bluuebunny/crossref_metadata_2025 huggingface dataset:
Delivering physiotherapy services in developing countries for children with cerebral palsy: An example from North Uganda
Authors: Alberghina Laura , Ochola Emmanuel , Turibamwe Cosmas , Omona Venice , Stacchiotti Silvia , Malloggi Chiara
Published: April 2022

Objectives

This study aims to test the feasibility of a mixed outpatient/home physiotherapy programme on a sample of children with cerebral palsy screened at St. Mary’s Hospital Lacor in Gulu, Uganda from January to December 2017.

Methods

Improvement in motor function was investigated using the Gross Motor Function Measure 66-item version (GMFM-66, range: 0 to 100, the higher the score, the better the condition). Physiotherapy treatment and home exercise training for the caregivers of children were carried out at baseline and then every 2 weeks for 3 months to follow. Changes in GMFM-66 score were collected in week six and twelve.

Results

Patients who attended at least one of these visits were analysed. Fifty-five children aged 0.5–12 years were enrolled, 67% (37/55) were lost at follow-ups. The eighteen participating children throughout the programme scored a median GMFM-66 score of 13.5 at baseline, 16.0 in week six, and 19.7 in week twelve (P = 0.02).

Conclusions

This programme can lead to clinical improvement. Feasibility, however, depends on the accessibility of physiotherapy services and on community-based interventions.
An objective framework for evaluating unrecognized bias in medical AI models predicting COVID-19 outcomes
Authors: Estiri Hossein , Strasser Zachary H , Rashidian Sina , Klann Jeffrey G , Wagholikar Kavishwar B , McCoy Thomas H , Murphy Shawn N
Published: April 2022

Objective

The increasing translation of artificial intelligence (AI)/machine learning (ML) models into clinical practice brings an increased risk of direct harm from modeling bias; however, bias remains incompletely measured in many medical AI applications. This article aims to provide a framework for objective evaluation of medical AI from multiple aspects, focusing on binary classification models.

Materials and Methods

Using data from over 56 000 Mass General Brigham (MGB) patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we evaluate unrecognized bias in 4 AI models developed during the early months of the pandemic in Boston, Massachusetts that predict risks of hospital admission, ICU admission, mechanical ventilation, and death after a SARS-CoV-2 infection purely based on their pre-infection longitudinal medical records. Models were evaluated both retrospectively and prospectively using model-level metrics of discrimination, accuracy, and reliability, and a novel individual-level metric for error.

Results

We found inconsistent instances of model-level bias in the prediction models. From an individual-level aspect, however, we found most all models performing with slightly higher error rates for older patients.

Discussion

While a model can be biased against certain protected groups (ie, perform worse) in certain tasks, it can be at the same time biased towards another protected group (ie, perform better). As such, current bias evaluation studies may lack a full depiction of the variable effects of a model on its subpopulations.

Conclusion

Only a holistic evaluation, a diligent search for unrecognized bias, can provide enough information for an unbiased judgment of AI bias that can invigorate follow-up investigations on identifying the underlying roots of bias and ultimately make a change.
Estimation of spin and mass of the black hole in MAXI J1348–630 from the soft state using NICER and NuSTAR observations
Authors: Kumar Raj , Bhattacharyya Subir , Bhatt Nilay , Misra Ranjeev
Published: April 2022

Black holes are characterized by their mass and spin. X-ray observations can be used to estimate these two quantities in black hole systems such as black hole X-ray binaries (BHXRB). Here we analysed near-simultaneous data of BHXRB MAXI J1348–630 from Neutron Star Interior Composition Explorer (NICER) (0.6–10.0 keV) and Nuclear Spectroscopic Telescope Array (NuSTAR) (3.0–79 keV) during the soft and hard states. Considering the distance of the source to be 2.2 kpc, the spin and mass of the black hole were estimated from the modeling of the soft state spectrum of the source. The spin and mass of the black hole were found to be $0.80_{-0.02}^{+0.02}$ and $8.7_{-0.3}^{+0.3}\, \mathrm{M}_\odot$, respectively. The inclination of the source was determined to be $36.5^{\circ}\, \pm \, 1.0^{\circ}$. Using these quantities in the hard state spectral model, the inner radius of the accretion disc was constrained for all three hard states of the source.
A unified model for the evolution of cataclysmic variables
Authors: Sarkar Arnab , Tout Christopher A
Published: April 2022

We give an updated version of the analytical equation of state used in the Cambridge stellar evolution code (stars) as a free to use open-source package that we have used to model cool white dwarfs (WDs) down to temperatures $\log _{10}(T_\mathrm{eff}/\mathrm{K})\, =\, 3$. With this update in the stars code, we model the secular evolution of cataclysmic variable (CV) stars using a double dynamo model wherein there is an interplay between two α − Ω dynamos, one in the convective envelope and the other at the boundary of a slowly rotating shrinking radiative core and the growing convective envelope. We confirm that this model provides a physical formalism for the interrupted magnetic braking paradigm. In addition, our model also provides a mechanism for extra angular momentum loss below the period gap. We construct the relative probability distribution of orbital periods Porb using the mass distribution of WDs in CVs and find that our model excellently reproduces the period gap and the observed period minimum spike in CV distribution. We also compare the evolutionary trajectories from our model with those of other empirical models and find agreement between the two. We also report good agreement between our modelled systems and observational data.
Toward a Notion of Embodiment: Gestures, Sign Language, and Sexuality
Authors: Stamp Rose
Published: April 2022

Signers employ different articulators of the body—hands, head, face, torso—to signal aspects of their social identities, including sexuality and gender. Yet few studies to date have integrated the study of social meaning in sign languages with the study of embodiment. This chapter presents an overview of two research fields and how they interconnect: sociolinguistic research on sexuality-indexed sign varieties used by deaf signers, and gestural research on the perception and production of sexual identity by hearing speakers. Although movement features by gay signers have traditionally been described as an aspect of gay sign variation, a comparison of movement features produced by signers of Israeli Sign Language to those produced by speakers of Hebrew suggests that deaf and hearing individuals may exploit similar movements of the body to index gay identities, regardless of language modality. The chapter therefore highlights the importance of a deeper consideration of embodiment when it comes to analyzing gender and sexuality in sign languages.
Imagining Performances: Entangled Temporalities and Corporalities in Drag King Encounters
Authors: Greco Luca
Published: April 2022

This chapter examines the imaginative aspects of performance, drawing on fieldwork conducted in drag king workshops in Brussels. To collectively imagine a future performance, participants navigate between several possible chronotopes, including a present space-time (the here-and-now of the interaction, in which participants think of a performance that has not yet taken place) and a past space-time (in which participants recruit cultural models in order to think about an upcoming performance). The ethnographic, linguistic, and interactional analysis sheds light on “staged” and “everyday” performances, refreshes the debate between performance and performativity, and highlights creative assemblages of bodies, spatialities, and temporalities. The chapter suggests that a consideration of imagination in the analysis of performance will enhance language and sexuality research by reframing gender through the idea of a body that exceeds itself and carries the power to transform lives.
Enacting New Worlds of Gender
Authors: Steele Ariana J.
Published: April 2022

Nonbinary and gender-nonconforming people resist normative binary gender by identifying themselves and inhabiting their bodies in ways that are less rigid and less tied to social expectations than seen in dichotomous understandings of gender. This review of nonbinary language practices considers the ways that Black nonbinary speakers use language to resist the modern Western gender binary that emerged from colonialism and slavery. Their various ways of pushing back against binary views of gender complicate theories of language, gender, and sexuality. A sociophonetics study on the variables of pitch and /s/ among both Black and white nonbinary speakers in the United States demonstrates how Black nonbinary speakers challenge colonialist legacies of racialized binary gender to create new ways of expressing gender. The chapter calls for further investigation by scholars of language, gender, and sexuality into the gender binary and the influence of race on gender expression.
SMAX1 Integrates Karrikin and Light Signals into GA-Mediated Hypocotyl Growth during Seedling Establishment
Authors: Kim Jae Young , Park Young-Joon , Lee June-Hee , Park Chung-Mo
Published: April 2022

Morphogenic adaptation of young seedlings to light environments is a critical developmental process that ensures plant survival and propagation, as they emerge from the soil. Photomorphogenic responses are facilitated by a network of light and growth hormonal signals, such as auxin and gibberellic acid (GA). Karrikins (KARs), a group of butenolide compounds produced from burning plant materials in wildfires, are known to stimulate seed germination in fire-prone plant species. Notably, recent studies support that they also regulate seedling growth, while underlying molecular mechanisms have been unexplored yet. Here, we demonstrate that SUPPRESSOR OF MAX2 1 (SMAX1), a negative regulator of KAR signaling, integrates light and KAR signals into GA–DELLA pathways that regulate hypocotyl growth during seedling establishment. We found that SMAX1 facilitates degradation of DELLA proteins in the hypocotyls. Interestingly, light induces the accumulation of SMAX1 proteins, and SMAX1-mediated degradation of DELLA is elevated in seedling establishment during the dark-to-light transition. Our observations indicate that SMAX1-mediated integration of light and KAR signals into GA pathways elaborately modulates seedling establishment.
Time Course and Risk Profile of Work-Related Neck Disability: A Longitudinal Latent Class Growth Analysis
Authors: Xie Yanfei , Coombes Brooke K , Thomas Lucy , Johnston Venerina
Published: April 2022

Objective

Given the economic burden of work-related neck pain and disability, it is important to understand its time course and associated risk factors to direct better management strategies. This study aimed to identify the 1-year trajectories of work-related neck disability in a high-risk occupation group such as sonography and to investigate which baseline biopsychosocial factors are associated with the identified trajectories.

Methods

A longitudinal study was conducted among 92 sonographers with neck disability assessed at 3 time points—baseline, 6 months, and 12 months—using the Neck Disability Index. Baseline biopsychosocial measures included individual characteristics (demographics and physical activity levels), work-related physical and psychosocial factors (eg, ergonomic risk, workplace social support, job satisfaction), general psychological features (depression, anxiety, pain catastrophizing, and fear-avoidance beliefs), and quantitative sensory testing of somatosensory function (cold and pressure pain thresholds at neck and tibialis anterior, and temporal summation).

Results

Two distinct trajectories of neck disability were identified, including a “low-resolving disability” trajectory showing slow improvement toward no disability (64.8%) and a “moderate-fluctuating disability” trajectory characterized by persistent moderate disability with a small fluctuation across time (35.2%). The trajectory of moderate-fluctuating disability was associated with more severe symptoms, lower vigorous physical activity, higher ergonomic risk, remote cold hyperalgesia, widespread mechanical hyperalgesia, heightened pain facilitation, and several psychosocial factors such as anxiety, depression, lower job satisfaction, and lower workplace social support at baseline.

Conclusion

Over one-third of sonographers were at risk of developing a moderate-fluctuating disability trajectory. This unfavorable trajectory was associated with low physical activity level, poor ergonomics, psychosocial distress, and central sensitization at baseline.

Impact

This study has important implications for the management of neck disability in workers. Addressing modifiable factors including low vigorous physical activity, poor ergonomics, anxiety, depression, and lack of workplace social support may improve the trajectory of work-related neck disability.
Motivic Limits for Fano Varieties of k-Planes
Authors: Park Soohyun
Published: April 2022

We study the probability that an $(n - m)$-dimensional linear subspace in $\mathbb{P}^n$ or a collection of points spanning such a linear subspace is contained in an m-dimensional variety $Y \subset \mathbb{P}^n$. This involves a strategy used by Galkin–Shinder to connect properties of a cubic hypersurface to its Fano variety of lines via cut-and-paste relations in the Grothendieck ring of varieties. Generalizing this idea to varieties of higher codimension and degree, we can measure growth rates of weighted probabilities of k-planes contained in a sequence of varieties with varying initial parameters over a finite field. In the course of doing this, we move an identity motivated by rationality problems involving cubic hypersurfaces to a motivic statistics setting associated with cohomological stability.
How Do You Want Your Eggs? The Medical Management of Kin-Making and Reproductive Inequalities in the United States and India
Authors: Mukherjee Meghna
Published: April 2022

Scholarship establishes that assisted reproductive technology (ART) implementation often stratifies the logics of who can (and should) reproduce. However, we know less about how social inequalities inform practices and reproductive logics within fertility clinics and across contexts. Mobilizing the concept of strategic naturalization and denaturalization (SN/SD) – the conceptual reconfiguration of an egg’s heritable components – this article addresses that gap. Examining clinic-based egg donation arrangements in Kolkata, India, and the United States’ San Francisco Bay Area, it addresses when and why reproductive logics are developed using SN/SD and how this development varies based on a country’s race, class, and gender dynamics. Using participant observation and in-depth interviews, this study explains why certain traits are conceptualized as genetic versus social during donor-patient matching and highlights variation across sociocultural sites. In both sites, actors use SN/SD to reimagine eggs to confer social advantage, navigating three structural and contextual axes while doing so: (1) clinical structures and policies, (2) donor pool characteristics, and (3) degree of technological reliance. Though resulting logics to reimagine donor eggs vary, reproductive strategies in both sites ultimately reflect existing social hierarchies that prioritize norms associated with hegemonic upper middle-class families.
REACH: A Required Curriculum to Foster the Well-Being of Medical Students
Authors: Ferguson Catherine C. , Ark Tavinder K. , Kalet Adina L.
Published: April 2022

Problem

The extent of medical student unwellness is well documented. Learner distress may impact patient care, workforce adequacy, and learners’ performance and personal health. The authors describe the philosophy, structure, and content of the novel REACH (Recognize, Empathize, Allow, Care, Hold each other up) curriculum and provide a preliminary evaluation.

Approach

The REACH curriculum is a mandatory, longitudinal well-being curriculum for first- and second-year medical students at the Medical College of Wisconsin (MCW) designed to prepare them for the emotional life of being a physician. The curriculum uses a framework, core concepts, and skills from the field of trauma stewardship. It builds on effective medical student well-being interventions (e.g., mindfulness-based training) and the sharing of personal stories by instructors during didactic and small-group sessions that are integrated into the regular MCW curriculum. During the first 2 years of implementation (2018–2019 and 2019–2020), the curriculum was evaluated using mid- and postcurriculum student surveys.

Outcomes

Over 700 students have completed the REACH curriculum as of March 2022. Overall, most students who responded to the surveys in 2018–2020 reported that they felt the REACH curriculum material was important, that the curriculum met their expectations for a quality medical school course, and that they would recommend other schools incorporate a similar curriculum. Respondents to the 2019–2020 postcurriculum survey indicated the REACH curriculum helped them develop self-care (84% [85/101]), mindfulness (76% [76/101]), and help-seeking (71% [72/101]) skills.

Next Steps

The initial outcomes show that integrating a mandatory well-being curriculum is feasible and acceptable to medical students. The authors plan to examine the relationships between student-reported well-being metrics, academic and clinical performance data, and professional identity formation. They are also prototyping electronic dashboards that will allow students to interact with their well-being data to promote timely help-seeking and behavior change.
Characterization of the Epidemiology and Risk Factors for Hand Fractures in Patients Aged 1 to 19 Presenting to United States Emergency Departments: A Retrospective Study of 21,031 Cases
Authors: Albright J. Alex , Rebello Elliott , Kosinski Lindsay R. , Patel Devan D. , Spears J. Reid , Gil Joseph A. , Katarincic Julia A.
Published: April 2022

Background:

Hand fractures are among the most common injuries presenting in pediatric emergency departments (EDs) with incidence reported as high as 624 hand fractures per 100,000 person-years. If gone untreated, these injuries can lead to pain, loss of function, and psychological trauma. The purpose of this study was to identify risk factors and characterize pediatric hand fractures over a 5-year period.

Methods:

The National Electronic Injury Surveillance System (NEISS) was queried for all hand fractures in patients aged 1 to 19 years presenting to US EDs between 2016 and 2020. Incidence was calculated using US census data. Cases were retrospectively analyzed using age, location of the injury, sex, coronavirus disease-2019 (COVID-19) era, and etiology of injury. Bivariate logistic regression was used where appropriate.

Results:

A total of 21,031 pediatric hand fractures were identified, representing an estimated 565,833 pediatric hand fractures presenting to EDs between 2016 and 2020. The mean incidence of pediatric hand fractures was 138.3 fractures for 100,000 person-years [95% confidence interval (CI): 136.2-140.4], with a 39.2% decrease in incidence occurring between 2019 and 2020. It was found that 42.2% of the fractures were in patients aged 10 to 14. The incidence of hand fractures for males and females was 97.9 (95% CI: 96.2-99.7) and 40.4 (95% CI: 39.2-41.5), respectively, with the male rate peaking at age 14 and the female rate peaking at age 12. Age, sex, location of the injury, and injury during the COVID-19 pandemic were demonstrated to influence the frequency and etiology of the fracture.

Conclusion:

This study determined the incidence of pediatric hand fractures presenting to EDs across the United States. In addition, it identified risk factors for common hand fracture etiologies (sports-related, falling, crush, punching) and demonstrated the change in rates of different etiologies of pediatric hand fractures that presented to US EDs during the COVID-19 pandemic.

Level of Evidence:

Level III—retrospective comparative study.
Using the Omaha System to Determine Health and Social Problems of Roma Population in Istanbul
Authors: Ardic Aysun , Aktas Emine
Published: April 2022

The aim of this study was to determine the health and social problems and related behaviors of the Roma population by using the Omaha System. The data were collected from 650 Roma individuals. This study was a cross-sectional secondary data analysis and the data were collected in two stages. First, the “Technical Assistance for Promoting Social Inclusion in Densely Roman Populated Areas Project (SIROMA)” Act team evaluated health problems among Roma individuals. Second, data were reanalyzed using the Omaha System. When sociodemographic and economic characteristics were evaluated, low education level, adolescent marriages, a high number of live births, soiled living areas, unemployment, and substance use were found in the Roma population. In this context, using the Omaha System, the frequently diagnosed health and social problems were Sanitation (13.5%), Healthcare supervision (11.8%), Nutrition (11.0%), Income (9.8%), Respiration (8.3%), Substance use (7.3%), and Neighborhood/workplace safety (6.0%). This study results found out that the Roma population is less prone than natives to have healthy lifestyle behaviors and more prone to experience a deterioration in both their general and mental health. The Omaha System is a valid method used to collect and analyze data for a vulnerable population in the community. Also, it has been proven that the Omaha System Problem Classification Scheme can provide a more detailed and comprehensive assessment.
Nurses' Perceptions of Using Personal Digital Assistants in Tertiary Hospitals
Authors: Jeong Hye Won , Lee Seonah
Published: April 2022

Personal digital assistants can perform multiple functions such as Internet search, documentation, calculating, and barcode scanning. This study examined nurses' perceptions of personal digital assistants used as a barcode scanner for medication administration, blood transfusions, and blood collection. A total of 236 nurses participated in the survey using the instrument developed by the researchers. The data collected were analyzed using descriptive statistics, one-way analysis of variance, and the Scheffe test. Written responses to the advantages and drawbacks of using personal digital assistants were categorized by meaning. The results showed that the nurses perceived more drawbacks than advantages in using personal digital assistants because of nonworking barcodes, prescription practice requiring additional scanning, poor interfacing between personal digital assistants and the EMR, and frequent Wi-Fi disconnection. The drawbacks resulted in delays in nursing workflow for patient care. Therefore, increasing the availability of barcode scanning for all medications applicable to personal digital assistant use, redesigning the practice of current prescriptions to eliminate additional scanning, and seamless interfacing between personal digital assistants and EMRs should be considered. This enables the nurses to use personal digital assistants more efficiently and effectively for patient care.
Effortlessness and Security
Authors: Golay Diane , Salminen Karlsson Minna , Cajander Åsa
Published: April 2022

Nurses' well-being at work has been an increasing concern the past few years, in particular in connection with work-related information technology use. Researchers have thus been called to explore ways of fostering nurses' well-being at work. However, little is known about the factors related to information technology that contribute to nurses' positive experience of and well-being at work. In this study, we sought to understand the appraisals and emotions at the core of nurses' positive experiences with information technology use at work. We conducted focus groups and semistructured interviews with 15 ward nurses working at a large Swedish hospital. The data were analyzed qualitatively using process and causation coding. We found appraisals of easy goal accomplishment, doing less of a particular task, knowing what the situation is and what has to be done, mastering the system, reduced risk of mistakes and omissions, and assured access to patient information. Using design theory, we connected these appraisals with four positive emotions: joy, relief, confidence, and relaxation. These findings suggest that effortlessness and security are central to nurses' positive experience of information technology. Implementing information technology–related features and practices associated with them in healthcare organizations may foster nurses' well-being at work.
Carceral Amplification of COVID-19: Impacts for Community, Corrections Officer, and Incarcerated Population Risks
Authors: Lofgren Eric T. , Lum Kristian , Horowitz Aaron , Mabubuonwu Brooke , Meyers Kellen , Fefferman Nina H.
Published: April 2022

COVID-19 is challenging many societal institutions, including our criminal justice systems. Some have proposed or enacted (e.g., the State of New Jersey) reductions in the jail and/or prison populations. We present a mathematical model to explore the epidemiologic impact of such interventions in jails and contrast them with the consequences of maintaining unaltered practices. We consider infection risk and likely in-custody deaths, and estimate how within-jail dynamics lead to spill-over risks, not only affecting incarcerated people but increasing exposure, infection, and death rates for both corrections officers and the broader community beyond the justice system. We show that, given a typical jail-community dynamic, operating in a business-as-usual way results in substantial, rapid, and ongoing loss of life. Our results are consistent with the hypothesis that large-scale reductions in arrest and speeding of releases are likely to save the lives of incarcerated people, jail staff, and the wider community.
Prescription Stimulants and the Risk of Psychosis
Authors: Gallagher Keith E. , Funaro Melissa C. , Woods Scott W.
Published: April 2022

Purpose/Background

Stimulants can cause psychotic symptoms at high doses and with parenteral use, but it remains uncertain whether the clinical use of prescription stimulants (PS) at therapeutic doses precipitates psychosis or influences long-term psychosis risk. Although serious, psychosis is a relatively uncommon event that is difficult to detect in brief randomized controlled trials. There have been several large-scale observational studies of PS and psychosis risk, which have not been reviewed; therefore, we conducted a systematic review of observational studies of PS and psychosis risk in adults and children.

Methods/Procedure

We conducted a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered with International Prospective Register of Systematic Reviews (CRD42021243484). Eligible studies were longitudinal observational studies, either cohort or case-control, published in English that reported on PS exposure and risk of psychotic events or disorders. Risk of bias assessments were performed with the ROBINS-I instrument.

Findings/Results

There were 10,736 reports screened, and 8 were ultimately included (n = 232,567 patients): 4 retrospective cohort studies, 1 nested case-control study, 2 self-controlled case series, and 1 prospective cohort study. Exposure to methylphenidate (MPH) was more commonly studied than amphetamine (AMPH). In the 3 studies with lowest risk of bias, there was no effect of MPH exposure on psychosis risk, but there was evidence for increased risk with AMPH in 1 study.

Implications/Conclusions

We conclude that observational studies do not support a clear-cut effect of prescribed MPH on psychosis risk but that AMPH has been less well studied and may increase psychosis risk.
Using Retrofit, Reform, and Reimagine to Advance Toward Health Equity
Authors: McLemore Monica R.
Published: April 2022

Objectives:

The purpose of this commentary is to provide an overview of the current landscape for childbearing families and pregnancy-capable people and a call to action toward the courage to align health and human services that support improved health outcomes. The commentary is broken into 3 parts.

Research:

The framework of retrofit, reform, and reimagine is developed to provide a conceptual framework that supports a shared language.

Methods:

The current landscape is juxtaposed on the framework of retrofit, reform, and reimagine to connect the dots for health equity.

Conclusions:

The commentary ends with a call to action that demonstrates a bold roadmap for birth workers, clinicians, nurses, doulas, physicians, and other clinical health services providers to coconstruct paths to human services that should resolve health inequities.
Ampullary gangliocytic paraganglioma with lymph node metastasis
Authors: Choi Hanlim , Choi Jae-Woon , Ryu Dong Hee , Park Sungmin , Kim Myung Jo , Yoo Kwon Cheol , Woo Chang Gok
Published: April 2022

Rationale:

Gangliocytic paraganglioma (GP) is a rare tumor that mostly develops in the duodenum and is composed of the following 3 cell types: epithelioid endocrine, spindle-like, and ganglion-like cells. It manifests as symptoms such as abdominal pain, gastrointestinal bleeding, and weight loss; however, occasionally, it is incidentally detected on endoscopic or radiologic examinations. Although GP is usually benign, it can metastasize to the lymph nodes, and distant metastases have been reported in some cases.

Patient concerns:

A 46-year-old woman presented with anemia on health surveillance examination. She had no other specific symptoms, and her physical examination did not reveal any abnormal finding.

Diagnosis:

Endoscopic ultrasound-guided fine-needle aspiration biopsy was performed, and the endoscopist obtained samples from the inner side of the ampullary mass. Pathological examination suggested GP or a neuroendocrine tumor.

Interventions:

Initially, we planned transduodenal ampullectomy with lymph node excision. However, there was severe fibrosis around the duodenum, and an examination of a frozen biopsy sample from the periduodenal lymph node showed atypical cells in the lymph node. Therefore, we performed pylorus-preserving pancreaticoduodenectomy with lymph node dissection.

Outcomes:

The final pathological diagnosis was GP located in the ampulla of Vater. The GP showed lymphovascular and perineural invasion and invaded the duodenal wall. Furthermore, 4 out of 18 harvested lymph nodes showed metastasis.

Lessons:

We described a case of GP confined to the ampulla with regional lymph node metastasis and reviewed published literature on ampullary GP with lymph node metastasis.
Viral exanthem following influenza vaccine
Authors: Musaed Alsharafi Amr Faisal , Al-Obaidli Amina Mohamednoor , Alhyassat Samir Abdulghani , Ibrahim Tayseer Sabah , Al-Nesf Maryam Ali
Published: April 2022

Introduction:

Influenza vaccination (flu vaccine) is associated with some musculoskeletal and neurological complications despite its wide use and significant safety profile. Skin is one of the most common systems for drug reactions and side effects. Skin rashes such as bullous eruptions and vasculitis have been reported, but viral exanthem are seldom reported in association with the influenza vaccine. In particular, herpes simplex virus-2 reactivation and myelitis following influenza vaccination manifesting as severe herpes simplex virus type 2 and associated with blisters on the back of a single patient have been reported before. However, data on the rate of such complications are scarce in the literature.

Patient concerns:

A young woman complained of an unusual presentation of eruptive vesicular skin lesions following influenza vaccination complicated by allergic contact dermatitis to lemon soap applied to the lesions.

Diagnosis:

Viral exanthem were diagnosed based on clinical presentation and supported by a skin biopsy.

Interventions:

Medical treatment with antiviral and corticosteroids.

Outcomes:

The patient had a favorable outcome.

Conclusion:

Dermatologists should be vigilant to the association with any new medications and skin lesions, observe the progression of the lesions, and revisit the medical history to establish the correct relationships for any possible new causative agent to an evolving or new developing lesion.
Methods used in the spatial analysis of diarrhea
Authors: Seboka Binyam Tariku , Hailegebreal Samuel , Yehualashet Delelegn Emwodew , Kabthymer Robel Hussen , Negas Belay , Kanno Girum Gebremeskel , Tesfa Getanew Aschalew , Yasmin Farah
Published: April 2022

Introduction:

Diarrhea is a major waterborne disease that creates a high burden of mortality and morbidity worldwide. Spatial analysis tools have been emerging and show promising results in global health, it is unclear and little is known about the extent they have been applied to investigate the epidemiology of diarrhea. The objective of this systematic review will be to assess and summarize spatial evaluation approaches across the globe in diarrhea.

Methods and analysis:

The proposed study protocol conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols checklist. We will conduct a systematic search of articles investigating the epidemiology of diarrhea using spatial methodologies and approaches in the study design and analysis through PubMed, EMBASE, and Web of Science databases. Articles to be included will be screened by 2 independent reviewers based on the inclusion criteria., consistency and inter-rater agreement in the selection of studies will be checked by using Cohen’s kappa statistic. Furthermore, the methodological quality of included primary articles will be assessed by reviewers. Findings will be synthesized by using narrative synthesis and tables of evidence for all studies included in this systematic review. A grounded and inductive analysis will be used to show a thematic summary of spatial analysis approaches.

Discussion:

We anticipate that this systematic review will provide a summary of the applications of GIS and spatial analysis techniques that have been used to explore the epidemiology of diarrhea.

Systematic review registration:

The systematic review protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) [CRD42021292523].
New Mothers' Perceptions of Pressure to Breastfeed
Authors: Korth Christina X. , Keim Sarah A. , Crerand Canice E. , Jackson Jamie L.
Published: April 2022

Purpose:

Develop a measure to quantitatively assess perceived pressure to breastfeed and examine associations between perceived pressure, emotional distress, and the breastfeeding experience and self-efficacy among women with 2- to 6-month-old infants.

Study Design and Methods:

A cross-sectional study using an online survey to assess perceived pressure to breastfeed, emotional distress, and the breastfeeding experience and self-efficacy was conducted. Participants were recruited through ResearchMatch, a national online service that matches potential participants to research studies, and online community forums (e.g., Facebook).

Results:

Women (n = 187) reported themselves and society as the greatest sources of pressure. Pressure to breastfeed was negatively associated with the breastfeeding experience (r = -.34, p < .01) and self-efficacy (r = -.39, p < .01), but not emotional distress. Pressure to breastfeed remained a significant explanatory factor, even when considering demographic covariates, with the final models accounting for 16% and 20% of the variance in the breastfeeding experience and self-efficacy, respectively.

Clinical Implications:

Perceived pressure to breastfeed may be an important psychosocial factor to consider when aiming to improve women's breastfeeding experiences. Reducing perceived pressure may be beneficial for promoting breastfeeding outcomes.
Management of Priapism in the Emergency Department
Authors: Adams Lina Ashley , Evans Dian Dowling
Published: April 2022

Patients presenting to the emergency department with priapism require immediate evaluation and treatment. Priapism is a urological emergency that carries the risk of erectile dysfunction if not managed in a timely manner. Therefore, it is important for providers to be able to identify and manage these patients emergently. Priapism has various causes, and knowing the difference between high-flow and low-flow priapism will help determine the appropriate patient management. Although the prevalence of priapism is thought to be low, there have been increasing reports over the years linked to new drugs used for the treatment of erectile dysfunction (Roghmann et al., 2013). For this reason, it is imperative that providers understand the etiology behind the different causes of priapism. Using a case of drug-induced priapism as an exemplar, this article discusses the epidemiology, etiology, and management of priapism conditions.
Informed Consent for Potential Recipients of Pig Kidney Xenotransplantation in the United States
Authors: Padilla Luz A. , Hurst Daniel , Maxwell Kathryn , Gawlowicz Kennan , Paris Wayne , Cleveland David , Cooper David K.C.
Published: April 2022

Clinical trials of kidney xenotransplantation are being considered in the United States. Before this novel procedure can take place, investigators will have to obtain approval from the institutional review board. The consent form that will be used for such a trial and that will receive approval from the institutional review board will be complex. Informed consent—the process by which a research participant provides his/her permission to participate in a clinical trial—is a staple of the research process and most commonly is in the form of a physical document. In the case of a novel procedure with uncertain benefits and risks and a participant population in acute need of a transplant, the consent process is crucial. These complexities may raise several ethical considerations for the initial pig kidney xenotransplantation recipients in the United States that will require adaptations of the required elements of the informed consent process by the US Department of Human and Health Services. The ethical issues include (1) a subject’s ability to withdraw from the trial, (2) restrictions on their reproductive rights, and (3) the possibility of the need for quarantine if there is a perceived risk of xenozoonosis. This article aims to discuss ethical considerations that may challenge the general required elements of the informed consent form stipulated by the 45 Code of Federal Regulations 46 of the US Department of Health and Human Services and to suggest recommendations for deliberation.
The unappreciated generative role of cell movements in pattern formation
Authors: Fulton Timothy , Verd Berta , Steventon Benjamin
Published: April 2022

The mechanisms underpinning the formation of patterned cellular landscapes has been the subject of extensive study as a fundamental problem of developmental biology. In most cases, attention has been given to situations in which cell movements are negligible, allowing researchers to focus on the cell-extrinsic signalling mechanisms, and intrinsic gene regulatory interactions that lead to pattern emergence at the tissue level. However, in many scenarios during development, cells rapidly change their neighbour relationships in order to drive tissue morphogenesis, while also undergoing patterning. To draw attention to the ubiquity of this problem and propose methodologies that will accommodate morphogenesis into the study of pattern formation, we review the current approaches to studying pattern formation in both static and motile cellular environments. We then consider how the cell movements themselves may contribute to the generation of pattern, rather than hinder it, with both a species specific and evolutionary viewpoint.
Familiarity mediates apes' attentional biases toward human faces
Authors: Leinwand Jesse G. , Fidino Mason , Ross Stephen R. , Hopper Lydia M.
Published: April 2022

In zoos, primates experience markedly different interactions with familiar humans, such as the zookeepers who care for them, compared with those with unfamiliar humans, such as the large volume of zoo visitors to whom they are regularly exposed. While the behaviour of zoo-housed primates in the presence of unfamiliar, and to a lesser extent familiar, humans has received considerable attention, if and how they spontaneously distinguish familiar from unfamiliar people, and the cognitive mechanisms underlying the relationships they form with familiar and unfamiliar humans, remain poorly understood. Using a dot-probe paradigm, we assessed whether primates (chimpanzees and gorillas) show an attentional bias toward the faces of familiar humans, with whom the apes presumably had a positive relationship. Contrary to our predictions, all subjects showed a significant attentional bias toward unfamiliar people's faces compared with familiar people's faces when the faces showed a neutral expression, both with and without a surgical face mask on, but no significant attentional bias when the faces showed a surprised expression. These results demonstrate that apes can spontaneously categorize humans based on familiarity and we argue that the attentional biases the apes showed for unfamiliar human faces reflect a novelty effect.
Profiling, monitoring and conserving caterpillar fungus in the Himalayan region using anchored hybrid enrichment markers
Authors: Wang Zhengyang , Da Wa , Negi Chandra Singh , Ghimire Puspa Lal , Wangdi Karma , Yadav Pramod K. , Pubu Zhuoma , Lama Laiku , Yarpel Kuenga , Maunsell Sarah C. , Liu Yong , Kunte Krushnamegh , Bawa Kamaljit S. , Yang Darong , Pierce Naomi E.
Published: April 2022

The collection of caterpillar fungus accounts for 50–70% of the household income of thousands of Himalayan communities and has an estimated market value of $5–11 billion across Asia. However, Himalayan collectors are at multiple economic disadvantages compared with collectors on the Tibetan Plateau because their product is not legally recognized. Using a customized hybrid-enrichment probe set and market-grade caterpillar fungus (with samples up to 30 years old) from 94 production zones across Asia, we uncovered clear geography-based signatures of historical dispersal and significant isolation-by-distance among caterpillar fungus hosts. This high-throughput approach can readily distinguish samples from major production zones with definitive geographical resolution, especially for samples from the Himalayan region that form monophyletic clades in our analysis. Based on these results, we propose a two-step procedure to help local communities authenticate their produce and improve this multi-national trade-route without creating opportunities for illegal exports and other forms of economic exploitation. We argue that policymakers and conservation practitioners must encourage the fair trade of caterpillar fungus in addition to sustainable harvesting to support a trans-boundary conservation effort that is much needed for this natural commodity in the Himalayan region.
Dissociable use-dependent processes for volitional goal-directed reaching
Authors: Tsay Jonathan S. , Kim Hyosub E. , Saxena Arohi , Parvin Darius E. , Verstynen Timothy , Ivry Richard B.
Published: April 2022

Repetition of specific movement biases subsequent actions towards the practiced movement, a phenomenon known as use-dependent learning (UDL). Recent experiments that impose strict constraints on planning time have revealed two sources of use-dependent biases, one arising from dynamic changes occurring during motor planning and another reflecting a stable shift in motor execution. Here, we used a distributional analysis to examine the contribution of these biases in reaching. To create the conditions for UDL, the target appeared at a designated ‘frequent’ location on most trials, and at one of six ‘rare’ locations on other trials. Strikingly, the heading angles were bimodally distributed, with peaks at both frequent and rare target locations. Despite having no constraints on planning time, participants exhibited a robust bias towards the frequent target when movements were self-initiated quickly, the signature of a planning bias; notably, the peak near the rare target was shifted in the frequently practiced direction, the signature of an execution bias. Furthermore, these execution biases were not only replicated in a delayed-response task but were also insensitive to reward. Taken together, these results extend our understanding of how volitional movements are influenced by recent experience.
Why bears hibernate? Redefining the scaling energetics of hibernation
Authors: Nespolo Roberto F. , Mejias Carlos , Bozinovic Francisco
Published: April 2022

Hibernation is a natural state of suspended animation that many mammals experience and has been interpreted as an adaptive strategy for saving energy. However, the actual amount of savings that hibernation represents, and particularly its dependence on body mass (the ‘scaling’) has not been calculated properly. Here, we estimated the scaling of daily energy expenditure of hibernation (DEEH), covering a range of five orders of magnitude in mass. We found that DEEHscales isometrically with mass, which means that a gram of hibernating bat has a similar metabolism to that of a gram of bear, 20 000 times larger. Given that metabolic rate of active animals scales allometrically, the point where these scaling curves intersect with DEEHrepresents the mass where energy savings by hibernation are zero. For BMR, these zero savings are attained for a relatively small bear (approx. 75 kg). Calculated on a per cell basis, the cellular metabolic power of hibernation was estimated to be 1.3 × 10−12± 2.6 × 10−13W cell−1, which is lower than the minimum metabolism of isolated mammalian cells. This supports the idea of the existence of a minimum metabolism that permits cells to survive under a combination of cold and hypoxia.
Modified MRI anonymization (de-facing) for improved MEG coregistration
Authors: Bruña Ricardo , Vaghari Delshad , Greve Andrea , Cooper Elisa , Mada Marius M. , Henson Richard N.
Published: April 2022

Localising the sources of MEG/EEG signals often requires a structural MRI to create a head model, while ensuring reproducible scientific results requires sharing data and code. However, sharing of structural MRI data often requires removal of the face to help protect the identity of the individuals concerned. While automated de-facing methods exist, they tend to remove the whole face, which can impair methods for coregistering the MRI data with the EEG/MEG data. We show that a new, automated de-facing method that retains the nose maintains good MRI-MEG/EEG coregistration. Importantly, behavioural data show that this “face-trimming” method does not increase levels of identification relative to a standard de-facing approach, and has less effect on the automated segmentation and surface extraction sometimes used to create head models for MEG/EEG localisation. We suggest that this trimming approach could be employed for future sharing of structural MRI data, at least for those to be used in forward modelling (source reconstruction) of EEG/MEG data.