bluuebunny/crossref_metadata_2025 huggingface dataset:
Leveraging Radiopharmaceutical Programmatic Collaboration for Management of Pretherapy and On-treatment Urinary Incontinence
Authors: Kunos Charles A. , Lemieux Bryan P. , Recca Kimyli , Oates M. Elizabeth , El Khouli Riham H.
Published: August 2023

Many parenteral radiopharmaceuticals available as anticancer therapy are filtered by the kidneys and excreted in the urine. Here, physician leaders of radiation medicine, nuclear medicine/molecular imaging, and the radiotheranostics programs as well as radiation safety officers, collaborated to develop a decision-making guideline for the administration of therapeutic radiopharmaceuticals in patients with pretherapy or day-of-treatment incontinence. We discussed challenges and opportunities in the screening of patients in urine collection strategies according to grade of urinary incontinence and in subsequent coordination of care. Lutetium-177 (177Lu)-based radiopharmaceutical therapies provided clinical examples of how our procedures were operationalized. Our key management issues of urinary incontinence were cutaneous radiation injury and redness, infection, or pain. In response, we developed clinical practice guidelines for the recognition and management of incontinence-related adverse events. Common adverse events of urinary incontinence were noted in this study. Our how-to guideline for the safe administration of therapeutic radiopharmaceuticals for patients with urinary incontinence warrants further investigation and should continue to be evaluated across all radiopharmaceutical therapy agents.
The platelet-to-lymphocyte ratio as an indirect outcome predictor in primary hypertension: a retrospective study
Authors: Pinho Rita , Ribeiro Rui , Ferrão Diana , Medeiros Rui , Lima Maria João , Almeida Jorge , Freitas-Silva Margarida
Published: August 2023

Background:

Nondipper hypertensive patients have higher levels of platelet-to-lymphocyte ratio, a new studied inflammatory biomarker in primary hypertension. Furthermore, these patients have a higher risk of cardiovascular morbidity and mortality. This study aimed to assess the relationship between platelet-to-lymphocyte ratio and hypertensive pattern (dipper vs nondipper) and the association between the hypertensive pattern and major adverse cardiovascular events.

Methods:

A retrospective analysis was performed. One hundred fifty-three patients were included and classified as dipper or nondipper according to 24-hour ambulatory blood pressure measurements. Platelet-to-lymphocyte ratio was calculated based on complete blood count data.

Results:

The dipper group included 109 patients, and the nondipper group included 44 patients. Nondipper patients have 2.11 more risk of presenting a higher platelet-to-lymphocyte ratio than dipper individuals (odds ratio [OR] = 2.11; 95% CI, 1.220–3.664; P = .007). Nondipper patients also registered earlier cardiovascular events, such as acute myocardial infarction and stroke (P < .001).

Conclusions:

Nondipper hypertensive individuals registered higher levels of platelet-to-lymphocyte ratio and earlier cardiovascular events than dipper patients. Therefore, platelet-to-lymphocyte ratio could be used as an indirect predictor of cardiovascular risk in primary hypertension and contribute to optimize preventive strategies.
The Application of Adaptive Minimum Match k-Nearest Neighbors to Identify At-Risk Students in Health Professions Education
Authors: Kumar Anshul , DiJohnson Taylor , Edwards Roger A. , Walker Lisa
Published: August 2023

Introduction

When learners fail to reach milestones, educators often wonder if any warning signs could have allowed them to intervene sooner. Machine learning can predict which students are at risk for failing a high-stakes certification examination. If predictions can be made well before the examination, educators can meaningfully intervene before students take the examination to reduce their chances of failing.

Methods

The authors used already-collected, first-year student assessment data from 5 cohorts in a single Master of Physician Assistant Studies program to implement an “adaptive minimum match” version of the k-nearest neighbors algorithm using changing numbers of neighbors to predict each student's future examination scores on the Physician Assistant National Certifying Exam (PANCE). Validation occurred in 2 ways by using leave-one-out cross-validation (LOOCV) and by evaluating predictions in a new cohort.

Results

“Adaptive minimum match” version of the k-nearest neighbors algorithm achieved an accuracy of 93% in LOOCV. “Adaptive minimum match” version of the k-nearest neighbors algorithm generates a predicted PANCE score for each student one year before they take the examination. Students are classified into extra support, optional extra support, or no extra support categories. Then, one year remains to provide appropriate support to each category of student.

Discussion

Predictive analytics can identify at-risk students who might need additional support or remediation before high-stakes certification examinations. Educators can use the included methods and code to generate predicted test outcomes for students. The authors recommend that educators use predictive modeling responsibly and transparently, as one of many tools used to support students. More research is needed to test alternative machine learning methods across a variety of educational programs.
Outcomes Associated with Concomitant Lower-Limb Amputation in Persons with Major Upper-Limb Amputation: Results of a National Study
Authors: Witt Oksana , Webster Joseph B. , Borgia Matthew , Resnik Linda
Published: August 2023

Introduction

The challenges faced by persons with amputations are amplified for those with multiple limb loss, compared with single limb loss. However, there is limited research describing the functional outcomes of mixed upper and lower limb loss or the long-term psychosocial and health-related quality of life (HRQoL) outcomes among this group.

Materials and Methods

A cross-sectional, national telephone survey of 808 US veterans with major upper-limb amputation (ULA) with and without concomitant lower-limb amputation (LLA) who received care at US Veterans Affairs Medical Centers between 2010 and 2015 was conducted. T-tests and χ2 tests identified any significant differences in characteristics and outcomes of groups with and without LLA. Linear regressions examined the association between amputation laterality and outcomes.

Results

In comparison to those with no LLA, respondents with concomitant LLA were slightly younger (60.0 vs. 63.7) and had similar mean time in years from initial amputation (31.5 vs. 31.4). Transfemoral was the most common level of LLA (67.7%), and there was no significant difference in the distribution of ULA levels between the 2 groups. Phantom pain was less common among those with concomitant LLA compared with ULA only (64.4% vs. 74.5%, P < 0.05). No significant differences were found in prevalence of residual limb, neck, or back pain; measures of disability (QuickDASH); HRQoL; or need for activities of daily living help across the two groups.

Conclusions

In veterans with concomitant LLA and ULA, transfemoral amputation was the most common level of LLA. Those with concomitant LLA were less likely to report phantom limb pain. No statistically significant differences were found by group in need for ADL help, disability, or HRQoL.

Clinical Relevance

These results provide clinicians with a greater appreciation of the similarities and differences between the two groups in relation to amputation characteristics, pain, prosthesis utilization, prosthesis satisfaction, and functional outcomes.
Perfluorocarbons in Research and Clinical Practice: A Narrative Review
Authors: Nocentini Giulia , MacLaren Graeme , Bartlett Robert , De Luca Daniele , Perdichizzi Salvatore , Stoppa Francesca , Marano Marco , Cecchetti Corrado , Biasucci Daniele G. , Polito Angelo , AlGhobaishi Abdullah , Guner Yit , Gowda Sharada H. , Hirschl Ronald B. , Di Nardo Matteo
Published: August 2023

Perfluorocarbons (PFCs) are organic liquids derived from hydrocarbons in which some of the hydrogen atoms have been replaced by fluorine atoms. They are chemically and biologically inert substances with a good safety profile. They are stable at room temperature, easy to store, and immiscible in water. Perfluorocarbons have been studied in biomedical research since 1960 for their unique properties as oxygen carriers. In particular, PFCs have been used for liquid ventilation in unusual environments such as deep-sea diving and simulations of zero gravity, and more recently for drug delivery and diagnostic imaging. Additionally, when delivered as emulsions, PFCs have been used as red blood cell substitutes. This narrative review will discuss the multifaceted utilization of PFCs in therapeutics, diagnostics, and research. We will specifically emphasize the potential role of PFCs as red blood cell substitutes, as airway mechanotransducers during artificial placenta procedures, as a means to improve donor organ perfusion during the ex vivo assessment, and as an adjunct in cancer therapies because of their ability to reduce local tissue hypoxia.
Efficacy and Safety of Cold Snare Endoscopic Mucosal Resection (CS-EMR) for Nonampullary Duodenal Polyps
Authors: Mohamed Mouhand F.H. , Ahmed Khalid , Rajadurai Suvithan , Jaber Fouad , Hamid Osama , Abdalla Abubaker O. , Johnson Willie M. , Umar Shifa , Chandan Saurabh , Abdallah Mohamed , Bilal Mohammad
Published: August 2023

Introduction:

There is an increasing interest in cold snare endoscopic mucosal resection (CS-EMR), and studies have shown its safety and efficacy for colonic polyps. This meta-analysis aims to assess the safety and efficacy of CS-EMR for the removal of duodenal adenomas.

Methods:

We conducted a comprehensive literature search of several databases, from inception through February 2023, for studies that addressed outcomes of CS-EMR for nonampullary duodenal adenomas. We used the random-effects model for the statistical analysis. The weighted pooled rates were used to summarize the technical success, polyp recurrence, bleeding, and perforation events. Cochran Q test and I
2 statistics adjudicated heterogeneity.

Results:

Six studies were included in the analysis. In all, 178 duodenal polyps were resected using CS-EMR. The pooled rates were 95.8% (95% CI 89.1–98.5%, I
2=21.5%) for technical success and 21.2% (95% CI 8.5–43.6%, I
2=78%) for polyp recurrence. With regards to CS-EMR safety, the pooled rates were 4.2% (95% CI 1.6–10.5%, I
2=12%) for immediate bleeding, 3.4% (95% CI 1.5–7.6%, I
2=0%) for delayed bleeding, 2.8% (95% CI 1.1–6.7%, I
2=0%) for perforation, and 2% (95% CL 0.5–7.5%, I
2=0%) for post-polypectomy syndrome. Rates were not significantly different for large adenomas. Three studies reported data on CS-EMR and conventional EMR. Compared with conventional EMR, CS-EMR had lower odds of delayed bleeding, OR 0.11 (CI 0.02–0.62, P value 0.012, I
2=0%).

Conclusion:

Our findings suggest that CS-EMR is a safe and effective strategy for the resection of nonampullary duodenal adenomas, with an acceptable recurrence rate. Data from larger randomized controlled studies are needed to validate our findings.
Phospholipid transport by ABCA1: the extracellular translocase or alternating access model?
Authors: Segrest Jere P. , Davidson W. Sean , Heinecke Jay W.
Published: August 2023

Purpose of review

ATP-binding cassette transporter A1 (ABCA1) plays a key role in high-density lipoprotein (HDL) biogenesis and cholesterol export from artery wall cells. Recent evidence challenges the generally accepted model for lipid transport by ABCA1, termed the alternating access mechanism, which proposes that phospholipid moves from the inner leaflet to the outer leaflet of the plasma membrane.

Recent findings

In contrast to the standard model, our computer simulations of ABCA1 indicate that ABCA1 extracts phospholipid from the plasma membrane's outer leaflet. The lipid then diffuses into the interior of ABCA1 to contact a structure termed the ‘gateway’. A conformational change opens the gateway and forces the lipid through a ring-shaped domain, the ‘annulus orifice’, into the base of an elongated hydrophobic tunnel in the transporter's extracellular domain. Engineered mutations in the gateway and annulus strongly inhibited lipid export by ABCA1 without affecting cell-surface expression levels of the transporter, strongly supporting the proposed model.

Our demonstration that ABCA1 extracts lipid from the outer face of the plasma membrane and forces it into an elongated hydrophobic tunnel contrasts with the alternating access model, which flops phospholipid from the membrane's inner leaflet to its outer leaflet. These results suggest that ABCA1 is a phospholipid translocase that transports lipids by a mechanism distinct from that of other ABC transporters.
Diagnostic Utility of Mucosal Biopsies Taken During Colonoscopy-Guided Colonic Manometry Catheter Placement
Authors: Armstrong Derek G. , Chumpitazi Bruno P. , Chiou Eric H. , Balakrishnan Keshawadhana
Published: August 2023

Objectives:

The diagnostic utility of mucosal biopsies taken during colonoscopy-guided colonic manometry catheter placement is unknown. The aims of our study were to determine the frequency and histopathology results of mucosal biopsies during these procedures and to assess whether there were any associations between the histology or gross findings with manometry results.

Methods:

We performed a retrospective chart review of children who had a colonic manometry study completed between 2008 and 2020 at a quaternary children’s hospital. We captured patient demographics, biopsy locations, histopathology results, gross endoscopy findings, and manometry results. The chi-squared test and when appropriate Fisher exact test was used to evaluate categorical associations.

Results:

One hundred forty-eight patients were included. One hundred eighteen (80%) had colonic biopsy and 63 (43%) had ileal biopsy. Colonic histology findings, which patients could have multiple, included lymphonodular hyperplasia (34%), normal (27%), chronic inflammation (24%), melanosis coli (21%), colonic eosinophilia (10%), and acute inflammation (8%). Ileal histology findings included increased Peyer patches (44%), normal (44%), acute inflammation (11%), chronic inflammation (3%), eosinophilia (5%), and eosinophilic ileitis (3%). The majority of acute and chronic inflammation was graded as mild. There were no statistically significant associations of histology to gross endoscopy or manometry findings.

Conclusions:

Colonic biopsies are obtained in the majority of patients presenting for colonic manometry evaluation with ileal biopsies obtained less frequently. Histopathology findings are noted frequently, but the majority are the result of or did not impact clinical care. There were no associations between abnormal histopathology or abnormal gross endoscopy findings with colonic manometry results.
Comparison of Placental Pathology Reports From Spontaneous Preterm Births Finalized by General Surgical Pathologists Versus Perinatal Pathologist
Authors: Ernst Linda M. , Basic Ena , Freedman Alexa A. , Price Erica , Suresh Sunitha
Published: August 2023

Placental examination, frequently performed by general surgical pathologists, plays an important role in understanding patient outcomes and explaining the underlying mechanisms leading to preterm birth (PTB). This secondary analysis of a larger study recurrent PTB aimed to compare diagnoses between general surgical pathologists (GSP) and a perinatal pathologist (PP) in preterm placentas examined between 2009 and 2018 at a single institution. Pathology diagnoses were coded into 4 categories (acute inflammation [AI], chronic inflammation, fetal vascular malperfusion, maternal vascular malperfusion) based on original reports for the GSP and second review by the single PP. A total of 331 placentas were included, representing placentas finalized by 17 GSPs. The prevalence of all 4 placental diagnostic categories was higher for the PP, and nearly half (49.2%) of placentas finalized by GSP had no diagnostic findings. Agreement was highest for AI at κ=0.50 (weak agreement). However, there was no agreement for maternal vascular malperfusion (κ=0.063), chronic inflammation (κ=0.0026), and fetal vascular malperfusion (κ=−0.018). Chronic basal deciduitis with plasma cells had the highest false-negative rate (missed in 107 cases by GSP). Villous infarction had the highest false-positive rate (overcalled in 28/41 [68%] cases) with the majority of the “infarcts” representing intervillous thrombi. In conclusion, there is no agreement between GSP and PP when assessing placental pathology other than AI, and weak agreement even for AI. These findings are a call to action to implement educational efforts and structural/organizational changes to improve consistency of placental pathology reporting.
Parental Perception and Measured Functional Status Following Pediatric Critical Illness: A Secondary Analysis of the Survivor Outcomes Study
Authors: Gouda Suzanne R. , Pinto Neethi P.
Published: August 2023

OBJECTIVES:

We evaluated the concordance between parent/guardian perception of child long-term function and objectively scored long-term functional status using the Functional Status Scale (FSS) among PICU survivors.

DESIGN:

Secondary analysis of prospective cohort study.

SETTING:

Urban, tertiary, academic PICU.

PATIENTS:

PICU patients less than 18 years old were admitted between June and August 2012.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We conducted telephone interviews of parents/guardians of PICU survivors (n = 77) 6 months post-PICU discharge. We asked parents/guardians to characterize their child’s functional status, and we determined FSS scores using scripted interview questions. Concordance between parent/guardian perceptions and FSS scores was assessed, revealing that parent/guardian perceptions of their child’s functional status aligned poorly with FSS scores at 6 months (kappa coefficient 0.16).

CONCLUSIONS:

These findings shed light on a critical disconnect between parent/guardian perspective and our current tools to measure a child’s functional status following critical illness. In an era of decreased PICU mortality and increased long-term morbidity, the discordance between parent/guardian perception and available scoring tools in the assessment of long-term functional status highlights a key opportunity to improve communication and anchor expectations for long-term outcomes among PICU survivors.
Emergency Department Arrival Modes
Authors: Sacchetti Alfred , Hicken Eric , Bukata W. Richard , Durso Dana
Published: August 2023

Introduction

Because small children can be transported by private vehicles, many children seek emergency care outside of Emergency Medical Services (EMS). Such transports may access the closest emergency departments (EDs) without knowledge of their pediatric competence. This study quantifies this practice and the concept of mandatory pediatric readiness.

Methods

The electronic health records of 3 general EDs and 2 pediatric EDs were queried for all pediatric and young adult visits for the year 2022. Data collected included patient age, ED type, arrival mode (EMS/police or private mode), and disposition (admission/transfer or discharge). Study patients were categorized as “small children” if aged younger than 10 years, “large children” if 10 to 18 years, and “young adult" if 19 to 40 years. Associations between mode of arrival, ED type, and disposition were analyzed through χ2 and analysis of variance.

Results

The study population included 37,866 small children, 19,108 large children, and 68,293 young adults. When compared with EMS/police transports, a private arrival mode was selected by 96.1% of small children, 90.0% of large children, and 85.4% of young adults (P < 0.0001). For the admission/transfer patients, private transportation was selected by 87.4% of small children, 73.8% of large children, and 78.8% of young adults (P < 0.0001). For admitted/transferred children, the private mode was used by 80.4% of those in the general ED and 81.9% in the pediatric ED (P > 0.41).

Conclusions

Pediatric patients seeking ED care overwhelmingly arrive through a private mode regardless of the severity of their problem or type of ED in which treated. Emergency Medical Services programs and state hospital regulatory agencies need to recognize this practice and assure the pediatric competence of every ED within their system.
Improved Compliance of Pediatrics High Blood Pressure Guidelines in Well-Child Clinic Visits
Authors: Khin Ei Ei , Villanos Maria Theresa , Alvarado Juliana Garcia , Rodriguez David , Arbab Bisma , De Guzman Kris Nicole
Published: August 2023

Introduction:

Childhood hypertension can lead to cardiovascular morbidity and mortality in young adult life. We aim to improve compliance with the American Academy of Pediatrics recommended blood pressure (BP) guideline steps to 75% over 12 months in children 9 to 18 years old during well-child visits.

Methods:

The providers were educated on American Academy of Pediatrics high BP clinical practice guidelines. We integrated the guideline steps into the electronic medical record (EMR) and analyzed outcome measures. The outcome measures were: (1) BP recorded in the chart, (2) screening done by simplified BP table by clinic staff, (3) repeat manual BP by the provider, (4) BP classification, (5) documentation of BP classification, (6) management plan, and (7) follow-up schedule. Specific interventions were made based on each plan-do-study-act (PDSA) cycle, including reeducating the guidelines, reemphasizing following the EMR steps, and providing providers with individualized feedback and alerts.

Results:

Six of 7 outcome measures (except repeat manual BP by provider) achieved 86%–100% range after the second PDSA cycle. The annotated run chart demonstrates that repeat manual BP by provider improved from 38% to 89% in the fourth PDSA cycle.

Conclusion:

Pediatric residents who run well-child clinics improved adherence to pediatric high BP guidelines by providing education and integrating prompts and information into the EMR.
Increasing Engagement of Imaging Professionals in Quality Improvement Using an Encounter-specific Quality-reporting Tool
Authors: Ruess Lynne , Thompson Benjamin P. , Mesi Erin L. , Chmil Margarita , Zumberge Nicholas A. , Jorgenson Kari , Krishnamurthy Rajesh
Published: August 2023

Introduction:

The involvement of pediatric imaging professionals in quality improvement (QI) in our department was low, with few available informatics tools to report issues or suggest improvement opportunities in a timely and efficient manner. We aimed to increase QI engagement in radiology by creating a real-time, encounter-specific reporting tool embedded into the clinical imaging workflow.

Methods:

A multidisciplinary team outlined requirements for a new electronic quality-reporting tool, including point-of-care access during imaging workflow and simultaneous automatic capture of encounter-specific clinical information from the hospital information system. Information system experts created a user-friendly interface for categories based on stages of imaging workflow (Planning, Acquisition, Processing, Interpretation, Communication, and Data Collection). Team members trained all department staff. Quality coordinators sorted entries and monitored personnel engagement for two 36-week periods: immediately after launch and 3 years later. Descriptive statistics were used to analyze proposed and completed QI projects during these periods.

Results:

There were 1,498 entries during the first 36 weeks. Ninety-three percent of radiologists and 56% of technologists participated. Three years later, there were 1,251 entries in 36 weeks. Data collection entries for established QI projects increased from 380 (25%) to 487(39%). The engagement continued among radiologists but decreased among technologists over time. Submissions for QI projects increased from baseline. The project completion rate increased.

Conclusion:

We created a QI reporting tool embedded into the clinical imaging workflow, which improved the participation of our imaging professionals and increased the number of completed QI projects.
Improving Usability of the Pediatric Code Cart by Combining Lean and Human Factors Principles
Authors: Frazier Maria , Webster Kristen , Dewan Maya , Hutson Tamara , Collins Kelly , Fettig Tina , Grooms Taylor , Cordray Mary , Tegtmeyer Ken
Published: August 2023

Introduction:

Cardiac arrests are common in hospitalized children. Well-organized code carts are needed during these events to help staff efficiently find supplies and medications for the patient. This study aimed to improve the efficiency and utilization of the code cart at a major academic pediatric medical center.

Methods:

This quality improvement project used a phased approach to redesign the code cart. A multidisciplinary team used Lean and Human Factors principles to improve the efficiency and intuitiveness of the redesigned cart. Nurses and respiratory therapists participated in simulations asking for certain supplies with the original and redesigned code cart and filled out surveys for feedback on each code cart. Facilitators measured retrieval times during each simulation.

Results:

We performed 10 simulations with the original code cart and 13 with the redesigned code cart. Staff could find intraosseous access equipment more quickly (23.9 versus 46.4 seconds; P = 0.003). In addition, staff reported they were less likely to open the wrong drawer or grab the wrong equipment and that the redesigned code cart was overall more well organized than the original code cart. Finally, the redesigned code cart reduced the cost by over 800 dollars per full cart restock.

Conclusion:

Revising the code cart using Lean and Human Factors improves efficiency and usability and can contribute to cost savings.
Quality Improvement to Eliminate Disparities in Developmental Screening for Patients Needing Interpreters
Authors: Brown Courtney M. , Dillon Beth , Toth Christina , Decker Emily , Alexander Robin N. , Chandawarkar Aarti R. , Bester Stefanie , Ricket Elizabeth , Snyder Dane A.
Published: August 2023

Background:

Children from households with a preferred language other than English are less likely to receive timely identification and treatment for developmental delay than children of native English speakers. In dismantling this inequity, the role of primary care pediatrics is to establish equitable systems for screening and referral. This project, conducted in a network of twelve pediatric primary care centers, focused on eliminating a small but systematic disparity in developmental screening rates between families who did and did not require interpreters (86% versus 92%). The specific aim was to increase developmental screen completion among patients needing interpreters from 86% to 92% of age-appropriate well-child visits.

Methods:

Data were extracted from the electronic health record (EHR) to measure the proportion of 9-, 18-, 24-, and 30-month well-child visits at which developmental screens were completed, stratified by interpreter need (n = 31,461 visits; 7500 needing interpreters). One primary care center tested small changes to standardize processes, eliminate workarounds, and leverage EHR features using the Institute for Healthcare Improvement’s Model for Improvement. The QI team plotted screen completion on control charts and spread successful changes to all 12 clinics. Statistical process control evaluated the significance of changes in screening rates.

Results:

For patients needing interpreters, screen completion rose across all clinics from 86% to 93% when the clinics implemented the new process. Screen completion for patients not needing interpreters remained at 92%.

Conclusion:

A standardized process supported by the EHR improved developmental screening among patients needing interpreters, eliminating disparities.
Development, Validation, and Comparison of 2 Ultrasound Feature–Guided Machine Learning Models to Distinguish Cervical Lymphadenopathy
Authors: Zhong Rong , Wang Yuegui , Chen Yifeng , Yang Qiuting , Yang Caiyun , Lin Congmeng , Shen Haolin
Published: August 2023

The objective of this study is to develop and validate the performance of 2 ultrasound (US) feature–guided machine learning models in distinguishing cervical lymphadenopathy. We enrolled 705 patients whose US characteristics of lymph nodes were collected at our hospital. B-mode US and color Doppler US features of cervical lymph nodes in both cohorts were analyzed by 2 radiologists. The decision tree and back propagation (BP) neural network were developed by combining clinical data (age, sex, and history of tumor) and US features. The performance of the 2 models was evaluated by calculating the area under the receiver operating characteristics curve (AUC), accuracy value, precision value, recall value, and balanced F score (F1 score). The AUC of the decision tree and BP model in the modeling cohort were 0.796 (0.757, 0.835) and 0.854 (0.756, 0.952), respectively. The AUC, accuracy value, precision value, recall value, and F1 score of the decision tree in the validation cohort were all higher than those of the BP model: 0.817 (0.786, 0.848) vs 0.674 (0.601, 0.747), 0.774 (0.737, 0.811) vs 0.702 (0.629, 0.775), 0.786 (0.739, 0.833) vs 0.644 (0.568, 0.720), 0.733 (0.694, 0.772) vs 0.630 (0.542, 0.718), and 0.750 (0.705, 0.795) vs 0.627 (0.541, 0.713), respectively. The US feature–guided decision tree model was more efficient in the diagnosis of cervical lymphadenopathy than the BP model.
THE EFFICACY AND SAFETY OF VASOPRESSORS FOR SEPTIC SHOCK PATIENTS: A SYSTEMIC REVIEW AND NETWORK META-ANALYSIS
Authors: Jia Lu , Wang Pufeng , Li Cong , Xie Jianfeng
Published: August 2023

Background: Septic shock is a distributive shock with decreased systemic vascular resistance and MAP. Septic shock contributes to the most common causes of death in the intensive care unit (ICU). Current guidelines recommend the use of norepinephrine as the first-line vasopressor, whereas adrenergic agonists and vasopressin analogs are also commonly used by physicians. To date, very few studies have synthetically compared the effects of multiple types of vasoactive medications. The aim of this study was to systemically evaluate the efficacy of vasoactive agents both individually and in combination to treat septic shock. Methods: The PubMed, MEDLINE, Embase, Web of Science, and Cochrane Central Register for Controlled Trials (CENTRAL) were searched up to May 12, 2022, to identify relevant randomized controlled trials. A network meta-analysis was performed to evaluate the effect of different types of vasopressors. The primary outcome was 28-day all-cause mortality. The secondary outcome was the ICU length of stay. Adverse events are defined as any undesirable outcomes, including myocardial infarction, cardiac arrhythmia, peripheral ischemia, or stroke and cerebrovascular events. Findings: Thirty-three randomized controlled trials comprising 4,966 patients and assessing 8 types of vasoactive treatments were included in the network meta-analysis. The surface under the cumulative ranking curve provided a ranking of vasoactive medications in terms of 28-day all-cause mortality from most effective to least effective: norepinephrine plus dobutamine, epinephrine, vasopressin, terlipressin, norepinephrine, norepinephrine plus vasopressin, dopamine, and dobutamine. Dopamine was associated with a significantly shorter ICU stay than norepinephrine, terlipressin, and vasopressin, whereas other vasoactive medications showed no definite difference in ICU length of stay. Regarding adverse events, norepinephrine was associated with the highest incidences of myocardial infarction and peripheral ischemia. Dopamine was associated with the highest incidence of cardiac arrhythmia. Epinephrine and terlipressin were associated with the highest incidences of myocardial infarction and peripheral ischemia. Interpretation: The results of this network meta-analysis suggest that norepinephrine plus dobutamine is associated with a lower risk of 28-day mortality in septic shock patients than other vasoactive medications, and the use of dopamine is associated with a higher risk of 28-day mortality due to septic shock than norepinephrine, terlipressin, and vasopressin.
How ‘visual’ is the visual cortex? The interactions between the visual cortex and other sensory, motivational and motor systems as enabling factors for visual perception
Authors: Pennartz Cyriel M. A. , Oude Lohuis Matthijs N. , Olcese Umberto
Published: August 2023

The definition of the visual cortex is primarily based on the evidence that lesions of this area impair visual perception. However, this does not exclude that the visual cortex may process more information than of retinal origin alone, or that other brain structures contribute to vision. Indeed, research across the past decades has shown that non-visual information, such as neural activity related to reward expectation and value, locomotion, working memory and other sensory modalities, can modulate primary visual cortical responses to retinal inputs. Nevertheless, the function of this non-visual information is poorly understood. Here we review recent evidence, coming primarily from studies in rodents, arguing that non-visual and motor effects in visual cortex play a role in visual processing itself, for instance disentangling direct auditory effects on visual cortex from effects of sound-evoked orofacial movement. These findings are placed in a broader framework casting vision in terms of predictive processing under control of frontal, reward- and motor-related systems. In contrast to the prevalent notion that vision is exclusively constructed by the visual cortical system, we propose that visual percepts are generated by a larger network—the extended visual system—spanning other sensory cortices, supramodal areas and frontal systems.

This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
Causal inference during closed-loop navigation: parsing of self- and object-motion
Authors: Noel Jean-Paul , Bill Johannes , Ding Haoran , Vastola John , DeAngelis Gregory C. , Angelaki Dora E. , Drugowitsch Jan
Published: August 2023

A key computation in building adaptive internal models of the external world is to ascribe sensory signals to their likely cause(s), a process of causal inference (CI). CI is well studied within the framework of two-alternative forced-choice tasks, but less well understood within the cadre of naturalistic action–perception loops. Here, we examine the process of disambiguating retinal motion caused by self- and/or object-motion during closed-loop navigation. First, we derive a normative account specifying how observers ought to intercept hidden and moving targets given their belief about (i) whether retinal motion was caused by the target moving, and (ii) if so, with what velocity. Next, in line with the modelling results, we show that humans report targets as stationary and steer towards their initial rather than final position more often when they are themselves moving, suggesting a putative misattribution of object-motion to the self. Further, we predict that observers should misattribute retinal motion more often: (i) during passive rather than active self-motion (given the lack of an efference copy informing self-motion estimates in the former), and (ii) when targets are presented eccentrically rather than centrally (given that lateral self-motion flow vectors are larger at eccentric locations during forward self-motion). Results support both of these predictions. Lastly, analysis of eye movements show that, while initial saccades toward targets were largely accurate regardless of the self-motion condition, subsequent gaze pursuit was modulated by target velocity during object-only motion, but not during concurrent object- and self-motion. These results demonstrate CI within action–perception loops, and suggest a protracted temporal unfolding of the computations characterizing CI.

This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
Metacognition in the audiovisual McGurk illusion: perceptual and causal confidence
Authors: Meijer David , Noppeney Uta
Published: August 2023

Almost all decisions in everyday life rely on multiple sensory inputs that can come from common or independent causes. These situations invoke perceptual uncertainty about environmental properties and the signals' causal structure. Using the audiovisual McGurk illusion, this study investigated how observers formed perceptual and causal confidence judgements in information integration tasks under causal uncertainty. Observers were presented with spoken syllables, their corresponding articulatory lip movements or their congruent and McGurk combinations (e.g. auditory B/P with visual G/K). Observers reported their perceived auditory syllable, the causal structure and confidence for each judgement. Observers were more accurate and confident on congruent than unisensory trials. Their perceptual and causal confidence were tightly related over trials as predicted by the interactive nature of perceptual and causal inference. Further, observers assigned comparable perceptual and causal confidence to veridical ‘G/K’ percepts on audiovisual congruent trials and their causal and perceptual metamers on McGurk trials (i.e. illusory ‘G/K’ percepts). Thus, observers metacognitively evaluate the integrated audiovisual percept with limited access to the conflicting unisensory stimulus components on McGurk trials. Collectively, our results suggest that observers form meaningful perceptual and causal confidence judgements about multisensory scenes that are qualitatively consistent with principles of Bayesian causal inference.

This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
Case report: isolation of Hydrogenophaga from septic blood culture following near-death drowning in lakewater
Authors: Feichtinger Stuart , Lazar Angela A. , Luebbe Megan A. , Accola Molly A. , Jung-Hynes Brittney D. , Anderson Patti J. , Koglin Kelly M. , Schliesman Karen S. , Ehlenbach William , Smith Jeannina , Chen Derrick J. , Rehrauer William M. , Bailey Adam L.
Published: August 2023

A patient suffered a non-fatal wet drowning in a freshwater lake and developed bacteremia several days later. Blood culture grew a Gram-negative rod that could not be identified by MALDI-TOF MS. 16S ribosomal RNA sequencing of the isolate identified the microbe as Hydrogenophaga laconesensis––an environmental microbe commonly found in freshwater. The recovery of multiple pathogenic microorganisms (although not Hydrogenophaga laconesensis) from culture of respiratory specimens prompted the initiation of antibiotic therapy with cefepime and, later, vancomycin. The patient’s clinical course gradually improved over the course of two weeks and she was ultimately discharged home with minimal sequelae. To our knowledge, this is the first evidence of human infection with bacteria in the Hydrogenophaga genus. Hydrogenophaga may be considered in cases of freshwater near-drowning, and MALDI-TOF MS databases should be updated to include Hydrogenophaga laconesensis.
New viruses of Cladosporium sp. expand considerably the taxonomic structure of Gammapartitivirus genus
Authors: Jaccard Augustine , Dubuis Nathalie , Kellenberger Isabelle , Brodard Justine , Schnee Sylvain , Gindro Katia , Schumpp Olivier
Published: August 2023

Despite the fact that Cladosporium sp. are ubiquitous fungi, their viromes have been little studied. By analysing a collection of Cladosporium fungi, two new partitiviruses named Cladosporium cladosporioides partitivirus 1 (CcPV1) and Cladosporium cladosporioides partitivirus 2 (CcPV2) co-infecting a strain of Cladosporium cladosporioides were identified. Their complete genome consists of two monocistronic dsRNA segments (RNA1 and RNA2) with a high percentage of pairwise identity on 5′ and 3′ end. The RNA directed RNA polymerase (RdRp) of both viruses and the capsid protein (CP) of CcPV1 display the classic characteristics required for their assignment to the Gammapartitivirus genus. In contrast, CcPV2 RNA2 encodes for a 41 KDa CP that is unusually smaller when aligned to CPs of other viruses classified in this genus. The structural role of this protein is confirmed by electrophoresis on acrylamide gel of purified viral particles. Despite the low percentage of identity between the capsid proteins of CcPV1 and CcPV2, their three-dimensional structures predicted by AlphaFold2 show strong similarities and confirm functional proximity. Fifteen similar viral sequences of unknown function were annotated using the CcPV2 CP sequence. The phylogeny of the CP was highly consistent with the phylogeny of their corresponding RdRp, supporting the organization of Gammapartitiviruses into three distinct clades despite stretching the current demarcation criteria. It is proposed that a new subgenus be created within the genus Gammapartitivirus for this new group.
Impact of Adjustment for Differential Testing by Age and Sex on Apparent Epidemiology of SARS-CoV-2 Infection in Ontario, Canada
Authors: Bosco Savana , Peng Amy , Tuite Ashleigh R. , Simmons Alison , Fisman David N.
Published: August 2023

Background

Surveillance of communicable diseases typically relies on case counts for estimates of risk, and counts can be strongly influenced by testing rates. In the Canadian province of Ontario, testing rates varied markedly by age, sex, geography and time over the course of the SARS-CoV-2 pandemic. We applied a standardization-based approach to test-adjustment to better understand pandemic dynamics from 2020 to 2022, and to better understand when test-adjustment is necessary for accurate estimation of risk.

Methods

SARS-CoV-2 case counts by age, sex, public health unit and week were obtained from Ontario’s Case and Contact Management system (CCM), which includes all SARS-CoV-2 cases from March 2020 to August 2022. Complete data on testing volumes was obtained from the Ontario Laboratory Information System (OLIS). Case counts were adjusted for under-testing using a previously published standardization-based approach that estimates case numbers that would have been expected if the entire population was tested at the same rate as most-tested age and sex groups. Logistic regression was used to identify threshold testing rates beyond which test-adjustment was unnecessary.

Results

Testing rates varied markedly by age, sex, public health unit and pandemic wave. After adjustment for under-testing, overall case counts increased threefold. Adjusted epidemic curves suggested, in contrast to reported case counts, that the first two pandemic waves were equivalent in size, and that there were three distinct pandemic waves in 2022, due to the emergence of Omicron variants. Under-reporting was greatest in children and young males, and varied significantly across public health units, with variation explained partly by testing rates and prevalence of multigenerational households. Test adjustment resulted in little change in the epidemic curve during pandemic waves when testing rates were highest; we found that test-adjustment did not increase case counts once weekly per capita testing rates exceeded 6.3%.

Conclusions

Standardization-based adjustment for differential testing by age and sex, and for dynamic changes in testing over time, results in a different picture of infection risk during the SARS-CoV-2 pandemic in Ontario; test-adjusted epidemic curves are concordant with observed patterns of mortality during the pandemic and have face validity. This methodology offers an alternative to sero-epidemiology for identification of true burden of infection when reinfection, sero-reversion, and non-specificity of serological assays make sero-epidemiology challenging.
The effect of High Definition Transcranial Direct Current Stimulation (HD-tDCS) on pain in Somatic Symptom Disorder with predominant pain (SSD-P): a randomized single-blind sham controlled cross-over study
Authors: Kathiravan Sanjana , Ghosh Abhishek , Singh Shubh Mohan
Published: August 2023

Background

Somatic Symptom Disorder with predominant pain (SSD-P) is a common disorder with unsatisfactory treatment options. Transcranial Direct Current Stimulation(tDCS) is useful in chronic pain conditions.

Objective

To assess the effect of two within session repeated High Definition tDCS (HD-tDCS) over left motor cortex on pain and other associated variables in SSD-P.

Methods

Institute Ethics Committee approval was sought and the study was registered in the Clinical Trials Registry of India. Single-blind, sham controlled, cross-over study design was employed. Thirty right handed patients with DSM-5 diagnosis of SSD-P, aged 18-60 years, receiving stable treatment were enrolled by consecutive sampling. After simple randomization, two short interval repeated sessions (2mA, 20 minutes each) of either active or sham HD-tDCS was administered followed by a wash out period of seven days and cross over. Assessments were done at baseline, week one and two. Analysis was done using SPSS 21.

Results

Participants were comparable on all baseline parameters. ANCOVA showed no order×group interaction. On RM-ANOVA all participants irrespective of entering active or sham arm showed statistically significant difference (Cohen’s d >0.8) in pain and associated parameters like depression, anxiety, pain related interference, burden and disability at week two (p< 0.01). But at week one, this was observed only in active arm. Transient mild local side effects like burning, pain and itching were noted, with no cognitive side effects.

Conclusion

This was the first study of HD-tDCS on SSD-P. Single session repeated protocol can be effective in pain reduction with sustained effects up to one week.