bluuebunny/crossref_metadata_2025 huggingface dataset:
Selective Serotonin Reuptake Inhibitors: How Long Is Long Enough?
Authors: Thom Robyn P. , Alexander Jeanne L. , Baron David , Garakani Amir , Gross Lawrence , Pine Janet H. , Radhakrishnan Rajiv , Slaby Andrew , Sumner Calvin R.
Published: September 2021

Selective serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed medications. They are among the first-line medications for several chronic or relapsing-remitting psychiatric conditions, including major depressive disorder and anxiety disorders. The advantages of SSRI use include ease of titration and their tolerability and safety profile. Guidelines for the short-term use of SSRIs are widely available, but there is no well-organized guidance on how and whether to maintain a patient on SSRIs for the long-term. In this article, we discuss the benefits and possible adverse consequences of long-term SSRI use, as well as clinical practice considerations when using SSRIs chronically. The major benefit of long-term SSRI use is relapse prevention. The current literature suggests that the general health risks of long-term SSRI use are low; however, further research, particularly in special populations including youth and the elderly, is needed. Long-term SSRI use increases the risk of tachyphylaxis and discontinuation syndrome. Recognizing that many patients may remain on SSRIs for many years, there are several factors that prescribers should consider if they choose to use an SSRI when initiating treatment and during long-term monitoring. The decision to continue or to discontinue an SSRI should be an active one, involving both the patient and prescriber, and should be revisited periodically. Patients who remain on SSRIs for the long-term should also have periodic monitoring to reassess the risk-benefit ratio of remaining on the SSRI, as well as to assess the safety, tolerability, and efficacy of the medication.
Incision Location Predicts 30-Day Major Adverse Events after Cosmetic Breast Augmentation: An Analysis of the Tracking Outcomes and Operations for Plastic Surgeons Database
Authors: Valente Denis S. , Pannucci Christopher J. , King Timothy W. , Gutowski Karol A. , Gusenoff Jeffrey A. , Rodby Katherine A. , Zanella Rafaela K. , Friji M.T. , Day Kristopher M. , Kaye Alison E.
Published: September 2021

Background:

Enhanced understanding of early postoperative adverse events will improve patient counseling and preoperative risk modification to decrease complications in implant-based breast augmentation. This study seeks to evaluate the early major adverse events following cosmetic breast augmentation.

Methods:

A retrospective cohort analysis of the Tracking Outcomes and Operations for Plastic Surgeons database was performed to identify any women undergoing augmentation mammaplasty with an implant between 2008 and 2016.

Results:

A total of 84,296 patients were studied. Major adverse events were identified in 0.37 percent. Seroma requiring drainage was observed in 0.08 percent, hematoma requiring drainage was observed in 0.15 percent, deep wound disruption was observed in 0.09 percent, and implant loss was observed in 0.11 percent. The authors identified multiple independent predictors of major adverse events, including body mass index greater than 30 kg/m2 (relative risk, 2.05; p < 0.001), tobacco use (relative risk, 2.25; p < 0.001), and diabetes mellitus (relative risk, 1.8; p < 0.05). Use of a periareolar incision significantly increased the risk of developing an early postoperative complication (relative risk, 1.77; p < 0.001).

Conclusions:

The findings of this study indicate an early major adverse event rate following cosmetic breast augmentation with implants of 0.37 percent. The authors identified multiple independent predictors of major adverse events, including body mass index greater than 30 kg/m2, tobacco use, and diabetes mellitus. In addition, when controlling for other factors, periareolar incision significantly increased the risk for major adverse events, when compared to an inframammary incision.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Leveraging the Tracking Operations and Outcomes for Plastic Surgeons Database for Plastic Surgery Research: A “How-To” Guide
Authors: Valente Denis Souto , Kaye Alison E. , Simmons Christopher J. , Zanella Rafaela K. , Pannucci Christopher J.
Published: September 2021

The Plastic Surgeries Registry Network supported by the American Society of Plastic Surgeons (ASPS) and the Plastic Surgery Foundation offers a variety of options for procedural data and outcomes assessment and research. The Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database is a registry created for and used by active members of ASPS to monitor all types of procedural outcomes. It functions as a way for individual or group practices to follow surgical outcomes and constitutes a huge research registry available to ASPS members to access for registry-based projects. The TOPS registry was launched in 2002 and has undergone several iterations and improvements over the years and now includes more than 1 million procedure records. Although ASPS member surgeons have proven valuable assets in contributing their data to the TOPS registry, fewer have leveraged the database for registry-based research. This article overviews the authors’ experience using the TOPS registry for a database research project to demonstrate the process, usefulness, and accessibility of TOPS data for ASPS member surgeons to conduct registry-based research. This article pairs with the report of the authors’ TOPS registry investigation related to 30-day adverse events associated with incision location for augmentation mammaplasty.
Robust clinical detection of SARS-CoV-2 variants by RT-PCR/MALDI-TOF multi-target approach
Authors: Hernandez Matthew M. , Banu Radhika , Gonzalez-Reiche Ana S. , van de Guchte Adriana , Khan Zenab , Shrestha Paras , Cao Liyong , Chen Feng , Shi Huanzhi , Hanna Ayman , Alshammary Hala , Fabre Shelcie , Amoako Angela , Obla Ajay , Alburquerque Bremy , Helena Patiño Luz , Ramírez Juan David , Sebra Robert , Gitman Melissa R. , Nowak Michael D. , Cordon-Cardo Carlos , Schutzbank Ted E. , Simon Viviana , van Bakel Harm , Sordillo Emilia Mia , Paniz-Mondolfi Alberto E.
Published: September 2021

The COVID-19 pandemic sparked rapid development of SARS-CoV-2 diagnostics. However, emerging variants pose the risk for target dropout and false-negative results secondary to primer/probe binding site (PBS) mismatches. The Agena MassARRAY® SARS-CoV-2 Panel combines RT-PCR and MALDI-TOF mass-spectrometry to probe for five targets across N and ORF1ab genes, which provides a robust platform to accommodate PBS mismatches in divergent viruses. Herein, we utilize a deidentified dataset of 1,262 SARS-CoV-2-positive specimens from Mount Sinai Health System (New York City) from December 2020 through April 2021 to evaluate target results and corresponding sequencing data. Overall, the level of PBS mismatches was greater in specimens with target dropout. Of specimens with N3 target dropout, 57% harbored an A28095T substitution that is highly-specific for the alpha (B.1.1.7) variant of concern. These data highlight the benefit of redundancy in target design and the potential for target performance to illuminate the dynamics of circulating SARS-CoV-2 variants.
Is sensor space analysis good enough? Spatial patterns as a tool for assessing spatial mixing of EEG/MEG rhythms
Authors: Schaworonkow Natalie , Nikulin Vadim V.
Published: September 2021

Analyzing non-invasive recordings of electroencephalography (EEG) and magnetoencephalography (MEG) directly in sensor space, using the signal from individual sensors, is a convenient and standard way of working with this type of data. However, volume conduction introduces considerable challenges for sensor space analysis. While the general idea of signal mixing due to volume conduction in EEG/MEG is recognized, the implications have not yet been clearly exemplified. Here, we illustrate how different types of activity overlap on the level of individual sensors. We show spatial mixing in the context of alpha rhythms, which are known to have generators in different areas of the brain. Using simulations with a realistic 3D head model and lead field and data analysis of a large resting-state EEG dataset, we show that electrode signals can be differentially affected by spatial mixing by computing a sensor complexity measure. While prominent occipital alpha rhythms result in less heterogeneous spatial mixing on posterior electrodes, central electrodes show a diversity of rhythms present. This makes the individual contributions, such as the sensorimotor mu-rhythm and temporal alpha rhythms, hard to disentangle from the dominant occipital alpha. Additionally, we show how strong occipital rhythms rhythms can contribute the majority of activity to frontal channels, potentially compromising analyses that are solely conducted in sensor space. We also outline specific consequences of signal mixing for frequently used assessment of power, power ratios and connectivity profiles in basic research and for neurofeedback application. With this work, we hope to illustrate the effects of volume conduction in a concrete way, such that the provided practical illustrations may be of use to EEG researchers to in order to evaluate whether sensor space is an appropriate choice for their topic of investigation.
What pushed Israel out of herd immunity? Modeling COVID-19 spread of Delta and Waning immunity
Authors: De-Leon Hilla , Aran Dvir
Published: September 2021

Following a successful vaccination campaign at the beginning of 2021 in Israel, where approximately 60% of the population were vaccinated with an mRNA BNT162b2 vaccine, it seemed that Israel had crossed the herd immunity threshold (HIT). Nonetheless, Israel has seen a steady rise in COVID-19 morbidity since June 2021, reaching over 1,000 cases per million by August. This outbreak is attributed to several events that came together: the temporal decline of the vaccine’s effectiveness (VE); lower effectiveness of the vaccine against the current Delta (B.1.617.2) variant; highly infectiousness of Delta; and temporary halt of mandated NPIs (non-pharmaceutical interventions) or any combination of the above. Using a novel spatial-dynamic model and recent aggregate data from Israel, we examine the extent of the impact of the Delta variant on morbidity and whether it can solely explain the outbreak. We conclude that both Delta infectiousness and waning immunity could have been able to push Israel below the HIT independently, and thus, to mitigate the outbreak effective NPIs are required. Our analysis cautions countries that once vaccines’ will wane a highly infectious spread is expected, and therefore, the expected decline in the vaccine’s effectiveness in those countries should be accompanied by another vaccination campaign and effective NPIs.
A Cross-Sectional Examination of Conflict-of-Interest Disclosures of Physician-Authors Publishing in High-Impact US Medical Journals
Authors: Baraldi James H. , Picozzo Steven A. , Arnold Jacob C. , Volarich Kathryn , Gionfriddo Michael R. , Piper Brian J.
Published: September 2021

Objective

To assess the accuracy of self-reported financial conflict-of-interest (COI) disclosures in the New England Journal of Medicine (NEJM) and Journal of the American Medical Association (JAMA) within the requisite disclosure period prior to article submission.

Design

Cross-sectional investigation.

Data Sources

Original clinical-trial research articles published in NEJM (n = 206) or JAMA (n = 188) from January 1 to December 31, 2017; self-reported COI disclosure forms submitted to NEJM or JAMA with the authors’ published articles; Open Payments website (from database inception; latest search: August 2019).

Main outcome measures

Financial data reported to Open Payments from 2014 to 2016 (time period that included all subjects’ requisite disclosure windows) were compared to self-reported disclosure forms submitted to the journals. Payments were defined as those not associated with a research study or formal research funding. Payment types were categorized as “disclosed,” “undisclosed,” “indeterminate,” or “unrelated.”

Results

Thirty-one articles from NEJM and 31 articles from JAMA met inclusion criteria. The physician-authors (n = 118) received a combined total of $7.48 million. Of the 106 authors (89.8%) who received payments, 86 (81.1%) received undisclosed payments. The top 23 most highly compensated received $6.32 million, of which $3.00 million (47.6%) was undisclosed. Disclosure rates were the equivalent between the top 23 and the entire sample.

Conclusions

High payment amounts, as well as high proportions of undisclosed financial compensation, regardless of amount received, comprised potential COIs for two influential US medical journals. Further research is needed to explain why such high proportions of general payments were undisclosed and whether journals that rely on self-reported COI disclosure need to reconsider their policies.
Insulin resistance and adipose tissue inflammation induced by a high-fat diet are attenuated in the absence of hepcidin
Authors: James Jithu Varghese , Varghese Joe , John Nikhitha Mariya , Deschemin Jean-Christophe , Vaulont Sophie , McKie Andrew T. , Jacob Molly
Published: September 2021

Increased body iron stores and inflammation in adipose tissue have been implicated in the pathogenesis of insulin resistance (IR) and type 2 diabetes mellitus. However, the underlying basis of these associations are unclear. In order to assess this, we studied how IR and associated inflammation in adipose tissue developed in the presence of increased body iron stores. Male hepcidin knock-out (Hamp1-/-) mice, which have increased body iron stores, and wild-type (WT) mice were fed a high-fat diet (HFD) for 12 and 24 weeks. Development of IR and metabolic parameters linked to this, insulin signaling in tissue, and inflammation and iron-related parameters in visceral adipose tissue were studied in these animals. HFD-feeding resulted in impaired glucose tolerance in both genotypes of mice. In response to the HFD for 24 weeks, Hamp1-/- mice gained less body weight and developed less IR than corresponding WT mice. This was associated with less lipid accumulation in the liver and decreased inflammation and lipolysis in the adipose tissue in the knock-out mice, than in the WT animals. Fewer macrophages infiltrated the adipose tissue in the knockout mice than in wild-type mice, with these macrophages exhibiting a predominantly anti-inflammatory (M2-like) phenotype. These observations suggest a novel role of hepcidin (central regulator of systemic iron homeostasis) in the development of inflammation in adipose tissue and insulin resistance, in response to a high-fat diet.

CLINICAL PERSPECTIVES

Elevated body iron stores and inflammation in adipose tissue have been implicated in the pathogenesis of insulin resistance (IR) and type 2 diabetes mellitus. However, the underlying molecular mechanisms linking them are unclear.

In response to high-fat diet (HFD)-feeding (to induce IR), mice that lacked hepcidin (Hamp1-/-) (and hence had elevated body iron stores) gained less body weight and developed less insulin resistance than wild-type (WT) mice. Inflammation and infiltration of macrophages into adipose tissue of HFD-fed Hamp1-/- mice were less than in WT mice, with the macrophages exhibiting an anti-inflammatory M2-like phenotype.

These findings suggest a novel role of iron and hepcidin in HFD-induced inflammation in adipose tissue and development of insulin resistance. They raise the possibility that modulation of body iron may represent a potential way to inhibit these processes.
Transcutaneous auricular vagus nerve stimulation increases eye-gaze on salient facial features and oxytocin release
Authors: Zhu Siyu , Qing Yanan , Zhang Yingying , Zhang Xiaolu , Ding Fangyuan , Zhang Rong , Yao Shuxia , Kendrick Keith , Zhao Weihua
Published: September 2021

Background

Transcutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive neuromodulation technique with promising therapeutic potential in the context of epilepsy, pain, and depression and which may also have beneficial effects on social cognition. However, the underlying mechanisms of taVNS are unclear and evidence regarding its role in social cognition improvement is limited.

Objective

In order to investigate the impact of taVNS on social cognition we have studied its effects on gaze towards emotional faces using an eye-tracking task and also on release of the neuropeptide oxytocin which plays a key role in influencing social cognition and motivation.

Methods

A total of fifty-four subjects were enrolled in a sham-controlled, participant-blind crossover experiment, consisting of two treatment sessions, separated by one week. In one session participants received 30-min taVNS (tragus), and in the other, they received 30-min sham (earlobe) stimulation with the treatment order counterbalanced across participants. Gaze duration towards the faces and facial features (eyes, nose, and mouth) were measured together with resting pupil size. Additionally, saliva samples were taken for the measurement of oxytocin concentrations by enzyme-linked immunoassay.

Results

Saliva oxytocin concentrations increased significantly after taVNS compared to sham stimulation, while resting pupil size did not. In addition, taVNS increased fixation time on the nose region irrespective of face emotion, and this was positively correlated with increased saliva oxytocin concentrations.

Conclusion

Our findings suggest that taVNS biases visual attention towards socially salient facial features across different emotions and this is associated with its effects on increasing endogenous oxytocin release.
Health systems performance for hypertension control using a cascade of care approach in South Africa, 2008-2017
Authors: Benade Mariet , Prasad Sridevi K. , Mchiza Zandile , Yan Lily D. , Brennan Alana T. , Davies Justine , Sudharsanan Nikkil , Manne-Goehler Jennifer , Fox Matthew P. , Bor Jacob , Rosen Sydney B. , Stokes Andrew C.
Published: September 2021

Background

Hypertension is a major contributor to global morbidity and mortality. In South Africa, the government has employed a whole systems approach to address the growing burden of non-communicable diseases. We used a novel incident care cascade approach to measure changes in the South African health system’s ability to manage hypertension between 2008 and 2017.

Methods

We used data from Waves 1-5 of the National Income Dynamics Study (NIDS) to estimate trends in the hypertension care cascade and unmet treatment need across four successive cohorts with incident hypertension. We used a negative binomial regression to identify factors that may predict higher rates of hypertension control, controlling for socio-demographic and healthcare factors. The largest cascade attrition occurred prior to diagnosis.

Results

In 2011, 19·6% (95%CI 14·2, 26·2) of individuals with incident hypertension were diagnosed, 15·4% (95%CI 10·8, 21·4) were on treatment and 7.1% had controlled blood pressure. By 2017, the proportion of individuals with diagnosed incident hypertension had increased to 24·4% (95%CI 15·9, 35·4) with increases in treatment (23·3%, 95%CI 15·0, 34·3) and control (22·1%, 95%CI 14·1, 33·.0) were also observed, translating to a decrease in unmet need from 92·9% in 2011 to 77·9% in 2017. Multivariable regression showed that participants with incident hypertension in 2017 were 3·01 (95%CI 1·77, 5·13) times more likely to have a controlled blood pressure compared to those in 2011.

Conclusions

The proportion of people with incident hypertension who successfully progressed to controlled blood pressure tripled between 2011 and 2017 in South Africa. Despite these improvements, a low absolute proportion of the population were able to control their blood pressure and a high burden of unmet need remains.

Summary Box

What is already known

Prevalent cascades provide insight to where losses in care cascades occur.

While mostly used in the management of HIV, recently they have also been adopted in studying the management of non-communicable diseases on a population level.

Prevalent hypertension cascades in South Africa showed a high burden of unmet need, with the biggest losses where lost between disease development and diagnosis.

What are the new findings

Incident hypertension cascades improved from 2008 to 2017 in South Africa.

What do the new findings imply

Incident cascades provide an improved means to measure changes in management cascades as this allows us to distinguish between historical and current health system performance.

Our data show that while substantial improvements in the care cascade occurred between 2008 and 2017, a large burden of unmet need remains.
The Impact of Non-Price In-premise Marketing on Food and Beverage Purchasing and Consumer Behaviour: A Systematic Review
Authors: Whitehead R. , Greci S. , Thomson H , Armour G. , Angus K. , Martin L.
Published: September 2021

In-premise marketing is commonly used to promote foods that are high in fat, sugar or salt. In order to inform development of public policy in this area, this systematic review sought to determine the quantity and quality of English-language evidence which examines the role and impact of in-premise advertising (e.g., signage, posters) and positional promotions (e.g., checkout displays) on consumer behaviour and diet-related outcomes in retail, out-of-home (i.e., cafés, restaurants, takeaways) and online purchasing environments. Sixty-two studies met inclusion criteria, of which 69% (n=42) were identified as being methodologically weak. The best-available evidence constitutes findings from four methodologically strong studies, and ten moderate studies which are not confounded by additional promotions such as price or availability. These studies predominantly found evidence that in-premise marketing is likely to be successful in influencing consumer behaviour towards targeted items, across retail and out-of-home settings. These findings provide a basis for authorities to consider acting to restrict in-premise marketing of unhealthy foods and encouraging the in-premise marketing of healthier products. This review identified gaps in the evidence available on non-sales outcomes, and on online purchase environments. These gaps, and identified methodological limitations of the extant evidence remain to be addressed by future research.
Integrative multi-omics analysis of childhood aggressive behavior
Authors: Hagenbeek Fiona A. , van Dongen Jenny , Pool René , Roetman Peter J. , Harms Amy C. , Hottenga Jouke Jan , Kluft Cornelis , Colins Olivier F. , van Beijsterveldt Catharina E.M. , Fanos Vassilios , Ehli Erik A. , Hankemeier Thomas , Vermeiren Robert R. J. M. , Bartels Meike , Déjean Sébastien , Boomsma Dorret I.
Published: September 2021

This study introduces and illustrates the potential of an integrated multi-omics approach in investigating the underlying biology of complex traits such as childhood aggressive behavior. In 645 twins (cases=42%), we trained single- and integrative multi-omics models to identify biomarkers for subclinical aggression and investigated the connections among these biomarkers. Our data comprised transmitted and two non-transmitted polygenic scores (PGSs) for 15 traits, 78772 CpGs, and 90 metabolites. The single-omics models selected 31 PGSs, 1614 CpGs, and 90 metabolites, and the multi-omics model comprised 44 PGSs, 746 CpGs, and 90 metabolites. The predictive accuracy for these models in the test (N=277, cases=42%) and independent clinical data (N=142, cases=45%) ranged from 43% to 57%. We observed strong connections between DNA methylation, amino acids, and parental non-transmitted PGSs for ADHD, Autism Spectrum Disorder, intelligence, smoking initiation, and self-reported health. Aggression-related omics traits link to known and novel risk factors, including inflammation, carcinogens, and smoking.
Episodic future thinking and compassion reduce public health guideline noncompliance urges: A randomised controlled trial
Authors: van Baal Simon , Verdejo-García Antonio , Hohwy Jakob
Published: September 2021

Background

During the COVID-19 pandemic, public health departments have issued guidelines to limit viral transmission. In this environment, people will feel urges to engage in activities that violate these guidelines, but research on guideline adherence has been reliant on surveys asking people to self-report their typical behaviour, which may fail to capture these urges as they unfold. Guideline adherence could be improved through behaviour change interventions, but considering the wide range of behaviours that COVID-19 guidelines prescribe, there are few methods that allow observing changes of aggregate guideline adherence in the ‘wild’.

Methods

In order to administer interventions and to obtain contemporaneous data on a wide range of behaviours, we use ecological momentary assessment. In this preregistered parallel randomised trial, 95 participants aged 18-65 from the UK were assigned to three conditions using blinded block randomisation, and engage in episodic future thinking (n = 33), compassion exercises (n = 31), or a sham procedure (n = 31) and report regularly on the intensity of their occurrent urges (min. 1, max. 10) and their ability to control them. We investigate whether state impulsivity and vaccine attitudes predict guideline adherence, while assessing through which mechanism these predictors affect behaviour.

Findings

We found that episodic future thinking (b = -1.60) and compassion exercises (b = -1.40) reduce the intensity of urges. State impulsivity is associated with stronger urges, but we found no evidence that vaccine hesitancy predicts lesser self-control.

Interpretation

We conclude that episodic future thinking exercises and compassion training may be used to stimulate compliance of individuals who are a risk for the community, such as those in voluntary self-isolation.
Reduced levels of convalescent neutralizing antibodies against SARS-CoV-2 B.1+L249S+E484K lineage
Authors: Álvarez-Díaz Diego A. , Laiton-Donato Katherine , Torres-García Orlando Alfredo , Ruiz-Moreno Hector Alejandro , Franco-Muñoz Carlos , Beltran Maria Angie , Mercado-Reyes Marcela , Rueda Miguel Germán , Muñoz Ana Luisa
Published: September 2021

The E484K mutation at the SARS-CoV-2 Spike protein emerged independently in different variants around the world, probably as part of the ongoing adaptation of the virus to the human host, and has been widely associated with immune escape from neutralizing antibodies generated during previous infection or vaccination. In this work, the B.1+L249S+E484K lineage was isolated along with A.1, B.1.420 and B.1.111 SARS-CoV-2 lineages without the E484K mutation and the neutralizing titer of convalescent sera was compared using microneutralization assays. While no significant differences in the neutralizing antibody titers were found between A1 and B lineages without the E484K mutation, the neutralizing titers against B.1+L249S+E484K were 1.5, 1.9, 2.1, and 1.3-fold lower than against A.1, B.1.420, B.1.111-I, and B.1.111-II, respectively. However, molecular epidemiological data indicate that there is no increase in the transmissibility rate associated with this new lineage. Hence, although the evidence provided in this study support a Variant of Interest Status (VOI) for the B1+L249S+E484K lineage, enhanced laboratory characterization of this particular lineage and other emerging lineages with the E484K mutation should be carried out in individuals with immunity acquired by natural infection and vaccination. This study accentuated the capability of new variants with the E484K mutation to be resistant to neutralization by humoral immunity, and therefore the need to intensify surveillance programs.

HIGHLIGHT

⍰

The E484K mutation in B.1+L249S+E484K appears not to affect the viral titer

⍰

Sensitivity of lineages without E484K mutation to neutralizing antibodies did not change

⍰

B.1+L249S+E484K lineage shows a reduction in its neutralizing capacity
Resilience Assessment of healthcare facilities within urban context: Learning from a non-profit hospital in Tehran, Iran
Authors: Rahmani Mehrdad , Lotfata Aynaz , Khoshnevis Sarasadat , Javanmardi Komar
Published: September 2021

Tehran's healthcare system is under increasing strain due to population expansion and a lack of disaster preparedness measures. The purpose of this paper is to analyze hospital resilience in an urban setting to identify areas for improvement to keep the studied hospital operational during a crisis. In this study, the Urban Resilience Index (URI) in Amir-Alam hospital was assessed using a customized version of the City Resilience Profiling Tool (CRPT) established by the United Nations Office for Disaster Risk Reduction (UNISDR). The 36 indicators were analyzed in 5 components. The result has revealed that the hospital's urban resilience score was calculated to be 51.75 out of 100, indicating medium resilience, while, regarding the critical indicators, the score was 20.25 out of 60, which is not acceptable. The physical, organizational, and spatial attributes of the Amir-Alam hospital are among the least resilient, but the functional and dynamic characteristics are reasonably decent.
Intraoperative microseizure detection using a high-density micro-electrocorticography electrode array
Authors: Sun James , Barth Katrina , Qiao Shaoyu , Chiang Chia-Han , Wang Charles , Rahimpour Shervin , Trumpis Michael , Duraivel Suseendrakumar , Dubey Agrita , Wingel Katie E. , Rachinskiy Iakov , Voinas Alex S. , Ferrentino Breonna , Southwell Derek G. , Haglund Michael M. , Friedman Allan H. , Lad Shivanand P. , Doyle Werner K. , Solzbacher Florian , Cogan Gregory , Sinha Saurabh R. , Devore Sasha , Devinsky Orrin , Friedman Daniel , Pesaran Bijan , Viventi Jonathan
Published: September 2021

One-third of epilepsy patients suffer from medication-resistant seizures. While surgery to remove epileptogenic tissue helps some patients, 30–70% of patients continue to experience seizures following resection. Surgical outcomes may be improved with more accurate localization of epileptogenic tissue. We have previously developed novel thin-film, subdural electrode arrays with hundreds of microelectrodes over a 100–1,000 mm2 area to enable high-resolution mapping of neural activity. Here we used these high-density arrays to study microscale properties of human epileptiform activity. We performed intraoperative micro-electrocorticographic recordings within epileptic cortex (the site of seizure onset and early spread) in nine patients with epilepsy. In two of these patients, we obtained recordings from cortical areas distal to the epileptic cortex. Additionally, we recorded from two non-epileptic patients with movement disorders undergoing deep brain stimulator implantation as non-epileptic tissue controls. A board-certified epileptologist identified microseizures, which resembled electrographic seizures normally observed with clinical macroelectrodes. Epileptic cortex exhibited a significantly higher microseizure rate (2.01 events/min) than non-epileptic cortex (0.01 events/min; permutation test, P=0.0068). Using spatial averaging to simulate recordings from larger electrode contacts, we found that the number of detected microseizures decreased rapidly with increasing contact diameter and decreasing contact density. In cases in which microseizures were spatially distributed across multiple channels, the approximate onset region was identified. Our results suggest that micro-electrocorticographic electrode arrays with a high density of contacts and large coverage are essential for capturing microseizures in epilepsy patients and may be beneficial for localizing epileptogenic tissue to plan surgery or target brain stimulation.
Adverse reactions to BNT162b2 mRNA COVID-19 vaccine in medical staffs with a history of allergy
Authors: Inoue Sumito , Igarashi Akira , Morikane Keita , Hachiya Osamu , Watanabe Masafumi , Kakehata Seiji , Sato Shinya , Ueno Yoshiyuki
Published: September 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) vaccination is progressing globally. Several adverse reactions have been reported with vaccination against COVID-19. It is unknown whether adverse reactions to COVID-19 vaccination are severe in individuals with allergies. We administered the COVID-19 vaccine to the medical staff at Yamagata University Hospital from March to August 2021. Subsequently, we conducted an online questionnaire-based survey to investigate the presence of allergy and adverse reactions after vaccination and examined the association between allergy and adverse reactions after immunization.

Responses were collected from 1586 subjects after the first vaccination and 1306 subjects after the second administration of the BNT162b2 mRNA COVID-19 vaccine. Adverse reactions included injection site pain, injection site swelling, fever, fatigue or malaise, headache, chills, nausea, muscle pain outside the injection site, and arthralgia. The frequency and severity of most adverse reactions were higher after the second vaccination compared to the first. The frequency of some adverse reactions and their severity were higher, and the duration of symptoms was longer in subjects with allergies than in subjects without allergies. Although several participants visited the emergency room for treatment after the first and second vaccinations, nobody was diagnosed with anaphylaxis.

Given the serious consequence of COVID-19 and the reported high efficacy of this vaccine against this disease, we conclude that vaccination of allergic individuals is generally recommended.
Selective ensemble methods for deep learning segmentation of major vessels in invasive coronary angiography
Authors: Park Jeeone , Kweon Jihoon , Bark Hyehyeon , Kim Young In , Back Inwook , Chae Jihye , Roh Jae-Hyung , Kang Do-Yoon , Lee Pil Hyung , Ahn Jung-Min , Kang Soo-Jin , Park Duk-Woo , Lee Seung-Whan , Lee Cheol Whan , Park Seong-Wook , Park Seung-Jung , Kim Young-Hak
Published: September 2021

Abstract

Invasive coronary angiography is a primary imaging modality that visualizes the lumen area of coronary arteries for the diagnosis of coronary artery diseases and guidance for interventional devices. In the current practice of quantitative coronary analysis (QCA), semi-automatic segmentation tools require labor-intensive and time-consuming manual correction; this limits their application in the catheterization room. For a more automated QCA, it is necessary to minimize operator intervention through robust segmentation methods with improved predictability. In this study, we introduced two selective ensemble methods that integrated the weighted ensemble approach with per-image quality estimation. In our selective ensemble methods, the segmentation outcomes from five base models with different loss functions were ranked by mask morphology or estimated dice similarity coefficient (DSC). The final output was determined by imposing different weights according to the ranking. The ranking criteria based on mask morphology were determined empirically to avoid frequent types of segmentation errors, whereas the estimation of DSCs was performed by comparing the pseudo-ground truth generated from a meta-learner. In the assessment with 7,426 frames from 2,924 patients, the selective ensemble methods improved segmentation performance with DSCs of up to 93.11% and provided a better delineation of lumen boundaries near the coronary lesion with local DSCs of up to 94.04%, outperforming all individual models and hard voting ensembles. The probability of mask disconnection at the most narrowed region could be minimized to <1%. The robustness of the proposed methods was evident in the external validation. Inference time for major vessel segmentation was approximately one-third, indicating that our selective ensemble methods may allow the real-time application of QCA-based diagnostic methods in routine clinical settings.
Relationships between barley consumption and gut microbiome characteristics in a healthy Japanese population: a cross-sectional study
Authors: Matsuoka Tsubasa , Hosomi Koji , Park Jonguk , Goto Yuka , Nishimura Mao , Nakashima Satoko , Murakami Haruka , Konishi Kana , Miyachi Motohiko , Kawashima Hitoshi , Mizuguchi Kenji , Kobayashi Toshiki , Yokomichi Hiroshi , Kunisawa Jun , Yamagata Zentaro
Published: September 2021

Objective

Barley contains abundant soluble β-glucan fibres, which have established health benefits. In addition, the health benefits conferred by the gut microbiota have attracted considerable interest. However, few studies have focused on the barley intake and microbiota of the Japanese population. In this study, we aimed to identify the relationship between the barley consumption and gut microbiota composition of the Japanese population.

Research Methods & Procedures

A total of 236 participants were recruited in Japan, and 94 participants with no complication of diabetes, hypertension, and dyslipidemia were selected for the study. We analysed faecal samples from the participants, their medical check-up results, and responses to questionnaires about dietary habits. The participants were grouped according to their median barley intake. Then, we assessed the relative abundance of 50 microbial genera throughout the group and selected 20 that differed at P < 0.1 (Mann–Whitney U-test). We also analysed the networks and clustering of the 20 selected genera.

Results

According to their relative abundance, Bifidobacterium, Anaerostipes, and Butyricicoccus were candidate characteristic microbiota of the group that consumed large amounts of barley (P < 0.05). Furthermore, network and cluster analyses revealed that barley directly correlated with Bifidobacterium and Butyricicoccus.

Conclusions

Barley consumption generates changes in the intestinal microbiota of the Japanese population. We found that Bifidobacterium, Anaerostipes, and Butyricicoccus abundance was positively associated with barley consumption. This study showed that barley is important for gut microbiota and relates to Japanese traditional food like natto.
SARS-CoV-2 anti-spike IgG antibody responses after second dose of ChAdOx1 or BNT162b2 and correlates of protection in the UK general population
Authors: Wei Jia , Pouwels Koen B. , Stoesser Nicole , Matthews Philippa C. , Diamond Ian , Studley Ruth , Rourke Emma , Cook Duncan , Bell John I , Newton John N , Farrar Jeremy , Howarth Alison , Marsden Brian D. , Hoosdally Sarah , Jones E Yvonne , Stuart David I , Crook Derrick W. , Peto Tim E. A. , Walker A. Sarah , Eyre David W. ,   COVID-19 Infection Survey team
Published: September 2021

We investigated anti-spike IgG antibody responses and correlates of protection following second doses of ChAdOx1 or BNT162b2 SARS-CoV-2 vaccines in the UK general population. In 222,493 individuals, we found significant boosting of anti-spike IgG by second doses of both vaccines in all ages and using different dosing intervals, including the 3-week interval for BNT162b2. After second vaccination, BNT162b2 generated higher peak levels than ChAdOX1. Older individuals and males had lower peak levels with BNT162b2 but not ChAdOx1, while declines were similar across ages and sexes with ChAdOX1 or BNT162b2. Prior infection significantly increased antibody peak level and half-life with both vaccines. Anti-spike IgG levels were associated with protection from infection after vaccination and, to an even greater degree, after prior infection. At least 67% protection against infection was estimated to last for 2-3 months after two ChAdOx1 doses and 5-8 months after two BNT162b2 doses in those without prior infection, and 1-2 years for those unvaccinated after natural infection. A third booster dose may be needed, prioritised to ChAdOx1 recipients and those more clinically vulnerable.
Potentially Inappropriate Medication Use and the Hospitalization Rate among Thai Elderly Patients: a Retrospective Cohort Study
Authors: Varavithya Vorawee , Tirapat Chayanee , Rojpibulstit Penpitcha , Poovichayasumlit Panadda , Prasert Vanida , Vatcharavongvan Pasitpon
Published: September 2021

Purpose

To examine the association between potentially inappropriate medications (PIMs) use and the hospitalization rate in elderly Thai patients.

Methods

In this retrospective cohort study, we collected the electronic medical data of elderly patients aged 60 years and older who visited the outpatient department (OPD) at Thammasat University Hospital in Thailand in 2015. The patients were categorized into PIM and non-PIM users according to the Beers 2019 criteria. We calculated descriptive statistics for demographic variables. We also examined the association between PIM use and various different factors with hospitalization rate during follow-up using log-binomial regression. We calculated the relative risk for association between PIM use and other factors with the hospitalization rate.

Results

We collected data for a total of 32,261 patients. The majority of participants were female (59.65%) and had a mean age of 70.21 years (SD=7.88). Overall, 63.98% of the patients (n=20,641) were PIM users and 49.45% (n=15,952) received polypharmacy (≥5 medications). The most common PIM prescription was proton-pump inhibitors, which were 27.51% of all medications prescribed. We found that PIM use increased the risk of hospitalization by 1.31 times (adjusted RR=1.31, 95% CI: 1.21 – 1.41, p-value < 0.001). Other factors associated with a higher rate of hospitalizations included older age, male gender, polypharmacy, and a higher number of OPD visits.

Conclusion

PIMs were commonly prescribed to the elderly in the OPD, and were significantly associated with subsequent hospitalization. The provision of an alternative drug list can help physicians avoid prescribing PIMs to the elderly. If PIMs prescription is unavoidable, physicians should closely monitor patients for drug-related problems and deprescribe PIMs when they are no longer indicated.
The Role of Physical Environmental Characteristics and Intellectual Disability in Conduct Problem Trajectories Across Childhood: A Population-Based Cohort Study
Authors: Baird Alister , Papachristou Efstathios , Hassiotis Angela , Flouri Eirini
Published: September 2021

Background

The paucity of research investigating the role of the physical environment in the developmental progression of conduct problems and the potential moderating effects of intellectual disability (ID) is surprising, given the clinical relevance of elucidating environmental determinants of disruptive behaviours.

Aims

To use data from a large UK cohort study to assess associations between physical environmental exposures, ID, and conduct problem trajectories.

Method

The sample included 8,168 Millennium Cohort Study children (1.9% with ID). Multilevel growth curve modelling was used to examine the role of physical environment characteristics in the developmental trajectories of conduct problems after adjustments for ID status.

Results

Exposure to external environmental domains was not associated with differences in children’s conduct problems across development. Alternatively, internal aspects of the household environment: spatial density (b = 0.40, p<.001) and damp problems (b = 0.14, p<.001) were both significantly associated with increased trajectories. Various individual and familial covariates were positively associated with conduct problems over time, including: presence of ID (b = 0.96, p<.001), autism spectrum disorder (b = 1.18, p<.001), male sex (b = 0.26, p<.001), poverty (b = 0.19, p<.001), maternal depression (b = 0.65, p<.001), and non-nuclear family structure (b = 0.35, p<.001). Positive ID status appeared to moderate the effects of internal household spatial density, reporting a non-linear negative association with spatial density and conduct problems across development (b = -1.08, p<.01).

Conclusions

Our findings highlight the potential harmful consequences of poor internal residential conditions on children’s development of disruptive behaviours.
How do we measure the adequacy of cancer pain management? Testing the performance of 4 commonly used measures and steps towards measurement refinement
Authors: Cabric Vanja , Harrison Rebecca , Gauthier Lynn R. , Graham Carol A , Gagliese Lucia
Published: September 2021

Although pain is the most common and disabling cancer symptom requiring management, the best index of cancer pain management adequacy is unknown. While the Pain Management Index is most commonly used, other indices have included relief, satisfaction, and pain intensity. We evaluated their correlations and agreement, compared their biopsychosocial correlates, and investigated whether they represented a single construct reflecting the adequacy of cancer pain management in 269 people with advanced cancer and pain. Despite moderate-to-severe average pain in 52.8% of participants, 85.1% had PMI scores suggesting adequate analgesia, pain relief was moderate and satisfaction was high. Correlations and agreement were low-to-moderate, suggesting low construct validity. Although the correlates of pain management adequacy were multidimensional, including lower pain interference, neuropathic and nociceptive pain, and catastrophizing, shorter cancer duration, and greater physical symptoms, no single index captured this multidimensionality. Principal component analysis demonstrated a single underlying construct, thus we constructed the Adequacy of Cancer Pain Management from factor loadings. It had somewhat better agreement, however correlates were limited to pain interference and neuropathic pain. This study demonstrates the psychometric shortcomings of commonly used indices. We provide suggestions for future research to improve measurement, a critical step in optimizing cancer pain management.

Perspective

The Pain Management Index and other commonly used indices of cancer pain management adequacy have poor construct validity. This study provides suggestions to improve the measurement of the adequacy of cancer pain management.
A linked mixture model of coronary atherosclerosis
Authors: Beheim Bret
Published: September 2021

Background & Objectives

Characterizing the progression of coronary atherosclerosis is a critical public health goal. The most common quantitative summary, the CAC score, is modelled by a variety of statistical methods, both as a predictor of coronary events and as an outcome of behavioral and population-specific risk factors. Little attempt has been made, however, to ground these statistical models in the underlying physiology of arterial aging, which would allow us to describe the onset and growth of CAC over a patient's life.

Methods

Using a generative growth model for arterial plaque accumulation, we identify severe under-estimation in the age of initial onset and rate of progression (doubling time) of CAC growth with standard ln(CAC + 1) or ln(CAC | CAC > 0) models, and use this growth model to motivate new statistical approaches to CAC using logistic and log-linear mixture regressions. We compare statistical models directly by computing their average parameter biases using 540 growth trajectory simulations (113,760 patients, 268,200 observations).

Results

While all models used can successfully estimate the influence of risk factors with minimal bias, we demonstrate substantial improvements in predictive accuracy in the timing of CAC onset and progression with logistic regression and linked hurdle-lognormal mixture regression, compared with standard ln(CAC + 1) or ln(CAC | CAC > 0) models.

Conclusions

Using models that can account for patient-specific onset and progression rates, accurate descriptions of CAC trajectories can be made even in cross-sectional (single scan per patient) designs, with substantial clinical and epidemiological utility.