bluuebunny/crossref_metadata_2025 huggingface dataset:
The micro- and megafossil record of Nothofagaceae from South America
Authors: Pujana Roberto R , Fernández Damián A , Panti Carolina , Caviglia Nicolás
Published: October 2020

We compiled the numerous fossil records (486) assigned to Nothofagaceae including pollen grains (from surface sediments and continental and oceanic borehole cores), leaves, woods and reproductive structures from South America. All the records are revised and the latest systematic treatments and ages of the bearing strata of each record are followed. When possible, we proposed a subgeneric affinity to each record based on updated bibliography. Fossils of three (Nothofagus, Fuscospora and Lophozonia) of the four subgenera are found in similar proportions through time since the Late Cretaceous. Fossils with reliable affinity with subgenus Brassospora were not found in South America. Most of the records are concentrated in the southern tip of South America (Patagonia Region) and nearby areas. After a significant presence of Nothofagaceae in the Cretaceous, the family declined in diversity and abundance in the Palaeocene and then increased from the Eocene to the Miocene. In the Miocene, the records reach their maximum diversity and abundance, and Nothofagaceae usually dominate the assemblages of pollen, leaves and woods from Patagonia. Pliocene Nothofagaceae records are virtually absent, probably because sedimentary rocks of that age are rare in Patagonia. The fossil record for Nothofagaceae varies according to environmental turnover; when tropical/subtropical floras were present in Patagonia in the Palaeocene–early Eocene, Nothofagaceae contracted southwards and when open steppes developed in the Miocene of east Patagonia, Nothofagaceae contracted westward.
Prioritizing Health Care and Employment Resources During COVID-19: Roles of Benevolent and Hostile Ageism
Authors: Apriceno MaryBeth , Lytle Ashley , Monahan Caitlin , Macdonald Jamie , Levy Sheri R
Published: October 2020

Background and Objectives

Benevolent and hostile ageism are subtypes of ageism that characterize older adults as incompetent. With benevolent ageism, older adults are also viewed as warm. The coronavirus disease 2019 (COVID-19) pandemic has strained resources and prompted debates about priority for older adults versus other groups.

Research Design and Methods

College students completed an online survey of how much priority should be given to older adults in 3 relevant health care-related scenarios and 3 relevant employment scenarios.

Results

Benevolent ageism significantly predicted higher priority for older adults to receive health care (triage, COVID-19 vaccine, and COVID-19 testing) and employment resources (retention of job and working from home) while greater endorsement of hostile ageism significantly predicted lower priority ratings.

Discussion and Implications

These findings replicate and extend past work. As the COVID-19 pandemic continues to wreak havoc on health care and employment resources, this study sheds light on one factor—benevolent and hostile ageism—that contributes to a greater understanding of prioritization views toward a vulnerable segment of the population.
The Hull Grundy collection in the Museum of Medicine and Health, University of Manchester
Authors: Mohr Peter , Seville Stephanie
Published: October 2020

Anne Hull Grundy and her husband, John, were prolific antique collectors, remembered for their generous donations of fine and decorative arts to several major museums. Less well known is their collection of over 200 items broadly related to medical topics and donated to the University of Manchester Museum of Medicine and Health (mmh) between 1978 and 1983. The donation includes items of equipment in silver, a collection of commemorative medals and a set of framed prints, all linked to medicine and medical history. This paper describes the Hull Grundy collection and its place in the history of the museum. Short biographical sketches of Anne and John Hull Grundy and a brief history of the mmh, are followed by an account of the artefacts in the collection. The role of donors and donations in defining the nature of a ‘medical history museum’, and its potential use for social history and the medical humanities are also discussed.
The Denial of the Right of Return as a Rome Statute Crime
Authors: Kearney Micheal G
Published: October 2020

In 2018, Pre-Trial Chamber I of the International Criminal Court (ICC) held that conduct preventing the return of members of the Rohingya people to Myanmar could fall within Article 7(1)(k) of the Statute, on the grounds that denial of the right of return constitutes a crime against humanity. No international tribunal has prosecuted this conduct as a discrete violation, but given the significance of the right of return to Palestinians, it can be expected that such an offence would be of central importance should the ICC investigate the situation in Palestine. This comment will review the recognition of this crime against humanity during the process prompted by the Prosecutor’s 2018 Request for a ruling as to the Court’s jurisdiction over trans-boundary crimes in Bangladesh/Myanmar. It will consider the basis for the right of return in general international law, with a specific focus on the Palestinian right of return. The final section will review the elements of the denial of right of return as a crime against humanity, as proposed by the Office of the Prosecutor in its 2019 Request for Authorization of an investigation in Bangladesh/Myanmar.
A Story Half Told—Selective Benefit Assessment in the New US CVD Rule for Exchange Rates
Authors: Lee Jaemin
Published: October 2020

The new countervailing duty proceeding rule of the United States on exchange rates aims to address currency undervaluation through a subsidy tool under the Agreement on Subsidies and Countervailing Measures. As there is no prohibition in the Agreement on Subsidies and Countervailing Measures (ASCM) making macro-economic policies off-limits from the reach of subsidy norms, exchange rates can be subject to countervailing duty proceedings. However, there are specific requirements to be met under the ASCM and World Trade Organization jurisprudence. Most notably, the new countervailing duty proceeding rule arguably fails to meet the ‘benefit’ analysis requirements. It takes into account the effect that negatively weighs on foreign exporters subject to a countervailing duty proceeding while ignoring the one that positively weighs. This skewed benefit analysis of selective nature is difficult to sustain under the ASCM and its jurisprudence. A more detailed and thorough benefit analysis is needed to make this new scheme work in a World Trade Organization (WTO)–consistent manner. The new countervailing duty rule showcases structural problems addressing macro-economic policies through a subsidy framework.
Immunogenicity and Safety of Inactivated Enterovirus 71 Vaccine in Children Aged 36–71 Months: A Double-Blind, Randomized, Controlled, Non-inferiority Phase III Trial
Authors: Zhang Lifen , Gao Fan , Zeng Gang , Yang Haitao , Zhu Taotao , Yang Shuangmin , Meng Xing , Mao Qunying , Liu Xiaoqiang
Published: October 2020

Background

The Sinovac enterovirus 71 (EV71) vaccine has been given to children aged 6–35 months with good safety, immunogenicity, and efficacy. Further exploration is needed for the application of Sinovac EV71 vaccine in older children.

Methods

A phase III, double-blind, single-center, randomized, controlled, non-inferiority, and bridging-designed trial enrolled 300 participants aged 6–35 months and 600 participants aged 36–71 months. Non-inferiority and superiority analyses were made to determine the immunogenicity of Sinovac EV71 vaccine in older children (Older-S group), comparing with that of control EV71 vaccine in the same age group (Older-C group), or comparing with that of Sinovac EV71 vaccine in younger children (Younger-S group).

Results

The seroconversion rate of anti-EV71 in Older-S group (95.5%) was superior to that of Older-C group (86.0%), and non-inferior to that of Younger-S group (98.5%). For baseline seronegative participants, the geometric mean titer of Older-S group (370.0) was non-inferior to that of Older-C group (296.2) and superior to that of Younger-S group (176.5). Incidence of adverse reactions in Older-S group (47.0%) was similar to that of Older-C group (44.8%), or Younger-S group (49.8%).

Conclusions

This study showed good safety and immunogenicity of Sinovac EV71 vaccine in children aged 36–71 months.

Clinical Trials Registration

NCT03909074

URL

https://clinicaltrials.gov/ct2/show/NCT03909074?term=NCT03909074&draw=2&rank=1
Fighting for Family Reunification: the Congolese Experience in São Paulo, Brazil
Authors: Martuscelli Patrícia Nabuco
Published: October 2020

Refugees in Brazil have no political rights. However, problems with family reunification visas in the Brazilian Embassy in Kinshasa was a cause that united Congolese refugees in Brazil. This article analyzes the political articulation of this group in São Paulo. I conducted semi-structured interviews with refugees who act as spokespersons for this movement, and I analysed their strategies of organization, presentation of claims, and political pressure to solve this issue through analysis of documents produced by them and delivered to Brazilian authorities. Even though they had no success, they developed an organizational structure composed by a WhatsApp group for fast communication and periodic meetings in person in the centre of São Paulo. This structure can be used to demand other rights and to continue to pressure the Brazilian government.
We Are Here for the Future of Our Kids: Parental Involvement in Refugee Adolescents’ Educational Endeavours in the United States
Authors: Gandarilla Ocampo Maria , Bennouna Cyril , Seff Ilana , Wessells Michael , Robinson Mackenzie V , Allaf Carine , Stark Lindsay
Published: October 2020

Every year, thousands of young refugees and their families face challenges as they adjust to schools in the US. This article explores how families resettled to the US from conflict-affected, Arab-majority countries in the Middle East and North Africa region, such as Iraq and Syria, view education, and how parents support their children’s education following the experiences of resettlement. To centre the voices and lived experiences of these families, we analysed focus group discussions with 30 adolescents and in-depth interviews with 30 parents and 27 key informants. Analysis using constant comparative method and thematic analysis showed that, upon resettlement, education remained highly valued by families. Our study finds that, despite the challenges associated with families’ newcomer status, parents in this study provided educational support to their children by engaging with the school and with their children’s learning at home. We offer suggestions on how schools and organizations can bolster parents’ ability to support their children’s education.
Adenoid cystic carcinoma of the breast with distant metastasis to the liver and spleen: a case report
Authors: Gillie Breanne , Kmeid Michael , Asarian Armand , Xiao Philip
Published: October 2020

Adenoid cystic carcinoma (ACC) of the breast is a rare malignancy, accounting for 0.1–1% of breast cancers. Histologically breast ACC is similar to ACC’s found in salivary tissue and is a triple-negative breast cancer with an uncharacteristically favorable prognosis and low incidence of metastasis. Most cases present as a painful, palpable mass; however, asymptomatic cases found on screening mammograms have also been noted. Core needle biopsy or excisional biopsy is necessary for definitive diagnosis of breast ACC. Immunohistochemistry of these cancers can differentiate breast ACC from masses with similar histology, such as invasive cribriform carcinoma and collagenous spherulosis. There is no well-established treatment guideline for ACC; however, it has been noted that reoccurrence and metastasis are noted more in cases of local resection than mastectomy.
Becoming Foreign in the Victorian Novel: International Migration in Little Dorrit and Villette
Authors: Wagner Tamara S
Published: October 2020

This article analyses the representation of migrant workers in Victorian fiction. While exploring the seldom-discussed experience of such migrants, I argue that in the fiction of the time, migration for work outside of the empire expresses the experience of individual isolation as the result of increasing urban anonymity as well as of global exchanges. The figure of the migrant thereby literalizes modern isolation in an emergent society of strangers. In depicting migratory characters as embodiments of loneliness, while establishing it as a shared experience through parallel plots, nineteenth-century novels map out possible connections in a globalizing world. In parsing the interplay of isolation and imaginary sympathy in two texts of the 1850s, Charles Dickens’s Little Dorrit and Charlotte Brontë’s Villette, I argue that the experience of feeling foreign while working abroad enables characters to seek connections that transcend boundaries of class and national identity, even as the sympathy they imagine might be flawed, warped by projection and identification. In Little Dorrit, Cavalletto’s accident in the streets of London enacts a pivotal moment of imagined sympathy for the recently returned Arthur Clennam that ultimately helps to solve the renegotiation of home and host country in the novel, while in Villette, a female migrant articulates an increasingly widespread experience not only of modern isolation, social invisibility, and cultural disorientation, but also of the power of anonymity. A critical analysis of migratory work in Victorian fiction adds an important new dimension to nineteenth-century global studies.
Screening Positive for Military Sexual Harassment or Assault Is Associated With Higher Compulsive Sexual Behavior in Men Military Service Members/Veterans
Authors: Blais Rebecca K
Published: October 2020

Introduction

Compulsive sexual behavior (CSB) is understudied in military service members/veterans despite elevated risk for psychological disorders that are associated with CSB, including posttraumatic stress disorder (PTSD), depression, and alcohol misuse. Civilian research shows that sexual trauma is associated with higher CSB. Among military service members/veterans, sexual trauma that occurred before military service is identified as a risk factor for CSB, but the impact of screening positive for sexual trauma that occurred during military service (military sexual harassment[MSH]/military sexual assault[MSA]) on CSB is unknown. Moreover, screening positive for MSH/A confers a higher risk for distress relative to sexual trauma that occurred before or after military service, suggesting that MSH/A may be a robust predictor of CSB. The current study examined whether screening positive for MSH/A was associated with higher CSB after accounting for mental health and demographic characteristics. The current study specifically focused on men service members/veterans given that men show higher engagement and distress associated with CSB relative to women.

Materials and Method

Male service member/veterans (n = 508) completed self-report measures of CSB, MSH/A, PTSD and depression severity, hazardous drinking, and age. CSB was regressed on MSH/A, PTSD and depression severity, hazardous drinking, and age to determine if MSH/A was uniquely associated with CSB after accounting for other risk factors.

Results

A total of 9.25% to 12.01% of the sample reported scores suggestive of high levels of CSB. The regression of CSB on MSH/A screen status, PTSD, depression, alcohol use, and age explained 22.3% of the variance. Screening positive for MSH/A, higher PTSD symptoms, and higher depression symptoms were associated with higher CSB, but age or alcohol use were not.

Conclusion

Screening positive for MSH/A appears to be a unique risk factor for higher CSB above and beyond the effects of depression and PTSD. Since screening for CSB is not part of routine mental health care, clinicians may consider a positive screen for MSH/A as a possible indicator that CSB may be of clinical concern. Previous research on MSH/A and individual and sexual health outcomes suggest that distinguishing between MSH/A severities (harassment only vs. assault) is critical as the most dysfunction is observed with sexual trauma that involves assault. Owing to low endorsement of MSA, this study did not examine differences between MSA and MSH. Future research in this area would be strengthened by exploring MSH/A severities as a correlate of CSB.
Renohepatic crosstalk: a review of the effects of acute kidney injury on the liver
Authors: Bonavia Anthony , Stiles Nicholas
Published: October 2020

Several theories regarding acute kidney injury (AKI)-related mortality have been entertained, although mounting evidence supports the paradigm that impaired kidney function directly and adversely affects the function of several remote organs. The kidneys and liver are fundamental to human metabolism and detoxification, and it is therefore hardly surprising that critical illness complicated by hepatorenal dysfunction portends a poor prognosis. Several diseases can simultaneously impact the proper functioning of the liver and kidneys, although this review will address the impact of AKI on liver function. While evidence for this relationship in humans remains sparse, we present supportive studies and then discuss the most likely mechanisms by which AKI can cause liver dysfunction. These include ‘traditional’ complications of AKI (uremia, volume overload and acute metabolic acidosis, among others) as well as systemic inflammation, hepatic leukocyte infiltration, cytokine-mediated liver injury and hepatic oxidative stress. We conclude by addressing the therapeutic implications of these findings to clinical medicine.
Urban Morphology
Authors: Oliveira Vítor
Published: October 2020

Urban morphology is the study of urban forms and of the agents and processes responsible for their transformation over time. Urban form refers to the main physical elements that structure and shape the city including streets, squares (the public space), street blocks, plots, and buildings, to name the most important. The word “morphology” was first proposed by Goethe, the German writer and thinker, who devoted part of his work to biology. Goethe used the word “morphology” to designate the science that deals with the essence of forms. Although it was proposed as a branch of biology, the general and abstract nature of morphology enabled its application in many different fields, and at the end of the 19th century in central Europe, it started to be used in the study of cities. Urban morphology had a golden age in the first three decades of the 20th century, and then it lost importance, as urban functions and urban structures become the major concerns of urban geographers. In the second half of the 20th century, there were again innovative contributions to the study of urban form, stimulated by the activities of geographers and architects. Some of these individual contributions led to the development of schools of thought, fed by an increasing number of researchers in different parts of the world. Nowadays, four dominant schools of thought in urban morphology can be identified, with their own theories, concepts, and methods to address the physical form of cities and, as such, their impact on the social, economic, and environmental aspects of life in cities. The article is divided into thirteen sections. After this brief introduction and the presentation of some pioneer texts and general overviews on this field of knowledge, it moves to the presentation of works on the elements of urban form, on agents and processes of transformation, and then to the identification of some key works on the history of urban form. The article then shifts the focus from the “object” (the city) to the “researcher,” addressing classics in urban studies and four dominant approaches in urban morphology: historico-geographical, process-typological, space syntax, and spatial analysis. After addressing books and papers on the main theories, concepts, and methods proposed by these approaches, the article focuses on works on how these are applied in professional practice and on their relationship with wider environmental, social, and economic dimensions of cities.
Climate Change and Cities
Authors: Hughes Sara
Published: October 2020

Cities are playing an increasingly important role in addressing climate change, adopting increasingly ambitious policies and plans for addressing its causes and consequences. A substantial body of work has emerged over the last twenty-five years focused on the relationship between cities, urban governance, and climate change response. This review provides a starting point for those interested in climate change and cities, and presents the broad contours of the literature: general overviews, cities in relation to global policy and transnational networks, the forces that shape local policy adoption, the political and institutional dimensions of urban climate governance, and the role of social justice and equity in urban responses to climate change.
Perioperative Bacterial Contamination from Patients on Contact Precaution in Operating Room Environment
Authors: Kanamori Hajime , Rutala William A , Gergen Maria F , Weber David J
Published: October 2020

We investigated the microbial burden on the operating room environment when patients on contact precautions for a multidrug-resistant pathogen received surgery. Our study demonstrated that the perioperative environment was contaminated with aerobic bacteria and MRSA after surgery, and that MRSA persisted environmentally even after cleaning/disinfection, highlighting the need for meticulous cleaning/disinfection in the perioperative environment.
Protocol-driven intensive outpatient management of pregnant patients with symptomatic COVID-19
Authors: Soffer M D , Shook L L , James K , Sawyer M R , Ciaranello A , Mahrouk R , Bernstein S N , Boatin A A , Edlow A G , York-Best C , Kaimal A J , Goldfarb I T
Published: October 2020

Background

Reports of SARS-CoV2 infection have focused on pregnant women hospitalized due to moderate to severe COVID-19 disease or asymptomatic women diagnosed through universal screening at the time of obstetric admission. Many pregnant women who have symptomatic SARS-CoV2 infection may not meet criteria for hospitalization; however, whether and how these women can be managed safely in outpatient setting is not well described.

Objective

We sought to describe the time to symptom and viral clearance and to identify predictors of hospitalization in order to better understand the safety of monitoring pregnant patients with symptomatic COVID-19 in the outpatient setting.

Study Design

We performed a retrospective cohort study of pregnant patients with symptomatic, confirmed COVID-19 illness at a large academic medical center. Patients had systematic telehealth follow up by a clinician team to assess for symptoms, provide virtual prenatal care, and arrange in-person visits when appropriate in a dedicated outpatient center. Data was collected via chart abstraction.

Results

Of 180 pregnant patients presenting with symptoms and undergoing RT-PCR testing, 67 patients with confirmed COVID-19 infection were identified during the study period. Nineteen (28%) required acute care given worsening of COVID-19 symptoms, and 95% of these were directed to this acute care setting due to symptom severity telehealth evaluation. Nine women (13%) were admitted to the hospital given worsening symptoms, 3 required ICU care, 2 required ventilatory support, and 2 required delivery. Women with the presenting symptoms of fever, cough, shortness of breath, chest pain, or nausea and vomiting were more likely to require admission. The median duration from initial positive test to RT-PCR viral clearance was 26 days. Disease progression, time to viral clearance and duration of symptoms did not vary significantly by trimester of infection.

Conclusions

Management of the majority of pregnant women with symptomatic COVID-19 illness can be accomplished in the outpatient setting with intensive and protocol-driven monitoring for symptom progression.
Impact of exercise on older adults’ mood is moderated by sleep and mediated by altered brain connectivity
Authors: Alfini Alfonso J , Won Junyeon , Weiss Lauren R , Nyhuis Casandra C , Shackman Alexander J , Spira Adam P , Smith J Carson
Published: October 2020

Older adults comprise the fastest growing global demographic and are at increased risk of poor mental health outcomes. Although aerobic exercise and sleep are critical to the preservation of emotional well-being, few studies have examined their combined mood-enhancing effects, or the potential neural mechanisms underlying these effects. Here, we used a randomized crossover design to test the impact of acute exercise on mood and the intrinsic functional connectivity (iFC) of the cingulo-opercular network in physically healthy older adults. Wrist actigraphy provided objective indices of sleep. Results revealed that 30 min of moderate-intensity aerobic exercise acutely enhanced positive affect (PA) and reduced iFC between the cingulo-opercular network and the hippocampus. Both effects were magnified among older adults with greater sleep disturbance. Exercise-induced changes in hippocampal iFC mediated relations between sleep disturbance and exercise-induced increases in PA. These findings provide evidence that aerobic exercise enhances mood, that it does so by altering connectivity between the anterior insula—a key hub in the cingulo-opercular network—and the hippocampus and that lower sleep quality is a stronger predictor of these effects among older adults. These observations underscore the benefits of moderate-intensity exercise—a safe and scalable behavioral intervention—and provide new clues about the neural circuitry underlying the interactive effects of sleep and exercise on mood.
Natural Infection Rate of Known Tomato chlorosis virus-Susceptible Hosts and the Influence of the Host Plant on the Virus Relationship With Bemisia tabaci MEAM1
Authors: Esquivel-Fariña Arnaldo , Rezende Jorge Alberto Marques , Wintermantel William M. , Hladky Laura Jenkins , Bampi Daiana
Published: October 2020

Tomato chlorosis virus (ToCV; genus Crinivirus, family Closteroviridae) was identified in tomato crops in São Paulo State, Brazil, in 2006. Management strategies to control external sources of inoculum are necessary, because chemical control of the whitefly vector Bemisia tabaci Middle East-Asia Minor 1 (MEAM1) has not efficiently prevented virus infections and no commercial tomato varieties or hybrids are resistant to this crinivirus. We first evaluated the natural infection rate of some known wild and cultivated ToCV-susceptible hosts and their attractiveness for B. tabaci MEAM1 oviposition. Physalis angulata was the most susceptible to natural infection in all six exposures in 2018 and 2019. No plants of Capsicum annuum ‘Dahra’ or Chenopodium album became infected. Solanum melongena ‘Napoli’ had only two infected plants of 60 exposed. Capsicum annuum and Chenopodium album were the least preferred, and Nicotiana tabacum and S. melongena were the most preferred for whitefly oviposition. In addition, from 2016 to 2019, we surveyed different tomato crops and the surrounding vegetation to identify ToCV in weeds and cultivated plants in the region of Sumaré, São Paulo State. Only S. americanum, vila vila (S. sisymbriifolium), and Chenopodium album were found naturally infected, with incidences of 18, 20, and 1.4%, respectively. Finally, we estimated the ToCV titer (U.S. and Brazilian isolates ToCV-FL and ToCV-SP, respectively) by quantitative reverse transcription PCR in different ToCV-susceptible host plants and evaluated the relationship between virus acquisition and transmission by B. tabaci MEAM1. The results clearly showed significant differences in ToCV concentrations in the tissues of ToCV-susceptible host plants, which appeared to be influenced by the virus isolate. The concentration of the virus in plant tissues, in turn, directly influenced the ToCV-B. tabaci MEAM1 relationship and subsequent transmission to tomato plants. To minimize or prevent damage from tomato yellowing disease through management of external sources of ToCV, it is necessary to correctly identify potentially important ToCV-susceptible hosts in the vicinity of new plantings.
Secondary pneumothorax as a potential marker of apatinib efficacy in osteosarcoma: a multicenter analysis
Authors: Tian Zhichao , Liu Huimin , Zhao Yao , Wang Xiaofeng , Ren Hongyan , Zhang Fan , Li Po , Zhang Peng , Wang Jiaqiang , Yao Weitao
Published: October 2020

This study was performed to investigate pneumothorax characteristics and association with clinical outcomes in patients with osteosarcoma treated with apatinib. We retrospectively reviewed the medical records of osteosarcoma patients treated with apatinib between January 2016 and April 2020 at three institutions. We evaluated the prevalence, healing time, recurrence, severity, clinical management, and prognosis of pneumothorax in these patients. A total of 54 osteosarcoma patients who received apatinib treatment were enrolled in this study. Among them, 14 patients had pneumothorax. There were significant differences between the patients with and without pneumothorax with regard to the cavitating rate of lung metastases (92.86 vs. 32.50%, respectively, P < 0.001), objective response rate (42.86 vs. 10.00%, P = 0.013), disease control rate (85.71 vs. 42.50%, P = 0.006), 4-month progression-free survival (PFS) rate (57.10 vs. 20.00%, P < 0.001), and median PFS (5.65 vs. 2.90 months, P = 0.011). Compared with pneumothorax patients treated with chest tube drainage only [non-staphylococcal enterotoxin C (SEC) group], those treated with chest tube drainage and SEC thoracic perfusion in parallel (SEC group) had a shorter pneumothorax healing time (12.00 ± 4.50 days vs. 24.00 ± 14.63 days for SEC group and non-SEC group, respectively, P = 0.103), a lower recurrence rate of pneumothorax (25.00% vs. 66.67%, P = 0.277), and a longer median PFS (5.9 months vs. 4.75 months, P = 0.964). however, these numerical differences for the SEC/non-SEC data did not reach statistical significance. Pneumothorax and cavitation in lung metastases may be effective prognostic markers for patients with osteosarcoma treated with apatinib. SEC may be effective for treatment of such pneumothorax patients, warranting further study.
Case Report: Tapioca Iris Melanoma: An Uncommon Presentation of an Uncommon Tumor
Authors: Monferrer-Adsuara Clara , Calvo-Andrés Ramón , Montero-Hernández Javier , Mata-Moret Lucia , Ortiz-Salvador Miguel , Cervera-Taulet Enrique
Published: October 2020

SIGNIFICANCE

Iris tumors are rare conditions, and there is a relative paucity of recent published data on its broad clinical spectrum. Tapioca iris melanoma is a rarer yet devastating form with wide and challenging differential diagnoses because of its amelanotic nodular appearance.

PURPOSE

This study aimed to report the challenging presentation of an uncommon iris melanoma, describing the clinical and histological findings and comparing them with the existing published data.

CASE REPORT

An uncommon clinicopathological report on the tumor unusual localization, patient age, absence of elevated IOP and heterochromia, and negative S-100 stain that caused diagnostic uncertainty is presented. The patient remains free of metastatic disease 7 years after a complete tumor full-thickness excision.

CONCLUSIONS

Tapioca iris melanomas are uncommon tumors with a presentation/surgical management that differs from other malignant tumors. Ophthalmologists should consider it among the vast differential diagnoses when observing amelanotic lesions, even without the hallmark signs being evident.
Female Urethral Stricture Management: The Initial Experience of an Female Pelvic Medicine and Reconstructive Surgery-Trained Urologist
Authors: Elliott Christopher S.
Published: October 2020

Objective

Given the rarity of female urethral strictures (the cause of <1% of female lower urinary tract symptoms), most trainees have little experience diagnosing and managing the problem as they begin practice. Presented are the female urethral stricture outcomes of an attending surgeon after the completion of a female pelvic medicine and reconstructive surgery fellowship.

Methods

With institutional review board approval, a retrospective review of all cases of suspected female urethral stricture through the first 7 years of practice was completed.

Results

Over the study period, 13 women were treated for urethral stricture. One underwent simple meatotomy, 9 underwent vaginal wall flap (Blandy) urethroplasty, and 3 underwent urethral dilation only because they were not reconstructive candidates (1 due to severe radiation damage and 2 with panurethral strictures that included the bladder neck). Women undergoing urethral dilations (n = 3) have all required subsequent dilations, whereas those undergoing reconstructive procedures have not required further intervention (all with max flow rates greater than 17 mL/s at last follow-up [median = 35 months, range = 10–70]).

Conclusion

Over the course of 7 years, our limited experience suggests that (a) urethral dilation is not usually successful but surgical reconstruction is, (b) preoperative urethral rest before reconstruction may reduce failure rates, (c) staging a stricture in the operating room is the best route to confirm the diagnosis, (d) de novo stress urinary incontinence seems to rarely if ever occur after female urethroplasty, and (e) postoperative follow-up with simple uroflow and postvoid residual testing suffices.
Atypical Ocular Coloboma in Tuberous Sclerosis-2: Report of Two Novel Cases
Authors: Bacci Giacomo M. , Polizzi Silvio , Mari Francesco , Conti Valerio , Caputo Roberto , Guerrini Renzo
Published: October 2020

Tuberous sclerosis complex (TSC) is an autosomal dominant multisystemic disorder caused by mutations in either TSC1 or TSC2 genes and is characterized by hamartomas in multiple organs. The most frequent and best-known ocular manifestation in TSC is the retinal hamartoma. Less frequent ocular manifestations include punched out areas of retinal depigmentation, eyelid angiofibromas, uveal colobomas, papilledema, and sector iris depigmentation. In this article, we report 2 patients carrying known pathogenic variants in the TSC2 gene who exhibited an atypical, unilateral, iris coloboma associated with localized areas of retinal dysembryogenesis.
Enhanced Depth Imaging Optical Coherence Tomography Technology Reveals a Significant Association Between Optic Nerve Drusen Anterior Displacement and Retinal Nerve Fiber Layer Thinning Over Time
Authors: Ortiz-Toquero Sara , Muñoz-Negrete Francisco J. , Rebolleda Gema
Published: October 2020

Background:

Optic disc drusen (ODD) are a dynamic phenomenon, and their appearance, size, and relative location may change. The purpose of this study is to evaluate and quantify the longitudinal changes of buried ODD with enhanced depth imaging (EDI) optical coherence tomography (OCT) over time.

Methods:

ODD were analyzed with Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany) and EDI technology. The peripapillary retinal nerve fiber layer (RNFL) thickness was also measured. The size and depth of ODD were compared between the baseline and study visit (at least 2 years of follow-up), and the changes were correlated with mean RNFL thickness. The repeatability, coefficient of variation, and cutoff values for size and depth on EDI-OCT were calculated.

Results:

Of 21 previously identified patients with ODD, only 12 patients (21 eyes) met the most recent diagnostic criteria according to the ODD Studies Consortium recommendations for using OCT-EDI technology. The 21 eyes were reanalyzed after a mean period of 44.7 ± 13.2 months (range: 24–71 months). Overall, 132 ODD were evaluated with a mean of 6.1 ± 2.5 ODD per eye and 1.9 ± 1.1 ODD per scan. Overall, we found a significant forward movement of the drusen between visits (P = 0.01). Most drusen (67.4%) moved anteriorly, and in approximately one-third (35.6%), this displacement exceeded the cutoff value (64.28 µm). Furthermore, we found a significant correlation between ODD shallowing and RNFL thinning during the follow-up (P ≤ 0.03; R ≥ 0.370). We did not find any significant changes in size measurements (P = 0.10) over time.

Conclusions:

In approximately one-third of buried ODD, a significant anterior movement occurred over 2 years of follow-up, and this movement was associated with significant RNFL thinning. By contrast, no significant change was detected in the size of the buried ODD.
Comparison of Peripapillary Vessel Density of Acute Nonarteritic Anterior Ischemic Optic Neuropathy and Other Optic Neuropathies With Disc Swelling Using Optical Coherence Tomography Angiography: A Pilot Study
Authors: Chuang Jasmine C. , Chan Noel C. Y. , Cheung Carol Y. , Lok Jerry K. H. , Chan Carmen K. M.
Published: October 2020

Background:

The purpose of this study is to quantitatively compare the peripapillary vessel density (PPVD), measured with optical coherence tomography angiography (OCT-A), between acute nonarteritic anterior ischemic optic neuropathy (NAION) and other causes of disc swelling (“others”).

Methods:

In this prospective comparative case series, patients with unilateral disc swelling due to acute NAION (n = 7) and “others” (n = 7) underwent OCT-A scanning of the optic nerve head with a swept-source OCT (Triton DRI-OCT), in addition to functional assessment. OCT-A images were analyzed using an automated customized MATLAB program. Comparison was made between total and 6 sectoral PPVD (radial peripapillary capillary [RPC] and choroid layers) of affected and fellow eyes; and between the 2 groups' affected eyes. Five NAION patients had repeated assessments at 1, 3, and 6 months.

Results:

Acute NAION eyes had a significantly lower total and superonasal PPVD (both layers) compared to fellow eyes. No such difference was observed in “others” group for the RPC layer. NAION eyes also had significantly lower total RPC PPVD than affected eyes in the “others” group. Over 6 months, NAION eyes had persistently lower RPC PPVD compared to fellow eyes but the reduced choroidal PPVD resolved by 1 month.

Conclusion:

The study demonstrated reduced superonasal and total RPC PPVD in acute NAION, which persisted over 6 months. Because there is currently no single diagnostic test for NAION, use of OCT-A images to analyze RPC PPVD may potentially help distinguish acute NAION from other causes of disc swelling by quantitatively demonstrating capillary dropout in the RPC layer.
Adaptive COVID-19 Forecasting via Bayesian Optimization
Authors: Bannur Nayana , Maheshwari Harsh , Jain Sansiddh , Shetty Shreyas , Merugu Srujana , Raval Alpan
Published: October 2020

Accurate forecasts of infections for localized regions are valuable for policy making and medical capacity planning. Existing compartmental and agent-based models [1, 7–11] for epidemiological forecasting employ static parameter choices and cannot be readily contextualized, while adaptive solutions [4, 13] focus primarily on the reproduction number. In the current work, we propose a novel model-agnostic Bayesian optimization approach [3] for learning model parameters from observed data that generalizes to multiple application-specific fidelity criteria. Empirical results demonstrate the efficacy of the proposed approach with SEIR-like compartmental models on COVID-19 case forecasting tasks. A city-level forecasting system based on this approach is being used for COVID-19 response in a few highly impacted Indian cities.
COVID-19 infections following outdoor mass gatherings in low incidence areas: retrospective cohort study
Authors: Miron Oren , Yu Kun-Hsing , Wilf-Miron Rachel , Davidovitch Nadav
Published: October 2020

Objective

Indoor mass gatherings in counties with high COVID-19 incidence have been linked to infections. We examined if outdoor mass gatherings in counties with low COVID-19 incidence are also followed by infections.

Methods

We retrospectively examined COVID-19 incidence in 20 counties that held mass gathering rallies (19 outdoor and 1 indoor) in the United States in August-September 2020. They were compared to the rest of the United States counties. We utilized a 7-day moving average and compared the change on the gathering date and 15 days later, based on the 95% confidence interval. For control counties we used the median of the gathering dates.

Setting

The United States

Population

8.4 million in the counties holding mass gatherings, and 324 Million in the rest of the counties in the United States.

Main Outcome Measure

Change in COVID-19 incidence rate per 100,000 capita during the two weeks following mass gatherings.

Results

In the two weeks following the gatherings, the COVID-19 incidence increased significantly in 14 of 20 counties. The county with the highest incidence increase (3.8-fold) had the 2nd lowest incidence before the gathering. The county with the highest decrease (0.4-fold) had the 3rd highest incidence before the gathering. At the gathering date, the average incidence of counties with gatherings was lower than the rest of the United States, and after the gathering, it increased 1.5-fold, while the rest of the United States increased 1.02-fold.

Conclusion

These results suggest that even outdoor gatherings in areas with low COVID-19 incidence are followed by increased infections, and that further precautions should be taken at such gatherings.

What is already known on the topic

Mass gatherings have been linked to COVID-19 infections, but it is less clear how much it happens outdoors, and in areas with low incidence.

What this study adds

COVID-19 infections increased significantly in 14 of 20 counties that held mass gathering rallies in the United States, 19 of which were outdoors. The county with the highest incidence increase (3.8-fold) was outdoors and had a low incidence before the gathering. The average incidence of all 20 counties with gatherings was lower at the gathering day compared with the rest of the United State, and it increased 1.5-fold following the gatherings. Our findings suggest a need for precautions in mass gatherings, even when outdoors and in areas with a low incidence of COVID-19.
Frailty and comorbidity in predicting community COVID-19 mortality in the UK Biobank: the effect of sampling
Authors: Mak Jonathan K. L. , Kuja-Halkola Ralf , Wang Yunzhang , Hägg Sara , Jylhävä Juulia
Published: October 2020

Frailty has been linked to increased risk of COVID-19 mortality, but evidence is mainly limited to hospitalized older individuals and analyses in community samples are scarce. This study aims to assess and compare the predictive abilities of different frailty measures – the frailty phenotype (FP), frailty index (FI), and Hospital Frailty Risk Score (HFRS), and comorbidity, measured using the Charlson Comorbidity Index (CCI), on COVID-19 mortality in a UK community sample of adults aged 52–86 years. We analyzed (i) the full sample of 428,754 UK Biobank participants and (ii) a subsample of 2,287 COVID-19 positive UK Biobank participants with data on COVID-19 outcomes between March 1 and September 21, 2020. COVID-19 positivity was confirmed by PCR, hospital records and/or death registers. Logistic regression models adjusted for age, sex, smoking, ethnicity, and socioeconomic variables with areas under the receiver operating characteristic curves (AUCs) were used in the modelling. Overall, 391 individuals died of COVID-19. In the full sample, all frailty measures and the CCI were associated with COVID-19 mortality but only the HFRS and CCI improved the predictive ability of a model including age and sex, yielding AUCs>0.80. However, when restricting analyses to the COVID-19 positive subsample, which had an over-representation of frail individuals, similar improvement in AUCs was not observed in which only the CCI was significantly associated with COVID-19 mortality. Our results suggest that HFRS and CCI can be used in COVID-19 mortality risk stratification at the population level, but they show limited added value in COVID-19 positive individuals.
Impact of Reduced Sampling Rate on Accelerometer-based Physical Activity Monitoring and Machine Learning Activity Classification
Authors: Small Scott R , Khalid Sara , Dhiman Paula , Chan Shing , Jackson Dan , Doherty Aiden R , Price Andrew J
Published: October 2020

Purpose

Lowering the sampling rate of accelerometer devices can dramatically increase study monitoring periods through longer battery life, however the validity of its output is poorly documented. We therefore aimed to assess the effect of reduced sampling rate on measuring physical activity both overall and by specific behaviour types.

Methods

Healthy adults wore two Axivity AX3 accelerometers on the dominant wrist and two on the hip for 24 hours. At each location one accelerometer recorded at 25 Hz and the other at 100 Hz. Overall acceleration magnitude, time in moderate-to-vigorous activity, and behavioural activities were calculated using standard methods. Correlation between acceleration magnitude and activity classifications at both sampling rates was calculated and linear regression was performed.

Results

54 participants wore both hip and wrist monitors, with 45 of the participants contributing >20 hours of wear time at the hip and 51 contributing >20 hours of wear time at the wrist. Strong correlation was observed between 25 Hz and 100 Hz sampling rates in overall activity measurement (r = 0.962 to 0.991), yet consistently lower overall acceleration was observed in data collected at 25 Hz (12.3% to 12.8%). Excellent agreement between sampling rates was observed in all machine learning classified activities (r = 0.850 to 0.952). Wrist-worn vector magnitude measured at 25 Hz (Acc25) can be compared to 100 Hz (Acc100) data using the transformation, Acc100 = 1.038*Acc25 + 3.310.

Conclusions

25 Hz and 100 Hz accelerometer data are highly correlated with predictable differences which can be accounted for in inter-study comparisons. Sampling rate should be consistently reported in physical activity studies, carefully considered in study design, and tailored to the outcome of interest.
Development of Brain Network Connectivity in Risky Drinkers During Adolescence
Authors: Baker Simon T. E. , Yücel Murat , Fornito Alex , Zalesky Andrew , Whittle Sarah , Allen Nicholas B. , Lubman Dan I.
Published: October 2020

Alcohol consumption is common in adolescence, a time when the human brain undergoes substantial development, raising concerns about the neurodevelopmental impact of drinking alcohol, especially at high levels. Risky drinking may adversely affect the developing white matter, comprised of axonal fibre pathways that integrate anatomically distributed, and functionally specialised, neural systems. We used diffusion-weighted magnetic resonance imaging (MRI) to perform the first prospective, comprehensive and regionally unbiased connectome-wide analysis of longitudinal changes in inter-regional structural connectivity between 16.5 and 18.8 years of age, comparing adolescents who reported frequent risky drinking (n = 20) with those who reported limited risky drinking (n = 19) across this developmental period. We found no difference in the development of structural connectivity between these groups, regardless of whether inter-regional connections were quantified using streamline count, fractional anisotropy, mean diffusivity, axial diffusivity, or radial diffusivity. These findings suggest that risky drinking may have limited adverse effects on the development of inter-regional structural connectivity during mid to late adolescence.