bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical therapy for a patient with neuromyelitis optica during the acute phase: A case report
Authors: Nishikawa Yuichi , Maeda Noriaki , Kimura Hiroaki
Published: May 2021

The aim of this report was to examine the safety of physical therapy for hemiplegia in a patient with neuromyelitis optica in the acute phase. A 32-year-old female with neuromyelitis optica diagnosed by magnetic resonance imaging had a T2-weighted hyperintense lesion in the central cord from C2 to T2 and was positive for serum anti-aquaporin-4 antibodies. Upon admission to the hospital, her Expanded Disability Status Scale, Medical Research Council scale for muscle strength score, and sensory score (according to the American Spinal Injury Association sensory assessment) were 9.0, 37, and 158, respectively. The patient commenced physical therapy on day 4. A locomotion exercise using an orthosis was started as soon as possible. Her left-side limb muscle strength improved to approximately grade 4 by a manual muscle test with improvements in the Expanded Disability Status Scale score (from 9.0 to 6.0), Medical Research Council scale for muscle strength score (from 37 to 54), sensory score (from 152 to 203), and all functional independence measure dominants compared with the respective values on admission. This report shows that a carefully supervised physical therapy program did not cause deterioration of the patient’s symptoms.
Electroangiographic Correlation of Simultaneous ST-Segment Elevations of Anterior and Inferior Segment: Who Is the Culprit?
Authors: Jariwala Pankaj , Zaidi Shanehyder , Jadhav Kartik
Published: May 2021

Simultaneous ST-segment elevation (SST-SE) in anterior and inferior leads in the setting of ST-segment elevation myocardial infarction is often confounding for a cardiologist and further more challenging is the angiographic localization of the culprit vessel. SST-SE can be fatal as it jeopardizes simultaneously a larger area of myocardium. This phenomenon could be due to “one lesion, one artery,” “two lesions, one artery,” “two lesions, two arteries,” or combinations in two different coronary arteries. We have discussed an index case where we encountered a phenomenon of SST-SE and coronary angiography demonstrated “two lesions, one artery” (proximal occlusion and distal critical diffuse stenoses of the wrap-around left anterior descending [LAD] artery) and “two lesions, two (different coronary) arteries” (previously mentioned stenoses of the LAD artery and critical stenosis of the posterolateral branch of the right coronary arteries). We have also described in brief the possible causes of this phenomena and their electroangiographic correlation of the culprit vessels.
Frequency of positive anti-PF4/polyanion antibody tests after COVID-19 vaccination with ChAdOx1 nCoV-19 and BNT162b2
Authors: Thiele Thomas , Ulm Lena , Holtfreter Silva , Schönborn Linda , Kuhn Sven Olaf , Scheer Christian , Warkentin Theodore E. , Bröker Barbara M. , Becker Karsten , Aurich Konstanze , Selleng Kathleen , Hübner Nils-Olaf , Greinacher Andreas
Published: May 2021

Vaccination using the adenoviral vector COVID-19 vaccine ChAdOx1 nCoV-19 (AstraZeneca) has been associated with rare vaccine-induced immune thrombotic thrombocytopenia (VITT). Affected patients test strongly positive in platelet factor 4 (PF4)/polyanion enzyme immunoassays (EIAs), and serum-induced platelet activation is maximal in the presence of PF4. We determined the frequency of anti-PF4/polyanion antibodies in healthy vaccinees and assessed whether PF4/polyanion EIA+ sera exhibit platelet-activating properties after vaccination with ChAdOx1 nCoV-19 (n = 138) or BNT162b2 (BioNTech/Pfizer; n = 143). In total, 19 of 281 participants tested positive for anti-PF4/polyanion antibodies postvaccination (All: 6.8% [95% confidence interval (CI), 4.4-10.3]; BNT162b2: 5.6% [95% CI, 2.9-10.7]; ChAdOx1 nCoV-19: 8.0% [95% CI, 4.5% to 13.7%]). Optical densities were mostly low (between 0.5 and 1.0 units; reference range, <0.50), and none of the PF4/polyanion EIA+ samples induced platelet activation in the presence of PF4. We conclude that positive PF4/polyanion EIAs can occur after severe acute respiratory syndrome coronavirus 2 vaccination with both messenger RNA- and adenoviral vector-based vaccines, but many of these antibodies likely have minor (if any) clinical relevance. Accordingly, low-titer positive PF4/polyanion EIA results should be interpreted with caution when screening asymptomatic individuals after vaccination against COVID-19. Pathogenic platelet-activating antibodies that cause VITT do not occur commonly following vaccination.
Transcriptome analysis of ovary tissues from low- and high-yielding Changshun green-shell laying hens
Authors: Mu Ren , Yu Yi-yin , Gegen Tuya , Wen Di , Wang Fen , Chen Zhi , Xu Wen-bin
Published: May 2021

Background

Changshun green-shell laying hens are unique to Guizhou Province, China, and have high egg quality. Improving egg production performance has become an important breeding task, and in recent years, the development of high-throughput sequencing technology provides a fast and exact method for genetic selection. Therefore, we aimed to use this technology to analyze the differences between the ovarian mRNA transcriptome of low and high-yield Changshun green-shell layer hens, identify critical pathways and candidate genes involved in controlling the egg production rate, and provide basic data for layer breeding.

Results

The egg production rates of the low egg production group (LP) and the high egg production group (HP) were 68.00 ± 5.56 % and 93.67 ± 7.09 %, with significant differences between the groups (p < 0.01). Moreover, the egg weight, shell thickness, strength and layer weight of the LP were significantly greater than those of the HP (p < 0.05). More than 41 million clean reads per sample were obtained, and more than 90 % of the clean reads were mapped to the Gallus gallus genome. Further analysis identified 142 differentially expressed genes (DEGs), and among them, 55 were upregulated and 87 were downregulated in the ovaries. KEGG pathway enrichment analysis identified 9 significantly enriched pathways, with the neuroactive ligand-receptor interaction pathway being the most enriched. GO enrichment analysis indicated that the GO term transmembrane receptor protein tyrosine kinase activity, and the DEGs identified in this GO term, including PRLR, NRP1, IL15, BANK1, NTRK1, CCK, and HGF may be associated with crucial roles in the regulation of egg production.

Conclusions

The above-mentioned DEGs may be relevant for the molecular breeding of Changshun green-shell laying hens. Moreover, enrichment analysis indicated that the neuroactive ligand-receptor interaction pathway and receptor protein tyrosine kinases may play crucial roles in the regulation of ovarian function and egg production.
Association of gestational diabetes mellitus with changes in gut microbiota composition at the species level
Authors: Chen Fang , Gan Yu , Li Yingtao , He Wenzhi , Wu Weizhen , Wang Kejian , Li Qing
Published: May 2021

Background

Gestational diabetes mellitus (GDM), a common endocrine disorder with rising prevalence in pregnancy, has been reported to be associated with alteration of gut microbiota in recent years. However, the role of gut microbiome in GDM physiopathology remains unclear. This pilot study aims to characterize the alteration of gut microbiota in GDM on species-level resolution and evaluate the relationship with occurrence of GDM.

Methods

An analysis based on 16S rRNA microarray was performed on fecal samples obtained from 30 women with GDM and 28 healthy pregnant women.

Results

We found 54 and 141 differentially abundant taxa between GDM and control group at the genus and the species level respectively. Among GDM patients, Peptostreptococcus anaerobius was inversely correlated with fasting glucose while certain species (e.g., Aureimonas altamirensis, Kosakonia cowanii) were positively correlated with fasting glucose.

Conclusions

This study suggests that there are large amounts of differentially abundant taxa between GDM and control group at the genus and the species level. Some of these taxa were correlated with blood glucose level and might be used as biomarkers for diagnoses and therapeutic targets for probiotics or synbiotics.
The relationship of coffee consumption and CVD risk factors in elderly patients with T2DM
Authors: Ghavami Hossein Sayed , Khoshtinat Mehran , Sadeghi-Farah Sepehr , Kalimani Arman Bayati , Ferrie Suzie , Faraji Hossein
Published: May 2021

Objective

Clinical studies suggest increasing prevalence of cardiovascular disease (CVD) risk factors and diabetes among the elderly. Meanwhile, some food compounds, such as coffee, can also have beneficial effects on CVD risk factors. The aim of the present study was to examine the relationship between coffee consumption and CVD risk factors in the elderly with type 2 diabetes mellitus (T2DM).

Methods

This cross-sectional study was performed during 2017 on 300 elderly people above 60 years of age with T2DM in Isfahan, Iran. Dietary assessment was performed using a food frequency questionnaire. Coffee consumption was classified into three groups including < 1, 1–3, and > 3 cups/day. Partial correlation test was used to investigate the relationship between CVD risk factors and usual coffee consumption.

Results

The mean age and body mass index of participants were 70.04 ± 4.87 years and 24.74 ± 3.34 kg/m2 respectively. Coffee consumption had a significant inverse relationship with fasting plasma glucose (FPG) and diastolic blood pressure (DBP) in the elderly with T2DM (r: − 0.117, 0.134; p: 0.046, 0.022). Triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) had a significant positive relationship with coffee consumption levels (r: 0.636, 0.128; p: 0.028, 0.029). These results were obtained after controlling for potential confounders.

Conclusion

Increasing coffee consumption was linked to improved status of some CVD risk factors including FPG, HDL-C, and DBP in the elderly with T2DM. Nevertheless, increasing coffee consumption was also associated with higher TG level and had no significant effect on other risk factors. Further studies are required to confirm these results.
Lymphocyte subset analysis to evaluate the prognosis of HIV-negative patients with pneumocystis pneumonia
Authors: Jin Fan , Xie Jing , Wang Huan-ling
Published: May 2021

Objectives

We analysed the peripheral blood lymphocyte subsets of human immunodeficiency virus (HIV)-negative patients infected with pneumocystis pneumonia (PCP) to determine the relationships between the levels of different types of lymphocytes and the prognosis of patients.

Methods

We retrospectively reviewed HIV-negative patients with PCP diagnosed in our department. All the eligible patients underwent lymphocyte subset analysis on admission.

Results

A total of 88 HIV-negative PCP patients were enrolled in the study. In univariate analyses, low CD4+ T cell count, low CD8+ T cell count, and low natural killer cell (NK cell) count were associated with higher in-hospital mortality. CD8+ T cell count ≤300/μL was found to be an independent risk factor for poor prognosis in multivariate logistical regression analysis (p = 0.015, OR = 11.526, 95% CI = 1.597–83.158). Although low CD4+ T cell and NK cell counts were not independent risk factors, the mortality rates of PCP patients decreased as the CD4+ T cell and NK cell counts increased.

Conclusion

The immune process ofPneumocystis jiroveciiinfection is complex but important. We propose that lymphocyte subsets could give clinicians a better understanding of patient immune status, helping with the early identification of potentially lethal infections and treatment decision making, such as adjusting the immunosuppressive regimen and choosing an appropriate patient monitoring level.
“Part of getting to where we are is because we have been open to change” integrating community health workers on care teams at ten Ryan White HIV/AIDS program recipient sites
Authors: Sprague Martinez Linda , Davoust Melissa , Rajabiun Serena , Baughman Allyson , Bachman Sara S. , Bowers-Sword Rachel , Campos Rojo Maria , Sullivan Marena , Drainoni Mari-Lynn
Published: May 2021

Background

Community Health Workers (CHWs) have long been integrated in the delivery of HIV care in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US-based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes.

There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities.

Methods

Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n = 20).

Findings

Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and Technical Assistance strategies.

Conclusions

Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for healthcare organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW program implementation. The integration of the CHWs in the delivery of HIV care requires clearly distinguishing their role from the roles of other members of the healthcare delivery team.
Cervico-thoracic pain and associated impairments in air force personnel: a cross-sectional study
Authors: Tegern Matthias , Aasa Ulrika , Larsson Helena
Published: May 2021

Background

Pain and impaired function in the cervical region are common in Air Force personnel (AFP), but evidence is limited regarding the thoracic region. This cross-sectional cohort study examined associations between cervico-thoracic pain and physical performance among Swedish AFP and explored possible differences and similarities in test performance between fighter pilots (FP), helicopter pilots (HP) and rear crew (RC).

Methods

AFP (n = 73) from one airbase performed eight tests of movement control of the spine, active cervical range of motion (ROM) in all six directions and isometric strength and endurance of the cervical flexors and extensors. The association between test performance and cervico-thoracic pain (based on the ‘Musculoskeletal screening protocol’ questionnaire) were analysed in a multiple binary logistic regression model.

Results

For AFP with cervico-thoracic pain (30%), movement control was impaired in the ‘neck flexion test’ (OR [95%CI] =3.61 [1.06–12.34]) and the ‘forward lean test’ (OR [95%CI] =3.43[1.04–11.37]), together with reduced flexion ROM (OR [95%CI] =0.93 [0.87–0.99]). Test performance was in general similar between the three groups, but FP and HP could control the ‘forward lean test’ to a significantly higher degree than RC (p = 0.000). Further, FP showed significantly greater ROM in lateral flexion to the right compared to HP and RC (mean: 40.3°, 36.2° and 33.4°, respectively, p = 0.000), and they showed higher, although not significant, flexor strength than RC (p = 0.026).

Conclusions

The impaired function associated with cervico-thoracic pain highlights the need for a deeper understanding of such relationships when designing tools to systematically optimize the physical performance and prevent pain among AFP. Studies with a longitudinal design are warranted to examine any causative associations between pain and impairments.
A physician assistant entry-level doctoral degree: more harm than good?
Authors: Kulo Violet , Fleming Shani , Gordes Karen L. , Jun Hyun-Jin , Cawley James F. , Kayingo Gerald
Published: May 2021

Background

As most health professions in the United States have adopted clinical or practice doctorates, there has been an ongoing debate on whether physician assistants (PAs) should transition from a master’s to a doctorate as the terminal degree. The authors examined perceived risks, benefits and impact of transitioning to an entry-level PA doctoral degree.

Methods

A multi-prong, mixed-methods approach was used that included a literature review and collecting quantitative and qualitative data using a survey and interviews. Bivariate analysis and binomial logistic regression were performed to evaluate relationships between perceptions/perspectives on an entry-level PA doctoral degree and the anticipated impact of it causing more harm than good to the PA profession. Deductive content analysis was used to analyze the qualitative data.

Results

Of 636 PA clinicians and students (46% response rate), 457 (72%) disagreed that an entry-level PA doctoral degree should be required. More than half of the respondents (54%) agreed that it should be offered but not required and 380 respondents (60%) agreed that an entry-level doctoral degree would cause more harm than good. Race, educational attainment, occupation, and length of practice as a PA were significantly associated with having a perception of causing more harm. There was strong positive association between the perception of a doctoral degree causing more harm with expectations of having a negative impact on the availability of clinical training sites (OR = 4.39, p < .05). The most commonly cited benefits were parity with other professions and competitive advantage, whereas the perceived risks were increased cost for education, decreased diversity in the profession, and negative impact on the PA/physician relationship.

Conclusions

The major takeaway of our study was that perceived benefits and risks are strongly influenced by the lens of the stakeholder. While the majority of PAs and students appear to be not in favor mainly due to the potential harm, the proportion of those in favor is not insignificant and their views should not be ignored. Addressing concerns with key stakeholders could help the PA profession to transition to a doctoral degree with minimal adverse impact.
Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study
Authors:   the COVID-ICU investigators, Dres Martin , Hajage David , Lebbah Said , Kimmoun Antoine , Pham Tai , Béduneau Gaëtan , Combes Alain , Mercat Alain , Guidet Bertrand , Demoule Alexandre , Schmidt Matthieu
Published: May 2021

Background

The COVID-19 pandemic is a heavy burden in terms of health care resources. Future decision-making policies require consistent data on the management and prognosis of the older patients (> 70 years old) with COVID-19 admitted in the intensive care unit (ICU).

Methods

Characteristics, management, and prognosis of critically ill old patients (> 70 years) were extracted from the international prospective COVID-ICU database. A propensity score weighted-comparison evaluated the impact of intubation upon admission on Day-90 mortality.

Results

The analysis included 1199 (28% of the COVID-ICU cohort) patients (median [interquartile] age 74 [72–78] years). Fifty-three percent, 31%, and 16% were 70–74, 75–79, and over 80 years old, respectively. The most frequent comorbidities were chronic hypertension (62%), diabetes (30%), and chronic respiratory disease (25%). Median Clinical Frailty Scale was 3 (2–3). Upon admission, the PaO2/FiO2ratio was 154 (105–222). 740 (62%) patients were intubated on Day-1 and eventually 938 (78%) during their ICU stay. Overall Day-90 mortality was 46% and reached 67% among the 193 patients over 80 years old. Mortality was higher in older patients, diabetics, and those with a lower PaO2/FiO2ratio upon admission, cardiovascular dysfunction, and a shorter time between first symptoms and ICU admission. In propensity analysis, early intubation at ICU admission was associated with a significantly higher Day-90 mortality (42% vs 28%; hazard ratio 1.68; 95% CI 1.24–2.27;p < 0·001).

Conclusion

Patients over 70 years old represented more than a quarter of the COVID-19 population admitted in the participating ICUs during the first wave. Day-90 mortality was 46%, with dismal outcomes reported for patients older than 80 years or those intubated upon ICU admission.
Comprehensive analysis of clinical, pathological, and genomic characteristics of follicular helper T-cell derived lymphomas
Authors: Yoon Sang Eun , Cho Junhun , Kim Yeon Jeong , Ko Young Hyeh , Park Woong-Yang , Kim Seok Jin , Kim Won Seog
Published: May 2021

Background

The 2016 World Health Organization (WHO) classification introduced nodal lymphomas of T follicular helper (Tfh) cell origin, such as angioimmunoblastic T-cell lymphoma (AITL), follicular peripheral T-cell lymphoma (F-PTCL), and nodal peripheral T-cell lymphoma with T follicular helper phenotype (nodal PTCL with TFH phenotype). However, the accurate incidence rate and clinical characteristics of F-PTCL and nodal PTCL with TFH are unstudied.

Methods

Between February 2012 to June 2020, a total of 207 cases diagnosed with nodal lymphomas of T follicular helper (Tfh) cell origin and PTCL-NOS were reviewed for clinical and histopathologic data. PTCL-NOS was defined to not correlate to any of the specific entities of mature T cell lymphoma in the WHO 2016 classification. We attempted to classify PTCL-GATA3 and PTCL-TBX21 by IHC staining. Target gene analysis was performed on a few patients with sufficient blood and tissue samples additionally.

Results

Among 207 patients, 111 patients (53.6%) had AITL, 67 patients (32.4%) had PTCL-NOS, 19 patients (9.2%) had F-PTCL, and 10 patients (4.8%) had nodal PTCL with TFH phenotype. We re-defined and analyzed F-PTCL and nodal PTCL with TFH phenotype into other TFH lymphomas. AITL (N = 101/111, 91.0%) was found to have a higher frequency of stage III/IV cancers compared to other TFH lymphomas (N = 22/29, 75.0%) and PTCL-NOS (N = 53/67, 79.1%; p-value = 0.03). The OS of AITL and other TFH lymphomas was similarly superior to PTCL-NOS (p-value = 0.02). AITL and other TFH lymphomas showed the TBX21 subtype more commonly than the GATA3 subtype. Mutations related to the RAS family (RHOA) and those related to epigenetic regulators (IDH2, DNMT3A, and TET2) were shown mainly in AITL and other TFH lymphomas.

Conclusions

Other TFH lymphomas appear to be a rare disease entity around one-quarter in nodal lymphomas of T follicular helper (Tfh) cell origin. Their less aggressive clinical feature than we did not expect is utterly different from PTCL-NOS and AITL. On the other hand, other TFH lymphomas share some characteristics, such as the cell of origin, a more common TBX21 subtype, and genetic variation such as RAS family mutation and epigenetic regulators, with AITL.
Stand-level biomass models for predicting C stock for the main Spanish pine species
Authors: Aguirre Ana , del Río Miren , Ruiz-Peinado Ricardo , Condés Sonia
Published: May 2021

Background

National and international institutions periodically demand information on forest indicators that are used for global reporting. Among other aspects, the carbon accumulated in the biomass of forest species must be reported. For this purpose, one of the main sources of data is the National Forest Inventory (NFI), which together with statistical empirical approaches and updating procedures can even allow annual estimates of the requested indicators.

Methods

Stand level biomass models, relating the dry weight of the biomass with the stand volume were developed for the five main pine species in the Iberian Peninsula (Pinus sylvestris, Pinus pinea, Pinus halepensis, Pinus nigra and Pinus pinaster). The dependence of the model on aridity and/or mean tree size was explored, as well as the importance of including the stand form factor to correct model bias. Furthermore, the capability of the models to estimate forest carbon stocks, updated for a given year, was also analysed.

Results

The strong relationship between stand dry weight biomass and stand volume was modulated by the mean tree size, although the effect varied among the five pine species. Site humidity, measured using the Martonne aridity index, increased the biomass for a given volume in the cases of Pinus sylvestris, Pinus halepensis and Pinus nigra. Models that consider both mean tree size and stand form factor were more accurate and less biased than those that do not. The models developed allow carbon stocks in the main Iberian Peninsula pine forests to be estimated at stand level with biases of less than 0.2 Mg∙ha− 1.

Conclusions

The results of this study reveal the importance of considering variables related with environmental conditions and stand structure when developing stand dry weight biomass models. The described methodology together with the models developed provide a precise tool that can be used for quantifying biomass and carbon stored in the Spanish pine forests in specific years when no field data are available.
Automated NLP Extraction of Clinical Rationale for Treatment Discontinuation in Breast Cancer
Authors: Alkaitis Matthew S. , Agrawal Monica N. , Riely Gregory J. , Razavi Pedram , Sontag David
Published: May 2021

PURPOSE

Key oncology end points are not routinely encoded into electronic medical records (EMRs). We assessed whether natural language processing (NLP) can abstract treatment discontinuation rationale from unstructured EMR notes to estimate toxicity incidence and progression-free survival (PFS).

METHODS

We constructed a retrospective cohort of 6,115 patients with early-stage and 701 patients with metastatic breast cancer initiating care at Memorial Sloan Kettering Cancer Center from 2008 to 2019. Each cohort was divided into training (70%), validation (15%), and test (15%) subsets. Human abstractors identified the clinical rationale associated with treatment discontinuation events. Concatenated EMR notes were used to train high-dimensional logistic regression and convolutional neural network models. Kaplan-Meier analyses were used to compare toxicity incidence and PFS estimated by our NLP models to estimates generated by manual labeling and time-to-treatment discontinuation (TTD).

RESULTS

Our best high-dimensional logistic regression models identified toxicity events in early-stage patients with an area under the curve of the receiver-operator characteristic of 0.857 ± 0.014 (standard deviation) and progression events in metastatic patients with an area under the curve of 0.752 ± 0.027 (standard deviation). NLP-extracted toxicity incidence and PFS curves were not significantly different from manually extracted curves ( P = .95 and P = .67, respectively). By contrast, TTD overestimated toxicity in early-stage patients ( P < .001) and underestimated PFS in metastatic patients ( P < .001). Additionally, we tested an extrapolation approach in which 20% of the metastatic cohort were labeled manually, and NLP algorithms were used to abstract the remaining 80%. This extrapolated outcomes approach resolved PFS differences between receptor subtypes ( P < .001 for hormone receptor+/human epidermal growth factor receptor 2− v human epidermal growth factor receptor 2+ v triple-negative) that could not be resolved with TTD.

CONCLUSION

NLP models are capable of abstracting treatment discontinuation rationale with minimal manual labeling.
Enabling Precision Medicine in Cancer Care Through a Molecular Data Warehouse: The Moffitt Experience
Authors: Eschrich Steven A. , Teer Jamie K. , Reisman Phillip , Siegel Erin , Challa Chandan , Lewis Patricia , Fellows Katherine , Malpica Everin , Carvajal Rodrigo , Gonzalez Guillermo , Cukras Scott , Betin-Montes Miguel , Aden-Buie Garrick , Avedon Melissa , Manning Daniel , Tan Aik Choon , Fridley Brooke L. , Gerke Travis , Van Looveren Mattias , Blake Amilcar , Greenman Jennifer , Rollison Dana E.
Published: May 2021

PURPOSE

The use of genomics within cancer research and clinical oncology practice has become commonplace. Efforts such as The Cancer Genome Atlas have characterized the cancer genome and suggested a wealth of targets for implementing precision medicine strategies for patients with cancer. The data produced from research studies and clinical care have many potential secondary uses beyond their originally intended purpose. Effective storage, query, retrieval, and visualization of these data are essential to create an infrastructure to enable new discoveries in cancer research.

METHODS

Moffitt Cancer Center implemented a molecular data warehouse to complement the extensive enterprise clinical data warehouse (Health and Research Informatics). Seven different sequencing experiment types were included in the warehouse, with data from institutional research studies and clinical sequencing.

RESULTS

The implementation of the molecular warehouse involved the close collaboration of many teams with different expertise and a use case–focused approach. Cornerstones of project success included project planning, open communication, institutional buy-in, piloting the implementation, implementing custom solutions to address specific problems, data quality improvement, and data governance, unique aspects of which are featured here. We describe our experience in selecting, configuring, and loading molecular data into the molecular data warehouse. Specifically, we developed solutions for heterogeneous genomic sequencing cohorts (many different platforms) and integration with our existing clinical data warehouse.

CONCLUSION

The implementation was ultimately successful despite challenges encountered, many of which can be generalized to other research cancer centers.
Maternal Intensive Care Unit Admission as an Indicator of Severe Acute Maternal Morbidity: A Population-Based Study
Authors: Godeberge Charlotte , Deneux-Tharaux Catherine , Seco Aurélien , Rossignol Mathias , Chantry Anne Alice , Bonnet Marie-Pierre ,   on behalf of the EPIMOMS Study Group
Published: May 2021

BACKGROUND:

Severe acute maternal morbidity (SAMM) accounts for any life-threatening complication during pregnancy or after delivery. Measuring and monitoring SAMM seem critical to assessing the quality of maternal health care. The objectives were to explore the validity of intensive care unit (ICU) admission as an indicator of SAMM by characterizing the profile of women admitted to an ICU and of their ICU stay, according to the association with other SAMM criterion.

METHODS:

We performed a secondary analysis of the 2540 women with SAMM included in the epidemiology of severe acute maternal morbidity (EPIMOMS) multiregional prospective population-based study (2012–2013, n = 182,309 deliveries). The EPIMOMS definition of SAMM, based on national experts’ consensus, is a combination of diagnosis, organ dysfunctions, and intervention criteria, including ICU admission. Among women with SAMM, we identified characteristics associated with maternal ICU admission with or with no other SAMM criterion compared with ICU admission, by using multivariable multinomial logistic regression models.

RESULTS:

Overall, 511 women were admitted to an ICU during or up to 42 days after pregnancy, for a population-based rate of 2.8 of 1000 deliveries (511/182,309; 95% confidence interval [CI], 2.6-3.1); 15.5% of them (79/511; 95% CI, 12.4-18.9) had no other SAMM criterion compared with ICU admission. Among women with SAMM, the odds of ICU admission with no other morbidity criterion were increased in women with preexisting medical conditions (adjusted odds ratio (aOR), 2.13; 95% CI, 1.17-3.86) and cesarean before labor (aOR, 3.12; 95% CI, 1.47-6.64). Women admitted to ICU with no other SAMM criterion had more often decompensation of a preexisting condition, no interventions for organ support, and a shorter length of stay than women admitted with other SAMM criteria.

CONCLUSIONS:

Among women with SAMM, 1 in 5 is admitted to an ICU; 15.5% of those admitted in ICU have no other SAMM criterion and a less acute condition. These results challenge the use of ICU admission as a criterion of SAMM.
Floating Roots: Agnès Varda's Uncle Yanco
Authors: King Homay
Published: May 2021

This article traces one source of Agnès Varda's artistic inspiration to Jean “Yanco” Varda, the subject of her 1967 short film Uncle Yanco (US/France). Jean Varda was a peripatetic artist who lived on a houseboat and was part of a bohemian circle that included Henry Miller, Anaïs Nin, Alan Watts, and other luminaries of the San Francisco counterculture. Both Vardas were gleaners and artists. The author argues that both saw the imagination as a place where matter and spirit were reconciled. The article builds on previous work about Varda's The Gleaners and I (Les glaneurs et la glaneuse, France, 2000), exploring Varda's materialist feminism and her use of earthly and tactile materials. The author focuses not only on matter but also on the imagination and the intangible images, colors, and forms that are prominent in her oeuvre, arguing that Yanco served as a muse to his niece.
Synthesis, Electronic Properties, and Lewis Acidity of Rhodium Complexes Bearing X-Type PBP, PAlP, and PGaP Pincer Ligands
Authors: Hara Naofumi , Yamamoto Konosuke , Tanaka Yuuki , Saito Teruhiko , Sakaki Shigeyoshi , Nakao Yoshiaki
Published: May 2021

We have synthesized rhodium complexes that bear X-type PBP and PGaP pincer ligands. X-ray diffraction analysis and IR spectroscopy of the PBP– and PGaP–Rh(CO)2 complexes showed that the σ-donicity and trans-influence of the X-type boryl ligand are stronger than those of the X-type gallyl ligand. Moreover, the Lewis acidity of the PEP–Rh complexes (E = B, Al, Ga) was examined. The PBP–Rh complex did not interact with the Lewis base N,N-dimethyl-4-aminopyridine (DMAP), while the PAlP–Rh complex coordinated DMAP more strongly via the Al atom than the PGaP–Rh complex via the Ga atom. DFT calculations of the PEP–Rh complexes revealed the details of the electronic properties and Lewis acidity of the X-type PEP pincer ligands. Their σ-donicity increases in the order Ga < B < Al, and the strength of their trans-influence follows the order Ga < Al < B. The polarity of the Eδ+–Rhδ− bond was found to be the greatest for Al and the smallest for B. The Lewis acidity based on the calculated binding energy increases in the order B ≪ Ga < Al, which is consistent with the experimental results.
IR Intensities of CO Molecules Adsorbed on Atop and Low-Coordinate Sites of Pd Nanoparticles: Analysis Using Natural Perturbation Orbitals
Authors: Miyamoto Masaya , Hada Masahiko
Published: May 2021

The natural perturbation orbital (NPO) computational method was applied to the analysis of infrared (IR) intensities of CO molecules adsorbed on the surfaces of Pd nanoparticles. Enhancement of the IR intensities for a CO bonded to a single low-coordinate metal adsorbed on the metal surface (low-coordinate model) was compared with those for a CO bonded directly to the metal surface (atop model). This enhancement was ascribed to the mixing between occupied and virtual orbitals induced by molecular vibrations. The occ-virt term, representing this mixing, was efficiently decomposed into contributions from three NPO pairs ($\sigma _{z} - \sigma _{z}^{*}$, $\pi _{x} - \pi _{x}^{*}$, and $\pi _{y} - \pi _{y}^{*}$) for each model. The main contributors were the $\pi _{x} - \pi _{x}^{*}$ and $\pi _{y} - \pi _{y}^{*}$ pairs, which were localized around CO in the atop model, but delocalized throughout the Pd cluster in the low-coordinate model. This variance in orbital delocalization comes from differing interactions between Pd and CO in the atop and low-coordinate models.
Heat Tolerance and Occupational Heat Exposure Limits in Older Men with and without Type 2 Diabetes or Hypertension
Authors: NOTLEY SEAN R. , AKERMAN ASHLEY P. , FRIESEN BRIAN J. , POIRIER MARTIN P. , SIGAL RONALD J. , FLOURIS ANDREAS D. , BOULAY PIERRE , MCCOURT EMMA , RUZICKA MARCEL , KENNY GLEN P.
Published: May 2021

Purpose

To mitigate rises in core temperature >1°C, the American Conference of Governmental Industrial Hygienists (ACGIH) recommends upper limits for heat stress (action limit values [ALV]), defined by wet-bulb globe temperature (WBGT) and a worker’s metabolic rate. However, these limits are based on data from young men and are assumed to be suitable for all workers, irrespective of age or health status. We therefore explored the effect of aging, type 2 diabetes (T2D), and hypertension (HTN) on tolerance to prolonged, moderate-intensity work above and below these limits.

Methods

Core temperature and heart rate were assessed in healthy, heat unacclimatized young (18–30 yr, n = 13) and older (50–70 yr) men (n = 14) and heat unacclimatized older men with T2D (n = 10) or HTN (n = 13) during moderate-intensity (metabolic rate: 200 W·m−2) walking for 180 min (or until termination) in environments above (28°C and 32°C WBGT) and below (16°C and 24°C WBGT) the ALV for continuous work at this intensity (25°C WBGT).

Results

Work tolerance in the 32°C WBGT was shorter in men with T2D (median [IQR]; 109 [91–173] min; P = 0.041) and HTN (120 [65–170] min; P = 0.010) compared with healthy older men (180 [133–180] min). However, aging, T2D, and HTN did not significantly influence (i) core temperature or heart rate reserve, irrespective of WBGT; (ii) the probability that core temperature exceeded recommended limits (>1°C) under the ALV; and (iii) work duration before core temperature exceeded recommended limits (>1°C) above the ALV.

Conclusion

These findings demonstrate that T2D and HTN attenuate tolerance to uncompensable heat stress (32°C WBGT); however, these chronic diseases do not significantly impact thermal and cardiovascular strain, or the validity of ACIGH recommendations during moderate-intensity work.
Diffusion kurtosis imaging features of renal cell carcinoma: a preliminary study
Authors: Zhu Qingqiang , Xu Qing , Dou Weiqiang , Zhu Wenrong , Wu Jingtao , Chen Wenxin , Ye Jing
Published: May 2021

Objective:

To explore the feasibility of diffusion kurtosis imaging (DKI) in differentiating different types of renal cell carcinoma (RCC).

Methods:

36 patients with clear cell RCC (CCRCC, low-grade,n = 20 and high-grade, n = 16), 19 with papillary RCC, 11 with chromophobe RCC, and 9 with collecting duct carcinoma (CDC) were examined with DKI technique. b values of 0, 500 and 1000 s/mm2 were adopted. The DKI parameters, i.e., mean diffusivity (MD), mean kurtosis (MK), kurtosis anisotropy (KA), radial kurtosis (RK) and signa-to-noise ration (SNR) of DKI images at different b values were used.

Results:

The mean SNRs of DKI images at b = 0, 500 and 1000 s/mm2 were 32.8, 14.2 and 9.18, respectively. For MD parameter, a significant higher value was shown in CCRCC than those of papillary RCC, chromophobe RCC and CDC (p < 0.05). In addition, both chromophobe RCC and CDC have larger MD values than papillary RCC (p < 0.05), however, there was no significant differences between chromophobe RCC and CDC (p > 0.05). For MK, KA and RK parameters, a significant higher value was shown in papillary RCC than those of CCRCC, chromophobe RCC and CDC (p < 0.05). Moreover, both chromophobe RCC and CDC have significantly larger values of MK, KA and RK than CCRCC (p < 0.05).

Conclusion:

Our preliminary study demonstrated significant differences in the DKI parameters between the subtypes of RCCs, given an adequate SNR of DKI images.

Advances in knowledge:

1.The MD value is the best parameter to distinguish CCRCC from other RCCs.

2.The MK, KA and RK values are the best parameters to distinguish papillary RCC from other RCCs.

3.DKI is able to provide images with sufficient SNRs in kidney disease.
Quantitative magnetic resonance imaging for focal liver lesions: bridging the gap between research and clinical practice
Authors: Cannella Roberto , Sartoris Riccardo , Grégory Jules , Garzelli Lorenzo , Vilgrain Valérie , Ronot Maxime , Dioguardi Burgio Marco
Published: May 2021

Magnetic resonance imaging (MRI) is highly important for the detection, characterization, and follow-up of focal liver lesions. Several quantitative MRI-based methods have been proposed in addition to qualitative imaging interpretation to improve the diagnostic work-up and prognostics in patients with focal liver lesions. This includes DWI with apparent diffusion coefficient measurements, intravoxel incoherent motion, perfusion imaging, MR elastography, and radiomics. Multiple research studies have reported promising results with quantitative MRI methods in various clinical settings. Nevertheless, applications in everyday clinical practice are limited. This review describes the basic principles of quantitative MRI-based techniques and discusses the main current applications and limitations for the assessment of focal liver lesions.
Total perfusion-diffusion mismatch detected using resting-state functional MRI
Authors: Khalil Ahmed , Röhrs Kian , Nolte Christian H , Galinovic Ivana
Published: May 2021

Total perfusion-diffusion mismatch is a well-recognised phenomenon in patients with acute ischaemic stroke. We describe a case of total perfusion-diffusion mismatch detected using an emerging contrast-agent-free perfusion imaging technique in a young patient with acute cerebellar stroke.
Animal assisted interventions in the children's hospital: protocol for a scoping review
Authors: Howe Rachel , Nicholson Sandra , Lafferty Attracta , Davies Carmel , Stokes Diarmuid , Kroll Thilo
Published: May 2021

The introduction of Animal Assisted Interventions (AAIs) in healthcare is relatively common; however, their actual effectiveness and long-term impact are not so well known, especially in relation to the children’s hospital setting.  It is important to plot where and why animal interventions take place but also to focus on how the human animal bond impacts on children in a children’s hospital setting.  Family members, including companion animals, are important supports which help children to relax and give them a sense of familiarity to navigate the busy and stressful hospital environment.  The scoping review of the literature proposed will explore the scientific evidence base for AAIs in children’s hospitals and will map results prior to undertaking a full scale research project.   Arksey and O’Malley’s framework guided by the Joanna Briggs Institute will frame this review protocol.  Appendices are used to ensure transparency of methods. The protocol is presented in narrative style to demonstrate flow, fluency, and appeal to wider readership.
The use of music for children and adolescents living with rare diseases in the healthcare setting: a scoping review study protocol
Authors: Karpaviciute Simona , Sweeney Alison , O‘Neill Aimee , McNulty Sandra , Kroll Thilo , Somanadhan Suja
Published: May 2021

Background: Interest in the application of music in the health, social care and community contexts is growing worldwide. There is an emerging body of literature about the positive effects of music on the well-being and social relationships of children and adult populations. Music has also been found to promote social interaction, communication skills, and social-emotional behaviours of children with medically complex care needs. Despite significant advancements in the area, to the authors’ knowledge, this is the first scoping review to investigate the evidence for using music therapy and music-based interventions for children living with rare diseases in the healthcare setting. Therefore, the purpose of this study is to conduct a scoping review of the literature to map out the existing studies about the use of music therapy and music-based interventions with children who have rare diseases in the healthcare setting. This review will also identify gaps in current knowledge and use of these interventions.

Method: This study follows the Joanna Briggs Institute’s methodology for scoping reviews, utilising Arksey and O’Malley’s six-stage scoping review framework: 1) identifying the research question; 2) identifying relevant studies; 3) study selection; 4) charting the data; 5) collating, summarising and reporting results; and 6) consulting with relevant stakeholders step. A comprehensive search will be conducted in CINAHL Complete; MEDLINE Complete; Psychology and Behavioral Sciences Collection; and PubMed Central databases. A search strategy with selected inclusion and exclusion criteria will be used to reveal a wide range of evidence. This study will include quantitative, qualitative and mixed research methods studies published in English from 2010 to 2020.
Orthorexia nervosa – a distorted approach to healthy eating
Authors: Gortat Mateusz , Samardakiewicz Marzena , Perzyński Adam
Published: May 2021

Konsumenci coraz częściej sięgają po żywność bezpieczną dla zdrowia. Trend ten może prowadzić do rozwoju zaburzenia odżywiania się definiowanego jako ortoreksja psychiczna. Rozpowszechnienie w społeczeństwie ortoreksji mieści się w granicach od 1% do 60% i związane jest głównie trybem życia. Badania naukowe prowadzone na przestrzeni ostatnich 10 lat wskazują, że liczba osób zagrożonych ortoreksją wzrasta. Osoba chora na ortoreksję zwraca szczególną uwagę na jakość spożywanych produktów co prowadzi do eliminacji niektórych produktów z diety. Utrzymaniu restrykcji żywieniowych towarzyszy stres, niepokój, wstręt do samego siebie. W pracy podjęto próbę usystematyzowania wiedzy dotyczącej ortoreksji, analizując najnowsze publikacje dotyczące tego zaburzenia w tym opisano narzędzia psychometryczne stosowane do diagnozy ortoreksji. Dostępne dotychczas kwestionariusze do diagnozy ryzyka wystąpienia ortoreksji cechują się różną wartością psychometryczną, co często utrudnia ocenę zjawiska ortoreksji na świecie. Stosowane narzędzia badawcze nie pozwalają w dostatecznym stopniu określić granicy pomiędzy nadmiernym zainteresowaniem zdrowym odżywianiem i stylem życia, a rzeczywistym zaburzeniem, które zakłóca codzienne funkcjonowanie.
Editorial
Authors: Dudek Dominika , Sobański Jerzy , Klasa Katarzyna
Published: May 2021

brak streszczenia
Asset Selling Under Debt Obligations
Authors: Ahn Hyun-Soo , Wang Derek D. , Wu Owen Q.
Published: May 2021

We extend the classical asset-selling problem to include debt repayment obligation, selling capacity constraint, and Markov price evolution. Specifically, we consider the problem of selling a divisible asset that is acquired through debt financing. The amount of asset that can be sold per period may be limited by physical constraints. The seller uses part of the sales revenue to repay the debt. If unable to pay off the debt, the seller must go bankrupt and liquidate the remaining asset. Our analysis reveals that in the presence of debt, the optimal asset-selling policy must take into account two opposing forces: an incentive to sell part of the asset early to secure debt payment and an incentive to delay selling the asset to capture revenue potential under limited liability. We analyze how these two forces, originating from debt financing, will distort the seller’s optimal policy.