bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 341: A Simple Prognostic Tool for In-Hospital Death in Patients Presenting with Out-of-Hospital Cardiac Arrest and ST-Elevation Myocardial Infarction
Authors: Tran Andy T , Hart Anthony J , Spertus John , Jones Philip , Malik Ali O , Chan Paul S
Published: November 2020

Background:
In the emergent setting of ST-Elevation Myocardial Infarction (STEMI) complicating out-of-hospital cardiac arrest (OHCA), decisions for immediate coronary angiography are made when the likelihood of hospital survival is unknown. Estimating the risk of mortality at the time of hospital arrival might inform decisions for primary percutaneous coronary intervention.

Methods:
From the Cardiac Arrest Registry to Enhance Survival (CARES), we included adult OHCA patients from 2013-2018 presenting to hospitals with a STEMI. We developed a predictive model for in-hospital mortality using multivariable logistic regression to derive a scoring tool that was internally validated with bootstrap methods.

Results:
Of 7120 patients with OHCA and STEMI admitted at a hospital (mean age 62±13.2 years, 27% female), 3159 (44.4%) died during hospitalization. Higher age, unwitnessed arrest, non-shockable cardiac arrest rhythm, no sustained return of spontaneous circulation (ROSC) at the time of hospital admission, and resuscitation time on scene were most predictive of mortality (C-index, 0.82). Using the model β coefficients, we developed an integer risk score ranging from 0 to 10 points, corresponding to observed mortality rates of 5% to 100% (Figure 1). The odds of in-hospital mortality doubled for each 1-unit score increase (odds ratio, 2.01; 95% CI, 1.94-2.09; p<0.0001), and a score of ≥6, involving ~15% of patients, was associated with ≥85% in-hospital mortality risk.

Conclusions:
This risk score, based on simple prehospital characteristics, stratifies the range of in-hospital mortality from 5% to nearly 100% in OHCA patients with STEMI at the time of hospital presentation. The benefits of such a model in decision-making for immediate coronary angiography should be prospectively studied.
Abstract 363: Just Another Post-Arrest?: Predicting Outcomes in Traumatic Arrest and Hemorrhagic Shock
Authors: Poliner David T , Holena Daniel N , Seamon Mark , Abella Benjamin
Published: November 2020

Introduction:
Traumatic cardiac arrest is a challenging presentation at trauma centers globally, with a high mortality and subsequent morbidity among survivors. For those who do obtain return of spontaneous circulation (ROSC), there is even less clarity with respect to how best to prognosticate outcomes. The previously derived and validated Pittsburgh Cardiac Arrest Categories (PCAC) have demonstrated value in predicting functional outcome and survival to hospital discharge in non-traumatic arrest. It is a 1 to 4 categorical score wherein a higher category is correlative to a worse clinical outcome. We hypothesized that the PCAC would be able to accurately predict outcomes in a trauma cohort.

Methods:
Utilizing the Pennsylvania Trauma Outcome System registry, 30 patients from 2018-2020 presented to a single, urban, tertiary trauma center with traumatic arrest. Demographics, vital statistics, injury patterns, and hospital course were abstracted and matched with subsequent PCAC scoring in accordance with previously published methods.

Results:
Population was predominantly male 16 (80%), black (75%) with a mean age 33 y (SD 13) . Penetrating trauma comprised 76% with average injury severity score of 38 (SD 22). Six (30%) were discharged alive with 5 requiring inpatient rehabilitation. Average length of hospital stay was 16 days (SD 18) with approximately 11 ventilator free days (SD 9). Average GFR at time of discharge was 44mg/dl (SD 31). The majority, 12 (57%), were PCAC 4 on arrival owing to predominant evidence of coma, 61%. By post-arrest day 1, there was a more even distribution between PCAC categories with category 2 (28%) and 3 (28%) each having 3 survivors and PCAC 4 (28%) having 2. By day 3, PCAC scores were less normally distributed with PCAC 1 having 6 survivors (42%) and PCAC 4 having 5 (35%). Day 1 and 3 categories continued to be driven principally be median Coma scores 0 (IQR: 0-8) but with regression of median SOFA cardiopulmonary scores 4 (IQR:0-6). SOFA Renal scores in survivors predictably increased from no injury to moderate dysfunction across this same period (IQR:1-4).

Conclusion:
PCAC scores in traumatic cardiac arrest patients who achieve ROSC do not predict multisystem organ failure but do predict neurologic outcome.
Abstract 364: Continuous Electrocardiogram Classification During Resuscitation Using Transfer Learning
Authors: Coult Jason , Sashidhar Diya , Rea Thomas , Blackwood Jennifer E , Kudenchuk Peter , Kutz J. Nathan , Kwok Heemun
Published: November 2020

Introduction:
Cardiac arrest resuscitation requires CPR interruption for ECG rhythm analysis, but pausing CPR is adversely associated with survival. Ideally, automated rhythm analysis would occur agnostic of CPR state throughout resuscitation and discriminate non-shockable from shockable rhythms. Transfer learning of pre-trained deep convolutional neural networks (CNNs) may enable accurate ECG analysis when applied to time-frequency representations of the ECG. We designed and evaluated a transfer learning algorithm to identify ventricular fibrillation (VF), asystole (AS), and organized (OR) rhythms agnostic of CPR.

Methods:
In this observational study of out-of-hospital cardiac arrest, rhythms were manually diagnosed in continuous defibrillator ECG recordings. Non-overlapping adjacent 2-s ECG segments were extracted from the first 30 min of each case regardless of CPR during VF, AS, and OR. Each segment was represented by an intrafrequency-normalized Morlet wavelet transform from 4-40 Hz. Using a 2/3 subset of patients for training, a series of two ResNet-101 CNNs were retrained to perform a shock decision (VF vs. non-shockable) followed by a specific non-shockable prediction (AS, OR, or Indeterminate). Performance was evaluated in a 1/3 validation subset of patients using a range of probability decision thresholds to predict the class of each segment.

Results:
In total, 275100 segments were collected from 461 patients. Of 90962 segments from 152 validation patients, using a 0.7 probability threshold for class prediction, 21% (18930/90962) were indeterminate, shock vs. no-shock sensitivity and specificity were 90% (19702/21930) and 97% (48421/50102), and specificities among non-shockable rhythms for AS vs. OR were 84% (5032/5998) and 86% (37760/44104), respectively (Fig 1).

Conclusion:
Transfer learning may enable shock/no-shock and rhythm-specific ECG classification continuously throughout resuscitation regardless of CPR.
Abstract 369: Noninvasive Cerebral Perfusion Pressure and Neurologic Outcome in Post-cardiac Arrest Patients with Targeted Temperature Management
Authors: Chae Minjung K , Lee Sung Eun , Cho Sumin , Kim Taeyoung , Yoon Dukyong
Published: November 2020

Introduction:
Hypoxic ischemic brain injury (HIBI) is the leading cause of mortality and long-term neurologic disability in survivors of cardiac arrest. Recently, the role of cerebral monitoring is emphasized for individualizing therapy and mitigating secondary brain injury in HIBI patients after return of spontaneous circulation (ROSC). The first step of cerebral monitoring is checking the driving force by cerebral perfusion pressure (CPP). However, as CPP is calculated by mean arterial pressure (MAP) minus intracranial pressure (ICP), the process of obtaining ICP is invasive. Noninvasive CPP can be estimated by parameters obtained from transcranial doppler (TCD). Therefore, we aimed to investigate non-invasively measured CPP from TCD and its association with neurologic outcome in post cardiac arrest patients that underwent targeted temperature management (TTM).

Methods:
This retrospective single-center study included patients who had been treated with TTM following cardiac arrest and who underwent TCD evaluation between July 2017 and July 2019. We aimed to perform TCD evaluation within 48h of ROSC, but sometimes this could not be achieved due to limited resources. Patients with TCD that was performed after 72 hours were excluded. The MFV was calculated using the peak systolic flow velocity (PSV) and the end-diastolic flow velocity (EDV) as below. Two methods of estimating CPP non-invasively was calculated as below.MFV = PSV+(EDVх2) / 3 eCPP_A= MAP*diastolic FVmca/MFVmca + 14eCPP_B= MFVmca*(MAP-DBP)/FVmean-FVdia

Results: Table 1.
Baseline characteristics of study population

Data are presented as mean (standard deviation), number (%) or median (interquartile range).OHCA, out of hospital cardiac arrest; CPR, cardiopulmonary resuscitation; AED, automated external defibrillator; TCD, transcranial doppler; CPP, cerebral perfusion pressure.

Table 2.
Cut off values and diagnostic values in predicting poor neurologic outcome with 100% specificityCPP, cerebral perfusion pressure.

Conclusion:
eCPP cut off values of <50 mmHg and <60mmHg predicted poor neurological outcome with high specificity. This study suggests that eCPP obtained from TCD may be feasible to predict neurologic outcome.
Orthostatic Hypertension and Intensive Blood Pressure Control; Post-Hoc Analyses of SPRINT
Authors: Rahman Mahboob , Pradhan Nishigandha , Chen Zhengyi , Kanthety Radhika , Townsend Raymond R. , Tatsuoka Curtis , Wright Jackson T.
Published: November 2020

We evaluated the association between orthostatic hypertension and cardiovascular outcomes and the effect of intensive blood pressure (BP) control on cardiovascular outcomes in patients with orthostatic hypertension. Post hoc analyses of the SPRINT (Systolic Blood Pressure Intervention Trial) data were conducted; orthostatic hypertension was defined as increase in systolic BP≥20 mm Hg or increase in diastolic BP≥10 mm Hg with standing. Of 9329 participants, 1986 (21.2%) had orthostatic hypertension at baseline. Within the intensive treatment group, participants with orthostatic hypertension were at higher risk of developing the composite cardiovascular outcome (hazard ratio, 1.44 [95% CI, 1.1–1.87],
P
=0.007) compared with participants without orthostatic hypertension. Within the standard treatment group, there were no significant differences in cardiovascular outcome between participants with and without orthostatic hypertension. In participants with orthostatic hypertension, there was no statistically significant difference in risk of the composite cardiovascular outcome between the intensive and the standard BP treatment group (hazard ratio, 1.07 [95% CI, 0.78–1.47],
P
=0.68). In participants without orthostatic hypertension at baseline, the intensive treatment group was associated with a lower risk of the composite cardiovascular outcome (hazard ratio, 0.67 [95% CI, 0.56–0.79],
P
<0.0001). Orthostatic hypertension was associated with a higher risk of cardiovascular outcomes in the intensive and not in the standard treatment group; intensive treatment of BP did not reduce the risk of cardiovascular outcomes compared with standard treatment in patients with orthostatic hypertension. These post hoc analyses are hypothesis generating and will need to be confirmed in future studies.
SAA (Serum Amyloid A)
Authors: Schweizer Juliane , Bustamante Alejandro , Lapierre-Fétaud Vanessa , Faura Júlia , Scherrer Natalie , Azurmendi Gil Leire , Fluri Felix , Schütz Valerie , Luft Andreas , Boned Sandra , Sanchez Jean-Charles , Montaner Joan , Katan Mira
Published: November 2020

Background and Purpose:

The aim of this study was to evaluate and independently validate SAA (serum amyloid A)—a recently discovered blood biomarker—to predict poststroke infections.

Methods:

The derivation cohort (A) was composed of 283 acute ischemic stroke patients and the independent validation cohort (B), of 367 patients. The primary outcome measure was any stroke-associated infection, defined by the criteria of the US Centers for Disease Control and Prevention, occurring during hospitalization. To determine the association of SAA levels on admission with the development of infections, logistic regression models were calculated. The discriminatory ability of SAA was assessed, by calculating the area under the receiver operating characteristic curve.

Results:

After adjusting for all predictors that were significantly associated with any infection in the univariate analysis, SAA remained an independent predictor in study A (adjusted odds ratio, 1.44 [95% CI, 1.16–1.79];
P
=0.001) and in study B (adjusted odds ratio, 1.52 [1.05–2.22];
P
=0.028). Adding SAA to the best regression model without the biomarker, the discriminatory accuracy improved from 0.76 (0.69–0.83) to 0.79 (0.72–0.86;
P
<0.001; likelihood ratio test) in study A. These results were externally validated in study B with an improvement in the area under the receiver operating characteristic curve, from 0.75 (0.70–0.81) to 0.76 (0.71–0.82;
P
<0.038).

Conclusions:

Among patients with ischemic stroke, blood SAA measured on admission is a novel independent predictor of infection after stroke. SAA improved the discrimination between patients who developed an infection compared with those who did not in both derivation and validation cohorts.

Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00390962.
A newly available database of an important family of phytophagous mites: Tenuipalpidae Database
Authors: CASTRO ELIZEU B. , MESA NORA C. , FERES REINALDO J.F. , DE MORAES GILBERTO J. , OCHOA RONALD , BEARD JENNIFER J. , DEMITE PETERSON R.
Published: November 2020

This paper announces a database on the taxonomy, distribution and host plants of mites of the family Tenuipalpidae Berlese (Acari: Tetranychoidea), available online at https://www.tenuipalpidae.ibilce.unesp.br/. In the Tenuipalpidae Database the recorded world distribution and range of host plants are provided for each tenuipalpid species, including synonyms, with a list of all relevant publications.
Two new species of Phytoecia Dejean, 1835 (Coleoptera, Cerambycidae) from Iran
Authors: FAIZI FARDIN , DANILEVSKY MIKHAIL L. , GHOBARI HAMED , NOZARI JAMASB
Published: November 2020

Two new species are described from Iran: Ph. (Helladia) euimperialis Faizi & Danilevsky, sp. n. (Kurdistan prov., Marivan-county, Bardeh Sepi) and Ph. (s. str.) ambrusi Faizi & Danilevsky, sp. n. (Kurdistan prov., Marivan county, Chuin). Moreover, Phytoecia (Helladia) imperialis dorud (Sama, Rapuzzi & Rejzek, 2007) is elevated to species rank as Ph. (Helladia) dorud (Sama, Rapuzzi & Rejzek, 2007), stat. nov.
Communication Factors Influencing Flood-Risk-Mitigation Motivation and Intention among College Students
Authors: Rainear Adam M. , Lin Carolyn A.
Published: November 2020

When attempting to communicate flood risk, trust in and perceptions toward risk information dissemination as well as individual efficacy factors can play a significant role in affecting risk-mitigation motivation and intention. This study seeks to examine how risk communication, risk perception, and efficacy factors affect evacuation motivation and behavioral intentions in response to a presumed flood risk, as based on a conceptual framework guided by protection motivation theory. An online survey was administered to college students (N = 239) from a region that is subject to sea level rise and storm surges. Path analysis results indicate that, while less information-source trust predicts greater risk perception, greater information-source trust predicts greater mitigation-information-seeking intention, lower self-efficacy, and stronger response efficacy. As lower mitigation-information-seeking intention similarly predicts greater risk perception, greater mitigation-information-seeking intention also predicts stronger response efficacy. Significant predictors of evacuation motivation include lower risk perception as well as greater information-source trust, severity perception, and response efficacy. Implications of these findings are discussed in terms of information dissemination channels, messaging strategies, and recent severe flooding events.
Prevalence of disordered eating behaviors and associated factors in Brazilian university students
Authors: de Matos Ana Paula , Rodrigues Paulo Rogério Melo , Fonseca Lorena Barbosa , Ferreira Márcia Gonçalves , Muraro Ana Paula
Published: November 2020

Background:

University students may be a vulnerable group to adopt unhealthy behaviors, including changes in eating behavior. Assessment of factors associated with the prevalence of disordered eating behaviors in this population may facilitate the early identification of their predictors, thus allowing fast interventions.

Aim:

To analyze the prevalence of disordered eating behaviors (DEB) and associated factors in Brazilian university students.

Methods:

Cross-sectional study of male and female students aged 16–25 years, enrolled in full-time degree program at a public university in the mid-west of Brazil. Disordered eating behaviors in the last three months (binge eating, purging, and food restriction), through an adapted version of the instrument developed by Hay, was evaluated and the association with demographic and socioeconomic characteristics, including lifestyle, body image, perceived stress, depressive symptoms, and excess weight, was analyzed. A hierarchical analysis model was performed to determine the relative importance of factors on the prevalence of DEB.

Results:

A total of 1608 university students were evaluated (50.7% male). Prevalence of DEB was 4.4% for binge eating, 2.5% for purging and 9.1% for food restriction, all of which were higher among women (7.0%, 4.4%, and 13.5%) compared with men (1.8%, 0,6%, and 4.9%, respectively). The factors that remained significantly associated with these behaviors were female sex, smoking, consumption of alcoholic beverages, dissatisfaction with body image, excess weight, high perceived stress, and presence of self-reported depressive symptoms.

Conclusion:

Factors associated with DEB signal that intervention is required to create synergy between individual and population-level interventions in lifestyle behaviors.
Transient loss of interhemispheric functional connectivity following unilateral cortical spreading depression in awake rats
Authors: Vinogradova Lyudmila V , Suleymanova Elena M , Medvedeva Tatiana M
Published: November 2020

Objective

Growing evidence shows a critical role of network disturbances in the pathogenesis of migraine. Unilateral pattern of neurological symptoms of aura suggests disruption of interhemispheric interactions during the early phase of a migraine attack. Using local field potentials data from the visual and motor cortices, this study explored effects of unilateral cortical spreading depression, the likely pathophysiological mechanism of migraine aura, on interhemispheric functional connectivity in freely behaving rats.

Methods

Temporal evolution of the functional connectivity was evaluated using mutual information and phase synchronization measures applied to local field potentials recordings obtained in homotopic points of the motor and visual cortices of the two hemispheres in freely behaving rats after induction of a single unilateral cortical spreading depression in the somatosensory S1 cortex and sham cortical stimulation.

Results

Cortical spreading depression was followed by a dramatic broadband loss of interhemispheric functional connectivity in the visual and motor regions of the cortex. The hemispheric disconnection started after the end of the depolarization phase of cortical spreading depression, progressed gradually, and terminated by 5 min after initiation of cortical spreading depression. The network impairment had region- and frequency-specific characteristics and was more pronounced in the visual cortex than in the motor cortex. The period of impaired neural synchrony coincided with post-cortical spreading depression electrographic aberrant activation of the ipsilateral cortex and abnormal behavior.

Conclusion

The study provides the first evidence that unilateral cortical spreading depression induces a reversible loss of functional hemispheric connectivity in the cortex of awake animals. Given a critical role of long-distance cortical synchronization in sensory processing and sensorimotor integration, the post-cortical spreading depression breakdown of functional connectivity may contribute to neuropathological mechanisms of aura generation.
Thematic Evolution of Blue Tourism: A Scientometric Analysis and Systematic Review
Authors: Sharafuddin Mohammed Ali , Madhavan Meena
Published: November 2020

This study adopts a novel mix of scientometrics, theme-based, citation-based systematic review and interpretative aggregation approach (STCSR-IA) with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. It presents a macro-level scientometric analysis of tourism research in coastal, marine and maritime (blue tourism) environments by using 986 research articles published in 130 Scopus-indexed journals from 2000 to 2019. The thematic evolution of research in five time periods of four years each (2000–2003, 2004–2007, 2008–2011, 2012–2015, 2016–2019) was analysed using the authors’ keywords and classified as (a) preliminary (b) transversal stage I (c) transversal stage II and (d) growth stage. The massive evolution of research areas in the growth stage and their themes along with the growing nexus of conceptual relationship within blue tourism is systematically reviewed and presented as a thematic research framework.
Modeling and numerical simulation of the dynamic behavior of magneto-electro-elastic multilayer plates based on a Winkler-Pasternak elastic foundation
Authors: Hamidi Mustapha , Zaki Smail , Aboussaleh Mohamed
Published: November 2020

This work presents the effect of the elastic foundation and the viscoelastic interface on the dynamic behavior of laminated magneto-electro-elastic rectangular plates with simply supported boundary conditions using the state space method in Laplace domain. The Kelvin-Voigt model is used to take into accounted the viscoelastic interface effects in this domain. The final solution is transferred to the time domain by the Fourier inversion method. The dynamic responses of 3D displacements, stresses, and electric and magnetic displacements are analyzed with respect to the thickness direction and the orthotropic behavior under harmonic stress. A variant of the numerical tests shown the effect of the Winkler-Pasternak elastic foundation on a magneto-electro-elastic rectangular plates dynamic behavior and may contribute to optimize the design and the manufacturing of these materials.
Bayesian inference and uncertainty propagation using efficient fractional-order viscoelastic models for dielectric elastomers
Authors: Miles Paul R , Pash Graham T , Smith Ralph C , Oates William S
Published: November 2020

Dielectric elastomers are employed for a wide variety of adaptive structures. Many of these soft elastomers exhibit significant rate-dependencies in their response. Accurately quantifying this viscoelastic behavior is non-trivial and in many cases a nonlinear modeling framework is required. Fractional-order operators have been applied to modeling viscoelastic behavior for many years, and recent research has shown fractional-order methods to be effective for nonlinear frameworks. This implementation can become computationally expensive to achieve an accurate approximation of the fractional-order derivative. Accurate estimation of the elastomer’s viscoelastic behavior to quantify parameter uncertainty motivates the use of Markov Chain Monte Carlo (MCMC) methods. Since MCMC is a sampling based method, requiring many model evaluations, efficient estimation of the fractional derivative operator is crucial. In this paper, we demonstrate the effectiveness of using quadrature techniques to approximate the Riemann–Liouville definition for fractional derivatives in the context of estimating the uncertainty of a nonlinear viscoelastic model. We also demonstrate the use of parameter subset selection techniques to isolate parameters that are identifiable in the sense that they are uniquely determined by measured data. For those identifiable parameters, we employ Bayesian inference to compute posterior distributions for parameters. Finally, we propagate parameter uncertainties through the models to compute prediction intervals for quantities of interest.
Access to Palliative Care Services and Clinical Outcomes of Patients With Solid Malignancy-Associated Myelophthisis in a Resource-Limited Setting
Authors: Vargas-Serafin Cesar , Acosta-Medina Aldo A. , Teran-De-la-Sancha Kevin , Delgado-de-la-Mora Jesus , Bourlon María T. , Bourlon Christianne
Published: November 2020

Background:

Myelophthisis (MPT) has been associated with a dreadful prognosis. Patients’ access to palliative care (PC) and factors influencing its clinical outcomes are poorly described. Our aim was to analyze the impact of patient- and disease-specific characteristics on survival of patients with MPT and describe their use of PC in a resource-limited setting.

Methods:

Retrospective study including patients with solid tumor MPT, diagnosed between 1996 and 2018.

Results:

Seventy patients ( median 58 years) were included. 58% were synchronously diagnosed with MPT at time of primary tumor diagnosis. Most common oncologic diagnoses were prostate (25.7%), gastrointestinal (20%), and breast (18.6%) neoplasms. Median overall survival (OS) was 1.9 months. Primaries other than prostate, breast, and lung (HR 1.37, 95% CI 1.15 - 1.8; p = 0.02) and transfusion requirements (HR 2.8, 95% CI 1.01 – 7.9; p = 0.04) were independently associated with decreased OS. Administration of multiple systemic therapeutic interventions (HR 0.15, 95% CI 0.06 – 0.39; p = 0.01) was the sole factor improving OS. Assessment by PC was pursued in 51.4% of patients. The median number of consults per patient was two, with no difference in assessment rate or consult number across different primaries ( P = 0.96). Four cases of palliative sedation were reported, all performed by the primary care team.

Conclusion:

MPT is highly heterogeneous and risk stratification to optimize the use of therapeutic interventions in unison with palliative interventions is needed to maximize efforts toward improving patient quality of life. There is an alarming need of PC services in the multidisciplinary management of patients within developing regions.
Adaptation or Revolution: Telemental Health and Advanced Practice Psychiatric Nursing During COVID-19
Authors: Schroeder Rebecca A.
Published: November 2020

OBJECTIVE:

This article will describe the current COVID-19 crisis and the evolving mental health concerns associated with it, discuss how mental health practice has changed, and ways in which psychiatric mental health nurse practitioners (PMHNPs) can adapt and prepare for the future.

METHOD:

A search of current literature on the COVID-19 crisis, and topics relevant to the mental health components associated with the pandemic are reviewed. Telemental health (TMH) and PMHNP practice are discussed as they relate to the unfolding picture of the viral pandemic.

RESULTS:

The COVID-19 crisis is having far-reaching implications for mental health treatment and in particular for PMHNPs in practice settings. There have been widespread consequences of the containment measures used for the protection and mitigation of the disease. One such result has been the inability of patients to have face-to-face contact with their providers. The role of TMH has become increasingly important as an adaptation in professional practice.

CONCLUSION:

Technology has rapidly transformed traditional practice due to the COVID-19 crisis and there is strong evidence that it is well accepted by patients and providers. It is incumbent on PMHNPs to embrace TMH and become educated on best practices and TMH services.
Mechanical, water absorption and wear characteristics of novel polymeric composites: Impact of hybrid natural fibers and oil cake filler addition
Authors: Sumesh KR , Kavimani V , Rajeshkumar G , Indran S , Khan Anish
Published: November 2020

A novel epoxy-based composites were fabricated by reinforcing pineapple/flax (PF) fibers and peanut oil cake (PCF) filler using the hand layup cum compression moulding technique and investigated its mechanical, water absorption and wear properties as a function of wt.% of PF fibers (20–40 wt.%) and PCF (1–3 wt.%). The XRD and FTIR results proved the presence of lignocellulosic nature in PCF. Mechanical test results showed significant enhancement in the properties after the addition of PCF. The maximum tensile, flexural and impact properties of 37. 89 MPa, 70.28 MPa and 96.99 J/m were observed in the composites having 20 wt.% of PF and 2 wt.% of PCF. Taguchi based optimization observed a lower specific wear rate (SWR) with 2 wt.% PCF/20 wt.% PF/5 N load and 1500 m sliding distance (SD) combination. The ANOVA results proved the significance of PCF, PF fiber, sliding distance, and load for SWR in this experimentation. The Taguchi optimized results observed a lower coefficient of friction (COF) in 2 wt.% PCF/20 wt.% PF/5N load/500 m SD combination. SEM results displayed surface deformations in the wear-tested composites.
Prediction of Cervical Lymph Node Metastasis Using MRI Radiomics Approach in Papillary Thyroid Carcinoma: A Feasibility Study
Authors: Zhang Heng , Hu Shudong , Wang Xian , He Junlin , Liu Wenhua , Yu Chunjing , Sun Zongqiong , Ge Yuxi , Duan Shaofeng
Published: November 2020

Background:

Cervical lymph node (LN) metastasis of papillary thyroid carcinoma (PTC) is critical for treatment and prognosis. To examine the feasibility of MRI radiomics to preoperatively predict cervical LN metastasis in patients with PTC.

Methods:

Between January 2015 and March 2018, a total of 61 patients with pathologically confirmed PTC were analyzed retrospectively. The patients were divided into cervical LN metastasis group (n = 37) and no cervical LN metastasis (n = 24). T2WI and T2WI-fat-suppression (T2WI-FS) images were collected. A number of radiomic features were automatically extracted from the largest section of tumor. Three types of classifier (the random forests, the support vector machine classifier and the generalized linear model) based on T2WI and T2WI-FS images of cervical LN metastasis and no cervical LN metastasis were constructed and evaluated with a nested cross-validation scheme.

Results:

Radiomic features extracted from T2WI images were more discriminative than T2WI-FS images. The random forests model showed the best discriminate performance with the highest area under the curve (0.85, CI:0.76 -1), accuracy (0.87), sensitivity (0.83), specificity (1.00), positive predictive value (PPV = 1.00) and negative predictive value (NPV = 0.88).

Conclusion:

MRI radiomics analysis based on conventional T2WI and T2WI-FS can predict cervical LN metastasis in patients with PTC, and the radiomics is shown to be an assistant diagnosis tool for radiologists.
Strange Bedfellows: Exploring Methodological Intersections Between Realist Inquiry and Structural Equation Modeling
Authors: Brown Allison , Hecker Kent G. , Bok Harold , Ellaway Rachel H.
Published: November 2020

Realist inquiry, based on the philosophy of critical realism, focuses on exploring the underlying mechanisms that drive social phenomena. Structural equation modeling is a collection of quantitative analytical methods that take a theory-based, confirmatory approach to examining statistical relationships between measured (observable) and underlying (latent) variables. Despite originating from different scientific traditions, the apparent similarities between these two approaches hold promise for their combination in mixed methods research. This article contributes to the field of mixed methods research by exploring their potential synergies, how each approach could contribute to the other, and proposing a framework for their combinations in mixed methods research, which has implications in terms of the implied and explicit ontological and epistemological positionings of these two approaches.
Hip Stability May Influence the Development of Greater Trochanteric Pain Syndrome: A Case-Control Study of Consecutive Patients
Authors: Goldman LCDR Ashton H. , Land ENS Vaughn , Adsit Matthew H. , Balazs CDR George C.
Published: November 2020

Background:

Greater trochanteric pain syndrome (GTPS) is thought to relate primarily to tendinosis/tendinopathy of the hip abductors. Previous studies have suggested that certain anatomic factors may predispose one to development of the condition.

Hypothesis:

It was hypothesized that intrinsic acetabular bony stability of the hip is related to the development of GTPS.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 198 consecutive patients diagnosed with GTPS were compared with 198 consecutive patients without clinical evidence of GTPS. Electronic health records of the included patients were examined; data recorded included patient age, sex, race, and body mass index (BMI). Standing anteroposterior radiographs were evaluated by 2 blinded examiners who measured the Tönnis angle, lateral center-edge angle (LCEA), and acetabular depth/width ratio (ADW) and assessed for the presence of a posterior wall sign. The number of dysplastic measures was recorded for each patient based on published norms. Associations between radiographic and patient variables versus the presence or absence of GTPS were determined. Factors with univariate associations where P < .20 were included in a binary logistic regression model to identify independent predictors of the presence of GTPS.

Results:

There was no difference between groups in terms of age, BMI, or race. There were significantly more women than men in the GTPS group (71% vs 30%; P < .001). Intraclass correlation coefficients were good for the LCEA (0.82) and Tönnis angle (0.82) and poor (0.08) for the ADW. Kappa was moderate for the presence of a posterior wall sign (0.51). An increased Tönnis angle, decreased ADW, and ADW <0.25 were significantly associated with the presence of GTPS. The binary logistic regression model identified an increased Tönnis angle ( P < .010) and female sex ( P < .001) as independent risk factors for GTPS.

Conclusion:

Based on this preliminary retrospective study, decreased intrinsic acetabular bony stability of the hip may be associated with an increased risk of GTPS.
Clinical characteristics of 10 children with a pediatric inflammatory multisystem syndrome associated with COVID-19 in Iran
Authors: Shahbaznejad Leila , Navaeifar Mohammad Reza , Abbaskhanian Ali , Hosseinzadeh Fatemeh , Rahimzadeh Golnar , Rezai Mohammad Sadegh
Published: November 2020

Background

Although symptoms and signs of COVID-19 (Coronavirus disease 2019) in children are milder than adults, there are reports of more severe cases which were defined as pediatric inflammatory multisystem syndrome (PIMS). The purpose of this report was to describe the possible association between COVID-19 and PIMS in children.

Methods

From 28 March to 24 June 2020, 10 febrile children were admitted with COVID-19 infection showing characteristics of PIMS in Buali tertiary hospital of Sari, in Mazandaran province, northern Iran. Demographic and clinical characteristics, laboratory and imaging findings, and therapeutic modalities were recorded and analyzed.

Results

The mean age of the patients was 5.37 ± 3.9 years (13 months to 12 years). Six of them were boys. Kawasaki disease, myocarditis, toxic shock syndrome, appendicitis, sepsis, urosepsis, prolonged febrile seizure, acute hemorrhagic edema of infancy, and COVID-19-related pneumonia were their first presentation. All of them had increased C-reactive protein levels, and most of them had elevated erythrocyte sedimentation rate, lymphopenia, anemia, and hypoalbuminemia. Three of them had thrombocytopenia(PLT < 106). Six of them were serologically or polymerase chain reaction positive for COVID-19, and 4 of them were diagnosed as COVID-19 just by chest computed tomography scan. Most of the patients improved without a residual sequel, except one who died with multiorgan failure and another case was discharged with a giant coronary aneurysm.

Conclusions

Children with COVID-19 may present symptoms similar to Kawasaki disease and inflammatory syndromes. PIMS should be considered in children with fever, rash, seizure, cough, tachypnea, and gastrointestinal symptoms such as vomiting, diarrhea, and abdominal pain.
Ethnic disparities in receiving benefits for disability following postpartum mental illness during first two years after delivery: an Israeli nationwide study
Authors: Savitsky Bella , Radomislensky Irina , Frid Zhanna , Gitelson Natalia , Glasser Saralee , Hendel Tova
Published: November 2020

Background

Despite relatively high rates of Postpartum Depression (PPD), little is known about the granting of social security benefits to women who are disabled as a result of PPD or of other postpartum mood and anxiety disorders (PMAD). This study aims to identify populations at risk for underutilization of social security benefits due to PMAD among Israeli women, with a focus on ethnic minorities.

Methods

This retrospective cohort study is based on the National Insurance Institute (NII) database. The study population included a simple 10% random sample of 79,391 female Israeli citizens who gave birth during 2008–2016 (these women delivered a total of 143,871 infants during the study period), and who had not been eligible for NII mental health disability benefits before 2008.

The dependent variable was receipt of Benefit Entitlement (BE) due to mental illness within 2 years following childbirth. Maternal age at delivery, population group, Socio-Economic Status (SES), family status, employment status of the mother and her spouse, and infant mortality were the independent variables. Left truncation COX proportional hazard model with time-dependent variables was used, and birth number served as a time discrete variable.

Results

Bedouin and Arab women had significantly lower likelihood of BE (2.6 times lower and twice lower) compared with other ethnic groups (HR = 0.38; 95% CI: 0.26–0.56; HR = 0.47; 95% CI: 0.37–0.60 respectively). The probability of divorced or widowed women for BE was significantly higher compared to those living with a spouse (HR = 3.64; 95% CI: 2.49–5.33). Lack of employment was associated with higher likelihood of BE (HR = 1.54; 95% CI: 1.30–1.82). Income had a dose-response relationship with BE in multivariable analysis: lower income was associated with the nearly four-fold greater probability compared to the highest income quartile (HR = 3.83; 95% CI: 2.89–5.07).

Conclusions

Despite the exceptionally high prevalence of PMAD among ethnic minorities, Bedouins and Arabs had lowest likelihood of Benefit Entitlement. In addition to developing programs for early identification of postpartum emotional disorders among unprivileged ethnic groups, awareness regarding entitlement to a mental health disability allowance among ethnic minorities should be improved.
Evidence of integrated primary-secondary health care in low-and middle-income countries: protocol for a scoping review
Authors: Hasan Md Zabir , Singh Shalini , Arora Dinesh , Jain Nishant , Gupta Shivam
Published: November 2020

Background

Integrated care is a people-centered health delivery approach that ensures the comprehensiveness, quality, and continuity of service across the settings and levels of health systems. The World Health Organization (WHO) recommends integration across levels and building-blocks of health systems as a prerequisite of Universal Health Coverage (UHC). While health systems of low- and middle-income countries (LMICs) are often fragmented and led by siloed service delivery structure, several LMICs—including India—have attempted health system integration. Several systematic reviews of evidence on healthcare integration from developed countries exist, but no synthesis from LMICs was reported to date. This review will overview the existing evidence of primary-secondary care integration (PSI) in the context of LMICs, aiming to support policy decisions for the effective integration of health delivery systems in India.

Methods

The review will be conducted following the six steps recommend by Arksey and O'Malley. Scientific and grey literature will be systematically selected from PubMed, Embase, Scopus, Web of Science, Global Index Medicus, and electronic repositories (such as WHO, World Bank, Health Policy Plus, and OpenGrey). Using a comprehensive search strategy, literature written in English and published between 2000 and 2020 will be selected, and two independent authors will screen their titles and abstracts. The result will be charted using a data extraction form and reported using tables, figures, and narrative forms.

Discussion

No ethical approval is necessary for the review. The final report will be developed with the consultation of other stakeholders and disseminated through workshops, conference papers, and peer review articles. The review will serve as a guiding tool to approach, implement, and test the PSI models in India and other LMICs.

Scoping review registration

https://osf.io/kjhzt.
Epidemiological factors of septoria tritici blotch (Zymoseptoria tritici) in durum wheat (Triticum turgidum) in the highlands of Wollo, Ethiopia
Authors: Hailemariam Bogale Nigir , Kidane Yosef Geberehawariat , Ayalew Amare
Published: November 2020

Background

Septoria tritici blotch (STB) (Zymoseptoria tritici) is a major disease of durum wheat, an economic crop grown in the highlands of Wollo in Ethiopia.

Methods

To determine the status of this disease, we conducted surveys in five districts of Wollo (Meket, Woreilu, Wadila, Jama, and Dessie Zuria) during the 2015 cropping season. We visited 75 farm plots to determine the prevalence, incidence, and severity of STB.

Results

STB prevalence varied among locations, genotypes, planting dates, growth stages, previous crops, plant population, weed population, and soil types. Similarly, disease intensity also varied along all independent variables. The level of incidence was high in all the visited districts, and the level severity ranged from 9.9 to 59.3% while the incidence varied from 50 to 100%. The mean differences in incidence and severity within the districts’ variable classes, altitude, varieties, growth stage, plant population, planting date, previous crop, weed population, and soil type were high. The independent variables, districts, altitude, varieties, growth stage, plant population, planting date, previous crops, weed population, and soil type, were significantly associated with high incidence and severity of STB as single predictor in the logistic regression model. A reduced multiple variable model was fitted using districts, altitude, varieties, growth stage, plant population, planting date, previous crop, weed population, and soil type as independent variables. High incidence (> 50%) and severity (> 25%) had a high probability of association to all independent variables, except previous crop. Low disease incidence (≤ 50%) and low disease severity (≤ 25%) had high probability of association to the previous crop.

Conclusion

Environmental variables, cultivation practice, and responses were important for the development of STB. Therefore, these factors must be considered in designing strategies for the effective management of STB.
Present and future suitability of the Lake Tana Biosphere Reserve in Ethiopia for the Nile monitor (Varanus niloticus) using the MaxEnt model
Authors: Ejigu Dessalegn , Tassie Nega
Published: November 2020

Introduction

The Nile monitor (Varanus niloticus) is the largest lizard native to Sub-Saharan Africa along the Nile River. The species inhabits a wide variety of habitats including woodlands, grasslands, mangroves, and swamps. Although the practice is not common in the Lake Tana Biosphere Reserve, the species is being hunted in Sahelian Africa for its leather, food, and pet trade. Consequently, the species is listed under the Convention on International Trade in Endangered Species.

Methodology

Data collection was based on onsite GIS aided presence recording. Each record of the species was first vetted for data quality. A multicollinearity analysis was conducted before fitting the MaxEnt model to the 19 bioclimatic variables. Since it provides good coverage for Africa, the Hadley Global Environment Model 2-Atmosphere Ocean (HadGEM2-AO) model was used for extracting future climate scenarios. The implementation of change factor was to correct the modeled mean climate from the climate models. The jackknife test was selected to measure the contribution of each environmental predictor variable. Area under the curve of the receiver operating characteristic was used to evaluate the performance of MaxEnt model.

Results

On average 2750 individuals of Nile monitor were recorded within the Lake Tana Biosphere Reserve. Mean annual temperature, precipitation and temperature were the most important predictors that limit the potential distribution of Nile monitor in the area. Most of the suitable habitats of Nile monitor were mainly predicted in the northern parts of Lake Tana. The ecological niche model produced an average AUC of 0.85. Notable records of the species were found in the vicinity of the lake and the nearby wetlands. Future projection of potential suitable areas revealed that the currently available suitable area to Nile monitor will decline in both 2050 and 2070 under both RCP 6.5 and RCP 8.5, of which the decline in suitable area under the business as usual scenario is the greatest.

Conclusion

The potential distribution map for Nile monitor in the Lake Tana Biosphere Reserve can help in planning land use management around its existing habitat range, discover new populations or set priorities to restore its natural habitat for more effective conservation. Extensive reductions in the amount of suitable areas under future climate scenarios suggest that the species may become threatened in future if effective conservation measures are not implemented.