bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation approaches and barriers for rule-based and machine learning-based sepsis risk prediction tools: a qualitative study
Authors: Joshi Mugdha , Mecklai Keizra , Rozenblum Ronen , Samal Lipika
Published: April 2022

Objective

Many options are currently available for sepsis surveillance clinical decision support (CDS) from electronic medical record (EMR) vendors, third party, and homegrown models drawing on rule-based (RB) and machine learning (ML) algorithms. This study explores sepsis CDS implementation from the perspective of implementation leads by describing the motivations, tool choices, and implementation experiences of a diverse group of implementers.

Materials and Methods

Semi-structured interviews were conducted with and a questionnaire was administered to 21 hospital leaders overseeing CDS implementation at 15 US medical centers. Participants were recruited via convenience sampling. Responses were coded by 2 coders with consensus approach and inductively analyzed for themes.

Results

Use of sepsis CDS is motivated in part by quality metrics for sepsis patients. Choice of tool is driven by ease of integration, customization capability, and perceived predictive potential. Implementation processes for these CDS tools are complex, time-consuming, interdisciplinary undertakings resulting in heterogeneous choice of tools and workflow integration. To improve clinician acceptance, implementers addressed both optimization of the alerts as well as clinician understanding and buy in. More distrust and confusion was reported for ML models, as compared to RB models. Respondents described a variety of approaches to overcome implementation barriers; these approaches related to alert firing, content, integration, and buy-in.

Discussion

While there are shared socio-technical challenges of implementing CDS for both RB and ML models, attention to user education, support, expectation management, and dissemination of effective practices may improve feasibility and effectiveness of ML models in quality improvement efforts.

Conclusion

Further implementation science research is needed to determine real world efficacy of these tools. Clinician acceptance is a significant barrier to sepsis CDS implementation. Successful implementation of less clinically intuitive ML models may require additional attention to user confusion and distrust.
Machine-learning-based quality-level-estimation system for inspecting steel microstructures
Authors: Nishiura Hiromi , Miyamoto Atsushi , Ito Akira , Harada Minoru , Suzuki Shogo , Fujii Kouhei , Morifuji Hiroshi , Takatsuka Hiroyuki
Published: April 2022

Quality control of special steel is accomplished through visual inspection of its microstructure based on microscopic images. This study proposes an ‘automatic-quality-level-estimation system’ based on machine learning. Visual inspection of this type is sensory-based, so training data may include variations in judgments and training errors due to individual differences between inspectors, which makes it easy for a drop in generalization performance to occur due to overfitting. To deal with this issue, we here propose the preprocessing of inspection images and a data augmentation technique. Preprocessing reduces variation in images by extracting features that are highly related to the level of quality from inspection images. Data augmentation, meanwhile, suppresses the problem of overfitting when training with a small number of images by taking into account information on variation in judgment values obtained from on-site experience. While the correct-answer rate for judging the quality level by an inspector was about 90%, the proposed method achieved a correct-answer rate of 92.5%, which indicates that the method shows promise for practical applications.
Hydroxynitrile lyase defends Arabidopsis againstTetranychus urticae
Authors: Arnaiz Ana , Santamaria M Estrella , Rosa-Diaz Irene , Garcia Irene , Dixit Sameer , Vallejos Saul , Gotor Cecilia , Martinez Manuel , Grbic Vojislava , Diaz Isabel
Published: April 2022

Plant–pest interactions involve multifaceted processes encompassing a complex crosstalk of pathways, molecules, and regulators aimed at overcoming defenses developed by each interacting organism. Among plant defensive compounds against phytophagous arthropods, cyanide-derived products are toxic molecules that directly target pest physiology. Here, we identified the Arabidopsis (Arabidopsis thaliana) gene encoding hydroxynitrile lyase (AtHNL, At5g10300) as one gene induced in response to spider mite (Tetranychus urticae) infestation. AtHNL catalyzes the reversible interconversion between cyanohydrins and derived carbonyl compounds with free cyanide. AtHNL loss- and gain-of-function Arabidopsis plants showed that specific activity of AtHNL using mandelonitrile as substrate was higher in the overexpressing lines than in wild-type (WT) and mutant lines. Concomitantly, mandelonitrile accumulated at higher levels in mutant lines than in WT plants and was significantly reduced in the AtHNL overexpressing lines. After mite infestation, mandelonitrile content increased in WT and overexpressing plants but not in mutant lines, while hydrogen cyanide (HCN) accumulated in the three infested Arabidopsis genotypes. Feeding bioassays demonstrated that the AtHNL gene participated in Arabidopsis defense against T. urticae. The reduced leaf damage detected in the AtHNL overexpressing lines reflected the mite’s reduced ability to feed on leaves, which consequently restricted mite fecundity. In turn, mites upregulated TuCAS1 encoding β-cyanoalanine synthase to avoid the respiratory damage produced by HCN. This detoxification effect was functionally demonstrated by reduced mite fecundity observed when dsRNA-TuCAS-treated mites fed on WT plants and hnl1 mutant lines. These findings add more players in the Arabidopsis–T. urticae interplay to overcome mutual defenses.
Minimum complexity drives regulatory logic in Boolean models of living systems
Authors: Subbaroyan Ajay , Martin Olivier C , Samal Areejit
Published: April 2022

The properties of random Boolean networks have been investigated extensively as models of regulation in biological systems. However, the Boolean functions (BFs) specifying the associated logical update rules should not be expected to be random. In this contribution, we focus on biologically meaningful types of BFs, and perform a systematic study of their preponderance in a compilation of 2,687 functions extracted from published models. A surprising feature is that most of these BFs have odd “bias”, that is they produce “on” outputs for a total number of input combinations that is odd. Upon further analysis, we are able to explain this observation, along with the enrichment of read-once functions (RoFs) and its nested canalyzing functions (NCFs) subset, in terms of 2 complexity measures: Boolean complexity based on string lengths in formal logic, which is yet unexplored in biological contexts, and the so-called average sensitivity. RoFs minimize Boolean complexity and all such functions have odd bias. Furthermore, NCFs minimize not only the Boolean complexity but also the average sensitivity. These results reveal the importance of minimum complexity in the regulatory logic of biological networks.
Multiplexed detection of bacterial nucleic acids using Cas13 in droplet microarrays
Authors: Thakku Sri Gowtham , Ackerman Cheri M , Myhrvold Cameron , Bhattacharyya Roby P , Livny Jonathan , Ma Peijun , Gomez Giselle Isabella , Sabeti Pardis C , Blainey Paul C , Hung Deborah T
Published: April 2022

Rapid and accurate diagnosis of infections is fundamental to individual patient care and public health management. Nucleic acid detection methods are critical to this effort, but are limited either in the breadth of pathogens targeted or by the expertise and infrastructure required. We present here a high-throughput system that enables rapid identification of bacterial pathogens, bCARMEN, which utilizes: (1) modular CRISPR-Cas13-based nucleic acid detection with enhanced sensitivity and specificity; and (2) a droplet microfluidic system that enables thousands of simultaneous, spatially multiplexed detection reactions at nanoliter volumes; and (3) a novel preamplification strategy that further enhances sensitivity and specificity. We demonstrate bCARMEN is capable of detecting and discriminating 52 clinically relevant bacterial species and several key antibiotic resistance genes. We further develop a simple proof of principle workflow using stabilized reagents and cell phone camera optical readout, opening up the possibility of a rapid point-of-care multiplexed bacterial pathogen identification and antibiotic susceptibility testing.
Artificial light at night: an underappreciated effect on phenology of deciduous woody plants
Authors: Meng Lin , Zhou Yuyu , Román Miguel O , Stokes Eleanor C , Wang Zhuosen , Asrar Ghassem R , Mao Jiafu , Richardson Andrew D , Gu Lianhong , Wang Yiming
Published: April 2022

Artificial light at night (ALAN), an increasing anthropogenic driver, is widespread and shows rapid expansion with potential adverse impact on the terrestrial ecosystem. However, whether and to what extent does ALAN affect plant phenology, a critical factor influencing the timing of terrestrial ecosystem processes, remains unexplored due to limited ALAN observation. Here, we used the Black Marble ALAN product and phenology observations from USA National Phenology Network to investigate the impact of ALAN on deciduous woody plants phenology in the conterminous United States. We found that (1) ALAN significantly advanced the date of breaking leaf buds by 8.9 ± 6.9 days (mean ± SD) and delayed the coloring of leaves by 6.0 ± 11.9 days on average; (2) the magnitude of phenological changes was significantly correlated with the intensity of ALAN (P < 0.001); and (3) there was an interaction between ALAN and temperature on the coloring of leaves, but not on breaking leaf buds. We further showed that under future climate warming scenarios, ALAN will accelerate the advance in breaking leaf buds but exert a more complex effect on the coloring of leaves. This study suggests intensified ALAN may have far-reaching but underappreciated consequences in disrupting key ecosystem functions and services, which requires an interdisciplinary approach to investigate. Developing lighting strategies that minimize the impact of ALAN on ecosystems, especially those embedded and surrounding major cities, is challenging but must be pursued.
Erosion of N = 28 shell closure: Shape coexistence and monopole transition
Authors: Suzuki Y , Horiuchi W , Kimura M
Published: April 2022

In neutron-rich nuclei neighboring 42Si, the quenching of the N = 28 shell gap occurs and is expected to induce shape coexistence in their excitation spectra. We have applied the theoretical framework of antisymmetrized molecular dynamics with the Gogny D1S density functional to describe the shape coexistence in the N = 28 isotones 40Mg, 42Si, and 44S. We show that different nuclear shapes coexist in these nuclei: Rigid shapes with different deformations coexist in 40Mg and 42Si, while 44S exhibits large-amplitude collective motion and does not have any particular shape. These characteristics are reflected well in the monopole transition strengths that can be utilized as a probe for the shape coexistence.
Valuing the Global Mortality Consequences of Climate Change Accounting for Adaptation Costs and Benefits
Authors: Carleton Tamma , Jina Amir , Delgado Michael , Greenstone Michael , Houser Trevor , Hsiang Solomon , Hultgren Andrew , Kopp Robert E , McCusker Kelly E , Nath Ishan , Rising James , Rode Ashwin , Seo Hee Kwon , Viaene Arvid , Yuan Jiacan , Zhang Alice Tianbo
Published: April 2022

Using 40 countries’ subnational data, we estimate age-specific mortality-temperature relationships and extrapolate them to countries without data today and into a future with climate change. We uncover a U-shaped relationship where extre6me cold and hot temperatures increase mortality rates, especially for the elderly. Critically, this relationship is flattened by higher incomes and adaptation to local climate. Using a revealed-preference approach to recover unobserved adaptation costs, we estimate that the mean global increase in mortality risk due to climate change, accounting for adaptation benefits and costs, is valued at roughly 3.2% of global GDP in 2100 under a high-emissions scenario. Notably, today’s cold locations are projected to benefit, while today’s poor and hot locations have large projected damages. Finally, our central estimates indicate that the release of an additional ton of CO2 today will cause mortality-related damages of $36.6 under a high-emissions scenario, with an interquartile range accounting for both econometric and climate uncertainty of [−$7.8, $73.0]. These empirically grounded estimates exceed the previous literature’s estimates by an order of magnitude.
Investing in Infants: the Lasting Effects of Cash Transfers to New Families
Authors: Barr Andrew , Eggleston Jonathan , Smith Alexander A
Published: April 2022

We provide new evidence that cash transfers following the birth of a first child can have large and long-lasting effects on that child’s outcomes. We take advantage of the January 1 birthdate cutoff for U.S. child-related tax benefits, which results in families of otherwise similar children receiving substantially different refunds during the first year of life. For the average low-income single-child family in our sample, this difference amounts to roughly ${\$}$1,300, or 10% of income. Using the universe of administrative federal tax data in selected years, we show that this transfer in infancy increases young adult earnings by at least 1%–2%, with larger effects for males. These effects show up at earlier ages in terms of improved math and reading test scores and a higher likelihood of high-school graduation. The observed effects on shorter-run parental outcomes suggest that additional liquidity during the critical window following the birth of a first child leads to persistent increases in family income that likely contribute to the downstream effects on children’s outcomes. The longer-term effects on child earnings alone are large enough that the transfer pays for itself through subsequent increases in federal income tax revenue.
Zinc-based metal organic framework with antibacterial and anti-inflammatory properties for promoting wound healing
Authors: Chen Yuting , Cai Jinhong , Liu Dachang , Liu Shuhan , Lei Doudou , Zheng Li , Wei Qingjun , Gao Ming
Published: April 2022

The synergistic effect of antibacterial and anti-inflammatory is needed to overcome the problem of wound healing difficulties. Based on the favorable antibacterial and anti-inflammatory effect of zinc ions (Zn2+) and the physicochemical properties of metal organic frameworks (MOFs), we prepared nanosized zinc-based MOF: Zn-BTC with the ability to slowly release Zn2+. In cellular levels, Zn-BTC possessed lower toxicity to fibroblasts and enhanced capacity of cell proliferation and migration. It also had good bactericidal effect on multiple drug-resistant bacteria by reducing 41.4% MRSA and 47.2% Escherichia coli. In addition, Zn-BTC also displayed the ability of lowering the expression of antioxidant genes: superoxide dismutase 1, superoxide dismutase 2 and interleukin 6, and enhancing the expression of wound healing genes: transforming growth factors-β and type I collagen. Finally, it also demonstrated that Zn-BTC could effectively improve the skin wound healing of SD rats and had no toxicity on major organs. The favorable biocompatibility, antibacterial and anti-inflammatory properties of Zn-BTC gave a new insight of designing novel MOFs for promoting skin wound healing.
VERTICAL MIXING NEAR THE SEA SURFACE OBSERVED BY SHORT-LIVED NATURAL RADIONUCLIDES ( 214PB AND 214BI)
Authors: Kofuji Hisaki
Published: April 2022

I performed continuous gamma-ray measurements in seawater to observe the temporal variation of radon progenies ( 214Pb and 214Bi) derived from atmospheric precipitation. Underwater gamma-ray measurements using two NaI(Tl) detectors at different installation depths (1 and 4 m) were recorded from July to November 2011 at the marine observation buoy. An increase in the concentration of 214Pb + 214Bi in seawater was observed due to precipitation when the wind velocity was <2 m s−1. However, this increase was only detected at 1 m depth and a downward spread of 214Pb + 214Bi was not observed. In contrast, at a wind velocity of >8 m s−1, the 214Pb + 214Bi concentration ratio at 4 m/1 m was almost constant (0.6–0.7) for most of the measurement irrespective of precipitation intensity. Assuming one-dimensional diffusion in the water column, the apparent vertical diffusion coefficient estimated from the temporal variation of 214Pb + 214Bi concentrations at 4 m/1 m varied from <10 to 500 cm2 s−1 depending on the wind velocity.
Survival of Conidia of the Boxwood Blight Pathogen Calonectria pseudonaviculata Under Different Relative Humidity Conditions
Authors: Kodati Srikanth , Cowles Richard S. , LaMondia James A.
Published: April 2022

Boxwood blight, caused by Calonectria pseudonaviculata, is a significant disease affecting both nursery production and landscape boxwood plantings. C. pseudonaviculata conidia are produced in clumps in an extracellular mucilaginous matrix. Local spread of the pathogen is by dispersal of conidia in water splash or direct contact dispersal, but the effects of relative humidity (RH) on survival and germination of dispersed conidia over time are unknown. We investigated the effects of 15, 40, 80, and 100% RH on the survival of individual conidia or conidia aggregated in clumps over time. Conidia were transferred to a dry glass surface and scored for the incidence of survival and percentage germination over 3, 6, and 9 days. Conidia in clumps had higher incidence of survival and percentage germination than individual conidia. RH significantly and positively influenced germination and survival, as measured by the presence or absence of germination by individual conidia, but not by clumps of conidia. Individual conidia survived for at least 6 days at all RH tested. No germination was observed for any individual conidium exposed to 15% RH for 9 days, whereas conidia in clumps survived and germinated at all RH levels for at least 9 days. This study indicates that simply pruning or working in infected boxwoods under dry conditions may be insufficient to limit the spread of the pathogen and, ultimately, disease. Further measures such as frequent disinfestation of tools with alcohol or fungicide application before or after possible spread of conidial clumps may be necessary.
Role of Early Enteral Nutrition in Mechanically Ventilated COVID-19 Patients
Authors: Haines Krista , Parker Virginia , Ohnuma Tetsu , Krishnamoorthy Vijay , Raghunathan Karthik , Sulo Suela , Kerr Kirk W. , Besecker Beth Y. , Cassady Bridget A. , Wischmeyer Paul E.
Published: April 2022

OBJECTIVES:

Current guidance recommends initiation of early enteral nutrition (early EN) within 24–36 hours of ICU admission in critically ill COVID-19 patients. Despite this recommendation, there is quite limited evidence describing the effect of early EN on outcomes in COVID-19 patients. The association between early EN (within 3 d post intubation) and clinical outcomes in adult COVID-19 patients requiring mechanical ventilation (within 2 d post ICU admission) was evaluated.

DESIGN:

We performed a nationwide observational cohort study using a nationwide administrative-financial database (Premier) in United States.

SETTING:

Information pertaining to all COVID-19 patients admitted to ICU from 75 hospitals between April and December 2020 was analyzed.

PATIENTS:

A total of 861 COVID-19 patients were included.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Clinical outcomes were assessed via regression models to control for patient and hospital characteristics. We identified 513 COVID-19 ICU patients (59.2%) requiring mechanical ventilation who received early EN and had similar baseline characteristics to late EN group. Compared with late EN group, the early EN group had shorter ICU (hazard ratio [HR], 1.39; 95% CI, 1.15–1.68) and hospital length of stays (LOS) (HR, 1.53; 95% CI, 1.23–1.91), fewer mechanical ventilation days (HR, 1.25; 95% CI, 1.01–1.54), and lower cost (–$22,443; 95% CI, –$32,342 to –$12,534). All comparisons were statistically significant (p < 0.05).

CONCLUSIONS:

In patients with COVID-19 requiring mechanical ventilation, early EN is associated with earlier liberation from mechanical ventilation, shorter ICU and hospital LOS, and decreased cost. Our results are among the first to support guideline recommendations for initiation of early EN in COVID-19 ICU patients. Further, our data show nearly 40% of critically ill COVID-19 patients fail to have early EN initiated, even at 3 d post initiation of mechanical ventilation. These results emphasize the need for targeted strategies promoting initiation of early EN, as this may lead to improved clinical and economic outcomes in severe COVID-19 patients.
Prevention, Diagnosis, and Management of Upper Extremity Lymphedema Complications: Altmetric Analysis of Online Media
Authors: Kirloskar Kunal M. , Abu El Hawa Areeg A. , Kim Kevin G. , Dekker Paige K. , Shaposhnik Guy , Fan Kenneth L.
Published: April 2022

Background:

Traditional citation-based metrics do not capture the dissemination of upper extremity lymphedema (UEL) research that occurs online and in mainstream media. There is limited literature reporting the most impactful UEL articles based on citation rate and/or online mentions. We sought to use the Altmetric Attention Score (AAS) to determine the most impactful UEL articles in online media and to report trends in the diagnosis, treatment, and prevention of complications.

Methods:

The Altmetric database was queried to identify all published articles regarding the management, diagnosis, and prevention of complications seen in the setting of UEL. Extracted data points included article topic and type, journal, and number of online mentions on several platforms.

Results:

Our index search yielded 638 studies published between 2000 and 2021. Fifty articles with the highest AAS scores were included for analysis. The median AAS was 27.5, but the top four articles had AAS scores that were substantially higher (AAS ≥ 334) than all other studies. Of the top 50 articles, 68% (34/50) were original research. Of those, 23.5% (8/34) were randomized control trials. The most common article topic was the treatment of UEL (36%; 18/50) followed by diagnostic methods of UEL (30%; 15/50). There were a total of 1156 Twitter mentions (median:14) for the top 50 articles. Of all media platforms, news mentions correlated most strongly with AAS (R2 = 0.99, P < 0.001).

Conclusions:

Our findings suggest that alternative metrics measure distinct components of article impact and add an important dimension to understanding the overall impact of published research on UEL.
Incidence of Testicular Cancer in Transfeminine Patients following Vaginoplasty with Orchidectomy
Authors: Bonapace-Potvin Michelle , Bijou-Coulon Sabrina , Medor Maria Cassandre , Brassard Pierre , Bélanger Maud
Published: April 2022

Background:

Little is known about the prevalence of testicular cancer in the transfeminine population. Only six cases have been reported in the literature. This case series reports six additional cases of various testicular cancers found in transfeminine patients who underwent vaginoplasty with orchidectomy in our institution.

Methods:

In our institution, all specimens are routinely sent to pathology following vaginoplasty with orchidectomy. This permitted the identification of all positive cases of testicular cancer. A chart review was conducted to retrieve patient demographics, duration of hormonotherapy, type of neoplasm, the context of its discovery, and cancer follow-up.

Results:

A total of 2555 patients underwent vaginoplasty with orchidectomy between January 2016 and January 2021. All specimens were sent to pathology for analysis. A total of six (0.23% of patients) specimens revealed malignant lesions.

Conclusions:

Increased societal awareness toward the transgender population encourages recourse to gender-affirming procedures. Little is known about the incidence of testicular cancer in the transfeminine population. In total, 0.23% of patients in our cohort presented with positive pathology findings indicative of testicular cancer. All cancers were found to be only locally invasive, and all patients were successfully treated. We therefore encourage routine pathology examination for all specimens following vaginoplasty with orchidectomy.
Nonsurgical Treatment of Carpal Tunnel Syndrome: A Survey of Hand Surgeons
Authors: Billig Jessica I. , Sears Erika D.
Published: April 2022

Background:

The nonsurgical treatment of carpal tunnel syndrome (CTS) consists of multiple modalities: splinting, corticosteroid injections, hand therapy, and oral medications. However, data supporting the effectiveness of these different modalities are varied, thus creating controversy regarding the optimal nonsurgical treatment. It is unknown how current hand surgeons utilize nonsurgical treatments for CTS.

Methods:

An anonymous web-based survey was sent to 3289 members of the American Society for Surgery of the Hand to assess nonsurgical treatment patterns for CTS. We pretested the survey using expert survey and content review and cognitively tested the survey for readability and understandability.

Results:

We analyzed surveys from 770 hand surgeons. Of the respondents, 41.2% of respondents recommend steroid injections for the treatment of CTS, 81.3% of respondents do not believe that oral steroids are beneficial for the treatment of CTS, and 3.6% of respondents typically prescribe gabapentinoids for the treatment of CTS. In total, 561 (72.9%) respondents always, usually, or sometimes encounter patients with more than two steroid injections for CTS before hand surgeon evaluation.

Conclusions:

There is variation in the use of nonsurgical modalities for the treatment of CTS among American Society for Surgery of the Hand members. However, patients do not obtain long-term benefit from multiple steroid injections and gabapentinoids for the treatment of CTS, highlighting the importance of dissemination of evidence-based nonsurgical management of CTS. Collectively, these findings underscore the importance of providing clear guidelines as to which patients benefit most from nonsurgical treatments.
Frontal Sinus Fractures: Evidence and Clinical Reflections
Authors: Lopez Christopher D. , Rodriguez Colon Ricardo , Lopez Joseph , Manson Paul N. , Rodriguez Eduardo D.
Published: April 2022

Background:

Despite significant advances in the management of frontal sinus fractures, there is still a paucity of large-cohort data, and a comprehensive synthesis of the current literature is warranted. The purpose of this study was to present an evidence-based overview of frontal sinus fracture management and outcomes.

Methods:

A comprehensive literature search of PubMed and MEDLINE was conducted for studies published between 1992 and 2020 investigating frontal sinus fractures. Data on fracture type, intervention, and outcome measurements were reported.

Results:

In total, 456 articles were identified, of which 53 met our criteria and were included in our analysis. No statistically significant difference in mechanism of injury, fracture pattern, form of management, or total complication rate was identified. We found a statistically significant increase in complication rates in patients with nasofrontal outflow tract injury compared with those without.

Conclusions:

Frontal sinus fracture management is a challenging clinical situation, with no widely accepted algorithm to guide appropriate management. Thorough clinical assessment of the fracture pattern and associated injuries can facilitate clinical decision-making.
An Online Calculator for Estimating Breast Implant Volume from Imaging
Authors: Mateja Kirby L. , Long Aaron S. , Hauc Sacha C. , Glahn Joshua Z. , Weber Clara F. , Junn Adam H. , Juan Hui Yu , Bobba Pratheek S. , Persing John A. , Alperovich Michael
Published: April 2022

Breast implant surgery remains one of the most common surgical procedures performed in the United States. Implant exchange can be complicated by unavailability of medical records or implant identification cards. Using chest imaging of 154 breast implants, an algorithm for estimating breast implant volume was generated. Based on four simple measurements and patient body mass index, a free, online calculator was created with a mean error of volume estimate of less than 1 cm3 and a SD of 44 cm3. In instances where a surgeon does not have implant records available but has chest imaging, this online tool can be used to obtain a relatively accurate estimate of implant volume.
Developing Machine Learning Algorithms to Support Patient-centered, Value-based Carpal Tunnel Decompression Surgery
Authors: Harrison Conrad J. , Geoghegan Luke , Sidey-Gibbons Chris J. , Stirling Paul H. C. , McEachan Jane E. , Rodrigues Jeremy N.
Published: April 2022

Background:

Carpal tunnel syndrome (CTS) is extremely common and typically treated with carpal tunnel decompression (CTD). Although generally an effective treatment, up to 25% of patients do not experience meaningful benefit. Given the prevalence, this amounts to considerable morbidity and cost without return. Being able to reliably predict which patients would benefit from CTD preoperatively would support more patient-centered and value-based care.

Methods:

We used registry data from 1916 consecutive patients undergoing CTD for CTS at a regional hand center between 2010 and 2019. Improvement was defined as change exceeding the respective QuickDASH subscale’s minimal important change estimate. Predictors included a range of clinical, demographic and patient-reported variables. Data were split into training (75%) and test (25%) sets. A range of machine learning algorithms was developed using the training data and evaluated with the test data. We also used a machine learning technique called chi-squared automatic interaction detection to develop flowcharts that could help clinicians and patients to understand the chances of a patient improving with surgery.

Results:

The top performing models predicted functional and symptomatic improvement with accuracies of 0.718 (95% confidence interval 0.660, 0.771) and 0.759 (95% confidence interval 0.708, 0.810), respectively. The chi-squared automatic interaction detection flowcharts could provide valuable clinical insights from as little as two preoperative questions.

Conclusions:

Patient-reported outcome measures and machine learning can support patient-centered and value-based healthcare. Our algorithms can be used for expectation management and to rationalize treatment risks and costs associated with CTD.
The Effect of Mindfulness-Based Breathing and Music Therapy Practice on Nurses' Stress, Work-Related Strain, and Psychological Well-being During the COVID-19 Pandemic
Authors: Yıldırım Dilek , Çiriş Yıldız Cennet
Published: April 2022

Infectious diseases cause psychological problems for health care workers and especially nurses. Nurses who provided coronavirus disease-2019 (COVID-19) patients with care experience negative feelings such as stress, work-related strain, discomfort, and helplessness related to their high-intensity work. The aims of this study are to investigate the effect of the mindfulness-based breathing and music therapy practice on stress, work-related strain, and psychological well-being levels of nurses who provided COVID-19 patients with care. This randomized controlled trial was conducted in a COVID-19 department at a university hospital in Turkey. Nurses who care for patients infected with COVID-19 were randomly divided into an intervention group (n = 52) and a no-treatment control group (n = 52). The intervention group received mindfulness-based breathing and music therapy. In data collection, the Personal Information Form, State Anxiety Inventory, Work-Related Strain Scale, and Psychological Well-Being Scale were used. The data from the study showed that mindfulness-based breathing and music therapy decreased stress and work-related strain (P < .05) and increased psychological well-being (P < .05). The control group showed no statistically significant changes on these measures (P > .05). The mindfulness-based breathing and music therapy practice reduced nurses' stress and work-related strain and increased psychological well-being during the COVID-19 pandemic.
IMAGING THE VITREOUS WITH A NOVEL BOOSTED OPTICAL COHERENCE TOMOGRAPHY TECHNIQUE
Authors: Spaide Richard F. , Valmaggia Philippe , Maloca Peter M.
Published: April 2022

Purpose:

To evaluate the anatomic changes in the vitreous associated with evolving posterior vitreous detachment over the macula.

Methods:

A novel scanning method by which four A-scans at each position were averaged before the Fourier transform that boosted the image quality sufficiently such that frame averaging could occur. B-scans and volume rendered images of eyes with evidence of any partial separation of the vitreous in the macular regions were evaluated.

Results:

There were 43 eyes of 23 subjects with particular attention paid to the findings of seven eyes with various stages of posterior vitreous detachment occurring over the macula. In eyes from young subjects with no vitreous degeneration, the outer vitreous showed a diffuse, poorly defined increase in reflectivity in the region where the vitreous cortex was expected to be. In eyes with vitreous degeneration, there was a hyperreflective zone, called the cortical vitreous condensation, that coursed parallel to the curvature of the retina. The posterior vitreous face elevated from the retina with either a well-defined, smooth outer surface, consistent with the posterior vitreous membrane, or a poorly defined flocculent outer border. The cortical vitreous near the fovea was thin and in eyes in the process of posterior vitreous detachment had visible tears. In more advanced eyes, a circular dehiscence of the cortical vitreous in the central macula occurred with herniation of the vitreous gel through the hole.

Conclusion:

The methodology produced images of unprecedented clarity that highlighted several newly described details concerning the vitreous changes associated with posterior vitreous detachment over the macula.
CYTOMEGALOVIRUS RETINITIS SCREENING USING MACHINE LEARNING TECHNOLOGY
Authors: Srisuriyajan Pitchapa , Cheewaruangroj Nontawat , Polpinit Pattarawit , Laovirojjanakul Wipada
Published: April 2022

Propose:

A screening protocol for cytomegalovirus retinitis (CMVR) by fundus photography was generated, and the diagnostic accuracy of machine learning technology for CMVR screening in HIV patients was investigated.

Methods:

One hundred sixty-five eyes of 90 HIV-positive patients were enrolled and evaluated for CMVR with binocular indirect ophthalmoscopy. Then, a single central field of the fundus image was recorded from each eye. All images were then interpreted by both machine learning models, generated by using the Keras application, and by a third-year ophthalmology resident. Diagnostic performance of CMVR screening using a machine learning model and the third-year ophthalmology resident were analyzed and compared.

Results:

Machine learning model, Keras application (VGG16), provided 68.8% (95% confidence interval [CI] = 50%–83.9%) sensitivity and 100% (95% CI = 97.2%–100%) specificity. The program provided accuracy of 93.94%. However, the sensitivity and specificity for the third-year ophthalmology grading were 67.7% (95% CI = 48.6%–83.3%) and 98.4% (95% CI = 94.5%–99.8%). The accuracy for CMVR classification was 89.70%. When considering for sight-threatening retinitis in Zone 1 and excluded Zones 2 and 3, the machine learning model provided high sensitivity of 88.2% (95% CI = 63.6%–98.5%) and high specificity of 100% (95% CI = 97.2%–100%).

Conclusion:

This study demonstrated the benefit of the machine learning model VGG16, which provided high sensitivity and specificity for detecting sight-threatening CMVR in HIV-positive patients. This model is a useful tool for ophthalmologists in clinical practice for preventing blindness from CMVR, especially during the Coronavrus Disease 2019 pandemic.
Increase in Haemophilus influenzae Detection in 13-Valent Pneumococcal Conjugate Vaccine Immunized Children With Acute Otitis Media
Authors: Klein Ayala , Tamir Sharon Ovnat , Sorek Nadav , Hanun Galia , Yeshayahu Yonatan , Marom Tal
Published: April 2022

NTHi was the predominant pathogen in ear cultures from severe acute otitis media (AOM) episodes in PCV-13 vaccinated children, more commonly in girls. NTHi-AOM episodes were associated with more myringotomies due to a higher treatment failure incidence. The low rate of β-lactamase NTHi isolates in middle ear fluid cultures from PCV-13 vaccinated children presenting with AOM strengthens to still use amoxicillin as the first-line antibiotics.
Multisystem Inflammatory Syndrome in Children and Acute Kidney Injury: Retrospective Study of Five Italian PICUs
Authors: Ricci Zaccaria , Colosimo Denise , Cumbo Silvia , L’Erario Manuela , Duchini Pierpaolo , Rufini Paolo , Perrotta Daniela , De Sanctis Francesco , Di Nardo Matteo , Amigoni Angela , Pulitanò Silvia ,   MIS-C PICU Italian Study Group
Published: April 2022

OBJECTIVES:

Multisystem inflammatory syndrome in children (MIS-C) manifests with heart dysfunction and respiratory failure some weeks after a severe acute respiratory syndrome coronavirus disease 2 infection. The aim of our study was to explore the prevalence, severity, timing, and duration of acute kidney injury (AKI) in MIS-C patients. Furthermore, we evaluated which clinical variables and outcomes are associated with AKI.

DESIGN:

Multicenter retrospective study.

SETTING:

Five tertiary hospital PICUs in Italy. Data were collected in the first 7 days of PICU admission and renal function was followed throughout the hospital stay.

PATIENTS:

Patients less than 18 years old admitted to the PICU for greater than 24 hours with MIS-C.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We collected the following data, including: demographic information, inflammatory biomarkers, lactate levels, Pao
2/Fio
2, ejection fraction, N-terminal pro–B-type natriuretic peptide (NT-proBNP), renal function (serum creatinine, urinary output, fluid balance, and percentage fluid accumulation), Vasoactive-Inotropic Score (VIS), pediatric Sequential Organ Failure Assessment (pSOFA), and Pediatric Index of Mortality 3. AKI was diagnosed in eight of 38 patients (21%) and severe AKI was present in four of eight patients. In all cases, AKI was present at PICU admission and its median (interquartile range) duration was 3.5 days (1.5–5.7 d). We did not identify differences between AKI and no-AKI patients when not making correction for multiple comparisons, for example, in weight, ejection fraction, pSOFA, Pao
2/Fio
2, and lactates. We failed to identify any difference in these groups in urine output and fluid balance. Exploratory analyses of serial data between no-AKI and AKI patients showed significant differences on lymphocyte count, NT-proBNP value, ejection fraction, pSOFA, Pao
2/Fio
2, and VIS.

CONCLUSIONS:

In this multicenter Italian PICU experience, MIS-C is associated with AKI in one-in-five cases. In general, AKI is characterized by an associated reduction in glomerular filtration rate with a self-limiting time course.
Epidemiology of Pediatric Critical Care Admissions in 43 United States Children’s Hospitals, 2014–2019*
Authors: Heneghan Julia A. , Rogerson Colin , Goodman Denise M. , Hall Matt , Kohne Joseph G. , Kane Jason M.
Published: April 2022

OBJECTIVES:

To identify trends in the population of patients in PICUs over time.

DESIGN:

Cross-sectional, retrospective cohort study using the Pediatric Health Information System database.

SETTING:

Forty-three U.S. children’s hospitals.

PATIENTS:

All patients admitted to Pediatric Health Information System-participating hospitals from January 2014 to December 2019. Individuals greater than 65 years old and normal newborns were excluded.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

PICU care occurred in 13.8% of all pediatric hospital encounters and increased over the study period from 13.3% to 14.3%. Resource intensity, based on average Hospitalization Resource Intensity Scores for Kids score, increased significantly across epochs (6.5 in 2014–2015 vs 6.9 in 2018–2019; p < 0.001), although this was not consistently manifested as additional procedural exposure. Geometric mean PICU cost per patient encounter was stable. The two most common disease categories in PICU patients were respiratory failure and cardiac and circulatory congenital anomalies. Of all PICU encounters, 35.5% involved mechanical ventilation, and 25.9% involved vasoactive infusions. Hospital-level variation in the percentage of days spent in the PICU ranged from 15.1% to 63.5% across the participating sites. Of the total hospital costs for patients admitted to the PICU, 41.7% of costs were accrued during the patients’ PICU stay.

CONCLUSIONS:

The proportional use of PICU beds is increasing over time, although was variable across centers. Case-based resource use and complexity of pediatric patients are also increasing. Despite the higher use of PICU resources, the standardized costs of PICU care per patient encounter have remained stable. These data may help to inform current PICU resource allocation and future PICU capacity planning.
Apportioning archaic variants among modern populations
Authors: Witt Kelsey E. , Villanea Fernando , Loughran Elle , Zhang Xinjun , Huerta-Sanchez Emilia
Published: April 2022

The apportionment of human genetic diversity within and between populations has been measured to understand human relatedness and demographic history. Likewise, the distribution of archaic ancestry in modern populations can be leveraged to better understand the interaction between our species and its archaic relatives. Resolving the interactions between modern and archaic human populations can be difficult, as archaic variants in modern populations have been shaped by genetic drift, bottlenecks and gene flow. Here, we investigate the distribution of archaic variation in Eurasian populations. We find that archaic ancestry coverage at the individual- and population-level present distinct patterns in modern human populations: South Asians have nearly twice the number of population-unique archaic alleles compared with Europeans or East Asians, indicating that these populations experienced differing demographic and archaic admixture events. We confirm previous observations that East Asian individuals have more Neanderthal ancestry than European individuals, but surprisingly, when we compare the number of single nucleotide polymorphisms with archaic alleles found across a population, Europeans have more Neanderthal ancestry than East Asians. We compare these results to simulated models and conclude that these patterns are consistent with multiple admixture events between modern humans and Neanderthals.

This article is part of the theme issue ‘Celebrating 50 years since Lewontin's apportionment of human diversity’.
Diversity and its causes: Lewontin on racism, biological determinism and the adaptationist programme
Authors: Shen Hao , Feldman Marcus W.
Published: April 2022

Lewontin's 1972 paper (RC Lewontin, 1972
The apportionment of human diversity
,

in
Evolutionary biology, vol. 6
(eds T Dobzhansky, MK Hecht, WC Steere), pp. 381–398) can be viewed as one foray in his battle against biological determinism. Our paper shows where Lewontin,
The apportionment of human diversity
, fits in the debate over human classification that it stimulated. We outline three assumptions inherent in the biological deterministic view of human phenotypic diversity and show how the 1972 paper, as well as Lewontin's papers in 1970 and 1974 on the problems with the heritability statistic and his 1979 criticism of naive pan-selectionism, invalidate these assumptions. These papers were crucial components of his campaign against biological determinism and the racism with which it was associated. In the current climate of widespread racism and the rise of sociogenomics, it is important to revisit Lewontin's writings and to disseminate the messages they contain.

This article is part of the theme issue ‘Celebrating 50 years since Lewontin's apportionment of human diversity’.
Animals in higher education settings: Do animal-assisted interventions improve mental and cognitive health outcomes of students? A systematic review and meta-analysis
Authors: Huber Annalena , Klug Stefanie J. , Abraham Annette , Westenberg Erica , Schmidt Veronika , Winkler Andrea S.
Published: April 2022

Background

Due to the high burden of mental health issues among students at higher education institutions world-wide, animal-assisted interventions (AAIs) are being increasingly used to relieve student stress. The objective of this study was to systematically review of the effects of AAIs on the mental and cognitive health outcomes of higher education students.

Methods

Randomized controlled trials using any unfamiliar animal as the sole intervention tool were included in the systematic review. Study quality was assessed using the Cochrane Risk-of-Bias tool. Where possible, effect sizes (Hedges’ g) were pooled for individual outcomes using random-effects meta-analyses. Albatross plots were used to supplement the data synthesis.

Results

Of 2.401 identified studies, 35 were included. Almost all studies used dogs as the intervention animal. The quality of most included studies was rated as moderate. Studies showed an overall reduction of acute anxiety (g= -0.57 (95%CI -1.45;0.31)) and stress. For other mental outcomes, studies showed an overall small reduction of negative affect (g= -0.47 (95%CI -1.46;0.52)), chronic stress (g= -0.23 (95%CI -0.57;0.11)) and depression, as well as small increases in arousal, happiness and positive affect (g= 0.06 (95%CI -0.78;0.90)). Studies showed no effect on heart rate and heart rate variability, a small reduction in salivary cortisol and mixed effects on blood pressure. No effect on cognitive outcomes was found.

Conclusion

Overall, evidence suggests that AAIs are effective at improving mental, but not physiological or cognitive outcomes of students. Strong methodological heterogeneity between studies limited the ability to draw clear conclusions.