bluuebunny/crossref_metadata_2025 huggingface dataset:
In homage to Descartes and Spinoza: A cosmo‐ontological case for God
Authors: Istvan Michael Anthony
Published: February 2021

Integrating cosmological and ontological lines of reasoning, I argue that there is a self‐necessary being that (a) serves as the sufficient condition for everything, that (b) has the most perfect collection of whatever attributes of perfection there might be, and that (c) is an independent, eternal, unique, simple, indivisible, immutable, all‐actual, all‐free, all‐present, all‐powerful, all‐knowing, all‐good, and personal creator of every expression of itself that everything is. My cosmo‐ontological case for such a being, an everything‐maker with the core features ascribed to the God of classical theism, addresses the standard worries plaguing these lines of reasoning: (1) the richness required of such a being dissolves it into many beings; (2) the metaphysical possibility of such a being is assumed on insufficient grounds; (3) the features we ascribe to such a being are mere human‐all‐too‐human projections.
Personal reflections on navigating the COVID‐19 pandemic: From vision to reality
Authors: Webb Karelle
Published: February 2021

Transitioning from bedside nursing to public health nursing after graduating with my Master's in Public Health was a unique experience, particularly as I navigated the COVID‐19 pandemic as a new public health and nursing leader. Personal reflection pieces can provide a meaningful review of the experiences of integrating clinical nursing practice and more broad public health practice. The purpose of this paper is to offer my reflection and synthesis of the lessons learned while leading a Federally Qualified Health Center (FQHC) through the COVID‐19 pandemic. Additionally, I reflect on the future of FQHCs and the critical need to advance public health as a field and empower public health nurses.
Why and how does the regulation of emerging technologies occur? Explaining the adoption of the EU General Data Protection Regulation using the multiple streams framework
Authors: Goyal Nihit , Howlett Michael , Taeihagh Araz
Published: February 2021

Why and how the regulation of emerging technologies occurs is not clear in the literature. In this study, we adapt the multiple streams framework – often used for explaining agenda‐setting and policy adoption – to examine the phenomenon. We hypothesize how technological change affects policy‐making and identify conditions under which the streams can be (de‐)coupled. We trace the formulation of the General Data Protection Regulation to show that the regulation occupied the legislative agenda when a policy window was exploited through policy entrepreneurship to frame technological change as a problem for data privacy and legislative harmonization within the European Union. Although constituencies interested in promoting internet technologies made every effort to stall the regulation, various actors, activities, and events helped the streams remain coupled, eventually leading to its adoption. We conclude that the alignment of problem, policy, politics, and technology – through policy entrepreneurship – influences the timing and design of technology regulation.
Physiology and pathology of eosinophils: Recent developments
Authors: Renz Harald , Bachert Claus , Berek Claudia , Hamelmann Eckard , Levi‐Schaffer Francesca , Raap Ulrike , Simon Hans‐Uwe , Ploetz Sabine , Taube Christian , Valent Peter , Voehringer David , Werfel Thomas , Zhang Nan , Ring Johannes
Published: February 2021

Over the last century, eosinophils have been regarded ambiguously either as ‘friends’ or ‘foes’. Recent developments have greatly enhanced our understanding of the role and function of eosinophils in health and disease. Pathogenic eosinophilic inflammation can lead to severe diseases in various organs, such as the gastrointestinal tract, airways, heart and skin. In a 2‐day focus workshop of the German Society for Allergology and Clinical Immunology (DGAKI), the state of the art was discussed and practical recommendations for diagnosis and treatment of eosinophilic diseases, with a particular focus on new biologics, such as anti‐interleukin 5 and anti‐interleukin 5R, were derived.
Clinical trials for rapid changes in suicidal ideation: Lessons from ketamine
Authors: Ballard Elizabeth D. , Fields Jessica , Farmer Cristan A. , Zarate Carlos A.
Published: February 2021

Rapid‐acting treatments for suicidal thoughts are critically needed. Consequently, there is a burgeoning literature exploring psychotherapeutic, pharmacologic, or device‐based brief interventions for suicidal thoughts characterized by a rapid onset of action. Not only do these innovative treatments have potentially important clinical benefits to patient populations, they also highlight a number of methodological considerations for suicide research. First, while most clinical trials related to suicide risk focus on suicide attempts, new clinical trials that use suicidal thoughts as the primary outcome require a number of slight modifications to their clinical trial design. Second, the rapid onset of these new interventions permits an experimental therapeutics approach to suicide research, in which psychological and neurobiological markers are embedded into clinical trials to better understand the underlying pathophysiology of suicidal thoughts. The following review discusses these methodological innovations in light of recent research using the N‐methyl‐D‐aspartate (NMDA) receptor antagonist ketamine, which has been associated with rapid effects on suicidal thoughts. We hope that “lessons learned” from the ketamine literature will provide a blueprint for all researchers evaluating rapid‐acting treatments for suicidal thoughts, whether pharmacologic or psychotherapeutic.
Applying text mining methods to suicide research
Authors: Cheng Qijin , Lui Carrie S. M.
Published: February 2021

Objective

To introduce the research methods of computerized text mining and its possible applications in suicide research and to demonstrate the procedures of applying a specific text mining area, document classification, to a suicide‐related study.

Method

A systematic search of academic papers that applied text mining methods to suicide research was conducted. Relevant papers were reviewed focusing on their research objectives and sources of data. Furthermore, a case of using natural language processing and document classification methods to analyze a large amount of suicide news was elaborated to showcase the methods.

Results

Eighty‐six papers using text mining methods for suicide research have been published since 2001. The most common research objective (72.1%) was to classify which documents exhibit suicide risk or were written by suicidal people. The most frequently used data source was online social media posts (45.3%), followed by e‐healthcare records (25.6%). For the news classification case, the top three classifiers trained for classification tasks achieved 84% or higher accuracy.

Conclusions

Computerized text mining methods can help to scale up content analysis capacity and efficiency and uncover new insights and perspectives for suicide research.
Causal inference in suicide research: When you should (and should not!) control for extraneous variables
Authors: Cero Ian , Mitchell Sean M. , Morris Nicole M.
Published: February 2021

Objective

Although causal inference is often straightforward in experimental contexts, few research questions in suicide are amenable to experimental manipulation and randomized control. Instead, suicide prevention specialists must rely on observational data and statistical control of confounding variables to make effective causal inferences. We provide a brief summary of recent covariate practice and a tutorial on casual inference tools for covariate selection in suicide research.

Method

We provide an introduction to modern causal inference tools, suggestions for statistical control selection, and demonstrations using simulated data.

Results

Statistical controls are often mistakenly selected due to their significant correlation with other study variables, their consistency with previous research, or no explicit reason at all. We clarify what it means to control for a variable and when controlling for the wrong covariates systematically distorts results. We describe directed acyclic graphs (DAGs) and tools for identifying the right choice of covariates. Finally, we provide four best practices for integrating causal inference tools in future studies.

Conclusion

The use of causal model tools, such as DAGs, allows researchers to carefully and thoughtfully select statistical controls and avoid presenting distorted findings; however, limitations of this approach are discussed.
Coalition‐building and the forging of solidarity across difference and inequality
Authors: Gawerc Michelle I.
Published: February 2021

Diverse coalitions hold great potential for social movements, but they also face tremendous challenges. In this article, I review the literature on diverse alliances with a focus on how trust, commitment, and ultimately, solidarity can be developed and sustained across divides. The article begins by discussing the needs of diverse alliances to build trust and commitment, and the coalitional characteristics deemed vital for doing so, with a focus on shared neutral space, ongoing interaction, and social ties and bridgebuilders. Five coalitional processes and practices are identified and discussed that have been empirically found or theorized to be imperative for cultivating solidarity across difference and inequality. These processes include (a) uniting around shared principles while engaging difference; (b) acknowledging and managing inequalities; (c) making space for each other; (d) attention to managing conflicts; and (e) actions that confirm the shared commitments and negotiated identity. I conclude by evaluating the state of research on developing and sustaining alliances across divides.
The Transferability of Out‐Group Contact: Does Knowing a Member of the LGBT Community Improve Feelings Toward Racial Minorities, Muslims, and Immigrants?
Authors: Lindsay Spencer
Published: February 2021

Objective

This article seeks to establish a positive relationship between in‐group contact with members of one particular out‐group and affect toward all out‐groups. I hope to provide early evidence that contact with one specific out‐group may have a transferable effect on feelings toward all out‐groups.

Methods

Using data from the American National Election Study, I use a series of regression models to estimate the effect of Lesbian, Gay, Bisexual and Transsexual (LGBT) contact on authoritarianism, social dominance orientation, and ethnocentrism as well as feeling thermometers toward Muslims, undocumented immigrants, Latinos, Asian Americans, and blacks. I also analyze the effect of LGBT contact on political issues that affect other out‐groups.

Results

I find that contact with a member of the LGBT community is negatively associated with ethnocentrism, authoritarianism, and social dominance orientation. It is also positively associated with feelings toward Muslims, undocumented immigrants, and racial minorities. It also seems to be correlated with political positions that affect these groups, though these results are less robust.

Conclusions

This article provides preliminary support for the hypothesis that out‐group contact has transferable effects. It suggests that contact with members of one out‐group may affect how in‐group members see all out‐groups.
The New Era of Digital Transformation and COVID-19 Effect on The Employment in Mobile Operators in Egypt
Authors: Elsafty Ashraf , Elzeftawy Ahmed
Published: February 2021

A fear from Technological Advances mainly automation and artificial intelligence (AI) has been raised since the beginning of the 21st century, that machines will eliminate human beings performing certain tasks. Several models were developed to measure the effect of the Automation & AI on the employment and was applied on several countries. The first model was developed by Carl Benedikt Frey and Michael A. Osborne was called An Occupation-Based Approach, 2013. In which they define several tasks and call it “Engineering-Bottlenecks”. Katharina Dengler, Britta Matthes and Wiebke Paulus, 2014 made The Occupational Tasks model in which they use the assignment of activities explained by Alexandra Spitz-Oener and categorize the non-automatable tasks as: analytical non-routine tasks, interactive non-routine tasks. The last model was A-Task Based Approach by Melanie Arntz, Terry Gregory, 2016 in which they argue that FO Model Ignore that, the occupations consist of many tasks, part of them can be automated and another part cannot be. These models were applied on the level of the countries but not on corporate levels.The purpose of this paper is to combine the above three models and applying them on the Mobile operators in Egypt to determine the effect of Automation and AI on the Employment there, taking into consideration the incremental risk from COVID-19 which influenced the humanity.The conclusion of this research is that 41% of the staff working in the Technology field on the mobile operators, their jobs are subject to automation and COVID-19 will make an incremental Risk of 8%, due to creation of efficiency on performing the un-automatable tasks from home through digital platforms.
Impact-Induced Cortical Strain Concentrations at the Sulcal Base and Its Implications for Mild Traumatic Brain Injury
Authors: Mazurkiewicz Ashley , Xu Sheng , Frei Hanspeter , Banton Rohan , Piehler Thuvan , Petel Oren E.
Published: February 2021

This study investigated impact-induced strain fields within brain tissue surrogates having different cortical gyrification. Two elastomeric surrogates, one representative of a lissencephalic brain and the other of a gyrencephalic brain, were drop impacted in unison at four different heights and in two different orientations. Each surrogate contained a radiopaque speckle pattern that was used to calculate strain fields. Two different approaches, digital image correlation (DIC) and a particle tracking method, enabled comparisons of full-field and localized strain responses. The DIC results demonstrated increased localized deviations from the mean strain field in the surrogate with a gyrified cortex. Particle tracking algorithms, defining four-node quadrilateral elements, were used to investigate the differences in the strain response of three regions: the base of a sulcus, the adjacent gyrus, and the internal capsule of the surrogates. The results demonstrated that the strains in the cortex were concentrated at the sulcal base. This mechanical mechanism of increased strain is consistent with neurodegenerative markers observed in postmortem analyses, suggesting a potential mechanism of local damage due to strain amplification at the sulcal bases in gyrencephalic brains. This strain amplification mechanism may be responsible for cumulative neurodegeneration from repeated subconcussive impacts. The observed results suggest that lissencephalic animal models, such as rodents, would not have the same modes of injury present in a gyrencephalic brain, such as that of a human. As such, a shift toward representative mild traumatic brain injury animal models having gyrencephalic cortical structures should be strongly considered.
Lattice Structure Optimization With Orientation-Dependent Material Properties
Authors: Sharpe Conner , Seepersad Carolyn C.
Published: February 2021

Advances in additive manufacturing (AM) techniques have enabled the production of parts with complex internal geometries. However, the layer-based nature of additive processes often results in mechanical properties that vary based on the orientation of the feature relative to the build plane. Lattice structures have been a popular design application for additive manufacturing due to their potential uses in lightweight structural applications. Many recent works have explored the modeling, design, and fabrication challenges that arise in the multiscale setting of lattice structures. However, there remains a significant challenge in bridging the simplified computational models used in the design process and the more complex properties actually realized in fabrication. This study develops a design approach that captures orientation-dependent material properties that have been observed in metal AM processes, while remaining suitable for use in an iterative design process. Exemplar problems are utilized to investigate the potential design changes and performance improvements that can be attained by taking the directional dependence of the manufacturing process into account in the design of lattice structures.
Design of Ga2O3 modulation doped field effect transistors
Authors: Mastro Michael A. , Tadjer Marko J. , Kim Jihyun , Ren Fan , Pearton Stephen J.
Published: February 2021

The design of β-Ga2O3-based modulation-doped field effect transistors is discussed with a focus on the role of self-heating and resultant modification of the electron mobility profile. Temperature- and doping-dependent model of the electron mobility as well as temperature- and orientation-dependent approximations of the thermal conductivity of β-Ga2O3 are presented. A decrease in drain current was attributed to a position-dependent mobility reduction caused by a coupled self-heating mechanism and a high electric-field mobility reduction mechanism. A simple thermal management solution is presented where heat is extracted through the source contact metal. Additionally, it is shown that an undesired secondary channel can form at the modulation-doped layer that is distinguished by an inflection in the transconductance curve.
Goal-dependent tuning of muscle spindle receptors during movement preparation
Authors: Papaioannou Stylianos , Dimitriou Michael
Published: February 2021

Movement preparation tunes muscle stiffness via the goal-dependent control of muscle spindle sensors.
Globally distributed iridium layer preserved within the Chicxulub impact structure
Authors: Goderis Steven , Sato Honami , Ferrière Ludovic , Schmitz Birger , Burney David , Kaskes Pim , Vellekoop Johan , Wittmann Axel , Schulz Toni , Chernonozhkin Stepan M. , Claeys Philippe , de Graaff Sietze J. , Déhais Thomas , de Winter Niels J. , Elfman Mikael , Feignon Jean-Guillaume , Ishikawa Akira , Koeberl Christian , Kristiansson Per , Neal Clive R. , Owens Jeremy D. , Schmieder Martin , Sinnesael Matthias , Vanhaecke Frank , Van Malderen Stijn J. M. , Bralower Timothy J. , Gulick Sean P. S. , Kring David A. , Lowery Christopher M. , Morgan Joanna V. , Smit Jan , Whalen Michael T. ,   IODP-ICDP Expedition 364 Scientists
Published: February 2021

The preservation of the iridium-rich layer within the Chicxulub crater captures the timing of the K-Pg boundary events.
Radiotherapy and immunotherapy converge on elimination of tumor-promoting erythroid progenitor cells through adaptive immunity
Authors: Hou Yuzhu , Liang Hua L. , Yu Xinshuang , Liu Zhida , Cao Xuezhi , Rao Enyu , Huang Xiaona , Wang Liangliang , Li Lei , Bugno Jason , Fu Yanbin , Chmura Steven J. , Wu Wenjun , Luo Sean Z. , Zheng Wenxin , Arina Ainhoa , Jutzy Jessica , McCall Anne R. , Vokes Everett E. , Pitroda Sean P. , Fu Yang-Xin , Weichselbaum Ralph R.
Published: February 2021

Radiation and immunotherapy reduce tumor-induced erythroid progenitor cells, revealing possible targets for potentiating cancer therapies.
Functional reconstruction of human AML reveals stem cell origin and vulnerability of treatment-resistant MLL-rearranged leukemia
Authors: Zeisig Bernd B. , Fung Tsz Kan , Zarowiecki Magdalena , Tsai Chiou Tsun , Luo Huacheng , Stanojevic Boban , Lynn Claire , Leung Anskar Y. H. , Zuna Jan , Zaliova Marketa , Bornhauser Martin , von Bonin Malte , Lenhard Boris , Huang Suming , Mufti Ghulam J. , So Chi Wai Eric
Published: February 2021

Chemoresistant human CD34
−/lo
/CD38
+
MLL leukemic stem cells originate from HSCs and can be resensitized by targeting ABCC3 with fidaxomicin.
Transitional B cell cytokines predict renal allograft outcomes
Authors: Cherukuri Aravind , Salama Alan D. , Mehta Rajil , Mohib Kanishka , Zheng Leting , Magee Ciara , Harber Mark , Stauss Hans , Baker Richard J. , Tevar Amit , Landsittel Douglas , Lakkis Fadi G. , Hariharan Sundaram , Rothstein David M.
Published: February 2021

A low transitional-1 B cell IL-10/TNFα ratio predicts rejection and supports preemptive intervention for patients after kidney transplantation.
Performance and Implementation Evaluation of the Abbott BinaxNOW Rapid Antigen Test in a High-Throughput Drive-Through Community Testing Site in Massachusetts
Authors: Pollock Nira R. , Jacobs Jesica R. , Tran Kristine , Cranston Amber E. , Smith Sita , O’Kane Claire Y. , Roady Tyler J. , Moran Anne , Scarry Alison , Carroll Melissa , Volinsky Leila , Perez Gloria , Patel Pinal , Gabriel Stacey , Lennon Niall J. , Madoff Lawrence C. , Brown Catherine , Smole Sandra C.
Published: February 2021

Rapid diagnostic tests (RDTs) for SARS-CoV-2 antigens (Ag) that can be performed at point of care (POC) can supplement molecular testing and help mitigate the COVID-19 pandemic. Deployment of an Ag RDT requires an understanding of its operational and performance characteristics under real-world conditions and in relevant subpopulations.
Genome Sequence of a SARS-CoV-2 Strain from Bangladesh That Is Nearly Identical to United Kingdom SARS-CoV-2 Variant B.1.1.7
Authors: Hossain Mohammad Enayet , Rahman M. Mahfuzur , Alam M. Shaheen , Karim Yeasir , Hoque Ananya Ferdous , Rahman Sezanur , Rahman Mohammed Ziaur , Rahman Mustafizur
Published: February 2021

The coding-complete genome sequence of a coronavirus strain, SARS-CoV-2/human/BGD/G039392/2021, obtained from a symptomatic male patient with coronavirus disease 2019 (COVID-19) in Dhaka, Bangladesh, is reported. The strain G039392 is 99.9% identical to the UK variant B.1.1.7.
Draft Genome Sequence of a Novel
Mycoplasma
Species Identified from the Respiratory Tract of an Alaska Moose (
Alces alces gigas
)
Authors: Herndon David R. , Beckmen Kimberlee B. , Highland Margaret A.
Published: February 2021

The mycoplasmas represent a large and diverse group of bacteria, many of which are pathogens of humans and animals. Here, we describe a draft genome sequence of a novel
Mycoplasma
species. This novel
Mycoplasma
species has potential to cause false-positive PCR results for
Mycoplasma ovipneumoniae
, a respiratory-associated pathogen of ruminants.
No ring fracture in Mono Basin, California
Authors: Hildreth Wes , Fierstein Judy , Ryan-Davis Juliet
Published: February 2021

In Mono Basin, California, USA, a near-circular ring fracture 12 km in diameter was proposed by R.W. Kistler in 1966 to have originated as the protoclastic margin of the Cretaceous Aeolian Buttes pluton, to have been reactivated in the middle Pleistocene, and to have influenced the arcuate trend of the chain of 30 young (62–0.7 ka) rhyolite domes called the Mono Craters. In view of the frequency and recency of explosive eruptions along the Mono chain, and because many geophysicists accepted the ring fracture model, we assembled evidence to test its plausibility. The shear zone interpreted as the margin of the Aeolian Buttes pluton by Kistler is 50–400 m wide but is exposed only along a 7-km-long set of four southwesterly outcrops that subtend only a 70° sector of the proposed ring. The southeast end of the exposed shear zone is largely within the older June Lake pluton, and at its northwest end, the contact of the Aeolian Buttes pluton with a much older one crosses the shear zone obliquely. Conflicting attitudes of shear structures are hard to reconcile with intrusive protoclasis. Also inconsistent with the margin of the ovoid intrusion proposed by Kistler, unsheared salients of the pluton extend ∼1 km north of its postulated circular outline at Williams Butte, where there is no fault or other structure to define the northern half of the hypothetical ring. The shear zone may represent regional Cretaceous transpression rather than the margin of a single intrusion. There is no evidence for the Aeolian Buttes pluton along the aqueduct tunnel beneath the Mono chain, nor is there evidence for a fault that could have influenced its vent pattern. The apparently arcuate chain actually consists of three linear segments that reflect Quaternary tectonic influence and not Cretaceous inheritance. A rhyolitic magma reservoir under the central segment of the Mono chain has erupted many times in the late Holocene and as recently as 700 years ago. The ring fracture idea, however, prompted several geophysical investigations that sought a much broader magma body, but none identified a low-density or low-velocity anomaly beneath the purported 12-km-wide ring, which we conclude does not exist.
Adenoid cystic carcinoma and chronic lymphocytic leukaemia: synchronous presentations in the lung
Authors: Webb Philip S , Zhang Yu Zhi , Burrell Kirsten , Sinclair Georges
Published: February 2021

A 59-year-old male active smoker presented with a 6-month history of cough and breathlessness and was found to have a right upper lobe mass. Histology revealed this to be an adenoid cystic carcinoma (ACC) of the lung, while local lymph node dissection revealed a synchronous diagnosis of chronic lymphocytic leukaemia (CLL). The connection between CLL and solid organ malignancy is well documented, but the reporting of ACC in this context is novel. Mechanisms linking the two processes are revealed with the possibility of causality, and heightened vigilance for the development of primary lung tumours in CLL, and their management, is recommended.
Tension pneumocephalus following an implant removal from spine
Authors: Kundangar Raghuraj Suresh , Bhat Shyamasunder N , Mohanty Simanchal P
Published: February 2021

Pneumocephalus is commonly seen after skull and maxillofacial fractures. It can also occur following cerebrospinal fluid leak after skull base surgery and epidural catheter placement. We report a rare case report of a 20-year-old man who developed tension pneumocephalus following implant removal from the spine. He responded well to the conservative treatment without any neurological complications.
Impact of in-season injury on quality of life and sleep duration in female youth volleyball athletes: a prospective study of 2073 players
Authors: Watson Andrew , Biese Kevin , Kliethermes Stephanie A , Post Eric , Brooks M Alison , Lang Pamela J , Bell David R , Haraldsdottir Kristin , McGuine Timothy
Published: February 2021

Objectives

The psychological impacts of injuries in youth athletes remain poorly defined. The purpose of this study was to evaluate the influence of injury on quality of life (QOL) and sleep in female high school volleyball athletes.

Methods

2073 female high school volleyball players (15.6±1.1 years) completed the Pediatric Quality of Life survey (total QOL, physical, social, school, emotional and psychosocial function) and reported average sleep duration at the start and end of the season. Injury data were collected by school athletic trainers. Mixed effects linear regression models were used to compare changes in QOL and sleep duration during the season between (1) injured and uninjured athletes and (2) injured athletes who did or did not suffer a season-ending injury.

Results

Time-loss injuries were reported in 187 athletes with complete preseason and postseason data. During the season, injured athletes demonstrated a greater decrease in total QOL (β=−1.3±0.5, p=0.012), as well as physical function (β=−1.6±0.6, p=0.012), school function (β=−2.0±0.76, p=0.01) and psychosocial function domains (β=−1.2±0.6, p=0.039) compared with uninjured athletes. Athletes who sustained a season-ending injury had a significantly greater decrease in total QOL (β=−6.8±2.0, p=0.006) and physical function (β=-17±2.9, p<0.001) compared with injured athletes who were able to return to play during the season.

Conclusion

In-season injuries are associated with significant decreases in total QOL as well as physical and psychosocial function. Healthcare providers should consider the impacts of injuries on QOL and sleep in youth athletes in order to optimise management and improve overall health.
Multilevel clustering approach driven by continuous glucose monitoring data for further classification of type 2 diabetes
Authors: Tao Rui , Yu Xia , Lu Jingyi , Shen Yun , Lu Wei , Zhu Wei , Bao Yuqian , Li Hongru , Zhou Jian
Published: February 2021

Introduction

Mining knowledge from continuous glucose monitoring (CGM) data to classify highly heterogeneous patients with type 2 diabetes according to their characteristics remains unaddressed. A refined clustering method that retrieves hidden information from CGM data could provide a viable method to identify patients with different degrees of dysglycemia and clinical phenotypes.

Research design and methods

From Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, we selected 908 patients with type 2 diabetes (18–83 years) who wore blinded CGM sensors (iPro2, Medtronic, California, USA). Participants were clustered based on CGM data during a 24-hour period by our method. The first level extracted the knowledge-based and statistics-based features to describe CGM signals from multiple perspectives. The Fisher score and variables cluster analysis were applied to fuse features into low dimensions at the second level. The third level divided subjects into subgroups with different clinical phenotypes. The four subgroups of patients were determined by clinical phenotypes.

Results

Four subgroups of patients with type 2 diabetes with significantly different statistical features and clinical phenotypes were identified by our method. In particular, individuals in cluster 1 were characterized by the lowest glucose level factor and glucose fluctuation factor, and the highest negative glucose factor and C peptide index. By contrast, cluster 2 had the highest glucose level factor and the lowest C peptide index. Cluster 4 was characterized by the greatest degree of glucose fluctuation factor, was the most insulin-sensitive, and had the lowest insulin resistance. Cluster 3 ranked in the middle concerning the CGM-derived metrics and clinical phenotypes compared with those of the other three groups.

Conclusion

A novel multilevel clustering approach for knowledge mining from CGM data in type 2 diabetes is presented. The results demonstrate that subgroups are adequately distinguished with notable statistical and clinical differences.
Glucolipotoxicity and GLP-1 secretion
Authors: Hong Jung-Hee , Kim Dae-Hee , Lee Moon-Kyu
Published: February 2021

Introduction

The concept of glucolipotoxicity refers to the combined, deleterious effects of elevated glucose and/or fatty acid levels.

Research design and methods

To investigate the effects of chronic glucolipotoxicity on glucagon-like peptide-1-(7-36) amide (GLP-1) secretion, we generated glucolipotoxic conditions in human NCI-H716 enteroendocrine cells using either 5 or 25 mM glucose with or without 500 µM palmitate for 72 hours. For in vivo study, we have established a chronic nutrient infusion model in the rat. Serial blood samples were collected for 2 hours after the consumption of a mixed meal to evaluate insulin sensitivity and β-cell function.

Results

Chronic glucolipotoxic conditions decreased GLP-1 secretion and the expressions of pCREB, pGSK3β, β-catenin, and TCF7L2 in NCI-H716 cells. Glucolipotoxicity conditions reduced glucose transporter expression, glucose uptake, and nicotinamide-adenine dinucleotide phosphate (NADPH) levels in L-cells, and increased triglyceride accumulation. In contrast, PPARα and ATP levels were reduced, which correlated well with decreased levels of SUR1 and Kir6.2, cAMP contents and expressions of pCAMK2, EPAC and PKA. We also observed an increase in reactive oxygen species production, UCP2 expression and Complex I activity. Simultaneous treatment with insulin restored the GLP-1 secretion. Glucolipotoxic conditions decreased insulin secretion in a time-dependent manner in INS-1 cells, which was recovered with exendin-4 cotreatment. Glucose and SMOFlipid infusion for 6 hours decreased GLP-1 secretion and proglucagon mRNA levels as well as impaired the glucose tolerance, insulin and C-peptide secretion in rats.

Conclusion

These results provide evidence for the first time that glucolipotoxicity could affect GLP-1 secretion through changes in glucose and lipid metabolism, gene expressions, and proglucagon biosynthesis and suggest the interrelationship between glucolipotoxicities of L-cells and β-cells which develops earlier than that of L-cells.
Scoping and testing rural acute care at home: a simulation analysis
Authors: Levine David M , Desai Meghna P , Ross Joseph B , Como Natalie , Holley Steve
Published: February 2021

Purpose

Hospital-level care provided at home improves patient outcomes, yet nearly all programmes function in urban environments. It remains unknown whether rural home hospital care can be feasibly delivered.

Methods

Based on prior stakeholder learning and detailed landscape analyses of various rural areas across the country, we re-engineered the workflows, personnel and technology needed to respond to many of the challenges of delivering acute care in rural homes. We performed a preliminary ‘mock admission’ in a simulation laboratory with actor feedback, followed by mock admissions in rural homes in Utah of chronically ill patients who feigned acute illness. We employed rapid cycle feedback from clinicians, patients and their caregivers and qualitative analysis of participant feedback.

Findings

Following rapid cycle feedback in the simulation laboratory and rural homes, mock admission, daily rounds and discharge were successfully conducted. Technology performed to laboratory-determined specifications but presented challenges. Patients noted significant comfort with and preference for rural home hospital care, while clinicians also preferred the model with the caveat that proper patient selection was paramount. Patients and clinicians perceived rural home hospital as safe. Clinicians noted rural home hospital workflows were feasible after streamlining remote and in-home roles.

Conclusions

Rural home hospital care is technically feasible, well-received and desired. It requires testing with acutely ill adults in rural settings.
Comparison between binocular therapy and patching for treatment of amblyopia: a meta-analysis of randomised controlled trials
Authors: Chen Chun-Wen , Zhu Qin , Duan Yu-Bing , Yao Jing-Yan
Published: February 2021

Several studies have compared binocular therapy and patching for the treatment of amblyopia. However, most of them involved a small number of cases and reported controversial results. Thus, the benefit of binocular therapy remains to be confirmed. We conducted a meta-analysis to evaluate the efficacy of binocular therapy versus patching and to testify whether binocular therapy could become supplementary method in children with amblyopia. Randomised controlled trials that evaluated the efficacy of binocular therapy for amblyopia versus patching were identified using PubMed, Embase, Cochrane Library, Ovid, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. Data screening, extraction and quality assessment were performed independently by two researchers. Six trials were identified and analysed to compare binocular therapy (708 eyes) with patching (664 eyes) for change in best-corrected visual acuity and stereoacuity. Efficacy estimates were evaluated by standard mean difference (SMD) and 95% CI. The best-corrected visual acuity in binocular group was better than that of in patching group (SMD=−0.21 logarithm of the minimum angle of resolution (log MAR), 95% CI of −0.50 to 0.08 log MAR, p=0.003). The results showed statistically significant difference in the change of best-corrected visual acuity between the groups, but not in stereoacuity. Binocular therapy may be a promising treatment of conditions affecting visual acuity, and could be applied as a supplementary method to patching for amblyopia in clinical practice. The present analysis showed that some children with amblyopia may benefit from binocular therapy. Nevertheless, larger randomised controlled clinical trials are required to confirm these findings.
Parents’ willingness to pay for children’s spectacles in Cambodia
Authors: Burnett Anthea , Paudel Prakash , Massie Jessica , Kong Neath , Kunthea Ek , Thomas Varghese , Fricke Tim R , Lee Ling
Published: February 2021

Background/aim

To determine willingness to pay for children’s spectacles, and barriers to purchasing children’s spectacles in Cambodia.

Methods

We conducted vision screenings, and eye examinations as indicated, for all consenting children at 21 randomly selected secondary schools. We invited parents/guardians of children found to have refractive problems to complete a willingness to pay for spectacles survey, using a binary-with-follow-up technique.

Results

We conducted vision screenings on 12 128 secondary schoolchildren, and willingness to pay for spectacles surveys with 491 parents/guardians (n=491) from Kandal and Phnom Penh provinces in Cambodia. We found 519 children with refractive error, 7 who had pre-existing spectacles and 14 recommended spectacles for lower ametropias. About half (53.2%; 95% CI 44.0% to 62.1%) of parents/guardians were willing to pay KHR70 000 (US$17.5; average market price) or more for spectacles. Mean willingness-to-pay price was KHR74 595 (US$18.6; 95% CI KHR64 505 to 86 262; 95% CI US$16.1 to US$21.6) in Phnom Penh and KHR55 651 (US$13.9; 95% CI KHR48 021 to 64 494; 95% CI US$12.0 to US$16.1) in Kandal province. Logistic regression suggested parents/guardians with college education (OR 6.8; p<0.001), higher household incomes (OR 8.0; p=0.006) and those wearing spectacles (OR 2.2; p=0.01) were more likely to be willing to pay ≥US$17.5. The most common reasons for being unwilling to pay US$17.5 were related to cost (58.8%). The most common barrier to spectacle wear was fear that spectacles weaken children’s eyes (36.0%).

Conclusions

With almost half of parents/guardians unwilling to pay for spectacles at the current average market price, financial support through a subsidised spectacle scheme might be required for children to access spectacles in Cambodia.
Assessment of SARS-CoV-2 infectivity of upper respiratory specimens from COVID-19 patients by virus isolation using VeroE6/TMPRSS2 cells
Authors: Yamada Souichi , Fukushi Shuetsu , Kinoshita Hitomi , Ohnishi Makoto , Suzuki Tadaki , Fujimoto Tsuguto , Saijo Masayuki , Maeda Ken
Published: February 2021

Background

An outbreak of novel coronavirus (SARS-CoV-2)-associated respiratory infectious diseases (COVID-19) emerged in 2019 and has spread rapidly in humans around the world. The demonstration of in vitro infectiousness of respiratory specimens is an informative surrogate for SARS-CoV-2 transmission from patients with COVID-19; accordingly, viral isolation assays in cell culture are an important aspect of laboratory diagnostics for COVID-19.

Methods

We developed a simple and rapid protocol for isolating SARS-CoV-2 from respiratory specimens using VeroE6/TMPRSS2 cells, a cell line that is highly susceptible to the virus. We also investigated a correlation between isolation of SARS-CoV-2 and viral load detected by real-time RT-PCR (rRT-PCR) using N2 primer/probe set that has been developed for testing of COVID-19 in Japan.

Results

The SARS-CoV-2 isolation protocol did not require blind passage of inoculated cells and yielded the results of viral isolation within 7 days after inoculation. Specimens with cycle threshold (Ct) values of <20.2, determined by rRT-PCR, were predicted to be isolation-positive. On the other hand, 6.9% of specimens with Ct values >35 were virus isolation-positive, indicating that low viral loads (high Ct values) in upper respiratory specimens do not always indicate no risk of containing transmissible virus.

Conclusion

In combination with rRT-PCR, the SARS-CoV-2 isolation protocol provides a means for assessing the potential risk of transmissible virus in upper respiratory specimens.
Quantification of the effect of body mass index on cricothyroid membrane depth: a cross-sectional analysis of clinical CT images
Authors: Ghaffar Sadia , Blankenstein Tom Nicholas , Patel Dilip , Theodosiou Catherine , Griffith David
Published: February 2021

Objectives

The recommended front of neck access procedure in can’t intubate, can’t oxygenate scenarios relies on palpation of the cricothyroid membrane (CTM), or dissection of the neck down to the larynx if CTM is impalpable. CTM palpation is particularly challenging in obese patients, most likely due to an increased distance between the skin and the CTM (CTM depth). The aims of this study were to measure the CTM depth in a representative clinical sample, and to quantify the relationship between body mass index (BMI) and CTM depth.

Methods

This is a retrospective analysis of 355 clinical CT scans performed at a teaching hospital over an 8-month period. CTM depth was measured by two radiologists, and mean CTM depth calculated. Age, gender, height and weight were recorded, and BMI calculated. Linear relationships between patient characteristics and CTM depth were assessed in order to derive a predictive equation for calculating CTM depth. The variables included for this model were those with a strong association with CTM depth, that is, a p value of 0.10 or less.

Results

Mean CTM depth was 8.12 mm (IQR 6.36–11.70). There was no association between CTM depth and sex (β −0.33, 95% CI −1.33 to 0.68, p=0.53), height (cm) (β 0.01, 95% CI −0.05 to 0.06, p=0.79) or age (years) (β −0.01, 95% CI 0.10 to 0.15, p=0.62). Increasing weight (kg) (β 0.12, 95% CI 0.10 to 0.15, p<0.001) and BMI (kg/m3) (β 0.52, 95% CI 0.44 to 0.60, p<0.001) were strongly associated with CTM depth. Predicted CTM depth increased from 6.4 mm (95% CI 4.9 to 8.1) at a BMI of 20 kg/m2to 16.8 (95% CI 13.7 to 20.1) at BMI 40 kg/m2.

Conclusion

CTM depth was strongly associated with BMI in a retrospective analysis of patients having clinical CT scans.
Hospital variation of 30-day readmission rate following transcatheter aortic valve implantation
Authors: Ando Tomo , Ashraf Said , Kuno Toshiki , Briasoulis Alexandros , Takagi Hisato , Grines Cindy , Malik Aaqib
Published: February 2021

Objectives

Thirty-day readmission rate is one of the hospital quality metrics. Outcomes of transcatheter aortic valve implantation (TAVI) have improved significantly, but it remains unclear whether hospital-level variance in 30-day readmission rate exists in the contemporary TAVI era.

Methods

From the 2017 US Nationwide Readmission Database, endovascular TAVI were identified. The unadjusted 30-day readmission rate and 30-day risk-standardised readmission rate (RSRR) were calculated and we then conducted model testing to determine the relative contribution of hospital characteristics, patient-level covariates and economic status to the variation in readmission rates observed between the hospitals.

Results

A total of 44 899 TAVI from 338 hospitals were identified. The range of unadjusted 30-day readmission rate and 30-day RSRR was 2.0%–33.3% and 9.4%–15.3%, respectively. Median 30-day RSRR was 11.8% and there was a significant hospital-level variation (median OR 1.22, 95% CI 1.16 to 1.32, p<0.01) and this was similar in both readmissions caused due to major cardiac and non-cardiac conditions. Patient, hospital and economic factors accounted for 9.6%, 1.9% and 3.8% of the variability in hospital readmission rate, respectively.

Conclusions

There was significant hospital-level variation in 30-day RSRR following TAVI. Further measures are required to mitigate this variance in the readmission rate.
May I have your uterus? The contribution of considering complexities preceding live uterus transplantation
Authors: Guntram Lisa
Published: February 2021

Uterus transplantation combined with in vitro fertilisation (IVF) (henceforth called UTx-IVF) as a treatment for infertility caused by an absence or malfunction of the uterus is advancing. About 50 transplantations have been conducted worldwide and at least 14 children have been born—9 of them by women taking part in a Swedish research project on UTx-IVF. The Swedish research protocol initially stated that the potential recipient must ‘have her own donor’ who is preferably related to the recipient. But what does it mean to ask someone for a uterus? What challenges does this question instigate? And what norms may it enact? In this article, I explore how 10 women—who have considered, and sometimes pursued, UTx-IVF—describe their experiences of searching for a donor. I aim to show how an analysis of such accounts can help us unpack some of the specific relational and gendered dimensions of UTx-IVF and by doing so enrich discussions of risks, benefits, care and support in UTx-IVF. Drawing on research in social sciences and medical humanities that has demonstrated how assisted reproductive technologies and organ donation can provoke social and familial conundrums, with respect to such topics as embodiment and identity, I present three patterns that describe different dimensions of the interviewees’ quest for a uterus donor. I discuss the negotiations that took place, how expectations unfolded and how entanglements were managed as the interviewees considered asking someone for a donation. Such an examination, I suggest, contributes to make care and support more attuned to the experiences and entanglements that UTx-IVF entails for those pursuing it. This will become increasingly important if (or when) UTx-IVF becomes part of general healthcare. To conclude, I problematise responsibilities and relational challenges in medical innovation, and in this way provide insights into how the ethical debate over UTx-IVF can broaden its scope.
Resolving the hyper-triton yield description puzzle in high energy nuclear collisions
Authors: Vitiuk O. V. , Bugaev K. A. , Zherebtsova E. S. , Blaschke D. B. , Bravina L. V. , Zabrodin E. E. , Zinovjev G. M.
Published: February 2021

The recently developed hadron resonance gas model with multicomponent hard-core repulsion is used to address and resolve the long standing problem to describe the light nuclear cluster multiplicities including the hyper-triton measured by the STAR Collaboration, known as the hyper-triton chemical freeze-out puzzle. An improved description for the hadronic and light nuclear cluster data measured by STAR at the collision energy $$\sqrt{s_{NN}} =200$$

s

NN

=
200

GeV and by ALICE at $$\sqrt{s_{NN}} =2.76$$

s

NN

=
2.76

TeV is obtained. This is achieved by applying a new strategy of analyzing the light nuclear cluster data and by using the value for the hard-core radius of the (anti-)$$\varLambda $$
Λ
hyperons found in earlier work. One of the most striking results of the present work is that for the most probable scenario of chemical freeze-out for the STAR energy the obtained parameters allow to simultaneously reproduce the values of the experimental ratios $$S_3$$

S
3

and $${\overline{S}}_3$$

S
¯

3

which were not included in the fit.