bluuebunny/crossref_metadata_2025 huggingface dataset:
GD 424 – a helium-atmosphere white dwarf with a large amount of trace hydrogen in the process of digesting a rocky planetesimal
Authors: Izquierdo Paula , Toloza Odette , Gänsicke Boris T , Rodríguez-Gil Pablo , Farihi Jay , Koester Detlev , Guo Jincheng , Redfield Seth
Published: December 2020

The photospheric metal pollution of white dwarfs is now well established as the signature of the accretion of planetary debris. However, the origin of the trace hydrogen detected in many white dwarfs with helium atmospheres is still debated. Here, we report the analysis of GD 424: a metal-polluted, helium-atmosphere white dwarf with a large amount of trace hydrogen. We determined the atmospheric parameters using a hybrid analysis that combines the sensitivity of spectroscopy to the atmospheric composition, log(H/He), with that of photometry and astrometry to the effective temperature, Teff, and surface gravity, log g. The resulting white dwarf mass, radius, and cooling age are $\mbox{$M_{\mathrm{WD}}$}=0.77\pm 0.01\, \mbox{$\mathrm{M}_{\odot }$}$, $\mbox{$R_{\mathrm{WD}}$}=0.0109\pm 0.0001\, \mbox{$\mathrm{R}_{\odot }$}$, and τcool = 215 ± 10 Myr, respectively. We identified and measured the abundances of 11 photospheric metals and argue that the accretion event is most likely either in the increasing or in steady state, and that the disrupted planetesimal resembles either CI chondrites or the bulk Earth in terms of its composition. We suggest that the observed 1.33 × 1022 g of trace hydrogen in GD 424 was at least partly acquired through accretion of water-rich planetary debris in an earlier accretion episode.
Bimodality of [α Fe]–[Fe/H] distributions is a natural outcome of dissipative collapse and disc growth in Milky Way-type galaxies
Authors: Khoperskov Sergey , Haywood Misha , Snaith Owain , Di Matteo Paola , Lehnert Matthew , Vasiliev Evgenii , Naroenkov Sergey , Berczik Peter
Published: December 2020

By using chemo-dynamical simulations of the Milky Way-type galaxies formation, we find that the two α-sequences are formed in quite different physical environments. The high-α sequence is formed early from a burst of star formation in a turbulent, compact gaseous disc that forms a thick disc. The low-α stellar population is the result of quiescent star formation supported by the slow accretion of enriched gas on to a radially extended thin disc. Feedback-driven outflows during the formation of the thick disc are responsible for the enrichment of the surrounding gaseous halo, which subsequently feeds the disc on a longer time-scale. During the thin disc phase, chemical evolution reaches an equilibrium metallicity and abundance, where the stars pile-up. This equilibrium metallicity decreases towards the outer disc, generating the ridge line that forms the low-α sequence. We identify a second mechanism capable of creating a low-α sequence in one of our simulations. A rapid shutdown of the star formation due to feedback at the end of the thick disc phase, suppresses the chemical enrichment of the halo gas, which, once accreted on to the star-forming disc, dilutes the interstellar medium at the beginning of the thin disc formation. Therefore, the bimodality is independent of any particular merger history, suggesting that it could be much more widespread than has been claimed. We also find that radial migration has a negligible effect on the $\rm [\alpha / Fe]\!-\![Fe / H]$ distribution over time, suggesting that α-bimodality results purely from the presence of different star formation regimes over the galaxy’s formation.
Testing the impact of coronal mass ejections on cosmic-ray intensity modulation with algorithm selected Forbush decreases
Authors: Okike O , Nwuzor O C , Odo F C , Iyida E U , Ekpe J E , Chukwude A E
Published: December 2020

The relationship between coronal mass ejections (CMEs) and Forbush decreases (FDs) has been investigated in the past. But the selection of both solar events are difficult. Researchers have developed manual and automated methods in efforts to identify CMEs as well as FDs. While scientists investigating CMEs have made significant advancement, leading to several CME catalogues, including manual and automated events catalogues, those analyzing FDs have recorded relatively less progress. Till date, there are no comprehensive manual FD catalogues, for example. There are also paucity of automated FD lists. Many investigators, therefore, attempt to manually select FDs which are subsequently used in the analysis of the impact of CMEs on galactic cosmic-ray (GCR) flux depressions. However, some of the CME versus FD correlation results might be biased since manual event identification is usually subjective, unable to account for the presence of solar-diurnal anisotropy which characterizes GCR flux variations. The current paper investigates the relation between CMEs and FDs with emphasis on accurate and careful Forbush event selection.
Reliability of mecA in Predicting Phenotypic Susceptibilities of Coagulase-Negative Staphylococci and Staphylococcus aureus
Authors: Williams Manon C , Dominguez Samuel R , Prinzi Andrea , Lee Kayla , Parker Sarah K
Published: December 2020

The mecA gene is commonly used to identify resistance in Staphylococcus aureus, but historically is not used for coagulase-negative staphylococci (CoNS). Analysis of 412 staphylococcal blood cultures (2014–2018) revealed that the absence of mecA had high concordance (100%) with oxacillin susceptibility for S. aureus and CoNS alike.
Transient photoinhibition and photo-oxidative stress as an integral part of stress acclimation and plant development in a dioecious tree adapted to Mediterranean ecosystems
Authors: Muñoz Paula , Cotado Alba , Munné-Bosch Sergi
Published: December 2020

Mastic trees (Pistacia lentiscus L.) are dioecious perennial plants that are highly adapted to Mediterranean climates but display a high sensitivity to winter periods. In order to understand how sex, leaf phenology and ecological context could condition sensitivity to winter and associated mechanisms to acclimate to these conditions, photoinhibition and photo-oxidative stress markers were examined in mastic trees (P. lentiscus) from a natural population growing in the Garraf Natural Park for a consecutive 12-month period (seasonal study), as well as in three populations naturally growing in the Montseny Natural Park, including the highest altitudes described for this species, during winter (altitudinal study). Results from these studies indicate that both the winter period and higher elevation influenced the degree of photoinhibition, but this was not conditioned by sex. In fact, winter photoinhibition occurred transiently even though it was accompanied by chlorophyll loss and malondialdehyde contents. Stress acclimation was achieved through biochemical adjustments in chloroplasts, characterized by anthocyanin shielding, increased de-epoxidation state of the xanthophyll cycle as well as tocopherol accumulation, and phenological adaptations, the latter allowing a complete resetting of the physiological performance of leaves. Moreover, although females showed higher lipid peroxidation than males during the coldest winter months, at the highest elevation and during flowering in spring, this oxidative stress was mild and transient with no negative consequences for the physiology of plants. It is concluded that evergreen mastic trees acclimate to winter conditions and higher elevations by activation of antioxidant defenses together with phenological adjustments, altogether playing a crucial role in plant survival. Sexual dimorphism in mastic trees appears as a relevant factor when considering sensitivity to photo-oxidative stress in winter and altitudinal conditions.
Noise Outcomes in Servicemembers Epidemiology (NOISE) Study: Design, Methods, and Baseline Results
Authors: Henry James A. , Griest Susan , Reavis Kelly M. , Grush Leslie , Theodoroff Sarah M. , Young Sarah , Thielman Emily J. , Carlson Kathleen F.
Published: December 2020

Objectives:

Military Service members and Veterans commonly report hearing loss and tinnitus, both of which can result in significant disability. During military service, Service members are exposed to many different types of loud noise, which is strongly associated with hearing loss and tinnitus. Other military-related exposures, such as chemicals and traumatic brain injury (TBI), are also linked with auditory problems. The purpose of the “Noise Outcomes in Servicemembers Epidemiology” (NOISE) study is to gather information from Active-Duty Service members and recently separated Veterans about their military and nonmilitary noise exposures, other relevant military and nonmilitary exposures, and potential outcomes of these exposures including tinnitus, hearing loss, and other hearing-related health concerns.

Design:

The NOISE study assesses lifetime noise exposures, chemical and blast exposures, TBI, physical and psychiatric comorbidities, and other military and nonmilitary exposures and outcomes that can affect auditory function. Participants undergo comprehensive in-person audiologic examinations; those who experience tinnitus undergo a complete tinnitus assessment. Exposures and select outcomes are reassessed annually by mail, and the comprehensive in-person assessment is completed every 5 years. This report presents descriptive, baseline data obtained from the first 690 participants enrolled between 2014 and 2018.

Results:

Some notable findings from this analysis include: (1) the prevalence of hearing loss in the sample was 8% for low frequencies (0.25 to 2 kHz), 20% for high frequencies (3 to 8 kHz), and 39% for extended high frequencies (9 to 16 kHz); (2) the prevalence of tinnitus was 53%; (3) the prevalence of both hearing loss and tinnitus was higher among those with higher age, more years of military service, greater degree of noise exposure, and exposures to blasts and/or TBI in the military; and (4) tinnitus was most prevalent among participants who serve/served in the Army relative to the other military branches.

Conclusions:

The NOISE study is acquiring comprehensive data on military-related auditory dysfunction. It is the first of its kind to enroll active Service members and recently separated Veterans into a longitudinal study to examine the etiology and outcomes of tinnitus and hearing loss in this population. Although these data do not necessarily represent the entire military and Veteran populations, ongoing enrollment is focused on increasing generalizability and will also provide the statistical power to conduct multivariable analyses. This will allow us to examine longitudinal associations of interest while controlling for potential confounders and other possible sources of error. These data will provide critical knowledge to refine future military hearing conservation efforts and inform efforts to develop future treatments.
The impact of 6 years of the National Colorectal Cancer Screening Program on colorectal cancer incidence and 5-year survival
Authors: Tepeš Bojan , Mlakar Dominika Novak , Stefanovič Milan , Štabuc Borut , Grazio Snježana Frkovič , Zakotnik Jožica Maučec
Published: December 2020

We aimed to assess the impact of the first three rounds of the National Colorectal Cancer Screening Program (NCCSP) on CRC incidence and mortality in Slovenia. In NCCSP, we use two fecal immune tests (FITs) and if test is positive patient is referred to colonoscopy. From 2009, we invite Slovenian residents aged 50–69 years, one screening round takes 2 years. The response rate was from 56.9 to 59.9%. FIT was positive in 6.0–6.2% (more in older patients and in men; P < 0.05). The adenoma detection rate was >51.3% (more in men; P < 0.01). In NCCSP, 70.3% of all cancers diagnosed were in stages I and II, while 20.7% of all CRC were found in polyps resected during colonoscopies. Patients with positive first FIT have odds ratio 2.19 [95% confidence interval (CI), 2.06–2.32] for advanced neoplasia and cancer compared to patients with two negative FITs. The incidence rate for CRC has dropped significantly after 6 years in population and in men (P < 0.01) but not in women. Five-year CRC survival was 31.3% higher if cancer was diagnosed in NCCSP (P < 0.05). After 6 years of NCCSP, the incidence rate for CRC has dropped significantly (P < 0.01). Hazard ratio for death from CRC was 3.84 higher (95% CI, 3.36–4.40; P < 0.001) in patients with cancer detected outside the program.
What Is the Correlation Among dGEMRIC, T1p, and T2* Quantitative MRI Cartilage Mapping Techniques in Developmental Hip Dysplasia?
Authors: Melkus Gerd , Beaulé Paul E. , Wilkin Geoffrey , Rakhra Kawan S.
Published: December 2020

Background

Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) is a validated technique for evaluating cartilage health in developmental dysplasia of the hip (DDH), which can be a helpful prognosticator for the response to surgical treatments. dGEMRIC requires intravenous injection of gadolinium contrast, however, which adds time, expense, and possible adverse reactions to the imaging procedure. Newer MRI cartilage mapping techniques such as T1 rho (ρ) and T2* have been performed in the hip without the need for any contrast, although it is unknown whether they are equivalent to dGEMRIC.

Question/purpose

In this study, our purpose was to determine the correlation between the relaxation values of three cartilage mapping techniques, dGEMRIC, T1ρ, and T2*, in patients with DDH.

Methods

Fifteen patients with DDH (three male, 12 female; mean age 29 ± 9 years) scheduled for periacetabular osteotomy underwent preoperative dGEMRIC, T1ρ, and T2* MRI at 3T with quantitative cartilage mapping. The outcomes of dGEMRIC, T1ρ, and T2* mapping were calculated for three regions of interest (ROI) to analyze the weightbearing cartilage of the hip: global ROI, anterior and posterior ROI, and further subdivided into medial, intermediate, and lateral to generate six smaller ROIs. The correlation between the respective relaxation time values was evaluated using the Spearman correlation coefficient (rS) for each ROI, categorized as negligible, weak, moderate, strong, or very strong. The relaxation values within the subdivided ROIs were compared for each of the three cartilage mapping techniques using the Kruskal-Wallis test.

Results

There was a moderate correlation of T1ρ and T2* relaxation values with dGEMRIC relaxation values. For the global ROI, there was a moderate correlation between dGEMRIC and T2* (moderate; rS= 0.63; p = 0.01). For the anterior ROI, a moderate or strong correlation was found between dGEMRIC and both T1ρ and T2*: dGEMRIC and T1ρ (strong; rS= -0.71; p = 0.003) and dGEMRIC and T2* (moderate; rS= 0.69; p = 0.004). There were no correlations for the posterior ROI. The mean dGEMRIC, T1ρ, and T2* relaxation values were not different between the anterior and posterior ROIs nor between the subdivided six ROIs.

Conclusion

Quantitative T1ρ and T2* cartilage mapping demonstrated a moderate correlation with dGEMRIC, anteriorly and globally, respectively. However, the clinical relevance of such a correlation remains unclear. Further research investigating the correlation of these two noncontrast techniques with clinical function and outcome scores is needed before broad implementation in the preoperative investigation of DDH.

Level of Evidence

Level II, diagnostic study.
The ABCD Keratoconus Grading System–A Useful Tool to Estimate Keratoconus Progression in the Pediatric Population
Authors: Dubinsky-Pertzov Biana , Reinhardt Ophir , Gazit Inbal , Or Lior , Hecht Idan , Pras Eran , Einan-Lifshitz Adi
Published: December 2020

Purpose:

To evaluate the ABCD grading system in pediatric keratoconus.

Methods:

A retrospective cohort analysis of all children with keratoconus followed up at the Shamir medical center between 2010 and 2017. A recommendation by the treating physician to undergo corneal crosslinking (CXL) was used as an estimate for clinically significant disease progression. The ABCD grading was not available to the treating physician and was computed post hoc. The ABCD grading was compared between patients who required CXL with those who did not. A single eye of each patient was included.

Results:

Fifty eyes of 50 children were analyzed. The mean age at presentation was 15.56 ± 1.36 years. In 23 eyes, progression of keratoconus was recorded and CXL was performed (CXL-group). On presentation, the stable and CXL groups did not differ significantly in their clinical parameters. In the CXL-group, a statistically significant increase was seen in the ABCD staging (P < 0.001). In the stable group, the ABCD staging did not change significantly in parallel visits (P = 0.87). An increase of 1 point in the sum of the ABCD staging showed a 5-fold risk for undergoing CXL (odds ratio = 5.28; 95% CI, 1.82–15.34). There was no significant change in the Amsler–Krumeich classification in the CXL group.

Conclusions:

Among a cohort of pediatric patients with keratoconus, worsening in the ABCD grading was associated with disease progression, whereas no significant change was demonstrated in the Amsler–Krumeich classification The ABCD grading system is a useful tool for initial assessment of disease progression in the pediatric population, in which early recognition is of paramount importance.
Simplified, Readily Available Method for the Treatment of Band Keratopathy With Ethylenediaminetetraacetic Acid
Authors: Narvaez Julio , Chang Matthew , Ing Jeffrey , De Chance Daniel , Narvaez Joshua J.
Published: December 2020

Purpose:

To compare 3 methods for creating ethylenediaminetetraacetic acid (EDTA) solution using readily available Vacutainer tubes for the treatment of band keratopathy.

Methods:

All 3 protocols used commercially available Vacutainer blood collection tubes coated with K2EDTA. An osmometer was used to measure and compare the concentration of EDTA created using 3 different protocols. The time required for preparation of the solution was measured and compared to evaluate its efficiency for everyday clinical use. In addition, volume of EDTA solution obtained was measured for method 1. The most promising protocol for clinical use was then used for treatment of a series of patients.

Results:

Average osmolarity was 532, 285, and 422 for methods 1, 2, and 3, respectively (ANOVA P < 0.01, all Tukey honestly significant difference P < 0.01). For the respective mixtures, average concentration was 65, 35, and 52 mg/mL, and average time to create solution was 189, 38, and 83 seconds (ANOVA P < 0.01, all Tukey honestly significant difference P < 0.01). The most promising, method 3, was found to be safe and effective in removing calcium from the corneal stroma in a series of 5 patients with 6 eyes treated. It also yielded 25% more solution for clinical use than method 1.

Conclusions:

Method 3 using a single 10-mL Vacutainer tube with 18 mg of K2-EDTA had the best balance of effective concentration of EDTA, time to preparation, and simplicity of methodology, when compared with previously published methods 1 and 2. It also yielded a greater final volume of solution.
Feasibility of Using the O-Arm Imaging System During ENB-rEBUS–guided Peripheral Lung Biopsy
Authors: Cho Roy J. , Senitko Michal , Wong Jennifer , Dincer Erhan H. , Khosravi Hamid , Abraham George E.
Published: December 2020

Background:

There is a paucity of real-time imaging modalities available for the bronchoscopic biopsy of peripheral lung nodules. We aim to demonstrate the feasibility of the O-arm imaging system to guide real-time biopsies of peripheral lung nodules during electromagnetic navigation bronchoscopy.

Methods:

A retrospective review was performed at 2 academic medical centers utilizing O-arm guidance.

Results:

The average nodule size was 2.1×2.0 cm and were mostly solid (66%) with a positive bronchus sign (83%). O-arm imaging confirmed tool-in-lesion in all cases. The diagnostic yield was 33%. Four cases were nondiagnostic of the 6 cases performed. In these cases, necrotic tissue was the most common (75%) and showed resolution following subsequent imaging. The average 3-dimensional (3D) spin time was 23.5 seconds. The average number of 3D spins performed per case was 4.33. The average effective dose per 3D spin was 3.73 mSv.

Conclusion:

We have demonstrated the O-arm’s feasibility with electromagnetic navigation bronchoscopy for peripheral lung nodules. The O-arm was able to confirm tool-in-lesion in all cases which added confidence to the biopsy. Four high-resolution 3D spins per case may limit the total computed tomography effective dose. We also noted that both metal and radiation scatter were minimal when appropriate radiation safety standards were met. Although additional experience and data will be required to verify the O-arm approach for routine use, our initial experience is promising.
Concept-Based Learning for Capstone Clinical Experiences in Hospital and Community Settings
Authors: Nielsen Ann , Lanciotti Kristy , Garner Annette , Brown Linda
Published: December 2020

Background: Capstone clinical experiences provide opportunities for students to develop increasing competence and independence in nursing practice, as well as to focus on care that is fundamental to contemporary nursing practice.

Problem: Increasingly in the United States, nursing practice is expanding to community settings, with enhanced focus on population health, whereas promoting safe practice within acute care settings remains an imperative. Student learning needs vary by the clinical setting as does delivery of clinical experiences and associated programmatic challenges. Yet, safe and effective practice is required in all environments.

Approach: This article describes 2 concept-based approaches to promote deep understanding of key aspects of nursing care developed to manage specific challenges in hospital and community settings.

Outcomes/Conclusions: Concept-based learning activities, used to promote deeper clinical thinking and integration of theory with practice, support students to develop increased competence in care of specific patient populations in both environments.
Frontiers in Celiac Disease
Authors: Patel Natalie , Robert Marie E.
Published: December 2020

Celiac disease is a chronic, immune-mediated enteropathy driven by dietary gluten found in genetically susceptible hosts. It has a worldwide distribution, is one of the most common autoimmune disorders globally, and is the only autoimmune condition for which the trigger is known. Despite advances in characterizing mechanisms of disease, gaps in understanding of celiac disease pathogenesis remain. A “frontier” concept is considering what moves an HLA-DQ2 or DQ8-positive individual from asymptomatic gluten tolerance to celiac disease manifestation. In this arena, environmental triggers, including age at the time of initial gluten exposure, the occurrence of usual childhood viral infections, and microbiome alterations have emerged as key events in triggering the symptomatic disease. Pathologists play a major role in frontier aspects of celiac disease. This includes the discovery that duodenal mucosal histology in follow-up biopsies does not correlate with ongoing patient symptoms, antitissue transglutaminase antibody titers and diet adherence in celiac disease patients. Further, in light of recent evidence that the detection of monoclonal T-cell populations in formalin-fixed biopsies is not specific for type II refractory celiac disease, pathologists should resist performing such analyses until common causes of “apparent” refractoriness are excluded. The promise of therapies in celiac disease has led to clinical trials targeting many steps in the inflammatory cascade, which depend upon a pathologist’s confirmation of the initial diagnosis and evaluation of responses to therapies. As pathologists continue to be active participants in celiac disease research, partnering with other stakeholders, we will continue to impact this important autoimmune disease.
Stage 4S Neuroblastoma
Authors: Kawano Asuka , Hazard Florette K. , Chiu Bill , Naranjo Arlene , LaBarre Brian , London Wendy B. , Hogarty Michael D. , Cohn Susan L. , Maris John M. , Park Julie R. , Gastier-Foster Julie M. , Ikegaki Naohiko , Shimada Hiroyuki
Published: December 2020

Stage 4S neuroblastoma (4SNB) is associated with spontaneous tumor regression and an excellent prognosis. However, a small group of the patients have a poor prognosis. One hundred eighty-five stage 4SNB cases filed at the Children’s Oncology Group Neuroblastoma Pathology Reference Laboratory were studied. MYCN oncogene status [non-amplified (NA) vs. Amplified (A)] determined by fluorescence in situ hybridization, MYC-family (MYCN/MYC) protein expression [no-overexpression(−)/(+/−) vs. overexpression(+)] by immunohistochemistry and histopathology by International Neuroblastoma Pathology Classification [Favorable Histology (FH) vs. Unfavorable Histology (UH)] with particular attention to nucleolar hypertrophy [NH(−) vs. (+)] were assessed with patient survival. One hundred forty-seven (79.5%) tumors were MYCN-NA, FH, MYC-family protein(−)/(+/−), and NH(−) with a good prognosis [88.5±3.1% 3-y event-free survival (EFS); 94.1±2.3% 3-y overall survival (OS)]. Among MYCN-NA tumors, 11 demonstrated MYCN protein(+) with a moderate and uniform (M/U) staining pattern: they were FH(10/11), NH(−), 1 showed MYC protein(+) simultaneously, and all patients are alive. Also found were 5 MYC protein(+) and MYCN(−)/(+/−) tumors; they were FH without NH (4/5), and all patients are alive. Among MYCN-A tumors, 18 had MYCN protein(+) with a strong and heterogeneous (S/H) staining pattern, 9 had UH (44.4±23.4% EFS/OS) and 9 had FH (68.6±19.2% EFS/OS), and 15 showed NH(+). Two tumors had MYCN protein(−)/(+/−) despite MYCN-A; both were FH and NH(−), and 1 patient died. S/H staining pattern of MYCN protein overexpression by immunohistochemistry was associated with MYCN amplification, NH(+) and a poor prognosis. In contrast, the M/U staining pattern was associated with MYCN nonamplification and NH(−), and had no adverse prognostic effects for the stage 4SNB patients.
Long-term consequences of interpersonal violence experiences on treatment engagement and health status in people living with HIV
Authors: Budd Alexandra S. , Krentz Hartmut B. , Rubin Leah H. , Power Christopher , Gill Michael J. , Fujiwara Esther
Published: December 2020

Objective:

To examine the impact of previous interpersonal violence (IPersV) experiences on long-term healthcare engagement and health outcomes in a large Canadian HIV-cohort.

Design:

People living with HIV (PLHIV) were screened for IPersV, and their healthcare outcomes over the nine subsequent years were analyzed.

Methods:

A total of 1064 PLHIV were screened for past and present IPersV experiences through semistructured interviews. Follow-up included core treatment engagement (e.g. clinic visits) and health-status variables (HIV viral load, CD4+ T-cell count, mortality, comorbidities), analyzed descriptively and with longitudinal Cox regressions.

Results:

At intake, 385 (36%) PLHIV reported past or present IPersV including childhood (n = 224, 21%) or adulthood experiences (n = 161, 15%) and were offered conventional social work support. Over 9 years, individuals with any IPersV experiences were 36% more likely to discontinue care, 81% more likely to experience viremia, 47% more likely to experience a drop in CD4+ cell counts below 200/μl, and 65% more likely to die compared with patients not reporting IPersV (P < 0.05). Outcomes were similar when adjusted for sociodemographic factors. Childhood IPersV in particular was linked to several of the outcomes, with higher rates of discontinuation of care, viremia, and mortality related to mental health/addiction or HIV-related complications.

Conclusion:

IPersV is associated with an increased risk over time of healthcare discontinuation, poorer long-term HIV-related health outcomes, and increased mortality, especially for patients victimized in childhood. Apart from targeted IPersV screening to initiate conventional supports (e.g. through social work), increased efforts to engage vulnerable populations in their long-term care seems warranted.
Assessment of Intramyocardial Fat Content Using Computed Tomography
Authors: Yacoub Basel , Spandorfer Adam , Schoepf U. Joseph , Litwin Sheldon E.
Published: December 2020

Background:

Fat deposition in the liver and the skeletal muscle are linked to cardiovascular risk factors. Fat content in tissues can be estimated by measuring attenuation on noncontrast computed tomography (CT). Quantifying intramyocardial fat content is of interest as it may be related to myocardial dysfunction or development of heart failure. We hypothesized that myocardial fat content would correlate with severity of obesity, liver fat, and components of the metabolic syndrome.

Methods:

We measured attenuation values on 121 noncontrast CT scans from the spleen, liver, erector spinae muscle, and myocardial septum. A chart review was performed for patient demographics and clinical characteristics. We tested for correlations between attenuation values in each of the tissues and various clinical parameters.

Results:

We studied 78 females and 43 males, with a mean age of 54.5±11.2 years. Weak, but significant inverse Spearman correlation between body mass index and attenuation values were found in the liver (ρ=−0.228, P=0.012), spleen (ρ=−0.225, P=0.017), and erector spinae muscle (ρ=−0.211, P=0.022) but not in the myocardial septum (ρ=0.012, P=0.897). Mean attenuation in the nonobese group versus obese group (body mass index >30 kg/m2) were 41.1±5.0 versus 42.3±6.9 (P=0.270) in myocardial septum, 56.1±8.7 versus 51.7±10.9 (P=0.016) in the liver, 43.9±8.9 versus 40.1±10.4 (P=0.043) in the spleen, and 41.7±8.3 versus 39.0±8.8 (P=0.087) in the erector spinae muscle.

Conclusions:

Although CT is a theoretically appealing modality to assess fat content of the myocardium, we did not find a relationship between myocardial CT attenuation and obesity, or other cardiovascular risk factors. These findings suggest that the degree of myocardial fat accumulation in obesity or metabolic syndrome is too small to be detected with this modality.
Early Left Ventricular Diastolic Dysfunction and Abnormal Left Ventricular-left Atrial Coupling in Asymptomatic Patients With Hypertension
Authors: Song Yanyan , Li Lu , Chen Xiuyu , Shao Xiaoning , Lu Minjie , Cheng Jingliang , Zhao Shihua
Published: December 2020

Purpose:

Hypertension (HTN) patients suffer from increased risk of left ventricular (LV) diastolic dysfunction and LV hypertrophy (LVH). Evaluation of early LV diastolic function requires accurate noninvasive diagnostic tools. The aim of this study was to evaluate whether cardiovascular magnetic resonance feature-tracking (CMR-FT) could detect early LV dysfunction and evaluate LV-left atrium (LA) correlation in HTN patients.

Materials and Methods:

In all, 89 HTN patients and 38 age-matched and sex-matched controls were retrospectively enrolled and underwent CMR examination. HTN patients were divided into LVH (n=38) and non-LVH (n=51) groups. All LV deformation parameters were analyzed in radial, circumferential, and longitudinal directions, including peak strain, peak systolic strain rate and peak diastolic strain rate (PDSR), LA strain and strain rate (SR), including LA reservoir function (εs, SRs), conduit function (εe, SRe), and booster pump function (εa, SRa).

Results:

Compared with controls, the LV PDSR in radial, circumferential, and longitudinal directions and the LA reservoir and conduit function were significantly impaired in HTN patients regardless of LVH (all P<0.05). LV longitudinal and radial PDSR were correlated with LA reservoir and conduit function (all P<0.01). Among all LV and LA impaired deformation parameters, the longitudinal PDSR (in LV) and εe (in LA) were the most sensitive parameter for the discrimination between non-LVH and healthy volunteers, with an area under the curve of 0.70 (specificity 79%, sensitivity 55%) and 0.76 (specificity 95%, sensitivity 49%), respectively. The area under the curve reached 0.81 (specificity 82%, sensitivity 75%) combined with the longitudinal PDSR and εe.

Conclusion:

CMR-FT could detect early LV diastolic dysfunction in HTN patients, which might be associated with LA reservoir and conduit dysfunction.
Long-Term Neurocognitive Outcomes in Sagittal Synostosis: The Impact of Reoperation
Authors: Chuang Carolyn , Chaunzwa Tafadzwa L. , Wu Robin , Singh Anusha , Patel Anup , Yang Jenny F. , Hashim Peter W. , Travieso Roberto , Terner Jordan S. , Mayes Linda C. , Duncan Charles C. , Jane John A. , Lin Kant Y. , Bridgett David J. , Persing John A.
Published: December 2020

Introduction:

Optimal age at surgery in nonsyndromic sagittal craniosynostosis continues to be debated. Previous reports suggest that earlier age at whole vault cranioplasty more frequently requires reoperation. It is unknown, however, whether reoperation affects neurocognitive outcome. This study examined the impact of reoperation on neurocognitive outcome in children with nonsyndromic sagittal craniosynostosis using comprehensive neurocognitive testing.

Methods:

Forty-seven school-age children (age 5–16 years) with nonsyndromic sagittal craniosynostosis who underwent whole-vault cranioplasty were included in this analysis. Participants were administered a battery of standardized neuropsychological testing to measure neurocognitive outcomes.

Results:

Thirteen of the 47 participants underwent reoperation (27.7%); 11 out of the 13 reoperations were minor revisions while 2 reoperations were cranioplasties. Reoperation rate was not statistically different between patients who had earlier surgery (at age ≤6 months) versus later surgery (at age >6 months) (P > 0.05). Nonreoperated patients who had only one later-in-life surgery did not perform statistically better than reoperated patients on any outcome measure of neurocognitive function, including IQ, academic achievement, visuomotor integration, executive function, and behavior. Comparing reoperated earlier surgery patients with nonreoperated later surgery patients, reoperated earlier surgery patients had higher full-scale and verbal IQ (P < 0.05), scored higher on word reading, reading comprehension, spelling, numerical operations, and visuomotor integration (P < 0.05), and had fewer indicators of suspected learning disabilities (P < 0.01) compared to nonreoperated later surgery patients.

Conclusion:

Reoperation rate after whole vault cranioplasty was 27.7%, with few cases of repeat cranioplasty (4.2% of all patients). Reoperation was not associated with worse neurocognitive outcome. Reoperated earlier surgery patients in fact performed better in IQ, academic achievement and visuomotor integration when compared to nonreoperated later surgery patients.
Acquisition of Teamwork and Communication Skills Using High-Technology Simulation for Preclerkship Medical Students
Authors: Menon Vidya , Bhoja Ravi , Reisch Joan , Kosemund Matthew , Hogg Deborah , Ambardekar Aditee
Published: December 2020

Introduction

Teamwork failures are a major source of preventable error in medicine. Acquisition of skills early in training seems beneficial for impacting system-level change. Simulation-based curricula provide a psychologically safe and formative environment to learn and practice team skills. This project aims to assess teamwork and communication skill acquisition in preclerkship medical students during a longitudinal simulation-based curriculum.

Methods

This is a prospective, observational study of medical students participating in a high-technology simulation curriculum on team principles. Students, in groups of 5 to 7, participated in 6 mannequin-based simulation sessions over 10 months coordinated with an organ system–based preclerkship course. Each scenario was executed by a simulation technologist and guided by a simulation educator who functioned as a bedside nurse and led a postsimulation debrief. Likert-based, self- and global assessments completed by students and facilitators, respectively, were used to evaluate the teams. Descriptive statistics and Mann-Whitney U test were used to analyze data using a P value of less than 0.05 for statistical significance and a null hypothesis stating that there would be no change in behavior. The primary outcome measure was improvement in the teamwork and communication domains of both assessments.

Results

Students (N = 231) were divided into the same 32 groups during every session. At the end of every session, each student completed a self-assessment and each educator completed the team's global assessment for teamwork. Median scores for teamwork and communication domains increased between the first and sixth sessions on both assessments. Mann-Whitney U analysis of self-assessment scores showed Z values between −5.30 and −8.83 and P values of less than 0.00001. Mann-Whitney U analysis of global assessment scores showed Z values ranging from −3.43 to −5.24 and P values between 0.0031 and less than 0.00001.

Conclusions

There was meaningful improvement in scores in the domains of teamwork and communication over the 10-month, simulation-based curriculum designed to teach and hone teamwork skills.
A Systematic Review and Meta-analysis on the Impact of Proficiency-based Progression Simulation Training on Performance Outcomes
Authors: Mazzone Elio , Puliatti Stefano , Amato Marco , Bunting Brendan , Rocco Bernardo , Montorsi Francesco , Mottrie Alexandre , Gallagher Anthony G.
Published: December 2020

Objective:

To analyze all published prospective, randomized, and blinded clinical studies on the proficiency-based progression (PBP) training using objective performance metrics.

Background:

The benefit of PBP methodology to learning clinical skills in comparison to conventional training is not settled.

Methods:

Search of PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases, from inception to 1st March 2020. Two independent reviewers extracted the data. The Medical Education Research Study Quality Instrument (MERSQI) was used to assess the methodological quality of included studies. Results were pooled using biased corrected standardized mean difference and ratio-of-means. Summary effects were evaluated using a series of fixed and random effects models. The primary outcome was the number of procedural errors performed comparing PBP and non-PBP-based training pathways. Secondary outcomes were the number of procedural steps completed and the time to complete the task/procedure.

Results:

From the initial pool of 468 studies, 12 randomized clinical studies with a total of 239 participants were included in the analysis. In comparison to the non-PBP training, ratio-of-means results showed that PBP training reduced the number of performance errors by 60% (P < 0.001) and procedural time by 15% (P = 0.003) and increased the number of steps performed by 47% (P < 0.001).

Conclusions and Relevance:

Our systematic review and meta-analysis confirms that PBP training in comparison to conventional or quality assured training improved trainees’ performances, by decreasing procedural errors and procedural time, while increasing the number of correct steps taken when compared to standard simulation-based training.
Bringing COVID-19 home for Christmas: a need for enhanced testing in healthcare institutions after the holidays
Authors: Smith David R. M. , Duval Audrey , Zahar Jean Ralph , Opatowski Lulla , Temime Laura
Published: December 2020

Festive gatherings this 2020 holiday season threaten to cause a surge in new cases of novel coronavirus disease 2019 (COVID-19). Hospitals and long-term care facilities are key hotspots for COVID-19 outbreaks, and may be at elevated risk as patients and staff return from holiday celebrations in the community. Some settings and institutions have proposed fortified post-holiday testing regimes to mitigate this risk. We use an existing model to assess whether implementing a single round of post-holiday screening is sufficient to detect and manage holiday-associated spikes in COVID-19 introductions to the long-term care setting. We show that while testing early helps to detect cases prior to potential onward transmission, it likely to miss a substantial share of introductions owing to false negative test results, which are more probable early in infection. We propose a two-stage post-holiday testing regime as a means to maximize case detection and mitigate the risk of nosocomial COVID-19 outbreaks into the start of the new year. Whether all patients and staff should be screened, or only community-exposed patients, depends on available testing capacity: the former will be more effective, but also more resource-intensive.
Hospitalization for self-harm during the early months of the Covid-19 pandemic in France: a nationwide study
Authors: Jollant Fabrice , Roussot Adrien , Corruble Emmanuelle , Chauvet-Gelinier Jean-Christophe , Falissard Bruno , Mikaeloff Yann , Quantin Catherine
Published: December 2020

Introduction

Little is known to date about the impact of Covid-19 pandemic on self-harm incidence.

Methods

The number of hospitalizations for self-harm in France (mainland and overseas) from January to August 2020 (which includes the first confinement from March 17th to May 11th) was compared to the same period in 2019-2017. Hospital data with the ICD-10 codes X60-84 were extracted from the national administrative database (PMSI).

Results

There were 53,583 hospitalizations for self-harm in France between January and August 2020. Compared to the same period in 2019, this represents an overall 8.5% decrease. This decrease started the first week of the confinement and the number of hospitalizations remained at lower levels relative to 2019 until the end of August. The decrease was more marked in women (−9.8%) than men (−6.4%). However, an increase in hospitalizations was observed in individuals aged 75 and older (+5.3 to +11.6%). Moreover, the number of self-harm by firearm (+20.3%), jumping from height (+10.5%), and drowning (+4.7%) increased between 2019 and 2020, as well as the number of hospitalizations in intensive care (+3.5%) and deaths at discharge from hospital (+8.0%). No correlation was found between the evolution in the number of hospitalizations for self-harm and the number of severe cases of Covid-19 (hospitalization and mortality rates) across administrative departments.

Discussion

During the early months of the Covid-19 pandemic in France - including the first confinement -, a general decrease in the number of hospitalizations for self-harm was observed. However, an increase was found among elderly, a population at higher Covid 19-related mortality risk, and in the number of more severe suicidal acts. These results, therefore, shed light on a complex relationship between the pandemic and self-harm occurrence. This situation may change with time, which requires active suicide prevention strategies.
Rapid COVID-19 Diagnosis Using Deep Learning of the Computerized Tomography Scans
Authors: Tabrizchi Hamed , Mosavi Amir , Szabo-Gali Akos , Nadai Laszlo
Published: December 2020

Several studies suggest that COVID-19 may be accompanied by symptoms such as a dry cough, muscle aches, sore throat, and mild to moderate respiratory illness. The symptoms of this disease indicate the fact that COVID-19 causes noticeable negative effects on the lungs. Therefore, considering the health status of the lungs using X-rays and CT scans of the chest can significantly help diagnose COVID-19 infection. Due to the fact that most of the methods that have been proposed to COVID-19 diagnose deal with the lengthy testing time and also might give more false positive and false negative results, this paper aims to review and implement artificial intelligence (AI) image-based diagnosis methods in order to detect coronavirus infection with zero or near to zero false positives and false negatives rates. Besides the already existing AI image-based medical diagnosis method for the other well-known disease, this study aims on finding the most accurate COVID-19 detection method among AI methods such as machine learning (ML) and artificial neural network (ANN), ensemble learning (EL) methods.
Direct RNA nanopore sequencing of SARS-CoV-2 extracted from critical material from swabs
Authors: Vacca Davide , Fiannaca Antonino , Tramuto Fabio , Cancila Valeria , La Paglia Laura , Mazzucco Walter , Gulino Alessandro , La Rosa Massimo , Maida Carmelo Massimo , Morello Gaia , Belmonte Beatrice , Casuccio Alessandra , Maugeri Rosario , Iacopino Gerardo , Vitale Francesco , Tripodo Claudio , Urso Alfonso
Published: December 2020

Background

In consideration of the increasing prevalence of COVID-19 cases in several countries and the resulting demand for unbiased sequencing approaches, we performed a direct RNA sequencing experiment using critical oropharyngeal swab samples collected from Italian patients infected with SARS-CoV-2 from the Palermo region in Sicily.

Methods

Here, we identified the sequences SARS-CoV-2 directly in RNA extracted from critical samples using the Oxford Nanopore MinION technology without prior cDNA retro-transcription.

Results

Using an appropriate bioinformatics pipeline, we could identify mutations in the nucleocapisid (N) gene, which have been reported previously in studies conducted in other countries.

Conclusion

To the best of our knowledge, the technique used in this study has not been used for SARS-CoV-2 detection previously owing to the difficulties in the extraction of RNA of sufficient quantity and quality from routine oropharyngeal swabs.

Despite these limitations, this approach provides the advantages of true native RNA sequencing, and does not include amplification steps that could introduce systematic errors.

This study can provide novel information relevant to the current strategies adopted in SARS-CoV-2 next-generation sequencing.

We deposited the gene sequence in the NCBI database under the following URL:https://www.ncbi.nlm.nih.gov/nuccore/MT457389