bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of the 3M™ Molecular Detection Assay 2—STEC Gene Screen (stx and eae) for Detection of Shiga Toxin Gene (stx1 and/or stx2) and Intimin Gene (eae) in Dried Cannabis Flower and Dried Hemp Flower: AOAC Performance Tested MethodSM 071902
Authors: Rosauer Micki L , Lopez-Velasco Gabriela , Silbernagel Karen M , Horine Leo , Tudor Alexandra
Published: June 2022

Background

The 3M™ Molecular Detection Assay 2—STEC Gene Screen (stx and eae) method is based on gene amplification by the use of real time loop-mediated isothermal amplification when used with the 3M Molecular Detection System for the rapid and specific detection of Shiga toxin gene (stx1 and/or stx2) and intimin gene (eae) from Shiga toxin-producing Escherichia coli (STEC) in enriched products. The 3M Molecular Detection Assay 2—STEC Gene Screen (stx and eae) was approved as AOAC Performance Tested MethodSM Certificate No. 071902.

Objective

This matrix extension study evaluated the 3M Molecular Detection Assay 2—STEC Gene Screen (stx and eae) method for detection of STECs in dried cannabis flower [>0.3% delta 9-tetrahydrocannabinol (THC)] and dried hemp flower (≤0.3% THC) at a 10 g test portion size.

Method

Testing followed procedures outlined in 3M Molecular Detection Assay 2—STEC Gene Screen (stx and eae) product instructions and Standard Method Performance Requirements (SMPR®) for Detection of Shiga Toxin-Producing Escherichia coli in Cannabis and Cannabis Products (AOAC SMPR 2020.012). The method was evaluated at low, high, and non-inoculated levels.

Results

Results showed no statistically significant difference between the presumptive positive 3M Molecular Detection Assay 2—STEC Gene Screen (stx and eae) results and the SMPR 2020.012 recommended cultural confirmations.

Conclusions

This study provides data that demonstrate the 3M Molecular Detection Assay 2—STEC Gene Screen (stx and eae) is a reliable method for the rapid and specific detection of STEC organisms in dried cannabis flower and dried hemp flower.

Highlights

The 3M Molecular Detection Assay 2—STEC Gene Screen (stx and eae) method is suitable for the rapid and specific detection of STEC organisms in dried cannabis flower and dried hemp flower.
Rare case of concurrent suprasternal and cardiac metastasis from small bowel neuroendocrine tumour
Authors: Nan Xinyi , Dharmawardhane Anoj
Published: June 2022

Neuroendocrine tumours (NETs) are rare tumours derived from the neuroendocrine cell system, arising across a wide range of organs, most commonly the gastrointestinal tract and bronchopulmonary symptoms. Although NETs can metastasis widely throughout the body, cardiac metastasis is rare with an incidence of 2–4% and usually presents in the presence of extensive metastasis elsewhere. Suprasternal metastasis to the neck is exceedingly rare with <20 cases reported in the literature. We report the case of a 71-year-old female with concurrent cardiac and suprasternal metastasis at diagnosis of terminal ileal NET.
The Coping Long Term with Active Suicide Program (CLASP)
Authors: Miller Ivan , Gaudiano Brandon , Weinstock Lauren
Published: June 2022

The Coping Long Term with Active Suicide Program (CLASP): Clinician Guide focuses on the development, studies, formats, and therapeutic strategies of CLASP in an effort to reduce suicide. Suicidal behavior is a major public health problem across the world. Moreover, evidence-based practice offers the most responsible course of action for the mental health professional in the emerging health care system. CLASP is specifically designed as an adjunctive program that can be used as a complement to other ongoing psychotherapeutic and pharmacological treatments. The title is expected to provide practitioners with a highly useful guide in decreasing the suicide risk of vulnerable patients and supporting their long-term recovery.
Detailed Session Outline
Authors: Miller Ivan W. , Gaudiano Brandon A. , Weinstock Lauren M.
Published: June 2022

This chapter looks into the detailed session outline of CLASP. The step-by-step process of CLASP includes the establishment of the patient’s Life Plan document, family meetings with the patient and their significant other, and follow-up phone contacts. Moreover, sessions could be conducted during an inpatient stay depending on the duration of hospitalization. The establishment of a collaborative and trusting relationship is vital for a successful therapeutic contact. It is also important to have a patient’s brief psychiatric and suicide history and current level of suicidal risk. The second session of CLASP tackles values discussion and formulation of treatment goals. The chapter also highlights the importance of significant others’ participation and telephone sessions in the process.
Trauma-Related Disorders and Dissociation
Authors: Brand Bethany L. , Schielke Hugo J. , Schiavone Francesca , Lanius Ruth A.
Published: June 2022

This chapter defines dissociation and trauma-related disorders (TRD), discusses the etiology of TRD, and describes the prevalence and complex symptom presentations of individuals who have experienced complex trauma. Despite being at least as prevalent as many other types of mental illness, complex TRDs are underrecognized. Consequently, most of these individuals do not receive treatment specifically targeting the dissociative symptoms that maintain them. Due to a variety of factors, including lack of training for professionals, misunderstandings about dissociation, and a shortage of trauma-trained therapists, individuals with TRD are “hidden in plain sight” despite typically seeking mental health treatment for years. Furthermore, the shortage of clinicians trained in assessing and treating TRD creates a barrier for obtaining treatment that is of meaningful help in stabilizing trauma-related reactions including dissociation. The costs of being underrecognized and undertreated are enormous for dissociative individuals, the health care system, and society.
Addressing Challenges Related to Dissociation, Emotions, and Somatic Symptoms
Authors: Brand Bethany L. , Schielke Hugo J. , Schiavone Francesca , Lanius Ruth A.
Published: June 2022

Traumatized individuals often become triggered and overwhelmed without noticing they are ungrounded. They typically do not yet know how to safely self-regulate. When dysregulated, patients cannot integrate new information or work productively in therapy. Therefore, it is crucial that clinicians are skilled in detecting signs of dysregulation and know strategies to help patients get regulated. Repeatedly working on noticing dysregulation and practicing grounding in sessions teaches patients how to engage in therapy from within a grounded state; this is a crucial skill they can transfer to their daily lives. This chapter provides clinicians with the information and tools they need to do this work, including descriptions of signs of hyperarousal and hypoarousal, ways to teach patients how to get grounded and regulated, and instructive roleplays that provide the language and approaches that are useful for supporting patients’ management of dissociation, emotions, and somatic symptoms.
Getting and Feeling Safer, Part 1
Authors: Schielke Hugo J. , Brand Bethany L. , Lanius Ruth A.
Published: June 2022

This module focuses on recognizing and interrupting patterns that increase the risk of doing things that are risky, unhealthy, or unsafe. It also offers things you can do to help yourself get and feel safer. As part of this work, you will learn why getting your healthy needs met safely is so important for your healing, and we will help you recognize what your healthy needs are and how to work toward meeting them. You will also learn how to recognize and manage challenging situations and how to notice and respond to early warning signs in order to break the cycle of unhealthy behavior and reduce trauma-related reactions.
Sticking With the Process and Building on Progress
Authors: Schielke Hugo J. , Brand Bethany L. , Lanius Ruth A.
Published: June 2022

Over the course of this program, you’ve been learning how to help yourself heal from the effects of trauma, including learning healthy ways to manage trauma-related symptoms. You’ve also been learning how to have healthy relationships with your emotions and all of who you are—including increasing self-compassion, getting your healthy needs met safely, and giving yourself the care you need. This module will help you learn how to keep making progress toward feeling safer, including feeling safe while feeling your feelings, how to help yourself be OK with feeling good, and how to keep healing. It will also guide you in noticing and giving yourself credit for what you have been doing, identifying and addressing factors that may be keeping you from feeling safer and better, and recognizing the changes you’ve made. Finally, you can think about what you would like to revisit and practice more.
Introduction
Authors: Zinsser Katherine M.
Published: June 2022

Lance was pushed out or expelled from seven early childhood programs before he turned 5 years old. His story is unfortunately familiar—thousands of young American children face exclusionary discipline each year. This chapter sets up the ecological framing for No Longer Welcome by describing how characteristics of and interactions among children, parents, teachers, programs, and policy all contribute to the exclusion of young children and must, therefore, be examined when seeking a solution. This chapter draws on research from older students and limited preschool studies to explore the short and long-term academic, social-emotional, and financial consequences of early exclusion for individual children and families and our society as a whole.
Biased Perceptions of and Responses to Behavior
Authors: Zinsser Katherine M.
Published: June 2022

The arrest of 5-year-old Kaia Roller for having a temper tantrum not only caught the nation’s attention, but also provides a troubling view into how adults’ biased perceptions of children’s behavior can have damning consequences. This chapter explores the psychological processes and implicit biases that lead adults to make decisions that result in even very young children being excluded from care. Empirical evidence demonstrates that the behavior of boys and Black children, in particular, are scrutinized more harshly, which aligns with the disproportionate expulsion of these children. This chapter also considers the impact of teachers’ own racial and ethnic identities and the consequences of adopting a “colorblind” worldview.
Teacher Well-Being and Exclusionary Decision-Making
Authors: Zinsser Katherine M.
Published: June 2022

Understanding the contextual work experiences of early childhood educators is a critical component to addressing expulsion. Our society’s lack of support for the workforce has placed teachers in an impossible position—torn between meeting the needs of an entire classroom and being present with a child struggling emotionally; forced to choose between their own physical and emotional health and safety and the retention of a single child; expected to function in a system that routinely discounts their value despite decades of evidence to the contrary. This chapter presents evidence of this workforce crisis and demonstrates how teachers’ well-being can, directly and indirectly, inform their perception of and responses to children’s challenging behavior.
The Power of Relationships
Authors: Zinsser Katherine M.
Published: June 2022

If she was going to prevent Jiang’s expulsion, Roseanne knew that she needed to help his teachers form a positive relationship with the boy’s family. A child’s parent-teacher relationship is essential to their academic and social success and directly influences their likelihood of being expelled. Despite ample evidence of the power of these early relationships, teachers and parents routinely report that it is difficult to form and maintain open, collaborative, and supportive home-school connections. This chapter lays out the evidence for the critical role that empathy and communication can play in forestalling the expulsion process described in the previous chapter. Vignettes and quotes from families and teachers also frame a discussion of the implicit biases and logistical challenges that impede the formation of these connections and enhance disciplinary disparities. The chapter concludes with some recommendations for steps that teachers and administrators can take proactively to support positive parent-teacher relationships.
Conclusion
Authors: Zinsser Katherine M.
Published: June 2022

Lance’s family can still see the ramifications of his early expulsions and exclusions today. Unfortunately, there are thousands of children who have had similar experiences. Recent reports have shown that although overall expulsion rates have dropped in some parts of the country, racial disparities persist, with Black children continuing to be excluded at alarming rates. Despite an accumulation of research into the drivers of and factors associated with early expulsion, we still know comparatively little about the long-term consequences of early expulsion. This chapter echoes a call for further investment in the infrastructure necessary to study and end the nation’s early childhood expulsion crisis.
Purposes and Premises
Authors: McVeigh Brian J.
Published: June 2022

This chapter establishes definitions. Cognition is an inclusive term, while consciousness, a moment-to-moment product of cognition, is narrower in definition. The three interrelated approaches of this book are introduced: (1) positive psychotherapy; (2) the “common factors” of therapeutic effectiveness; and (3) a Jaynesian therapeutic paradigm. Six aspects of a Jaynesian therapeutic paradigm are postulated: (1) nonconscious mentation; (2) the inherent self-healing potential of the features/functions of conscious interiority (FOCI); (3) mental imagery as an artifact of adaptive hallucinations; (4) lessons from altered cognition (hypnosis, i.e., the therapeutic benefits of turning consciousness off); (5) metaphors as an example of meta-framing; and (6) emotions as interiorized affects. Other themes of this book include: temporality and the adaptive psyche; historical changes in psychological processes; adaptive phasic structures (APSs); the self as systemized, serialized, and dramatized; and multiculturalism. This book’s purpose is not to offer new therapeutic techniques or recommend certain therapies over others.
A Brief History of the Interiorization of Psychotherapy
Authors: McVeigh Brian J.
Published: June 2022

The nature of conscious interiority can be better appreciated if one traces how it configured the development of psychotherapy. In other words, this chapter historically contextualizes the relations between conscious interiorization and the emergence of treatments and interventions. It begins by examining the psychoanalytic discovery of the “psychological”; neo-psychoanalytic contributions; object relations theory; how behaviorism discarded introspection and conscious interiority; the legacy of behaviorism and neo-behaviorism; and the shift in treatment focus from objective behavior to subjective experience. This chapter also investigates the three waves of: (1) behavior therapy; (2) cognitive behavior and rational emotive behavior therapies; (3) and acceptance and commitment and dialectical behavior therapies. The interiorization of the humanistic tradition (client-centered therapy, existential therapy, and Gestalt therapy), as well as the downside of conscious interiorization, are also explored.
The Nature of Self
Authors: McVeigh Brian J.
Published: June 2022

This chapter, to better appreciate the nature of selfhood, approaches it from several angles. First, it is viewed as part of a system (systemized, i.e., the networked psyche as informed by a systems theory approach). Second, the self is investigated as a sequential, serialized, and narratizable entity. Third, the “staginess” of the self is introduced; this dramatized angle sets the groundwork for the role-self perspective (RSP) or how one performs scripts that give life to oneself. As there is no such thing as a completely socially detached role, selves are inherently theatrical and “multi-roled” within the context of social relations. In this sense, selves interlink an individual to family, friends, and wider social networks. RSP is grounded in the therapeutic centrality of gaining self-objectivity through distancing one’s observing “I” and observed “me”; this is achieved through role-playing. This chapter demonstrates the linkages between RSP, psychodrama, and positive psychology.
Key Therapeutic Skills and Conscious Interiority
Authors: McVeigh Brian J.
Published: June 2022

After introducing the significance of the therapeutic alliance and the healing power of socioaffiliative presence, this chapter examines the art of counseling from a dramaturgical perspective, listing the requisite basic skills and techniques. It explores how the therapeutic role is learned by the mental health care provider; the vital importance of active listening; paying close attention to the feelings of others; the self-presentation of the therapist; providing feedback; staying focused on the interaction between the therapist and the patient; observation skills and collecting information; the usefulness of silence; the advantages and benefits as well as the disadvantages and risks of self-revelation; third-person psychotherapy; and the dynamics of the therapist‒patient feedback loop.
Human Diversity, Social Adaptation, and Psychotherapy
Authors: McVeigh Brian J.
Published: June 2022

This chapter explores the intersection of multiculturalism, conscious interiority, and therapy. Its premise is that “every person is a culture,” i.e., all counseling is cross-cultural. Each person—being a dynamic, complex constellation of socioeconomic factors, ethnocultural influences, sexual and gendered identities, spiritual sentiments, personal predispositions, familial traditions—possesses his or her own culture. The nature of this “individualized culture” (self-individuation) must be appreciated when treating a patient within a clinical setting. This chapter’s core argument distinguishes between the uses and misuses of identity. This is achieved by breaking “identity” down into: identification and categorization by others; interiorizing identity and self-understanding; commonality and sameness; emotional connectedness; and groupness (belonging to a distinctive, bounded, solidary group). This chapter also explains individualizing the collectivity (carelessly applying monolithic characterizations that stereotype); collectivizing the individual (misuses and misapplications of group identity); biases and nonconscious cognition; the need to acknowledge macro-contextual forces; and what is required to be a multiculturally sensitive therapist.
Adolescent medicine subspecialty workforce: Insights from Canada
Authors: Roy-Lavallée Julien , Findlay Sheri M , Chen Allison , Katzman Debra K
Published: June 2022

Objectives

Adolescent Medicine (AM) in Canada has undergone significant growth since being accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) in May 2007. A deeper understanding of the workforce is needed in order to identify current gaps, to improve clinical care and scholarly endeavors, and to inform future developments.

Methods

This is the first AM workforce survey administered in Canada and included 39 multiple-choice and 3 open-ended questions. Descriptive statistics were calculated, and thematic analysis was used for open-ended questions.

Results

We identified 62 AM specialists from across Canada. The overall response was 97% (60/62). Most AM specialists were women (39/53, 74%), Caucasian (38/53, 72%), between 30 and 39 years old (22/53, 42%), and completed their subspecialty training in either Toronto (24/48, 50%) or Montreal (12/48, 25%). Nearly half of participants worked in either the Toronto, Ontario (13/49, 27%) or Montreal, Quebec (10/49, 20%). Nearly all participants (46/49, 94%) practiced in large urban population centres and were based in academic health science centres. The primary clinical areas of focus included eating disorders (25/51, 49%) and mental health (9/51, 18%). Almost all participants were satisfied with their career choice (41/50, 82%). Two-thirds of the participants (31/48, 65%) believed that there was an insufficient number of AM specialists in Canada.

Conclusions

Highlighting current characteristics of the AM subspecialty will help government and academic policymakers in understanding the workforce available to care for Canadian adolescents and the need to develop training programs and policies to address gaps and shortages.
Examining the lineage autonomous role of β3‐integrin in muscle regeneration
Authors: Gerassimov Nathalie , Crain Colt , Bilyeu Colin , Jacob Andrew , Fan Chen‐Ming
Published: June 2022

Skeletal muscles can regenerate over the lifetime from resident muscle stem cells (MuSCs). Interactions between MuSCs and extracellular matrix (ECM) proteins are essential for muscle regeneration. The best‐known receptors for ECM proteins are integrins, a family composed of twenty‐some heterodimeric combinations of an α‐ and a β‐subunit. β1‐integrin (encoded by Itgb1) is required for quiescence, proliferation, migration, and fusion of Pax7+ MuSCs in the mouse model. β3‐integrin (encoded by Itgb3) has been reported to be critical for the myogenic differentiation of C2C12 myoblasts, and Itgb3 germline mutant mice were shown to regenerate few if any myofibers after injury. To investigate the autonomous role of Itgb3 in the myogenic lineage in vivo, we conditionally inactivated a floxed Itgb3 allele (Itgb3F) by constitutive Pax7‐Cre and tamoxifen‐inducible Pax7‐CreERT2 drivers. Unexpectedly, we found no defects in muscle regeneration in both conditional knockout models. In vitro studies using Itgb3 mutant myoblasts or RNAi knockdown of Itgb3 in myoblasts also did not reveal a role for myogenic differentiation. As β1‐ and β3‐integrins share ECM ligands and downstream signaling effectors, we further examined Itgb3's role in a Itgb1 haploid background. Still, we found no evidence for an autonomous role of Itgb3 in muscle regeneration in vivo. Thus, while Itgb3 is critical for the differentiation of C2C12 cells, the regenerative defects reported for the Itgb3 germline mutant are not due to its role in the MuSC. We conclude that if β3‐integrin does have a role in Pax7+ MuSCs, it is compensated by β1‐ and/or another β‐integrin(s).
Preventing falls with remote video monitoring
Authors: Baez Milagros , Karl Cherry
Published: June 2022

This article describes an evidence-based project that aimed to identify nursing staff perceptions on the use of remote video monitoring (RVM), collect fall data following the implementation of RVM, and determine the benefits of RVM in reducing falls.
Analysis of Scoliosis-related Medical Services in South Korea Between 2010 and 2018
Authors: Hong Doohyun , Lim Yu-Cheol , Lee Sook-Hyun , Sung Won-Suk , Lee Yoon Jae , Kim Eun-Jung , Ha In-Hyuk
Published: June 2022

Study Design.

Retrospective, cross-sectional study.

Objectives.

The aim of this study was to analyze types and cost of care for scoliosis and present health care utilization by patients to provide data on the standard treatment and cost for scoliosis in South Korea.

Summary of Background Data.

Scoliosis is defined as an abnormally laterally curved spine with a Cobb angle of ≥10°.Data are lacking on which treatments are popular for general scoliosis and which service categories incur the most cost in South Korea.

Methods.

Data from the Health Insurance Review and Assessment Service-National Patient Sample were used. In total, 108,643 final cases and 32,362 patients in South Korea who received Western medicine care or Korean medicine care at least once with scoliosis (ICD-10 code M41) as the principal diagnosis during January 2010 to December 2018 comprised the study sample. We analyzed health care utilization according to certain factors (e.g., age, sex, payer type, type of visit, and medical institution), health care utilization by service category and service code, and medication prescriptions filled by private or hospital pharmacies.

Results.

Patients aged 24 years or younger most frequently utilized health care services, with more female (64.84%) than male patients (35.16%). Most patients received only Western medicine care (92.18%), whereas 6.56% only received Korean medicine care. Most cases (99.37%) corresponded to outpatient. Regarding service category, treatment and surgery, examination, special equipment and radiologic diagnosis accounted for a substantial percentage. Regarding service code, cost of examination, imaging, and physiotherapy comprised a high percentage of Western medicine, whereas cost of examination, acupuncture, and cupping therapy accounted for a high percentage of Korean medicine. The most commonly prescribed medications for scoliosis in pharmacies were anti-inflammatory analgesics (nonsteroidal anti-inflammatory drugs), antacids, and skeletal muscle relaxers.

Conclusion.

The findings can be used as foundational data for experts such as health care policymakers, clinicians, and researchers.

Level of Evidence: 4
Sutureless Lyophilized Amniotic Membrane Grafting for Corneal Epithelial Defects
Authors: Delbarre Maxime , Boucenna William , Froussart-Maille Françoise
Published: June 2022

Objectives:

To report the tolerability, safety, and efficacy of the lyophilized amniotic membrane (AM) Visio-AMTRIX placed under a bandage contact lens (BCL) in treating persistent epithelial defects (PEDs).

Methods:

This retrospective study included consecutive patients with PEDs treated with a lyophilized AM placed under the BCL. Patients with PEDs who did not respond to medical treatment were included. Patients with a follow-up time less than 3 months were excluded.

Results:

Eleven eyes of 11 patients (mean age, 61.6±15.9 years) were included. Time from PED presentation to AM transplantation (AMT) was 27.7±4.9 days, with the mean PED area of 13.2±11.3 mm2. Complete resolution was achieved in 8 of 11 eyes after a single AM graft. The epithelial defect persisted after the first AMT in three eyes (27.3%), and a second graft was necessary to achieve complete healing. The corneal epithelial defect healed in an average of 11.0±4.4 days after grafting. After PED resolution, the best-corrected visual acuity significantly improved from 0.66±0.30 logMAR (20/91 Snellen) to 0.58±0.24 logMAR (20/77 Snellen) (P=0.036) compared with baseline. The AM resorbed within 2 weeks in all cases. No complication or recurrence was observed.

Conclusions:

A sutureless lyophilized AM under the BCL can resolve PEDs with a significant improvement in vision.
Impacts of the Statewide COVID-19 Lockdown Interventions on Excess Mortality, Unemployment, and Employment Growth
Authors: Pugh Trevor , Harris Jeffrey , Jarnagin Kyle , Thiese Matthew S. , Hegmann Kurt T.
Published: June 2022

Objective

The aim of the study is to determine relationships between lockdowns and excess mortality, unemployment, and employment growth.

Methods

Each US states’ mortality data for 2020 were compared with the prior 3 years to determine excess mortality. Data were compared using measures of lockdowns, or state openness scores and adjusted for age, sex, race/ethnicity, and cardiovascular disease. Comparisons were made with unemployment rates and employment growth rates.

Results

The 2020 excess mortality ranged from −9% to 46%. The average openness score was not significant (P= 0.20). However, openness was strongly associated with both unemployment (P= 0.01) and employment growth (P= 0.0008).

Conclusions

There was no statistical relationship between excess mortality and openness scores, while there were strong relationships with employment measures. These results suggest that lockdowns are not sufficiently beneficial for future use in this pandemic and raise concerns for use in future pandemics.
Surgical Outcome Measures in a Cohort of Patients at High Risk of Breast Cancer Treated by Bilateral Risk-Reducing Mastectomy and Breast Reconstruction
Authors: Gandhi Ashu , Duxbury Paula , Clancy Tara , Lalloo Fiona , Wisely Julie A. , Kirwan Cliona C. , Foden Philip , Stocking Katie , Howell Anthony , Evans D. Gareth
Published: June 2022

Background:

Women with breast cancer–related genetic pathogenic variants (e.g., BRCA1, BRCA2) or with a strong family history carry lifetime risks of developing breast cancer of up to 80 to 90 percent. A significant proportion of these women proceed to bilateral risk-reducing mastectomy. The authors aimed to document the surgical morbidity of risk-reducing mastectomy and establish whether a diagnosis of breast cancer at the time of surgery impacted outcomes.

Methods:

Clinical details of 445 women identified as having a greater than 25 percent lifetime risk of developing breast cancer who underwent risk-reducing mastectomy and breast reconstruction were interrogated for surgical outcomes such as planned, unplanned, and emergency procedures; complication rates; length of stay; and longevity of breast reconstruction. These outcome measures were recorded in women diagnosed with breast cancer perioperatively (cancer group) and those without malignancy (benign group).

Results:

Median follow-up was similar in both groups (benign group, 70 months; cancer group, 73 months). Patients were older in the cancer group than in the benign group (43 years versus 39 years; p < 0.001). Women in the cancer group required more planned procedures to complete reconstruction than those in the benign group (four versus two; p = 0.002). Emergency procedures, unplanned surgical interventions (e.g., capsulectomy), and postreconstruction complication rates were similar between groups. One in five women overall required revision surgery. Patients with autologous reconstructions had a revision rate of 1.24 per 1000 person-years compared with 2.52 per 1000 person-years in the implant reconstruction group.

Conclusions:

Women contemplating risk-reducing mastectomy can be reassured that this is a safe and effective procedure but will likely take multiple interventions. This knowledge should be integral to obtaining informed consent.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
31P-MRS of healthy human brain: revealing the hidden PME signals under phosphoethanolamine and phosphocholine resonances at 7T
Authors: Ren Jimin
Published: June 2022

Purpose

For decades, it has been common practice to quantify brain phosphomonoester (PME) 31P signals by a two-component model composed of phosphoethanoamine (PE) and phosphcholine (PC). This study presented the evidence of hidden PME (h-PME) signals and their selective detections toward accurate quantification of PE and PC.

Methods

Gaussian lineshape analysis was modeled to reveal h-PME. Inversion-recovery (IR) sequence was employed to null the PE and PC resonances for selective detection of h-PME. The fully-relaxed 31P spectra after h-PME correction were used to quantify PE, PC and other brain metabolites in a group of 16 healthy subjects.

Results

Spectral lineshape analysis and IR modulation revealed previously overlooked h-PME signals underlying sharp PE and PC resonances. The h-PME signals appeared as a broad “bump” (LW1/2: 105 ± 25 Hz, N = 16), leading to poor spectral resolution between PE and PC. Fast relaxing h-PME signals, tentatively assigned to blood 2,3-DPG, were selectively detectable using IR sequence at an optimal inversion delay of 5.8 s. In fully relaxed 31P spectra, h-PME measured 44 ± 9 % of the total PME signal, equivalent to 1.36 ± 0.39 mM in single phosphoryl unit, compared to 1.41 ± 0.23 mM for PE and 0.31± 0.10 mM for PC.

Conclusion

Hidden PME signals are a significant constitute of PME signals in human brain 31P spectra, and need to be taken into account for quantifying PE and PC as biomarkers of altered phospholipid metabolism in brain pathologies.
Demystifying the role of prognostic biomarkers in breast cancer through integrated transcriptome and pathway enrichment analyses
Authors: Mishra Divya , Mishra Ashish , Singh M.P.
Published: June 2022

Breast cancer (BC) is the most commonly diagnosed cancer and the leading cause of death in women. There has been discovered an increasing number of molecular targets for BC prognosis and therapy. However, it is still urgent to identify new biomarkers. Therefore, we evaluated biomarkers that may contribute to the diagnosis and treatment of BC. We searched TCGA datasets and identified differentially expressed genes (DEGs) by comparing tumor (100 samples) and non-tumor (100 samples) tissues using the Deseq2 package. Pathway and functional enrichment analysis of the DEGs were done using DAVID (The Database for Annotation, Visualization, and Integrated Discovery) database. The protein-protein interaction (PPI) network was identified using the STRING database and visualized through Cytoscape software. Hub gene analysis of the PPI network was done using Cytohubba plugins. The associations between the identified genes and overall survival (OS) were analyzed using Kaplan–Meier plot. Finally, we have identified hub genes at the transcriptome level. A total of 824 DEGs were identified, which were mostly enriched in cell proliferation, signal transduction, and cell division. The PPI network comprised 822 nodes and 12145 edges. Elevated expression of the 5 hub genes AURKA, BUB1B, CCNA2, CCNB2, and PBK are related to poor OS in breast cancer patients. A promoter methylation study showed these genes to be hypomethylated. Validation through genetic alteration and missense mutations resulted in chromosomal instability leading to improper chromosome segregation causing aneuploidy. The enriched functions and pathways included the cell cycle, oocyte meiosis, and the p53 signaling pathway. The identified five hub genes in breast cancer have the potential to become useful targets for the diagnosis and treatment of breast cancer.
Nose-only Exposure to Cherry and Tobacco Flavored E-cigarettes Induced Lung Inflammation in Mice in a Sex-dependent Manner
Authors: Lamb Thomas , Muthumalage Thivanka , Meehan-Atrash Jiries , Rahman Irfan
Published: June 2022

Flavoring chemicals utilized in electronic nicotine delivery systems (ENDS) have been shown to result in an increase in cellular inflammation, meanwhile, the effects of fruit and tobacco flavors on lung inflammation by nose-only exposures to mice are relatively unknown. We hypothesized that C57BL/6J mice exposed to flavored e-cigarettes would result in an increase in lung inflammation. C57BL/6J mice were exposed to air, propylene glycol/vegetable glycerin (PG/VG), and e-liquids “Apple”, “Cherry”, “Strawberry”, “Wintergreen”, and “Smooth & Mild Tobacco”, for one hour per day for a three day exposure. Quantification of flavoring chemicals was measured by proton nuclear magnetic resonance spectroscopy (1H NMR), differential cell counts by flow cytometry, pro-inflammatory cytokines/chemokines by ELISA, and matrix metalloproteinase levels by western blot. Exposure to PG/VG, Apple, and Smooth & Mild Tobacco resulted in an increase in neutrophil cell count in lung bronchoalveolar lavage fluid (BALF). Strawberry exposure increased KC levels in BALF while in lung homogenate KC levels were increased in PG/VG, Cherry, and Smooth & Mild Tobacco exposure. Exposure to PG/VG and Cherry increased IL-6 levels and in all exposed mice there was a male-specific decrease in MCP-1 levels in lung homogenate. Mice exposed to PG/VG, Apple, Cherry, and Wintergreen resulted in an increase in MMP2 levels. Our results indicate that female mice exposed to cherry flavored e-liquids and male mice exposed to tobacco flavored e-liquids resulted in an increase in inflammation, while exposure to mint flavored e-liquids resulted in a decrease in inflammatory cytokine and an increase in tissue repair proteins. This study revealed that flavored-based e-cigarette exposure elicited sex-specific alterations in lung inflammation, with cherry flavors/benzaldehyde eliciting female-specific increases in inflammation. This highlights the toxicity of flavored chemicals and the further need for regulation of flavoring chemicals.
A metagenomic view on fungal diversity in freshwater lakes
Authors: Sanyal Anushree , Kluge Mariana , Redondo Miguel Angel , Buck Moritz , Mehrshad Maliheh , Garcia Sarahi L , Bertilsson Stefan , Peura Sari
Published: June 2022

Fungi are essential components in a wide range of ecosystems and while major efforts have been spent on disentangling the diversity and functional roles of fungi in terrestrial environments, our knowledge about aquatic fungi is lagging. To address this knowledge gap, we explored metagenomes from 25 lakes from the arctic and boreal zone and one tropical reservoir with the aim of describing the community structure of fungi and fungi-like organisms (Oomycota). A second objective was to identify possible environmental factors influencing the composition of the fungal communities. Our results show that the main fungal phyla and orders are the same across all the lakes despite the differences in geographic location and prevailing climate. Still, there was differential distribution of more highly resolved taxa across the lakes that accordingly featured distinct communities, possibly caused by differential availability of carbon substrates in the lakes. A more detailed classification of sequences related to the pathogenic Oomycota genus Phytophthora clearly demonstrated that while technologies now exist for sequencing entire microbial communities in great detail, we are still severely limited by insufficient coverage of eukaryotic sequences and genomes in public databases.
A knowledge integration strategy for the selection of a robust multi-stress biomarkers panel for Bacillus subtilis
Authors: Huang Yiming , Sinha Nishant , Wipat Anil , Bacardit Jaume
Published: June 2022

Recent advances in high-throughput omics technologies have enhanced the identification of molecular biomarkers specific to phenotypes or states in bacteria. Using these biomarkers to monitor the state of bacteria used in biotechnological processes promises to increase process efficiency. However, live-cell monitoring systems applied to recognise bacterial cellular states in real time can only accommodate a small number of gene expression biomarkers. Computational methods are required to identify and prioritise robust biomarkers for experimental characterisation and verification. This study focused on designing a knowledge integration strategy for the selection of an optimal minimised gene expression biomarker panel to sense various stress states in Bacillus subtilis. We developed a computational method that ranks the candidate biomarker panels based on complementary information from machine learning model, gene regulatory network and co-expression network. We identified a recommended biomarker panel showing high stress sensing power for a variety of conditions included in both the dataset used for biomarker identification (mean f1-score achieved at 0.99) and the independent datasets from different sources (mean f1-score achieved at 0.98). We discovered a significant correlation between stress sensing power and evaluation metrics such as the number of associated regulators in a B. subtilis gene regulatory network (GRN) and the number of associated modules in a B. subtilis co-expression network (CEN). GRNs and CENs provide information relevant to the diversity of biological processes encoded by biomarker genes. We demonstrate that quantitatively relating meaningful evaluation metrics with stress sensing power has potential for recognising biomarkers that show better sensitivity and robustness to an extended set of stress conditions. We conclude that this approach is readily applicable to biomarker discovery model selection.
Deep-learning-based automatic detection of pulmonary nodules from chest radiographs
Authors: Ajmera Pranav , Pant Richa , Seth Jitesh , Ghuwalewala Suraj , Kathuria Sahil , Rathi Snehal , Patil Sonali , Edara Manaswani , Saini Mukul , Raj Preeti , Duddalwar Vinay , Kulkarni VM , Patil Parag , Kulkarni Viraj , Kharat Amit
Published: June 2022

Objective

To assess a deep learning-based artificial intelligence model for the detection of pulmonary nodules on chest radiographs and to compare its performance with board-certified human readers.

Methods

For this retrospective study, 308 chest radiographs were obtained between January 2019 to December 2021 from a tertiary care hospital. All radiographs were analyzed using a deep learning AI model called DxNodule AI Screen. Two expert board-certified radiologists established the ground truth, and 11 test readers independently reviewed all radiographs in two sessions (unaided and AI-aided mode) with a washout period of one month.

Results

The standalone model had an AUROC of 0.905 [0.87, 0.94] in detecting pulmonary nodules. The mean AUROC across the 11 readers improved from 0.798 [0.74, 0.86] for unaided interpretation to 0.846 [0.82, 0.880] for AI-aided interpretation. With DxNodule AI Screen, readers were able to identify nodules at the correct locations, which they otherwise missed. The mean specificity, accuracy, PPV, and NPV of the readers improved significantly from 0.87 [0.78, 0.96], 0.78 [0.72, 0.84], 0.77 [0.65, 0.88], and 0.86 [0.81, 0.90] in the unaided session to 0.89 [0.82, 0.96], 0.83 [0.80, 0.85], 0.82 [0.73, 0.9], and 0.89 [0.86, 0.92], respectively in the aided session.

Conclusion

DxNodule AI Screen outperformed human readers in nodule detection performance on chest radiographs, and enhanced human readers’ performances when used as an aid.
Defining reference values for body composition indexes by magnetic resonance imaging in UK Biobank
Authors: Dai Liang , Huang Xiao-yan , Lu Yue-qi , Liu Yu-yang , Song Cong-ying , Zhang Jing-wen , Li Jing , Zhang Yue , Shan Ying , Shi Yu
Published: June 2022

Background

Magnetic resonance imaging (MRI) is the gold standard for body composition measurements, while such reference range data have not been reported yet.

Methods

We used MRI-measured body composition data from the UK Biobank cohort, including three lean tissue parameters and seven adipose tissue parameters. Participants aged between 45 to 74 years from both genders with at least one parameter data were screened. Age- and sex-specific percentile curves were generated by the lambda–mu–sigma method. Three levels of reference ranges were provided, which were equivalent to mean ± 1 standard deviation (SD), 2 SDs, and 2.5 SDs, respectively.

Results

The final analysis set for each parameter ranged from 4 842 to 14 148 participants (53.4-56.6 % women) with median ages around 61 years after eligibility confirmation. For lean tissue parameters, from age 45 to age 70, median percentiles of total lean tissue volume and total thigh fat-free muscle volume reduced by 2.83 L and 1.73 L in men, and by 3.02 L and 1.51 L in women, respectively. Within the age range, median percentiles of weight-to-muscle ratio elevated by 0.51 kg/L in men and 0.83 kg/L in women, respectively. Adipose tissue parameters presented inconsistent trajectories. For men, median percentiles of muscle fat infiltration, visceral adipose tissue (VAT) volume, total abdominal adipose tissue index, and abdominal fat ratio elevated by 1.48 %, 0.32 L, 0.08 L/m2 and 0.04, while abdominal subcutaneous adipose tissue (ASAT) volume and total adipose tissue volume reduced by 0.47 L and 0.41 L from age 45 to age 70, respectively. And total trunk fat volume remained stable with aging (approximate 9.52 L). For women, muscle fat infiltration and VAT volume showed similar trends with men, increased by 1.68 % and 0.76 L from age 45 to age 70. Other five parameters firstly increased from age 45 to age 60 (ASAT volume: 0.35 L, total adipose tissue volume: 0.78 L, total trunk fat volume: 1.12 L, total abdominal adipose tissue index: 0.49 L/m2, and abdominal fat ratio: 0.06), then kept stable (total abdominal adipose tissue index and abdominal fat ratio) or presented a slight reduction afterwards (ASAT volume: 0.33 L, total adipose tissue volume: 0.14 L, and total trunk fat volume: 0.20 L).

Conclusions

We have established reference ranges for MRI-measured body composition parameters based on large community-dwelling population. The data would benefit more accurate assessment of abnormal adipose and muscle conditions.
The association of personality traits with childhood obesity: a systematic review and meta-analysis
Authors: Jiang Dong-Xia , Huang Tian-Yu , Chen Jing , Xiao Wu-Cai , Liu Zheng
Published: June 2022

A growing body of evidence has shown the association of personality with obesity, but findings of such studies in children remain mixed. This review aimed to systematically summarize the existing literature regarding the association between personality and childhood obesity and explore the underlying mechanisms. A meta-analysis was performed based on the data from 12 included studies and personality traits were classified into five domains (Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness) based on the five-factor model. Conscientiousness was significantly associated with BMI across 2 studies and the pooled correlation coefficient was −0.09 (95% CI: −0.17 to 0.00; I2 = 0%); another 3 studies indicated a significant difference in Conscientiousness between children with obesity and those with normal weight, and the pooled SMD was −0.08 (95% CI: −0.13 to −0.03; I2 = 66%). No consistent patterns were found in the associations between other personality traits and childhood obesity. We hypothesized three possible pathways (moderation, mediation, and confounding) underlying the personality-obesity associations. Findings of our review indicate that, within the context of childhood obesity interventions, identification of subgroups of children with specific personality traits is necessary, especially for measures of Conscientiousness.
Acceleration of regional, racial and gender disparities in drug overdoses across the United States driven by COVID-19 and fentanyl use
Authors: D’Orsogna Maria R. , Böttcher Lucas , Chou Tom
Published: June 2022

Objectives

To examine trends in drug overdose deaths by gender, race and geography in the United States during the period 2013-2020.

Methods

We used the final National Vital Statistics System multiple cause-of-death mortality files to extract crude rates by gender and race and to calculate the male-to-female ratios of crude rates between 2013 and 2020. We established 2013-2019 temporal trends for four major drug types: psychostimulants with addiction potential (T43.6, such as methamphetamines); heroin (T40.1); natural and semi-synthetic opioids (T40.2, such as those contained in prescription pain-killers); synthetic opioids (T40.4, such as fentanyl and its derivatives) through a quadratic regression and determined whether changes in the pandemic year 2020 were statistically significant. We also identified states, race and gender categories most impacted by drug overdoses.

Results

Nationwide, the year 2020 saw statistically significant increases in overdoses for all drug categories except heroin, surpassing predictions based on 2013-2019 trends. Crude rates for Blacks of both genders surpassed those for Whites for fentanyl and psychostimulants in 2018 creating a gap that widened through 2020. In some regions mortality among Whites decreased while overdose rates for Blacks kept rising. The largest 2020 mortality statistic is for Black males in the District of Columbia, with a record 134 overdoses per 100,000 due to fentanyl, 9.4 times more than the fatality rate among White males. Male overdose crude rates in 2020 remain larger than those of females for all drug categories except in Idaho, Utah and Arkansas where crude rates of overdoses by natural and semisynthetic opioids for females exceeded those of males.

Public Health Implications

Drug prevention, mitigation and no-harm strategies should include racial, geographical and gender-specific efforts, to better identify and serve at risk groups.