bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of phenotype classifiers across multiple sites in the observational health data sciences and informatics network
Authors: Kashyap Mehr , Seneviratne Martin , Banda Juan M , Falconer Thomas , Ryu Borim , Yoo Sooyoung , Hripcsak George , Shah Nigam H
Published: March 2020

Objective

Accurate electronic phenotyping is essential to support collaborative observational research. Supervised machine learning methods can be used to train phenotype classifiers in a high-throughput manner using imperfectly labeled data. We developed 10 phenotype classifiers using this approach and evaluated performance across multiple sites within the Observational Health Data Sciences and Informatics (OHDSI) network.

Materials and Methods

We constructed classifiers using the Automated PHenotype Routine for Observational Definition, Identification, Training and Evaluation (APHRODITE) R-package, an open-source framework for learning phenotype classifiers using datasets in the Observational Medical Outcomes Partnership Common Data Model. We labeled training data based on the presence of multiple mentions of disease-specific codes. Performance was evaluated on cohorts derived using rule-based definitions and real-world disease prevalence. Classifiers were developed and evaluated across 3 medical centers, including 1 international site.

Results

Compared to the multiple mentions labeling heuristic, classifiers showed a mean recall boost of 0.43 with a mean precision loss of 0.17. Performance decreased slightly when classifiers were shared across medical centers, with mean recall and precision decreasing by 0.08 and 0.01, respectively, at a site within the USA, and by 0.18 and 0.10, respectively, at an international site.

Discussion and Conclusion

We demonstrate a high-throughput pipeline for constructing and sharing phenotype classifiers across sites within the OHDSI network using APHRODITE. Classifiers exhibit good portability between sites within the USA, however limited portability internationally, indicating that classifier generalizability may have geographic limitations, and, consequently, sharing the classifier-building recipe, rather than the pretrained classifiers, may be more useful for facilitating collaborative observational research.
Determination of Vitamin K in Milk and Infant Formulas by Liquid Chromatography: Collaborative Study
Authors: Indyk Harvey E , Woollard David C
Published: March 2020

A simple procedure for determination of vitamin K1 was developed for routine compliance monitoring of supplemented infant formula and measurement of endogenous levels in milk and milk powders. Samples are digested with lipase and extracted into hexane; an aliquot is evaporated, reconstituted in methanol, and analyzed by reversed-phase LC. Post-column zinc reduction of phylloquinone facilitates detection by fluorescence. The procedure was subjected to an AOAC collaborative study involving 8 materials, each in blind duplicate, across the range of 5–120 μg/100 g solids and including NIST 1846 reference material. Thirty-three laboratories returned valid data which were then statistically analyzed for outliers and precision parameters. Mean RSDR (%) was 6.53 (4.33–10.94), with a mean HORRAT value of 0.33 (0.23–0.43) and RSDr:RSDR ratio of 0.74. K1 isomers (cis and trans) were aggregated with conventional C18 columns, but may be selectively estimated with use of the C30 column.
Simultaneous Determination of Residues of Chloramphenicol, Florfenicol, Florfenicol Amine, and Thiamphenicol in Shrimp Tissue by Gas Chromatography with Electron Capture Detection
Authors: Pfenning Allen P , Roybal José E , Rupp Heidi S , Turnipseed Sherri B , Gonzales Steve A , Hurlbut Jeffrey A
Published: March 2020

A gas chromatographic (GC) method is presented for determining residues of chloramphenicol (CAP), florfenicol (FF), florfenicol amine (FFa), and thiamphenicol (TAP) in shrimp tissues, with meta-nitrochloramphenicol (mCAP) as the internal standard. The composited shrimp is extracted with basic ethyl acetate, followed by an acetonitrile–basic ethyl acetate mixture. This extract is centrifuged, filtered, evaporated, and reconstituted in water; the reconstituted extract is acidified, defatted with hexane, and passed through a propylsulfonic acid (PRS) and C18 solid-phase extraction (SPE) system. The C18 SPE column is eluted with methanol, and the PRS SPE column is eluted with basic MeOH plus counter ion. The combined eluates are evaporated, reconstituted in acetonitrile, and derivatized with Sylon BFT. After derivatization, the addition of toluene directly to the sample, followed by the addition of basic water, quenches the derivatization process. After centrifugation, the organic layer is carefully removed, and the analytes are determined by GC with electron capture detection. Shrimp tissues were fortified with fenicols (i.e., CAP, FF, FFa, and TAP) at 5, 10, 20, 40, and 80 ng/mL. Overall recoveries were 88, 101, 91, and 84% with overall interassay (between-day) variabilities (i.e., relative standard deviations) of 5.3, 9.4, 12.8, and 7.4% for CAP, FF, FFa, and TAP, respectively. The method detection limits were calculated as 0.7, 1.4, 2.4, and 1.3 ng/g (ppb) for CAP, FF, FFa, and TAP, respectively, based on a 10 g sample. The quantitation limit as determined empirically by this method is the lower limit of the standard curve, which is about 5 ng/g (ppb) for each analyte.
Bayesian Discriminant Analysis of Yogurt Products Based on Raman Spectroscopy
Authors: Zhang Zheng-Yong , Yao An-Yang , Yue Tong-Tong , Niu Min-Qiu , Wang Hai-Yan
Published: March 2020

Background

The quality discrimination of dairy products is an important basis on which to achieve quality assurance.

Objective

Taking the discriminant analysis of brand yogurt products as an example, a new rapid discriminant method can be constructed.

Method

The first three principal components were selected as the pattern vectors of the samples. Then, at random, 75% of the samples were collected as a training set, and their mean values and covariance matrices were calculated to construct a Gauss Bayesian discriminant model. The remaining 25% of samples were employed as a test set, and the pattern vectors of each sample were input into the above model. Next, the posterior probability of each sample in relation to each category could be obtained. Results: The category corresponding to the maximum posterior probability as the brand classification of each sample was defined.

Conclusions

We constructed a Gauss Bayesian discriminant model to discriminate these different yogurt products after the principal component feature extraction of Raman properties. The results indicate the rationality and wide application prospects of this approach.

Highlights

A fast dairy product discriminant method based on Gauss Bayesian model and Raman spectroscopy was established.
Growth and development of North Pacific gray whales (Eschrichtius robustus)
Authors: Agbayani Selina , Fortune Sarah M E , Trites Andrew W
Published: March 2020

Understanding variability in growth patterns of marine mammals provides insights into the health of individuals and status of populations. Body growth of gray whales (Eschrichtius robustus) has been described for particular life stages, but has not been quantified across all ages. We derived a comprehensive growth equation for gray whales by fitting a two-phased growth model to age-specific length data of eastern North Pacific gray whales that were captured, stranded, or harvested between 1926 and 1997. To predict mass-at-age, we used the allometric relationship between mass and length. We found that on average (± SD), calves were 4.6 ± 0.043 m and 972 ± 26 kg at birth, and reached 8.5 ± 0.095 m and 6,019 ± 196 kg by the end of their first year of life (n = 118). Thus, calves almost double (2×) in length and octuple (8×) in mass while nursing, and are effectively about two-thirds of their asymptotic adult length and one-third of their maximum mass when weaned. The large sample of aged individuals (n = 730) indicates that gray whales live up to ~48 years and have a life expectancy of < 30 years. Adult females attain a mean (± SD) asymptotic size of 13.1 ± 0.048 m and 20,758 ± 222 kg, while the smaller males average 12.6 ± 0.048 m and 19,938 ± 222 kg at ~40 years of age. Females are thereby ~4% longer and heavier than males. These age-specific estimates of body size can be used to estimate food requirements and assess nutritional status of individuals.
Managing Forest Health through Collaboration on the Allegheny High Unglaciated Plateau
Authors: Hanson Joshua W , Hille Andrea T , Stout Susan L , McDonough Maureen , Oldland William
Published: March 2020

Forests in the High Allegheny Unglaciated Plateau Subsection of Pennsylvania and New York, including the Allegheny National Forest, have been increasingly impacted by an array of native and introduced forest insects, pathogens, plants, and other disturbances for decades. An unbalanced age-class distribution, changing soil nutrient status, seedling establishment issues, droughts, and storm events also threaten forest health and structure. In 2017, the Allegheny National Forest convened a broad cross-section of forest stakeholders to collaboratively assess and prioritize these threats and develop effective strategies to address them. Relying on consensus and shared learning, the Allegheny Forest Health Collaborative assigned priorities and created working groups to address priority threats. This paper describes the collaboration and features a case study of followup, multilandowner work to assign treatment priorities to affected stands and develop silvicultural strategies for stands with poor and decreasing seed source.
School Exclusions During Selected Pertussis Outbreaks, Oregon, 2017–2018
Authors: Liko Juventila , Cieslak Paul R
Published: March 2020

Fifteen Oregon schools excluded undervaccinated students when struck by pertussis outbreaks during the 2017–2018 school year. Of 243 under- or unvaccinated, exposed, students in these schools, 134 (55%) accepted vaccination, and 87 (36%) were excluded and missed a total of 975½ school days. No excluded students were subsequently reported as cases.
Rash and Mucositis Associated With Mycoplasma pneumoniae and Chlamydophila pneumoniae: A Recurrence of MIRM?
Authors: Brazel Danielle , Kulp Brooke , Bautista Geoanna , Bonwit Andrew
Published: March 2020

Introduction

A new concept has come to light recently, that is, Mycoplasma-induced rash and mucositis (MIRM). Here, we report the first case of recurrent rash, mucositis, and conjunctivitis involving Mycoplasma pneumoniae and C. pneumoniae that fits under the criteria of what is currently defined as MIRM.

Case Presentation

A patient aged 12 years with a history of recurrent aphthous ulcers presented in 2013 with worsening oral lesions, conjunctivitis, and vesicular rash. Her respiratory polymerase chain reaction (PCR) panel was positive for M. pneumoniae. She was diagnosed with Stevens-Johnson syndrome (SJS) secondary to M. pneumoniae and treated with a macrolide, acyclovir, and intravenous immunoglobulin (IVIG). The same patient returned 3 years later with an identical constellation of symptoms, at which time her PCR was positive for C. pneumoniae. In addition to IVIG and a macrolide, a corticosteroid treatment was administered.

Discussion

Here, we present the case of a pediatric patient with a recurrence of mucocutaneous disease that is more consistent with MIRM than the proposed SJS or erythema multiforme (EM) documented via histology. Our patient’s symptoms were controlled with azithromycin and IVIG and, in the second episode, with corticosteroids as well. This case adds to that of Mayor-Ibarguren et al, providing further evidence that C. pneumonia may also be a trigger for MIRM. Patients will benefit from expanding the definition of MIRM, as the pathogenesis differs from SJS and EM and could result in more specific treatment options.
Interrupting transmission of COVID-19: lessons from containment efforts in Singapore
Authors: Lee Vernon J , Chiew Calvin J , Khong Wei Xin
Published: March 2020

Despite multiple importations resulting in local chains of transmission, Singapore has been able to control the COVID-19 outbreak without major disruption to daily living. In this article, we describe the combination of measures taken by Singapore to contain COVID-19 and share some early lessons learnt from the experience.
A weak spectral signature of water vapour in the atmosphere of HD 179949 b at high spectral resolution in the L band
Authors: Webb Rebecca K , Brogi Matteo , Gandhi Siddharth , Line Michael R , Birkby Jayne L , Chubb Katy L , Snellen Ignas A G , Yurchenko Sergey N
Published: March 2020

High-resolution spectroscopy ($R\, \geqslant \, 20\, 000$) is currently the only known method to constrain the orbital solution and atmospheric properties of non-transiting hot Jupiters. It does so by resolving the spectral features of the planet into a forest of spectral lines and directly observing its Doppler shift while orbiting the host star. In this study, we analyse VLT/CRIRES ($R=100\, 000$) L-band observations of the non-transiting giant planet HD 179949 b centred around 3.5 ${\mu {m}}$. We observe a weak (3.0σ, or S/N = 4.8) spectral signature of H2O in absorption contained within the radial velocity of the planet at superior-conjunction, with a mild dependence on the choice of line list used for the modelling. Combining this data with previous observations in the K band, we measure a detection significance of 8.4 σ for an atmosphere that is most consistent with a shallow lapse-rate, solar C/O ratio, and with CO and H2O being the only major sources of opacity in this wavelength range. As the two sets of data were taken 3 yr apart, this points to the absence of strong radial-velocity anomalies due, e.g. to variability in atmospheric circulation. We measure a projected orbital velocity for the planet of KP = (145.2 ± 2.0) km s−1 (1σ) and improve the error bars on this parameter by ∼70 per cent. However, we only marginally tighten constraints on orbital inclination ($66.2^{+3.7}_{-3.1}$ deg) and planet mass ($0.963^{+0.036}_{-0.031}$ Jupiter masses), due to the dominant uncertainties of stellar mass and semimajor axis. Follow ups of radial-velocity planets are thus crucial to fully enable their accurate characterization via high-resolution spectroscopy.
R-process enrichment in ultrafaint dwarf galaxies
Authors: Tarumi Yuta , Yoshida Naoki , Inoue Shigeki
Published: March 2020

We study the enrichment and mixing of r-process elements in ultrafaint dwarf galaxies (UFDs). We assume that r-process elements are produced by neutron-star mergers (NSMs), and examine multiple models with different natal kick velocities and explosion energies. To this end, we perform cosmological simulations of galaxy formation to follow mixing of the dispersed r-process elements driven by star formation and the associated stellar feedback in progenitors of UFDs. We show that the observed europium abundance in Reticulum II is reproduced by our inner explosion model where an NSM is triggered at the centre of the galaxy, whereas the relatively low abundance in Tucana III is reproduced if an NSM occurs near the virial radius of the progenitor galaxy. The latter case is realized only if the neutron-star binary has a large natal kick velocity and travels over a long distance of a kiloparsec before merger. In both the inner and outer explosion cases, it is necessary for the progenitor galaxy to sustain prolonged star formation over a few hundred million years after the NSM, so that the dispersed r-process elements are well mixed within the interstellar medium. Short-duration star formation results in inefficient mixing, and then a large variation is imprinted in the stellar europium abundances, which is inconsistent with the observations of Reticulum II and Tucana III.
The synthetic Emission Line COSMOS catalogue: Hα and [O ii] galaxy luminosity functions and counts at 0.3 < z < 2.5
Authors: Saito Shun , de la Torre Sylvain , Ilbert Olivier , Dubois Cédric , Yabe Kiyoto , Coupon Jean
Published: March 2020

Star-forming galaxies with strong nebular and collisional emission lines are privileged target galaxies in forthcoming cosmological large galaxy redshift surveys. We use the COSMOS2015 photometric catalogue to model galaxy spectral energy distributions and emission-line fluxes. We adopt an empirical but physically motivated model that uses information from the best-fitting spectral energy distribution of stellar continuum to each galaxy. The emission-line flux model is calibrated and validated against direct flux measurements in subsets of galaxies that have 3D-HST or zCOSMOS-Bright spectra. We take a particular care in modelling dust attenuation such that our model can explain both Hα and [O ii] observed fluxes at different redshifts. We find that a simple solution to this is to introduce a redshift evolution in the dust attenuation fraction parameter, f = Estar(B − V)/Egas(B − V), as f(z) = 0.44 + 0.2z. From this catalogue, we derive the Hα and [O ii] luminosity functions up to redshifts of about 2.5 after carefully accounting for emission line flux and redshift errors. This allows us to make predictions for Hα and [O ii] galaxy number counts in next-generation cosmological redshift surveys. Our modelled emission lines and spectra in the COSMOS2015 catalogue shall be useful to study the target selection for planned next-generation galaxy redshift surveys and we make them publicly available as ‘EL-COSMOS’ on the ASPIC data base.
Label-free multiphoton imaging allows brain tumor recognition based on texture analysis—a study of 382 tumor patients
Authors: Uckermann Ortrud , Galli Roberta , Mark Georg , Meinhardt Matthias , Koch Edmund , Schackert Gabriele , Steiner Gerald , Kirsch Matthias
Published: March 2020

Background

Label-free multiphoton microscopy has been suggested for intraoperative recognition and delineation of brain tumors. For any future clinical application, appropriate approaches for image acquisition and analysis have to be developed. Moreover, an evaluation of the reliability of the approach, taking into account inter- and intrapatient variability, is needed.

Methods

Coherent anti-Stokes Raman scattering (CARS), two-photon excited fluorescence (TPEF), and second-harmonic generation were acquired on cryosections of brain tumors of 382 patients and 28 human nontumor brain samples. Texture parameters of those images were calculated and used as input for linear discriminant analysis.

Results

The combined analysis of texture parameters of the CARS and TPEF signal proved to be most suited for the discrimination of nontumor brain versus brain tumors (low- and high-grade astrocytoma, oligodendroglioma, glioblastoma, recurrent glioblastoma, brain metastases of lung, colon, renal, and breast cancer and of malignant melanoma) leading to a correct rate of 96% (sensitivity: 96%, specificity: 100%). To approximate the clinical setting, the results were validated on 42 fresh, unfixed tumor biopsies. 82% of the tumors and, most important, all of the nontumor samples were correctly recognized. An image resolution of 1 µm was sufficient to distinguish brain tumors and nontumor brain. Moreover, the vast majority of single fields of view of each patient’s sample were correctly classified with high probabilities, which is important for clinical translation.

Conclusion

Label-free multiphoton imaging might allow fast and accurate intraoperative delineation of primary and secondary brain tumors in combination with endoscopic systems.
A Novel Technical Refinement of Microvascular Decompression: Pain Relief and Complication Rate in a Consecutive Series of Patients With Trigeminal Neuralgia
Authors: Tomasello Francesco , Germanò Antonino , Lavano Angelo , Romano Alberto , Cafarella Daniele , Gorgoglione Nicola , La Torre Domenico
Published: March 2020

BACKGROUND

Microvascular decompression (MVD) represents a milestone for the treatment of trigeminal neuralgia (TN). Nevertheless, several complications still occur and may negatively affect the outcome. We recently proposed some technical nuances for complication avoidance related to MVD.

OBJECTIVE

To verify the efficacy of the proposed refinement of the standard MVD technique in terms of resolution of the pain and reduction of complication rates.

METHODS

We analyzed surgical and outcome data of patients with TN using a novel surgical refinement to MVD, over the last 4 yr. Outcome variables included pain relief, facial numbness, muscular atrophy, local cutaneous occipital and temporal pain or numbness, cerebellar injury, hearing loss, cranial nerve deficits, wound infection, and cerebrospinal fluid (CSF) leak. Overall complication rate was defined as the occurrence of any of the aforementioned items.

RESULTS

A total of 72 consecutive patients were enrolled in the study. Pain relief was achieved in 91.6% and 88.8% of patients at 1- and 4-yr follow-up, respectively. No patient reported postoperative facial numbness during the entire follow-up period. The incidence of CSF leak was 1.4%. One patient developed a complete hearing loss and another a minor cerebellar ischemia. There was no mortality. The overall complication rate was 5.6%, but only 1.4% of patients experienced permanent sequelae.

CONCLUSION

The proposed refinement of the standard MVD technique has proved effective in maintaining excellent results in terms of pain relief while minimizing the overall complication rate associated with this surgical approach.
A Tale of Two Women: A Comparative Gendered Media Analysis of UK Prime Ministers Margaret Thatcher and Theresa May
Authors: Williams Blair E
Published: March 2020

This article compares how the print media portrayed Margaret Thatcher and Theresa May in the first three weeks of their respective prime ministerial terms. Examining the similarities and differences between the media coverage of the two leaders, who ascended to the prime ministerial role almost 40 years apart, helps us understand how mainstream media coverage concentrates on the gendered differences of women political leaders from the masculine leadership norm. Seven major daily newspapers were examined, using feminist content analysis and feminist critical discourse analysis. The study revealed that, contrary to expectations, not only was there more attention to May’s gender than to Thatcher’s, but it was also more detailed and elaborate, particularly in the conservative press.
Pharmacare in Canada: The paediatric perspective
Authors: McLaughlin Tom , Jong Geert ‘t , Gilpin Andrea , Hepburn Charlotte Moore
Published: March 2020

Canada’s drug insurance system is one of the most expensive in the world, yet millions of Canadians still struggle to access necessary medications. As a result, provincial, territorial, and federal governments are considering public pharmacare policy proposals to ensure that all Canadians can access the medications they need. Pharmacare policies offer an opportunity to prioritize children and youth, whose unique drug needs have long been neglected. Prescription drug use is common in this population, with approximately half of Canadian children and youth requiring at least one prescription in any given year. Drug use remains concentrated, however, among those with complex, chronic, and serious diseases. Children and youth rely heavily on compounded and off-label prescription drugs, which impacts safety, efficacy, palatability, and cost. Reimbursement decision-making bodies do not appropriately value the unique benefits of paediatric drugs, including child-friendly formulations, improved quality of life for children and families, and cost-savings outside the healthcare system. Regardless of the pharmacare model ultimately implemented, ensuring universal, comprehensive, and portable prescription drug coverage for all children and youth is essential. To accomplish this, paediatric drug experts should develop a national, evidence-informed formulary of paediatric drugs. Health Canada should also improve processes to make commercial paediatric drugs and child-friendly formulations more available and accessible. The federal government must also support paediatric drug research and development to this end.
The Discrepancy of (nkx)k=1∞ With Respect to Certain Probability Measures
Authors: Technau Niclas , Zafeiropoulos Agamemnon
Published: March 2020

Let $(n_k)_{k=1}^{\infty }$ be a lacunary sequence of integers. We show that if $\mu$ is a probability measure on $[0,1)$ such that $|\widehat{\mu }(t)|\leq c|t|^{-\eta }$, then for $\mu$-almost all $x$, the discrepancy $D_N(n_kx)$ satisfies $$\begin{equation*}\frac{1}{4} \leq \limsup_{N\to\infty}\frac{N D_N(n_kx)}{\sqrt{N\log\log N}} \leq C\end{equation*}$$for some constant $C>0$. This proves a conjecture of Haynes, Jensen and Kristensen and allows an improvement on their previous result relevant to an inhomogeneous version of the Littlewood conjecture.
Novel whole-body magnetic resonance imaging response and remission criteria document diminished inflammation during golimumab treatment in axial spondyloarthritis
Authors: Krabbe Simon , Eshed Iris , Sørensen Inge J , Møller Jakob , Jensen Bente , Madsen Ole R , Klarlund Mette , Pedersen Susanne J , Østergaard Mikkel
Published: March 2020

Objectives

To investigate criteria for treatment response and remission in patients with axial SpA as assessed by whole-body magnetic resonance imaging (WB-MRI) of axial and peripheral joints and entheses during treatment with golimumab.

Methods

We performed an investigator-initiated cohort study of 53 patients who underwent WB-MRI at weeks 0, 4, 16 and 52 after initiation of golimumab. Images were assessed according to the Spondyloarthritis Research Consortium of Canada MRI SI joint inflammation index, Canada–Denmark MRI spine inflammation score and the MRI peripheral joints and entheses inflammation index.

Results

At weeks 4, 16 and 52, WB-MRI demonstrated an at least 50% reduction of MRI inflammation of the sacroiliac joints in 16, 29 and 32 (30%, 55% and 60%) patients, of the spine in 20, 30 and 31 (38%, 57% and 58%) patients and of peripheral joints and entheses in 8, 17 and 15 (15%, 32% and 28%) patients, respectively. The BASDAI50 response was achieved by 29, 31 and 31 (55%, 58% and 58%) patients, while ASDAS clinically important improvement (ASDAS-CII) was achieved by 37, 40 and 34 (70%, 75% and 64%) patients. WB-MRI remission criteria for spine, sacroiliac joints and peripheral joints and entheses were explored; total WB-MRI remission was attained by 2, 6 and 3 (4%, 11% and 6%) patients. At week 16, among 35 patients with an at least 50% reduction in the MRI Axial Inflammation Index (sacroiliac joint and spine inflammation), 29 (83%) achieved BASDAI50 and 35 (100%) achieved ASDAS-CII; among 16 patients with MRI axial inflammation non-response, 14 (88%) were BASDAI50 non-responders and 11 (69%) did not achieve ASDAS-CII.

Conclusion

WB-MRI demonstrated a significant reduction of inflammation in both the spine, sacroiliac joints and peripheral joints and entheses during golimumab treatment. Few patients achieved total WB-MRI remission. Combining spinal and sacroiliac joint inflammation in an MRI Axial Inflammation Index increased the ability to capture response.

Trial registration

ClinicalTrials.gov, http://clinicaltrials.gov, NCT02011386.
All in the balance: sustainable investment and the role of the fiduciary
Authors: Wickham Henry
Published: March 2020

Sustainable investing is generating a lot of interest in terms of catering for the needs and desires of the next generation and baby boomers alike. In particular, global transparency is focusing clients’ minds more on the responsibility that wealth brings and, on the flipside, the potential for large-scale reputational risk if this is ignored.
Alternaria Leaf Spot Caused by Alternaria Species: An Emerging Problem on Ornamental Plants in Italy
Authors: Matić Slavica , Tabone Giulia , Garibaldi Angelo , Gullino Maria Lodovica
Published: March 2020

Serious outbreaks of Alternaria leaf spot and plant decay have recently been recorded on several ornamental plants in the Biella Province (Northern Italy). Twenty-two fungal isolates were obtained from Alternaria infected plant tissues from 13 ornamental hosts. All the isolates were identified morphologically as small-spored Alternaria species. Multilocus sequence typing, carried out by means of ITS, rpb2, tef1, endoPG, Alt a 1, and OPA10-2, assigned 19 isolates as Alternaria alternata, two isolates as belonging to the Alternaria arborescens species complex, and one isolate as an unknown Alternaria sp. Haplotype analyses of ornamental and reference A. alternata isolates from 12 countries identified 14 OPA10-2 and 11 endoPG haplotypes showing a relatively high haplotype diversity. A lack of host specialization or geographic distribution was observed. The host range of the studied A. alternata isolates expanded in cross-pathogenicity assays, and more aggressiveness was frequently observed on the experimental plants than on the host plants from which the fungal isolates were originally isolated. High disease severity, population expansion, intraspecies diversity, and increased range of experimental hosts were seen in the emergence of Alternaria disease on ornamentals. More epidemiological and molecular studies should be performed to better understand these diseases, taking into consideration factors such as seed transmission and ongoing climate changes.
Adverse Infant and Maternal Outcomes Among Low-Risk Term Pregnancies Stratified by Race and Ethnicity
Authors: Parchem Jacqueline G. , Gupta Megha , Chen Han-Yang , Wagner Stephen , Mendez-Figueroa Hector , Chauhan Suneet P.
Published: March 2020

OBJECTIVE:

To assess whether racial and ethnic disparities in adverse infant and maternal outcomes exist among low-risk term pregnancies.

METHODS:

This population-based retrospective cohort study used U.S. vital statistics data from 2014 to 2017. Women with low-risk, nonanomalous singleton pregnancies who labored and delivered at 37–41 weeks of gestation were included and categorized by maternal race and ethnicity: non-Hispanic white (white), non-Hispanic black (black), Hispanic, and non-Hispanic Asian (Asian). Multivariable Poisson regression models were used to estimate the associations of composite neonatal adverse outcome (Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, neonatal seizure, or neonatal death), infant mortality, and composite maternal adverse outcome (blood transfusion, admission to the intensive care unit, uterine rupture, or unplanned hysterectomy) with maternal race and ethnicity.

RESULTS:

Of 9,205,873 women included, 55.5% were white, 13.7% were black, 24.3% were Hispanic, and 6.5% were Asian. Risk for the composite neonatal adverse outcome was higher among neonates of black women (unadjusted relative risk [uRR] 1.16, 95% CI 1.13–1.18; adjusted relative risk [aRR] 1.07, 95% CI 1.05–1.10), and lower for neonates of Hispanic and Asian women compared with neonates of white women. A similar pattern of disparity was observed for infant mortality; the risk for infants of black women was significantly increased (uRR 1.89, 95% CI 1.81–1.98; aRR 1.33, 95% CI 1.26–1.39). For the composite maternal adverse outcome, the risk was highest for Asian mothers (uRR 1.09, 95% CI 1.03–1.14; aRR 1.12, 95% CI 1.06–1.18), lowest for Hispanic mothers, and similar for black mothers when compared with white mothers after adjustment for confounders.

CONCLUSION:

Among low-risk term pregnancies, the risk for adverse outcomes varied by maternal race and ethnicity. Infants of black women were at the highest risk for neonatal morbidity and infant mortality, and Asian mothers were most likely to experience maternal adverse outcomes.
Regional and Racial–Ethnic Differences in Perinatal Interventions Among Periviable Births
Authors: Boghossian Nansi S. , Geraci Marco , Edwards Erika M. , Ehret Danielle E.Y. , Saade George R. , Horbar Jeffrey D.
Published: March 2020

OBJECTIVE:

To examine whether there are: 1) regional differences in three perinatal interventions that reflect active treatment among periviable gestations and 2) racial–ethnic differences in the receipt of these perinatal interventions after accounting for hospital region.

METHODS:

We conducted a retrospective study on neonates born at 776 U.S. centers that participated in the Vermont Oxford Network (2006–2017) with a gestational age of 22–25 weeks. The primary outcome was postnatal life support. Secondary outcomes included maternal administration of antenatal corticosteroids and cesarean delivery. We examined rates and 99% CI of the three outcomes by region. We also calculated the adjusted relative risks (aRRs) and 99% CIs for the three outcomes by race and ethnicity within each region using modified Poisson regression models with robust variance estimation.

RESULTS:

Major regional variation exists in the use of the three interventions at 22 and 23 weeks of gestation but not at 24 and 25 weeks. For example, at 22 weeks of gestation, rates of life support in the South (38.3%; 99% CI 36.3–40.2) and the Midwest (32.7%; 99% CI 30.4–35.0) were higher than in the Northeast (20.2%; 99% CI 17.6–22.8) and the West (22.2%; 99% CI 20.0–24.4). Particularly in the Northeast, black and Hispanic neonates born at 22 or 23 weeks of gestation had a higher provision of postnatal life support than white neonates (at 22 weeks: black: aRR 1.84 [99% CI 1.33–2.56], Hispanic: aRR 1.80 [1.23–2.64]; at 23 weeks: black: aRR 1.14 [99% CI 1.08–1.20], Hispanic: aRR 1.12 [1.05–1.19]). In the West, black and Hispanic neonates born at 23 weeks of gestation also had a higher provision of life support (black: aRR 1.11 [99% CI 1.03–1.19]; Hispanic: aRR 1.10 [1.04–1.16]).

CONCLUSION:

Major regional variation exists in perinatal interventions when managing 22- and 23-week neonates. In the Northeast and the West regions, minority neonates born at 22 and 23 weeks of gestation had higher provision of postnatal life support.
Distal femoral deformity correction by percutaneous open-wedge osteotomy and a simplified external fixation technique: a retrospective case series
Authors: Atef Ashraf , El-Rosasy Mahmoud , El-Gebaly Osama
Published: March 2020

Background:

Varus and valgus distal femoral malalignments increase medial and lateral loads of the knee respectively. Early femoral realignment osteotomy reduces symptoms and may prevent joint degeneration. Several osteotomy techniques and fixation methods have been described to maintain such corrective osteotomy. There is little evidence supporting the choice of one technique over the other for correction of distal femoral deformities. The aims of this study were to determine if a minimally invasive external fixation technique could correct deformity and report treatment-related complications.

Methods:

Fifty-two limbs in 30 patients presented with distal femoral deformities due to different etiologies. The patients underwent minimally invasive external fixation techniques with a minimum 2-year follow-up. Their ages ranged from 14 to 24 years (average 20.8 years). Limb length discrepancy (LLD) was present in eight patients and ranged from 4 to 8 cm (average 5.4 cm). The deformity was valgus in 38 limbs and varus in 14 limbs.

Results:

All osteotomies united successfully after an average 5.2 months, and the external fixation index was an average of 1.1 months/cm. None of the patients had residual deformity or LLD. All patients reported a satisfactory outcome except two patients who had loss of the last 10 degrees of knee flexion. Superficial pin track infection occurred in all patients, but no nerve or vascular injuries or deep infections occurred.

Conclusions:

The distal femoral osteotomy (DFO) with a unilateral Ilizarov fixator modification is an entirely percutaneous procedure that has less risk of primary or secondary loss of correction. Stability of the construct allows early mobilization.

Level of Evidence:

Level IV.
A retrospective cohort review of opioid prescribing and patient-reported consumption patterns following upper extremity surgery
Authors: Turcotte Justin J. , Palsgrove Andrew C. , Fowler Marcia B. , Adams Stephanie A. , Crowley Kevin R. , Gelfand Jeffrey M.
Published: March 2020

Background:

Across upper extremity procedures, patients are being prescribed approximately three times the opioid medication needed. The aim of this study was to evaluate opioid prescribing and consumption trends for patients undergoing various upper extremity surgeries at a regional medical center to further refine prescribing guidelines.

Methods:

A retrospective review of 152 patients undergoing shoulder, wrist, and forearm or hand surgery who completed a patient-reported opioid consumption tracking form between June 2017 and May 2018 was conducted. Opioid prescription and consumption data were converted into morphine milligram equivalents (MMEs).

Results:

Average total MME prescribed for the population was 147.5±130.1 MME and was significantly different across procedures (P<0.001). Average MME taken across the cohort was 55.5±61.5 with significant differences across procedure types (P<0.001). Controlling for gender and patient age, when compared with shoulder patients, patients undergoing wrist and forearm or hand procedures were significantly less likely to be overprescribed (OR=0.309, P=0.014; OR=0.225, P=0.001) and were overprescribed less MME on average (wrist and forearm β=−120.1, P<0.001; hand β=−144.4, P<0.001). There was no significant difference in the percentage of patients requiring second opioid fills, with an average refill rate of 14.5% across the cohort (P=0.116).

Conclusions:

Significant differences in the need for opioid analgesia exist across upper extremity procedures, with shoulder surgery patients being overprescribed most frequently and by the highest MMEs. Due to the variability in narcotic utilization, patient-specific factors must be considered by providers when determining optimal opioid prescribing levels.

Level of Evidence:

Level IV.
The 2019 Cervical Spine Research Society (CSRS) Asia Pacific Traveling Fellowship
Authors: Aleem Ilyas , Tan Lee , Bosco Aju , Reinas Rui , ter Wengel Paula V. , Dennis Hey Hwee Weng
Published: March 2020

The Cervical Spine Research Society (CSRS) is dedicated to advancing the care of patients with cervical spine pathology. The authors present here highlights of the 2019 CSRS-Asia Pacific Traveling Fellowship.
The relationship between the index of nutritional quality and the risk of colorectal cancer and adenoma : a case-control study
Authors: Bahrami Alireza , Rafiee Pegah , Jafari Nasab Saeede , Hekmatdoost Azita , Sohrab Golbon , Sadeghi Amir , Hejazi Ehsan
Published: March 2020

Objective:

Colorectal cancer is one of the most common cancers in the world, whereas dietary factors are its most modifiable risk factors. The index of nutritional quality is considered as a general overview of the nutrient content of diet. The aim of this study is to determine the relationship between the index of nutritional quality and the risk of colorectal cancer and adenomas.

Methods:

Overall, 129 colorectal cancer and 130 colorectal adenoma cases and 240 healthy controls were studied in three major general hospitals in Tehran province, Iran. Index of nutritional quality scores were calculated based on information on the usual diet that was assessed by a valid and reliable Food Frequency Questionnaire. Multivariate logistic regression was used to estimate the relationship between the index of nutritional quality scores and the risk of colorectal cancer and adenoma.

Results:

After controlling for several confounding factors, the index of nutritional quality of calcium, vitamin C, riboflavin, folate and fiber were associated with decreased risk of colorectal cancer [ORcalcium: 0.21 (0.08–0.52), ORvitC: 0.16 (0.09–0.28), ORvitB2: 0.35 (0.18–0.65), ORfolate: 0.33 (0.16–0.65), ORfiber: 0.35 (0.21–0.58)]. Also, the inverse association were observed between risk of CRA and the index of nutritional quality of calcium, vitamin C, riboflavin, folate and fiber [OR calcium: 0.32 (0.14–0.74), ORvitC: 0.51 (0.34–0.73), ORvitB2: 0.48 (0.28–0.82), OR folate: 0.44 (0.23–0.81), OR fiber: 0.62 (0.42–0.92)].

Conclusion:

This study showed that individuals who have a healthier diet, high in calcium, vitamin C, riboflavin, folate and fiber and food groups like fruits, vegetables and whole-grain and less in sweets and red or process meats are at a lower risk of colorectal cancer and CRA than those with unhealthy and poor diet.
Prevalence of Cervical Cancer Overscreening
Authors: Franklin Mary , Webel Allison , Kaelber David , Evans Jill , Kelley Carol
Published: March 2020

Appropriately matching preventive health services and screenings with patient risk is an important quality indicator. Adherence by both providers and patients to cervical cancer screening guidelines has been inconsistent, resulting in overscreening and increased costs. This study examined the prevalence of cervical cancer overscreening following changes in screening guidelines in a wellness registry database. Cervical cancer overscreening after guideline implementation decreased for 18- to 20-year-old patients from 26.8% to 24.8% (P < .001) and increased for those aged 65 years and older from 11.1% to 12.5% (P = .0005). Black race, Hispanic ethnicity, Medicaid insurance, and the presence of a personal health record were associated with overscreening. Reliability and accuracy of data are a concern when data intended for one purpose, such as clinical care, are used for research. Correctly identifying screening tests in the electronic health record is important so that appropriate screening can be reliably assessed. In this study on the prevalence of cervical cancer overscreening, we used a focused chart review to identify whether screening Pap tests were accurately identified in the electronic medical record. Pap tests were correctly identified as screening in 85% of those aged 18 to 20, and in 74% of those aged 65 and older.
Assessing the Healthy People 2020 Objective to Expand Early Treatment Receipt Among a National Sample of Children with Autism Spectrum Disorder
Authors: Yingling Marissa E. , Creel Liza M. , Bell Bethany A.
Published: March 2020

Objective:

To assess the progress of the Healthy People 2020 (HP2020) objective to increase the proportion of children with autism spectrum disorder (ASD) who receive treatment by 48 months old and to examine the relationship between predisposing, enabling, and need factors and age of initial treatment receipt.

Method:

We used data from the National Survey of Children's Health, 2016 to 2017, a nationally representative study of US children. Our sample included children aged 3 to 17 years old with ASD who received treatment (N = 1333). We conducted χ2 goodness of fit tests and logistic regression.

Results:

The HP2020 objective to enroll 57.6% of 8-year-old children with ASD in treatment by 48 months old was not met (40.9%). Among 3- to 5-year-old children with ASD, the proportion who received treatment by 48 months old was more than double that of 8-year-old children (88.3%). We detected social inequities and significant differences by provider type and state mandate.

Conclusion:

Research with larger samples is needed to continue tracking progress. If the goal continues not to be met, work will be required to explain stagnation and to inform additional targeted efforts to reduce the age of initial treatment.
Parental Perceptions About Alcohol Use for Their Adolescent with Attention-Deficit/Hyperactivity Disorder
Authors: Harstad Elizabeth , Sideridis Georgios , Kaye Dylan , Wisk Lauren E. , Weitzman Elissa R. , Levy Sharon
Published: March 2020

Objective:

Alcohol use can worsen attention-deficit/hyperactivity disorder (ADHD) symptoms, interfere with treatment, and worsen outcomes. Our objective was to describe parental perceptions of alcohol use for their adolescents with ADHD.

Methods:

Parents of adolescents with ADHD completed an online survey about perceptions of adolescent alcohol use for adolescents with ADHD. We described the level of parental concern about the impacts of alcohol use on their adolescent's functioning. We assessed whether specific covariates were associated with the level of parental concern.

Results:

Of 290 parents who completed the survey, 96.5% were women, and 66.1% had an educational attainment of college degree or higher. Most adolescents (75.4%) took ADHD medication, and 59.9% had comorbid anxiety or depression. Almost one-third (30.3%) of parents perceived that their adolescent was more likely to use alcohol because of ADHD, whereas 34.8% of parents disagreed with this and 34.8% of parents were neutral. Parents who suspected their adolescent regularly used alcohol were less likely to report concern about the impact of alcohol on their adolescent's school performance or ADHD medication effectiveness compared with parents who did not suspect regular adolescent alcohol use. Almost half of the parents (48.5%) did not report discussing the impact of alcohol use on ADHD with their adolescent.

Conclusion:

Many parents of adolescents with ADHD do not understand the unique risks of alcohol use for their adolescents. In addition, if alcohol use harm is not obvious, parents may not perceive there to be concerns about alcohol use on functioning. Parental education about alcohol use and ADHD is needed.
Assessment of the Accuracy of Identification of Selected Disabilities and Conditions in Hospital Discharge Data for Pregnant Women
Authors: Schwartz Naomi R. M. , Crane Deborah A. , Doody David R. , Schiff Melissa A. , Mueller Beth A.
Published: March 2020

Background:

Linked birth certificate–hospital discharge records are a valuable resource for examining pregnancy outcomes among women with disability conditions. Few studies relying on these data have been able to assess the accuracy of identification of preexisting disability conditions. We assessed the accuracy of International Classification of Diseases version 9 (ICD9) codes for identifying selected physical, sensory, and intellectual conditions that may result in disability. As ICD9 codes were utilized until recently in most states, this information is useful to inform analyses with these records.

Methods:

We reviewed 280 of 311 (90%) medical records of pregnant women with disabilities based on ICD9 codes and 390 of 8,337 (5%) records of pregnant women without disabilities who had deliveries at a large university medical center. We estimated sensitivity, specificity, and positive predictive values (PPV) using the medical record as gold standard. We adjusted for verification bias using inverse probability weighting and imputation.

Results:

The estimated sensitivity of ICD9 codes to identify women with disabilities with deliveries 2009–2012 was 44%; PPV was 98%, improving over time. Although sensitivity was <50% for some conditions, PPVs were 87%–100% for all conditions except intellectual disability (67%). Many physical conditions had complete verification and no underreporting.

Conclusions:

These results are helpful for new studies using historical data comparing outcomes among women with and without these conditions and to inform interpretation of results from earlier studies. Assessment of the accuracy of disabilities as identified by ICD version 10 codes is warranted.