bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcranial Magnetic Stimulation Over the Human Medial Posterior Parietal Cortex Disrupts Depth Encoding During Reach Planning
Authors: Breveglieri Rossella , Bosco Annalisa , Borgomaneri Sara , Tessari Alessia , Galletti Claudio , Avenanti Alessio , Fattori Patrizia
Published: July 2020

Accumulating evidence supports the view that the medial part of the posterior parietal cortex (mPPC) is involved in the planning of reaching, but while plenty of studies investigated reaching performed toward different directions, only a few studied different depths. Here, we investigated the causal role of mPPC (putatively, human area V6A–hV6A) in encoding depth and direction of reaching. Specifically, we applied single-pulse transcranial magnetic stimulation (TMS) over the left hV6A at different time points while 15 participants were planning immediate, visually guided reaching by using different eye-hand configurations. We found that TMS delivered over hV6A 200 ms after the Go signal affected the encoding of the depth of reaching by decreasing the accuracy of movements toward targets located farther with respect to the gazed position, but only when they were also far from the body. The effectiveness of both retinotopic (farther with respect to the gaze) and spatial position (far from the body) is in agreement with the presence in the monkey V6A of neurons employing either retinotopic, spatial, or mixed reference frames during reach plan. This work provides the first causal evidence of the critical role of hV6A in the planning of visually guided reaching movements in depth.
The Claustrum is Involved in Cognitive Processes Related to the Classical Conditioning of Eyelid Responses in Behaving Rabbits
Authors: Reus-García M Mar , Sánchez-Campusano Raudel , Ledderose Julia , Dogbevia Godwin K , Treviño Mario , Hasan Mazahir T , Gruart Agnès , Delgado-García José M
Published: July 2020

It is assumed that the claustrum (CL) is involved in sensorimotor integration and cognitive processes. We recorded the firing activity of identified CL neurons during classical eyeblink conditioning in rabbits, using a delay paradigm in which a tone was presented as conditioned stimulus (CS), followed by a corneal air puff as unconditioned stimulus (US). Neurons were identified by their activation from motor (MC), cingulate (CC), and medial prefrontal (mPFC) cortices. CL neurons were rarely activated by single stimuli of any modality. In contrast, their firing was significantly modulated during the first sessions of paired CS/US presentations, but not in well-trained animals. Neuron firing rates did not correlate with the kinematics of conditioned responses (CRs). CL local field potentials (LFPs) changed their spectral power across learning and presented well-differentiated CL–mPFC/CL–MC network dynamics, as shown by crossfrequency spectral measurements. CL electrical stimulation did not evoke eyelid responses, even in trained animals. Silencing of synaptic transmission of CL neurons by the vINSIST method delayed the acquisition of CRs but did not affect their presentation rate. The CL plays an important role in the acquisition of associative learning, mostly in relation to the novelty of CS/US association, but not in the expression of CRs.
Multidrug Resistant Tuberculosis With Simultaneously Acquired Drug Resistance to Bedaquiline and Delamanid
Authors: Yoshiyama Takashi , Takaki Akiko , Aono Akio , Mitarai Satoshi , Okumura Masao , Ohta Ken , Kato Seiya
Published: July 2020

This study is the first to report a clinical case of simultaneously acquired resistance to bedaquiline (BDQ) and delamanid (DLM). Whole genome sequencing revealed 2 nucleotide insertions (Rv0678 and fbiC) in the Mycobacterium tuberculosis isolate. The minimum inhibitory concentrations for BDQ and DLM were 0.25 µg/mL and >2.0 µg/mL, respectively.
CYP2B6 Genotype and Weight Gain Differences Between Dolutegravir and Efavirenz
Authors: Griesel Rulan , Maartens Gary , Chirehwa Maxwell , Sokhela Simiso , Akpomiemie Godspower , Moorhouse Michelle , Venter Francois , Sinxadi Phumla
Published: July 2020

Background

Dolutegravir is associated with more weight gain than efavirenz. Loss-of-function polymorphisms in CYP2B6 result in higher efavirenz concentrations, which we hypothesized would impair weight gain among people living with human immunodeficiency virus (HIV; PLWH) starting efavirenz-based antiretroviral therapy (ART).

Methods

We studied ART-naive participants from the ADVANCE study randomized to the efavirenz /emtricitabine/tenofovir disoproxil fumarate (TDF) and dolutegravir/emtricitabine/TDF arms. We compared changes in weight and regional fat on DXA from baseline to week 48 between CYP2B6 metabolizer genotypes in the efavirenz arm, and with the dolutegravir arm.

Results

There were 342 participants in the dolutegravir arm and 168 in the efavirenz arm who consented to genotyping. Baseline characteristics were similar. Weight gain was greater in women than men. In the efavirenz arm CYP2B6 metaboliser genotype was associated with weight gain (P = .009), with extensive metabolizers gaining the most weight, and with changes in regional fat in women, but not in men. Weight gain was similar in CYP2B6 extensive metabolizers in the efavirenz arm and in the dolutegravir arm (P = .836). The following variables were independently associated with weight gain in all participants: baseline CD4 count, baseline human immunodeficiency virus type 1 (HIV-1) RNA, and CYP2B6 metaboliser genotype.

Conclusions

CYP2B6 metaboliser genotype was associated with weight gain in PLWH starting efavirenz-based ART. Weight gain was similar between CYP2B6 extensive metabolizers in the efavirenz arm and in the dolutegravir arm, suggesting that impaired weight gain among CYP2B6 slow or intermediate metabolizers could explain the increased weight gain on dolutegravir compared with efavirenz observed in ADVANCE and other studies.
Evaluation of regenerated tracheal cilia function on a collagen-conjugated scaffold in a canine model
Authors: Ueda Yuichiro , Sato Toshihiko , Nakamura Ryosuke , Tamari Shigeyuki , Muranishi Yusuke , Yutaka Yojiro , Nakamura Tatsuo , Omori Koichi , Iwasaki Akinori , Date Hiroshi
Published: July 2020

OBJECTIVES

It is unclear whether the movement and function of the regenerated cilia on collagen-conjugated artificial trachea are the same as those of normal cilia. This study assessed the ciliary beat frequency (CBF) and ciliary transport functions (CTFs) of regenerated cilia in a canine model.

METHODS

A tracheal defect introduced into the anterior portion of the cervical trachea of an adult beagle dog was covered with a collagen-conjugated prosthesis. Two months later, the trachea was harvested along the long axis, both from normal and regenerated regions. The cilia were stained with isothiocyanate-conjugated wheat germ agglutinin, and their movement was monitored with a high-speed camera to analyse CBF and CTF. Four samples each were obtained from the regenerated and normal regions for CBF analysis and 7 samples each were obtained for CTF analysis.

RESULTS

The wheat germ agglutinin-stained cells showed well-regulated beats in both the regenerated and normal regions of the trachea. Mean CBF in the regenerated and normal regions did not differ significantly (7.11 ± 0.41 vs 7.14 ± 1.09 Hz; P = 981). By contrast, CTF was significantly lower in the regenerated region than in the normal region (30.0 ± 6.62 vs 7.43 ± 0.58 μm/s; P = 0.005).

CONCLUSIONS

Mean CBF in the regenerated and normal regions did not differ significantly at 2 months. The CTF in the regenerated region recovered partially but remained lower than those in the normal region. Methods are needed to improve the CTF of regenerated cilia.
Drug Resistance Mutations and Associated Phenotypes Detected in Clinical Trials of Maribavir for Treatment of Cytomegalovirus Infection
Authors: Chou Sunwen , Song Kening , Wu Jingyang , Bo Tien , Crumpacker Clyde
Published: July 2020

Background

In separate phase 2 trials, 120 patients received maribavir for cytomegalovirus (CMV) infection failing conventional therapy (trial 202) and 119 received maribavir for asymptomatic infection (trial 203). Overall, 172 cleared their CMV infection (CMV DNA <200 copies/mL) within 6 weeks.

Methods

Baseline and posttreatment plasma samples were tested for mutations in viral genes UL97, UL54, and/or UL27. Selected viral mutants were phenotyped for drug susceptibility.

Results

Baseline samples revealed UL54 mutations newly phenotyped as conferring resistance to standard DNA polymerase inhibitor(s), including K493N, P497S, K513T, L565V, V823A, A987V, and E989D. Of 29 patients (including 25 from trial 202) who cleared but later experienced recurrent CMV infection while on maribavir, 23 had available UL97 genotyping data; 17 had known resistance mutations (T409M or H411Y) and 5 additional had UL97 C480F alone. The newly phenotyped mutation C480F conferred high-grade maribavir resistance and low-grade ganciclovir resistance. Among 25 who did not respond to >14 days of therapy, 9 showed T409M or H411Y and 4 others showed C480F alone.

Conclusions

After maribavir therapy (400–1200 mg twice daily), UL97 mutations T409M, H411Y, or C480F emerge to confer maribavir resistance in patients with recurrent CMV infection while on therapy or no response to therapy.

Clinical Trials Registration

NCT01611974 and EudraCT 2010-024247-32.
Progress towards elimination of lymphatic filariasis in the Americas region
Authors: Fontes Gilberto , da Rocha Eliana Maria Mauricio , Scholte Ronaldo Guilherme Carvalho , Nicholls Rubén Santiago
Published: July 2020

In South and Central America, lymphatic filariasis (LF) is caused by Wuchereria bancrofti, which is transmitted by Culex quinquefasciatus, the only vector species in this region. Of the seven countries considered endemic for LF in the Americas in the last decade, Costa Rica, Suriname and Trinidad and Tobago were removed from the World Health Organization list in 2011. The remaining countries, Brazil, Dominican Republic, Guyana and Haiti, have achieved important progress in recent years. Brazil was the first country in the Americas to stop mass drug administration (MDA) and to establish post-MDA surveillance. Dominican Republic stopped MDA in all LF-endemic foci: La Ciénaga and Southwest passed the third Transmission Assessment Survey (TAS) and the Eastern focus passed TAS-1 in 2018. Haiti passed the TAS and interrupted transmission in >80% of endemic communes, achieving effective drug coverage. Guyana implemented effective coverage in MDAs in 2017 and 2018 and in 2019 scaled up the treatment for 100% of the geographical region, introducing ivermectin in the MDA in order to achieve LF elimination by the year 2026. The Americas region is on its way to eliminating LF transmission. However, efforts should be made to improve morbidity management to prevent disability of the already affected populations.
Clinical concept extraction using transformers
Authors: Yang Xi , Bian Jiang , Hogan William R , Wu Yonghui
Published: July 2020

Objective

The goal of this study is to explore transformer-based models (eg, Bidirectional Encoder Representations from Transformers [BERT]) for clinical concept extraction and develop an open-source package with pretrained clinical models to facilitate concept extraction and other downstream natural language processing (NLP) tasks in the medical domain.

Methods

We systematically explored 4 widely used transformer-based architectures, including BERT, RoBERTa, ALBERT, and ELECTRA, for extracting various types of clinical concepts using 3 public datasets from the 2010 and 2012 i2b2 challenges and the 2018 n2c2 challenge. We examined general transformer models pretrained using general English corpora as well as clinical transformer models pretrained using a clinical corpus and compared them with a long short-term memory conditional random fields (LSTM-CRFs) mode as a baseline. Furthermore, we integrated the 4 clinical transformer-based models into an open-source package.

Results and Conclusion

The RoBERTa-MIMIC model achieved state-of-the-art performance on 3 public clinical concept extraction datasets with F1-scores of 0.8994, 0.8053, and 0.8907, respectively. Compared to the baseline LSTM-CRFs model, RoBERTa-MIMIC remarkably improved the F1-score by approximately 4% and 6% on the 2010 and 2012 i2b2 datasets. This study demonstrated the efficiency of transformer-based models for clinical concept extraction. Our methods and systems can be applied to other clinical tasks. The clinical transformer package with 4 pretrained clinical models is publicly available at https://github.com/uf-hobi-informatics-lab/ClinicalTransformerNER. We believe this package will improve current practice on clinical concept extraction and other tasks in the medical domain.
Association between cancer immunity and treatment results in uterine cervical cancer patients treated with radiotherapy
Authors: Someya Masanori , Tsuchiya Takaaki , Fukushima Yuki , Hasegawa Tomokazu , Takada Yu , Hori Masakazu , Miura Katsutoshi , Kitagawa Mio , Gocho Toshio , Hirohashi Yoshihiko , Torigoe Toshihiko , Iwasaki Masahiro , Matsuura Motoki , Saito Tsuyoshi , Sakata Koh-ichi
Published: July 2020

Objective

To evaluate proteins related to tumor immune response and treatment outcome from radiotherapy for uterine cervical cancer patients.

Methods

We performed a retrospective immunohistochemical staining of 81 patients with uterine cervical cancer who underwent definitive radiotherapy. We examined the expression of programmed death ligand 1, human leukocyte antigen class I, tumor-infiltrating CD8+, and forkhead box P3+ (FoxP3+) T cells in tumor tissues.

Results

In biopsy specimen, patients with a higher number of CD8+ T cells and FoxP3+ T cells had a better disease-specific survival than patients with a lower number of CD8+ T cells and FoxP3+ cells (P = 0.018 and P = 0.009). Multivariate analysis showed that equivalent dose in 2 Gy fractions (EQD2) of the minimum dose to 90% of the high-risk clinical target volume, FoxP3+ T cells and expression of human leukocyte antigen class I were significant prognostic factors. When the EQD2 is 70 Gy or more, a higher local control rate is obtained regardless of the number of CD8- or FoxP3-positive cells. When EQD2 is <70 Gy, the number of CD8-positive cells has a significant impact on treatment outcome: the recurrence rate (local recurrence rate + distant metastasis rate) was 46.2% in the group with a CD8 value of 230 or higher, whereas the recurrence rate was 75.7% in the group with a CD8 value of less than 230.

Conclusion

The combination of CD8 or FoxP3 with EQD2 can be potentially useful to predict the treatment results of radiotherapy for cervical cancer, leading to individualized optimal selection of treatment for cervical cancer.
Properties of five z ∼ 0.3–0.4 confirmed LyC leakers: VLT/XShooter observations
Authors: Guseva N G , Izotov Y I , Schaerer D , Vílchez J M , Amorín R , Pérez-Montero E , Iglesias-Páramo J , Verhamme A , Kehrig C , Ramambason L
Published: July 2020

Using new Very Large Telescope (VLT)/XShooter spectral observations we analyse the physical properties of five z ∼ 0.3–0.4 confirmed Lyman continuum (LyC) leakers. Strong resonant Mg ii λλ2796, 2803 Å emission lines (I(λλ2796, 2803)/I(Hβ) ≃ 10–38 per cent) and non-resonant Fe ii* λλ2612, 2626 Å emission lines are observed in spectra of five and three galaxies, respectively. We find high electron densities Ne ∼ 400 cm−3, significantly higher than in typical low-z, but comparable to those measured in z ∼ 2–3 star-forming galaxies (SFGs). The galaxies have a mean value of log N/O = –1.16, close to the maximum values found for SFGs in the metallicity range of 12 + log O/H ≃ 7.7–8.1. All 11 low-z LyC emitting galaxies found by Izotov et al., including the ones considered in this study, are characterized by high equivalent width (EW) (Hβ) ∼ 200–400 Å, high ionization parameter (log(U) = –2.5 to –1.7), high average ionizing photon production efficiency ξ = 1025.54 Hz erg−1, and hard ionizing radiation. On the Baldwin–Phillips–Terlevich (BPT) diagram we find the same offset of our leakers from low-z main-sequence SFGs as that for local analogues of Lyman-break galaxies (LBGs) and extreme SFGs at z ∼ 2–3. We confirm the effectiveness of the He i emission lines diagnostics proposed by Izotov et al. in searching for LyC leaker candidates and find that their intensity ratios correspond to those in a median with low neutral hydrogen column density N(H i) = 1017–5 × 1017 cm−2 that permit leakage of LyC radiation, likely due to their density-bounded H ii regions.
The Milky Way’s bulge star formation history as constrained from its bimodal chemical abundance distribution
Authors: Lian Jianhui , Zasowski Gail , Hasselquist Sten , Nataf David M , Thomas Daniel , Moni Bidin Christian , Fernández-Trincado José G , Garcia-Hernandez D A , Lane Richard R , Majewski Steven R , Roman-Lopes Alexandre , Schultheis Mathias
Published: July 2020

We conduct a quantitative analysis of the star formation history (SFH) of the Milky Way’s (MW) bulge by exploiting the constraining power of its stellar [Fe/H] and [Mg/Fe] distribution functions. Using Apache Point Observatory Galactic Evolution Experiment survey data, we confirm the previously established bimodal [Mg/Fe]–[Fe/H] distribution within 3 kpc of the inner Galaxy. To fit the chemical bimodal distribution, we use a simple but flexible star formation framework, which assumes two distinct stages of gas accretion and star formation, and systematically evaluate a wide multidimensional parameter space. We find that the data favour a three-phase SFH that consists of an initial starburst, followed by a rapid star formation quenching episode, and a lengthy, quiescent secular evolution phase. The metal-poor, high-α bulge stars ([Fe/H] < 0.0 and [Mg/Fe] > 0.15) are formed rapidly (<2 Gyr) during the early starburst. The density gap between the high- and low-α sequences is due to the quenching process. The metal-rich, low-α population ([Fe/H] > 0.0 and [Mg/Fe] < 0.15) then accumulates gradually through inefficient star formation during the secular phase. This is qualitatively consistent with the early SFH of the inner disc. Given this scenario, a notable fraction of young stars (age <5 Gyr) is expected to persist in the bulge. Combined with extragalactic observations, these results suggest that a rapid star formation quenching process is responsible for bimodal distributions in both the MW’s stellar populations and in the general galaxy population and thus plays a critical role in galaxy evolution.
All-Cause Mortality and Causes of Death in the Swiss Hepatitis C Cohort Study (SCCS)
Authors: Roelens Maroussia , Bertisch Barbara , Moradpour Darius , Cerny Andreas , Semmo Nasser , Schmid Patrick , Müllhaupt Beat , Clerc Olivier , Semela David , Junker Christoph , Negro Francesco , Keiser Olivia ,   for the Swiss Hepatitis C Cohort Study, Negro Francesco , Kaiser Laurent , Heim Markus , Hirsch Hans , Semmo Nasser , Suter Franziska , Moradpour Darius , Aubert Vincent , Siegrist Hans , Cerny Andreas , Martinetti-Lucchini Gladys , Clerc Olivier , Semela David , Schmid Patrick , Dollenmaier Günter , Müllhaupt Beat , Probst-Müller Elsbeth , Benkert Pascal , Fabbro Thomas , Rutquist Marielle , Sluka Constantin
Published: July 2020

Background

With direct-acting antiviral agents (DAAs), mortality rates and causes of death among persons with hepatitis C virus (HCV) infection may change over time. However, the emergence of such trends may be delayed by the slow progression of chronic hepatitis C. To date, detailed analyses of cause-specific mortality among HCV-infected persons over time remain limited.

Methods

We evaluated changes in causes of death among Swiss Hepatitis C Cohort Study (SCCS) participants from 2008 to 2016. We analyzed risk factors for all-cause and cause-specific mortality, accounting for changes in treatment, fibrosis stage, and use of injectable drugs over time. Mortality ascertainment was completed by linking lost-to-follow-up participants to the Swiss Federal Statistical Office death registry.

Results

We included 4700 SCCS participants, of whom 478 died between 2008 and 2016. The proportion of unknown causes of death decreased substantially after linkage, from 42% to 10%. Leading causes of death were liver failure (crude death rate 4.4/1000 person-years), liver cancer (3.4/1000 person-years), and nonliver cancer (2.8/1000 person-years), with an increasing proportion of cancer-related deaths over time. Cause-specific analysis showed that persons with sustained virologic response were less at risk for liver-related mortality than those never treated or treated unsuccessfully.

Conclusions

Although the expected decrease in mortality is not yet observable, causes of death among HCV-infected persons have evolved over time. With the wider use of DAAs, liver-related mortality is expected to decline in the future. Continued monitoring of cause-specific mortality will remain important to assess the long-term effect of DAAs and design effective interventions.
Collagen Matrix With Mucoperiosteum Graft as an Effective Fatless Flapless Reconstruction After Endoscopic Pituitary Adenoma Resection
Authors: Shahein Mostafa , Montaser Alaa S , Barbero Juan M Revuelta , Maza Guillermo , Todeschini Alexandre B , Otto Bradley A , Carrau Ricardo L , Prevedello Daniel M
Published: July 2020

BACKGROUND

Proper skull base reconstruction after endoscopic endonasal pituitary surgery is of great importance to decrease the rate of complications.

OBJECTIVE

To assess the safety and efficacy of reconstruction with materials other than fat graft and naso-septal flaps (NSF) to avoid their associated morbidities.

METHODS

The authors’ institutional database for patients who underwent endoscopic endonasal approach for pituitary adenoma was reviewed. Exclusion criteria included recurrence, postradiation therapy, and reconstruction by fat graft or NSF. They were divided into group A, where collagen matrix (CM) (DuraGen® Plus Matrix, Integra LifeSciences Corporation, Plainsboro, New Jersey) alone was used; group B, where CM and simple mucoperiosteum graft were used and group C, which included cases without CM utilization.

RESULTS

The study included 252 patients. No age, gender, or body mass index statistically significant difference between groups. Group B included the largest tumor size (23.0 mm) in comparison to groups A (18.0 mm) and C (13.0 mm). Suprasellar extension was more frequently present (49.4%) in comparison to groups A (29.8%, P = .001) and C (21.2%, P < .001). Postoperative cerebrospinal fluid (CSF) leak rate was 0%, 2.9%, and 6% in groups A, B, and C, respectively. In group B, the CSF leak rate decreased from 45.9% intraoperatively to 2.9% postoperatively (P < .001). In group A, the CSF leak reduction rate was almost statistically significant (P = .06).

CONCLUSION

Utilization of CM and simple mucosperiosteal graft in skull base reconstruction following pituitary adenoma surgery is an effective method to avoid the morbidities associated with NSF or fat graft.
A Minimally Invasive Endoscopic Technique for Fascia Lata Graft Acquisition and Fascial Reapproximation
Authors: Skoch Jesse , Avila Mauricio J , Fennell Vernard S , Martirosyan Nikolay L , Baaj Ali A , Lemole Gerald M
Published: July 2020

BACKGROUND

Fascia lata remains a popular and robust graft to repair osteodural defects in endoscopic neurosurgery. Classically, this graft is obtained via a large incision in the thigh that is prone to pain and muscle herniation after surgery.

OBJECTIVE

To present a novel technique for harvesting fat and fascia lata graft and reapproximating the edges via an endoscopic approach through the thigh using an “outside-in” technique to prevent muscle herniation.

METHODS

Initially our technique was performed in cadavers and includes the following: small 2 cm incision in the lateral thigh to accommodate the endoscope, use of blunt dissection and endoscopic tools to obtain the graft, and reapproximation of the fascia via an outside-in technique using conventional sutures with endoscopic visualization to retrieve the sutures beneath the skin and tie them. We then applied the technique to a patient undergoing transsphenoidal tumor resection.

RESULTS

This technique was trialed in 3 cadaver specimens (6 limbs) and was used successfully in a patient with excellent cosmetic results seen in follow-up.

CONCLUSION

Endoscopic retrieval of fascia lata is feasible via a very small incision. Reapproximation of the cut fascial edges to minimize muscle herniation can quickly and easily be performed with an outside-in technique detailed here. Additional case series may help to solidify the endoscopic retrieval as a preferred technique for fascia lata graft.
Microsurgical Resection of Cervical Intradural Juxtamedullary Solitary Fibrous Tumor: 2-Dimensional Operative Video
Authors: Perrini Paolo , Di Carlo Davide Tiziano , Montemurro Nicola , Benedetto Nicola , Ortenzi Valerio , Naccarato Antonio Giuseppe
Published: July 2020

Solitary fibrous tumors (SFTs) are uncommon mesenchymal lesions originally described as pleura-based neoplasms. Intradural juxtamedullary SFTs are rare, hard, and scarcely vascularized and generally present a conspicuous extramedullary exophytic component without dural attachment and nerve root involvement. Gross-total resection is the mainstay of treatment, although the absence of an arachnoidal plane and the firm adherence to the spinal cord make resection challenging.

 We describe the case of a 74-yr-old female patient presenting with a history of progressive spastic tetraparesis due to a cervical juxtamedullary SFT. The patient was not able to walk and magnetic resonance imaging (MRI) of the cervical spine demonstrated a possible intramedullary lesion at C2-C3 with homogeneous enhancement after gadolinium injection. Given the progressive nature of symptoms, the patient elected to have surgical resection of the tumor. The patient underwent C2-C3 laminoplasty and tumor resection under neurophysiologic monitoring. The tumor presented extremely hard without dural attachment or nerve root involvement and was progressively debulked using microsurgical techniques and ultrasonic aspirator. The identification of a plane between the mass and the spinal cord white matter allowed for a gross total resection. Permanent pathological analysis eventually demonstrated SFT. The patient's neurological condition was unchanged postoperatively. MRI performed 2 mo after the operation demonstrated gross total resection of the lesion. At the 6-mo follow-up visit, the patient was able to walk with assistance.

 The patient signed the Institutional Consent Form to undergo the surgical procedure and to allow the use of her images and videos for any type of medical publications.
Development and Validation of the AdT-Physio Scale: A Tool to Assess Adherence and Perception of Physical Therapist Intervention in Patients With Cystic Fibrosis
Authors: del Corral Tamara , La Touche Roy , Cebrià i Iranzo Maria Àngels , Olmos Ricardo , Blanco-Royano Fernando , López-de-Uralde-Villanueva Ibai
Published: July 2020

Objective

The purpose of this study was to develop a scale to measure patient adherence to physical therapist intervention and to report psychometric properties in patients with cystic fibrosis (CF).

Methods

This observational, multicenter, qualitative, and cross-sectional study was divided into 2 phases: development of scale items (content validity) and assessment of psychometric properties (construct validity, reliability, and convergent/discriminant validity). Recruited were 121 patients with CF (aged ≥16 years). Sociodemographic characteristics, lung function testing, Coping with Stress Self-Efficacy, brief Coping Orientation to Problems Experienced inventory, and the scale of Adherence to Treatment of Physiotherapy (AdT-Physio) scale were evaluated.

Results

The final version of the AdT-Physio scale consists of 15 items distributed across 2 subscales: compliance and beliefs about treatment/therapist. The scale showed high internal consistency (Cronbach α = .897; 95% CI = 0.868–0.922) and subscales above 0.800. The 2-factor confirmatory factor analysis model fitted the data reasonably well: χ2 (76) = 111.96, comparative fit index = 0.982, Tucker-Lewis index = 0.978, root mean square error of approximation = 0.063, 95% CI = 0.036 to 0.086, and weighted root mean square residual = 0.720. No floor or ceiling effects were identified. There was a positive, significant, and moderate-low magnitude correlation with the total Coping Orientation to Problems Experienced inventory (r = .360) and Coping with Stress Self-Efficacy subscale efficacy expectations scores (r = .304). For discriminant validity, there was a positive, significant, and moderate correlation between the total and the age of the patients (r = .354).

Conclusions

The AdT-Physio scale is psychometrically valid and reliable for use in the clinic for the assessment of adherence to physical therapy in patients with CF.

Impact

Ultimately, the authors propose this documentary instrument to assess the evaluation of the therapeutic alliance in a valid and objective manner. The AdT-Physio scale provides us with a greater degree of understanding of the problems behind noncompliance with treatment to advance person-centered decisions in physical therapy and thereby enhance the effectiveness of care.
Why Does Equity Capital Flow out of High Tobin’s $\boldsymbol{q}$ Industries?
Authors: Lee Dong Wook , Shin Hyun-Han , Stulz René M
Published: July 2020

High Tobin’s $q$ industries receive more funding from capital markets than low Tobin’s $q$ industries from 1971 to 1996. Since then, the opposite is true. The key to understanding this shift is that large firms, for which $q$ is more a proxy for rents than investment opportunities, have become more important within industries. For these firms, repurchases but not capital expenditures increase in the cross-section with $q$, so that $q$ explains the variation of repurchases more than of capital expenditures. Consequently, equity capital flows out of high $q$ industries because for these industries stock repurchases are high and issuances are low.
Becoming the North Karelia Project: The Shaping of an Iconic Community Health Intervention in Finland (1970–1977)
Authors: Jauho Mikko
Published: July 2020

The article describes the shaping of an iconic public health intervention, the North Karelia Project (NKP) in Finland in the 1970s. NKP is widely hailed as a landmark project, contributing significantly to the development of the community approach to chronic disease prevention. This approach targets comprehensively a specified health problem in a circumscribed area among the whole population, not only high-risk individuals. Based on published and archival material as well as interviews with a few key actors, the article shows how two interlinked tensions shaped the project: the first between rigorous scientific inquiry and politically motivated practical healthcare development in a disadvantaged area and the second between a broad community approach and a focus on individualised health behaviour. These tensions played out in the planning, funding and administrative structure of NKP, were the key source of criticism of it and have affected the possibilities to evaluate its results.
Making Meaning without a Maker: Secular Consciousness through Narrative and Cultural Practice
Authors: Smith Jesse M , Halligan Caitlin L
Published: July 2020

Drawing on fieldwork and in-depth interviews, this study examines the ways affirmatively secular individuals construct moral frameworks, navigate hardship, and create meaningful selves. Based on an inductive, thematic analysis of the data, we show that secular individuals’ identities and interpretations of everyday experience and important life events are made meaningful through personal narratives and shared social spaces where cultural values are practiced, imbuing secular worldviews with a sense of legitimacy. Through participants’ responses to questions of “ultimate concern” including life’s purpose, and the meaning of happiness, hardship, and death, we argue that a sense of otherness, appeals to normative values, and the reframing of existential questions in secular terms plays an essential role in the lives of a segment of the growing, increasingly diverse nonreligious community. Our findings have implications for scholars of secularity, including the role of ambiguity in secular beliefs and the importance of narrative in worldview formation.
COVID-19 Pandemic-Related Practices and Policies Affecting the Continuity of Behavioral Health Care Among Children With Diabetes
Authors: Clary Lauren , Wang Christine , Byrne Meghan E , Monaghan Maureen
Published: July 2020

COVID-19 has led to substantial challenges in continuing to deliver behavioral health care to all patients, including children with chronic diseases. In the case of diabetes, maintaining strong connections among children, their families, and their care team is essential to promote and sustain daily adherence to a complex medical regimen. The purpose of this paper is to describe COVID-19 pandemic-related practices and policies affecting the continuity of behavioral health care among children with diabetes. Challenges and opportunities were encountered at the provider, patient, and family levels throughout the rapid transition period from in-person to online care to ensure continuity of services. Institutional, regional, and national policies that impacted the care team’s capacity to respond swiftly to patients’ changing needs were counterbalanced by those related to standards of care, education and training, and resource constraints. At the policy level, COVID-19 re-exposed a number of long-standing and complicated issues about professional licensure among behavioral health providers at the local and state levels and national long-distance practice restrictions during times of crisis. Issues of insurance reimbursement and regulations intended to protect the public may need to adapt and evolve as the practice of behavioral medicine increasingly takes place remotely, online, and over great distances. The sudden transition to telehealth instigated by COVID-19, in addition to the increasing recognition of the benefits of telehealth to favorably affect the reach and impact of traditional behavioral medicine services, offers an unprecedented opportunity to reimagine the medical home and continuity of care for children with diabetes.
X The Seventeenth Century: Part II
Authors: Baker William , Netzley Ryan , Airey Jennifer
Published: July 2020

This chapter has five sections: 1. General; 2. Poetry Excluding Dryden; 3. Restoration Drama Excluding Dryden; 4. Dryden; 5. Poetry and Prose. Section 1 is by William Baker; section 2 is by Ryan Netzley and is divided into six parts: (a) Marvell; (b) Traherne; (c) Vaughan; (d) Cowley; (e) Herrick; (f) Metaphysical and Religious Poets; sections 3 and 4 are by Jennifer Airey; section 5 is by William Baker and is divided into five parts: (a) Hobbes; (b) Locke; (c) Bunyan; (d) Aubrey, Walton, and Bishop Tillotson; (e) Rochester.
LUNG ULTRASOUND FINDINGS IN MEXICAN PATIENTS WITH SARS COV2 INFECTION
Authors: Fernández Luis Fernando Paredes , Martínez Iván Ilescas
Published: July 2020

In late December 2019, a new disease reported at the time by an unknown pathogen was reported, which was later found to be a new variant of coronavirus, now called SARS-CoV2. This new disease had a very rapid global spread, causing multiple deaths in a short time, and which led to putting the entire world on health alert. In patients who have this disease, they present bilateral opacities in frosted multilobar glass with peripheral distribution. Some authors have suggested the use of ultrasound at the point of care for its early recognition.

In this study, we evaluated the findings of lung ultrasound in 25 patients admitted to the General Hospital Dr. Enrique Cabrera, Mexico, with a diagnosis confirmed by RT-PCR of SARS CoV2. This small retrospective study suggests that artifacts like glass rockets with or without the Birolleau variant (White lung), confluent B-lines, thick irregular pleural lines, and variable size (subpleural) consolidations are typical findings of lung ultrasound in patients with COVID-19 pneumonia. The presence of these findings is useful when evaluating patients with suspected COVID-19. In resource-limited and austere settings where chest radiography, CT, and RT-PCR are not available or the response time is long, lung ultrasound performed by trained personnel can be an aid in the diagnosis of COVID-19.
High Rate of SARS-CoV-2 Transmission due to Choir Practice in France at the Beginning of the COVID-19 Pandemic
Authors: Charlotte Nathalie
Published: July 2020

Background

There has been little focus on the individual risk of acquiring COVID-19 related to choir practice.

Methods

We report the case of a high transmission rate of SARS-CoV-2 linked to an indoor choir rehearsal in France in March 2020 at the beginning of the COVID-19 pandemic.

Results

A total of 27 participants, including 25 male singers, a conductor and an accompanist attended a choir practice on March 12, 2020. The practice was indoor and took place in a non-ventilated space of 45 m2. No choir member reported having been symptomatic for COVID-19 between March 2 and March 12.The mean age of the participants was 66.9 (range 35-86) years. 70% of the participants (19 of 27) were diagnosed with COVID-19 from 1 to 12 days after the rehearsal with a median of 5.1 days. 36% of the cases needed a hospitalization (7/19), and 21% (4/19) were admitted to an ICU. The index cases were possibly multiple.

Discussion

The choir practice was planned in March 2020 at a period when the number of new cases of COVID-19 began to grow exponentially in France because SARS-CoV-2 was actively circulating. The secondary attack rate (70%) was much higher than it is described within households (10-20%) and among close contacts made outside households (0-5%). Singing might have contributed to enhance SARS-CoV-2 person-to-person transmission through emission of droplets and aerosolization in a closed non ventilated space with a relative high number of people including multiple pre-symptomatic suspected index cases.

Conclusion

Indoor choir practice should be suspended during SARS-CoV-2 outbreaks. Further studies are necessary to test the spread of the virus by the act of singing. As the benefits of the barrier measures and social distancing are known to be effective in terms of a reduction in the incidence of the COVID-19, experts’ recommendations concerning the resuming of choir practice are necessary.
Multiethnic genome-wide association study of differentiated thyroid cancer in the EPITHYR consortium
Authors: Truong Thérèse , Lesueur Fabienne , Sugier Pierre-Emmanuel , Guibon Julie , Xhaard Constance , Karimi Mojgan , Kulkarni Om , Lucotte Elise , Bacq-Daian Delphine , Boland-Auge Anne , Mulot Claire , Laurent-Puig Pierre , Schvartz Claire , Guizard Anne-Valérie , Ren Yan , Adjadj Elisabeth , Rachédi Frédérique , Borson-Chazot Francoise , Ortiz Rosa Maria , Lence-Anta Juan J. , Pereda Celia M. , Comiskey Daniel F. , He Huiling , Liyanarachchi Sandya , de la Chapelle Albert , Elisei Rosella , Gemignani Federica , Thomsen Hauke , Forsti Asta , Herzig Anthony F. , Leutenegger Anne-Louise , Rubino Carole , Ostroumova Evgenia , Kesminiene Ausrele , Boutron-Ruault Marie-Christine , Deleuze Jean-François , Guénel Pascal , de Vathaire Florent
Published: July 2020

Incidence of differentiated thyroid carcinoma (DTC) varies considerably between ethnic groups, with particularly high incidence rates in Pacific Islanders. Here, we conducted a genome-wide association study (GWAS) involving 1,554 cases/1,973 controls of European ancestry and 301 cases/348 controls of Oceanian ancestry from the EPITHYR consortium. Our results confirmed the association with the known DTC susceptibility loci at 2q35, 8p12, 9q22.33 and 14q13.3 in the European ancestry population and suggested two novel signals at 1p31.3 (rs334729) and 16q23.2 (rs16950982), which were associated with TSH levels in previous GWAS. We additionally replicated an association with 5p15.33 reported previously in Chinese and European populations. Except at 1p31.3, all associations were in the same direction in the population of Oceanian ancestry. The frequencies of risk alleles at 2q35, 5p15.33 and 16q23.2 were significantly higher in Oceanians than in Europeans and may explain part of the highest DTC incidence observed in Oceanians.
Interplay of IL6 and CRIM1 on thiopurine-induced neutropenia in leukemic patients with wild-type NUDT15 and TPMT
Authors: Kim Hyery , You Seungwon , Park Yoomi , Choi Jung Yoon , Ma Youngeun , Hong Kyung Tak , Koh Kyung-Nam , Yun Sunmin , Lee Kye Hwa , Shin Hee Young , Lee Suehyun , Yoo Keon Hee , Im Ho Joon , Kang Hyoung Jin , Kim Ju Han
Published: July 2020

Background

NUDT15 and TPMT variants are strong genetic determinants of thiopurine-induced hematological toxicity. Despite recent discovery of homozygous CRIM1 effect on thiopurine toxicity, many patients with wild-type NUDT15, TPMT, and CRIM1 still suffer from thiopurine toxicity, and therapeutic failure and relapse of acute lymphoblastic leukemia (ALL).

Methods

Novel PGx interactions associated with thiopurine toxicity in 320 pediatric ALL patients were investigated using whole-exome sequencing technology for the last-cycle 6-Mercaptopurine dose intensity percentage (DIP) tolerated by pediatric ALL patients.

Results

IL6 rs13306435 carriers (N=19) exhibited significantly lower DIP (48.0±27.3%) than non-carriers (N=209, 69.9±29.0%; p=0.0016 and 0.0028 by t-test and multiple linear regression, respectively). Of the 19 carriers, seven with both heterozygous IL6 rs13306435 and CRIM1 rs3821169 showed significantly decreased DIP (24.7±8.9%) than those with IL6 (N=12, 61.6±25.1%) or CRIM1 (N=94, 68.1±28.4%) variant only. Both IL6 and CRIM1 variants showed marked inter-ethnic variability. Significant interplay between IL6 and CRIM1 in thiopurine toxicity was suggested. GVB (Gene-wise Variant Burden)-based four-gene-interplay model showed the best odds ratio (8.06) and potential population impact (i.e., relative risk (5.73), population attributable fraction (58%), number needed to treat (3.67) and number needed to genotype (12.50)).

Conclusions

Interplay of IL6 rs13306435 and CRIM1 rs3821169 was suggested as independent and/or additive genetic determinant of thiopurine toxicity beyond NUDT15 and TPMT in pediatric ALL.
TESTING INFORMED SIR BASED EPIDEMIOLOGICAL MODEL FOR COVID-19 IN LUXEMBOURG
Authors: Sauter Thomas , Pacheco Maria Pires
Published: July 2020

The interpretation of the number of COVID-19 cases and deaths in a country or region is strongly dependent on the number of performed tests. We developed a novel SIR based epidemiological model (SIVRT) which allows the country-specific integration of testing information and other available data. The model thereby enables a dynamic inspection of the pandemic and allows estimating key figures, like the number of overall detected and undetected COVID-19 cases and the infection fatality rate. As proof of concept, the novel SIVRT model was used to simulate the first phase of the pandemic in Luxembourg. An overall number of infections of 13.000 and an infection fatality rate of 1,3% was estimated, which is in concordance with data from population-wide testing. Furthermore based on the data as of end of May 2020 and assuming a partial deconfinement, an increase of cases is predicted from mid of July 2020 on. This is consistent with the current observed rise and shows the predictive potential of the novel SIVRT model.
Prospective Observational Study of Screening Asymptomatic Healthcare Workers for SARS-CoV-2 at a Canadian Tertiary Care Center
Authors: Kumar Deepali , Ferreira Victor H. , Chruscinski Andrzej , Kulasingam Vathany , Pugh Trevor J. , Dus Tamara , Wouters Brad , Oza Amit , Ierullo Matthew , Ku Terrance , Majchrzak-Kita Beata , Humar Sonika T. , Bahinskaya Ilona , Pinzon Natalia , Zhang Jianhua , Heisler Lawrence E. , Krzyzanowski Paul M. , Lam Bernard , Lungu Ilinca M. , Manase Dorin , Pace Krista M. , Mashouri Pouria , Brudno Michael , Garrels Michael , Mazzulli Tony , Cybulsky Myron , Humar Atul
Published: July 2020

We screened three separate cohorts of healthcare workers for SARS-CoV-2 via nasopharyngeal swab PCR. A seroprevalence analysis using multiple assays was performed in a subgroup. The asymptomatic health care worker cohorts had a combined swap positivity rate of 29/5776 (0.50%, 95%CI 0.32-0.75) compared to the symptomatic cohort rate of 54/1597 (3.4%) (ratio of symptomatic to asymptomatic 6.8:1). Sequencing demonstrated several variants. The seroprevalence (n=996) was 1.4-3.4% depending on assay. Protein microarray analysis showed differing SARS-CoV-2 protein reactivities and helped define likely true positives vs. suspected false positives. Routine screening of asymptomatic health care workers helps identify a significant proportion of infections.
The Role of Mathematical Model in Curbing COVID-19 in Nigeria
Authors: Madubueze Chinwendu E. , Akabuike Nkiru M. , Dachollom Sambo
Published: July 2020

The role of mathematical models in controlling infectious diseases cannot be overemphasized. COVID-19 is a viral disease that is caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) which has no approved vaccine. The available control measures are non-pharmacological interventions like wearing face masks, social distancing, and lockdown which are being advocated for by the WHO. This work assesses the impact of non-pharmaceutical control measures (social distancing and use of face-masks) and mass testing on the spread of COVID-19 in Nigeria. A community-based transmission model for COVID-19 in Nigeria is formulated with observing social distancing, wearing face masks in public and mass testing. The model is parameterized using Nigeria data on COVID-19 in Nigeria. The basic reproduction number is found to be less than unity(R0< 1) when the compliance with intervention measures is moderate (50% ≤α<70%) and the testing rate per day is moderate (0.5 ≤σ2< 0.7) or when the liance with intervention measures is strict (α≥ 70%) and the testing rate per day is poor (σ2= 0.3). This implies that Nigeria will be able to halt the spread of COVID-19 under these two conditions. However, it will be easier to enforce strict compliance with intervention measures in the presence of poor testing rate due to the limited availability of testing facilities and manpower in Nigeria. Hence, this study advocates that Nigerian governments (Federal and States) should aim at achieving a testing rate of at least 0.3 per day while ensuring that all the citizens strictly comply with wearing face masks and observing social distancing in public.