bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of the Spatial Distribution and Development of Sequential Sampling Plans for Heteropteran-Associated Fruit Injury in Florida Peaches
Authors: Penca Cory , Hodges Amanda C , Leppla Norman C , Cottrell Ted E
Published: May 2021

Catfacing and gummosis/sap-type injury associated with a heteropteran pest complex were sampled at five peach orchards in southern Florida during two consecutive growing seasons. Trapping and visual surveys indicate that Euschistus servuis (Say) (Hemiptera: Pentatomidae) was the dominant heteropteran pest in the study orchards. The spatial arrangement of injury indicated a random distribution, as determined by Taylor’s power law. Spatial analysis by distance indices indicated a random arrangement of fruit injury in a majority of the sample site × date combinations and analysis of local clustering did not provide evidence of patches of fruit injury occurring near orchard borders. The coefficients from Taylor’s power law were used to develop sequential sampling plans based on hypothetical injury thresholds. Sequential sampling plans were compared to a simple random sample of 15 sample units using a simulation approach. The sequential sampling plan was able to achieve equivalent levels of accuracy when compared to the 15-unit fixed sampling plan while reducing the number of sample units required to an average of 7.99. The sequential sampling plans developed in this study are an improvement over simple random sampling; however, further research is needed to determine how to best implement sequential sampling of fruit injury in Florida peach orchards to better inform management decisions.
Changing Psychiatry or Changing Society? The Motion for the Rights of the “Mentally Ill” in Greece, 1980-1990
Authors: Kritsotaki Despo
Published: May 2021

In 1980, the first formal association of mental patients, their relatives, and mental health professionals was founded in Athens, Greece. The Motion for the Rights of the “Mentally Ill” proposed a total restructuring of mental health care and a novel conceptualization of mental illness. On the one hand, it demanded that the mental health system be based on open services, psychotherapy, and on patients’ active participation in all decisions concerning their treatment and life. On the other hand, it conceptualized mental illness as a political issue that concerned all. Thus, the Motion viewed the promotion of the rights of the mentally ill as part of a broader project of cultivating conscious, active, and collective citizenship. This paper traces the Motion’s history during the 1980s, showing that it was shaped by both the socio-political conditions of Greece in the post-dictatorship period, a time of intense politicization, and by the legacy of mental patient activism in the Western world during the 1970s and 1980s. It argues that, although the Motion had a limited long-term impact, it represented the mental patient movement in Greece as it furthered the latter’s main features, most importantly its twofold endeavor to change not only the mental health system and the attitudes towards mental illness, but also society.
The Complete Mitochondrial Genome of Lepidotrigona flavibasis (Hymenoptera: Meliponini) and High Gene Rearrangement in Lepidotrigona Mitogenomes
Authors: Wang Cheng-Ye , Zhao Min , Wang Shi-Jie , Xu Huan-Li , Yang Ye-Meng , Liu Li-Ning , Feng Ying
Published: May 2021

We reported the sequence and characteristics of the complete mitochondrial genome of an ecologically important stingless bee, Lepidotrigona flavibasis (Hymenoptera: Meliponini), that has suffered serious population declines in recent years. A phylogenetic analysis based on complete mitogenomes indicated that L. flavibasis was first clustered with another Lepidotrigona species (L. terminata) and then joined with the other two Melipona (Hymenoptera: Meliponini) stingless bees (M. scutellaris and M. bicolor), forming a single clade of stingless bees. The stingless bee clade has a closer relationship with bumblebees (Bombus) (Hymenoptera: Apidae) than with honeybees (Apis) (Hymenoptera: Apidae). Extremely high gene rearrangements involving tRNAs, rRNAs, D-loop regions, and protein-coding genes were observed in the Lepidotrigona mitogenomes, suggesting an overactive evolutionary status in Lepidotrigona species. These mitogenomic organization variations could provide a good system with which to understand the evolutionary history of Meliponini.
The Cryo-EM Effect: Structural Biology of Neurodegenerative Disease Aggregates
Authors: Creekmore Benjamin C , Chang Yi-Wei , Lee Edward B
Published: May 2021

Neurogenerative diseases are characterized by diverse protein aggregates with a variety of microscopic morphologic features. Although ultrastructural studies of human neurodegenerative disease tissues have been conducted since the 1960s, only recently have near-atomic resolution structures of neurodegenerative disease aggregates been described. Solid-state nuclear magnetic resonance spectroscopy and X-ray crystallography have provided near-atomic resolution information about in vitro aggregates but pose logistical challenges to resolving the structure of aggregates derived from human tissues. Recent advances in cryo-electron microscopy (cryo-EM) have provided the means for near-atomic resolution structures of tau, amyloid-β (Aβ), α-synuclein (α-syn), and transactive response element DNA-binding protein of 43 kDa (TDP-43) aggregates from a variety of diseases. Importantly, in vitro aggregate structures do not recapitulate ex vivo aggregate structures. Ex vivo tau aggregate structures indicate individual tauopathies have a consistent aggregate structure unique from other tauopathies. α-syn structures show that even within a disease, aggregate heterogeneity may correlate to disease course. Ex vivo structures have also provided insight into how posttranslational modifications may relate to aggregate structure. Though there is less cryo-EM data for human tissue-derived TDP-43 and Aβ, initial structural studies provide a basis for future endeavors. This review highlights structural variations across neurodegenerative diseases and reveals fundamental differences between experimental systems and human tissue derived protein inclusions.
The Logic of Secular Sense in Cendrars’ Epic Trilogy
Authors: Whistler Daniel
Published: May 2021

Engaging with Graham Ward’s contention that literature can never be entirely secular, I argue that some pieces of literature can, in fact, tell us a great deal about the conceptual logic of the secular. I turn, in particular, to three poems by Blaise Cendrars—Les Pâques à New York, Prose du Transsibérien et de la petite Jeanne de France, and Le Panama ou les aventures de mes sept oncles, written during the years of 1912 and 1914, so as to reconstruct the ways in which the poems themselves are entangled in a dispute over the very possibility of a purified secular plane. That is, Cendrars’ trilogy dramatises both the attempt to write secularly and the difficulty—even impossibility—of accomplishing precisely that task. Hence, I offer a reading of the journey traversed in Cendrars’ early trilogy that focuses on the desacralising movement at work in this journey, as well as the various resistances such movement encounters. On the one hand, the three poems tend towards a becoming-secular of poetry: the Christian regime of sense in Pâques is quickly replaced by a series of ‘any-spaces-whatsoever’ where secular figures are perpetually produced. On the other hand, this secular hero-narrative ends in tragedy, such that the poetic text ends up being figured as a utopia, an impossible space that offers compensation for the impossibility of performing secularity in life.
Resurrection of Ancestral Malate Dehydrogenases Reveals the Evolutionary History of Halobacterial Proteins: Deciphering Gene Trajectories and Changes in Biochemical Properties
Authors: Blanquart Samuel , Groussin Mathieu , Le Roy Aline , Szöllosi Gergely J , Girard Eric , Franzetti Bruno , Gouy Manolo , Madern Dominique
Published: May 2021

Extreme halophilic Archaea thrive in high salt, where, through proteomic adaptation, they cope with the strong osmolarity and extreme ionic conditions of their environment. In spite of wide fundamental interest, however, studies providing insights into this adaptation are scarce, because of practical difficulties inherent to the purification and characterization of halophilic enzymes. In this work, we describe the evolutionary history of malate dehydrogenases (MalDH) within Halobacteria (a class of the Euryarchaeota phylum). We resurrected nine ancestors along the inferred halobacterial MalDH phylogeny, including the Last Common Ancestral MalDH of Halobacteria (LCAHa) and compared their biochemical properties with those of five modern halobacterial MalDHs. We monitored the stability of these various MalDHs, their oligomeric states and enzymatic properties, as a function of concentration for different salts in the solvent. We found that a variety of evolutionary processes, such as amino acid replacement, gene duplication, loss of MalDH gene and replacement owing to horizontal transfer resulted in significant differences in solubility, stability and catalytic properties between these enzymes in the three Halobacteriales, Haloferacales, and Natrialbales orders since the LCAHa MalDH. We also showed how a stability trade-off might favor the emergence of new properties during adaptation to diverse environmental conditions. Altogether, our results suggest a new view of halophilic protein adaptation in Archaea.
The Effectiveness of Nicotine Replacement Therapy in Light Versus Heavier Smokers
Authors: Rahmani Noreen , Veldhuizen Scott , Wong Benjamin , Selby Peter , Zawertailo Laurie
Published: May 2021

Introduction

The prevalence of light smoking has increased in North America; however, research on the effectiveness of current treatments in this subpopulation of smokers is limited. We compared quit outcomes between light (1–10 cigarettes per day [CPD]) versus heavier smokers (>10 CPD) enrolled in a treatment program at their primary care clinic.

Aims and Methods

This secondary analysis analyzed 45 087 participants (light smokers [n = 9861]; heavier smokers [n = 35 226]) enrolled in a smoking cessation program between April 2016 and March 2020. The program offered cost-free nicotine replacement therapy (NRT) plus in-person counseling. Type, dose, and duration of NRT treatment were personalized. Data were collected at baseline, and at 6 months following enrollment to assess 7-day point prevalence abstinence (PPA), the primary outcome variable of interest. Logistic regression models were used for analyses.

Results

Seven-day PPA at 6 months was significantly higher among light smokers (30.6%) than heavier smokers (26.0%; odds ratio = 1.25, 95% confidence interval = 1.18–1.33, p < .001). Heavier smokers were prescribed more weeks of NRT than light smokers (B = 0.82, 95% confidence interval = 0.64–1.0, p < .001). The association between smoking cessation and daily NRT dose did not differ between groups (p = .98). However, a stronger positive relationship between the number of clinic visits attended and 7-day PPA was found among heavier smokers in comparison to light smokers (p < .001). All findings remained significant after adjusting for baseline variables.

Conclusions

There is a paucity of scientific literature on the effectiveness of NRT for light smokers. Our findings suggest that individualized doses of NRT may be helpful in these subpopulations, and highlight the different treatment needs of light smokers.

Implications

Current clinical guidelines do not provide formal recommendations for light smokers who want to quit smoking. Similar to heavy smokers, light smokers are at substantial risk for many adverse health problems. As such, it is important to understand what treatment options are effective in assisting light smokers to quit smoking. Findings from this study support the use of personalized treatment for all smokers who are interested in quitting smoking, including light smokers.
Vulnerability, Disability, and Public Health Crises
Authors: Riddle Christopher A
Published: May 2021

This article suggests that those individuals typically acknowledged as vulnerable during public health crises, such as pandemics, are often-times doubly so. I suggest that individuals can be vulnerable in a person-affecting way (in a way that suggests they are at greater risk to their physical person) as well as in a personhood-affecting way (in a manner that results in individuals being at risk of having their personhood or status as valuable members of a society challenged). I suggest that the former notion of vulnerability coincides with many existing accounts of vulnerability and that subsequently, many of the more standard arguments for moral and justice-based obligations to minimize such vulnerability, hold. I also suggest that the latter notion of vulnerability adds another layer of vulnerability to those that we typically view to be at risk. I argue that personhood-vulnerability constitutes a novel interpretation of vulnerability than expands our ideas of the kinds of harm that emerge during public health crises.
Perinatal mental health in India: protocol for a validation and cohort study
Authors: Fellmeth G , Kishore M T , Verma A , Desai G , Bharti O , Kanwar P , Singh S , Thippeswamy H , Chandra P S , Kurinczuk J J , Nair M , Alderdice F
Published: May 2021

Background

Common mental disorders (CMD) are among the largest contributors to global maternal morbidity and mortality. Although research on perinatal mental health in India has grown in recent years, important evidence gaps remain, especially regarding CMD. Our study aims to improve understanding of CMD among perinatal and non-perinatal women of reproductive age across two settings in India: Bangalore (Karnataka) and Tanda (Himachal Pradesh).

Methods

The study is embedded within the Maternal and Perinatal Health Research Collaboration India (MaatHRI). This mixed-methods observational study comprises three consecutive phases: (i) focus group discussions and individual interviews to explore women’s knowledge and seek feedback on CMD screening tools; (ii) validation of CMD screening tools; and (iii) prospective cohort study to identify CMD incidence, prevalence and risk factors among perinatal and non-perinatal women. Results of the three phases will be analyzed using inductive thematic analysis, psychometric analysis and multivariable regression analysis, respectively.

Conclusion

Improving understanding, detection and management of CMD among women is key to improving women’s health and promoting gender equality. This study will provide evidence of CMD screening tools for perinatal and non-perinatal women in two diverse Indian settings, produce data on CMD prevalence, incidence and risk factors and enhance understanding of the specific contribution of the perinatal state to CMD.
Looking for evidence of research impact and use: A qualitative study of an Australian research-policy system
Authors: Newson Robyn S , Rychetnik Lucie , King Lesley , Milat Andrew J , Bauman Adrian E
Published: May 2021

Current assessments of research impact have been criticized for capturing what can be easily counted not what actually counts. To empirically examine this issue, we approached measuring research impact from two directions, tracing forwards from research and backwards from policy, within a defined research-policy system (childhood obesity prevention research and policy in New South Wales, Australia from 2000 to 2015). The forward tracing research impact assessment component traced a sample of 148 local research projects forward to examine their policy impacts. Of the projects considered, 16% had an impact on local policy and for a further 19%, decision-makers were aware of the research, but there was no evidence it influenced policy decisions. The backward tracing component of the study included an analysis of research use across three policy initiatives. It provided a more nuanced understanding of the relative influence of research on policy. Both direct uses of specific research and indirect uses of research incorporated as broader bodies of knowledge were evident. Measuring research impact from both directions captured the diverse ways that research was used in decision-making. Our findings illustrate complexities in the assessment process and in real-life policymaking trajectories. They highlight the role that timing of assessment plays in perception of impacts and difficulties attributing longer-term impacts to specific research. This study supports the use of models where politics and complex system dynamics shape knowledge and its influence on decision-making, rather than research being the primary driver for policy change.
ASSESSMENT OF PATIENT’S RADIATION EXPOSURES RESULTED FROM PET/CT 18F-FCH AND 68GA-PSMA PROCEDURES
Authors: Salah H , Al-Mohammed H I , Mayhoub F H , Sulieman A , Alkhorayef M , Abolaban Fouad A , Khandaker Mayeen Uddin , Bradley D A
Published: May 2021

This study has sought to evaluate patient exposures during the course of particular diagnostic positron emission tomography and computed tomography (PET/CT) techniques. A total of 73 patients were examined using two types of radiopharmaceutical: 18F-fluorocholine (FCH, 48 patients) and 68Ga-prostate-specific membrane antigen (PSMA, 25 patients). The mean and range of administered activity (AA) in MBq, and effective dose (mSv) for FCH were 314.4 ± 61.6 (462.5–216.8) and 5.9 ± 1.2 (8.8–4.11), respectively. Quoted in the same set of units, the mean and range of AA and effective dose for 68Ga-PSMA were 179.3 ± 92.3 (603.1–115.1) and 17.9 ± 9.2 (60.3–11.5). Patient effective doses from 18F-FCH being a factor of two greater than the dose resulting from 68Ga-PSMA PET/CT procedures. CT accounts for some 84 and 23% for 18F-FCH and 68Ga-PSMA procedures, accordingly CT acquisition parameter optimization is recommended. Patient doses have been found to be slightly greater than previous studies.
The effects of age, sex, and hot carcass weight on cooked lamb flavor and off-flavor in four muscle cuts
Authors: Garza Horacio , Jaborek Jerad R , Zerby Henry N , Moeller Steven J , Wick Macdonald P , Fluharty Francis L , England Eric M , Garcia Lyda G
Published: May 2021

The present study used 48 lambs originating from three different locations in the Western United States (16 lambs per location; 8 ewes and 8 wethers per location). Each consisting of similar breed composition (Suffolk cross) that were selected to represent weight by age at harvest treatments: light weight carcasses at 5 mo (LW5, 31.81 ± 1.88 kg), light weight carcasses at 12 mo (LW12, 35.09 ± 4.45 kg), heavy weight carcasses at 12 mo (HW12, 57.89 ± 4.70 kg) with different carcass weight compositions. Older heavy weight lambs (HW12) had greater (P ≤ 0.01) hot carcass weight, ribeye area, backfat and body wall thickness, and yield grade compared with light weight lamb carcasses (LW5 and LW12). The longissimus thoracis longissimus thoracis (LT) from older lamb carcasses (LW12 and HW12) had a greater (P ≤ 0.01) total lipid percentage compared with younger lamb carcasses (LW5). Across harvest weight and age treatments, wether carcasses had greater (P ≤ 0.05) total lipid percentage compared with ewe carcasses. Slice shear force values were greater (P ≤ 0.01) for both the LT and semimembranosus from older lambs (LW12 and HW12) compared with LW5 lambs, with no differences between ewes and wethers. Lamb flavor intensity was greater (P ≤ 0.05) for the LT of LW12 lambs and tended (P = 0.08) to be greater for HW12 lambs, compared with the LT from LW5 lambs. The off-flavor intensity of the LT was greater (P ≤ 0.01) for older lambs (LW12 and HW12) compared with LW5 lambs. Interestingly, the lamb flavor and off-flavor intensity scores of the ground shoulder exhibited a treatment × sex interaction. Lamb flavor intensity of LW12 lamb was greater (P ≤ 0.05) from ewes compared with wethers, whereas wethers had a greater (P ≤ 0.05) lamb flavor intensity compared with ewes for HW12 lambs, and LW12 ewe lambs had a greater (P ≤ 0.05) off-flavor intensity compared with all other treatment × sex treatment combinations. Overall, lambs in the present study possessed a mild lamb flavor, typically with greater lamb flavor and off-flavor intensities for older animals; while slice shear force and LT lipid percentage increased as animal age increased at the time of harvest.
Socialism, Nationalism and Tom Nairn’s Dream of Escape
Authors: Campsie Alexandre
Published: May 2021

The relationship between socialism and nationalism in the thought of Scottish intellectual Tom Nairn has been of considerable historical interest. Focusing on the 1960s and 1970s, this article identifies a set of key themes that emerged during Nairn’s time within the London New Left, and which shed light on his move towards Scottish nationalism. It demonstrates that he gravitated towards Continental theory in the 1960s as it offered the prospect of political and personal emancipation from the conservatism of the British state. He in turn viewed the student movement of 1968 as an anti-authoritarian social formation ready to topple the establishment—though in a peculiarly intellectualized way that inoculated him from its wilder experimentalism. Nairn’s move towards nationalism in the 1970s was his way of furthering this project, though not straightforwardly. Echoing New Right critiques, Nairn argued that demands for Scottish independence stood alongside globalization and European integration as material forces sweeping aside the decrepit British state. He also used support for nationalism to admonish the ‘metropolitan-minded’ socialists of a New Left he was growing estranged from. Whether due to academic obscurantism or what he saw as a superficial concern with social movement politics, Nairn felt the English New Left was becoming divorced from its original aims of personal and cultural self-determination. Now back in living in Scotland, he saw nationalism as the best vehicle for escape. Nairn however simultaneously celebrated the utopianism and rooted pragmatism of Scottish nationalism, a distinctive position which characterises his career more broadly.
Improving Primary Care Behavioral Health Integration in an Academic Internal Medicine Practice
Authors: Yin Isabel , Staab Erin M. , Beckman Nancy , Vinci Lisa M. , Ari Mim , Araújo Fabiana S. , Yohanna Daniel , Laiteerapong Neda
Published: May 2021

This report details ongoing efforts to improve integration in the 2 years following implementation of the Primary Care Behavioral Health model at a general internal medicine clinic of an urban academic medical center. Efforts were informed by a modified version of the validated Level of Integration Measure, sent to all faculty and staff annually. At baseline, results indicated that the domains of systems integration, training, and integrated clinical practices had the greatest need for improvement. Over the 2 years, the authors increased availability of behavioral medicine appointments, improved depression screening processes, offered behavioral health training for providers, disseminated clinical decision support tools, and provided updates about integration progress during clinic meetings. Follow-up survey results demonstrated that physicians and staff perceived improvements in integration overall and in targeted domains. However, the main ongoing barrier to integration was insufficient behavioral health staff to meet patient demand for behavioral health services.
Matched Comparison of Bone Transport Using External Fixator Over a Nail Versus External Fixator Over a Plate for Segmental Tibial Bone Defects
Authors: Park Kyeong-Hyeon , Oh Chang-Wug , Kim Joon-Woo , Oh Jong-Keon , Yoon Yong-Cheol , Seo Il , Ha Sung-Soo , Chung Seung-Ho
Published: May 2021

Objective:

To compare the outcomes and complications of bone transport over a nail (BTON) with those of bone transport over a plate (BTOP) for segmental tibial bone defects.

Design:

Retrospective matched study design.

Setting:

A major metropolitan tertiary referral trauma center.

Patients:

Thirty-six patients with segmental tibial bone defects of >4 cm were included in this study.

Intervention:

Either BTON or BTOP was performed on 18 patients.

Main Outcome Measurements:

We compared the healing of the distraction process and of the docking site between the techniques. Distraction parameters including external fixator (EF) time, external fixation index, and healing index were compared. Bone and functional results were compared according to the Paley–Maar classification. Complications associated with each procedure were compared.

Results:

Both BTON and BTOP achieved similar rates of primary union (83% vs. 89%) at the distraction or docking site. Significantly less time wearing an EF was needed for BTOP than for BTON (2.8 vs. 5.4 months; P < 0.01). The external fixation index was significantly lower for BTOP than for BTON (0.45 vs. 0.94 mo/cm; P < 0.01), whereas the healing indexes were similar. The final outcomes and complication incidences were not significantly different.

Conclusions:

The EF time was significantly shorter for BTOP than for BTON; however, the final outcomes were similar. Therefore, BTOP could be considered an attractive option for bone transport in patients with segmental tibial defects.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Mobilization During Critical Illness: A Higher Level of Mobilization Improves Health Status at 6 Months, a Secondary Analysis of a Prospective Cohort Study
Authors: Paton Michelle , Lane Rebecca , Paul Eldho , Cuthburtson Georgina A. , Hodgson Carol L.
Published: May 2021

OBJECTIVES:

To determine the influence of active mobilization during critical illness on health status in survivors 6 months post ICU admission.

DESIGN:

Post hoc secondary analysis of a prospective cohort study conducted between November 2013 and March 2015.

SETTING:

Two tertiary hospital ICU’s in Victoria, Australia.

PATIENTS:

Of 194 eligible patients admitted, mobility data for 186 patients were obtained. Inclusion and exclusion criteria were as per the original trial.

INTERVENTIONS:

The dosage of mobilization in ICU was measured by: 1) the Intensive Care Mobility Scale where a higher Intensive Care Mobility Scale level was considered a higher intensity of mobilization or 2) the number of active mobilization sessions performed during the ICU stay. The data were extracted from medical records and analyzed against Euro-quality of life-5D-5 Level version answers obtained from phone interviews with survivors 6 months following ICU admission. The primary outcome was change in health status measured by the Euro-quality of life-5D-5 Level utility score, with change in Euro-quality of life-5D-5 Level mobility domain a secondary outcome.

MEASUREMENTS AND MAIN RESULTS:

Achieving higher levels of mobilization (as per the Intensive Care Mobility Scale) was independently associated with improved outcomes at 6 months (Euro-quality of life-5D-5 Level utility score unstandardized regression coefficient [β] 0.022 [95% CI, 0.002–0.042]; p = 0.033; Euro-quality of life-5D-5 Level mobility domain β = 0.127 [CI, 0.049–0.205]; p = 0.001). Increasing the number of active mobilization sessions was not found to independently influence health status. Illness severity, total comorbidities, and admission diagnosis also independently influenced health status.

CONCLUSIONS:

In critically ill survivors, achieving higher levels of mobilization, but not increasing the number of active mobilization sessions, improved health status 6 months after ICU admission.
Buspirone for the Treatment of Generalized Anxiety Disorder in Down Syndrome: 3 Cases
Authors: Howe Yamini J. , Thom Robyn P. , Notson Erin E. , McDougle Christopher J. , Palumbo Michelle L.
Published: May 2021

Objective:

Reports on the pharmacologic treatment of anxiety, including generalized anxiety disorder (GAD), in individuals with Down syndrome (DS) are lacking.

Methods:

We present the case histories of 1 adolescent and 2 young adults with DS and the treatment course of comorbid GAD with buspirone.

Results:

Treatment with buspirone was safe and well-tolerated and resulted in sustained improvement in symptoms of anxiety for a minimum of 2 years in all 3 cases.

Conclusion:

Buspirone's generally benign adverse effect profile makes it well suited for treating anxiety in individuals with DS in light of their common medical comorbidities.
Recent insights into pathophysiology and management of mechanical complications of myocardial infarction
Authors: Fatehi Hassanabad Ali , Elbatarny Malak , Wong Jonathan V.S. , Kim Angela , Ali Imtiaz S.
Published: May 2021

Purpose of review

Mechanical complications of myocardial infarction are a group of postischemic events and include papillary muscle rupture resulting in ischemic mitral regurgitation, ventricular septal defect, left ventricle free wall rupture, pseudoaneurysm, and true aneurysm. Advances made in management strategies, such as the institution of ‘Code STEMI’ and percutaneous interventions, have lowered the incidence of these complications. However, their presentation is still associated with increased morbidity and mortality. Early diagnosis and appropriate management is crucial for facilitating better clinical outcomes.

Recent findings

Although the exact timing of a curative intervention is not known, emerging percutaneous and transcatheter approaches and improving mechanical circulatory support (MCS) devices have greatly enhanced our ability to manage and treat some of the complications postinfarct.

Although the incidence of mechanical complications of myocardial infarction has decreased over the past few decades, these complications are still associated with high rates of morbidity and mortality. The combination of early and accurate diagnosis and subsequent appropriate management are imperative for optimizing clinical outcomes. Although more randomized clinical trials are needed, mechanical circulatory support devices and emerging therapeutic strategies can be offered to carefully selected patients.
Physician Assistant Teaching Effectiveness Through Incorporation of Active Learning and Interdisciplinary Pharmacy Students
Authors: Christopher Amy , Jenjebir Anastassia
Published: May 2021

Purpose

This study evaluated exam performance and course evaluation in a physician assistant (PA) interdisciplinary active learning (IAL)-incorporated program facilitated by a pharmacist and pharmacy student.

Methods

Two PA cohorts (n = 38 each) were compared using IAL versus minimal active learning (MAL). Course evaluation surveys of instruction were assessed for 2 pharmacology courses. Both cohorts were assessed for differences in exam scores and performance on higher analytical exam questions.

Results

The IAL cohort achieved higher course evaluation scores compared to the MAL cohort (p < .05). The students' positive comments demonstrated their desire for more IAL. No significant difference was seen in overall exam scores in either cohort or course (p < .45). IAL in neurology demonstrated significant improvement in exam performance on moderate Bloom's taxonomy-level questions (p = .008).

Conclusions

IAL may enable health professionals to provide more collaborative care. The students preferred IAL and demonstrated improved performance on comprehension and application exam questions.
Association Between COL5a1, COL11a1, and COL11a2 Gene Variations and Rotator Cuff Tendinopathy in Young Athletes
Authors: Alakhdar Yasser , Cook Jill , Gallego Diana , Querol Felipe , Chulvi-Medrano Iván , Alberola Antonio , Hernández-Sánchez Sergio
Published: May 2021

Objective:

Tendinopathy is a prevalent condition in young athletes and in older nonathletic people. Recent tendinopathy research has shown a growing interest in the role played by genetic factors, basically genes involved in collagen synthesis and regulation, in view of collagen disorganization typically present in tendon pathologies.

Design:

A case–control, genotype–phenotype association study.

Setting:

La Ribera Hospital, Valencia, Spain.

Participants:

A group of 137 young athletes (49 with rotator cuff tendon pathology and 88 healthy counterparts) who played upper-limb–loading sports were clinically and ultrasound (US) assessed for rotator cuff tendinopathy were included.

Intervention:

Genetic analysis was performed to determine whether there was a relationship between rotator cuff pathology and the genotype.

Main Outcome Measures:

We hypothesized that the following single nucleotide polymorphisms: COL5a1 rs12722, COL11a1 rs3753841, COL11a1 rs1676486, and COL11a2 rs1799907 would be associated with rotator cuff tendinopathy.

Results:

A direct relationship between CC genotype and bilateral US pathological images was statistically significant (χ2 = 0.0051) and confirmed by the Fisher test, with a correlation coefficient of 0.345 and a Cramer's v of 0.26.

Conclusion:

A significant association was found between COL5a1 rs12722 genotype and rotator cuff pathology, with the CC genotype conferring increased risk of tendon abnormalities and being associated with rotator cuff pathology.
Medical Encounters in a 90-km Ultramarathon Running Event: A 6-year Study in 103 131 Race Starters—SAFER XVII
Authors: Sewry Nicola , Schwellnus Martin , Boulter Jeremy , Seocharan Ishen , Jordaan Esme
Published: May 2021

Objective:

To determine the incidence and nature of illness-related medical encounters (MEs) at a 90-km, ultramarathon, mass, community-based, endurance running event.

Design:

Retrospective, descriptive epidemiological study.

Setting:

Comrades Marathon (90 km), South Africa.

Participants:

One lakh three thousand one hundred thirty-one race starters over 6 years (2014-2019).

Independent Variables:

Incidence of moderate and serious/life-threatening MEs.

Main Outcome Measures:

All MEs were recorded by race medical doctors on race day each year. Medical encounters were recorded by severity, organ system, and final specific diagnosis (2019 consensus statement definition on mass community–based events). Incidences (I: per 1000 starters; 95% confidence intervals) were calculated for MEs.

Results:

There were 1971 illness-related MEs, with an overall incidence of 19.1 (range, 18.3-20.0). The incidence for serious/life-threatening MEs was 1.8 (range, 1.6-2.1). Incidences of MEs by organ systems affected were as follows: fluid/electrolyte (8.8; 8.3-9.4), central nervous system (4.0; 3.7-4.5), and gastrointestinal system (2.9; 2.6-3.2). Dehydration (I = 7.5: 7.0-8.1) and exercise-associated muscle cramping (I = 3.2: 2.9-3.6) were the 2 most common specific diagnoses.

Conclusion:

The incidence of MEs in the 90-km Comrades Marathon was one of the highest incidences of MEs reported in an endurance running event (1 in 52 starters and 1 in 556 starters for serious/life-threatening MEs). Preventative measures to reduce MEs are needed, and further investigations into the risk factors associated with MEs could assist in managing the risk and better prepare athletes, race organizers, and medical directors.
Role of ketones, ketogenic diets and intermittent fasting in ICU
Authors: Gunst Jan , Casaer Michael P. , Langouche Lies , Van den Berghe Greet
Published: May 2021

Purpose of review

To summarize the clinical evidence for beneficial effects of ketones, ketogenic diets and intermittent fasting in critical illness, and to review potential mechanisms behind such effects.

Recent findings

Recent evidence demonstrates that activation of a metabolic fasting response may be beneficial to recover from critical insults. Potential protective mechanisms are, among others, activation of ketogenesis and of damage removal by autophagy. Novel feeding strategies, including ketone supplements, ketogenic diets and intermittent fasting regimens, can activate these pathways – at least partially – in critically ill patients. Randomized controlled trials (RCTs) studying these novel feeding strategies as compared with standard care, are scarce and have not shown consistent benefit. Yet, all RCTs were small and underpowered for clinical endpoints. Moreover, in intermittent fasting studies, the duration of the fasting interval may have been too short to develop a sustained metabolic fasting response.

These findings open perspectives for the further development of fasting-mimicking diets. Ultimately, clinical benefit should be confirmed by RCTs that are adequately powered for clinically relevant, patient-centered endpoints.
Labelling and denominating lung toxicity effects of pesticides
Authors: de Boer Alie
Published: May 2021

Purpose of review

With the development and use of pesticide products increasing, information on the safe handling of pesticides becomes increasingly important. In this article, the denomination of lung toxicity on labelling is reviewed.

Recent findings

The results highlight that whereas hazards, warning statements and instructions for safe use are broadly defined, the different categories of products used as pesticides are associated with different types of clinical manifestations of toxicity. These clinical manifestations are however not directly warned for by means of information provided on the label: more overarching terminology is used to describe hazards associated with acute toxicity, respiratory sensitization, specific lung toxicity after single or repeated exposure, as well as hazards from aspiration.

This misalignment between hazard labelling and experienced issues increases the difficulty for users of products and clinicians in dealing with adverse events. Together with ensuring that in risk assessment, an integrated approach is taken to study pesticide products, improving the labels will support the safe handling of pesticides.
Artificial intelligence in prostate histopathology: where are we in 2021?
Authors: Oszwald André , Wasinger Gabriel , Pradere Benjamin , Shariat Shahrokh F. , Compérat Eva M.
Published: May 2021

Purpose of review

Artificial intelligence has made an entrance into mainstream applications of daily life but the clinical deployment of artificial intelligence-supported histological analysis is still at infancy. Recent years have seen a surge in technological advance regarding the use of artificial intelligence in pathology, in particular in the diagnosis of prostate cancer.

Recent findings

We review first impressions of how artificial intelligence impacts the clinical performance of pathologists in the analysis of prostate tissue. Several challenges in the deployment of artificial intelligence remain to be overcome. Finally, we discuss how artificial intelligence can help in generating new knowledge that is interpretable by humans.

It is evident that artificial intelligence has the potential to outperform most pathologists in detecting prostate cancer, and does not suffer from inherent interobserver variability. Nonetheless, large clinical validation studies that unequivocally prove the benefit of artificial intelligence support in pathology are necessary. Regardless, artificial intelligence may soon automate and standardize many facets of routine work, including qualitative (i.e. Gleason Grading) and quantitative measures (i.e. portion of Gleason Grades and tumor volume). For the near future, a model where pathologists are enhanced by second-review or real-time artificial intelligence systems appears to be the most promising approach.
How the use of the artificial intelligence could improve surgical skills in urology: state of the art and future perspectives
Authors: Cacciamani Giovanni E. , Anvar Arya , Chen Andrew , Gill Inderbir , Hung Andrew J.
Published: May 2021

Purpose of review

As technology advances, surgical training has evolved in parallel over the previous decade. Training is commonly seen as a way to prepare surgeons for their day-to-day work; however, more importantly, it allows for certification of skills to ensure maximum patient safety. This article reviews advances in the use of machine learning and artificial intelligence for improvements of surgical skills in urology.

Recent findings

Six studies have been published, which met the inclusion criteria. All articles assessed the application of artificial intelligence in improving surgical training. Different approaches were taken, such as using machine learning to identify and classify suturing gestures, creating automated objective evaluation reports, and determining surgical technical skill levels to predict clinical outcomes. The articles illustrated the continuously growing role of artificial intelligence to address the difficulties currently present in evaluating urological surgical skills.

Artificial intelligence allows us to efficiently analyze the surmounting data related to surgical training and use it to come to conclusions that normally would require human intelligence. Although these metrics have been shown to predict surgeon expertise and surgical outcomes, evidence is still scarce regarding their ability to directly improve patient outcomes. Considering this, current active research is growing on the topic of deep learning-based computer vision to provide automated metrics needed for real-time surgeon feedback.
Alternatives to the Cerebrospinal Fluid Venereal Disease Research Laboratory Test for Neurosyphilis Diagnosis
Authors: Marra Christina M.
Published: May 2021

Background

The diagnosis of neurosyphilis relies in large part on the cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test, which is diagnostically specific but not sensitive.

Methods

We determined the sensitivity and specificity of 3 CSF tests in addition to the CSF-VDRL in participants with syphilis enrolled in a research study: detection of Treponema pallidum ribosomal RNA, T. pallidum particle agglutination titer, and chemokine (C-X-C motif) ligand 13 (CXCL13) concentration. Neurosyphilis was defined as asymptomatic or symptomatic meningitis: CSF white blood cells >10/μL without or with neurological symptoms, including new vision or hearing loss.

Results

Cerebrospinal fluid–VDRL, CSF T. pallidum ribosomal RNA detection, and CSF T. pallidum particle agglutination titer ≥1:640 were specific (89%–96%) but not sensitive (12%–48%). In contrast, diagnostic sensitivity of CSF-CXCL13 thresholds established from receiver operating characteristic curves using the Youden index was 78% to 83% and specificity was 76% to 81%. In individuals with nonreactive CSF-VDRL, neurosyphilis diagnosis could be confirmed by CSF-CXCL13 concentration in 69% to 75%.

Conclusions

Further studies of CSF-CXCL13 should include CSF samples from multiple cohorts and countries and should use standard neurosyphilis definitions to establish uniform thresholds for diagnosis.
Impulse control disorders and related behaviors in Parkinson's disease: risk factors, clinical and genetic aspects, and management
Authors: Faouzi Johann , Corvol Jean-Christophe , Mariani Louise-Laure
Published: May 2021

Purpose of review

To review recent findings and research directions on impulse control disorders and related behaviors (ICDRBs) in Parkinson's disease (PD).

Recent findings

Longitudinal studies found that prevalence increases during PD progression, incident ICDRBs being around 10% per year in patients treated with dopaminergic therapies. Screening tools and severity scales already developed have been validated and are available in several countries and languages. The main clinical risk factors include young age, male gender, type, doses and duration of dopaminergic therapy, PD motor severity and dyskinesia, depression, anxiety, apathy, sleep disorders, and impulsivity traits. Genetic factors are suspected by a high estimated heritability, but individual genes and variants remain to be replicated. Management of ICDRBs is centered on dopamine agonist decrease, with the risk to develop withdrawal symptoms. Cognitive behavioral therapy and subthalamic nucleus deep brain stimulation also improve ICDRBs. In the perspective of precision medicine, new individual prediction models of these disorders have been proposed, but they need further independent replication.

Regular monitoring of ICDRB during the course of PD is needed, particularly in the subject at high risk of developing these complications. Precision medicine will require the appropriate use of machine learning to be reached in the clinical setting.
Clinical Validation of Saliency Maps for Understanding Deep Neural Networks in Ophthalmology
Authors: Ayhan Murat Seçkin , Kümmerle Louis Benedikt , Kühlewein Laura , Inhoffen Werner , Aliyeva Gulnar , Ziemssen Focke , Berens Philipp
Published: May 2021

Deep neural networks (DNNs) have achieved physician-level accuracy on many imaging-based medical diagnostic tasks, for example classification of retinal images in ophthalmology. However, their decision mechanisms are often considered impenetrable leading to a lack of trust by clinicians and patients. To alle-viate this issue, a range of explanation methods have been proposed to expose the inner workings of DNNs leading to their decisions. For imaging-based tasks, this is often achieved via saliency maps. The quality of these maps are typically evaluated via perturbation analysis without experts involved. To facilitate the adoption and success of such automated systems, however, it is crucial to validate saliency maps against clinicians. In this study, we used three different network architectures and developed ensembles of DNNs to detect diabetic retinopathy and neovascular age-related macular degeneration from retinal fundus images and optical coherence tomography scans, respectively. We used a variety of explanation methods and obtained a comprehensive set of saliency maps for explaining the ensemble-based diagnostic decisions. Then, we systematically validated saliency maps against clinicians through two main analyses — a direct comparison of saliency maps with the expert annotations of disease-specific pathologies and perturbation analyses using also expert annotations as saliency maps. We found the choice of DNN architecture and explanation method to significantly influence the quality of saliency maps. Guided Backprop showed consistently good performance across disease scenarios and DNN architectures, suggesting that it provides a suitable starting point for explaining the decisions of DNNs on retinal images.
Estimating the Burden of Influenza on Daily Activity at Population Scale Using Commercial Wearable Sensors
Authors: Mezlini Aziz , Shapiro Allison , Daza Eric J. , Caddigan Eamon , Ramirez Ernesto , Althoff Tim , Foschini Luca
Published: May 2021

The severity of viral infections can vary widely, from asymptomatic cases to complications leading to hospitalizations and death. Milder cases, despite being more prevalent, often go undocumented and their public health impact unaccounted for. We estimated the burden of influenza-like-illness (ILI) by leveraging the widespread use of commercial activity trackers. Analysing data from 15,382 US participants who reported ILI symptoms during the 2018–2019 flu season (before the COVID-19 pandemic) and who had high-density wearable sensor data at symptom onset, we estimated an overall nationwide reduction in mobility equivalent to 257 billion steps lost due to ILI symptoms. This finding reflects significant changes in routines, mobility, and employment and is equivalent to 15% of the active US population becoming completely immobilized for 1 day. Moreover, ∼60% of this impact occurred among individuals who sought no medical care, who would otherwise be invisible to healthcare and public health reporting systems. We validated our measure against self-reported measures of disease severity. We believe this method has applications for public health, healthcare, and clinical research, from estimating costs of lost productivity at population scale, to measuring effectiveness of anti-ILI treatments, to monitoring recovery after acute viral syndromes, such as during ‘long COVID’.