient care. Understanding cybersecurity and information assurance is just the first preparative step for clinical laboratories as they ensure the protection of patient data and the continuity of their operations.
Use of Computer Simulation for Calculating Reference Limits for Distribution Overlap
Authors: Vidali Matteo
Published: January 2023

Background

In laboratory medicine, data collected in different settings or under different conditions are frequently analyzed to obtain meaningful information. Evaluation based only on location or variability measures, although useful, is not enough to extract all the value from data. Other mathematical or statistical approaches are possible, but the specific knowledge required is frequently out of the reach of most laboratorians. Computer simulation may help in solving the problem. The aim of this work was to use computer simulation for calculating reference limits for the overlap of 2 distributions.

Methods

Computer simulation was applied to find a reference value, and its confidence limits, from the overlapping area of 2 distributions when population means were allowed to differ by a pre-set amount. The allowable limits were compared with the overlapping area observed between data distributions reported from 3 laboratories. The simulation was run in R language. A description for the experimental setting was added, with the instructions for the simulation reported in structured English.

Results

The simulation allowed estimation of a limit to be used as a reference value when comparing two overlapping areas. Based on these limits, one laboratory in the study was found not to be aligned with the others.

Conclusions

Computer simulation is a low-cost, powerful, and easy to implement tool which may help in solving simple or complex problems, when assumptions are unrealistic or unmet, or when mathematical algorithms are not known or difficult to calculate.
Toward a contextualized understanding of well-being in the midwifery profession: An integrative review
Authors: Mharapara Tago L , Clemons Janine H , Greenslade-Yeats James , Ewertowska Tanya , Staniland Nimbus Awhina , Ravenswood Katherine
Published: January 2023

Our integrative review synthesizes and evaluates two decades of empirical research on well-being in the midwifery profession to reveal (1) how researchers have studied midwives’ well-being; (2) key findings of research on midwives’ well-being; (3) underlying assumptions of this research; and (4) limitations of this research. We find that research on midwives’ well-being is disproportionately focused on individual midwives, who are assumed to be largely responsible for their own well-being, and that well-being in the midwifery profession is generally equated with the absence of mental health problems such as burnout, anxiety, and stress. Researchers have largely taken a narrow and instrumental approach to study midwives’ well-being, focusing on work-related antecedents and consequences, and overlooking the influence of nonwork factors embedded in the broader socioeconomic and cultural environment. Drawing on more comprehensive and contextualized well-being frameworks, we propose a research model that (1) expands the well-being construct as it applies to midwives and (2) situates midwives’ well-being in broader social, economic, political, and cultural contexts. Although developed in the midwifery context, our proposed research model can be applied to a host of professions.
The study of 11 contact binaries with mass ratios less than 0.1
Authors: Liu Xin-Yi , Li Kai , Michel Raul , Gao Xiang , Gao Xing , Liu Fei , Yin Shi-Peng , Wang Xi , Sun Guo-You
Published: January 2023

Multi-band photometric observations of 11 totally eclipsing contact binaries were carried out. Applying the Wilson–Devinney program, photometric solutions were obtained. There are two W-subtype systems, which are CRTS J133031.1+161202 and CRTS J154254.0+324652, and the rest of the systems are A-subtype systems. CRTS J154254.0 + 324652 has the highest fill-out factor with 94.3 per cent, and the lowest object is CRTS J155009.2 + 493639 with only 18.9 per cent. The mass ratios of the 11 systems are all less than 0.1, which means that they are extremely low-mass ratio binary systems. We performed period variation investigation and found that the orbital periods of three systems decrease slowly, which may be caused by the materials may transfer from the primary component to the secondary component, and those of six systems increase slowly, which indicates that the materials may transfer from the secondary component to the primary component. LAMOST low-resolution spectra of four objects were analysed, and using the spectral subtraction technique, Hα emission line was detected, which means that the four objects exhibit chromospheric activity. In order to understand their evolutionary status, the mass–luminosity and mass–radius diagrams were plotted. The two diagrams indicate that the primary component is in the main sequence evolution stage, and the secondary component is above TAMS, indicating that they are over-luminous. To determine whether the 11 systems are in a stable state, the ratio of spin angular momentum to orbital angular momentum (Js/Jo) and the instability parameters were calculated, and we argued that CRTS J234634.7 + 222824 is on the verge of a merger.
Charge exchange between highly charged ions and atomic H for modelling comet C/1999 S4 X-ray emission
Authors: Zhang R T , Liao T , Zhang C J , Zou L P , Guo D L , Gao Y , Gu L Y , Zhu X L , Zhang S F , Ma X
Published: January 2023

Solar wind (SW) charge exchange (CX) is an important mechanism responsible for X-ray emissions in comets’ coma and many other astrophysical environments. By incorporating the experimentally derived total cross-sections and the tested state-selectivity models into the Kronos program, we generate X-ray spectra in H-like and fully stripped C, N, O ion CX collision with atomic H. Using these data, we revisit the fitting of Chandra X-ray data of Comet C/1999 S4 by considering the typical SW collision energies of 0.8 and 3 keV/u, respectively. Our results are in an excellent agreement with the astrophysical observation. We find that charge exchange between C5+,6+, N6+,7+, O7+,8+ and H significantly contributes to the comet’s spectrum ranging from 300 to 800 eV for both slow and fast SW ions, where N7+ abundance is underestimated in previous studies.
Unmet needs and wish for support of family caregivers of primary brain tumor patients
Authors: Pointon Lucy , Grant Robin , Peoples Sharon , Erridge Sara , Sherwood Paula , Klein Martin , Boele Florien
Published: January 2023

Background

Most primary brain tumor patients rely on family caregivers for support. Caregiving can be rewarding, but also leads to significant burden from unmet needs. We aimed to: (1) identify and characterize caregivers’ unmet needs; (2) determine associations between unmet needs and wish for support; (3) evaluate acceptability of the Caregiver Needs Screen (CNS) and perceived feasibility in clinical practice.

Methods

Family caregivers of primary brain tumor patients were recruited from outpatient clinics and asked to complete an adapted version of the CNS consisting of 33 common issues caregivers report (item scale 0–10), and the wish for support (yes/no). Participants ranked acceptability and feasibility (item scale 0–7; higher scores being positive) of the adapted CNS. Descriptive and non-parametric correlational analyses were applied.

Results

Caregivers (N = 71) reported 1–33 unmet caregiving needs (M = 17.20, sd = 7.98) but did not always wish for support (range 0–28, M = 5.82, sd = 6.96). A weak correlation was found between total number of unmet needs and wish for support (r = 0.296, P = .014). Most distressing items were patients’ changes in memory/concentration (M = 5.75, sd = 3.29), patients’ fatigue (M = 5.58, sd = 3.43), and signs of disease progression (M = 5.23, sd = 3.15).Caregivers most often wished support with recognizing disease progression (N = 24), and least often with managing spiritual issues (N = 0). Caregivers evaluated acceptability and feasibility of the CNS tool positively (mean scores ranged 4.2–6.2).

Conclusions

Family caregivers experience distress resulting from many neuro-oncology specific needs, but this is not directly related to wish for support. Family caregiver needs screening could be useful to tailor support to suit their preferences in clinical practice.
Mandatory Vaccinations, Religious Freedom, and Discrimination
Authors: Trispiotis Ilias
Published: January 2023

This article responds to the prevailing normative and doctrinal uncertainty over the compatibility of mandatory vaccination schemes with the right to freedom of religion or belief and the prohibition of discrimination on the grounds of religion or belief under the ECHR. The article develops an analytical framework that engages with the purpose of religious freedom and religious anti-discrimination; the scope of public health as a legitimate aim for state interference with those rights; the procedural fairness of mandatory vaccination schemes; and the empirical evidence underpinning those schemes. This multiprong analysis has important implications for any form of wide-ranging state restrictions on religious freedom and religious anti-discrimination, for reasons of public health, and more broadly.
Climate Risk Disclosure and Institutional Investors
Authors: Ilhan Emirhan , Krueger Philipp , Sautner Zacharias , Starks Laura T
Published: January 2023

Through a survey and analyses of observational data, we provide systematic evidence that institutional investors value and demand climate risk disclosures. The survey reveals the investors have a strong demand for climate risk disclosures, and many actively engage their portfolio firms for improvements. Empirical analyses of holdings data corroborate this evidence by showing a significantly positive association between climate-conscious institutional ownership and better firm-level climate risk disclosure. We establish further evidence of institutional investors’ influence on firms’ climate risk disclosures by examining a shock to the climate risk disclosure demand of French institutional investors (French Article 173).

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Association between maternal plasma total antioxidant capacity and dietary antioxidants intake with birth size outcomes
Authors: Shokri-Mashhadi Nafiseh , Khoshhali Mehri , Heidari-Beni Motahar , Kelishadi Roya
Published: January 2023

Background

Maternal antioxidants intake and plasma total antioxidant capacity (TAC) concentration during pregnancy might influence on birth outcomes. This study was conducted to determine the association between dietary antioxidants intake and plasma TAC during pregnancy with birth outcomes.

Methods

Overall, 220 mother–infant pairs were recruited in the first trimester of pregnancy. Maternal whole blood was collected and TAC was determined by the ELISA kit. Food frequency questionnaire was used to collect information regarding usual dietary intake. Birth size measurements including birth weight, length and head circumference were measured according to standardized protocols.

Results

Energy-adjusted intake of beta-carotene in the first trimester of gestation [beta (SE) = 0.0002 (0.00008); p = 0.016] and energy-adjusted intake of vitamin E in third trimester of pregnancy [beta (SE) = −0.31 (0.15); p = 0.046] had significantly positive and negative associations with birth length, respectively. The maternal plasma TAC was positively correlated with birth weight in both unadjusted and adjusted models [beta (SE) = 2.75 (1.35); p = 0.043 and beta (SE) = 3.43 (1.50); p = 0.023, respectively]. In addition, the adjusted model showed a significant positive relationship between the maternal plasma TAC and birth length [beta (SE) = 0.023 (0.009); p = 0.01].

Conclusion

This study showed the positive association of maternal plasma TAC with birth weight and length. Moreover, maternal dietary intake of beta-carotene in the first trimester and vitamin E in the third trimester of pregnancy had significant positive and negative correlations with birth length, respectively.
Women Legislators in Africa and Foreign Aid
Authors: Annen Kurt , Asiamah Henrietta A
Published: January 2023

There has been a significant rise in the share of women legislators in Africa. What makes this fact puzzling is that it cannot be attributed to an African electorate that values gender equality and having women in political leadership positions. In stark contrast to this, gender equality and women’s empowerment have successively moved up in the priority list of the international donor community over the last two decades. This raises the question of whether there is a relationship between women legislators in Africa and foreign-aid allocations. This study finds a strong and statistically robust relationship: an increase in the share of women legislators from 15 to 20 percent is associated with an increase of about 4 percent in aid conditional on current levels of aid. Additionally, the study finds that democratic countries receive more aid but does not find an interaction effect between democracy and the share of women legislators, which suggests that donors do not tailor their gender-selective aid towards more democratic countries. The results provide evidence in support of aid selectivity for policies that improve gender equality in aid-recipient countries in Sub-Saharan Africa.
Carbon Burial in Sediments below Seaweed Farms
Authors: Duarte Carlos M. , Delgado-Huertas Antonio , Marti Elisa , Gasser Beat , San Martin Isidro , Cousteau Alexandra , Neumeyer Fritz , Reilly-Cayten Megan , Boyce Joshua , Kuwae Tomohiro , Hori Masakazu , Miyajima Toshihiro , Price Nichole N. , Arnold Suzanne , Ricart Aurora M. , Davis Simon , Surugau Noumie , Abdul Al-Jeria , Wu Jiaping , Xiao Xi , Chung Ik Kyo , Choi Chang Geun , Sondak Calvyn F.A. , Albasri Hatim , Krause-Jensen Dorte , Bruhn Annette , Boderskov Teis , Hancke Kasper , Funderud Jon , Borrero-Santiago Ana R. , Pascal Fred , Joanne Paul , Ranivoarivelo Lanto , Collins William T. , Clark Jennifer , Gutierrez Juan Fermin , Riquelme Ricardo , Avila Marcela , Macreadie Peter I. , Masque Pere
Published: January 2023

The hypothesis that seaweed farming contributes to carbon burial below the farms was tested by quantifying burial rates in 20 seaweed farms distributed globally, ranging from 2 to 300 years in operation and from 1 ha to 15,000 ha in size. This involved combining analyses of organic carbon density with sediment accumulation rate in sediments below seaweed farms relative to reference sediments beyond the farm and/or prior to the farm operation. One in every four farms sampled was set over environments that export, rather than retain materials. For the farms that were placed over depositional environments, where sediment accumulation could be quantified, the thickness of sediment layers and stocks of carbon accumulated below the farms increased with farm age, reaching 140 ton C ha-1for the oldest farm, and tended to exceed those in reference sediments beyond the farm and/or prior to the operation of the farms. Organic carbon burial rates in the farm sediments averaged (± SE) 1.87 ± 0.73 ton CO2equivalent (CO2-eq) ha-1year-1(median 0.83, range 0.10 – 8.99 ton CO2-eqha-1year-1), twice the average (± SE) burial rate in reference sediments (0.90 ± 0.27, median 0.64, range 0.10-3.00 ton CO2-eqha-1year-1), so that the excess organic carbon burial attributable to the seaweed farms averaged 1.06 ± 0.74 ton CO2-eqha-1year-1(median 0.09, range −0.13-8.10 ton CO2-eqha-1year-1). This first direct quantification of carbon burial in sediments below seaweed farms confirms that, when placed over depositional environments, seaweed farming tend to sequester carbon in the underlying sediments, but do so at widely variable rates, increasing with farm yield.