bluuebunny/crossref_metadata_2025 huggingface dataset:
Child growth, neurodevelopment and pre and postnatal exposure to phthalates: first exposure data
Authors: Maione D , Lucaccioni L , Arletti M , Panciroli G , Poluzzi F , Ferrari A , Facchinetti F , Fantuzzi G , Righi E
Published: October 2020

Background

Phthalates, potential endocrine disruptors added to plastics, are found in numerous products and contaminate many environmental matrices, resulting in a widespread human exposure virtually interfering with fetal and neonatal development. This study aims to evaluate, by repeated mothers and children urine monitoring, the exposure to phthalates in newborns and to investigate its potential effects in early life.

Methods

A cohort study, recruiting mothers and newborns at an Italian hospital, is ongoing. Prenatal exposure is assessed by measuring 6 phthalates in maternal and neonatal urine; while postnatal exposure is assessed in the infants urines at 3rd and 6th month. Infants undergo periodic visits (t0, t3, t6, t12, t24) to assess growth, neurocognitive development and urinary sex hormone levels; mothers fill in exposure questionnaires at t0 and t6.

Results

To date, 148 mother-child couples have been enrolled, 74 children checked at t3 and 35 at t6. The newborns (3.4±0.3kg weight, 50.2±1.7cm length), show physiological hormonal levels: LH 0.6±1.8mIU/ml; FSH 1.5±1.6mIU/ml, testosterone 10.3±4.8ng/ml, estradiol 843.9±972.4pg/ml. Phthalates appear highly widespread both in mothers and infants, although at low levels. MEP shows the highest levels (mothers: 37.3±83.2µg/L; infants: 19.6±32.8µg/L), followed by MnBP (mothers: 11.3±14.4µg/L; infants: 21.3±25.5µg/L) and MBzP (mothers: 3.9±3.9µg/L; infants: 8.1±9.8µg/L). All mothers report frequent contact with products potentially containing phthalates, however mother-child couples levels showed very low correlations.

Conclusions

Exposure to phthalates for infants appears widespread, albeit at low levels. Neonatal urine biomonitoring is a valid tool to evaluate child exposure, able to produce more accurate information than maternal urine.

Key messages

Biomonitoring of childhood urine produces accurate data on pre and postnatal exposure to phthalates. Biomonitoring of childhood urinary phthalates can enhance the assessment of their potential effects on growth and development.
Paul Valéry’s Vitalism: Life and Entropy
Authors: Rosenberg Daniel
Published: October 2020

Paul Valéry’s interest in the life sciences is an important yet little-studied aspect of his work. Although Valéry was known primarily as a reader of mathematics and physics, his fascination with the life sciences has often been ignored or regarded as mere curiosity. This article examines Valéry’s writing on the subject of biology by focusing on the unique status he accords to the notion of life. In both his theoretical and poetic writings, Valéry addresses the notion of life as a category endowed with distinct ontological attributes — as a phenomenon that encompasses a distinct type of order. Life, as an independent force, is capable of resisting and even reversing the principle of entropy, which Valéry regards as a universal tendency towards degradation and dispersion that affects all inanimate matter. Valéry’s thought thus exhibits a complicated yet clear affinity with the intellectual tradition known as vitalism. The article discusses this affinity by analysing the presence of vitalist ideas and imagery in Valéry’s corpus, giving special attention to his most expressly ‘biological’ work, the essay ‘L’Homme et la coquille’ (‘The Man and the Seashell’).
Benchmarking Orthogroup Inference Accuracy: Revisiting Orthobench
Authors: Emms David M , Kelly Steven
Published: October 2020

Orthobench is the standard benchmark to assess the accuracy of orthogroup inference methods. It contains 70 expert-curated reference orthogroups (RefOGs) that span the Bilateria and cover a range of different challenges for orthogroup inference. Here, we leveraged improvements in tree inference algorithms and computational resources to reinterrogate these RefOGs and carry out an extensive phylogenetic delineation of their composition. This phylogenetic revision altered the membership of 31 of the 70 RefOGs, with 24 subject to extensive revision and 7 that required minor changes. We further used these revised and updated RefOGs to provide an assessment of the orthogroup inference accuracy of widely used orthogroup inference methods. Finally, we provide an open-source benchmarking suite to support the future development and use of the Orthobench benchmark.
Social Exclusion and Subjective Well-being Among Older Adults in Europe: Findings From the European Social Survey
Authors: Lee Sunwoo
Published: October 2020

Objectives

The current study aims to examine how social exclusion is related to subjective well-being in older adults across different European regions.

Methods

European population-based cross-sectional study design was employed using data sampled from the eighth round of the European Social Survey (ESS). Multiple items for social exclusion were used in this round, including household income, civic participation, frequent meetings with friends and relatives, basic health services, and neighborhood cohesion. Life satisfaction, happiness, and self-rated general health were also assessed. An ANOVA was performed to examine the regional differences related to social exclusion and subjective well-being, while a regression analysis was used to examine the relationship between the social exclusion and subjective well-being.

Results

There were significant regional differences in the social exclusion and subjective well-being of older Europeans. In addition, older adults in the Nordic nations are more likely to indicate higher levels of subjective well-being and lower levels of social exclusion, while older adults from Central and Eastern European nations tend to report lower levels of subjective well-being and higher levels of social exclusion. Material resources and basic services are highlighted as the most important domains pertaining to life satisfaction, happiness, and general health.

Discussion

The study findings reinforce the inequality in subjective well-being linked to social exclusion across different societies. Both global and country-specific exclusion models in later life should be implemented in order to enhance comparable research and provide insight into EU and national guidelines for interventions to diminish social exclusion.
Strategic ambiguity and the Trumpian approach to China–Taiwan relations
Authors: Boon Hoo Tiang , Sworn Hannah Elyse
Published: October 2020

The notion of strategic ambiguity has long guided the United States’ engagement in cross-strait relations, requiring that Washington is intentionally unclear about whether and how it would intervene in a China–Taiwan conflict in order to preserve a balance of assurance and deterrence for both sides. This article unpacks the US approach to strategic ambiguity under Trump. Adopting a neo-classical realist perspective, it argues that domestic and individual level drivers—in particular, US populism, Congress and the foreign policy establishment, and Trump's transactional and personalized approach to foreign policy—have interacted with the shifting US–China balance of power to produce a different mode of American strategic ambiguity in the Taiwan Strait. A common view is that as a function of the growing US–China power competition, the US has largely leaned towards Taiwan in recent years. Our analysis revises this assessment by revealing a form of strategic ambiguity under Trump that, despite appearing to upset the balance of ambiguity in favour of Taiwan—paradoxically and probably unintentionally—maintains assurances and warnings for both China and Taiwan. Yet, while Trump has arguably preserved the overall balance of strategic ambiguity, he has introduced greater volatility into cross-strait relations.
Comparative analysis of the results of video-assisted thoracic surgery lobectomy simulation using the three-dimensional-printed Biotexture wet-lung model and surgeons’ experience
Authors: Tanaka Takahiko , Shimada Yoshihisa , Furumoto Hideyuki , Makino Yojiro , Kudo Yujin , Maehara Sachio , Hagiwara Masaru , Kakihana Masatoshi , Kajiwara Naohiro , Ohira Tatsuo , Ikeda Norihiko
Published: October 2020

OBJECTIVES

We performed a comparative analysis of the performance of video-assisted thoracic surgery (VATS) lobectomy simulation using three-dimensional-printed Biotexture lung models by surgeons classified according to their level of expertise. The aim of this study was to investigate the association between surgeons’ experience and time to complete the VATS lobectomy simulation.

METHODS

Participants were divided into 3 groups: group A included those who had no experience of actual VATS lobectomy (n = 11), group B included those who had performed 5–10 VATS lobectomies (n = 12) and group C included those who had performed >100 VATS lobectomies (n = 6). Their performances were assessed based on total procedure time, duration to the exposure of the vessels, ligation of the arteries and stapling of the fissures. After the simulation, a questionnaire survey was performed.

RESULTS

The median total procedure time was significantly shorter in the group of surgeons with more experience (A vs B, P < 0.001; B vs C, P = 0.034; A vs C, P < 0.001). Regarding ‘the exposure of all the vessels to be resected’ and ‘ligation of the arteries’, group B completed these steps in less time than group A (P = 0.024 and P = 0.012, respectively). In the questionnaire, all groups answered that this simulation was useful for novices to improve their skills.

CONCLUSIONS

Although time to complete the VATS lobectomy simulation is only a part of evaluation points for real skills, this model can facilitate basic skill acquisitions for novices.
Galerkin approximation of linear problems in Banach and Hilbert spaces
Authors: Arendt W , Chalendar I , Eymard R
Published: October 2020

In this paper we study the conforming Galerkin approximation of the problem: find $u\in{{\mathcal{U}}}$ such that $a(u,v) = \langle L, v \rangle $ for all $v\in{{\mathcal{V}}}$, where ${{\mathcal{U}}}$ and ${{\mathcal{V}}}$ are Hilbert or Banach spaces, $a$ is a continuous bilinear or sesquilinear form and $L\in{{\mathcal{V}}}^{\prime}$ a given data. The approximate solution is sought in a finite-dimensional subspace of ${{\mathcal{U}}}$, and test functions are taken in a finite-dimensional subspace of ${{\mathcal{V}}}$. We provide a necessary and sufficient condition on the form $a$ for convergence of the Galerkin approximation, which is also equivalent to convergence of the Galerkin approximation for the adjoint problem. We also characterize the fact that ${{\mathcal{U}}}$ has a finite-dimensional Schauder decomposition in terms of properties related to the Galerkin approximation. In the case of Hilbert spaces we prove that the only bilinear or sesquilinear forms for which any Galerkin approximation converges (this property is called the universal Galerkin property) are the essentially coercive forms. In this case a generalization of the Aubin–Nitsche Theorem leads to optimal a priori estimates in terms of regularity properties of the right-hand side $L$, as shown by several applications. Finally, a section entitled ‘Supplement’ provides some consequences of our results for the approximation of saddle point problems.
Post-processing for spatial accuracy-enhancement of pure Lagrange–Galerkin schemes applied to convection-diffusion equations
Authors: Benítez Marta , Cockburn Bernardo
Published: October 2020

We analyze a technique to improve the spatial accuracy, by the single application at the end of the simulation of a local post-processing, for pure Lagrange–Galerkin (PLG) methods applied to evolutionary convection-diffusion (possibly pure convection/diffusion) equations with time-dependent domains. The post-processing technique is based on a simple convolution that extracts the ‘hidden accuracy’ of Galerkin schemes, and it is used and rigorously analyzed in a fully discrete context. We prove that, when applied to the numerical solution of PLG schemes, it improves the spatial accuracy in the $l^{\infty }(L^2(\varOmega ^0))$-norm from order $k+1$ to at least order $2k$, where $k$ is the degree of the polynomials defining the finite element space and $\varOmega ^0$ any interior region of the computational domain meshed with translation-invariant meshes. For pure convection, a spatial accuracy enhancement in the $l^{\infty }(L^2(\varOmega ^0))$-norm from order $k+1$ to order $2k+2$ is obtained by post-processing the numerical solution of PLG schemes. Numerical tests are presented that confirm these theoretical results.
A Premature Infant With Neonatal Actinomyces odontolyticus Sepsis
Authors: Rueda Maria S , Hefter Yosefa , Stone Brian , Hahn Andrea , Jantausch Barbara
Published: October 2020

We describe the presentation, diagnosis and management of a premature newborn with Actinomyces odontolyticus bacteremia; this is the first case report of neonatal sepsis secondary to this bacteria. Maternal dental infection was the likely source of the pathogen. The outcome was favorable, with good response to antimicrobial therapy with ampicillin/amoxicillin.
Kinking graft—an exceptional late complication of axillofemoral bypass grafting
Authors: Lozano Francisco , Rubio Carola , Velasco Paula , González-Porras José R
Published: October 2020

The axillary-femoral bypass is an extra-anatomical arterial reconstruction technique whose indications and complications have been thoroughly discussed in the literature. Shortening or lengthening of the prosthesis (by axillary artery traction or graft angulation, respectively) as a late postoperative complication of the procedure has been described only exceptionally. Here we report a kinking of the prosthesis with a very illustrative figure.
Epidemiology of infection in elderly populations in various settings
Authors: Gavazzi Gaëtan , Fraisse Thibaut , de Wazières Benoit
Published: October 2020

Age is associated with an increased risk of infection because of individual susceptibility (immunosenescence, comorbidities, malnutrition, functional status), as well as collective risk factors. Outcomes are also of concern, because for all infections, older patients exhibit higher short and long-term mortality rates. Over the last decade, subgroups of older populations (either community-dwelling, hospitalized or nursing home residents) have been distinguished, because epidemiological data regarding infections differ between these groups in terms of incidence, type, severity, and microbiology. Although urinary tract and respiratory tract infections appear to be the most frequent infections in these specific populations, skin/soft tissue and gastrointestinal infections, as well as meningitis are frequent in community-acquired infection (CAI), whereas outbreaks (respiratory and gastrointestinal) are more specific to nursing home infections, and antibiotic resistance is emerging as a major issue for both hospitalized and nursing home elder populations.
COVID-19 Disease
Authors: Conlon Christopher P. , Firth John D.
Published: October 2020

A novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2), first appeared in the city of Wuhan in Central China in December 2019. Initial cases appeared to be centred on a so-called wet market, but the outbreak spread rapidly. The World Health Organisation (WHO) declared a Pandemic Health Emergency of International Concern on 30 January, 2020. At the time of writing, there have been over 11 million cases globally and more than 500,000 deaths.
Alternative therapies
Authors: Ernst Edzard
Published: October 2020

Alternative therapies are used by many patients suffering from rheumatic conditions. In this chapter, the efficacy and safety of various forms of alternative medicine will be discussed based on the evidence from clinical trials and systematic reviews. The following treatments will be considered: acupuncture, Ayurvedic medicine, chiropractic, dietary supplements, herbal remedies, homeopathy, massage, osteopathy, t’ai chi, and yoga.
Perioperative management of immunosuppression
Authors: Carmona Loreto , Galindo Maria , Martin Maria
Published: October 2020

Many rheumatologists are concerned about the complications of maintaining immunosuppression at the time of elective surgery. Complications may be increased risk of infection, or a slow healing of the surgical wound. On the other hand, stopping medication may place the patient at undesirable levels of disease activity. Many rheumatologists actually act on art, stopping the drug perioperatively depending on blood count, drug type and dose, previous postoperative complications, type of surgery, and other factors. The timing of stopping treatment preoperatively and restarting after surgery also significantly differ among rheumatologists. All in all, there is a great variability in clinical practice related to the perioperative use of immunosuppressants.
This chapter reviews the evidence on methotrexate, glucocorticoids, and biological therapies related to the perioperative period, and it proposes some recommendations on the management of immunosuppressant drugs in rheumatic diseases. Factors that may be related to complications will also be reviewed.
Psoriatic arthritis
Authors: Coates Laura C. , Helliwell Philip S.
Published: October 2020

Psoriasis is a chronic skin condition affecting about 3% of Europeans and North Americans. About 15% of people afflicted with psoriasis will develop psoriatic arthritis—cutaneous risk factors for this are psoriasis of the nails, scalp, and flexures. Since most cases of arthritis develop in people with psoriasis, new screening tools, both clinical and imaging, are available. Some genetic factors may also explain susceptibility and severity. Historically, five clinical subgroups have been described but these may be simplified to axial and peripheral involvement, the latter dividing into oligo- and polyarticular patterns. The importance of these clinical subdivisions is still under debate and research but it is clear that there is marked heterogeneity in all manifestations of this disease. In recent times the importance of extra-articular features has gained prominence such that the metabolic syndrome and cardiovascular morbidity are now seen as important features of ’psoriatic disease’. The diverse changes seen in bone on imaging reflect both the underlying pathogenic mechanisms and the ways in which the disease progresses. Recent work with animal models and immunohistochemistry has further advanced our understanding of these features. In the biologic era renewed interest in psoriatic arthritis has stimulated research into outcome assessment and permitted clearer understanding of how these new drugs work on the different aspects of the disease. In addition, improved recognition of the impact of the disease on the person has stimulated the development of new patient-reported outcome tools.
Divergence and Remarkable Diversity of the Y Chromosome in Guppies
Authors: Almeida Pedro , Sandkam Benjamin A , Morris Jake , Darolti Iulia , Breden Felix , Mank Judith E
Published: October 2020

The guppy sex chromosomes show an extraordinary diversity in divergence across populations and closely related species. In order to understand the dynamics of the guppy Y chromosome, we used linked-read sequencing to assess Y chromosome evolution and diversity across upstream and downstream population pairs that vary in predator and food abundance in three replicate watersheds. Based on our population-specific genome assemblies, we first confirmed and extended earlier reports of two strata on the guppy sex chromosomes. Stratum I shows significant accumulation of male-specific sequence, consistent with Y divergence, and predates the colonization of Trinidad. In contrast, Stratum II shows divergence from the X, but no Y-specific sequence, and this divergence is greater in three replicate upstream populations compared with their downstream pair. Despite longstanding assumptions that sex chromosome recombination suppression is achieved through inversions, we find no evidence of inversions associated with either Stratum I or Stratum II. Instead, we observe a remarkable diversity in Y chromosome haplotypes within each population, even in the ancestral Stratum I. This diversity is likely due to gradual mechanisms of recombination suppression, which, unlike an inversion, allow for the maintenance of multiple haplotypes. In addition, we show that this Y diversity is dominated by low-frequency haplotypes segregating in the population, suggesting a link between haplotype diversity and female preference for rare Y-linked color variation. Our results reveal the complex interplay between recombination suppression and Y chromosome divergence at the earliest stages of sex chromosome divergence.
Using Benford’s law to assess the quality of COVID-19 register data in Brazil
Authors: Silva Lucas , Figueiredo Filho Dalson
Published: October 2020

We employ Newcomb–Benford law (NBL) to evaluate the reliability of COVID-19 figures in Brazil. Using official data from February 25 to September 15, we apply a first digit test for a national aggregate dataset of total cases and cumulative deaths. We find strong evidence that Brazilian reports do not conform to the NBL theoretical expectations. These results are robust to different goodness of fit (chi-square, mean absolute deviation and distortion factor) and data sources (John Hopkins University and Our World in Data). Despite the growing appreciation for evidence-based-policymaking, which requires valid and reliable data, we show that the Brazilian epidemiological surveillance system fails to provide trustful data under the NBL assumption on the COVID-19 epidemic.
Occurrence of Quinone Outside Inhibitor Resistance in Virginia Populations of Parastagonospora nodorum Infecting Wheat
Authors: Kaur Navjot , Mullins Chase , Kleczewski Nathan M. , Mehl Hillary L.
Published: October 2020

Stagonospora nodorum blotch (SNB) of wheat, caused by Parastagonospora nodorum, is managed using cultural practices, resistant varieties, and foliar fungicides. Frequent fungicide use can select for fungicide resistance, making certain chemistries less effective; this may in part explain the increasing severity of SNB in the mid-Atlantic United States. Quinone outside inhibitor (QoI) resistance has been documented for a diversity of fungi, but it has not been reported for P. nodorum in the United States. The objectives of this study were (i) to evaluate QoI sensitivity of P. nodorum from Virginia wheat fields, (ii) to screen P. nodorum for QoI target site mutations in the cytochrome b gene, and (iii) to develop a molecular assay to detect target site mutations associated with QoI resistance. Sensitivity of 16 isolates to pyraclostrobin and azoxystrobin was evaluated with radial growth assays, and the cytochrome b gene was sequenced. One isolate was insensitive to both fungicides and had the G143A mutation in the cytochrome b gene. For azoxystrobin, 10 isolates without target site mutations had reduced sensitivity. Additional isolates (n = 58) were sequenced. A total of seven isolates had the G143A mutation and also had reduced sensitivity to pyraclostrobin and azoxystrobin compared with a sensitive control isolate without the mutation. A pyrosequencing assay targeting G143A was developed as a rapid method to screen P. nodorum for the QoI resistance-conferring mutation. To our knowledge, this is the first report of QoI-resistant P. nodorum in the United States. Overall resistance frequency was low, but resistance management practices are needed to maintain the efficacy of fungicides for SNB control.
Artificial intelligence and the hunt for immunological disorders
Authors: Rider Nicholas L. , Srinivasan Renganathan , Khoury Paneez
Published: October 2020

Purpose of review

Artificial intelligence has pervasively transformed many industries and is beginning to shape medical practice. New use cases are being identified in subspecialty domains of medicine and, in particular, application of artificial intelligence has found its way to the practice of allergy-immunology. Here, we summarize recent developments, emerging applications and obstacles to realizing full potential.

Recent findings

Artificial/augmented intelligence and machine learning are being used to reduce dimensional complexity, understand cellular interactions and advance vaccine work in the basic sciences. In genomics, bioinformatic methods are critical for variant calling and classification. For clinical work, artificial intelligence is enabling disease detection, risk profiling and decision support. These approaches are just beginning to have impact upon the field of clinical immunology and much opportunity exists for further advancement.

This review highlights use of computational methods for analysis of large datasets across the spectrum of research and clinical care for patients with immunological disorders. Here, we discuss how big data methods are presently being used across the field clinical immunology.
Evaluating Core Clerkships: Lessons Learned From Implementing a Student-Driven Feedback System for Clinical Curricula
Authors: Russel Sarah M. , Geraghty Joseph R. , Kobayashi Kenji R. , Patel Savan , Stringham Richard , Hyderi Abbas , Curry Raymond H.
Published: October 2020

Problem

Medical schools have implemented various ways to engage students in improving medical curricula. These systems, however, usually focus on the preclerkship curriculum, perhaps because medical students move through this phase of medical education synchronously, making it easier to collect student input. In contrast, clerkship and postclerkship curricula often lack similar levels of student engagement in program evaluation.

Approach

To increase communication among students, faculty, and administration during the clinical years of medical education, the Student Curricular Board (SCB) at the University of Illinois College of Medicine’s Chicago campus (UICOM–Chicago) developed a student-driven feedback model in 2016 that aimed to parallel the system previously implemented in the preclerkship years. Interested fourth-year students were selected by their peers to represent individual core clerkships, and they communicated regularly with clerkship directors about concerns from current clerkship students. Third-year students applied and were selected to represent their cohort of peers moving through clerkship tracks. Proposed changes and improvements were tracked via novel, student-driven SOAP-Education (SOAP-Ed) progress notes written throughout the academic year.

Outcomes

In response to a program evaluation survey conducted after implementation of this pilot, third-year students said they felt that their feedback was taken seriously by faculty and administration. Furthermore, student feedback led to meaningful changes in core clerkship curricula and in the system used to gather clerkship feedback. Clerkship directors expressed appreciation for this partnership, and students said they gained valuable leadership experience and knowledge of curricular development.

Next Steps

Current SCB members and curricular leadership plan to assess student and faculty perceptions of this system and its efficacy and work toward expansion to all UICOM campuses. Lessons learned from this student-driven model of feedback in third-year core clerkships will likely add to the conversation on how to better engage medical students as active stakeholders in their own education.
Medical Student Progress Examination Performance and Its Relationship With Metacognition, Critical Thinking, and Self-Regulated Learning Strategies
Authors: Chang Chi , Colón-Berlingeri Migdalisel , Mavis Brian , Laird-Fick Heather S. , Parker Carol , Solomon David
Published: October 2020

Purpose

Metacognition and critical thinking are essential for academic success. The relationship between these components and medical student learning, as assessed with progress examinations, informs curriculum development and efforts to ensure learning progression of all students. This study assessed learning mechanisms by modeling medical students’ progress test performance longitudinally at Michigan State University College of Human Medicine.

Method

Medical students’ (n = 184) medical knowledge was assessed 5 times from fall 2017 through spring 2019 using the Comprehensive Basic Science Examination (CBSE). Structural equation modeling was conducted to investigate associations between 3 latent structures—metacognitive awareness, critical thinking, and self-regulation—and their relationship with students’ initial CBSE scores and growth in such scores. The authors measured metacognitive knowledge and regulation by the Metacognitive Awareness Inventory, critical thinking skills by the Watson-Glaser Critical Thinking Appraisal, and self-regulation by the Learning and Study Strategies Inventory.

Results

Students’ aggregate performance on 5 CBSE scores grew 31.0% the first semester, 16.5% the second semester, 30.1% the third semester, and 22.4% the last semester. Critical thinking had a significant positive relationship with initial performance (

JOURNAL/acmed/04.03/00001888-202102000-00048/inline-graphic1/v/2023-07-18T003513Z/r/image-tiff

1.956, P < .001), self-regulation had a significant positive relationship with growth (

JOURNAL/acmed/04.03/00001888-202102000-00048/inline-graphic2/v/2023-07-18T003513Z/r/image-tiff

3.287, P < .05), and metacognitive awareness had a negative relationship with growth of student performance in the progress test (

JOURNAL/acmed/04.03/00001888-202102000-00048/inline-graphic3/v/2023-07-18T003513Z/r/image-tiff

−3.426, P < .01).

Conclusions

This structural equation framework is useful for examining the relationships among 3 latent structures—critical thinking, metacognition, and self-regulation—and their relationships with students’ progress scores in academic achievement. The initial status of progress examination scores was explained by students’ critical thinking ability, but their learning growth on the progress scores was explained by their self-regulation and metacognitive ability. These findings help explain student performance on standardized progress examinations and can aid in interventions to promote student success.
COVID-19 Threatens Progress Toward Gender Equity Within Academic Medicine
Authors: Woitowich Nicole C. , Jain Shikha , Arora Vineet M. , Joffe Hadine
Published: October 2020

Women remain underrepresented within academic medicine despite past and present efforts to promote gender equity. The authors discuss how the COVID-19 pandemic could stymie progress toward gender parity within the biomedical workforce and limit the retention and advancement of women in science and medicine. Women faculty face distinct challenges as they navigate the impact of shelter-in-place and social distancing on work and home life. An unequal division of household labor and family care between men and women means women faculty are vulnerable to inequities that may develop in the workplace as they strive to maintain academic productivity and professional development without adequate assistance with domestic tasks and family care. Emerging data suggest that gender differences in academic productivity may be forthcoming as a direct result of the pandemic. Existing gender inequities in professional visibility, networking, and collaboration may be exacerbated as activities transition from in-person to virtual environments and create new barriers to advancement. Meanwhile, initiatives designed to promote gender equity within academic medicine may lose key funding due to the economic impact of COVID-19 on higher education. To ensure that the gender gap within academic medicine does not widen, the authors call upon academic leaders and the broader biomedical community to support women faculty through deliberate actions that promote gender equity, diversity, and inclusion. The authors provide several recommendations, including faculty needs assessments; review of gender bias within tenure-clock–extension offers; more opportunities for mentorship, sponsorship, and professional recognition; and financial commitments to support equity initiatives. Leadership for these efforts should be at the institutional and departmental levels, and leaders should ensure a gender balance on task forces and committees to avoid overburdening women faculty with additional service work. Together, these strategies will contribute to the development of a more equitable workforce capable of transformative medical discovery and care.
Clinical Correlation of Intraoperative Neuromonitoring in 319 Individuals Undergoing Posterior Decompression and Fixation of Spine
Authors: Modi Hitesh N. , Goel Shakti A. , Desai Yatin J. , Modi Poonam N.
Published: October 2020

Study Design:

This was a prospective study.

Objectives:

To correlate improvement in motor evoked potential (MEP) during spine surgery with postoperative clinical improvement.

Materials and Methods:

Three hundred fifty-three patients operated for posterior spinal decompression and fixation surgeries were prospectively selected and followed up. Patients who underwent lumbar, dorsal, and cervical surgeries were grouped into—group A, B, and C, respectively. Intraoperative neuromonitoring was done using MEP with free-running electromyography. Improvements in MEP scores were calculated in percentage. Similarly, postoperative improvement in Oswestry disability index (ODI) and visual analog scale (VAS) scores at 3 months were calculated in percentage. Improvements in MEP scores were correlated with clinical improvement using the Spearman ρ test and the r value was calculated to find out the association.

Results:

Of 353 patients, 319 (250—group A, 38—group B, and 31—group C) were included for the study. VAS and ODI improved significantly from preoperative 8.5±0.8 and 62.9±14.5, to postoperative 2.3±1.1 and 15.9±11.5, respectively, in the entire group. Average preoperative MEP were 127.8±191.0 mV on the right side and 132.3±206.6 mV on the left side, which significantly improved to 163.7±231.2 mV (P=0.0001) and 155.2±219.6 mV (P=0.0001), respectively, showing 157.0% and 178.5% improvement. Correlating MEP improvement with postoperative improvement in ODI showed poor correlation (r=0.088 right and 0.030 left sides). Similarly, correlating MEP improvement with improvement in VAS showed r=0.110 on the right and −0.023 on the left side suggesting poor correlation. Postoperative neurological complications (0.56%) were found in 2 patients in the form of screw malpositioning.

Conclusions:

Intraoperative neuromonitoring showed significant improvement during posterior decompression and fixation surgery, and reduction in postoperative neurological complication. The study also exhibited significant postoperative clinical improvement. However, improvement in MEP did not correlate with postoperative clinical improvement suggesting that it has no predictive role.
Iodine Redistribution During Trauma, Sepsis, and Hibernation: An Evolutionarily Conserved Response to Severe Stress
Authors: Morrison Michael L. , Iwata Akiko , Wick Merry L. , VandenEkart Emily , Insko Michael A. , Henning Daniel J. , Frare Carla , Rice Sarah A. , Drew Kelly L. , Maier Ronald V. , Roth Mark B.
Published: October 2020

Objective:

We performed these studies to learn how iodine in the form of free iodide behaves during stress.

Design:

Prospective observational trial using samples obtained from human trauma patients and retrospective observational study using remnant samples from human sepsis patients and arctic ground squirrels. Preclinical interventional study using hind-limb ischemia and reperfusion injury in mice.

Setting:

Level I trauma center emergency room and ICU and animal research laboratories.

Subjects:

Adult human sepsis and trauma patients, wild-caught adult arctic ground squirrels, and sexually mature laboratory mice.

Interventions:

Ischemia and reperfusion injury was induced in mice by temporary application of tourniquet to one hind-limb. Iodide was administered IV just prior to reperfusion.

Measurements and Main Results:

Free iodide was measured using ion chromatography. Relative to iodide in plasma from normal donors, iodide was increased 17-fold in plasma from trauma patients and 26-fold in plasma from sepsis patients. In arctic ground squirrels, iodide increases over three-fold during hibernation. And during ischemia/reperfusion injury in mice, iodide accumulates in ischemic tissue and reduces both local and systemic tissue damage.

Conclusions:

Iodide redistributes during stress and improves outcome after injury. Essential functions of iodide may have contributed to its evolutionary selection and be useful as a therapeutic intervention for human patients.
Prevalence and Clinical Correlates of Echo-Estimated Right and Left Heart Filling Pressures in Hospitalized Patients With Coronavirus Disease 2019
Authors: Goerlich Erin , Metkus Thomas S. , Gilotra Nisha A. , Wu Katherine C. , Cingolani Oscar H. , Hays Allison G.
Published: October 2020

Objectives:

The prevalence of elevated right and left heart filling pressures in coronavirus disease 2019 is not well characterized. We aimed to characterize the prevalence of pulmonary hypertension and concurrent elevated left heart filling pressure in hospitalized patients with coronavirus disease 2019. We hypothesized that a significant proportion of coronavirus disease 2019 patients has evidence of pulmonary hypertension associated with elevated left heart filling pressure on transthoracic echocardiography.

Design:

Retrospective cohort study.

Setting:

Academic tertiary-care center.

Patients:

Hospitalized coronavirus disease 2019 patients who underwent clinical transthoracic echocardiography.

Interventions:

None.

Measurements and Main Results:

The exposure variable of interest was right ventricular systolic pressure, calculated using the American Society of Echocardiography guidelines. Pulmonary hypertension was defined as right ventricular systolic pressure greater than 40 mm Hg. Left heart filling pressure was estimated with Nagueh’s method for pulmonary artery occlusion pressure using E/e’ ratio, and normal was considered pulmonary artery occlusion pressure less than 16 mm Hg. Clinical characteristics and outcomes were compared between the patients with and without pulmonary hypertension. A total of 73 patients (median age 66 yr [57–75 yr]; 46% women) were included. Median right ventricular systolic pressure was 39 mm Hg (interquartile range, 32–50 mm Hg), and 36 patients (49.3%) had evidence of pulmonary hypertension. Patients with pulmonary hypertension were more likely to require ICU admission (86% vs 65%; p = 0.035) and have acute respiratory distress syndrome (72% vs 49%; p = 0.0053) than those without. In-hospital mortality was 26% for those with pulmonary hypertension compared with 14% for those without (p = 0.19). Patients with pulmonary hypertension had higher median-estimated pulmonary artery occlusion pressure (17.4 mm Hg [12.7–21.3 mm Hg] vs 12.1 mm Hg [10.0–14.1 mm Hg]; p = 0.0008), and elevated left heart filling pressure was present in 59% of those with pulmonary hypertension.

Conclusions:

Pulmonary hypertension is common in hospitalized patients with coronavirus disease 2019 and is associated with poor clinical outcomes. Left ventricular filling pressure is elevated in over half of those with pulmonary hypertension and may represent a target to reduce right ventricular afterload and potentially improve outcomes in coronavirus disease 2019.
Conversion From Activated Clotting Time to Anti-Xa Heparin Activity Assay for Heparin Monitoring During Extracorporeal Membrane Oxygenation*
Authors: Figueroa Villalba Cristina A. , Brogan Thomas V. , McMullan D. Michael , Yalon Larissa , Jordan D. Ian , Chandler Wayne L.
Published: October 2020

Objectives:

Anticoagulation with unfractionated heparin remains the most common therapy used to prevent circuit thrombosis during extracorporeal membrane oxygenation, but no consensus exists on the optimal method or targets for heparin monitoring. From 2015 to 2018, we switched from monitoring heparin during extracorporeal membrane oxygenation using activated clotting times to anti-Xa heparin activity assays. This study describes the transition from activated clotting time to anti-Xa heparin activity assay monitoring and the associated clinical changes.

Design:

Retrospective analysis at single institution.

Setting:

Referral Children’s Hospital.

Patients:

A total of 145 pediatric patients over 152 extracorporeal membrane oxygenation runs using 206 extracorporeal membrane oxygenation circuits.

Interventions:

Anticoagulation protocol quality improvement.

Measurements and Main Results:

From 2015 to 2018, heparin monitoring during extracorporeal membrane oxygenation changed from hourly activated clotting time to anti-Xa heparin activity assay every 6 hours with an associated 75% reduction in the circuit changes per extracorporeal membrane oxygenation day. Over the 4 years, patients with an average anti-Xa heparin activity assay of at least 0.25 U/mL showed a 59% reduction in circuit changes per extracorporeal membrane oxygenation day compared with less than 0.15 U/mL. In addition to its association with reduced circuit changes, anti-Xa heparin activity assay monitoring was also associated with reduced heparin dose changes per day from 11 ± 4 to 2 ± 1 (p < 0.001), smaller heparin dose changes (less variation in dose), and reduced diagnostic phlebotomy volumes from 41 ± 6 to 25 ± 11 mL/day (p < 0.001). The number of patients with reported bleeding decreased from 69% using activated clotting time to 51% (p = 0.03). Transfusion rates did not change.

Conclusions:

Over 4 years, we replaced the activated clotting time assay with the anti-Xa heparin activity assay for heparin monitoring during extracorporeal membrane oxygenation. Minimum anti-Xa heparin activity assay levels of 0.25 U/mL were associated with reduced circuit changes. Further studies are needed to determine the optimum anti-Xa heparin activity assay therapeutic range during extracorporeal membrane oxygenation.
Identification of prognostic mRNAs in metastatic cutaneous melanoma
Authors: Lee Soohwan , Suh Hie Bum , Choi Su Ji , Kang Junho , Kang Ji Wan , Kwon Eun Jung , Kim Hak-Jun , Kim Yun Hak , Shin Kihyuk
Published: October 2020

Cutaneous melanoma is the most common cause of skin cancer-related deaths worldwide. There is an urgent need to identify prognostic biomarkers to facilitate decision-making for treatment of metastatic cutaneous melanoma. Gene expression microarrays and RNA-seq technology have recently improved or changed current prognostic and therapeutic strategies for several cancers. However, according to the current melanoma staging system, prognosis is almost entirely dependent on clinicopathological features. To identify novel prognostic biomarkers, we investigated gene expression and clinical data for patients with cutaneous melanoma from three cohorts of The Cancer Genome Atlas and Gene Expression Omnibus. Kaplan–Meier survival analysis using median values of each gene as cutoff value revealed that nine genes (ABCC3, CAPS2, CCR6, CDCA8, CLU, DPF1, PTK2B, SATB1, and SYNE1) were statistically significant prognostic biomarkers of metastatic cutaneous melanoma in all three independent cohorts. Low expression of two genes (CDCA8 and DPF1) and high expression of seven genes (ABCC3, CAPS2, CCR6, CLU, PTK2B, SATB1, and SYNE) were significantly associated with positive metastatic cutaneous melanoma prognoses. In conclusion, we suggest nine novel prognostic biomarkers for cutaneous metastatic melanoma.
Secondary in-the-bag Intraocular Lens Implantation in Aphakic Eyes After Vitrectomy and Silicone Oil Tamponade for Rhegmatogenous Retinal Detachment
Authors: Wu Kaicheng , Zong Yuan , Yu Jian , Fang Wangyi , Jiang Chunhui , Xu Gezhi
Published: October 2020

Purpose:

To describe a novel technique for capsular bag reopening and secondary in-the-bag intraocular lens (IOL) implantation in aphakic eyes after vitreoretinal surgery and intraocular tamponade.

Methods:

We enrolled 14 eyes of 14 patients who underwent primary vitreoretinal surgery with silicone oil tamponade for rhegmatogenous retinal detachment between September 2018 and September 2019. The novel technique was used for capsular bag reopening and foldable single-piece IOL implantation. Patients were followed up at least 24 weeks with routine ophthalmic examinations, corneal endothelial cell density, and IOL tilt and decentration measurement.

Results:

The procedure was successfully completed in 13 cases; in one case, because of posterior capsular tear, the IOL was implanted with ciliary sulcus fixation. After a mean follow-up of 48.8 ± 14.8 (range, 24.9–65.9) weeks, the best-corrected visual acuity (before 20/76 Snellen, 0.63 ± 0.23 logarithm of the minimum angle of resolution equivalent and after 20/35 Snellen, 0.32 ± 0.32 logarithm of the minimum angle of resolution equivalent; P = 0.001) and spherical equivalent (before +8.22 ± 4.08, after −2.39 ± 1.77 D; P < 0.001) improved, intraocular pressure (before 15.93 ± 4.40, after 16.25 ± 4.25 mmHg; P = 0.743) remained unchanged. The IOL was well centered with a mean horizontal and vertical tilt of 0.5070 ± 0.3319° and 0.4652 ± 0.3465°, respectively, and decentration of 0.1705 ± 0.1334 mm and 0.1712 ± 0.1576 mm, respectively.

Conclusion:

With this technique, capsular bag reopening and secondary in-the-bag IOL implantation could be achieved in most cases with satisfactory visual outcome and IOL position.
Epidemiology of Kawasaki Disease in South Korea: A Nationwide Survey 2015–2017
Authors: Kim Gi Beom , Eun Lucy Youngmin , Han Ji Whan , Kim Sung Hye , Yoon Kyung Lim , Han Mi Young , Yu Jeong Jin , Choi Jong-Woon , Rhim Jung Woo
Published: October 2020

Background:

This study aimed to investigate recent epidemiologic features of Kawasaki disease (KD) in South Korea.

Methods:

The ninth triennial nationwide questionnaire survey collected data on the demographic findings, symptoms and signs, treatment patterns and coronary artery complications of acute-phase KD occurred in 2015–2017 from 98 hospitals with pediatric residency programs and 108 community hospitals without residency programs.

Results:

We received data from 93 of the 98 hospitals (response rate: 94.9%) with residency programs and 75 of the 108 community-based children’s hospitals (response rate: 69.4%) without residency programs. In the 3-year survey period, a total of 15,378 (5449 in 2015, 5171 in 2016 and 4758 in 2017) cases of KD were reported. The mean age at diagnosis was 33.0 ± 24.8 months (range: 0–205 months), and the male-to-female ratio was 1.41:1. The overall KD incidence was 196.9 (202.2 in 2015, 197.1 in 2016 and 191.0 in 2017) per 100,000 younger than 5 years population. Recurrent cases were 4.85%. KD occurred more frequently during winter (December–January) and late spring (May–June). Intravenous immunoglobulin (IVIG) was administered to 95% of the patients; nonresponder rate for the first IVIG was 14.8%. Coronary artery aneurysms and giant coronary artery aneurysms (internal diameter >8 mm) occurred in 1.7% and 19 patients, respectively. Two patients died due to multiorgan failure and hepatic encephalopathy.

Conclusion:

Peak incidence of KD in South Korea was 202.2 per 100,000 younger than 5 years population (2015), and the incidence of giant coronary artery aneurysm decreased to 0.09% (2017).