bluuebunny/crossref_metadata_2025 huggingface dataset:
The three-dimensional printed template guided technique for S2 alar iliac screw placement and a comparison with freehand technique
Authors: Zhou Zhenhai , Zeng Zhimin , Yu Honggui , Xiong Jiachao , Liu Zhiming , Zhou Rongping , Wan Wenbing , Pan Zhimin , Chen Lu , Cao Kai
Published: October 2020

Purpose:

Sacropelvic fixation continues to present challenges when involved in the adult spinal deformity correction. The S2 alar iliac (S2AI) fixation is commonly used in sacropelvic fixation. Several techniques, including intraoperative navigation and freehand technique, were used for S2AI screws placement. The aim of this study is to analyze the anatomic parameters for S2AI screw trajectory in Asian population and introduce a novel technique described as a three-dimensional printed template guided technique (TGT). Meanwhile, the accuracy and safety of this technique were compared with the conventional freehand technique.

Methods:

The S2AI trajectory parameters were measured in 100 Asian adult volunteers. Parameters were compared between different genders. Forty-eight adult patients who underwent S2AI screw placement were reviewed: 28 patients received freehand technique and 20 patients received TGT technique. Postoperative computed tomography was used to assess the accuracy of screw trajectory and cortex violation-related complications were recorded.

Results:

The cephalocaudal angles (CAs), maximal length of screw pathway, narrowest width of pathway within the iliar teardrop, distance from the center of teardrop to sciatic notch, and distance of the start point distal to S1 dorsal foramen showed significant gender-related difference ( p < 0.05). All 48 patients were placed S2AI screws bilaterally (40 screws in TGT vs. 56 screws in freehand). One screw penetrated iliac cortex in the TGT group but 10 screws penetrated iliac cortex in the freehand group (3% vs. 17.9%) ( p < 0.05).

Conclusion:

Approximately 30–35° of CA and 39° mediolateral angle are appropriate for S2AI screw placement in Asian patients. Either freehand or TGT technique is safe for S2AI screw placement. TGT technique is more accurate compared with the conventional freehand technique.

Trial registration:

This is a retrospective study.
Contemplating on the Etiology of COVID-19 Severity and Mortality Sex Differences
Authors: Shweiki Dorit
Published: October 2020

COVID-19 displays a sex-biased behavior with a higher rate of intensity and mortality in men. In that sense, COVID-19 deflects-off the typical trend of many viral infections which are characterized by a higher rate of intensity and prevalence in males, yet a higher female mortality rate. Severity and mortality rates of COVID-19 are associated with several underlying diseases, which exhibit significant self-sufficient male-biased dimorphism, thus are at times hypothesized to be the ones responsible to tilt mortality balance toward higher men death in COVID-19. Yet, similar comorbidities prevail in other viral infections, raising curiosity to what makes COVID-19 unique? The answer may lay in the involvement of renin-angiotensin system and ACE2 receptor in COVID-19 progression, 2 players which are significant contributors to the fatality of COVID-19. A structured difference is evident in the expression and function of RAS and ACE2 between the sexes, presumably tipping over mortality rate tendency toward male-risk factor.
OnabotulinumtoxinA for chronic migraine during pregnancy: a real world experience on 45 patients
Authors: Wong Ho-Tin , Khalil Modar , Ahmed Fayyaz
Published: October 2020

Objective

To report the pregnancy outcomes on patients with chronic migraine exposed to onabotulinumtoxinA from Hull Headache Clinic.

Background

Migraines are common in women of reproductive age and those with chronic migraine have a major impact on their activities of daily living and health-related quality of life. Apart from low dose amitriptyline and beta-blockers all other prophylactic agents have proven teratogenic effects. OnabotulinumtoxinA is approved as preventive treatment for adult patients with chronic migraine, although its impact on pregnancy is unknown.

Methods

We prospectively collected data for efficacy and safety on all patients treated with onabotulinumtoxinA at the Hull Headache Clinic. The toxin is administered as per PREEMPT paradigm. Female patients of reproductive age group receiving onabotulinumtoxinA are given advice on contraception and the unknown impact of the toxin on pregnancy. They are asked to report pregnancy when they are appraised on the risk/benefit of treatment continuation. All patients are consented for access to their medical records and pregnancy outcome and those who wished to continue are asked to sign a disclaimer. Pregnancy outcome data was collected on all patients for the mode of delivery, birth weight and congenital malformation and any other unexpected outcomes.

Results

Over 9 years period 45 patients reported pregnancy while receiving onabotulinumtoxinA. All patients had received onabotulinumtoxinA within 3 months prior to the date of conception. 32 patients wished to continue treatment during pregnancy while the remaining 13 stopped treatment. Apart from 1 miscarriage in the treatment group, all patients had full term healthy babies of normal birth weight and no congenital malformations.

Conclusion

We report our experience of 45 patients exposed to onabotulinumtoxinA during pregnancy. Although the numbers are small, there was no impact of the toxin found on the pregnancy outcomes.
The sensitivity of a honeybee colony to worker mortality depends on season and resource availability
Authors: Lemanski Natalie J. , Bansal Siddhant , Fefferman Nina H.
Published: October 2020

Background

Honeybees have extraordinary phenotypic plasticity in their senescence rate, making them a fascinating model system for the evolution of aging. Seasonal variation in senescence and extrinsic mortality results in a tenfold increase in worker life expectancy in winter as compared to summer. To understand the evolution of this remarkable pattern of aging, we must understand how individual longevity scales up to effects on the entire colony. In addition, threats to the health of honey bees and other social insects are typically measured at the individual level. To predict the effects of environmental change on social insect populations, we must understand how individual effects impact colony performance. We develop a matrix model of colony demographics to ask how worker age-dependent and age-independent mortality affect colony fitness and how these effects differ by seasonal conditions.

Results

We find that there are seasonal differences in honeybee colony elasticity to both senescent and extrinsic worker mortality. Colonies are most elastic to extrinsic (age-independent) nurse and forager mortality during periods of higher extrinsic mortality and resource availability but most elastic to age-dependent mortality during periods of lower extrinsic mortality and lower resource availability.

Conclusions

These results suggest that seasonal changes in the strength of selection on worker senescence partly explain the observed pattern of seasonal differences in worker aging in honey bees. More broadly, these results extend our understanding of the role of extrinsic mortality in the evolution of senescence to social animals and improve our ability to model the effects of environmental change on social insect populations of economic or conservation concern.
circVAR database: genome-wide archive of genetic variants for human circular RNAs
Authors: Zhao Min , Qu Hong
Published: October 2020

Background

Circular RNAs (circRNAs) play important roles in regulating gene expression through binding miRNAs and RNA binding proteins. Genetic variation of circRNAs may affect complex traits/diseases by changing their binding efficiency to target miRNAs and proteins. There is a growing demand for investigations of the functions of genetic changes using large-scale experimental evidence. However, there is no online genetic resource for circRNA genes.

Results

We performed extensive genetic annotation of 295,526 circRNAs integrated from circBase, circNet and circRNAdb. All pre-computed genetic variants were presented at our online resource, circVAR, with data browsing and search functionality. We explored the chromosome-based distribution of circRNAs and their associated variants. We found that, based on mapping to the 1000 Genomes and ClinVAR databases, chromosome 17 has a relatively large number of circRNAs and associated common and health-related genetic variants. Following the annotation of genome wide association studies (GWAS)-based circRNA variants, we found many non-coding variants within circRNAs, suggesting novel mechanisms for common diseases reported from GWAS studies. For cancer-based somatic variants, we found that chromosome 7 has many highly complex mutations that have been overlooked in previous research.

Conclusion

We used the circVAR database to collect SNPs and small insertions and deletions (INDELs) in putative circRNA regions and to identify their potential phenotypic information. To provide a reusable resource for the circRNA research community, we have published all the pre-computed genetic data concerning circRNAs and associated genes together with data query and browsing functions at http://soft.bioinfo-minzhao.org/circvar.
Incidence of airway complications associated with deep extubation in adults
Authors: Juang Jeremy , Cordoba Martha , Ciaramella Alex , Xiao Mark , Goldfarb Jeremy , Bayter Jorge Enrique , Macias Alvaro Andres
Published: October 2020

Background

Endotracheal extubation is the most crucial step during emergence from general anesthesia and is usually carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as “deep extubation”, in order to provide a “smooth” emergence from anesthesia. Deep extubation is seldomly performed in adults, even in appropriate circumstances, likely due to concerns for potential respiratory complications and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults.

Methods

In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients’ demographic, comorbidity, airway assessment, O2saturation, end tidal CO2levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed.

Results

Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2saturation pre and post extubation, and longer time from end of surgery to out of OR (p < 0.05).

Conclusions

The complication rate during deep extubation in adults was relatively low compared to published reports in the literature and all easily reversible. BMI is possibly an important determinant in the success of deep extubation.
Correcting inaccurate background mortality in excess hazard models through breakpoints
Authors:   CENSUR working survival group, Mba Robert Darlin , Goungounga Juste Aristide , Grafféo Nathalie , Giorgi Roch
Published: October 2020

Background

Methods for estimating relative survival are widely used in population-based cancer survival studies. These methods are based on splitting the observed (the overall) mortality into excess mortality (due to cancer) and background mortality (due to other causes, as expected in the general population). The latter is derived from life tables usually stratified by age, sex, and calendar year but not by other covariates (such as the deprivation level or the socioeconomic status) which may lack though they would influence background mortality. The absence of these covariates leads to inaccurate background mortality, thus to biases in estimating the excess mortality. These biases may be avoided by adjusting the background mortality for these covariates whenever available.

Methods

In this work, we propose a regression model of excess mortality that corrects for potentially inaccurate background mortality by introducing age-dependent multiplicative parameters through breakpoints, which gives some flexibility. The performance of this model was first assessed with a single and two breakpoints in an intensive simulation study, then the method was applied to French population-based data on colorectal cancer.

Results

The proposed model proved to be interesting in the simulations and the applications to real data; it limited the bias in parameter estimates of the excess mortality in several scenarios and improved the results and the generalizability of Touraine’s proportional hazards model.

Conclusion

Finally, the proposed model is a good approach to correct reliably inaccurate background mortality by introducing multiplicative parameters that depend on age and on an additional variable through breakpoints.
Physiotherapists’ perceptions of challenges facing evidence-based practice and the importance of environmental empowerment in fall prevention in the municipality – a qualitative study
Authors: Worum Hilde , Lillekroken Daniela , Roaldsen Kirsti Skavberg , Ahlsen Birgitte , Bergland Astrid
Published: October 2020

Background

Falls in older adults are an increasingly important public-health concern. Despite abundant research, fall rates have not been reduced, because implementation of evidence-based fall-prevention measures has been slow and limited. This study aims to explore physiotherapists’ perceptions on external factors, such as public policy, organisation and leadership, regarding the relation between knowledge translation and the three elements of evidence-based practice (EBP) to effectively address barriers and facilitate the uptake of EBP in fall prevention.

Methods

We conducted semi-structured interviews with 18physiotherapists(men = 7; women = 11)working with fall prevention in the primary healthcare system.The physiotherapists ranged in age from 27 to 60 years (median 36 years) and had worked as a physiotherapist from 1 to 36 years (median 7 years). Data are analysed using thematic analysis.

Results

The analysis revealed one main theme and four sub-themes. The main theme was ‘Environmental empowerment enhances physiotherapists’ capabilities for using EBP’. A resourceful work environment facilitates EBP, having access to information about research-based knowledge, supportive leadership, enough human resources and opportunities to learn and grow at work. The four sub-themes were as follows: 1) ‘Tension between attributes of research-based knowledge and organisational routines and practices’; 2) ‘Evidence must be informed by policymakers—What works?’; 3) ‘Empowering culture and work environment—A steppingstone to EBP’ and 4) ‘Organisation readiness for EBP, managerial and clinical relations’. Success in environmental empowerment depends on the leader’s role in creating preconditions at the workplace that may lead to important positive personal and organisational outcomes for EBP. Two-way communication and transfer-of-information are also key factors in the development of positive work engagement when using EBP.

Conclusion

The findings of this study outline tension between policy, leadership, organisational facilitators and EBP. Leadership is influenced by policy with ripple effects for the organisation and clinicians. Organisational facilitators form structural empowerment, which is the foundation for creating an EBP environment.

Trial registration

2018/2227/REC south-east C. Registered 19 December 2018, Norwegian Ethics Committee for Medical and Health Research Ethics.
Conservative management of CIN2 p16 positive lesions in women with multiple HPV infection
Authors: Bruno Maria Teresa , Scalia Guido , Cassaro Nazario , Costanzo Maria , Boemi Sara
Published: October 2020

Background

According to the 2006 American Society for Colposcopy and Cervical Pathology guidelines, positive CIN2 p16 in women over the age of 25 should be managed with excisional treatment. However, excisional treatment is associated with physical, psychological and obstetric morbidity and can have a negative impact on sexual function. In our study we sought to identify a clear management strategy, addressing the impact of routine use of p16 immunohistochemistry in this population and identify appropriate criteria for patient selection with the aim of reducing over-treatment.

Method

We studied the medical records of 130 patients who had undergone laser therapy for CIN2. Each patient underwent colposcopy, biopsy and HPV test and were tested for p16 protein,. Patients were divided based on HPV infection into: single infections, multiple infections. All patients underwent ZTA laser therapy with follow-up (2-year follow-up).

Statistical analysis

Contingency tables were created to evaluate the correlation between single, multiple and CIN2+ infections. Values with p < 0.05 were considered statistically significant.

Results

Single infections had a histological regression of 61.8% (21/34) and a histological persistence rate of 35.3% (12/34), which was greater than the multiple infection rate. The common characteristic that the women with persistence and progression had was the dimension of the lesion and the genotype 16. Ten cases of histological persistence and the only case of progression had one lesion greater than three quarters of the cervix.

Conclusions

With the progress of our understanding of the natural history of infection from human papillomavirus and the increasing use of colposcopy, thanks to the addition of HPV genotyping and the technique of immunohistochemistry, conservative management of these lesions is now possible.
Learnings from conducting mental health research during 2004 tsunami in Tamil Nadu, India
Authors: Padmavati R. , Raghavan Vijaya , Rera Heather , Kearns Megan , Rao Kotteeswara , John Sujit , Thara R.
Published: October 2020

Background

The Indian Ocean tsunami experience in 2004 caused a major loss of life and subsequent emotional trauma for survivors. Psychosocial needs in the aftermath of this disaster were extensive, yet the cohesion and effectiveness of response were limited due to lack of preparedness and relevant policy. The Schizophrenia Research Foundation (SCARF) was one of the organizations that quickly responded to provide psychosocial assistance to people in the tsunami affected areas and recognized a need for relevant research on disaster response. Therefore, we undertook research on the challenges, success and limitations of psychosocial interventions in alleviating post-traumatic symptomology.

Discussion

Both community-level workers and researchers were limited in their preparedness to carry out tasks related to response. Language barriers, cultural differences, and a gap in long-term services limited the breadth and scope of research that was able to be completed. Lack of policy, poor co-ordination of services, lack of trained researchers and limited resources were challenges that emerged during this period and various strategies were adopted to meet these challenges.

Conclusions

Continued research and evaluation of data has brought crucial considerations to light, including the variance in symptomology, effective tools of measurement, and the nuanced response of survivors. Future research should take relevant factors into consideration including barriers to care. Understanding of the local language and religious beliefs are significant resources in understanding the nature of survivors’ trauma response and effective means of coping. Lastly, limitations regarding time frame and scope of research should be evaluated to provide more effective, comprehensive methods in future studies.
Evaluation of semi-quantitative compared to quantitative cultures of tracheal aspirates for the yield of culturable respiratory pathogens – a cross-sectional study
Authors: Rattani Salima , Farooqi Joveria , Jabeen Ghazala , Chandio Saeeda , Kash Qaiser , Khan Aijaz , Jabeen Kauser
Published: October 2020

Background

Diagnosis of lower respiratory tract infections (LRTI) depends on the presence of clinical, radiological and microbiological findings. Endotracheal suction aspirate (ETSA) is the commonest respiratory sample sent for culture from intubated patients. Very few studies have compared quantitative and semi-quantitative processing of ETSA cultures for LRTI diagnosis. We determined the diagnostic accuracy of quantitative and semi-quantitative ETSA culture for LRTI diagnosis, agreement between the quantitative and semi quantitative culture techniques and the yield of respiratory pathogens with both methods.

Methods

This was a cross-sectional study conducted at the Aga Khan University clinical laboratory, Karachi, Pakistan. One hundred and seventy-eight ETSA samples sent for routine bacteriological cultures were processed quantitatively as part of regular specimen processing method and semi-quantitatively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for both methods using clinical diagnosis of pneumonia as reference standard. Agreement between the quantitative and semi quantitative methods was assessed via the kappa statistic test. Pathogen yield between the two methods was compared using Pearson’s chi-square test.

Results

The quantitative and semi-quantitative methods yielded pathogens in 81 (45.5%) and 85 (47.8%) cases respectively. There was complete concordance of both techniques in 155 (87.1%) ETSA samples. No growth was observed in 45 (25.3%) ETSA specimens with quantitative culture and 37 (20.8%) cases by semi-quantitative culture. The diagnostic accuracy of both techniques were comparable; 64.6% for quantitative and 64.0% for semi-quantitative culture. The kappa agreement was found to be 0.84 (95% CI, 0.77–0.91) representing almost perfect agreement between the two methods. Although semi-quantitative cultures yielded more pathogens (47.8%) as compared to quantitative ETSA cultures (45.5%), the difference was only 2.3%. However, this difference achieved statistical (chi-square p-value < 0.001) favoring semi-quantitative culture methods over quantitative culture techniques for processing ETSA.

Conclusion

In conclusion, there is a strong agreement between the performances of both methods of processing ETSA cultures in terms of accuracy of LRTI diagnosis. Semi-quantitative cultures of ETSA yielded more pathogens as compared to quantitative cultures. Although both techniques were comparable, we recommend processing of ETSA using semi-quantitative technique due to its ease and reduced processing time.
8q24 clear cell renal cell carcinoma germline variant is associated with VHL mutation status and clinical aggressiveness
Authors: Eckel-Passow Jeanette E. , Yan Huihuang , Kosel Matthew L. , Serie Daniel , Decker Paul A. , Jenkins Robert B. , Costello Brian , Leibovich Bradley , Ho Thai H. , Parker Alexander
Published: October 2020

Background

The four most commonly-mutated genes in clear cell renal cell carcinoma (ccRCC) tumors are BAP1, PBRM1, SETD2 and VHL. And, there are currently 14 known RCC germline variants that have been reproducibly shown to be associated with RCC risk. However, the association of germline genetics with tumor genetics and clinical aggressiveness are unknown.

Methods

We analyzed 420 ccRCC patients from The Cancer Genome Atlas. Molecular subtype was determined based on acquired mutations in BAP1, PBRM1, SETD2 and VHL. Aggressive subtype was defined clinically using Mayo SSIGN score and molecularly using the ccA/ccB gene expression subtype. Publically-available Hi-C data were used to link germline risk variants with candidate target genes.

Results

The 8q24 variant rs35252396 was significantly associated with VHL mutation status (OR = 1.6, p = 0.0037) and SSIGN score (OR = 1.9, p = 0.00094), after adjusting for multiple comparisons. We observed that, while some germline variants have interactions with nearby genes, some variants demonstrate long-range interactions with target genes.

Conclusions

These data further demonstrate the link between rs35252396, HIF pathway and ccRCC clinical aggressiveness, providing a more comprehensive picture of how germline genetics and tumor genetics interact with respect to tumor development and progression.
Student perspective of classroom and distance learning during COVID-19 pandemic in the undergraduate dental study program Universitas Indonesia
Authors: Amir Lisa R. , Tanti Ira , Maharani Diah Ayu , Wimardhani Yuniardini Septorini , Julia Vera , Sulijaya Benso , Puspitawati Ria
Published: October 2020

Background

The COVID-19 pandemic has become a global health issue and has had a major impact on education. Consequently, half way through the second semester of the academic year 2019/2020, learning methods were delivered through distance learning (DL). We aimed to evaluate the student perspective of DL compared to classroom learning (CL) in the undergraduate dentistry study program at the Faculty of Dentistry Universitas Indonesia.

Methods

An online questionnaire was sent at the end of the semester. A total of 301 students participated in the study.

Results

Duration of study influenced student preference. Higher number of first-year students preferred DL compared to their seniors (p < 0.001). Students preferred CL for group discussion, as DL resulted in more difficult communication and gave less learning satisfaction. Only 44.2% students preferred DL over CL, although they agreed that DL gave a more efficient learning method (52.6%), it provided more time to study (87.9%) and to review study materials (87.3%). Challenges during DL included external factors such as unstable internet connection, extra financial burden for the internet quota and internal factors such as time management and difficulty to focus while learning online for a longer period of time.

Conclusion

Despite some challenges, dental students could adapt to the new learning methods of full DL and the majorities agreed blended learning that combined classroom and distance learning can be implemented henceforth. This current COVID-19 pandemic, changes not only the utilization of technology in education but the pedagogy strategies in the future.
Communication skills teaching and learning in Nepal; what are medical students’ perceptions and experiences? A qualitative study
Authors: Douglas Amanda Helen , Acharya Samita Pant , Allery Lynne A.
Published: October 2020

Background

Communication skills (CS) are vital for doctors. Indeed, as the most important element of consultations, are highly valued by patients. CS are core, teachable skills, however, have not been widely taught in South Asian medical schools, unlike their western counterparts.

Patan Academy of Health Sciences, is one of the first in Nepal to have CS central to its’ aims and curriculum. CS are taught from the first weeks of medical school and re-enforced during preclinical study (first 2 years). Our study seeks to explore students’ perceptions and experiences of CS teaching in this South Asian, Nepal context.

Methods

This study is a qualitative evaluation of a CS course in Nepal, exploring the experiences and perceptions of participants. The study aims to also identify aspects that were helpful or not for student learning and areas for potential development.

A purposive sample of twenty: second, fourth and Intern year students was selected for interview. Data were collected through audio recorded semi-structured interviews following a piloted schedule. Interview transcripts were manually coded and thematically analysed. Codes were arranged into themes and subthemes.

Results

The two main themes:

Positivity

Experiential learning.

Results demonstrate participants’ positive perceptions of CS teaching: believing it is important, effective, relevant and valuable for personal development. Participants identified experiential learning features as valuable for CS acquisition. Intern students recognised CS relevance and requested expanding teaching to clinical years,incorporating challenging communication scenarios.

Discussion

This study shows that PAHS’ CS course is well perceived and valuable to learners. Experiential learning is powerful for CS development. Expansion of formal, structured CS teaching through all years in a spiral curriculum, should be considered. Violence towards doctors in South Asia is increasing. Students recognised CS teaching’s significance in addressing this.

Conclusion

CS teaching,still in its’ infancy in South Asia, is a pressing issue for medical educators here. Our study provides evidence it is well perceived with positive impacts in this context, particularly when employing experiential learning. Medical schools in south Asia should be encouraged to incorporate and strengthen their CS teaching curriculum. .
Combining structured and unstructured data for predictive models: a deep learning approach
Authors: Zhang Dongdong , Yin Changchang , Zeng Jucheng , Yuan Xiaohui , Zhang Ping
Published: October 2020

Background

The broad adoption of electronic health records (EHRs) provides great opportunities to conduct health care research and solve various clinical problems in medicine. With recent advances and success, methods based on machine learning and deep learning have become increasingly popular in medical informatics. However, while many research studies utilize temporal structured data on predictive modeling, they typically neglect potentially valuable information in unstructured clinical notes. Integrating heterogeneous data types across EHRs through deep learning techniques may help improve the performance of prediction models.

Methods

In this research, we proposed 2 general-purpose multi-modal neural network architectures to enhance patient representation learning by combining sequential unstructured notes with structured data. The proposed fusion models leverage document embeddings for the representation of long clinical note documents and either convolutional neural network or long short-term memory networks to model the sequential clinical notes and temporal signals, and one-hot encoding for static information representation. The concatenated representation is the final patient representation which is used to make predictions.

Results

We evaluate the performance of proposed models on 3 risk prediction tasks (i.e. in-hospital mortality, 30-day hospital readmission, and long length of stay prediction) using derived data from the publicly available Medical Information Mart for Intensive Care III dataset. Our results show that by combining unstructured clinical notes with structured data, the proposed models outperform other models that utilize either unstructured notes or structured data only.

Conclusions

The proposed fusion models learn better patient representation by combining structured and unstructured data. Integrating heterogeneous data types across EHRs helps improve the performance of prediction models and reduce errors.
Measuring the quality of nursing clinical placements and the development of the Placement Evaluation Tool (PET) in a mixed methods co-design project
Authors: Cooper Simon , Cant Robyn , Waters Donna , Luders Elise , Henderson Amanda , Willetts Georgina , Tower Marion , Reid-Searl Kerry , Ryan Colleen , Hood Kerry
Published: October 2020

Background

The quality of nursing clinical placements has been found to vary. Placement evaluation tools for nursing students are available but lack contemporary reviews of clinical settings. Therefore, the aim of this study was to develop a feasible, valid and reliable clinical placement evaluation tool applicable to nursing student placements in Australia.

Methods

An exploratory mixed methods co-design project. Phase 1 included a literature review; expert rating of potential question items and Nominal Group Technique meetings with a range of stakeholders for item development. Phase 2 included on-line pilot testing of the Placement Evaluation Tool (PET) with 1263 nursing students, across all year levels at six Australian Universities and one further education college in 2019–20, to confirm validity, reliability and feasibility.

Results

The PET included 19-items (rated on a 5-point agreement scale) and one global satisfaction rating (a 10-point scale). Placements were generally positively rated. The total scale score (19 items) revealed a median student rating of 81 points from a maximum of 95 and a median global satisfaction rating of 9/10. Criterion validity was confirmed by item correlation: Intra-class Correlation Co-efficient ICC = .709; scale total to global score r = .722; and items to total score ranging from .609 to .832. Strong concurrent validity was demonstrated with the Clinical Learning Environment and Supervision Scale (r = .834). Internal reliability was identified and confirmed in two subscale factors: Clinical Environment (Cronbach’s alpha = .94) and Learning Support (alpha = .96). Based on the short time taken to complete the survey (median 3.5 min) and students’ comments, the tool was deemed applicable and feasible.

Conclusions

The PET was found to be valid, reliable and feasible. Use of the tool as a quality assurance measure is likely to improve education and practice in clinical environments. Further international evaluation of the instrument is required to fully determine its psychometric properties.
Perception of the healthcare professionals towards the current trauma and emergency care system in Kabul, Afghanistan: a mixed method study
Authors: Khudadad Umerdad , Aftab Wafa , Ali Asrar , Khan Nadeem Ullah , Razzak Junaid , Siddiqi Sameen
Published: October 2020

Background

Trauma and injury contribute to 11% of the all-cause mortality in Afghanistan. The study aimed to explore the perceptions of the healthcare providers (pre and in-hospital), hospital managers and policy makers of the public and private health sectors to identify the challenges in the provision of an effective trauma care in Kabul, Afghanistan.

Methods

A concurrent mixed method design was used, including key-informant interviews (healthcare providers, hospital managers and policy makers) of the trauma care system (N = 18) and simultaneous structured emergency care system assessment questionnaire (N = 35) from July 15 to September 25, 2019. Interviews were analyzed using content analysis approach and structured questionnaire data were descriptively analyzed.

Results

Four themes were identified that describe the challenges: 1) pre-hospital care, 2) cohesive trauma management system, 3) physical and human resources and 4) stewardship. Some key challenges were found related to scene and transportation care, in-hospital care and emergency preparedness within the wider trauma care system. Less than 25% of the population is covered by the pre-hospital ambulance system (n = 23, 65.7%) and there is no communication process between health care facilities to facilitate transfer (n = 28, 80%). Less than 25% of patients with an injury requiring emergent surgery have access to surgical care in a staffed operating theatre within 2 h of injury (n = 19, 54.2%) and there is no regular assessment of the ability of the emergency care system to mobilize resources (human and physical) to respond to disasters, and other large-scale emergencies (n = 28, 80%).

Conclusion

This study highlighted major challenges in the delivery of trauma care services across Kabul, Afghanistan. Systematic improvement in the workforce training, structural organization of the trauma care system and implementing externally validated clinical guidelines for trauma management could possibly enhance the functions of the existing trauma care services. However, an integrated state-run trauma care system will address the current burden of traumatic injury more effectively within the wider healthcare system of Afghanistan.
Postpartum vertebral artery dissection: case report and review of the literature
Authors: Manasewitsch Nicholas T. , Hanfy Ahmed A. , Beutler Bryce D. , Antwi-Amoabeng Daniel , Taha Moutaz , Elnaggar Mohamed , Chahal Gurpreet S.
Published: October 2020

Background

Hypertensive disorders of pregnancy are associated with vascular complications, including ischemic stroke and cervical artery dissection. Vertebral artery dissection (VAD), however, is rare. We describe a 31-year-old female who presented with vertigo, nausea, and vomiting and was found to have a VAD. In addition, we discuss the presentation, differential diagnosis, and pathogenesis of this uncommon but clinically significant vascular event and summarize other cases of vertebral artery dissection described in the medical literature.

Case presentation

A 31-year-old Hispanic woman presented 10 days postpartum with a one-day history of vertigo, nausea, vomiting, and frontal headache. The patient’s pregnancy course had been complicated by preeclampsia, chorioamnionitis, and iron-deficiency anemia, and her delivery was complicated by acute hemorrhage. Physical examination was significant for left leg ataxia. Laboratory studies showed marked thrombocytosis. Emergent computed tomography (CT) scan of the head was obtained and revealed a left cerebellar ischemic large vessel stroke. Subsequent CT angiography of the head and neck showed a left VAD. Based on correlation of the clinical history and laboratory and imaging findings, a diagnosis of vertebral artery dissection secondary to reactive (secondary) thrombocytosis from overlapping iron-deficiency anemia and acute hemorrhage was established. The patient was started on a heparin infusion and experienced significant improvement after a four-day hospitalization.

Conclusion

VAD is a rare but important cause of neurologic symptoms in the postpartum period and should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women aged 30 years or older and those with a history of a hypertensive disorder of pregnancy are at particularly high risk. Prompt diagnosis and management of VAD is essential to ensure favorable outcomes.
Chronic active Epstein–Barr virus infection manifesting as coronary artery aneurysm and uveitis
Authors: Xiao Haijuan , Hu Bing , Luo Rongmu , Hu Huili , Zhang Junmei , Kuang Weiying , Zhang Rui , Li Li , Liu Gang
Published: October 2020

Background

Chronic active Epstein–Barr virus (CAEBV) infection is a type of lymphoproliferative disorder characterized by chronic or recurrent infectious mononucleosis (IM)-like symptoms, which can have less-frequent clinical presentations. The prognosis of CAEBV is poor, and hematopoietic stem cell transplantation (HSCT) has been shown to be the only potentially effective treatment. In this article, we present a special CAEBV case of a patient who had no typical IM-like symptoms at the early stage, but manifested with severe and progressive coronary artery aneurysm (CAA), abdominal aortic lesions, and severe uveitis. These manifestations were uncommon features and could only be blocked by HSCT.

Case presentation

A 4-year-old girl with no special medical history complained of decreased vision for 10 months and cough after physical activities for three months. The blurred vision grew rapidly worse within one month, until only light perception remained. She was diagnosed with uveitis and cataract, and received prednisone and ciclosporin A treatment. However, her vision did not improve. Physical examination showed slight hepatosplenomegaly. Ultrasonic cardiogram showed bilateral CAA (5.0 mm and 5.7 mm for inner diameters), and abdominal CT scan revealed a thickened aortic wall, as well as stenosis and dilation of the segmental abdominal aorta. Other significant findings were increased EBV-DNA (3.29 × 104 copies/mL) from peripheral blood, positive EBV antibodies (EBV-CA-IgG, EBV-EA-IgA, and EBV-NA-IgG), and positive EBV-encoded small RNAs found by bone marrow biopsy. Based on her clinical manifestations and evidence for EBV infection, we diagnosed CAEBV. She received allogeneic HSCT, and the cataract operation was performed after HSCT. EBV-DNA could not be detected in peripheral blood after HSCT. Her CAAs did not progress, and uveitis was well controlled. Her vision recovered gradually over the 3 years after HSCT.

Conclusions

We present a rare CAEBV case of a patient who suffered from uncommon and severe cardiovascular and ocular involvement that was relieved by HSCT. Therefore, early recognition and diagnosis of CAEBV are of vital importance to improve its prognosis. In summary, this atypical CAEBV case could help us recognize similar cases more easily, make the right diagnosis as early as possible, and deliver proper and timely treatment.
Prediction and evolution of B cell epitopes of surface protein in SARS-CoV-2
Authors: Lon Jerome Rumdon , Bai Yunmeng , Zhong Bingxu , Cai Fuqiang , Du Hongli
Published: October 2020

Background

In order to obtain antibodies that recognize natural proteins, it is possible to predict the antigenic determinants of natural proteins, which are eventually embodied as polypeptides. The polypeptides can be coupled with corresponding vectors to stimulate the immune system to produce corresponding antibodies, which is also a simple and effective vaccine development method. The discovery of epitopes is helpful to the development of SARS-CoV-2 vaccine.

Methods

The analyses were related to epitopes on 3 proteins, including spike (S), envelope (E) and membrane (M) proteins, which are located on the lipid envelope of the SARS-CoV-2. Based on the NCBI Reference Sequence: NC_045512.2, the conformational and linear B cell epitopes of the surface protein were predicted separately by various prediction methods. Furthermore, the conservation of the epitopes, the adaptability and other evolutionary characteristics were also analyzed, the sequences of the whole genome of SARS-CoV-2 were obtained from the GISAID.

Results

7 epitopes were predicted, including 6 linear epitopes and 1 conformational epitope. One of the linear and one of the conformational consist of identical sequence, but represent different forms of epitopes. It is worth mentioning that all 6 identified epitopes were conserved in nearly 3500 SARS-CoV-2 genomes, showing that it is helpful to obtain stable and long-acting epitopes under the condition of high frequency of amino acid mutation, which deserved further study at the experiment level.

Conclusion

The findings would facilitate the vaccine development, had the potential to be directly applied on the prevention in this disease, but also have the potential to prevent the possible threats caused by other types of coronavirus.
Effect of advanced chelate technology based trace minerals on growth performance, mineral digestibility, tibia characteristics, and antioxidant status in broiler chickens
Authors: Ghasemi Hossein Ali , Hajkhodadadi Iman , Hafizi Maryam , Taherpour Kamran , Nazaran Mohammad Hassan
Published: October 2020

Background

Compared to the corresponding source of inorganic trace minerals (TM), chelated supplements are characterized by better physical heterogeneity and chemical stability and appear to be better absorbed in the gut due to possibly decreased interaction with other feed components.

Methods

This study was designed in broiler chickens to determine the effects of replacing inorganic trace minerals (TM) with an advanced chelate technology based supplement (Bonzachicken) on growth performance, mineral digestibility, tibia bone quality, and antioxidant status. A total of 625 male 1-day-old broiler chickens were allocated to 25 pens and assigned to 5 dietary treatments in a completely randomized design. Chelated TM (CTM) supplement was compared at 3 levels to no TM (NTM) or inorganic TM. A corn–soy-based control diet was supplemented with inorganic TM at the commercially recommended levels (ITM), i.e., iron, zinc, manganese, copper, selenium, iodine, and chromium at 80, 92, 100, 16, 0.3, 1.2, and 0.1 mg/kg, respectively, and varying concentration of CTM, i.e., match to 25, 50, and 100% of the ITM (diets CTM25, CTM50, and CTM100, respectively).

Results

Diets CTM50 and CTM100 increased average daily gain (ADG), European performance index (EPI), and tibia length compared to the NTM diet (P < 0.05). Broilers fed the CTM100 diet had lowest overall FCR and serum malondialdehyde level and highest EPI, tibia ash, zinc, manganese, and copper contents, and serum total antioxidant capacity (P < 0.05). The apparent ileal digestibilities of phosphorus and zinc were lower in the ITM group compared with the CTM25 and CTM50 groups (P < 0.05). Broiler chickens fed any of the diets, except diet CTM25, exhibited higher serum glutathione peroxidase and superoxide dismutase activities than those fed the NTM diet, where the best glutathione peroxidase activity was found for CTM100 treatment (P < 0.05).

Conclusions

These results indicate that while CTM supplementation to 25 and 50% of the commercially recommended levels could support growth performance, bone mineralization, and antioxidant status, a totally replacing ITM by equivalent levels of CTM could also improve performance index and glutathione peroxidase activity of broiler chickens under the conditions of this study.
Effect of the presence of the articular cartilage on the femoral component rotation in total knee arthroplasty in female and varus osteoarthritis knees
Authors: Nam Ji-Hoon , Koh Yong-Gon , Kim Paul Shinil , Park Joon-Hee , Kang Kyoung-Tak
Published: October 2020

Purpose

Surgical techniques for total knee arthroplasty (TKA) require femoral rotational corrections that alter the position of the surface of the posterior femoral joint especially in kinematic alignment. However, preoperative planning of TKA based on computed tomography (CT), without knowing the femoral cartilage thickness, may cause post-surgery failures in femoral rotation. Therefore, this study aimed to evaluate the effects of posterior condyle cartilage thickness on rotational alignment in the femoral component.

Methods

Three-dimensional magnetic resonance imaging (MRI) scans were obtained for 139 male and 531 female osteoarthritis patients. The angles defined by the femoral posterior condylar axis (PCA) and the surgical transepicondylar axis (TEA) were evaluated with respect to the presence of cartilage. Additionally, these effects were evaluated with respect to patient gender and varus/valgus condition.

Results

In all patients, the angle between the TEA and PCA was significantly greater in the presence of cartilage than in the absence of cartilage. This result was also seen in female patients. However, there was no difference in the TEA/PCA angle in male patients based on the presence of cartilage. The TEA/PCA angle was significantly greater in the presence of cartilage than in the absence of cartilage in the female varus group. However, there were no differences in the TEA/PCA angle based on the presence of cartilage in the male varus/valgus and female valgus groups. Cartilage thickness in the posterior femoral condyle was significantly greater on the lateral side than on the medial side in all and male patients. However, there was no difference between the genders regarding cartilage thickness.

Conclusion

Surgical planning for TKA based on CT does not consider articular cartilage and could lead to external malrotation of the femoral implant. Therefore, the effect of the remaining posterior condylar cartilage should be considered by surgeons to prevent over-rotation of the femoral component, especially in female varus knees.