bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploiting hierarchy in medical concept embedding*
Authors: Finch Anthony , Crowell Alexander , Bhatia Mamta , Parameshwarappa Pooja , Chang Yung-Chieh , Martinez Jose , Horberg Michael
Published: March 2021

Objective

To construct and publicly release a set of medical concept embeddings for codes following the ICD-10 coding standard which explicitly incorporate hierarchical information from medical codes into the embedding formulation.

Materials and Methods

We trained concept embeddings using several new extensions to the Word2Vec algorithm using a dataset of approximately 600,000 patients from a major integrated healthcare organization in the Mid-Atlantic US. Our concept embeddings included additional entities to account for the medical categories assigned to codes by the Clinical Classification Software Revised (CCSR) dataset. We compare these results to sets of publicly released pretrained embeddings and alternative training methodologies.

Results

We found that Word2Vec models which included hierarchical data outperformed ordinary Word2Vec alternatives on tasks which compared naïve clusters to canonical ones provided by CCSR. Our Skip-Gram model with both codes and categories achieved 61.4% normalized mutual information with canonical labels in comparison to 57.5% with traditional Skip-Gram. In models operating on two different outcomes, we found that including hierarchical embedding data improved classification performance 96.2% of the time. When controlling for all other variables, we found that co-training embeddings improved classification performance 66.7% of the time. We found that all models outperformed our competitive benchmarks.

Discussion

We found significant evidence that our proposed algorithms can express the hierarchical structure of medical codes more fully than ordinary Word2Vec models, and that this improvement carries forward into classification tasks. As part of this publication, we have released several sets of pretrained medical concept embeddings using the ICD-10 standard which significantly outperform other well-known pretrained vectors on our tested outcomes.
Progressive failure mechanical behaviour and response characteristics of sandstone under stress-seepage coupling
Authors: Song Zhixiang , Zhang Junwen
Published: March 2021

Conventional triaxial loading tests with different confining pressures and stress-seepage coupling tests on sandstone with different confining pressures and seepage pressures were conducted. A permeability model considering strength and strain was established, which better characterized the progressive deformation mechanical behaviour of sandstone under stress-seepage coupling. The results showed the following. (i) The confining pressure not only affects the peak strength of sandstone but also affects the axial deformation under conventional triaxial loading conditions. (ii) Compared with the seepage pressure effect, the degree of the confining pressure effect on the strength of sandstone was weaker, but the degree of that on the axial, radial and volumetric deformations of sandstone was stronger under stress-seepage coupling. (iii) With increasing confining pressure, the axial strain of sandstone decreased, while the corresponding radial and volumetric strains showed progressively increasing evolution characteristics under identical seepage pressures and different confining pressures. With increasing seepage pressure, the axial strain continuously decreased, while the corresponding radial and volumetric strains showed the progressive evolution characteristic of first increasing and then decreasing under identical confining pressures and different seepage pressures. (iv) Compared with the confining pressure effect, the degree of the seepage pressure effect on the permeability progressive evolution law of sandstone was weaker under stress-seepage coupling. The research conclusions could enrich the theories for the prevention and control of water inrush accidents in coal mines.
Genome mining for drug discovery: cyclic lipopeptides related to daptomycin
Authors: Baltz Richard H
Published: March 2021

The cyclic lipopeptide antibiotics structurally related to daptomycin were first reported in the 1950s. Several have common lipopeptide initiation, elongation, and termination mechanisms. Initiation requires the use of a fatty acyl-AMP ligase (FAAL), a free-standing acyl carrier protein (ACP), and a specialized condensation (CIII) domain on the first NRPS elongation module to couple the long chain fatty acid to the first amino acid. Termination is carried out by a dimodular NRPS that contains a terminal thioesterase (Te) domain (CAT-CATTe). Lipopeptide BGCs also encode ABC transporters, apparently for export and resistance. The use of this mechanism of initiation, elongation, and termination, coupled with molecular target-agnostic resistance, has provided a unique basis for robust natural and experimental combinatorial biosynthesis to generate a large variety of structurally related compounds, some with altered or different antibacterial mechanisms of action. The FAAL, ACP, and dimodular NRPS genes were used as molecular beacons to identify phylogenetically related BGCs by BLASTp analysis of finished and draft genome sequences. These and other molecular beacons have identified: (i) known, but previously unsequenced lipopeptide BGCs in draft genomes; (ii) a new daptomycin family BGC in a draft genome of Streptomyces sedi; and (iii) novel lipopeptide BGCs in the finished genome of Streptomyces ambofaciens and the draft genome of Streptomyces zhaozhouensis.
Corporations, high-stakes biomedical research, and research misconduct: yes they can (and sometimes do)
Authors: Morreim E H
Published: March 2021

Science has long been vulnerable to research misconduct (RM). Biomedical sciences, with vast financial stakes, carry heightened temptations. However, RM is standardly seen as an undertaking of individual scientists, not as something that could be committed by an organization such as a corporation or university. Rather, organizations are generally regarded merely as supervisors to encourage scientific integrity and investigate suspected RM. Indeed, federal regulations expressly embrace this perspective, and the federal Office of Research Integrity has never deemed an organization guilty of committing RM. This article aims to rewrite this corner of research integrity: organizations can directly commit RM and should be held accountable as such. Although the conclusions apply to organizations such as universities and government agencies, the focus here is on corporations in the biomedical sciences. After defining ‘research misconduct’ in Part II, Part III describes corporate-level RM and distinguishes it from individuals’ misconduct. Part IV provides five case studies exemplifying corporate RM, while Part V discusses implications, describes ways in which federal regulations could already encompass organization-level RM, and identifies some needed legal and regulatory adjustments.
The Influence of Indoor Environmental Factors on the Prevalence of House Dust Mites as Aeroallergens in Bandar Abbas Student Dormitories, South of Iran, 2019
Authors: Zare Mehdi , Hassani-Azad Mehdi , Soleimani-Ahmadi Moussa , Majnoon Raziea
Published: March 2021

This study was conducted to determine the influence of environmental factors on the prevalence of house dust mites in student dormitories of Bandar Abbas city. In this study, 64 dust samples were collected from seven randomly selected dormitories located in various areas of the Bandar Abbas. The collected mites were isolated and mounted in Hoyer’s medium and identified using a morphological key. The associations between the environmental factors and the density of house dust mites were investigated. In total, 1,093 adult mites were collected and identified. They consisted of four species including Dermatophagoides pteronyssinus Trouessart (57.6%), Dermatophagoides farinae Hughes (24.3%) and Dermatophagoides evansi Fain (14.9%) (Acari: Pyroglyphidae), and Cheyletus malaccensis Oudemans (3.2%) (Acari: Cheyletidae). All of the dormitories were contaminated by more than one house dust mites species and the mean density of house dust mites in dormitories was 8.3 ± 0.2 mites/g of dust. There was a significant relationship between average house dust mites density and some of environmental factors such as relative humidity, temperature, floor covering type, and number of occupants (P < 0.05). Results of this study revealed that two major allergenic dust mites, D. pteronyssinus and D. farinae, were the most prevalent and collected from all of dormitories and some of indoor environmental factors found to influence mites’ population.
Whose (Ir)Religion? Which Bioethics?
Authors: Parks Benjamin N
Published: March 2021

In this issue, contributors engage Timothy Murphy’s proposal for irreligious bioethics over against religious bioethics. Two essays take opposing sides in the debate, while a third seeks middle ground. Another essay questions the meaning of the words “religion,” “irreligion,” and “secular.” The final essay examines the religious nature of human existence and its implications for the debate.
Understanding Drug Development: A Primer on the Food and Drug Administration
Authors: Purandare Amol V
Published: March 2021

Over the past year, the Severe Acute Respiratory Syndrome Coronavirus 2 pandemic has led to rapid advancement regarding therapeutics, vaccines, and testing. In the United States, the Food and Drug Administration (FDA) is the agency ensuring standardization, reproducibility, and meeting benchmarks of safety and efficacy for these products. Among medical professionals and the public, there are often questions about the role of regulation, product development and approval, and terminology often used in regard to the FDA. This manuscript will serve as an introduction to the FDA, clarify the steps of drug development and approval, review terms related to product use, and discuss the role of the medical community and industry.

The FDA serves as a regulatory agency ensuring safety, efficacy, and quality are met in the approval of drugs, vaccines, biologics, and testing products. Understanding the terms of development can help providers with many new products being developed.
Functionalised molybdenum disulfide nanosheets for co-delivery of doxorubicin and siRNA for combined chemo/gene/photothermal therapy on multidrug-resistant cancer
Authors: Li Guo , Meng Fayan , Lu Taicheng , Wei Liying , Pan Xin , Nong Zhenzhen , Wei Mei , Liao Chuanan , Li Xuehua
Published: March 2021

Objective

Molybdenum disulfide (MoS2) has been developed for medical uses due to its excellent medically beneficial characteristics. This research was designed to develop a multifunctional nano-drug delivery system based on the nano-structure of MoS2 for combined chemo/gene/photothermal therapy targeting multidrug-resistant cancer.

Methods

MoS2 nanosheets were prepared by a hydrothermal reaction and modified. Afterward, the nanocarrier was characterised. In vitro cytotoxicity of the drug delivery systems on human breast adenocarcinoma cell lines was assessed.

Key findings

The nanocarrier was a flake-like structure with a uniform hydrodynamic diameter and possessing good colloidal stability. The nanocarrier showed the capacity to be deployed for co-delivery of Doxorubicin (DOX) and siRNA. The release of DOX could be triggered and enhanced by pH and application of near-infrared (NIR) laser. The nanocarrier had a good photothermic response and stability. The nanocarrier had little effect on the cells and exhibited good biocompatibility. Measurement of the therapeutic efficacy showed that synergistic therapy combining chemo-, gene- and photothermal therapy deploying this drug delivery system will achieve a better anticancer effect on drug-resistant cancer cells than DOX alone.

Conclusions

Our results suggest that this drug delivery system has potential application in the therapeutic strategy for drug-resistant cancer.
Myofibroblastoma of the breast: two case reports and literature review
Authors: Scardina Lorenzo , Franceschini Gianluca , Biondi Ersilia , Di Leone Alba , Sanchez Alejandro Martin , D'Archi Sabatino , Mason Elena Jane , Angelico Giuseppe , Santoro Angela , Mulè Antonino , Masetti Riccardo
Published: March 2021

Myofibroblastoma (MFB) is a relatively rare tumor of the breast parenchyma, which belongs to the family of the ‘benign stromal tumor of the breast’. Two cases of MFB of the breast are described. Radiological imaging is nonspecific in MFB, and pathological examination of needle biopsy or surgically resected specimen is necessary for the diagnosis. Surgery is recommended and considered curative without additional treatment; however, patients should be followed-up.
Genome-wide association studies reveal the coordinated regulatory networks underlying photosynthesis and wood formation in Populus
Authors: Quan Mingyang , Liu Xin , Du Qingzhang , Xiao Liang , Lu Wenjie , Fang Yuanyuan , Li Peng , Ji Li , Zhang Deqiang
Published: March 2021

Photosynthesis and wood formation underlie the ability of trees to provide renewable resources and perform ecological functions; however, the genetic basis and regulatory pathways coordinating these two linked processes remain unclear. Here, we used a systems genetics strategy, integrating genome-wide association studies, transcriptomic analyses, and transgenic experiments, to investigate the genetic architecture of photosynthesis and wood properties among 435 unrelated individuals of Populus tomentosa, and unravel the coordinated regulatory networks resulting in two trait categories. We detected 222 significant single-nucleotide polymorphisms, annotated to 177 candidate genes, for 10 traits of photosynthesis and wood properties. Epistasis uncovered 74 epistatic interactions for phenotypes. Strikingly, we deciphered the coordinated regulation patterns of pleiotropic genes underlying phenotypic variations for two trait categories. Furthermore, expression quantitative trait nucleotide mapping and coexpression analysis were integrated to unravel the potential transcriptional regulatory networks of candidate genes coordinating photosynthesis and wood properties. Finally, heterologous expression of two pleiotropic genes, PtoMYB62 and PtoMYB80, in Arabidopsis thaliana demonstrated that they control regulatory networks balancing photosynthesis and stem secondary cell wall components, respectively. Our study provides insights into the regulatory mechanisms coordinating photosynthesis and wood formation in poplar, and should facilitate genetic breeding in trees via molecular design.
XMMU J050722.1−684758: discovery of a new Be X-ray binary pulsar likely associated with the supernova remnant MCSNR J0507−6847
Authors: Maitra C , Haberl F , Maggi P , Kavanagh P J , Vasilopoulos G , Sasaki M , Filipović M D , Udalski A
Published: March 2021

We report the discovery of a new high-mass X-ray binary pulsar, XMMU J050722.1−684758, possibly associated with the supernova remnant (SNR) MCSNR J0507−6847 in the Large Magellanic Cloud, using XMM–NewtonX-ray observations. Pulsations with a periodicity of 570 s are discovered from the Be X-ray binary XMMU J050722.1−684758 confirming its nature as a HMXB pulsar. The HMXB is located near the geometric centre of the SNR MCSNR J0507−6847(0.9 arcmin from the centre) which supports the XRB-SNR association. The estimated age of the SNR is 43–63 kyr years which points to a middle aged to old SNR. The large diameter of the SNR combined with the lack of distinctive shell counterparts in optical and radio indicates that the SNR is expanding into the tenuous environment of the superbubble N103. The estimated magnetic field strength of the neutron star is B ≳ 1014 G assuming a spin equilibrium condition which is expected from the estimated age of the parent remnant and assuming that the measured mass-accretion rate remained constant throughout.
The excitation of CNCN in the interstellar medium: hyperfine resolved rate coefficients and non-LTE modelling
Authors: Ndaw D , Bop C T , Dieye G , Faye N A Boye , Lique F
Published: March 2021

The recent detections of CNCN and HNCCN+ are seen as further evidence of the large abundance of NCCN in the interstellar medium. The accurate determination of the abundance of these chemically related compounds from the observational spectra requires the prior calculation of collisional rate coefficients. In this work, we aimed at computing hyperfine resolved rate coefficients for the CNCN–He collisional system. First, we determined a new potential energy surface for the CNCN–He van der Waals complex from which we computed rotationally resolved excitation cross-sections for energies up to 800 cm−1 using the quantum mechanical close-coupling approach. Then, hyperfine resolved transitions between the 30 low-lying pure rotational levels of CNCN were computed for temperatures ranging from 5 to 150 K using an improved infinite order sudden approach. The analysis of the scattering results showed a propensity rule in favour of Δj = ΔF1 = ΔF for the hyperfine transitions and a slight dominance of the odd Δj transitions. Using these data, we carried out non-LTE radiative transfer calculations to simulate the excitation of CNCN in molecular clouds and to constrain the physical conditions of cold dark clouds. Preliminary results showed that the abundance of CNCN derived from observational spectra has to be revisited using these new collisional data.
Enhancer Pleiotropy, Gene Expression, and the Architecture of Human Enhancer–Gene Interactions
Authors: Singh Devika , Yi Soojin V
Published: March 2021

Enhancers are often studied as noncoding regulatory elements that modulate the precise spatiotemporal expression of genes in a highly tissue-specific manner. This paradigm has been challenged by recent evidence of individual enhancers acting in multiple tissues or developmental contexts. However, the frequency of these enhancers with high degrees of “pleiotropy” out of all putative enhancers is not well understood. Consequently, it is unclear how the variation of enhancer pleiotropy corresponds to the variation in expression breadth of target genes. Here, we use multi-tissue chromatin maps from diverse human tissues to investigate the enhancer–gene interaction architecture while accounting for 1) the distribution of enhancer pleiotropy, 2) the variations of regulatory links from enhancers to target genes, and 3) the expression breadth of target genes. We show that most enhancers are tissue-specific and that highly pleiotropy enhancers account for <1% of all putative regulatory sequences in the human genome. Notably, several genomic features are indicative of increasing enhancer pleiotropy, including longer sequence length, greater number of links to genes, increasing abundance and diversity of encoded transcription factor motifs, and stronger evolutionary conservation. Intriguingly, the number of enhancers per gene remains remarkably consistent for all genes (∼14). However, enhancer pleiotropy does not directly translate to the expression breadth of target genes. We further present a series of Gaussian Mixture Models to represent this organization architecture. Consequently, we demonstrate that a modest trend of more pleiotropic enhancers targeting more broadly expressed genes can generate the observed diversity of expression breadths in the human genome.
Secondhand Smoke Exposure is Associated with Prevalent Heart Failure: Longitudinal Examination of the National Health and Nutrition Examination Survey
Authors: Skipina T M , Upadhya B , Soliman E Z
Published: March 2021

Introduction

Serum cotinine is a sensitive and specific biomarker for tobacco exposure including second-hand smoke exposure (SHS). We sought to examine whether SHS is associated with heart failure (HF) among non-hospitalized adults.

Methods

This analysis included 11 219 non-smokers (age 48.4 ± 20.5 years, 55.9% women, 70.5% whites) from the United States Third National Health and Nutrition Examination (NHANES) years 1988–1994. SHS was defined as serum cotinine ≥1 ng/mL. To assess dose-response, cut-points of serum cotinine ≥3 ng/mL and ≥6 ng/mL were used. Multivariable logistic regression was used to examine the association between SHS and HF. The consistency of this association was tested among subgroups stratified by race, gender, and comorbidities. NHANES years 2003–2006 were examined for longitudinal comparison.

Results

18.9% (n = 2125) of participants had SHS exposure while 3.7% (n = 416) had HF. After adjusting for covariates, SHS was associated with a 35% increased odds of HF with a dose-response relationship between levels of serum cotinine and HF. This association was stronger in males than females (interaction p-value = 0.03) and those with a history of CVD versus those without (interaction p-value < 0.001). This association persisted in the NHANES 2003–2006 analysis.

Conclusion

There is a dose-response relationship between SHS and HF with possible effect modification by gender and prior CVD. This is a novel finding that underscores the harmful effects of passive smoking on the cardiovascular system and highlights the needs for further prohibition of smoking in public areas and a personalized risk assessment among high-risk groups, especially in regions with less-stringent public health policies.

Implications

This study showed a novel association between secondhand smoke exposure and prevalent heart failure among non-smokers, adding to the list of harmful cardiovascular manifestations of secondhand smoke exposure. This was more apparent in men and those with a prior history of cardiovascular disease. Heart failure is a debilitating disease process, so this finding has important policy implications in low-income countries and poor communities with less-stringent health policies because they are known to have the highest levels of exposure. Smoke-free policies targeting these regions would thus yield substantial public health benefits.
Impact of dietary mercury intake during pregnancy on the health of neonates and children: a systematic review
Authors: Saavedra Steven , Fernández-Recamales Ángeles , Sayago Ana , Cervera-Barajas Antonio , González-Domínguez Raúl , Gonzalez-Sanz Juan D
Published: March 2021

Context

Growing evidence suggests that prenatal exposure to methyl mercury through the maternal diet could have great influence on the neurological and physical development of neonates and young children.

Objective

The aim of this review was to evaluate the clinical repercussions of maternal exposure to methyl mercury during pregnancy on the health of fetuses, neonates, and children up to 8 years of age.

Data Sources

The Web of Science, PubMed, CINAHL, Scopus, and Dialnet Plus databases were searched for articles published in English or Spanish from 1990 to 2020.

Study Selection

Original articles published in English or Spanish from 1990 to 2020 were eligible for inclusion. All study designs were eligible. Animal studies were excluded. Two authors independently screened studies for inclusion. From the 971 records initially identified, 19 studies were included in the systematic review.

Data Extraction

PRISMA guidelines were followed. Outcomes extracted included maternal dietary exposure to methyl mercury during pregnancy, possible health repercussions in offspring up to 8 years of age, and quantitative measurement of mercury in a biological sample. All studies met the requirements established for assessing both study quality and risk of bias.

Results

Prenatal exposure to mercury was consistently associated with lower birth weight, but only one study reported a negative association with length at birth. Higher mercury levels were also related to lower scores in various neuropsychological and developmental tests.

Conclusion

The literature shows clear evidence of the adverse effects of maternal methyl mercury exposure on anthropometric variables and cognitive or physical development in children. It is noteworthy, however, that mercury toxicity may sometimes be mitigated by other essential nutrients in the maternal diet, such as polyunsaturated fatty acids.
Worker surveillance capital, labour share, and productivity
Authors: Askenazy Philippe
Published: March 2021

This paper proposes a basic model with two types of capital: productive capital directly involved in the production process and capital devoted to monitoring workers. Surveillance capital intensifies workers’ job strain, while wage recognition encourages their engagement. Firms face a double trade-off between the two types of capital, and between incentives and labour costs. Under simple assumptions, up to a certain threshold, technological innovation improves productivity, wages, and profits at the same pace, leading to a flat labour share in income. Then, once the threshold is breached, profit-maximization initiates a transfer from productive capital to monitoring tools. This progressive shift generates a decline in the labour share and a productivity slowdown, despite greater job strain. The model suggests the possibility of a third phase in which productivity recovers.
Ground Functionalism
Authors: Schaffer Jonathan
Published: March 2021

Can there be a materialist explanation for conscious experience? According to ground functionalism, there is a mind making principle such that Huma’s C-fibers firings ground her pain, and in general states playing the right role in a system ground mental states for that system. I have the bold ambition of reviving the hopeful materialist story, by adding a new chapter—ground functionalism—which integrates functionalist insights about the mind with ground-theoretic insights about explanation. The ground functionalist posits a mind making principle linking material states to mental states via functional role, such that a properly choreographed system dances out a mind. I argue that ground functionalism preserves the insights of functionalist conceptions of the mind, while enabling a materialist explanation for conscious experience. Minds are made by dancing, and even matter can dance.
Rational Rules
Authors: Nichols Shaun
Published: March 2021

Moral systems, like normative systems more broadly, involve complex mental representations. Rational Rules offers an account of the acquisition of key aspects of normative systems in terms of general-purpose rational learning procedures. In particular, it offers statistical learning accounts of: (1) how people come to think that a rule is act-based, that is, the rule prohibits producing certain consequences but not allowing such consequences to occur or persist; (2) how people come to expect that a new rule will also be act-based; (3) how people come to believe a principle of liberty, according to which whatever is not expressly prohibited is permitted; and (4) how people come to think that some normative claims hold universally while others hold only relative to some group. This provides an empiricist theory of a key part of moral acquisition, since the learning procedures are domain general. It also entails that crucial parts of our moral system enjoy rational credentials since the learning procedures are forms of rational inference. There is another sense in which rules can be rational—they can be effective for achieving our ends, given our ecological settings. Rational Rules argues that at least some central components of our moral systems are indeed ecologically rational: they are good at helping us attain common goals. In addition, the book argues that a basic form of rule representation brings motivation along automatically. Thus, part of the explanation for why we follow moral rules is that we are built to follow rules quite generally.
The use of oral opioids to control children’s pain in the post-codeine era
Authors: Rieder Michael J , Jong Geert ’t
Published: March 2021

Pain is a common problem for children, and pain management comprises both pharmacologic and nonpharmacologic measures. For moderate to severe pain, oral opioids have been a popular choice for the last few decades. Codeine has historically been the best-known oral opioid for use in children. However, availability and use of codeine have sharply declined due to safety concerns. A variety of other opioids have been used in place of codeine, but data are limited regarding their efficacy and safety in children. While the same pathways metabolize oral oxycodone as codeine, oxycodone’s pharmacokinetics varies widely. There are also limited data on the safety and efficacy of oral hydromorphone and tramadol use for children. Oral morphine is the opiate alternative to codeine for which there is the most evidence of safety and efficacy in children. Research is needed to investigate both other opioids and non-opioid approaches to guide evidence-based analgesic therapy and treatment for moderate-to-severe pain in children.
Solidarity and immunological reason
Authors: Rennesland Anton Heinrich
Published: March 2021

This letter points out a flaw in a recent correspondence’s argument of deontology and presents a viable path for solidarity through serious consideration of immunological reason which guides humanity’s sphere formation.
Does reviewing experience reduce disagreement in proposals evaluation? Insights from Marie Skłodowska-Curie and COST Actions
Authors: Seeber Marco , Vlegels Jef , Reimink Elwin , Marušić Ana , Pina David G
Published: March 2021

We have limited understanding of why reviewers tend to strongly disagree when scoring the same research proposal. Thus far, research that explored disagreement has focused on the characteristics of the proposal or the applicants, while ignoring the characteristics of the reviewers themselves. This article aims to address this gap by exploring which reviewer characteristics most affect disagreement among reviewers. We present hypotheses regarding the effect of a reviewer’s level of experience in evaluating research proposals for a specific granting scheme, that is, scheme reviewing experience. We test our hypotheses by studying two of the most important research funding programmes in the European Union from 2014 to 2018, namely, 52,488 proposals evaluated under three funding schemes of the Horizon 2020 Marie Sklodowska-Curie Actions (MSCA), and 1,939 proposals evaluated under the European Cooperation in Science and Technology Actions. We find that reviewing experience on previous calls of a specific scheme significantly reduces disagreement, while experience of evaluating proposals in other schemes—namely, general reviewing experience, does not have any effect. Moreover, in MSCA—Individual Fellowships, we observe an inverted U relationship between the number of proposals a reviewer evaluates in a given call and disagreement, with a remarkable decrease in disagreement above 13 evaluated proposals. Our results indicate that reviewing experience in a specific scheme improves reliability, curbing unwarranted disagreement by fine-tuning reviewers’ evaluation.
‘Deliver This Horse from Evil’: The Ritual Aspects of Responses to Veterinary Disease in the Late Middle Ages
Authors: Harrison Sunny
Published: March 2021

While the importance of religious and magical healing practices in the Late Middle Ages is well established, the ritual aspects of veterinary medicine have so far not been thoroughly explored. This article addresses this lacuna through analysis of a corpus of charms, prayers, and other rituals that were used to cure a group of devastating contagious diseases that afflicted horses: animals that were often afforded complex, professional medical care in this period. It considers the semantic aspects and common features of this group of disease rituals alongside discussions of contagious illness in veterinary treatises, identifying a distinctive set of healing rituals and explaining why they were such a common response to enzootic disease. It argues that magical and religious healing were significant elements of medieval horse-care and that veterinary medicine has been overlooked as one of the key manifestations of ritual healing.
Theorizing the Religious Habitus in the Context of Conversion to Islam among Polish Women of Catholic Background
Authors: Krotofil Joanna , Piela Anna , Górak-Sosnowska Katarzyna , Abdallah-Krzepkowska Beata
Published: March 2021

This article explores the conversion processes of Polish women of Catholic background to Islam. Data from participant observation of mosque-based, women-only weekend gatherings for converts and in-depth interviews with 29 Polish female converts to Islam are presented to illustrate the dialectic between the persistence and transformation of religious habitus. Our analysis demonstrates that in the conversion process, Catholic habitus remains pervasive, and shapes converts’ engagement with the new religion; however, some elements of it become reflexive and change. We make a case for extending the discussion on habitus transformation by drawing attention to what we term a “translation” of religious beliefs and practices. Women in our study translate the system of Islamic practices and beliefs into a specific Catholic logic that is more intelligible to them and, in the process, recognize some of the power dynamics inherent in the religious field.
Intracerebral hemorrhage after kratom ingestion
Authors: Regan Glenna A. , Papadakos Peter J.
Published: March 2021

Mitragyna speciosa, a tropical tree also known as kratom, is an emerging substance of abuse with dose-dependent stimulant and opioid-like effects. Kratom may be purchased legally in the United States and is marketed online as a safe alternative to opioids and a cheap alternative to opioid replacement therapy. However, adverse reactions to ingestion are largely unknown and may pose a significant public health risk. This article describes a man with an intracerebral hemorrhage possibly secondary to kratom ingestion.
On the hunt for a cure
Authors: de la Cruz Jennifer , Hwang Joseph
Published: March 2021

Huntington disease is a rare genetic disorder characterized by motor, cognitive, and psychiatric impairments. Although the typical patient has a positive family history and initially presents with chorea between ages 30 and 50 years, some patients do not have a typical presentation. Healthcare providers should know when to refer patients to neurology for testing for Huntington disease. The earlier the diagnosis is made, the earlier the patient and patient's family can receive education about the expected disease trajectory. A multidisciplinary approach is required to mitigate symptoms as the disease progresses. Although no cure exists, ongoing research is targeting genotypic abnormalities in hopes of finding a permanent treatment for Huntington disease.
An Anatomical Guide to the Terminal Facial Artery: Lumen Diameter and Associated Anatomy Relevant to Dermatologic Procedures
Authors: Money Silas M. , Wall Weston B. , Davis Loretta S. , Edmondson Anna C.
Published: March 2021

BACKGROUND

Dermal filler injection in the vicinity of the terminal facial artery (FA) can lead to vascular compromise with devastating consequences, including tissue necrosis, blindness, and stroke.

OBJECTIVE

The purpose of this study was to examine lumen diameter and other anatomical features of the terminal FA relevant to dermal filler injection.

MATERIALS AND METHODS

Eighteen embalmed adult cadavers were dissected along the distribution of the terminal FA. Gross and microscopic measurements were taken at predetermined points in its course.

RESULTS

Mean lumen diameter was largest at the midpoint between the oral commissure and the lateral supra-alar crease (0.81 ± 0.36 mm; point P1) and smallest at the midpoint between the lateral supra-alar crease and the medial canthus (0.43 ± 0.23 mm; point P3). Mean cutaneous depth was deepest at the lateral supra-alar crease (5.06 ± 1.84 mm; point P2) and most superficial at the midpoint between the lateral supra-alar crease and the medial canthus (3.13 ± 2.07 mm; point P3).

CONCLUSION

The large-caliber lumen diameter of the terminal FA creates the potential for intra-arterial injection with commonly used filler needles and blunt-tipped cannulas at all points in its course in the nasolabial fold and midface.
Plasma Concentration After the First Hemoperfusion has a High Predictive Value in Medium Level Acute Paraquat-Poisoned Patients
Authors: Tang Yahui , Chen Hui , Qiu Weiyong , Zhou Yanxue , Hong Guangliang , Hu Lufeng , Zhao Guangju , Chen Xiaorong , Zhi Shaoce , Lu Zhongqiu
Published: March 2021

Background:

Paraquat ( PQ) is very poisonous to humans and animals and there is no effective clinical antidote . The efficacy of hemoperfusion (HP) treatment for PQ poisoning remains controversial. To explore new ways to predict the prognosis of patients with acute PQ poisoning and assist in the development of better hemopurification treatment strategies.

Methods:

The clinical data of patients who were intoxicated with PQ through contact were diagnosed with PQ poisoning by high-performance liquid chromatography. Samples were collected by the Emergency Intensive Care Unit of the First Affiliated Hospital of Wenzhou Medical University from January 2012 to November 2016. Based on the prognosis, the patients were grouped into survival and death groups. Comparisons of the differences in the clinical indexes were performed, including the initial concentration of PQ at admission, PQ concentration after first HP, the number of HP cartridges used for the first hemoperfusion, whether HP was combined with continuous renal replacement therapy, and the number of concurrent organ injuries between the 2 groups. In addition, data were analyzed using multivariate logistic regression models and receiver operating characteristic curves. Moreover, prognostic factors in patients with acute PQ poisoning were analyzed.

Results:

Overall, 128 patients with acute PQ poisoning were enrolled in this study. The median plasma PQ concentrations of the patients at admission were 21 and 834 ng/mL (range: 50–1,099,118 ng/mL). The multiple logistic regression model revealed that the initial concentration of PQ and the PQ concentration after the first perfusion were independent risk factors for death in patients with acute PQ poisoning. The PQ concentration in the survival group after the first HP was <516 ng/mL and was mainly distributed at approximately 100 ng/mL. The percentage of patients whose concentration after the first HP was <516 ng/mL in the death group was only 19%.

Conclusions:

The initial plasma PQ concentration after admission and PQ concentration after the first HP are risk factors for death in patients with acute PQ poisoning. Moreover, PQ concentration after the first HP had a high predictive value for death. When the initial plasma PQ concentration after admission ranges from 50 ng/mL to 5000 ng/mL, the rapid reduction in plasma PQ concentration after HP treatment could improve the prognosis of patients with acute PQ poisoning.
Lower Extremity Combat Sustained Peripheral Nerve Injury in US Military Personnel
Authors: Eckhoff Michael D. , Craft Madison R. , Nicholson Tyler C. , Nesti Leon J. , Dunn John C.
Published: March 2021

Background:

Since the civil war, combat sustained peripheral nerve injuries (CSPNI) have been documented during wartime. Warfare has evolved and current combat involves a greater severity of blast injuries secondary to increased use of improvised explosive devices. The purpose of this study was to describe CSPNI and report outcomes after evaluation and treatment. We hypothesize that a shorter time to evaluation will improve outcomes.

Methods:

A database including all active duty service members who sustained a CSPNI and were treated by the PNC between 2004 and 2009 was used. Service member demographic information, injury mechanism, CSPNI description, and Medical Research Council (MRC) final motor and sensory outcomes were queried from this database.

Results:

One hundred and four military service members sustained 144 PNIs. The average age was 26.7 years, and nearly all were men (98.1%). There was no correlation between Sunderland classification and age, specific PNI, injury type, or time to evaluation. Higher Sunderland classifications were found to be correlated with worse final motor (r = 0.51, P < 0.001) and final sensory (r = 0.41, P < 0.001) scores. Final motor and sensory scores were not associated with specific nerve injury, mechanism of injury, initial EMG, or surgical procedure. Shorter time to initial assessment was associated with improved final motor and sensory scores, but was not found to be statistically significant.

Conclusions:

As the complexity of CSPNIs progress as combat weaponry evolves, a firm understanding of treatment factors is important. Our study demonstrates in recent conflict that military service members’ initial injury severity is a key factor in expected outcome.
Idiopathic Pediatric Tibial Nerve Palsy
Authors: Celano Emma , Fleury Christopher M. , Mantilla-Rivas Esperanza , Nasser Jacob S. , Phan Tiffany , Manrique Monica , Oh Albert K. , Keating Robert F. , Rogers Gary F.
Published: March 2021

Tibial nerve entrapment is uncommon in the pediatric population, and presents diagnostic and treatment challenges. We present the unusual case of a 3-year-old male child with progressive lower leg atrophy of an unknown etiology. Preoperative electrodiagnostic testing and magnetic resonance imaging suggested proximal tibial neuropathy. Surgical exploration showed compression of the tibial nerve at the inferior fascial edge of the long head of the biceps femoris and at the soleal sling. Release and external neurolysis led to improvement of distal leg motor function.
Adverse Discharge Outcomes Associated With the Medicare Hospital Readmissions Reduction Program Among Commercially Insured Adults
Authors: Alfandre David , Bipin Gandhi Aakash , Onukwugha Eberechukwu
Published: March 2021

It is unknown if changes in the rate of discharges against medical advice (DAMA) are related to the implementation of the Medicare Hospital Readmissions Reduction Program (HRRP). We performed an interrupted time series analysis of monthly DAMA rates per 1,000 discharges of all enrolled individuals 18–64 years old with a hospitalization between January 1, 2006, and December 31, 2015, in a commercially insured population. We performed a segmented linear regression with two interruptions: (1) April 2010 to coincide with the passage of the HRRP and (2) October 2012 to coincide with the implementation of HRRP penalties. There were 1,087,812 discharges representing 668,823 individuals over 120 months. The downward trend in monthly DAMA rates was reversed significantly after April 2010 with a sustained 0.1 increase in the monthly rate that continued after the implementation of penalties in October 2012. Allowing for the two interruptions, there was a statistically significant positive trend (0.10; 0.06–0.13, p < .01) in April 2010. Relative to the first interruption, there was no statistically significant change in the slope in October 2012; the estimated slope was −0.04 (−0.08 to 0.002). Monthly DAMA rates increased in anticipation of and after HRRP implementation, suggesting a potential relationship between the HRRP and DAMA.
Child Sport Concussion Assessment Tool 5th Edition: Normative Reference Values in Demographically Diverse Youth
Authors: Kelshaw Patricia M. , Cook Nathan E. , Terry Douglas P. , Iverson Grant L. , Caswell Shane V.
Published: March 2021

Objectives:

Examine sociodemographic differences (gender, age, and language spoken at home) on baseline Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) scores and establish normative reference data for the Child SCAT5 among middle school student athletes.

Design:

Cross-sectional study.

Setting:

Nine middle schools in Virginia.

Participants:

A sample of 1355 athletes playing competitive school-sponsored sports (ages 11-13, M = 12.3 ± 0.8; 40.1% girls, 59.9% boys) during the 2017 and 2018 school year. Certified athletic trainers administered the Child SCAT5 within the first 2 weeks of the sport season.

Independent Variables:

Self-reported gender, age, and language spoken at home.

Main Outcome Measures:

All Child SCAT5 outcome measures.

Results:

Gender, age, and language spoken at home were associated with Child SCAT5 scores, but the magnitude of differences was generally small. Specifically, girls endorsed more symptoms (girls: M = 8.4 ± 5.7, boys: M = 7.5 ± 5.7; P = 0.003) and greater symptom severity (girls: M = 11.6 ± 9.4, boys: M = 10.4 ± 9.3; P = 0.006) than boys and performed slightly better than boys on cognitive and balance tasks. Older students performed slightly better than younger students on tests of cognition (eg, SAC-C: 11-year-olds: M = 21.3 ± 2.1, 13-year-olds: M = 21.7 ± 2.1; P = 0.02). Total symptoms (P = 0.01), symptom severity (P = 0.01), immediate memory (P < 0.001), delayed recall (P = 0.001), and SAC-C total scores (P = 0.002) differed across language groups.

Conclusions:

Gender, age, and language spoken in the home are associated with baseline scores on multiple components of the Child SCAT5 among middle school students, although the magnitudes of observed differences are small. Normative reference values are provided for clinicians when interpreting Child SCAT5 scores.
Comparative Efficacy of Nonoperative Treatments for Greater Trochanteric Pain Syndrome: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
Authors: Gazendam Aaron , Ekhtiari Seper , Axelrod Daniel , Gouveia Kyle , Gyemi Lauren , Ayeni Olufemi , Bhandari Mohit
Published: March 2021

Objective:

An evolved understanding of the pathophysiology of greater trochanteric pain syndrome has led to a number of proposed nonoperative management strategies. The objective of this review was to compare the efficacy of the various nonoperative treatments for greater trochanteric pain syndrome (GTPS).

Design:

Systematic review and network meta-analysis.

Setting:

PubMed, Embase, CENTRAL, SCOPUS, and Web of Science were searched to January 2020.

Patients:

Patients undergoing nonoperative treatment for GTPS.

Interventions:

Nonoperative treatment strategies for GTPS including injections of corticosteroids, platelet-rich plasma, hyaluronic acid, dry needling, and structured exercise programs and extracorporeal shockwave therapy.

Main Outcome Measures:

Pain and functional outcomes. Bayesian random-effects model was performed to assess the direct and indirect comparison of all treatment options.

Results:

Thirteen randomized controlled trials and 1034 patients were included. For pain scores at 1 to 3 months follow-up, both platelet-rich plasma (PRP) and shockwave therapy demonstrated significantly better pain scores compared with the no treatment control group with PRP having the highest probability of being the best treatment at both 1 to 3 months and 6 to 12 months. No proposed therapies significantly outperformed the no treatment control group for pain scores at 6 to 12 months. Structured exercise had the highest probability of being the best treatment for improvements in functional outcomes and was the only treatment that significantly improved functional outcome scores compared with the no treatment arm at 1 to 3 months.

Conclusion:

Current evidence suggests that PRP and shockwave therapy may provide short-term (1-3 months) pain relief, and structured exercise leads to short-term (1-3 months) improvements in functional outcomes.