bluuebunny/crossref_metadata_2025 huggingface dataset:
New Mortgage Lenders and the Housing Market*
Authors: Szumilo Nikodem
Published: October 2020

This article examines the effect of a new lender’s entry into a local mortgage market on the supply of new loans, housing prices and repossessions in areas around its branches. I use the decision of the European Commission to force the UK’s largest retail bank to divest a part of its business as a shock to the entry of a new lender, and show that incumbent banks increase mortgage lending in areas where the new bank has its branches. Furthermore, house prices increase by around 5% in the real estate market impacted by the shock. Average transaction numbers and mortgage repossession rates also increase in places where the new bank enters. Overall, my results show that increased competition in the banking market can have adverse consequences for risk-taking and financial stability.
Being ‘in sync’—is interactional synchrony the key to understanding the social brain?
Authors: Schirmer Annett , Fairhurst Merle , Hoehl Stefanie
Published: October 2020

The past couple of decades produced a surge of interest in interaction synchrony. Moving from the study of behavioral coordination to investigating the coordination of psychophysiological and brain activity, relevant research has tackled a broad range of interactional settings with a multitude of measurement and analysis tools. This method diversity produced a host of interesting results converging on the fact that individuals engaged in social exchange tend to temporally align external as well as internal processes. Moreover, there appears to be a reciprocal relationship between the individuals’ affective bond and the extent of synchronization, which together benefit interaction outcomes. Notably, however, the current breadth of study approaches creates challenges for the field, including how to compare findings and how to develop a theoretical framework that unites and directs ongoing research efforts. More concerted efforts are called for to achieve the conceptual and methodological clarity needed to answer core questions and enabling a balanced pursuit of both synchronous and asynchronous processes.
Increasing prevalence and local transmission of non-B HIV-1 subtypes in the French Antilles and French Guiana between 1995 and 2018
Authors: Bello Gonzalo , Delatorre Edson , Lacoste Vincent , Darcissac Edith , Herrmann-Storck Cécile , Tressières Benoit , Cabras Ornella , Lamaury Isabelle , Cabié André , Visseaux Benoit , Chaix Marie-Laure , Descamps Diane , Césaire Raymond , Nacher Mathieu , Dos Santos Georges
Published: October 2020

The Caribbean and South American French Overseas Territories (CSAFOT) are the regions most heavily affected by the Human Immunodeficiency Virus type 1 (HIV-1) epidemic in France. Although dominated by HIV-1 subtype B, the detection of non-B subtypes and the great proportion of HIV-positive persons born abroad demonstrated the potential for local spread of non-B subtype strains in CSAFOT. To reconstruct the epidemiologic dynamics of major non-B subtype clusters spreading in CSAFOT, we conducted phylogenetic and evolutionary analyses of 2,523 HIV-1 pol sequences collected from patients living in Martinique, Guadeloupe, and French Guiana from 1995 to 2018. A large variety of HIV-1 non-B subtype strains (eight subtypes, twelve CRFs, and multiple URFs) have been introduced in CSAFOT and their prevalence significantly increases over time in Martinique and Guadeloupe. We identified twelve major transmission networks of non-B subtypes (CRF02_AG and subtypes A3, C, D, and F1) that probably arose in Guadeloupe, Martinique, French Guiana, and mainland France between the late 1970s and the middle 2000s. Phylogeographic analyses support frequent non-B subtype viral transmissions within CSAFOT as well as transatlantic transmission between CSAFOT and mainland France. Domestic transmission networks of non-B subtype variants in CSAFOT comprise both men having sex with men and heterosexual individuals from different age groups. Different HIV-1 non-B subtype variants were sequentially introduced in CSAFOT between the late 1970s and the middle 2000s and are currently spreading through domestic, regional, and/or transatlantic networks of individuals from different age and risk groups.
Radiologic Differentiation of Adrenal Lesions and Its Impact on Patient Management
Authors: Chorney Elizabeth , Rosen Ally , Lewis Sara , Wilck Eric , Simpson William
Published: October 2020

Adrenal lesions are a relatively common incidental finding and are estimated to be present in 4.4% of all abdominal CT scans.1 The detection of an adrenal lesion often necessitates a thorough clinical evaluation that frequently requires a comprehensive patient history, biochemical studies, and radiologic studies such as dedicated adrenal protocol CT or MRI. The primary goal of additional radiologic studies is to differentiate benign from malignant adrenal lesions. It is, therefore, important for the radiologist to be familiar with a variety of benign and malignant adrenal lesions and to recognize distinctive imaging characteristics that can help make this distinction. This article reviews typical and useful imaging features of more commonly encountered benign and malignant adrenal lesions.
Vicarious Resilience: Cultivating Internal Strength Through External Support
Authors: Jun Jin
Published: October 2020

Although burnout is shared among colleagues, most solutions have focused on the individual.
Mobile ECG Screening in Rural Pharmacies Can Detect Atrial Fibrillation
Authors: Rosenberg Karen
Published: October 2020

According to this study:

High rates of previously undiagnosed atrial fibrillation and other stroke risk factors were found through the use of a mobile electrocardiogram device.

This technology may have value in screening for atrial fibrillation in at-risk rural populations.
Update on cannabis and cannabinoids for cancer pain
Authors: Chung Matthew , Kim Hee Kee , Abdi Salahadin
Published: October 2020

Purpose of review

The prevalence of cancer pain will continue to rise as pain is common among the survivorship and general cancer population. As interest in cannabis and cannabinoids for medicinal use including pain management continues to rise, there is growing need to update and review the current state of evidence for their use. The literature was searched for articles in English with key words cannabis, cannabinoids, and cancer pain. The sources of articles were PubMed, Embase, and open Google search.

Recent findings

In a double-blind randomized placebo-controlled trial including a 3-week treatment period of nabiximol for advanced cancer patients with pain refractory to optimized opiate therapy, improvements in average pain were seen in the intention to treat population (P = 0.0854) and per- protocol population (P = 0.0378).

To date, preclinical data has demonstrated evidence to suggest promising potential for cancer pain and the urgent need to translate this into clinical practice. Unfortunately, due to limited data, for adults with advanced cancer being treated with opiate therapy, the addition of cannabis or cannabinoids is not currently supported to address cancer pain effectively.
Conversational Interaction Is the Brain in Action: Implications for the Evaluation of Hearing and Hearing Interventions
Authors: Carlile Simon , Keidser Gitte
Published: October 2020

Humans have evolved the unique capacity to efficiently communicate using the spoken word. Hearing plays a key role as a receiver in this process and dysfunction leads to difficulties in listening and communication. It is widely accepted that effective communication is not adequately captured with current behavioral speech tests that principally focus on passive sound detection and speech recognition with idealized stimuli. To address the question of what it will take to obtain more ecologically valid outcomes from behavioral speech tests, recent approaches, and test paradigms devised to address some of the acknowledged shortcomings of current speech tests were reviewed. Additionally, some recent work which has focused on understanding brain function in social and dynamic interaction scenarios, so-called second person neuroscience, was reviewed. These reviews revealed that, while recent efforts in bridging the gap between behavioral speech tests and everyday communication situations represent important steps in the right direction, they are unlikely to provide a complete account of everyday communication situations. Further, brain imaging studies, together with our growing understanding of “mirror” neurons and the development of theories around embodied cognition, have demonstrated that the brain networks recruited during emotionally engaged interaction between interlocutors are far more complex when compared to that of a passive listener. Speech and nonspeech (e.g., gaze direction, body posture, etc.) interactions between the interlocutors give rise to the perception of effective interaction (sense of “agency”) and activate neural networks important in decision-making and subsequent communication interaction. Successful conversational interaction represents the negotiation of a dynamic context and the emergence of a state of shared understanding between participants. In conclusion, to achieve highly ecologically valid outcomes related to communication, future testing will most likely require an interactive or conversational paradigm to elicit the brain states that are present in everyday social interactions.
Physiological Monitoring and Hearing Loss: Toward a More Integrated and Ecologically Validated Health Mapping
Authors: Caduff Andreas , Feldman Yuri , Ben Ishai Paul , Launer Stefan
Published: October 2020

With an ongoing shift from managing disease toward the inclusion of maintaining health and preventing disease, the world has seen the rise of increasingly sophisticated physiological monitoring and analytics. Innovations range from wearables, smartphone-based spot monitoring to highly complex noncontact, remote monitoring, utilizing different mechanisms. These tools empower the individual to better navigate their own health. They also generate powerful insights towards the detection of subclinical symptoms or processes via existing and novel digital biomarkers. In that context, a topic that is receiving increasing interest is the modulation of human physiology around an individual “baseline” in everyday life and the impact thereof on other sensorineural body functions such as hearing. More and more fully contextualized and truly long-term physiological data are becoming available that allows deeper insights into the response of the human body to our behavior, immediate environment and the understanding of how chronic conditions are evolving. Hearing loss often goes hand in hand with chronic conditions, such as diabetes, cognitive impairment, increased risk of fall, mental health, or cardiovascular risk factors. This inspires an interest to not only look at hearing impairment itself but to take a broader view, for example, to include contextualized vital signs. Interestingly, stress and its physiological implications have also been shown to be a relevant precursor to hearing loss and other chronic conditions. This article deduces the requirements for wearables and their ecosystems to detect relevant dynamics and connects that to the need for more ecologically valid data towards an integrated and more holistic mapping of hearing characteristics.
COVID-19 Gastrointestinal Manifestations Are Independent Predictors of PICU Admission in Hospitalized Pediatric Patients
Authors: Gonzalez Jimenez David , Velasco Rodríguez-Belvís Marta , Ferrer Gonzalez Pablo , Domínguez Ortega Gloria , Segarra Oscar , Medina Benitez Enrique , Garcia Tirado Diana , Garcia Romero Ruth , Vecino López Raquel , Crehuá-Gaudiza Elena , Queralt Macarena , Palomino Pérez Laura María , Diaz Martin Juan J.
Published: October 2020

Multicenter study conducted in 15 hospitals including 101 COVID-19 pediatric inpatients aiming to describe associated gastrointestinal (GI) manifestations. GI symptoms were present in 57% and were the first manifestation in 14%. Adjusted by confounding factors, those with GI symptoms had higher risk of pediatric intensive care unit admission. GI symptoms are predictive of severity in COVID-19 children admitted to hospitals.
Ten Years of National Seasonal Surveillance for Severe Complications of Influenza in Australian Children
Authors: Teutsch Suzy M. , Zurynski Yvonne A. , Nunez Carlos , Lester-Smith David , Festa Marino , Booy Robert , Elliott Elizabeth J. ,   for the Australian Paediatric Surveillance Unit
Published: October 2020

Background:

Severe complications of influenza in children are uncommon but may result in admission to hospital or an intensive care unit (ICU) and death.

Methods:

Active prospective surveillance using the Australian Paediatric Surveillance Unit with monthly reporting by pediatricians of national demographic and clinical data on children with <15 years of age hospitalized with severe complications of laboratory-confirmed influenza during ten influenza seasons 2008–2017.

Results:

Of 722 children notified, 613 had laboratory-confirmed influenza and at least one severe complication. Most (60%) were <5 years of age; 10% were <6 months, hence ineligible for vaccination. Almost half of all cases were admitted to ICU and 30 died. Most children were previously healthy: 40.3% had at least one underlying medical condition. Sixty-five different severe complications were reported; pneumonia was the most common, occurring in over half of all cases. Influenza A accounted for 68.6% hospitalizations; however, influenza B was more often associated with acute renal failure (P = 0.014), rhabdomyolysis (P = 0.019), myocarditis (P = 0.015), pericarditis (P = 0.013), and cardiomyopathy (P = 0.035). Children who died were more likely to be older (5–14 years), have underlying medical conditions, be admitted to ICU, and have encephalitis, acute renal failure, or myocarditis. Only 36.1% of all children reported received antiviral medications, and 8.5% were known to be vaccinated for seasonal influenza.

Conclusions:

Severe influenza complications cause morbidity and mortality in children, which may increase if coinfection with COVID-19 occurs in the 2020 season and beyond. Increased vaccination rates, even in healthy children, early diagnosis and timely antiviral treatment are needed to reduce severe complications and death.
Targeted Muscle Reinnervation as a Solution for Nerve Pain
Authors: Lanier Steven T. , Jordan Sumanas W. , Ko Jason H. , Dumanian Gregory A.
Published: October 2020

Learning Objectives:

After reading this article, the participants should be able to: 1. List current nonsurgical and surgical strategies for addressing postamputation neuroma pain and discuss their limitations. 2. Summarize the indications and rationale for targeted muscle reinnervation. 3. Develop an operative plan for targeted muscle reinnervation in an acute or delayed fashion for upper and lower extremity amputations. 4. Propose a management algorithm for treatment of symptomatic neuromas in an intact limb. 5. Discuss the risk of neuroma development after primary revision digital amputation or secondary surgery for a digital neuroma. 6. Compare and contrast targeted muscle reinnervation to the historical gold standard neuroma treatment of excision and burying the involved nerve in muscle, bone, or vein graft. 7. Interpret and discuss the evidence that targeted muscle reinnervation improves postamputation neuroma and phantom pain when performed either acutely or in a delayed fashion to treat existing pain.

Symptomatic injured nerves resulting from amputations, extremity trauma, or prior surgery are common and can decrease patient quality of life, thus necessitating an effective strategy for management. Targeted muscle reinnervation is a modern surgical strategy for prevention and treatment of neuroma pain that promotes nerve regeneration and healing rather than neuroma formation. Targeted muscle reinnervation involves the transfer of cut peripheral nerves to small motor nerves of adjacent, newly denervated segments of muscle and can be easily performed without specialized equipment. Targeted muscle reinnervation strategies exist for both upper and lower extremity amputations and for symptomatic neuromas of intact limbs. Targeted muscle reinnervation has been shown in a prospective, randomized, controlled trial to result in lower neuroma and phantom pain when compared to the historical gold standard of burying cut nerves in muscle.
Complications of Contralateral Prophylactic Mastectomy: Do They Delay Adjuvant Therapy?
Authors: Sharabi Safa E. , Baumann Donald P. , Selber Jesse C. , Killon Elizabeth , Mericli Alexander F. , Liu Jun , Caudle Abigail S. , Smith Benjamin D. , Chavez-MacGregor Mariana , Schaverien Mark V.
Published: October 2020

Background:

There is ongoing debate regarding the optimal timing of contralateral prophylactic mastectomy fueled by concern that performing it at the time of the mastectomy for the index breast cancer may delay adjuvant therapy. The study objective was to examine the effect of simultaneous contralateral prophylactic mastectomy with immediate breast reconstruction on the complication rate and adjuvant therapy timing.

Methods:

A retrospective study was conducted of consecutive patients who underwent contralateral prophylactic mastectomy with immediate breast reconstruction and received adjuvant therapy over a 6-year period. Demographic, treatment, and outcomes data were collected, and relationships between multiple variables and outcomes were evaluated.

Results:

Of 241 patients (482 breasts) included, 186 (372 breasts) underwent simultaneous index breast mastectomy and contralateral prophylactic mastectomy with immediate breast reconstruction followed by adjuvant therapy (immediate group), and 55 (110 breasts) underwent index mastectomy, then adjuvant therapy, followed by delayed contralateral prophylactic mastectomy with immediate breast reconstruction (delayed group). Demographics were similar, although breast cancer stage (p < 0.001), tumor category (p = 0.0072), and nodal category (p < 0.001) were significantly higher in the delayed group. In the immediate group, complications before adjuvant therapy occurred in 31 patients (16.7 percent), and in six patients (3.2 percent) complications occurred only in the contralateral prophylactic mastectomy breast; delay to adjuvant therapy occurred in 11 patients (5.9 percent), in four (2.2 percent) of whom the contralateral prophylactic mastectomy breast was responsible for the delay.

Conclusions:

Contralateral prophylactic mastectomy with immediate breast reconstruction can be performed safely at the time of the index mastectomy in carefully selected patients. These findings will engage patients seeking contralateral prophylactic mastectomy in shared decision-making regarding optimal timing with respect to the risks and benefits.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Board Certification in Cosmetic Surgery: An Evaluation of Training Backgrounds and Scope of Practice
Authors: Long Emily A. , Gabrick Kyle , Janis Jeffrey E. , Perdikis Galen , Drolet Brian C.
Published: October 2020

Background:

The American Board of Cosmetic Surgery (ABCS) offers a certification process for physicians desiring third-party credentials in aesthetic surgery. This study aims to examine the training backgrounds and scope of practice of ABCS-certified physicians.

Methods:

The ABCS online directory was used to identify diplomates. Additional board certifications were identified using the American Board of Medical Specialties physician database. Scope of training was defined using American Council for Graduate Medical Education or Commission on Dental Accreditation requirements for residency training programs. Scope of practice was determined using ABCS physician profiles and professional websites.

Results:

Three hundred forty-two ABCS-certified physicians were included in the study. Two-hundred twelve (60.2 percent) also held American Board of Medical Specialties board certifications. Over half (62.6 percent) of ABCS diplomates advertised surgical operations beyond the scope of their American Council for Graduate Medical Education or Commission on Dental Accreditation training. Specialties with the highest prevalence of practicing beyond scope of training were internal medicine [n = 2 (100 percent)], general surgery [n = 69 (95.8 percent)], obstetrics and gynecology [n = 17 (85 percent)], otolaryngology [n = 65 (59.1 percent)], dermatology [n = 16 (51.6 percent)], and oral and maxillofacial surgery [n = 30 (50 percent)]. The most commonly offered out-of-scope procedures were liposuction (59.6 percent), abdominoplasty (50.0 percent), breast augmentation (49.7 percent), and buttock augmentation (36.5 percent).

Conclusions:

ABCS–certified physicians include internists and dermatologists, who market themselves as board-certified cosmetic surgeons, and the majority of ABCS members perform complex aesthetic procedures outside the scope of their primary residency training. Patients who rely on ABCS certification when selecting a cosmetic surgeon may not understand the scope of that physician’s training experience and qualifications.
Using Artificial Intelligence to Measure Facial Expression following Facial Reanimation Surgery
Authors: Boonipat Thanapoom , Asaad Malke , Lin Jason , Glass Graeme E. , Mardini Samir , Stotland Mitchell
Published: October 2020

Social interactions are largely dependent on the interpretation of information conveyed through facial expressions. Although facial reanimation seeks restoration of the facial expression of emotion, outcome measures have not addressed this directly. This study evaluates the use of a machine learning technology to directly measure facial expression before and after facial reanimation surgery. Fifteen study subjects with facial palsy were evaluated both before and after undergoing cross-facial nerve grafting and free gracilis muscle transfer. Eight healthy volunteers were assessed for control comparison. Video footage of subjects with their face in repose and with a posed, closed-lip smile was obtained. The video data were then analyzed using the Noldus FaceReader software application to measure the relative proportions of seven cardinal facial expressions detected within each clip. The facial expression recognition application detected a far greater happy signal in postoperative (42 percent) versus preoperative (13 percent) smile videos (p < 0.0001), compared to 53 percent in videos of control faces smiling. This increase in postoperative happy signal was achieved in exchange for a reduction in the sad signal (15 percent to 9 percent; p = 0.092) and the neutral signal (57 percent to 37 percent; p = 0.0012). For video clips of patients in repose, no significant difference in happy emotion was detected between preoperative (3.1 percent) and postoperative (1.4 percent) states (p = 0.5). This study provides the first proof of concept for the use of a machine learning software application to objectively quantify facial expression before and after surgical reanimation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, IV.
Upper Blepharoplasty with Endoscopically Assisted Brow Lift to Restore Harmonious Upper Lid Arc Curvatures
Authors: Vaca Elbert E. , Alghoul Mohammed S.
Published: October 2020

Background:

Achieving excellent results in upper lid rejuvenation requires a balanced approach to address skin, muscle, fat, upper lid margin position, and brow aging changes. In the appropriately selected patient, brow lifting plays an essential complement to upper blepharoplasty to restore more youthful upper lid fold–to-pretarsal ratios. The goal of this study is to describe a safe and reproducible method to perform brow lifting and upper blepharoplasty.

Methods:

Medial to the temporal line of fusion, in-line with the brow peak, a 2-cm scalp incision is oriented parallel to the course of the deep branch of the supraorbital nerve to minimize the risk of nerve injury. The brow vector of pull is maximal in this location and secured to a monocortical bone channel with 3-0 polydioxanone. Lateral to the temporal line of fusion, an ellipse of scalp tissue is excised to gently elevate the brow tail. Upper blepharoplasty is performed in an individualized fashion to achieve a youthful contour of the upper lid fold.

Results:

The endoscopically assisted technique is designed to achieve tissue release under direct visualization. The brow-lift maximal vector of pull is centered over the brow peak and, to a lesser extent, at the brow tail to improve lateral upper lid fold height and a smooth contour of the pretarsal space. Muscle shaping sutures improve convexity of the lateral upper lid fold.

Conclusion:

In the appropriately selected patient, combined brow lift and upper blepharoplasty with muscle contouring are safe and effective techniques that help improve aesthetic upper lid topographic proportions.
Surgical Management of the Explant Patient: An Update on Options for Breast Contouring and Volume Restoration
Authors: Avashia Yash J. , Rohrich Rod J. , Gabriel Allen , Savetsky Ira L.
Published: October 2020

Background:

Breast implant removal is becoming a common procedure in light of the current events and controversies with silicone breast implants. The authors believe strongly in informing patients about the indications and options regarding both explantation and the management of the secondary breast deformity.

Methods:

Relevant literature regarding the management of the explant patient was reviewed and organized to provide an update on prior publications addressing the explant patient population.

Results:

Surgical management options after implant removal include breast contouring and volume restoration. Fat augmentation has been used in both aesthetic and reconstructive breast surgery.

Conclusions:

The authors review the surgical management for explantation, breast contouring, and autologous fat grafting for volume restoration. In the explant patient, autologous fat grafting serves as a reliable option for volume restoration.
Neoumbilicus after Selective Excision in Deep Inferior Epigastric Perforator Flap Breast Reconstruction
Authors: Haddock Nicholas T. , Kelling Joseph A. , Teotia Sumeet S.
Published: October 2020

The umbilicus offers no functional importance to the adult human but remains a key aesthetic landmark of the anterior abdominal wall, and its absence can be a cause for concern in aesthetic and reconstructive patients. Umbilical reconstruction or transposition for abdominoplasty and abdominally based flap operations is frequently complicated by umbilical death, infections, development of wounds needing prolonged wound care, and generally poor aesthetic outcomes. A multitude of techniques have been described to create the “ideal” neoumbilicus, but none has proven to be superior to the technique that comes before it. Our data demonstrate that, in a select set of patients, it may be beneficial to electively remove the umbilicus. Thus, umbilical reconstruction can be performed as an adjunct procedure to the primary operation with a superior aesthetic result and minimal risk for complications. This article describes the authors’ approach to delayed neoumbilical reconstruction in patients undergoing elective umbilical resection.
Rapid Ultrasound for Shock and Hypotension
Authors: Gonzalez Juan M. , Ortega Johis , Crenshaw Nichole , de Tantillo Lila
Published: October 2020

The Rapid Ultrasound for Shock and Hypotension (RUSH) examination is used for patients with hypotension without clear cause or undifferentiated hypotension. In the emergency department setting, clinicians may perform the RUSH examination to supplement the physical assessment and differentiate the diagnosis of hypovolemic, obstructive, cardiogenic, and distributive forms of shock. The key elements of the RUSH examination are the pump, tank, and pipes, meaning potentially causes of the hypotension are examined within the heart, vascular volume and integrity, and the vessels themselves. Clinicians follow a systemic protocol to seeking evidence of specific conditions including heart failure exacerbation, cardiac tamponade, pleural effusion, pneumothorax, abdominal aortic aneurysm, and deep vein thrombosis. Because ultrasonography is a user-dependent skill, the advanced practice nurse in the emergency department should be educated regarding the RUSH protocol and prepared to implement the examination.
Comparison of High-Sensitivity Troponin T Assay to Conventional Troponin T Assay for Rule Out of Acute Coronary Syndrome in the Emergency Department
Authors: Mungai Esther , Hamilton Bernita K. , Burns Djuana
Published: October 2020

Approximately 5% of all emergency department (ED) visits require evaluation of chest pain and atypical symptoms for diagnosis or exclusion of myocardial infarction or acute coronary syndrome (ACS) (P. Rui, K. Kang, & J. J. Ashman, 2016). Health care providers rely on effective tests and assessment protocols for definitive diagnosis of ACS. Cardiac biomarkers in troponin T assays enable rapid exclusion of ACS. This project compared high-sensitivity troponin T assay to conventional troponin T assay in reducing unnecessary stress tests for ACS exclusion, length of stay in the ED, and rate of readmissions within 30 days after ACS exclusion and discharge. A retrospective review of 300 medical records for exclusion of ACS compared 150 patients receiving conventional troponin T assay and 150 patients receiving high-sensitivity troponin T assay. The mean length of stay in the preintervention group was 8.3 hr (SD = 1.60) compared with 3.9 hr (SD = 1.56) in the postintervention group (t
(298) = 24.56, p < 0.001). A significant difference was found in necessary and unnecessary stress testing (X
2
(1) =17.42, p < 0.05). The preintervention group had significantly more normal stress tests and the postintervention group had significantly more abnormal stress tests. In the preintervention group, 4 (2.7%) patients were readmitted within 30 days with ACS; no readmissions were reported for the postintervention group. Findings supported outcome improvements with the high-sensitivity troponin T assay. Using high-sensitivity troponin T assay in the diagnosis protocol can improve length of stay for patients with exclusion of ACS and reduce unnecessary stress tests during the ED stay.
Mild Traumatic Brain Injury in the Emergency Department
Authors: Tucker Paula , Safier Frenkel Tova
Published: October 2020

This article, “Concussion Care in the Emergency Department: A Prospective Observational Brief Report,” by Koval et al. (2019) seeks to examine current clinician practice patterns related to the evaluation and management of patients identified as at risk for a sustained mild traumatic brain injury (mTBI). The findings are discussed in the context of an evaluation and management gap surrounding mTBI care among emergency department (ED) providers at a Level I trauma and emergency care center. Although variabilities exist among mTBI care in the ED, provider education, standardization of guidelines, and implementation practices are strategies for increasing the uptake of care in the ED for patients presenting with mTBI.
Enhanced functional connectivity between insular subregions correlates with the efficacy of music and instruction-guided relaxation in depression
Authors: Liu Chun-Hong , Lv Xue-Yu , Guo Zhi-Peng , Zhang Zhu-Qing , Yang Ming-Hao , Fang Jiliang , Wang Weidong
Published: October 2020

Music and instruction-guided relaxation (MIGR) is a complementary therapeutic tool used in the treatment of the major depressive disorder (MDD). However, the neural mechanism that underlies the effect of MIGR on MDD patients is not known. Twenty-three right-handed MDD patients and 23 age-, sex-, handedness-, and educational level-matched healthy controls were enrolled. Resting-state functional MRI data were acquired from patients before and after MIGR and from healthy controls. The relationships between insular subregion-based functional connectivity and Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale (HAM-A), Automatic Thoughts Questionnaire, and Ruminative Responses Scale scores were examined. One-way analysis of variance exhibited significant differences among the three groups in functional connectivity between the left dorsal anterior insula (dAI) and left superior medial frontal gyrus (SMFG), left dAI and left precuneus, left posterior insula and left gyrus rectus, right ventral anterior insula (vAI) and left posterior cingulate cortex (PCC), right vAI and right inferior frontal gyrus (R-IFG). Further comparisons in regions of interest showed that MDD patients before MIGR showed decreased functional connectivity between the left dAI and left SMFG, left dAI and left precuneus, left posterior insula, and left gyrus rectus, right vAI and left PCC, right vAI and R-IFG relative to those in healthy controls. The strength of functional connectivity between the right dAI and left putamen also exhibited a negative correlation with the HAM-A score in MDD cases before MIGR. MIGR may result in enhanced functional connectivity in insular subregions, thereby potentially increasing the regulatory influence of cognitive reappraisal.
Japanese encephalitis virus capsid protein interacts with non-lipidated MAP1LC3 on replication membranes and lipid droplets
Authors: Sarkar Riya , Sharma Kiran Bala , Kumari Anita , Asthana Shailendra , Kalia Manjula
Published: October 2020

Microtubule-associated protein 1 light chain 3 (MAP1LC3) is a protein with a well-defined function in autophagy, but still incompletely understood roles in several other autophagy-independent processess. Studies have shown MAP1LC3 is a host-dependency factor for the replication of several viruses. Japanese encephalitis virus (JEV), a neurotropic flavivirus, replicates on ER-derived membranes that are marked by autophagosome-negative non-lipidated MAP1LC3 (LC3-I). Depletion of LC3 exerts a profound inhibition on virus replication and egress. Here, we further characterize the role of LC3 in JEV replication, and through immunofluorescence and immunoprecipitation show that LC3-I interacts with the virus capsid protein in infected cells. This association was observed on capsid localized to both the replication complex and lipid droplets (LDs). JEV infection decreased the number of LDs per cell indicating a link between lipid metabolism and virus replication. This capsid-LC3 interaction was independent of the autophagy adaptor protein p62/Sequestosome 1 (SQSTM1). Further, no association of capsid was seen with the Gamma-aminobutyric acid receptor-associated protein family, suggesting that this interaction was specific for LC3. High-resolution protein-protein docking studies identified a putative LC3-interacting region in capsid, 56FTAL59,
and other key residues that could mediate a direct interaction between the two proteins.
Evidence for secondary thrombotic microangiopathy in COVID-19
Authors: Sweeney Joseph M. , Barouqa Mohammad , Krause Gregory J. , Gonzalez-Lugo Jesus D. , Rahman Shafia , Gil Morayma Reyes
Published: October 2020

The causes of coagulopathy associated with COVID-19 disease are poorly understood. We aimed to investigate the relationship between markers of endothelial activation, intravascular hemolysis, coagulation, and organ damage in COVID-19 patients and study their association with disease severity and mortality. We conducted a retrospective study of 181 hospitalized COVID-19 patients randomly selected with equal distribution of survivors and non-survivors. Patients who died had significantly lower ADAMTS13 activity, significantly higher LDH, schistocytes and von Willebrand Factor levels compared to patients discharged alive. Only 30% of patients with an initial ADAMTS13 activity <43% survived vs. 60% with ADAMTS13 ≥43% who survived. In conclusion, COVID-19 may manifest as a TMA-like illness in a subset of hospitalized patients. Presence of schistocytes on admission may warrant a work-up for TMA. These findings indicate the need for future investigation to study the relationship between endothelial and coagulation activation and the efficacy of TMA treatments in COVID-19.
SARS-CoV-2 antibodies in the Southern Region of New Zealand, 2020
Authors: Craigie Alyson , McGregor Reuben , Whitcombe Alana , Carlton Lauren , Harte David , Sutherland Michelle , Parry Matthew , Smit Erasmus , McAuliffe Gary , Ussher James , Moreland Nicole , Jack Susan , Upton Arlo
Published: October 2020

Background

During New Zealand’s first outbreak in early 2020 the Southern Region had the highest per capita SARS-CoV-2 infection rate. PCR testing was initially limited by a narrow case definition and limited laboratory capacity, so cases may have been missed.

Objectives

To evaluate the Abbott® SARS-CoV-2 IgG nucleocapsid assay, alongside spike-based assays, and to determine the frequency of antibodies among PCR-confirmed and probable cases, contacts, and higher risk individuals in the Southern Region of NZ.

Study design

Pre-pandemic sera (n=300) were used to establish assay specificity and sera from PCR-confirmed SARS-CoV-2 patients (n=78) to establish sensitivity. For prevalence analysis, all samples (n=1214) were tested on the Abbott assay, and all PCR-confirmed cases (n=78), probable cases (n=9), and higher risk individuals with grey-zone (n=14) or positive results (n=11) were tested on four additional SARS-CoV-2 serological assays.

Results

The median time from infection onset to serum collection for PCR-confirmed cases was 14 weeks (range 11-17 weeks). The Abbott assay demonstrated a specificity of 99.7% (95% CI, 98.2%-99.99%) and a sensitivity of 76.9% (95% CI, 66.0%-85.7%). Spike-based assays demonstrated superior sensitivity ranging 89.7-94.9%. Nine previously undiagnosed sero-positive individuals were identified, and all had epidemiological risk factors.

Conclusions

Spike-based assays demonstrated higher sensitivity than the Abbott IgG assay, likely due to temporal differences in antibody persistence. No unexpected SARS-CoV-2 infections were found in the Southern region of NZ, supporting the elimination status of the country at the time this study was conducted.
Trends in knowledge of HIV status and efficiency of HIV testing services in Sub-Saharan Africa (2000-2020): a modelling study of survey and HIV testing program data
Authors: Giguère Katia , Eaton Jeffrey W. , Marsh Kimberly , Johnson Leigh F. , Johnson Cheryl C. , Ehui Eboi , Jahn Andreas , Wanyeki Ian , Mbofana Francisco , Bakiono Fidèle , Mahy Mary , Maheu-Giroux Mathieu
Published: October 2020

Background

Knowledge of HIV status (KOS) among people living with HIV (PLHIV) is essential for an effective national HIV response. This study estimates progress and gaps in reaching the UNAIDS 2020 target of 90% KOS, and the efficiency of HIV testing services (HTS) in sub-Saharan Africa (SSA), where two thirds of all PLHIV live.

Methods

We used data from 183 population-based surveys (N=2.7 million participants) and national HTS programs (N=315 country-years) from 40 countries as inputs into a mathematical model to examine trends in KOS among PLHIV, median time from HIV infection to diagnosis, HIV testing positivity, and proportion of new diagnoses among all positive tests, adjusting for retesting.

Findings

Across SSA, KOS steadily increased from 6% (95% credible interval [95%CrI]: 5% to 7%) in 2000 to 84% (95%CrI: 82% to 86%) in 2020. Twelve countries and one region, Southern Africa, reached the 90% target. In 2020, KOS was lower among men (79%) than women (87%) across SSA. PLHIV aged 15-24 years were the least likely to know their status (65%), but the largest gap in terms of absolute numbers was among men aged 35-49 years, with over 700,000 left undiagnosed. As KOS increased from 2000 to 2020, the median time to diagnosis decreased from 10 to 3 years, HIV testing positivity declined from 9% to 3%, and the proportion of first-time diagnoses among all positive tests dropped from 89% to 42%.

Interpretation

On the path towards the next UNAIDS target of 95% diagnostic coverage by 2030, and in a context of declining positivity and yield of first-time diagnoses, we need to focus on addressing disparities in KOS. Increasing KOS and treatment coverage among older men could be critical to reduce HIV incidence among women in SSA, and by extension, reducing mother-to-child transmission.
Covid-19 in children: is there any correlation with renal function and severity of the disease?
Authors: Rachmadi Dedi , Widiasta Ahmedz , Sukandar Hadyana , Sekarwana Nanan , Hilmanto Dany
Published: October 2020

Background

Kidney manifestations are life-threatening conditions, such as end-stage renal disease (ESRD), especially when attributed to viral infections. The severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), is an emerging health problem worldwide, potentially affecting all organs, including the kidney. Most reports on kidney manifestations were conducted mostly on the adult and elderly population, and limited on children. Therefore, this study aims to analyse the correlation between kidney manifestations with the renal function of pediatric patients suffering from COVID-19.

Methods

An observational analytic study was conducted in Hasan Sadikin General Hospital, Bandung, Indonesia, from March to August 2020. The demographic data, clinical signs, laboratory results, and notable kidney function were analysed, while the disease was classified as severe and nonsevere based on its clinical appearance. The Mann-Whitney test for nonparametric was used to analyze the collected data. Results. In this study, 16 COVID-19 children were selected as the research subjects, the median eGFR value in the severe group was lower (49.59 ml / minute / 1.73m2) compared to the nonsevere (113 ml / minute / 1.73m2), however, not statistically significant (p = 0.521). Significant high CRP and low thrombocyte levels were found in severe SARS-CoV-2 infection (p<0.05). Conclusion. A severe SARS-CoV-2 infection tends to affect the kidney, which is manifested as decreased glomerular filtration rate (GFR).
NGSremix: A software tool for estimating pairwise relatedness between admixed individuals from next-generation sequencing data
Authors: Nøhr Anne Krogh , Hanghøj Kristian , Erill Genis Garcia , Moltke Ida , Albrechtsen Anders
Published: October 2020

Estimation of relatedness between pairs of individuals is important in many genetic research areas. When estimating relatedness, it is important to account for admixture if this is present. However, the methods that can account for admixture are all based on genotype data as input, which is a problem for low depth next-generation sequencing (NGS) data from which genotypes are called with high uncertainty. Here we present a software tool, NGSremix, for maximum likelihood estimation of relatedness between pairs of admixed individuals from low depth NGS data, which takes the uncertainty of the genotypes into account via geno-type likelihoods. Using both simulated and real NGS data for admixed individuals with an average depth of 4x or below we show that our method works well and clearly outperforms all the commonly used state-of-the-art relatedness estimation methods PLINK, KING, relateAdmix, and ngsRelate that all perform quite poorly. Hence, NGSremix is a useful new tool for estimating relatedness in admixed populations from low-depth NGS data. NGSremix is implemented in C/C++ in a multi-threaded software and is freely available on Githubhttps://github.com/KHanghoj/NGSremix.
Tocilizumab in nonventilated patients hospitalized with Covid-19 pneumonia
Authors: Salama Carlos , Han Jian , Yau Linda , Reiss William G. , Kramer Benjamin , Neidhart Jeffrey D. , Criner Gerard J. , Kaplan-Lewis Emma , Baden Rachel , Pandit Lavannya , Cameron Miriam L. , Garcia-Diaz Julia , Chávez Victoria , Mekebeb-Reuter Martha , Menezes Ferdinando Lima , Shah Reena , González-Lara Maria F. , Assman Beverly , Freedman Jamie , Mohan Shalini V.
Published: October 2020

Background

Coronavirus disease 2019 (Covid-19) pneumonia is often associated with hyperinflammation. Safety and efficacy of the anti–interleukin-6 receptor antibody tocilizumab was evaluated in patients hospitalized with Covid-19 pneumonia.

Methods

Nonventilated patients hospitalized with Covid-19 pneumonia were randomized (2:1) to tocilizumab (8 mg/kg intravenous) or placebo plus standard care. Sites enrolling high-risk and minority populations were emphasized. The primary endpoint was cumulative proportion of patients requiring mechanical ventilation or who had died by Day 28.

Results

Of 389 randomized patients, 249 patients received tocilizumab and 128 received placebo in the modified intent-to-treat population (Hispanic/Latino, 56.0%; Black/African American, 14.9%; American Indian/Alaska Native, 12.7%; White, 12.7%; other/unknown, 3.7%). The cumulative proportion (95% confidence interval [CI]) of patients requiring mechanical ventilation or who had died by Day 28 was 12.0% (8.52% to 16.86%) and 19.3 % (13.34% to 27.36%) for the tocilizumab and placebo arms, respectively (log-rank P=0.0360; hazard ratio, 0.56 [95% CI, 0.33 to 0.97]). Median time to clinical failure up to Day 28 favored tocilizumab over placebo (hazard ratio 0.55 [95% CI, 0.33 to 0.93]). All-cause mortality by Day 28 was 10.4% with tocilizumab and 8.6% with placebo (weighted difference, 2.0% [95% CI, – 5.2% to 7.8%). In the safety population, serious adverse events occurred in 15.2% of tocilizumab patients (38/250 patients) and 19.7% of placebo patients (25/127).

Conclusions

This trial demonstrated the efficacy and safety of tocilizumab over placebo in reducing the likelihood of progression to requiring mechanical ventilation or death in nonventilated patients hospitalized with Covid-19 pneumonia.

Trial registration

ClinicalTrials.govNCT04372186
Prevalence of Depressive Disorders and Associated Demographic Factors Among Refugees Amidst COVID-19 in Nakivale Refugee Camp in Southwestern Uganda
Authors: Kabunga Amir , Anyayo Lucas Goodgame
Published: October 2020

Introduction

The COVID-19 pandemic and health measures to prevent it have unprecedented effects on the mental health of the refugees. However, the situation of refugees in developing countries is unclear. Thus, this study estimated the prevalence of and associated demographic factors during COVID-19 pandemic.

The methodology

employed a cross-sectional survey carried out in June 2020 in which 146 adult refugees from Nakivale settlement camp were randomly selected to fill out a questionnaires-demographics and PHQ9.

Results

revealed that the majority of respondents were female (53%) and 47% had a depressive disorder. There was no statistical relationship between demographics (gender, age and marital status) and depressive disorders.

In Conclusion

findings indicate that depressive disorders are prevalent among refugees in Nakivale settlement and it is important to identify refugees affected mentally and given proper treatment.