bluuebunny/crossref_metadata_2025 huggingface dataset:
Scrotal meconium pseudocysts: meconium periorchitis as a rare cause of postnatal acute scrotum
Authors: Marzocchi Guido , Lassandro Giulia , Picchi Stefano Giusto , Monteduro Francesco
Published: June 2021

A 10-day-old newborn was taken to the paediatric emergency room due to scrotal swelling. Physical examination showed scrotal enlargement and palpable intrascrotal hard formations. Laboratory blood tests revealed no significant alterations. Testicular ultrasonography showed thickened and hypoechoic scrotal walls and bilateral intrascrotal isoechoic nodules with small internal calcifications. An abdominal X-ray confirmed evidence of bilateral scrotal microcalcifications and small calcifications in the left hypochondrium. Urgent laparotomy performed for scrotal exploration verified the presence of nodular formations on the vaginal tunic of both testicles; the nodules were removed. Bilateral orchidopexy was performed in the same surgical session. When dealing with an acute scrotum in a newborn both emergency radiologists and clinicians should consider the possibility of scrotal meconium pseudocyst as a rare but possible cause of periorchitis.
Prognostic ability of STarT Back Screening Tool combined with work-related factors in patients with low back pain in primary care: a prospective study
Authors: Unsgaard-Tøndel Monica , Vasseljen Ottar , Nilsen Tom Ivar Lund , Myhre Gard , Robinson Hilde Stendal , Meisingset Ingebrigt
Published: June 2021

Objective

Primary care screening tools for patients with low back pain may improve outcome by identifying modifiable obstacles for recovery. The STarT Back Screening Tool (SBST) consists of nine biological and psychological items, with less focus on work-related factors. We aimed at testing the prognostic ability of SBST and the effect of adding items for future and present work ability.

Methods

Prospective observational study in patients (n=158) attending primary care physical therapy for low back pain. The prognostic ability of SBST and the added prognostic value of two work items; expectation for future work ability and current work ability, were calculated for disability, pain and quality of life outcome at 3 months follow-up. The medium and high-risk group in the SBST were collapsed in the analyses due to few patients in the high-risk group. The prognostic ability was assessed using the explained variance (R2) of the outcomes from univariable and multivariable linear regression and beta values with 95% CIs were used to assess the prognostic value of individual items.

Results

The SBST classified 107 (67.7%) patients as low risk and 51 (32.3%) patients as medium/high risk. SBST provided prognostic ability for disability (R2=0.35), pain (R2=0.25) and quality of life (R2=0.28). Expectation for return to work predicted outcome in univariable analyses but provided limited additional prognostic ability when added to the SBST. Present work ability provided additional prognostic ability for disability (β=−2.5; 95% CI=−3.6 to −1.4), pain (β=−0.2; 95% CI=−0.5 to −0.002) and quality of life (β=0.02; 95% CI=0.001 to 0.04) in the multivariable analyses. The explained variance (R2) when work ability was added to the SBST was 0.60, 0.49 and 0.47 for disability, pain and quality of life, respectively.

Conclusions

Adding one work ability item to the SBST gives additional prognostic information across core outcomes.

Clinical trial number:NCT03626389
Cohort profile: indigenous human papillomavirus and oropharyngeal squamous cell carcinoma study - a prospective longitudinal cohort
Authors: Jamieson Lisa M , Garvey Gail , Hedges Joanne , Leane Cathy , Hill Isaac , Brown Alex , Ju Xiangqun , Sethi Sneha , Roder David , Logan Richard M , Johnson Newell , Smith Megan , Antonsson Annika , Canfell Karen
Published: June 2021

Purpose

Our aims are to: (1) estimate prevalence, incidence, clearance and persistence of oral human papillomavirus (HPV) infection among Indigenous Australians; (2) identify risk factors associated with oropharyngeal squamous cell carcinoma (OPSCC)-related HPV types (HPV 16 or 18); (3) develop HPV-related health state valuations and; (4) determine the impact on OPSCC and cervical cancers, and the cost-effectiveness of extending publicly-funded HPV vaccination among Indigenous Australians.

Participants

Participants were recruited from February 2018 to January 2019. Twelve-month follow-up occurred from March 2019 to March 2020. Participants provided socio-demographic characteristics, health-related behaviours including tobacco and alcohol use and sexual history. Health state preferences in regard to HPV vaccination, knowledge regarding HPV infection, OPSCC and cervical cancer were collected using a two-stage standard gamble approach. Participants provided saliva samples and DNA for microbial genotyping was extracted.

Findings to date

Of the 910 participants who were positive for β-globin at baseline, 35% had any oral HPV infection. The most prevalent HPV types were 13 or 32 (Heck’s disease; 23%). The second most prevalent types were associated with OPSCC (HPV 16 or 18; 3.3%). Of the 645 participants who were positive for β-globin at 12-month follow-up, 43% had any HPV infection. Of these, 33% were HPV types 13 or 32 and 2.5% were HPV 16 or 18. Some 588 participants had β-globin positive oral samples at baseline and 12-month follow-up. The prevalence of any oral HPV infection increased from 34% at baseline to 44% at 12-month follow-up; due to increases in HPV types 13 or 32 (20% at baseline and 34% at 12-month follow-up).

Future plans

Further funding will be sought to continue follow-up of this cohort, and to include (after a full medical history) a thorough clinical examination of the external head and neck; a complete oral examination and examination of the oropharynx. Blood tests for early stage OPSCC will also be undertaken.
Development and clinical implementation of a structured, simulation-based training programme in laparoscopic appendectomy: description, validation and evaluation
Authors: Skjold-Odegaard Benedicte , Ersdal Hege Langli , Assmus Jörg , Nedrebo Bjorn Steinar Olden , Sjo Ole , Soreide Kjetil
Published: June 2021

Background

Laparoscopic appendectomy is a common procedure in general surgery but is likely underused in structured and real-life teaching. This study describes the development, validation and evaluation of implementing a structured training programme for laparoscopic appendectomy.

Study design

A structured curriculum and simulation-based programme for trainees and trainers was developed. All general surgery trainees and trainers were involved in laparoscopic appendectomies. All trainees and trainers underwent the structured preprocedure training programme before real-life surgery evaluation. A standardised form evaluated eight technical steps (skills) of the procedure as well as an overall assessment, and nine elements of communication (feedback), and was used for bilateral evaluation by each trainee and trainer. A consecutive, observational cohort over a 12-month period was used to gauge real-life implementation.

Results

During 277 eligible real-life appendectomies, structured evaluation was performed in 173 (62%) laparoscopic appendectomies, for which 165 forms were completed by 19 trainees. Construct validity was found satisfactory. Inter-rater reliability demonstrated good correlation between trainee and trainer. The trainees’ and trainers’ stepwise and overall assessments of technical skills had an overall good reliability (intraclass correlation coefficient of 0.88). The vast majority (92.2%) of the trainees either agreed or strongly agreed that the training met their expectations.

Conclusion

Structured training for general surgery residents can be implemented for laparoscopic appendectomy. Skills assessment by trainees and trainers indicated reliable self-assessment. Overall, the trainees were satisfied with the training, including the feedback from the trainers.
Does simulation training in final year make new graduates feel more prepared for the realities of professional practice?
Authors: Carpenter Ciara , Keegan Tom , Vince Gill , Brewster Liz
Published: June 2021

Introduction

The transition from medical student to doctor has long been a source of concern, with widespread reporting of new graduates’ lack of preparedness for medical practice. Simulation has been suggested as a way to improve preparedness, particularly due to the difficulties in allowing full autonomy for patient care for undergraduate medical students. Few studies look at simulation alone for this purpose, and no studies have compared different simulation formats to assess their impact on preparedness.

Methods

This mixed-method study looked at two different simulation courses in two UK universities. Data were collected in two phases: immediately after the simulation and 3–4 months into the same students’ postgraduate training. Questionnaires provided quantitative data measuring preparedness and interviews provided a more in-depth analysis of experiential learning across final year and how this contributed to preparedness.

Results

There were no significant differences between the two courses for overall preparedness, stress or views on simulation, and no significant differences in opinions longitudinally. Although the study initially set out to look at simulation alone, emergent qualitative findings emphasised experiential learning as key in both clinical and simulated settings. This inter-relationship between simulation and the student assistantship prepared students for practice. Longitudinally, the emphasis on experiential learning in simulation was maintained and participants demonstrated using skills they had practised in simulation in their daily practice as doctors. Nevertheless, there was evidence that although students felt prepared, they were still scared about facing certain scenarios as foundation doctors.

Discussion

The results of this study suggest that simulation may positively affect students’ preparedness for practice as doctors. Simulation will never be a replacement for real clinical experience. However, when used prior to and alongside clinical experience, it may have positive effects on new doctors’ confidence and competence, and, therefore, positively impact patient care.
Cumulative burden of clinically significant aortic stenosis in community-dwelling older adults
Authors: Owens David S , Bartz Traci M , Buzkova Petra , Massera Daniele , Biggs Mary L , Carlson Selma D , Psaty Bruce M , Sotoodehnia Nona , Gottdiener John S , Kizer Jorge R
Published: June 2021

Objectives

Current estimates of aortic stenosis (AS) frequency have mostly relied on cross-sectional echocardiographic or longitudinal administrative data, making understanding of AS burden incomplete. We performed case adjudications to evaluate the frequency of AS and assess differences by age, sex and race in an older cohort with long-term follow-up.

Methods

We developed case-capture methods using study echocardiograms, procedure and diagnosis codes, heart failure events and deaths for targeted review of medical records in the Cardiovascular Health Study to identify moderate or severe AS and related procedures or hospitalisations. The primary outcome was clinically significant AS (severe AS or procedure). Assessment of incident AS burden was based on subdistribution survival methods, while associations with age, sex and race relied on cause-specific survival methods.

Results

The cohort comprised 5795 participants (age 73±6, 42.2% male, 14.3% Black). Cumulative frequency of clinically significant AS at maximal 25-year follow-up was 3.69% (probable/definite) to 4.67% (possible/probable/definite), while the corresponding 20-year cumulative incidence was 2.88% to 3.71%. Of incident cases, about 85% had a hospitalisation for severe AS, but roughly half did not undergo valve intervention. The adjusted incidence of clinically significant AS was higher in men (HR 1.62 [95% CI 1.21 to 2.17]) and increased with age (HR 1.08 [95% CI 1.04 to 1.11]), but was lower in Blacks (HR 0.43 [95% CI 0.23 to 0.81]).

Conclusions

In this community-based study, we identified a higher burden of clinically significant AS than reported previously, with differences by age, sex and race. These findings have important implications for public health resource planning, although the lower burden in Blacks merits further study.
Increased FNDC5/IRISIN protein expression in breast cancer tissue is associated with obesity in postmenopausal women
Authors: Tejeda María Elena , Canto Patricia , Tenorio-Torres Alberto , Orozco-Arguelles Letica , Coral-Vázquez Ramón Mauricio , Zentella-Dehesa Alejandro , Leal-García Marcela , Vega-García Claudia Cecilia , Bautista-Piña Verónica , Méndez Juan Pablo
Published: June 2021

Aim

To analyse the fibronectin type III domain containing 5 (FNDC5)/irisin expression in tumour tissue of postmenopausal women presenting breast cancer and different body mass indexes (BMIs), proposing that obesity deregulates the expression of FNDC5/irisin at the breast tumour level. In addition, we investigated if different breast cancer cell lines are capable to synthesise this protein.

Methods

A total of 150 postmenopausal women (50 with a normal BMI, 50 presenting overweight and 50 having obesity) diagnosed with operable breast cancer were included. FNDC5/irisin expression was determined by immunohistochemistry or by immunocytochemistry. Qualitative analysis of protein expression was performed by the H-Score method, through ImageJ’s IHC Profiler software. Statistical analyses were carried out using STATA V.14.0 (Texas, USA); p value<0.05 was accepted as statistically significant. Statistical power of the study was >80% with a p<0.05.

Results

FNDC5/irisin expression in breast cancer tissue of postmenopausal women with obesity was significantly increased when compared with FNDC5/irisin expression in women with a normal BMI (p=0.001). Furthermore, three breast cancer cell lines studied were capable to synthesise and express FNDC5/irisin, being the BT-474 cell line the one that exhibited the highest intensity of expression.

Conclusions

Our results confirm that women with breast cancer and obesity exhibit an increased irisin expression in their tumorous tissue compared with women with breast cancer and normal BMI. Likewise, in vitro breast cancer cell lines have the capacity to synthesise and express FNDC5/irisin, without any extracellular stimuli, however the microenvironment surrounding these cells in vivo participates in its regulation.
Abnormal umbilical cord insertions in singleton deliveries: placental histology and neonatal outcomes
Authors: Visentin Sivlia , Londero Ambrogio P , Santoro Luisa , Pizzi Sara , Andolfatto Matteo , Venturini Maria , Saraggi Deborah , Coati Irene , Sacchi Diana , Rugge Massimo , Cosmi Erich
Published: June 2021

Aims

This study aimed to identify any microscopic features associated with abnormal (membranous/velamentous or marginal) placental cord insertions and to analyse their adverse neonatal outcomes.

Methods

We retrospectively analysed the records—including pathological findings, clinical information and pregnancy outcomes—for 1060 singleton pregnancies, involving newborn delivered after 24 weeks of gestation.

Results

Marginal cord insertions were identified in 26.60% of cases and membranous cord insertions in 2.64%. Subchorionic vessel thrombus was more prevalent in marginal or membranous insertions (0.97%) than in normal cord insertions (0.27%) (p=0.129). Intervillous thrombi (13.73% vs 8.41%, p<0.05) and chorioamnionitis (8.53% vs 5.48%, p=0.089) were more prevalent in normal cord insertions. Premature rupture of membranes was significantly more commonly associated with abnormal (marginal 15.25% and membranous 17.86%) than with normal (9.87%) insertions (p<0.05). Pre-eclampsia was more common in the group with membranous cord insertions (7.14%) than in the other groups (marginal 0.35%; normal 0.80%) (p<0.05). Marginal and membranous placental cord insertions were associated with earlier gestational age at delivery and smaller fetuses than in the group with normal insertions. Intrauterine fetal demise, cardiac malformations and pregestational diabetes were also more common among cases of abnormal cord insertions.

Conclusions

Subchorionic vessel thrombus and adverse pregnancy-related outcomes were more prevalent in cases of marginal/membranous cord insertion than for normal insertions.
Protective effect of Shenfu on gut epithelium in a porcine model of hemorrhagic shock
Authors: Liang Yong , Li Chunsheng , Yuan Wei , Wu Junyuan , Zhang Qiang , Zhang Mingqing , Qin Hongjie , Li Zexuan
Published: June 2021

This study aimed to explore the protective effect of Shenfu on the hemodynamics and gut integrity in a porcine model of hemorrhagic shock. Hemorrhagic shock was induced in 32 domestic pigs with a rapid bleeding via the arterial sheath to a mean arterial pressure of 40 mm Hg within 10 min. Animals with hemorrhagic shock were then randomly assigned into the negative control group (n=8), receiving neither blood transfusion nor drug treatment; the blood transfusion group, in which animals were given blood transfusion alone; the saline group, in which animals were blood transfused and resuscitated with saline (3 mL/kg); and the Shenfu group, in which animals received blood transfusion and resuscitation with Shenfu (3 mL/kg). Blood tumor necrosis factor-alpha (TNF-α) and interleukin-6 were measured using ELISAs. Tissue levels of superoxide dismutase (SOD), malondialdehyde (MDA), Na+/K+-ATPase, Ca++ATPase, myeloperoxidase (MPO), and fatty acid binding protein 2 (FABP2) were determined using respective quantitation kits. Fluid resuscitation with Shenfu significantly improved HR, CI, and MAP of pig with hemorrhagic shock, which was accompanied with mitigation of tissue damages in intestinal epithelium. Blood TNF-α was reduced in the Shenfu group. Bcl-2 and cleaved caspase-3 expression in intestinal tissues were elevated and decreased, respectively, in pigs treated with Shenfu. Notably, treatment with Shenfu suppressed oxidative stress markers MDA, MPO, and FABP2 in the intestine. Oppositely, SOD, Na+/K+-ATPase and Ca++ATPase levels in intestinal tissues were promoted by Shenfu treatment. Shenfu demonstrates significant protective effect on the hemodynamics and gut epithelium of pigs with hemorrhagic shock.
Targeting cancer testis antigens in synovial sarcoma
Authors: Mitchell Geoffrey , Pollack Seth M , Wagner Michael J
Published: June 2021

Synovial sarcoma (SS) is a rare cancer that disproportionately affects children and young adults. Cancer testis antigens (CTAs) are proteins that are expressed early in embryonic development, but generally not expressed in normal tissue. They are aberrantly expressed in many different cancer types and are an attractive therapeutic target for immunotherapies. CTAs are expressed at high levels in SS. This high level of CTA expression makes SS an ideal cancer for treatment strategies aimed at harnessing the immune system to recognize aberrant CTA expression and fight against the cancer. Pivotal clinical trials are now underway, with the potential to dramatically alter the landscape of SS management and treatment from current standards of care. In this review, we describe the rationale for targeting CTAs in SS with a focus on NY-ESO-1 and MAGE-A4, the current state of vaccine and T-cell receptor-based therapies, and consider emerging opportunities for future development.
Deep immune profiling reveals targetable mechanisms of immune evasion in immune checkpoint inhibitor-refractory glioblastoma
Authors: Simonds Erin F , Lu Edbert D , Badillo Oscar , Karimi Shokoufeh , Liu Eric V , Tamaki Whitney , Rancan Chiara , Downey Kira M , Stultz Jacob , Sinha Meenal , McHenry Lauren K , Nasholm Nicole M , Chuntova Pavlina , Sundström Anders , Genoud Vassilis , Shahani Shilpa A , Wang Leo D , Brown Christine E , Walker Paul R , Swartling Fredrik J , Fong Lawrence , Okada Hideho , Weiss William A , Hellström Mats
Published: June 2021

Background

Glioblastoma (GBM) is refractory to immune checkpoint inhibitor (ICI) therapy. We sought to determine to what extent this immune evasion is due to intrinsic properties of the tumor cells versus the specialized immune context of the brain, and if it can be reversed.

Methods

We used CyTOF mass cytometry to compare the tumor immune microenvironments (TIME) of human tumors that are generally ICI-refractory (GBM and sarcoma) or ICI-responsive (renal cell carcinoma), as well as mouse models of GBM that are ICI-responsive (GL261) or ICI-refractory (SB28). We further compared SB28 tumors grown intracerebrally versus subcutaneously to determine how tumor site affects TIME and responsiveness to dual CTLA-4/PD-1 blockade. Informed by these data, we explored rational immunotherapeutic combinations.

Results

ICI-sensitivity in human and mouse tumors was associated with increased T cells and dendritic cells (DCs), and fewer myeloid cells, in particular PD-L1+ tumor-associated macrophages. The SB28 mouse model of GBM responded to ICI when grown subcutaneously but not intracerebrally, providing a system to explore mechanisms underlying ICI resistance in GBM. The response to ICI in the subcutaneous SB28 model required CD4 T cells and NK cells, but not CD8 T cells. Recombinant FLT3L expanded DCs, improved antigen-specific T cell priming, and prolonged survival of mice with intracerebral SB28 tumors, but at the cost of increased Tregs. Targeting PD-L1 also prolonged survival, especially when combined with stereotactic radiation.

Conclusions

Our data suggest that a major obstacle for effective immunotherapy of GBM is poor antigen presentation in the brain, rather than intrinsic immunosuppressive properties of GBM tumor cells. Deep immune profiling identified DCs and PD-L1+ tumor-associated macrophages as promising targetable cell populations, which was confirmed using therapeutic interventions in vivo.
Global effect of COVID-19 pandemic on the rate of acute coronary syndrome admissions: a comprehensive review of published literature
Authors: Helal Ayman , Shahin Lamis , Abdelsalam Mahmoud , Ibrahim Mokhtar
Published: June 2021

Background

The COVID-19 pandemic has disrupted healthcare systems across the world. The rate of acute coronary syndrome (ACS) admissions during the pandemic has varied significantly.

Objectives

The purpose of this study is to investigate the effect of the pandemic on ACS hospital admissions and to determine whether this is related to the number of COVID-19 cases in each country.

Method

Search engines including PubMed, Embase, Ovid and Google Scholar were searched from December 2019 to the 15 September 2020 to identify studies reporting ACS admission data during COVID-19 pandemic months in 2020 compared with 2019 admissions.

Results

A total of 40 studies were included in this multistudy analysis. They demonstrated a 28.1% reduction in the rate of admission with ACS during the COVID-19 pandemic period compared with the same period in 2019 (total of 28 613 patients in 2020 vs 39 225 in 2019). There was a significant correlation between the absolute risk reduction in the total number of ACS cases and the number of COVID-19 cases per 100 000 population (Pearson correlation=0.361 (p=0.028)). However, the correlation was not significant for each of the ACS subgroups: non-ST-elevation myocardial infarction (STEMI) (p=0.508), STEMI (p=0883) and unstable angina (p=0.175).

Conclusion

There was a significant reduction in the rate of ACS admission during the COVID-19 pandemic period compared with the same period in 2019 with a significant correlation with COVID-19 prevalence.
Concise genetic profile of lung carcinoma
Authors: Umakanthan Srikanth , Bukelo Maryann M
Published: June 2021

The WHO classification of lung cancer (2015) is based on immunohistochemistry and molecular evaluation. This also includes microscopic analysis of morphological patterns that aids in the pathological diagnosis and classification of lung cancers. Lung cancers are the leading cause of cancer deaths worldwide. Recent advancements in identifying the etiopathogenesis are majorly driven by gene mutation studies. This has been explained by The Cancer Genome Atlas, next-generation sequencer and TRAcking non-small cell lung cancer evolution through therapy [Rx]. This article reviews the genetic profile of adenocarcinoma, squamous cell carcinoma, small cell carcinoma, large cell neuroendocrine carcinoma and pulmonary carcinoids. This includes the prolific genetic alterations and novel molecular changes seen in these tumours. In addition, target- specific drugs that have shown promising effects in clinical use and trials are also briefly discussed.
Gender bias in reference letters for residency and academic medicine: a systematic review
Authors: Khan Shawn , Kirubarajan Abirami , Shamsheri Tahmina , Clayton Adam , Mehta Geeta
Published: June 2021

Reference letters play an important role for both postgraduate residency applications and medical faculty hiring processes. This study seeks to characterise the ways in which gender bias may manifest in the language of reference letters in academic medicine. In particular, we conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched Embase, MEDLINE and PsycINFO from database inception to July 2020 for original studies that assessed gendered language in medical reference letters for residency applications and medical faculty hiring. A total of 16 studies, involving 12 738 letters of recommendation written for 7074 applicants, were included. A total of 32% of applicants were women. There were significant differences in how women were described in reference letters. A total of 64% (7/11) studies found a significant difference in gendered adjectives between men and women. Among the 7 studies, a total of 86% (6/7) noted that women applicants were more likely to be described using communal adjectives, such as “delightful” or “compassionate”, while men applicants were more likely to be described using agentic adjectives, such as “leader” or “exceptional”. Several studies noted that reference letters for women applicants had more frequent use of doubt raisers and mentions of applicant personal life and/or physical appearance. Only one study assessed the outcome of gendered language on application success, noting a higher residency match rate for men applicants. Reference letters within medicine and medical education exhibit language discrepancies between men and women applicants, which may contribute to gender bias against women in medicine.
Effects of angiotensin receptor neprilysin inhibitor on renal function in patients with heart failure: a systematic review and meta-analysis
Authors: Shi Yuwu , Wang Yiwen , Chen Junhong , Lu Chi , Xuan Haochen , Wang Chaofan , Li Dongye , Xu Tongda
Published: June 2021

The angiotensin receptor neprilysin inhibitor (ARNI) has been recommended as a first-line treatment in patients with heart failure (HF). However, the effects of ARNI on renal function remain controversial.

The PubMed, Embase, the Cochrane Library of Trials and Web of Science were searched in the period from inception to 31 January 2021. Randomised controlled trial, cohort studies and observational studies reporting at least one of renal function indicators were included.

In patients with HF with reduced ejection fraction (HFrEF), ARNI did not lead to a significant decrease in estimated glomerular filtration rate (eGFR, p=0.87), and the risk of worsening renal function (WRF) dropped by 11% compared with control group. Though the level of serum creatinine (SCr) and serum potassium had a slight increase (p=0.01; p=0.02), in contrast to the baseline level, but without clinical significance. In patients with HF with preserved ejection fraction (HFpEF), the level of SCr and serum potassium did not have a significant change, and patients with HFpEF assigned to ARNI had a much lower rate of WRF (p=0.0007). In contrast to control group, both patients with HFrEF and HFpEF had a less decrease in eGFR and a lower rate of hyperkalaemia in ARNI group.

ARNI did not lead to a significant decrease in eGFR in HFrEF. Compared with control group, ARNI could delay the progression of decrease in eGFR and result in less events of hyperkalaemia in patients with HF. Besides, patients with HFpEF had a lower rate in the events of WRF.
Primary care-based smoking cessation treatment and subsequent healthcare service utilisation: a matched cohort study of smokers using linked administrative healthcare data
Authors: Baliunas Dolly , Selby Peter , de Oliveira Claire , Kurdyak Paul , Rosella Laura , Zawertailo Laurie , Fu Longdi , Sutradhar Rinku
Published: June 2021

Background

No research has assessed the individual-level impact of smoking cessation treatment delivered within a general primary care patient population on multiple forms of subsequent healthcare service use.

Objective

We aimed to compare the rate of outpatient visits, emergency department (ED) visits and hospitalisations during a 5-year follow-up period among smokers who had and had not accessed a smoking cessation treatment programme.

Methods

The study was a retrospective matched cohort study using linked demographic and administrative healthcare databases in Ontario, Canada. 9951 patients who accessed smoking cessation services between July 2011 and December 2012 were matched to a smoker who did not access services, obtained from the Canadian Community Health Survey, using a combination of hard matching and propensity score matching. Outcomes were rates of healthcare service use from index date (programme enrolment or survey response) to March 2017.

Results

After controlling for potential confounders, patients in the overall treatment cohort had modestly greater rates of the outcomes: outpatient visits (rate ratio (RR) 1.10, 95% CI: 1.06 to 1.14), ED visits (RR 1.08, 95% CI: 1.03 to 1.13) and hospitalisations (RR 1.09, 95% CI: 1.02 to 1.18). Effect modification of the association between smoking cessation treatment and healthcare service use by prevalent comorbidity was found for outpatient visits (p=0.006), and hospitalisations (p=0.050), but not ED visits.

Conclusions

Patients who enrolled in smoking cessation treatment offered through primary care clinics in Ontario displayed a modest but significantly greater rate of outpatient visits, ED visits and hospitalisations over a 5-year follow-up period.
Interannual variability in life-stage specific survival and life history diversity of coho salmon in a coastal Oregon basin
Authors: Jones Kim K. , Cornwell Trevan J. , Bottom Daniel L. , Stein Staci , Starcevich Steven
Published: June 2021

We quantified the population dynamics and life history diversity of seven brood years of coho salmon (Oncorhynchus kisutch) using a life-cycle approach. Four life history patterns, composed of fry, fry–nomad, parr, and yearling migrants indicated the importance of connectivity and access to a full range of freshwater and estuarine rearing environments through the year. Survival of each life history type varied annually with the yearling migrants contributing an average of 70% to the spawners in all but one return year. Fifty-eight percent of the spawners of the 2013 return year had an estuarine rearing strategy, primarily parr migrants that overwintered in the estuary. Fry migrants, thought to be surplus production, were consistently observed in the estuary and represented in the returning spawners. The annual contribution of alternative rearing strategies to the spawners may support the resilience and viability of the population. We recommend that life cycle models of coho salmon account for the contribution of estuary migrants to the productivity and persistence of coho salmon in support of management and restoration of populations.
Investing in a better future: higher education and post-COVID Canada
Authors: Brennan Jennifer , Deer Frank , Trilokekar Roopa Desai , Findlay Leonard , Foster Karen , Laforest Guy , Wheelahan Leesa , Wright Julia M.
Published: June 2021

Post-secondary education (PSE) is a vital part of civil society and any modern economy. When broadly accessible, it can enable socioeconomic mobility, improve health outcomes, advance social cohesion, and support a highly skilled workforce. It yields public benefits not only in improved well-being and economic prosperity, but also in reduced costs in health care and social services. Canada also relies heavily on the PSE sector for research. During the COVID-19 pandemic, PSE has supported research related to the pandemic response and other critical areas, including providing expert advice to support public health and government decision-making, while maintaining educational programs and continuing to contribute to local and regional economies. But the pandemic effort has stretched already strained PSE resources and people even further: for decades, declining public investment has driven increases in tuition and decreases in faculty complement, undermining Canada’s research capacity and increasing student debt as well as destabilizing the sector through a growing reliance on volatile international education markets. Given the challenges before us, including climate change, reconciliation, and the pandemic, it is imperative that we better draw on the full range of experience, knowledge, and creativity in Canada and beyond through an inclusive, stable, and globally engaged PSE. Supporting PSE’s recovery will be key to Canada’s ongoing pandemic response and recovery. The recommendations in this report are guided by a single goal—to make the post-secondary sector a more effective partner and support in building a more equitable, sustainable, and evidence-driven future for Canada, through and beyond the COVID-19 pandemic.
Effect of freeze–thaw cycles on soil physicochemical properties and fractions of Pb and Cr in the northeastern Qinghai–Tibet Plateau
Authors: Li Leiming , Wu Jun , Lu Jian , Min Xiuyun
Published: June 2021

Simulation experiments were conducted using soils in the northeastern Qinghai–Tibet Plateau to explore the effects of freeze–thaw cycles on soil physicochemical properties, Pb and Cr distribution, and fraction transformation. Soils were incubated at −15°C for 24 h and at 5°C for 24 h to complete a freeze–thaw cycle. The soil physicochemical properties and fractions of Pb and Cr were analyzed after serial freeze–thaw treatments. The results showed that different freeze–thaw cycles and water content affected soil physicochemical properties and fractions of Pb and Cr to some extent. The cation exchange capacity increased significantly in agricultural and pastoral soils after five freeze–thaw cycles. The sand proportion of soil in an urban area decreased at 60 cycles. Freeze–thaw cycles did not change the functional groups and mineral constituents of the soils. The infrared peaks of soils with different freeze–thaw conditions were very similar. The freeze–thaw treatment influenced the mobility, chemical fractions of Pb and ecological risk in most of the soils. The exchangeable Pb in agricultural and pastoral areas increased from 0.19 to 1.52/0.90% after 5/10 freeze–thaw cycles with 60% water content. The ecological values of Pb in urban soil were 8.32/7.38% higher at 10/15 freeze–thaw cycles compared with the control treatment. Hence, these findings provide useful information on physicochemical properties and fraction transformation of Pb and Cr in soils undergoing freeze–thaw cycles, and offer an additional insight on Pb and Cr behaviors in cold and freezing environments.

Thematic collection:
This article is part of the Hydrochemistry related to exploration and environmental issues collection available at:
https://www.lyellcollection.org/cc/hydrochemistry-related-to-exploration-and-environmental-issues
Federated Learning in a Medical Context: A Systematic Literature Review
Authors: Pfitzner Bjarne , Steckhan Nico , Arnrich Bert
Published: June 2021

Data privacy is a very important issue. Especially in fields like medicine, it is paramount to abide by the existing privacy regulations to preserve patients’ anonymity. However, data is required for research and training machine learning models that could help gain insight into complex correlations or personalised treatments that may otherwise stay undiscovered. Those models generally scale with the amount of data available, but the current situation often prohibits building large databases across sites. So it would be beneficial to be able to combine similar or related data from different sites all over the world while still preserving data privacy. Federated learning has been proposed as a solution for this, because it relies on the sharing of machine learning models, instead of the raw data itself. That means private data never leaves the site or device it was collected on. Federated learning is an emerging research area, and many domains have been identified for the application of those methods. This systematic literature review provides an extensive look at the concept of and research into federated learning and its applicability for confidential healthcare datasets.
A Novel Cloud-Assisted Secure Deep Feature Classification Framework for Cancer Histopathology Images
Authors: Kumar Abhinav , Singh Sanjay Kumar , Lakshmanan K , Saxena Sonal , Shrivastava Sameer
Published: June 2021

The advancements in the Internet of Things (IoT) and cloud services have enabled the availability of smart e-healthcare services in a distant and distributed environment. However, this has also raised major privacy and efficiency concerns that need to be addressed. While sharing clinical data across the cloud that often consists of sensitive patient-related information, privacy is a major challenge. Adequate protection of patients’ privacy helps to increase public trust in medical research. Additionally, DL-based models are complex, and in a cloud-based approach, efficient data processing in such models is complicated. To address these challenges, we propose an efficient and secure cancer diagnostic framework for histopathological image classification by utilizing both differential privacy and secure multi-party computation. For efficient computation, instead of performing the whole operation on the cloud, we decouple the layers into two modules: one for feature extraction using the VGGNetmodule at the user side and the remaining layers for private prediction over the cloud. The efficacy of the framework is validated on two datasets composed of histopathological images of the canine mammary tumor and human breast cancer. The application of differential privacy preserving to the proposed model makes the model secure and capable of preserving the privacy of sensitive data from any adversary, without significantly compromising the model accuracy. Extensive experiments show that the proposed model efficiently achieves the trade-off between privacy and model performance.
Graph Convolutional Network-based Model for Incident-related Congestion Prediction: A Case Study of Shanghai Expressways
Authors: Wang Xi , Chai Yibo , Li Hui , Wang Wenbin , Sun Weishan
Published: June 2021

Traffic congestion has become a significant obstacle to the development of mega cities in China. Although local governments have used many resources in constructing road infrastructure, it is still insufficient for the increasing traffic demands. As a first step toward optimizing real-time traffic control, this study uses Shanghai Expressways as a case study to predict incident-related congestions. Our study proposes a graph convolutional network-based model to identify correlations in multi-dimensional sensor-detected data, while simultaneously taking into account environmental, spatiotemporal, and network features in predicting traffic conditions immediately after a traffic incident. The average accuracy, average AUC, and average F-1 score of the predictive model are 92.78%, 95.98%, and 88.78%, respectively, on small-scale ground-truth data. Furthermore, we improve the predictive model’s performance using semi-supervised learning by including more unlabeled data instances. As a result, the accuracy, AUC, and F-1 score of the model increase by 2.69%, 1.25%, and 4.72%, respectively. The findings of this article have important implications that can be used to improve the management and development of Expressways in Shanghai, as well as other metropolitan areas in China.
Greenhouse Gas Emissions from Air Conditioning and Refrigeration Service Expansion in Developing Countries
Authors: Dong Yabin , Coleman Marney , Miller Shelie A.
Published: June 2021

Air conditioning and refrigeration services are increasing rapidly in developing countries due to improved living standards. The cooling services industry is currently responsible for over 10% of global greenhouse gas (GHG) emissions, so it is critical to investigate how the expansion of cooling services will impact future GHG emissions. In this article, we first examine the current status and expected expansion of cooling services worldwide and the associated GHG emissions. Then, we review potential improvements and innovations that could reduce future GHG emissions. Three approaches to reduce GHG emissions within the cooling sector include converting to alternative refrigerants, improving energy efficiency, and moving toward a lower-carbon electricity grid. In addition, we identify eight interventions that apply to the built environment or the food supply chain that would lead to additional GHG reductions in the cooling sector.
Low-Density, High-Temperature Co Base Superalloys
Authors: Makineni Surendra Kumar , Singh Mahander Pratap , Chattopadhyay Kamanio
Published: June 2021

Co base superalloys strengthened by coherent L12 ordered γ′ precipitate in a disordered face-centered cubic γ matrix represent a new opportunity for high-temperature alloy development. The emergence of alloys with low density and high specific yield strength at elevated temperatures has further energized the research and development efforts in the last 5 years. Initially stabilized by the addition of small amounts of Nb and Ta, these new generations of alloys with multiple alloying additions to form basic quaternary and ternary alloys have steadily expanded the property envelopes to raise hope for a modern class of superalloys with higher-temperature capabilities. This article reviews the work of a vibrant set of researchers across the globe whose findings are constantly unlocking the potential of these alloys. These developments have achieved high-temperature strength (at 870°C) >0.6 GPa, γ′ solvus temperature exceeding 1,100°C, and densities between 7.8 and 8.6 g/cm3.
Small Steps with Big Data: Using Machine Learning in Energy and Environmental Economics
Authors: Harding Matthew C. , Lamarche Carlos
Published: June 2021

This article reviews recent endeavors to incorporate big data and machine learning techniques into energy and environmental economics research. We find that novel datasets, from high frequency smart meter data to satellite images and social media data, are already used by researchers. At the same time most of the analyses rely on traditional econometric techniques. Nevertheless, we find applications of machine learning models that address the high dimensionality of the data and seek out new and better strategies for estimating heterogenous treatment effects. We provide an introduction to the main themes in machine learning, which are likely to be of use to economists in energy and environmental economics, and illustrate them using a real data example derived from an energy efficiency program evaluation. We provide the data and code in order to stimulate further research in this area.
Sex Differences in Respiratory Viral Pathogenesis and Treatments
Authors: Ursin Rebecca L. , Klein Sabra L.
Published: June 2021

Biological sex affects the outcome of diverse respiratory viral infections. The pathogenesis of respiratory infections caused by viruses ranging from respiratory syncytial virus to influenza viruses and severe acute respiratory syndrome coronavirus 2 differs between the sexes across the life course. Generally, males are more susceptible to severe outcomes from respiratory viral infections at younger and older ages. During reproductive years (i.e., after puberty and prior to menopause), females are often at greater risk than males for severe outcomes. Pregnancy and biological sex affect the pathogenesis of respiratory viral infections. In addition to sex differences in the pathogenesis of disease, there are consistent sex differences in responses to treatments, with females often developing greater immune responses but experiencing more adverse reactions than males. Animal models provide mechanistic insights into the causes of sex differences in respiratory virus pathogenesis and treatment outcomes, where available.
Local Electrochemical Measurements by 3D Printed Sf-MDC Equipped with Optical Microscope
Authors: Sakata Kei , Bilal Muhammad , Sakairi Masatoshi , Murata Takuya
Published: June 2021

A 3D printed solution flow type micro droplet cell (Sf-MDC) was attached to an optical microscope, making it possible to switch between the lens and Sf-MDC at the same observation/measurement area. Using this setup, precipitates in an Al-Si alloy were investigated. Open circuit potential measurements and potentiodynamic measurements were conducted at various surface areas of the Al-Si alloy. The precipitate area ratio affected open circuit potentials and anodic currents. This 3D printed Sf-MDC can be applied for the electrochemical investigation of precipitates in Al-Si alloy.
Determination of the working temperature of the MOS sensors used for the detection of ethanol and methanol
Authors: Paredes-Doig Ana Lucía , Cárcamo Henry , Doig-Camino Elizabeth , Picasso Gino , La Rosa-Toro Adolfo , Sun-Kou Rosario
Published: June 2021

In this work, some peruvian red wines were analyzed using gas chromatography coupled to mass spectrometry (GC-MS) and it was determined that ethanol was the major volatile component present in the aroma (12 % in volume). followed by methanol (2-3 % in volume). Some MOS sensors based on SnO2 doped with Pd and Pt were prepared by precipitation with metallic charges from 0.1 to 0.5% and were tested with the same Peruvian wines. The stability and reproducibility of the sensing signal was analyzed at different working temperatures (200, 220, 240, 260 and 280 °C). The best working temperature at which the highest intensity of the response signal of the sensors was obtained at 260 ⁰C. In most of the cases studied, the sensing signal of the sensors was in general repetitive and stable, maintaining its amplitude and shape during long periods of the analysis. However, at the temperature of 280 ° C the signal loses intensity and in contact with methanol the signal is distorted.