bluuebunny/crossref_metadata_2025 huggingface dataset:
Variable phenotype of Knobloch syndrome due to biallelic COL18A1 mutations in children
Authors: Levinger Nadav , Hendler Karen , Banin Eyal , Hanany Mor , Kimchi Adva , Mechoulam Hadas , Meiner Vardiella , Parag Yoav , Sharon Dror , Macarov Michal , Yahalom Claudia
Published: November 2020

Purpose:

Knobloch syndrome is a rare, recessively inherited disorder classically characterized by high myopia, retinal detachment, and occipital encephalocele. Our aim is to report the clinical and genetic findings of four Israeli children affected by Knobloch syndrome.

Methods:

Retrospective study of four patients diagnosed with Knobloch syndrome, who underwent full ophthalmic examination, electroretinography, and neuroradiologic imaging. Genetic analysis included whole exome sequencing (WES) and Sanger sequencing.

Results:

The four patients included in this study had high myopia and nystagmus at presentation. Ocular findings included vitreous syneresis, macular atrophy, macular coloboma, and retinal detachment. One child had iris transillumination defects and an albinotic fundus, initially leading to an erroneous clinical diagnosis of albinism. Electroretinography revealed a marked cone-rod pattern of dysfunction in all four children. Brain imaging demonstrated none to severe occipital pathology. Cutaneous scalp changes were present in three patients. WES analysis, confirmed by Sanger sequencing revealed COL18A1 biallelic null mutations in all affected individuals, consistent with autosomal recessive inheritance.

Conclusions:

This report describes variable features in patients with Knobloch syndrome, including marked lack of eye pigment similar to albinism in one child, macular coloboma in two children as well as advanced cone-rod dysfunction in all children. One patient had normal neuroradiologic findings, emphasizing that some affected individuals have isolated ocular disease. Awareness of this syndrome, with its variable phenotype may aid early diagnosis, monitoring for potential complications, and providing appropriate genetic counseling.
‘Smart’ crime prevention? Digitization and racialized crime control in a Smart City
Authors: O’Malley Pat , Smith Gavin JD
Published: November 2020

As part of the global Smart Cities movement, the Switching on Darwin programme foregrounds digitally enhanced government and urbanism. While promoting its environmental and democratizing potential, software-enhanced CCTV, LED lighting and geofencing were among the first components rolled out. In practice, these technologies will impact adversely on Aboriginal people, already disproportionately targeted by criminal justice processes. By integrating multiple ‘smart’ technologies with ‘public safety’ agendas, such Smart City developments provide the potential for intensified criminalization of visible minorities.
‘One man’s junk culture . . .’: A state-of-the-art review on the problem of mass culture in Argentine cultural studies
Authors: Labra Diego
Published: November 2020

Could you truly understand contemporary Argentine culture without considering the local appropriation of The Simpsons? In this article, we argue that mass culture has been a blind spot of Argentine social sciences and humanities because of the particular development of local cultural studies. In order to articulate a critique and build upon it, we will review relevant literature, identify promising current research, and offer an outline on how to rethink the problem of production, circulation and consumption of culture in 21st-century Argentina and beyond.
Analytical model for liquid film evaporation on fuel injector tip for the mitigation of injector tip wetting and the resulting particulate emissions in gasoline direct-injection engines
Authors: Alzahrani Fahad M , Fatouraie Mohammad , Sick Volker
Published: November 2020

Unevaporated fuel films forming on the fuel injector tip of gasoline direct-injection engines burn in a diffusion flame at the time of spark, producing particulates and at some operating conditions, these films have been identified as the dominating source of particulate emissions. This work developed an analytical model for liquid film evaporation on the injector tip, that is, injector tip drying, for the mitigation of injector tip wetting and the resulting particulate emissions. The model explains theoretically how fuel films on the injector tip evaporate with time from the end of injection to the spark. The model takes into consideration engine operating conditions, including engine load and speed, tip and fuel temperatures, gas temperature and pressure, and fuel properties. The model explains the observed trends in particulate number (PN) emissions due to injector tip wetting. Engine experiments were used to validate the model by correlating the predicted film mass at the time of spark to measurements of PN emissions at different conditions. A tip drying time constant was also defined and was found to correlate well with the measured PN for all conditions tested. This time constant is a deterministic factor for mitigating tip wetting. In general, the results indicate that the liquid film evaporation on the injector tip follows a first order, asymptotic behavior. Furthermore, the tip drying physics causes the observed increasing and decreasing non-linear trends in PN emissions with the engine load and the available time for tip drying, respectively. Additionally, the liquid film evaporation on the injector tip is highly sensitive to most of the injector initial and boundary conditions, including the initial film mass after the end of injection, the wetted surface area, the available time for tip drying and the injector tip temperature. The initial film temperature has the least effect on film mass evaporation.
Implicit influence on body image: methodological innovation for research into embodied experience
Authors: Lovell Hannah , Banfield Janet
Published: November 2020

With growing social science interest in the potential for images to facilitate access to embodied experience, this study re-examines the relative value of visual and verbal methods in body-oriented research. Taking one lead from Kyrölä’s (2016) idea of body image as the relationship between representation and corporeality, and another from Gendlin’s (1993, 1995, 1997) methods for attending to and articulating from pre-reflective experience, we develop a method that juxtaposes words and images to explore the role of pre-reflective understanding on body image among teenage girls. The study highlights both an influencing role for pre-reflective understanding in body image and the availability of pre-reflective understanding to participants. While recognising persistent challenges in communicating embodied experience, we propose a method for engaging and working with embodied or pre-reflective experience in social science research by integrating the verbal and the visual in a specific way.
Endovascular Treatment of Giant Celiac Artery Aneurysm in Behcet’s Disease
Authors: Dwivedi Arika , Wayne Erik , Sangroula Daisy , Sigdel Abindra
Published: November 2020

We report a case of a 17-year-old male with Behcet’s disease (BD) with giant celiac artery aneurysm and impending rupture. Over the past 8 weeks, patient began having intermittent back and abdominal pain that worsened and became persistent over the past few days. This was accompanied by anorexia and non-bilious vomiting. Computed tomography angiogram (CTA) demonstrated a wide neck large celiac artery aneurysm (60 mm diameter). Endovascular repair of the aneurysm was performed using stent graft of the aorta and transcatheter coil embolization of the aneurysm sac. Technical success was confirmed by interruption of flow in the aneurysm, and preservation of distal native circulation at the conclusion of the procedure. One-week post-embolization, a CTA demonstrated complete thrombosis of the aneurysm. On follow-up CTA at 3, 6, and 12 months after embolization, the aneurysm has completely thrombosed and decreased in size to 24 mm. Patient remains asymptomatic till date.
Effect of calculated plasma osmolality and atherogenic index of plasma on carotid artery blood flow velocities
Authors: Pala Arda Aybars , Urcun Yusuf Salim
Published: November 2020

Objectives

The increase in carotid artery blood flow velocity is a measure of the severity of the carotid artery stenosis caused by atherosclerosis. Carotid artery stenosis is progressive and is of great importance due to the risk of stroke it creates. As an alternative to radiological examinations in these patients, patient follow-up can be facilitated by associating novel laboratory parameters with the severity of stenosis. In this study, we aimed to investigate the effect of the calculated plasma osmolality and atherogenic index of plasma on carotid artery blood flow velocities in patients with carotid artery stenosis.

Methods

A total of 161 patients diagnosed with carotid artery stenosis who admitted to our clinic between May 2018 and May 2020 were retrospectively analyzed. According to the carotid artery blood flow velocities measured with the Doppler ultrasonography, the patients were divided into two groups as “Normal flow velocity group” ( n = 62) and “Increased flow velocity group” ( n = 99).

Results

The calculated plasma osmolality, atherogenic index of plasma, and mean platelet volume were significantly associated with increased carotid artery blood flow velocity ( p < 0.001, p < 0.001, p = 0.006; respectively). Calculated plasma osmolality and atherogenic index of plasma were identified as independent predictors of increase in carotid artery blood flow velocity ( p < 0.001, p < 0.001; respectively). In the Receiver Operating Characteristic curve analysis, the plasma osmolality cut-off value, which predicts the increase in carotid artery blood flow velocity was found to be 291.45 mOsm/kg (Area Under the Curve: 0.746, p < 0.001, 65.7% sensitivity, and 67.7% specificity), and atherogenic index of plasma cut-off value was 0.20 (Area Under the Curve: 0.735, p < 0.001, 65.7% sensitivity, and 66.1% specificity).

Conclusion

There was a significant relationship between the increase in carotid artery blood flow velocity and the increase in plasma osmolality and atherogenic index of plasma values. As a result, we can predict the increase in carotid artery blood flow velocity, that is, the increase in the severity of the carotid artery stenosis, with plasma osmolality and atherogenic index of plasma values that can be calculated simply from routine biochemical tests.
Preparation, crystal structures, properties, and time-dependent density functional theory of two cobalt complexes with 3-hydroxy-2-methyl-quinoline-4-carboxylate
Authors: Yi Xiu-Guang , Lai Fei-Ping , Yan Yun-Yi , Zhang Cong , Li Wen-Ping
Published: November 2020

One organic compound [HMCA]2 (1) and two novel cobalt complexes [Co(MCA)(bipy)(H2O)]·(H2O) (2), [Co2(MCA)2(Phen)3]·3(H2O) (3) are synthesized by a solvothermal approach and are structurally determined by single-crystal X-ray diffraction. Compound 1 exhibits a two-dimensional structure by hydrogen bond and π. . .π stacking interaction. The complexes exhibit a three-dimensional and one-dimensional metal-organic framework. Solid-state photoluminescence spectrums reveal that they show blue emission bands at 449 nm, and theoretical calculation results of time-dependent density functional theory show that all belong to ligand-to-ligand charge transfer. Solid-state diffuse reflectance spectrums reveal the presence of a narrow optical band gap of 1.72 and 1.60 eV in the complexes 2 and 3, respectively.
A subspace type incremental two-dimensional principal component analysis algorithm
Authors: Zhang Xiaowei , Teng Zhongming
Published: November 2020

Principal component analysis (PCA) has been a powerful tool for high-dimensional data analysis. It is usually redesigned to the incremental PCA algorithm for processing streaming data. In this paper, we propose a subspace type incremental two-dimensional PCA algorithm (SI2DPCA) derived from an incremental updating of the eigenspace to compute several principal eigenvectors at the same time for the online feature extraction. The algorithm overcomes the problem that the approximate eigenvectors extracted from the traditional incremental two-dimensional PCA algorithm (I2DPCA) are not mutually orthogonal, and it presents more efficiently. In numerical experiments, we compare the proposed SI2DPCA with the traditional I2DPCA in terms of the accuracy of computed approximations, orthogonality errors, and execution time based on widely used datasets, such as FERET, Yale, ORL, and so on, to confirm the superiority of SI2DPCA.
Covid-19 ICU remote-learning course (CIRLC): Rapid ICU remote training for frontline health professionals during the COVID-19 pandemic in the UK
Authors: Camilleri Matthew , Zhang Xiaoxi , Norris Meriel , Monkhouse Alex , Harvey Alex , Wiseman Allison , Sinha Pratik , Hemsley Alex , Tang Sophie , Menon Arun , Sinmayee Smruti , Jones Mandy , Buckley Jim , Johnson Ruth , Medici Thomas , Corner Evelyn
Published: November 2020

Background

The unprecedented increase in critically ill patients due to the COVID-19 pandemic mandated rapid training in critical care for redeployed staff to work safely in intensive care units (ICU).

Methods

The COVID-19 ICU Remote-Learning Course (CIRLC) is a remote delivery course developed in response to the pandemic. This was a one-day course focused on the fundamentals of Intensive Care. The course used blended learning with recorded lectures and interactive tutorials delivered by shielding and frontline ICU trained professionals. The course was developed within one week and piloted at three NHS Trusts. It was then made publicly available free of charge to redeployed healthcare professionals across the UK and Ireland. An iterative cycle of improvement was used to update the course content weekly. A course confidence questionnaire with quantitative and qualitative questions was used to evaluate effectiveness. Data is reported as n (%), means (SD) and thematic analysis was used for the open questions.

Results

1,269 candidates from 171 organisations completed the course, with 99 volunteer trainers. 96% of respondents rated the course as very or extremely useful. 86% rated the online platform as excellent. Overall confidence improved from 2.7/5 to 3.9/5. Qualitative data showed that the course was pitched at the appropriate level, accessible and built clinicians confidence to work in intensive care.

Conclusion

This model of educational delivery with a rapid iteration cycle was a pragmatic, effective solution to knowledge-based training under social distancing measures. Whilst full course evaluation was not possible, we believe that this work demonstrates practical guidance on educational response in a pandemic as well as highlighting the altruistic nature of the critical care community.
Hepatic epithelioid hemangioendothelioma associated with acute disseminated encephalomyelitis by a possible paraneoplastic process
Authors: Aktas Adem , Probst Daniel , Van Tine Brian , Marlow Kathryn
Published: November 2020

Epithelioid hemangioendothelioma (EHE) is a low-grade, malignant vascular neoplasm that frequently involves the liver, lungs, bone, and soft tissue. Although not commonly associated with a paraneoplastic syndrome, paraneoplastic syndromes in the setting of EHE have been reported. Acute disseminated encephalomyelitis (ADEM) is an acute, autoimmune, demyelinating disorder of the central nervous system that most commonly occurs after an infection or vaccination. We present the case of a 23 year old female who developed the acute onset of fevers, tremors, right sided hemiplegia, global aphasia, and incontinence of urine and stool. MRI demonstrated findings consistent with a demyelinating disorder and brain biopsy confirmed the diagnosis of ADEM. The patient’s work up revealed multiple liver lesions which were biopsy proven EHE. This case report discusses the diagnosis and treatment of two concurrent rare disease processes and the possible association of the processes via a paraneoplastic syndrome.
Biomimetic and osteogenic 3D silk fibroin composite scaffolds with nano MgO and mineralized hydroxyapatite for bone regeneration
Authors: Wu Ziquan , Meng Zhulong , Wu Qianjin , Zeng Delu , Guo Zhengdong , Yao Jiangling , Bian Yangyang , Gu Yuntao , Cheng Shaowen , Peng Lei , Zhao Yingzheng
Published: November 2020

Artificial bioactive materials have received increasing attention worldwide in clinical orthopedics to repair bone defects that are caused by trauma, infections or tumors, especially dedicated to the multifunctional composite effect of materials. In this study, a weakly alkaline, biomimetic and osteogenic, three-dimensional composite scaffold (3DS) with hydroxyapatite (HAp) and nano magnesium oxide (MgO) embedded in fiber (F) of silkworm cocoon and silk fibroin (SF) is evaluated comprehensively for its bone repair potential in vivo and in vitro experiments, particularly focusing on the combined effect between HAp and MgO. Magnesium ions (Mg2+) has long been proven to promote bone tissue regeneration, and HAp is provided with osteoconductive properties. Interestingly, the weak alkaline microenvironment from MgO may also be crucial to promote Sprague-Dawley (SD) rat bone mesenchymal stem cells (BMSCs) proliferation, osteogenic differentiation and alkaline phosphatase (ALP) activities. This SF/F/HAp/nano MgO (SFFHM) 3DS with superior biocompatibility and biodegradability has better mechanical properties, BMSCs proliferation ability, osteogenic activity and differentiation potential compared with the scaffolds adding HAp or MgO alone or neither. Similarly, corresponding meaningful results are also demonstrated in a model of distal lateral femoral defect in SD rat. Therefore, we provide a promising 3D composite scaffold for promoting bone regeneration applications in bone tissue engineering.
Beta-blockers in heart failure prognosis: Lessons learned by MECKI Score Group papers
Authors: Cattadori Gaia , Di Marco Silvia , Farina Stefania , Limongelli Giuseppe , Monda Emanuele , Badagliacca Roberto , Papa Silvia , Tricarico Lucia , Correale Michele
Published: November 2020

Heart failure is a complex syndrome affecting several organs including kidney, lungs, liver, brain muscles and sympathetic system. Each of these organs might contribute to its severity and prognosis. The prognosis assessment is critical for a correct heart failure management. It has already been demonstrated that a single parameter is weaker for prognosis than different parameters combined. The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score has been built and validated for heart failure with reduced ejection fraction (HFrEF) patients by considering cardiopulmonary exercise test data combined with clinical, laboratory and echocardiographic measurements. The betablockers treatment is a milestone in the HFrEF management. In the MECKI score database, the association of betablockers treatment with outcome has been investigated in different settings.
Influential Factors and the Realization Mechanism of Sustainable Information-Sharing in Virtual Communities from a Knowledge Fermenting Perspective
Authors: Zhang Meng , Gao Yang , Sun Minghe , Bi Datian
Published: November 2020

Little is known about sustainable information-sharing in virtual communities, although it is increasingly recognized as a useful information-sharing tool. The aim of this study is to explore the influential factors and the realization mechanism of sustainable information-sharing in virtual communities. Starting from the similarity between biological fermentation and the information-sharing process in virtual communities, the present study creatively introduces the knowledge fermenting theory used in the analysis. Six factors influencing sustainable information-sharing in virtual communities are first identified based on this theory, which include sharing bodies, interactive topics, communication mechanism, supporting technology, communication environment, and platform scale. The relations among these six factors are then analyzed using the Decision-Making and Trial Evaluation Laboratory (DEMATEL) method. The results indicate that the factor of sharing bodies has the strongest influence on other factors and the factor of interactive topics receives the most influences from the other factors. On this basis, the realization mechanism of sustainable information-sharing in virtual communities is elaborated from the following four aspects: the four stages of the information-sharing realization, the guide role of “strain,” the catalytic role of “enzyme,” and the effect of environment. The results indicate that sustainable information-sharing in virtual communities is a process of spiral evolution. Finally, recommendations are given to virtual community managers, users, and business firms.
Lines in the Mud: Tank Eco-restoration and Boundary Contestations in Chennai
Authors: Coelho Karen
Published: November 2020

This article analyses the politics of environmentalism revealed in struggles over the land–water boundary of an urbanising tank in Chennai. In contesting this boundary, property-less settlers on its banks called into question the tank’s ‘nature’ and functions in its urban milieu, and demanded a redrawing of boundaries to reflect the socio-natural transformations that had turned parts of it into land. Simultaneously, propertied residents, in concert with state eco-restoration schemes and court rulings, fought to restore the tank to its ‘original’ dimensions. In foregrounding the liminalities of the urbanising tank, this article suggests the limits of the contemporary property-determined eco-restoration discourse, premised on a return to pristine pasts and original boundaries. It proposes that the stand-off between water body restoration and the defence of working-class housing rights necessitates recognising the tank as an artefact assembled over time by socio-technical and natural processes.
Special Education Meetings: The Role of the Facilitator in Districts Serving Rural Communities
Authors: Beck Stephenson J. , DeSutter Keri
Published: November 2020

Special education professionals serve as facilitators of Individualized Education Program (IEP) team meetings. This study explores how facilitators see their IEP meeting roles and probes further into how IEP facilitators envision an ideal IEP meeting in school districts with rural schools. Findings indicate that facilitators see their roles in three parts: procedural due process, informal problem solving, and parental support. Their view of the ideal IEP meeting involved a strong presence by members, parental involvement, and achieving true collaboration. Implications for teachers and school leaders include agenda distribution, external meeting communication, and role clarification.
Presence ofPropionibacterium acnesin granulomas associates with a chronic disease course in Dutch sarcoidosis patients
Authors: Beijer Els , Seldenrijk Kees , Eishi Yoshinobu , Uchida Keisuke , Damen Jan , Grutters Jan C. , Veltkamp Marcel
Published: November 2020

Several studies demonstrated thatPropionibacterium acnesmay be involved in sarcoidosis pathogenesis. Presence ofP. acneswas found in granulomas of the majority of Japanese sarcoidosis patients. However, presence ofP. acnesin tissue has never been related to sarcoidosis phenotypes and clinical outcome. Therefore, the aims of our study were to demonstrate whetherP. acnescan be detected in granulomas of Dutch sarcoidosis patients and to investigate whether its presence is related to a clinical phenotype and/or course of disease.

Sections of formalin-fixed paraffin-embedded tissue blocks of 76 sarcoidosis patients were examined by immunostaining with aP. acnes-specific monoclonal antibody (PAB antibody) using a Ventana BenchMark ULTRA. Clinical outcome status (COS) was determined and classified into two phenotype groups: A: resolved, minimal or persistent disease without treatment (COS 1–6) and B: persistent disease with need for treatment (COS 7–9).

P. acneswas detected in samples of 31 patients (41%) and located within granulomas in samples of 13 patients (17%). The frequency ofP. acnesdetected in granulomas at diagnosis was significantly higher in patients with phenotype B compared to patients with phenotype A (29%versus0%, p=0.021).

Presence ofP. acnesin granulomas can be confirmed in Dutch sarcoidosis patients. It is intriguing that presence ofP. acnesin granulomas is more frequently found in patients with chronic disease requiring treatment. This adds to the rationale that a subgroup of sarcoidosis patients might benefit from antibiotic therapy.
A syndromic approach to assess diagnosis and management of patients presenting with respiratory symptoms to healthcare facilities in Vietnam
Authors: Huang Wan-Chun , Fox Gregory J. , Pham Ngoc Yen , Nguyen Thu Anh , Vu Van Giap , Ngo Quy Chau , Nguyen Viet Nhung , Jan Stephen , Negin Joel , Le Thi Tuyet Lan , Marks Guy B.
Published: November 2020

Background

The aim of the study was to establish syndromic diagnoses in patients presenting with respiratory symptoms to healthcare facilities in Vietnam and to compare the diagnoses with facility-level clinical diagnoses and treatment decisions.

Methods

A representative sample of patients aged ≥5 years, presenting with dyspnoea, cough, wheezing, and/or chest tightness to healthcare facilities in four provinces of Vietnam were systematically evaluated. Eight common syndromes were defined using data obtained.

Results

We enrolled 977 subjects at 39 facilities. We identified fixed airflow limitation (FAL) in 198 (20.3%) patients and reversible airflow limitation (RAL) in 26 (2.7%) patients. Patients meeting the criteria for upper respiratory tract infection (URTI) alone constituted 160 (16.4%) patients and 470 (48.1%) did not meet the criteria for any of the syndromes. Less than half of patients with FAL were given long-acting bronchodilators. A minority of patients with either RAL or FAL with eosinophilia were prescribed inhaled corticosteroids. Antibiotics were given to more than half of all patients, even among those with URTI alone.

Conclusion

This study identified a substantial discordance between prescribed treatment, clinician diagnosis and a standardised syndromic diagnosis among patients presenting with respiratory symptoms. Increased access to spirometry and implementation of locally relevant syndromic approaches to management may help to improve patient care in resource-limited settings.
The role of chest radiography in the diagnosis of bacteriologically confirmed pulmonary tuberculosis in hospitalised Xpert MTB/RIF-negative patients
Authors: Kebede Wakjira , Abebe Gemeda , Gudina Esayas Kebede , Kedir Elias , Tran Thuy Ngan , Van Rie Annelies
Published: November 2020

The role of chest radiography to diagnose active tuberculosis in symptomatic patients who have a negative Xpert MTB/RIF (Xpert) test result is unclear. This study aimed to assess the performance of chest radiography and the value of chest radiography findings for a prediction tool to identify cases of active pulmonary tuberculosis among symptomatic, Xpert-negative hospitalised patients.

Xpert-negative patients hospitalised between January and July 2019 at Jimma University Medical Center in Ethiopia were assessed by mycobacterial culture and chest radiography. Chest radiography was interpreted by a clinician for clinical decision making and by a radiologist for research purposes. Using bacteriological confirmation as the reference standard, the performance of chest radiography to diagnose active tuberculosis was assessed by the area under the receiver operating characteristic curve (AUC); predictors of active tuberculosis were identified using bivariate and multivariate logistic regression analyses.

Of 247 Xpert-negative patients, 38% and 40% were classified as suggestive of tuberculosis by clinician and radiologist, respectively. Of the 39 (15.8%) bacteriologically confirmed cases, 69% and 79% were classified as having chest radiography findings suggestive of tuberculosis by clinician or radiologist, respectively. While there was a strong association between bacteriologically confirmed tuberculosis and chest radiography classified by clinician as suggestive of tuberculosis (adjusted OR 2.7, 95% CI 1.2–6.6), chest radiography with signs typical of tuberculosis (adjusted OR 5.3, 95% CI 2.1–14.4) or compatible with tuberculosis (adjusted OR 5.1, 95% CI 1.3–20.0), the positive predictive value of the chest radiography was low (27% and 34% for classification by clinician and radiologist, respectively). The addition of chest radiography findings by clinician or radiologist to clinical characteristics did not improve the performance of the prediction tool, with similar risk classification distribution, AUCs and negative and positive prediction values.

Despite the strong association between chest radiography findings and active tuberculosis among hospitalised Xpert negative individuals, chest radiography findings did not improve the performance of a risk prediction tool based solely on clinical symptoms. Countries with a high tuberculosis/HIV burden should urgently replace Xpert by the more sensitive Xpert Ultra assay to improve the diagnosis of active tuberculosis.
Patient-specific record linkage between emergency department and hospital admission data for a cohort of people who inject drugs: methodological considerations for frequent presenters
Authors: Di Rico Rehana , Nambiar Dhanya , Gabbe Belinda , Stoové Mark , Dietze Paul
Published: November 2020

Background

People who inject drugs (PWID) have been identified as frequent users of emergency department (ED) and hospital inpatient services. The specific challenges of record linkage in cohorts with numerous administrative health records occurring in close proximity are not well understood. Here, we present a method for patient-specific record linkage of ED and hospital admission data for a cohort of PWID.

Methods

Data from 688 PWID were linked to two state-wide administrative health databases identifying all ED visits and hospital admissions for the cohort between January 2008 and June 2013. We linked patient-specific ED and hospital admissions data, using administrative date-time timestamps and pre-specified linkage criteria, to identify hospital admissions stemming from ED presentations for a given individual. The ability of standalone databases to identify linked ED visits or hospital admissions was examined.

Results

There were 3459 ED visits and 1877 hospital admissions identified during the study period. Thirty-four percent of ED visits were linked to hospital admissions. Most links had hospital admission timestamps in-between or identical to their ED visit timestamps (n = 1035, 87%). Allowing 24-h between ED visits and hospital admissions captured more linked records, but increased manual inspection requirements. In linked records (n = 1190), the ED ‘departure status’ variable correctly reflected subsequent hospital admission in only 68% of cases. The hospital ‘admission type’ variable was non-specific in identifying if a preceding ED visit had occurred.

Conclusions

Linking ED visits with subsequent hospital admissions in PWID requires access to date and time variables for accurate temporal sorting, especially for same-day presentations. Selecting time-windows to capture linked records requires discretion. Researchers risk under-ascertainment of hospital admissions if using ED data alone.
An elderly female with adult-onset Still’s disease initially misdiagnosed as prosthetic joint infection after total knee arthroplasty: lessons in differential diagnosis and treatment
Authors: Jiao Xufeng , Li Zheng , An Shuai , Huang Jiang , Yang Guangzhong , Zhao Yi , Shen Jianghua , Chu Yanqi , Yang Charlie C. , Cao Guanglei
Published: November 2020

Background

High fever, knee swelling and pain after knee arthroplasty are often considered as symptoms of acute prosthetic joint infection. However, similar symptoms can also present as primary manifestations of adult-onset Still’s disease, which creates some interference in differential diagnosis. To our knowledge, this is the first published case of misdiagnosis of adult Still’s disease after total knee arthroplasty, who was initially misdiagnosed as an prosthetic joint infection due to the above-mentioned symptoms. The symptoms of the knee infection was not relieve after several revisions and continous antibiotic treatment. Finally, after several consultations and repeated evaluation it was diagnosed as adult-onset Still’s disease.

Case presentation

A 77-year-old female who underwent bilateral total knee arthroplasty 6 years ago was admitted to our hospital with high fever, right knee effusion and painful knee. Based on the results of joint fluid aspiration and culture, we treated the right knee as acute hematogenous prosthetic joint infection. After three debridement and revision surgeries, the patient’s symptoms continued to persist. Subsequent manifestations of other symptoms such as typical rash and sore throat and laboratory examination suggested the possibility of adult-onset Still’s disease. So she underwent diagnostic steroid hormone therapy at the recommendation of a rheumatologist, and a final revision was performed after symptom was controlled. At the one-year follow-up, the patient’s symptoms completely resolved and the knee revision was functioning well.

Conclusions

When joint swelling and pain occurs after knee arthroplasty, the possibility of joint infection should not only be considered, but rheumatic autoimmune diseases should also be differentiated. Because the manifestations of joint infection and rheumatic immune disease sometimes overlap highly, when reasonable treatment over a period of time fails to relieve symptoms and signs, we should notice subtle differences in symptoms and laborotary tests and look for other diagnostic possibilities in time.
Risk factors for mortality in hospitalized patients with COVID-19 at the start of the pandemic in Belgium: a retrospective cohort study
Authors: van Halem Karlijn , Bruyndonckx Robin , van der Hilst Jeroen , Cox Janneke , Driesen Paulien , Opsomer Matthias , Van Steenkiste Eveline , Stessel Björn , Dubois Jasperina , Messiaen Peter
Published: November 2020

Background

Belgium was among the first countries in Europe with confirmed coronavirus disease 2019 (COVID-19) cases. Since the first diagnosis on February 3rd, the epidemic has quickly evolved, with Belgium at the crossroads of Europe, being one of the hardest hit countries. Although risk factors for severe disease in COVID-19 patients have been described in Chinese and United States (US) cohorts, good quality studies reporting on clinical characteristics, risk factors and outcome of European COVID-19 patients are still scarce.

Methods

This study describes the clinical characteristics, complications and outcomes of 319 hospitalized COVID-19 patients, admitted to a tertiary care center at the start of the pandemic in Belgium, and aims to identify the main risk factors for in-hospital mortality in a European context using univariate and multivariate logistic regression analysis.

Results

Most patients were male (60%), the median age was 74 (IQR 61–83) and 20% of patients were admitted to the intensive care unit, of whom 63% needed invasive mechanical ventilation. The overall case fatality rate was 25%. The best predictors of in-hospital mortality in multivariate analysis were older age, and renal insufficiency, higher lactate dehydrogenase and thrombocytopenia. Patients admitted early in the epidemic had a higher mortality compared to patients admitted later in the epidemic. In univariate analysis, patients with obesity did have an overall increased risk of death, while overweight on the other hand showed a trend towards lower mortality.

Conclusions

Most patients hospitalized with COVID-19 during the first weeks of the epidemic in Belgium were admitted with severe disease and the overall case fatality rate was high. The identified risk factors for mortality are not easily amenable at short term, underscoring the lasting need of effective therapeutic and preventative measures.
Machine learning algorithm for early detection of end-stage renal disease
Authors: Segal Zvi , Kalifa Dan , Radinsky Kira , Ehrenberg Bar , Elad Guy , Maor Gal , Lewis Maor , Tibi Muhammad , Korn Liat , Koren Gideon
Published: November 2020

Background

End stage renal disease (ESRD) describes the most severe stage of chronic kidney disease (CKD), when patients need dialysis or renal transplant. There is often a delay in recognizing, diagnosing, and treating the various etiologies of CKD. The objective of the present study was to employ machine learning algorithms to develop a prediction model for progression to ESRD based on a large-scale multidimensional database.

Methods

This study analyzed 10,000,000 medical insurance claims from 550,000 patient records using a commercial health insurance database. Inclusion criteria were patients over the age of 18 diagnosed with CKD Stages 1–4. We compiled 240 predictor candidates, divided into six feature groups: demographics, chronic conditions, diagnosis and procedure features, medication features, medical costs, and episode counts. We used a feature embedding method based on implementation of the Word2Vec algorithm to further capture temporal information for the three main components of the data: diagnosis, procedures, and medications. For the analysis, we used the gradient boosting tree algorithm (XGBoost implementation).

Results

The C-statistic for the model was 0.93 [(0.916–0.943) 95% confidence interval], with a sensitivity of 0.715 and specificity of 0.958. Positive Predictive Value (PPV) was 0.517, and Negative Predictive Value (NPV) was 0.981. For the top 1 percentile of patients identified by our model, the PPV was 1.0. In addition, for the top 5 percentile of patients identified by our model, the PPV was 0.71.

All the results above were tested on the test data only, and the threshold used to obtain these results was 0.1. Notable features contributing to the model were chronic heart and ischemic heart disease as a comorbidity, patient age, and number of hypertensive crisis events.

Conclusions

When a patient is approaching the threshold of ESRD risk, a warning message can be sent electronically to the physician, who will initiate a referral for a nephrology consultation to ensure an investigation to hasten the establishment of a diagnosis and initiate management and therapy when appropriate.
The effect of glucocorticoids on serum cystatin C in identifying acute kidney injury: a propensity-matched cohort study
Authors: Liang Silin , Shi Mai , Bai Yunpeng , Deng Yujun , Fang Miaoxian , Li Jiaxin , Wu Yijin , Peng Wenying , Hou Yating , Fang Heng , Zhang Huidan , Chen Chunbo
Published: November 2020

Background

Glucocorticoids may impact the accuracy of serum cystatin C (sCysC) in reflecting renal function. We aimed to assess the effect of glucocorticoids on the performance of sCysC in detecting acute kidney injury (AKI) in critically ill patients.

Methods

A prospective observational cohort study was performed in a general intensive care unit (ICU). Using propensity score matching, we successfully matched 240 glucocorticoid users with 960 non-users among 2716 patients. Serum creatinine (SCr) and sCysC were measured for all patients at ICU admission. Patients were divided into four groups based on cumulative doses of glucocorticoids within 5 days before ICU admission (Group I: non-users; Group II: 0 mg < prednisone ≤50 mg; Group III: 50 mg < prednisone ≤150 mg; Group IV: prednisone > 150 mg). We compared the performance of sCysC for diagnosing and predicting AKI in different groups using the area under the receiver operator characteristic curve (AUC).

Results

A total of 240 patients received glucocorticoid medication within 5 days before ICU admission. Before and after matching, the differences of sCysC levels between glucocorticoid users and non-users were both significant (P <  0.001). The multiple linear regression analysis revealed that glucocorticoids were independently associated with sCysC (P <  0.001). After matching, the group I had significantly lower sCysC levels than the group III and group IV (P <  0.05), but there were no significant differences in sCysC levels within different glucocorticoids recipient groups (P > 0.05). Simultaneously, we did not find significant differences in the AUC between any two groups in the matched cohort (P > 0.05).

Conclusions

Glucocorticoids did not impact the performance of sCysC in identifying AKI in critically ill patients.
Risk factors for pregnancy-related pelvic girdle pain: a scoping review
Authors: Wuytack Francesca , Begley Cecily , Daly Deirdre
Published: November 2020

Background

Pregnancy-related Pelvic Girdle Pain (PPGP) is a common complaint. The aetiology remains unclear and reports on risk factors for PPGP provide conflicting accounts. The aim of this scoping review was to map the body of literature on risk factors for experiencing PPGP.

Methods

We searched the databases PubMed, Embase, CINAHL, PsycINFO, MIDIRS, and ClinicalTrial.gov (3 August 2020). We selected studies with two reviewers independently. Observational studies assessing risk factors for PPGP were included. Studies examining specific diagnostic tests or interventions were excluded.

Results

We identified 5090 records from databases and 1077 from ClinicalTrial.gov. Twenty-four records met the inclusion criteria. A total of 148 factors were examined of which only 14 factors were examined in more than one study. Factors that were positively associated with PPGP included a history of low back or pelvic girdle pain, being overweight/obese, already having a child, younger age, lower educational level, no pre-pregnancy exercise, physically demanding work, previous back trauma/disease, progestin-intrauterine device use, stress, depression and anxiety.

Conclusions

A large number of factors have been examined as potential risk factors for PPGP, but there is a lack of repetition to be able to draw stronger conclusions and pool studies in systematic reviews. Factors that have been examined in more than five studies include age, body mass index, parity and smoking. We suggest a systematic review be conducted to assess the role of these factors further in the development of PPGP.
Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children: protocol for a community-driven continuous quality improvement approach
Authors: McCalman Janya , Bainbridge Roxanne , James Yvonne Cadet , Bailie Ross , Tsey Komla , Matthews Veronica , Ungar Michael , Askew Deborah , Fagan Ruth , Visser Hannah , Spurling Geoffrey , Percival Nikki , Blignault Ilse , Doran Chris
Published: November 2020

Background

Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children works towards developing a spectrum of effective, community-based services and supports. These services and supports are organised into a coordinated network, build meaningful partnerships with families and address their cultural and linguistic needs, to help children to function better at home, in school, in the community, and throughout life. This study is conducted in partnership with primary healthcare (PHC) and other services in three diverse Indigenous Australian communities. It entails conceptualising, co-designing, implementing, and evaluating the effectiveness of systems integration to promote the mental health and wellbeing of Indigenous school-aged children (4–17 years). This paper outlines a protocol for implementing such complex community-driven research.

Methods/design

Using continuous quality improvement processes, community co-designed strategies for improved systems integration will be informed by narratives from yarning circles with Indigenous children and service providers, and quantitative data from surveys of service providers and audits of PHC client records and intersectoral systems. Agreed strategies to improve the integration of community-based services and supports will be modelled using microsimulation software, with a preferred model implemented in each community. The evaluation will investigate changes in the: 1) availability of services that are community-driven, youth-informed and culturally competent; 2) extent of collaborative service networks; 3) identification by PHC services of children’s social and emotional wellbeing concerns; and 4) ratio of children receiving services to identified need. Costs and benefits of improvements to systems integration will also be calculated.

Discussion

The study will provide evidence-informed, community-driven, and tested models that can be used for implementing systems integration to promote the mental health and wellbeing of Indigenous children. It will identify the situational enablers and barriers that impact systems integration and determine the extent to which systems integration improves service availability, systems and child outcomes. Evidence for the cost effectiveness of systems-level integration will contribute to national mental health policy reform.
Proteasome inhibitors reduce thrombospondin-1 release in human dysferlin-deficient myotubes
Authors: Fernández-Simón Esther , Lleixà Cinta , Suarez-Calvet Xavier , Diaz-Manera Jordi , Illa Isabel , Gallardo Eduard , de Luna Noemí
Published: November 2020

Background

Dysferlinopathies are a group of muscle disorders causing muscle weakness and absence or low levels of dysferlin, a type-II transmembrane protein and the causative gene of these dystrophies. Dysferlin is implicated in vesicle fusion, trafficking, and membrane repair. Muscle biopsy of patients with dysferlinopathy is characterized by the presence of inflammatory infiltrates. Studies in the muscle of both human and mouse models of dysferlinopathy suggest dysferlin deficient muscle plays a role in this inflammation by releasing thrombospondin-1. It has also been reported that vitamin D3 treatment enhances dysferlin expression. The ubiquitin-proteasome system recognizes and removes proteins that fail to fold or assemble properly and previous studies suggest that its inhibition could have a therapeutic effect in muscle dystrophies. Here we assessed whether inhibition of the ubiquitin proteasome system prevented degradation of dysferlin in immortalized myoblasts from a patients with two missense mutations in exon 44.

Methods

To assess proteasome inhibition we treated dysferlin deficient myotubes with EB1089, a vitamin D3 analog, oprozomib and ixazomib. Western blot was performed to analyze the effect of these treatments on the recovery of dysferlin and myogenin expression. TSP-1 was quantified using the enzyme-linked immunosorbent assay to analyze the effect of these drugs on its release. A membrane repair assay was designed to assess the ability of treated myotubes to recover after membrane injury and fusion index was also measured with the different treatments. Data were analyzed using a one-way ANOVA test followed by Tukey post hoc test and analysis of variance. A p ≤ 0.05 was considered statistically significant.

Results

Treatment with proteasome inhibitors and EB1089 resulted in a trend towards an increase in dysferlin and myogenin expression. Furthermore, EB1089 and proteasome inhibitors reduced the release of TSP-1 in myotubes. However, no effect was observed on the repair of muscle membrane after injury.

Conclusions

Our findings indicate that the ubiquitin-proteasome system might not be the main mechanism of mutant dysferlin degradation. However, its inhibition could help to improve muscle inflammation by reducing TSP-1 release.