bluuebunny/crossref_metadata_2025 huggingface dataset:
Hybrid machine learning to localize atrial flutter substrates using the surface 12-lead electrocardiogram
Authors: Luongo Giorgio , Vacanti Gaetano , Nitzke Vincent , Nairn Deborah , Nagel Claudia , Kabiri Diba , Almeida Tiago P , Soriano Diogo C , Rivolta Massimo W , Ng Ghulam André , Dössel Olaf , Luik Armin , Sassi Roberto , Schmitt Claus , Loewe Axel
Published: December 2021

Aims

Atrial flutter (AFlut) is a common re-entrant atrial tachycardia driven by self-sustainable mechanisms that cause excitations to propagate along pathways different from sinus rhythm. Intra-cardiac electrophysiological mapping and catheter ablation are often performed without detailed prior knowledge of the mechanism perpetuating AFlut, likely prolonging the procedure time of these invasive interventions. We sought to discriminate the AFlut location [cavotricuspid isthmus-dependent (CTI), peri-mitral, and other left atrium (LA) AFlut classes] with a machine learning-based algorithm using only the non-invasive signals from the 12-lead electrocardiogram (ECG).

Methods and results

Hybrid 12-lead ECG dataset of 1769 signals was used (1424 in silico ECGs, and 345 clinical ECGs from 115 patients—three different ECG segments over time were extracted from each patient corresponding to single AFlut cycles). Seventy-seven features were extracted. A decision tree classifier with a hold-out classification approach was trained, validated, and tested on the dataset randomly split after selecting the most informative features. The clinical test set comprised 38 patients (114 clinical ECGs). The classifier yielded 76.3% accuracy on the clinical test set with a sensitivity of 89.7%, 75.0%, and 64.1% and a positive predictive value of 71.4%, 75.0%, and 86.2% for CTI, peri-mitral, and other LA class, respectively. Considering majority vote of the three segments taken from each patient, the CTI class was correctly classified at 92%.

Conclusion

Our results show that a machine learning classifier relying only on non-invasive signals can potentially identify the location of AFlut mechanisms. This method could aid in planning and tailoring patient-specific AFlut treatments.
Developing an alcohol harm prevention research agenda in West Africa: a mixed methods approach
Authors: Balenger Adelaide , Umenze Franklin , Dumbili Emeka , Sako Binta , Obot Isidore , Swahn Monica H
Published: December 2021

Research on alcohol use and its associated harm is scarce in West Africa. To mitigate the knowledge gap and to build momentum for future research, we determined research priorities for alcohol prevention among stakeholders across nine countries in West Africa. We analyzed a cross-sectional survey conducted in the fall of 2020, distributed by the West African Alcohol Policy Alliance (WAAPA). Respondents represented members of the WAAPA, members of intra-country alliances on alcohol and other stakeholders reached by snowball sampling. Quantitative and qualitative survey measures, adapted from the WHO’s readiness assessment for the prevention of child maltreatment or developed by the research team, assessed research priorities, awareness of alcohol-related harm, risk factors and data availability. We mapped the qualitative answers into general themes and conducted descriptive analysis on the quantitative responses. Participants outlined two general themes to focus on: (i) alcohol use among children and youth and (ii) the health-related impact of alcohol. The most commonly listed types of alcohol-related harms pertained to acute consequences, such as gender-based violence, injuries, traffic crashes and child maltreatment. Risk factors for alcohol-related harm included limited enforcement of alcohol policies, cheap alcohol, and limited knowledge. Strengthening the capacity for addressing these research priorities will be key in reducing alcohol-related harm in West Africa. The goal of these research priorities is to drive research that informs advocacy, programs and policy. In addition to research, an awareness campaign of the health effects of alcohol is urgently needed.
Nutritional evaluation of fish protein hydrolysate and its application in piglet production
Authors: Zhang Nan , Song Xiaoming , Dong Wenxuan , Liu Ling , Cui Zhiying , Ma Yongxi
Published: December 2021

This study was conducted to determine the digestible energy (DE), metabolizable energy (ME), and ileal digestibility of amino acids (AA) of fish protein hydrolysate (FPH), and to evaluate the effects of FPH on the performance of piglets. In Exp. 1, the available energy content of FPH was determined by difference methods: 12 barrows with an initial body weight (BW) of 40.0 ± 2.1 kg were randomly assigned into two dietary treatments with six replicates per treatment, the treatments contained a corn basal diet and an experimental diet in which 20% corn was replaced by FPH. The experiment lasted for 12 d, with 7 d adaptation period followed by 5 d total collection of feces and urine. In Exp. 2, the standardized ileal digestibility (SID) of AA in FPH by the N-free method was determined, 12 barrows (initial BW of 35.3 ± 1.8 kg) with ileal T-cannulas were randomly allotted into two treatments with six replicates per treatment, and the dietary treatments consisted of an experimental diet and a N-free diet. The experiment was lasted for 7 d, with 5 d adaptation period followed by 2 d collection of ileal digesta. In Exp. 3, the effect of FPH on the performance of piglets was conducted. One hundred ninety-two piglets (initial BW of 8.10 ± 1.8 kg) were randomly allotted into four treatments with six replicates per treatment. The treatments were a control diet with fish meal (FM) and part or all FM was replaced by FPH, receiving diets containing 2%, 3%, or 5% FPH. The experiment lasted for 28 d. Results showed that in Exp. 1, the DE and ME of FPH were 21.12 and 20.28 MJ/kg. In Exp. 2, the SID of Lys, Met, Thr, and Trp was 79.99%, 87.17%, 68.29%, and 71.53%, respectively. In Exp. 3, addition of 3% FPH increased nutrient digestibility and volatile fatty acid content in feces. Addition of 5% FPH increased the average daily feed intake (ADFI), significantly increased (P < 0.05) the activities of total antioxidant capacity (T-AOC), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and immunoglobulin A (IgA), while significantly decreased (P<0.05) the average daily gain (ADG). In conclusion, FPH had a high value of digestible energy and ileal digestible essential amino acids, and could improve nutrient digestibility, immunity, antioxidant capacity, and intestinal health of piglets, while adverse to nitrogen deposition in piglets.
Revision of the coral reef crab genusTweedieiaWard, 1935 (Decapoda: Brachyura: Xanthidae)
Authors: Lasley Robert M , Smith Austin , Paulay Gustav , Ng Peter K L
Published: December 2021

Xanthid crabs of the genus TweedieiaWard, 1935, are among the most beautiful decapod cryptofauna in Indo-West Pacific coral reefs, with an ornate arrangement of granules and setae, in combination with an eye-catching color pattern. The genus and three recognised species (T. odhneri (Gordon, 1934), T. laysani (Rathbun, 1906), and T. brevidactylaDai & Yang, 1998) are revised, and new diagnoses and figures are provided. The COI barcoding gene of 38 specimens was sequenced and used to generate maximum likelihood and neighbor-joining trees. Tweeedieia brevidactyla is here synonymized with T. odhneri. Tweedieia now comprises only two species, differentiated by morphological characters and sequence data. Tweedieia odhneri ranges from the western Indian Ocean to the Hawaiian Islands and French Polynesia, while the rare T. laysani is only recorded from the Hawaiian Islands. These crabs appear to favor clear, oligotrophic, oceanic waters and are common on oceanic islands and rare around continents and large islands of Australasia.
Spatial and trophic niche of an assemblage of native and non-native herbivores of arid Argentina
Authors: Bobadilla S Yasmin , Dacar Maria A , Jaksic Fabian M , Ojeda Ricardo A , Cuevas Maria F
Published: December 2021

The coexistence of ecologically similar species is facilitated by differential use of resources along habitat, diet, and/or temporal niche axes. We used feces of non-native rabbit (Oryctolagus cuniculus), hare (Lepus europaeus), goat (Capra hircus), and the native plains viscacha (Lagostomus maximus) to compare the utilization of spatial and trophic resources in an arid ecosystem of Argentina. We expected herbivores to present differential responses in the use of at least one of the niche axes (habitat and/or trophic) associated with seasonal changes in resource availability and according to the origin of the species (native, non-native). We evaluated habitat use and selection through Chi-squared goodness-of-fit tests and Bonferroni confidence intervals, and factors shaping habitat selection (particular components of the habitat type) using generalized linear mixed-effects models. We analyzed the seasonal compositions of diets, breadth of trophic niches, and dietary overlaps. The assemblage of herbivores did not segregate markedly in spatial resource use, showing that hares and goats were more generalist than rabbits and plains viscacha in the utilization of different habitat types. Native and non-native herbivores overlapped markedly in the trophic niche dimension but segregated to some degree in the use of space during wet and dry seasons. The four herbivores shared a similar diet composition. Among dietary items, grasses contributed high percentages during the wet season. Under conditions of resource limitation (dry season), the native plains viscacha differed in feeding strategy from the non-native herbivores. These results deepen our understanding of likely underlying mechanisms that allow coexistence of native and non-native herbivores in an arid ecosystem.
A Comparison of Hay and Fish Emulsion-Infused Water as Oviposition Attractants for the CDC Gravid Trap
Authors: McNamara Timothy D , Healy Kristen
Published: December 2021

Multiple oviposition attractants are used for Culex (Diptera: Culicidae) mosquito surveillance in the CDC Gravid Trap, including hay and fish emulsion-infused water. Despite the use of both in the United States, no research has compared their attractiveness. We conducted trapping throughout Louisiana to assess the attractiveness of hay and fish emulsion-infused water in various habitat types and climates. Our results indicate that fish emulsion-infused water attracts more mosquitoes overall, more Culex quinquefasciatus (Say, 1823), and a wider diversity of mosquitoes than hay-infused water. This trend was maintained, regardless of habitat type or climate.
Validation of the COVID-19 Exposure and Family Impact Scales
Authors: Enlow Paul T , Phan Thao-Ly T , Lewis Amanda M , Hildenbrand Aimee K , Sood Erica , Canter Kimberly S , Vega Gaby , Alderfer Melissa A , Kazak Anne E
Published: December 2021

Objective

The COVID-19 Exposure and Family Impact Scales (CEFIS) were developed in Spring 2020 to assess effects of the COVID-19 pandemic on families and caregivers. Initial psychometric properties were promising. The current study examined the factor structure and evaluated convergent and criterion validity of the CEFIS in a new sample.

Methods

In October and November 2020, caregivers (N = 2,531) of youth (0–21 years) scheduled for an ambulatory care visit at Nemours Children’s Hospital, Delaware completed the CEFIS and measures of convergent (PROMIS Global Mental Health Scale, Family Assessment Device) and criterion validity (PTSD Checklist—Civilian). Confirmatory factor analysis was used to examine the factor structure of the CEFIS. Bivariate correlations and logistic regression were used to examine convergent and criterion validity.

Results

Factor analysis supported the original six- and three-factor structures for the Exposure and Impact scales, respectively. Second-order factor analyses supported the use of Exposure, Impact, and Distress total scores. Higher scores on the CEFIS Exposure, Impact, and Distress scales were associated with increased mental health concerns and poorer family functioning. Higher scores on all CEFIS scales were also associated with greater odds of having clinically significant posttraumatic stress symptoms.

Conclusions

The CEFIS is a psychometrically sound measure of the impact of the COVID-19 pandemic on family and caregiver functioning and may also be useful in identifying families who would benefit from psychological supports.
Analysis of the clinical characteristics of the liver injury induced by levetiracetam
Authors: Sun Wei , He Yang , Li Zuojun , Wang Chunjiang
Published: December 2021

Objectives

Levetiracetam (LEV) has a low risk of hepatotoxicity due to low liver metabolism. Knowledge regarding the association between LEV exposure and liver injury is based mainly on case reports. The purpose of this study is to summarize the clinical features of LEV-induced liver injury.

Methods

We collected literature on liver injury induced by LEV for retrospective analysis from 1999 to April 2021 in Chinese and English.

Key findings

The median age of 21 patients (13 males and 8 females) was 31 years (range 0.13–76). The median time for liver injury was 19 days (range 3–120). The clinical manifestations of patients ranged from asymptomatic elevated liver enzymes in 5 patients (23.8%) to fever, digestive system symptoms and skin rash in 16 patients (76.2%). The median values of alanine aminotransferase and aspartate aminotransferase were 773 IU/L (range 60–4800) and 667.5 IU/L (range 53–10 387), respectively. Liver biopsy demonstrated hepatocellular necrosis. The liver function returned to normal at a median time of 9 days (range 2–270) after discontinuation of LEV.

Conclusions

LEV-induced liver injury is a rare adverse reaction, ranging from asymptomatic elevated transaminases to fulminant liver failure. Patients receiving long-term treatment with LEV should consider monitoring liver function.
Compound Heterozygous VPS13A Variants in a Patient with Neuroacanthocytosis: A Case Report and Review of the Literature
Authors: Kim Aryun , Chae Hee-Yun , Park Hee Sue
Published: December 2021

Chorea-acanthocytosis (ChAc) is a rare autosomal recessive neurodegenerative disorder caused by pathogenic variants of the vacuolar protein sorting 13A (VPS13A). Only a few patients with ChAc have been reported to date, and the variant spectrum of VPS13A has not been completely elucidated. We describe the case of a 36-year-old woman who had been experiencing orofacial dyskinesia since age 30 years. In a genetic study using next-generation sequencing, 2 variants of VPS13A, the nonsense variant c.4411C>T (p.Arg1471Ter) and the splicing variant c.145-2A>T, were identified. The splicing variant c.145-2A>T was newly classified as a pathogenic variant through a literature review. Consequently, the patient was diagnosed with ChAc based on the typical clinical manifestations, laboratory findings, and imaging results.
Modelling Ceteris Paribus Preferences with Deontic Logic
Authors: Loreggia Andrea , Lorini Emiliano , Sartor Giovanni
Published: December 2021

We present a formal semantics for deontic logic based on the concept of ceteris paribus preferences. We introduce notions of unconditional obligation and permission as well as conditional obligation and permission that are interpreted relative to this semantics. We show that these notions satisfy some intuitive properties and, at the same time, do not encounter some problems and paradoxes that have been extensively discussed in the deontic logic literature. We prove that the satisfiability problem for our logic is in NP. Finally, we show that the fragment of our logic in which the content of a deontic operator is a literal has an equivalent representation based on conditional preference networks (CP-nets).
Stars in the local galactic thick disc and halo in Gaia EDR3: a catalogue of half a million local main-sequence stars with photometric metallicities
Authors: Kim Bokyoung , Lépine Sebastien
Published: December 2021

We present a catalogue of 551 214 main-sequence stars in the local (d < 2 kpc) Galactic thick disc and halo, based on a search of stars with large proper motions ($\mu _{\rm tot} \gt 40.0~\rm mas\, yr^{-1}$) in the Gaia Early Data Release 3. We derive photometric metallicity calibrated from the colour–luminosity–metallicity distribution of 20 047 stars with spectroscopic metallicities, collected from various spectroscopic surveys, including SDSS SEGUE/APOGEE, GALAH DR3, and LAMOST DR6. We combine these results to construct an empirical colour–magnitude–metallicity grid, which can be used to estimate photometric metallicities for low-mass metal-poor stars of K and M subtypes from their absolute G magnitude and colour values. We find that low-mass, high-velocity stars in our catalogue share similar kinematics as reported in recent studies of more luminous Galactic halo stars. The pseudo-kinematic analysis of our sample recovers the main local halo structures, including the Gaia–Enceladus Stream and the Helmi stream; aside from these, the local halo stars appear to show a remarkably smooth distribution in velocity space. Since the future Gaia data release will provide radial velocity measurements for only a small number of our sample, our catalogue provides targets of high interest for the future spectroscopic observation programs.
Second-generation star formation in globular clusters of different masses
Authors: Yaghoobi A , Calura F , Rosdahl J , Haghi H
Published: December 2021

By means of three-dimensional hydrodynamical simulations, we investigate the formation of second-generation (SG) stars in young globular clusters of different masses. We consider clusters with a first generation of asymptotic giant branch (AGB) stars with mass 105 and $10^6\, \mathrm{M}_{\odot }$ moving at constant velocity through a uniform gas with density 10−24 and 10−23 g cm−3. Our set-up is designed to reproduce the encounter of a young cluster with a reservoir of dense gas, e.g. during its orbital motion in the host galaxy. In the low-density models, as a result of the cooling AGB ejecta which collect in the centre, weakly perturbed by the external ram pressure, a compact central He-rich SG stellar component is formed on a time-scale which decreases with increasing initial cluster mass. Our high-density models are subject to stronger ram pressure, which prevents the accumulation of the most He-rich AGB ejecta in the cluster centre. As a result, the SG is more extended and less He-enhanced than in the low-density models. By combining our results with previous simulations, we are able to study relevant, cluster-related scaling relations across a dynamical range of two orders of magnitude in mass (from $10^5 $ to $10^7 \, \mathrm{M}_{\odot }$). In agreement with current observationally based estimates, we find positive correlations between the SG-to-total number ratio and maximum He enhancement in SG stars as a function of the initial cluster mass.
Introducing the thesan project: radiation-magnetohydrodynamic simulations of the epoch of reionization
Authors: Kannan R , Garaldi E , Smith A , Pakmor R , Springel V , Vogelsberger M , Hernquist L
Published: December 2021

We introduce the thesan project, a suite of large volume ($L_\mathrm{box} = 95.5 \, \mathrm{cMpc}$) radiation-magnetohydrodynamic simulations that simultaneously model the large-scale statistical properties of the intergalactic medium during reionization and the resolved characteristics of the galaxies responsible for it. The flagship simulation has dark matter and baryonic mass resolutions of $3.1 \times 10^6\, {\rm M_\odot }$ and $5.8 \times 10^5\, {\rm M_\odot }$, respectively. The gravitational forces are softened on scales of 2.2 ckpc with the smallest cell sizes reaching 10 pc at z = 5.5, enabling predictions down to the atomic cooling limit. The simulations use an efficient radiation hydrodynamics solver (arepo-rt) that precisely captures the interaction between ionizing photons and gas, coupled to well-tested galaxy formation (IllustrisTNG) and dust models to accurately predict the properties of galaxies. Through a complementary set of medium resolution simulations we investigate the changes to reionization introduced by different assumptions for ionizing escape fractions, varying dark matter models, and numerical convergence. The fiducial simulation and model variations are calibrated to produce realistic reionization histories that match the observed evolution of the global neutral hydrogen fraction and electron scattering optical depth to reionization. They also match a wealth of high-redshift observationally inferred data, including the stellar-to-halo-mass relation, galaxy stellar mass function, star formation rate density, and the mass–metallicity relation, despite the galaxy formation model being mainly calibrated at z = 0. We demonstrate that different reionization models give rise to varied bubble size distributions that imprint unique signatures on the 21 cm emission, especially on the slope of the power spectrum at large spatial scales, enabling current and upcoming 21 cm experiments to accurately characterize the sources that dominate the ionizing photon budget.
Cigarette Price Increases, Advertising Ban, and Pictorial Warnings as Determinants of Youth Smoking Initiation in Poland
Authors: Stoklosa Michal , Pogorzelczyk Katarzyna , Balwicki Łukasz
Published: December 2021

Introduction

Europe’s Beating Cancer Plan aims to create a “Tobacco-Free Generation” by 2040. To generate meaningful public health policy to achieve this target, we must understand more clearly the determinants of youth smoking initiation.

Aims and Methods

We examine the determinants of cigarette-smoking initiation in Poland using survival analysis techniques and data from four youth smoking surveys: the 2003, 2009, and 2016 Global Youth Tobacco Surveys (GYTS) and the 2019 PolNicoYouth survey (number of person-period observations N = 164 807). Split-population duration models are employed. The hazard of smoking initiation is modeled as a function of cigarette prices, nonprice tobacco-control measures, and socioeconomic variables.

Results

Our study finds a negative and significant relationship between cigarette prices and the hazard of smoking initiation in all models (hazard ratio from 0.86 to 0.91). Lower hazards of smoking initiation were also associated with a comprehensive advertising ban (hazard ratio from 0.69 to 0.70) and with the introduction of pictorial warnings (hazard ratio from 0.65 to 0.68).

Conclusions

This study concludes that cigarette price increases, such as from higher cigarette excise taxes, could further significantly reduce cigarette youth smoking initiation in Poland. Removing promotional and advertising elements from cigarette packs and making the health warning more noticeable through plain packaging laws would further accelerate the reduction in smoking initiation.

Implications

The European Union is currently formally reconsidering the Tobacco Tax Directive. This makes this analysis of the impact of cigarette prices on youth smoking initiation both timely and germane. As ever more countries implement standardized cigarette packaging, findings here provide support for this measure that removes advertising elements from the packs and makes the health warning more noticeable.
Skilled Nursing Facility Organizational Characteristics Are More Strongly Associated With Multiparticipant Therapy Provision Than Patient Characteristics
Authors: Prusynski Rachel A , Pradhan Sujata , Mroz Tracy M
Published: December 2021

Objectives

Multiparticipant physical and occupational therapy provision has fluctuated significantly in skilled nursing facilities (SNFs) under shifts in Medicare reimbursement policy. Multiparticipant therapy includes group (2–6 individuals per therapist) and concurrent therapy (2 individuals per therapist). This study uses recent patient-level data to characterize multiparticipant therapy provision in SNFs to help anticipate shifts under new Medicare policy and the COVID-19 pandemic.

Methods

This secondary analysis used data on 1,016,984 post-acute rehabilitation stays in SNFs in 2018. This analysis identified patient predictors (eg, demographic, clinical) and organizational predictors (eg, ownership, quality, staffing) of receiving multiparticipant therapy using mixed-effects logistic regression. Among individuals who received any multiparticipant therapy, those patient or facility factors associated with high rates of multiparticipant therapy provision were also determined.

Results

Less than 3% of individuals received multiparticipant therapy in 2018. Patient functional and cognitive impairment and indicators of market regulation were associated with lower odds of multiparticipant therapy. Effect sizes for organizational factors associated with multiparticipant therapy provision were generally larger compared with patient factors. High multiparticipant therapy provision was concentrated in <2% of SNFs and was positively associated with for-profit ownership, contract staffing, and low 5-star quality ratings.

Conclusion

SNF organizational characteristics tended to have stronger associations with multiparticipant therapy provision than patient factors, suggesting that changes in patient case-mix, as expected during the COVID-19 pandemic, may have less of an impact on multiparticipant therapy provision than organizational factors. Results suggest that for-profit SNFs in states with higher market regulation, SNFs providing high volumes of therapy, and SNFs utilizing high proportions of assistants and contract staff may be more responsive to Medicare policy by increasing multiparticipant therapy provision.

Impact

This study may help identify SNFs that are more likely to increase multiparticipant therapy provision under new Medicare payment policy.
Multidimensional Development and Adaptive Behavioral Functioning in Younger and Older Children With Rett Syndrome
Authors: Wang Shih-Ya , Lee Wang-Tso , Shieh Jeng-Yi , Huang Yen-Hsun , Wong Lee-Chin , Tsao Chih-Hsuan , Chiu Yi-Lun , Wu Yen-Tzu
Published: December 2021

Objective

The purpose of this study was to examine clinical severity, multidimensional development, and adaptive behavioral functioning in younger and older children with Rett syndrome (RTT) in the pseudostationary stage (stage III).

Methods

Fourteen younger (≤10 years of age) and 15 older (11–18 years of age) children with confirmed stage III RTT (assigned to young-RTT and old-RTT groups, respectively) participated in this study. Clinical severity was determined using the Clinical Severity Score (CSS) scale for RTT. The children’s cognitive, language, motor, and sociocommunicative development was assessed using the Mullen Scales of Early Learning (MSEL) and the Early Social Communication Scale (ESCS). Their adaptive behavioral and daily functional skills were assessed using the Vineland Adaptive Behavior Scales-Chinese version (VABS-C) and Pediatric Evaluation of Disability Inventory-Chinese version (PEDI-C).

Results

Compared with the young-RTT group, the old-RTT group had higher severity of scoliosis on the CSS scale, poorer fine motor scores on the MSEL, reduced eye contact, reduced alternating eye gaze, and reduced turn-taking during social interaction on the ESCS. However, none of the VABS-C or PEDI-C subscale scores differed significantly between the groups. Higher CSSs were significantly correlated with lower scores in several subscales of MSEL, ESCS, VABS-C, and PEDI-C, especially for gross motor, mobility, and socialization functioning in all children with RTT.

Conclusion

Age-related differences in fine motor and sociocommunicative skills were observed between the young-RTT and old-RTT group, as measured using standardized assessments. Greater severity of RTT was correlated with poor motor, sociocommunicative, adaptive behavioral, and daily functional skills in stage III RTT.

Impact

Practitioners should be aware of clinical severity and the differences of developmental and adaptive behavioral functioning between younger and older children in the pseudostationary stage of RTT to provide specific age-related treatments.

Lay Summary

With an understanding of severity and differences of developmental and adaptive behavioral functioning between younger and older children, clinical professionals can provide specific age-related treatments.
An Information-based Theory of Financial Intermediation
Authors: Bethune Zachary , Sultanum Bruno , Trachter Nicholas
Published: December 2021

We build a theory of financial intermediation based on the premise that some investors are better able to figure out the trade motives of their counterparties in bilateral meetings—screening experts. We solve for the equilibrium market structure and study how information asymmetries stemming from heterogeneity in screening expertise shape up the core–periphery trade structure. In particular, the core of the market is populated by screening experts: they have the largest share of trade volume, they are actively engaged in middleman activity, and trade with the most counterparties. Using transaction-level micro-data and information disclosure requirements, we provide extensive evidence consistent only with our theory of financial intermediation.
The occurrence of multiple treatment switches in axial spondyloarthritis. Results from five Nordic rheumatology registries
Authors: Di Giuseppe Daniela , Lindström Ulf , Aaltonen Kalle , Relas Heikki , Provan Sella , Gudbjornsson Bjorn , Hetland Merete Lund , Askling Johan , Kauppi Markku , Geirsson Arni Jon , Chatzidionysiou Katerina , Jørgensen Tanja Schjødt , Dreyer Lene , Michelsen Brigitte , Jacobsson Lennart , Glintborg Bente
Published: December 2021

Objectives

In axial spondyloarthritis (axSpA), switching between multiple biologic or targeted synthetic (b/ts-) DMARDs might indicate difficult-to-treat disease. We aimed to explore the occurrence of multiple switching in routine care axSpA patients using various definitions, and to identify associated clinical characteristics upon start of first b/tsDMARD (baseline).

Methods

Observational cohort study including patients with axSpA starting a first-ever b/tsDMARD 2009–2018 based on data from five biologic registries (Denmark/Sweden/Finland/Norway/Iceland). Comorbidities and extra-articular manifestations were identified through linkage to national registries. Multi-switching was defined in overlapping categories according to b/tsDMARD treatment history: treatment with ≥3, ≥4 or ≥5 b/tsDMARDs during follow-up. We explored the cumulative incidence of patients becoming multi-switchers with ≥3 b/tsDMARDs stratified by calendar-period (2009–2011, 2012–2013, 2014–2015, 2016–2018). In the subgroup of patients starting a first b/tsDMARD 2009–2015, baseline characteristics associated with multi-switching (within 3 years’ follow-up) were explored using multiple logistic regression analyses.

Results

Among 8398 patients included, 6056 patients (63% male, median age 42 years) started a first b/tsDMARD in 2009–2015, whereof proportions treated with ≥3, ≥4 or ≥5 b/tsDMARDs within 3 years’ follow-up were 8%, 3% and 1%, respectively. Calendar-period did not affect the cumulative incidence of multi-switching. Baseline characteristics associated with multi-switching (≥3 b/tsDMARDs) were female gender, shorter disease duration, higher patient global score, comorbidities and having psoriasis but not uveitis.

Conclusion

In this large Nordic observational cohort of axSpA patients, multiple switching was frequent with no apparent time-trend. Clinical associated factors included gender, but also previous comorbidities and extra-articular manifestations illustrating the ongoing challenge of treating this patient group.
Using Information Theory to Detect Rogue Taxa and Improve Consensus Trees
Authors: Smith Martin R
Published: December 2021

“Rogue” taxa of uncertain affinity can confound attempts to summarize the results of phylogenetic analyses. Rogues reduce resolution and support values in consensus trees, potentially obscuring strong evidence for relationships between other taxa. Information theory provides a principled means of assessing the congruence between a set of trees and their consensus, allowing rogue taxa to be identified more effectively than when using ad hoc measures of tree quality. A basic implementation of this approach in R recovers reduced consensus trees that are better resolved, more accurate, and more informative than those generated by existing methods. [Consensus trees; information theory; phylogenetic software; Rogue taxa.]
Worrying levels of antimicrobial resistance in Gram-negative bacteria isolated from cell phones and uniforms of Peruvian intensive care unit workers
Authors: Ymaña Barbara , Luque Nestor , Ruiz Joaquim , Pons Maria J
Published: December 2021

Background

Healthcare worker (HCW) uniforms and cell phones are involved in pathogen transmission. This study aimed to characterize pathogenic microorganism isolates from HCW uniforms and cell phones.

Methods

Gram-negative microorganisms were recovered from HCW uniforms and cell phones. Antimicrobial susceptibility and the presence of extended-spectrum β-lactamases (ESBL) and carbapenemases were determined.

Results

Escherichia coli was the most prevalent microorganism. Overall, high levels of resistance to cephalosporins, quinolones, co-trimoxazole and colistin were found. ESBL were mainly related to blaCTX-M-15 and blaSHV- genes. Carbapenem-resistant isolates presented as blaKPC or blaNDM.

Conclusions

High levels of antimicrobial resistance, including colistin, were detected. Therefore, strategies are urgently needed to prevent bacterial dissemination.
Postural orthostatic tachycardia syndrome
Authors: Cline Holly M. , Einhardt Adam
Published: December 2021

Postural orthostatic tachycardia syndrome is an underdiagnosed disorder of the autonomic nervous system. The median time to achieve correct diagnosis is 2 years and may take more than 10 years for some patients. Symptoms can be devastating to the daily life of patients and can result in long-term disability. Treatment availability is limited due to the need for further studies.
CircCDK1 knockdown reduces CDK1 expression by targeting miR-489-3p to suppress the development of breast cancer and strengthen the sensitivity of Tamoxifen
Authors: Liu Di , Zhou Zhangjian , Guo Yize , Du Qin , Li Liang
Published: December 2021

Circular RNAs (circRNAs) are implicated with the progression of multiple cancers, including breast cancer. Besides, circRNA dysregulation is involved in the chemoresistance of cancer development. This study aimed to investigate the role of circRNA-cyclin dependent kinase 1 (circCDK1) in breast cancer. Quantitative real-time PCR (qPCR) and western blot were applied for expression analysis. Cell viability was determined by the cell counting kit-8 (CCK-8). Cell proliferation was evaluated by CCK-8, colony formation and 5-ethynyl-2’-deoxyuridine assays. Cell apoptosis was assessed by flow cytometry and the activities of caspase3 and caspase9. The potential binding between miR-489-3p and circCDK1 or CDK1 was verified by RNA immunoprecipitation assay, dual-luciferase reporter assay and pull-down assay. Animal models were constructed to explore the role of circCDK1 in vivo. CircCDK1 was overexpressed in Tamoxifen-resistant breast cancer cells, LCC2 and LCC9. The expression of circCDK1 in tumor tissues with Tamoxifen resistance was higher than that in tissues without Tamoxifen resistance. CircCDK1 knockdown strengthened the sensitivity of Tamoxifen in LCC2 and LCC9 cells and reduced Tamoxifen IC50. The downregulation of circCDK1 inhibited LCC2 andLCC9 cell proliferation and promoted cell apoptosis. CDK1 was the parent gene of circCDK1 and circCDK1 positively regulated CDK1 expression by targeting miR- 489-3p. CDK1 overexpression reversed the effects of circCDK1 knockdown. MiR-489-3p inhibition also reversed the effects of circCDK1 knockdown. CircCDK1 knockdown was verified to enhance Tamoxifen sensitivity in animal models. CircCDK1 knockdown enhanced the sensitivity of Tamoxifen in breast cancer cells and suppressed cell growth and survival by depleting CDK1 expression via releasing miR- 489-3p.
Associations of mid-childhood bisphenol A and bisphenol S exposure with mid-childhood and adolescent obesity
Authors: Gajjar Priya , Liu Yun , Li Nan , Buckley Jessie P. , Chen Aimin , Lanphear Bruce P. , Kalkwarf Heidi J. , Cecil Kim M. , Yolton Kimberly , Braun Joseph M.
Published: December 2021

Background:

Bisphenol A (BPA) is a suspected obesogen that has been associated with adiposity in children. Bisphenol S (BPS), a structural analog of BPA, is used as a BPA substitute and may have similar health effects as BPA. However, few studies have examined whether BPS is associated with childhood adiposity.

Methods:

We quantified urinary BPA and BPS concentrations in 212 children age 8 years from the HOME Study, a prospective pregnancy and birth cohort study that enrolled pregnant women in Cincinnati, Ohio (2003–2006). We assessed children’s adiposity by bioelectric impedance at age 8 years (n = 212), and by anthropometry and dual-energy X-ray absorptiometry at age 12 years (n = 181). We measured serum adipocytokine concentrations at age 12 years (n = 155). Using multivariable linear regression, we estimated covariate-adjusted associations of BPA and BPS with adiposity measures at ages 8 and 12 years and adipocytokine concentrations at age 12 years.

Results:

Each 10-fold increase in urinary BPA concentrations were inversely associated with percent body fat at age 8 years [β = −1.2, 95% confidence interval (CI) = −3.4, 1.0] and 12 years (β = −1.6, 95% CI = −4.0, 0.9). In contrast, urinary BPS concentrations were positively associated with percent body fat at age 8 years (β = 1.1, 95% CI = −0.6, 2.7), but not at 12 years (β = 0.1, 95% CI = −1.7, 1.8). Urinary BPA and BPS concentrations were not associated with serum adiponectin or leptin concentrations.

Conclusions:

We did not observe evidence that urinary BPA or BPS concentrations during childhood were associated with greater child adiposity at ages 8 and 12 years in this cohort.
Technique to Fix the Stubborn Deviated Caudal Septum with an Internal Bone Graft Splint
Authors: Gelidan Adnan G.
Published: December 2021

Background:

Septoplasty, especially of the caudal portion, during cosmetic rhinoplasty is a crucial step in achieving satisfactory straight outcomes for the bony cartilaginous infrastructure and the skin envelope. Many methods are available, which range from septal mucosal resection to internal splinting by bone in a batten fashion; a power tool is usually used. This study describes a simple technique using a nonpower tool to correct the stubborn deviated caudal septum, with a thin available bone.

Methods:

Patients who underwent cosmetic open septorhinoplasty for crooked nose deformity and did not respond to the traditional septoplasty techniques were included. Bony splint was harvested from the bony septum and fixed to the caudal septum using an 18-gauge needle to create holes to fix the bony splint to the caudal septum through horizontal matrix sutures to correct septal deviation.

Results:

Six rhinoplasty patients who had significant caudal septal deviation and did not respond to the traditional techniques of septoplasty were included in this study. The patients were successfully treated by using an internal bony batten splint to correct the deviation. No postoperative complications were noted, and none of the patients required a revision surgery.

Conclusions:

Bony batten graft is not a new concept. It involves correcting the resistant caudal septum deviation by splinting it internally by using power tools and drills to create the holes to fix the bony splint graft. Using an 18-gauge needle to drill the hole is a simple, quick, and effective technique to correct and straighten the septum for resistant cases.
Methods of Sentinel Lymph Node Identification in Auricular Melanoma
Authors: Noorbakhsh Seth , Papageorge Marianna , Maina Renee M. , Baumann Raymond , Moores Craig , Weiss Sarah A. , Pucar Darko , Ariyan Stephan , Olino Kelly , Clune James
Published: December 2021

Background:

Sentinel lymph node biopsy is used to evaluate for micrometastasis in auricular melanoma. However, lymphatic drainage patterns of the ear are not well defined and predicting the location of sentinel nodes can be difficult. The goal of this study was to define the lymphatic drainage patterns of the ear and to compare multiple modalities of sentinel node identification.

Methods:

A retrospective review of a prospectively maintained database evaluated 80 patients with auricular melanoma who underwent sentinel lymph node biopsy by comparing preoperative imaging with intraoperative identification of sentinel nodes. Patients were placed into two cohorts, based on the modality of preoperative imaging: (1) planar lymphoscintigraphy only (n = 63) and (2) single-photon emission computerized tomography combined with computerized tomography (SPECT-CT) only (n = 17). Sites of preoperative mapping and sites of intraoperative identification were recorded as parotid/preauricular, mastoid/postauricular, and/or cervical.

Results:

In patients that underwent planar lymphoscintigraphy preoperatively (n = 63), significantly more sentinel nodes were identified intraoperatively than were mapped preoperatively in both the parotid/preauricular (P = 0.0017) and mastoid/postauricular (P = 0.0047) regions. Thirty-two nodes were identified intraoperatively that were not mapped preoperatively in the planar lymphoscintigraphy group (n = 63), two of which were positive for micrometastatic disease. In contrast, there were no discrepancies between preoperative mapping and intraoperative identification of sentinel nodes in the SPECT-CT group (n = 17).

Conclusions:

SPECT-CT is more accurate than planar lymphoscintigraphy for the preoperative identification of draining sentinel lymph nodes in auricular melanoma. If SPECT-CT is not available, planar lymphoscintigraphy can also be used safely, but careful intraoperative evaluation, even in basins not mapped by lymphoscintigraphy, must be performed to avoid missed sentinel nodes.
Short-term Efficacy and Safety of Biological Tear Substitutes and Topical Secretagogues for Dry Eye Disease: A Systematic Review and Network Meta-analysis
Authors: Jongkhajornpong Passara , Anothaisintawee Thunyarat , Lekhanont Kaevalin , Numthavaj Pawin , McKay Gareth , Attia John , Thakkinstian Ammarin
Published: December 2021

Purpose:

The purpose of this study was to assess short-term efficacy and safety of tear promotion eye drops (biological tear substitutes and topical secretagogues) for treating dry eye disease.

Methods:

Randomized controlled trials comparing short-term effects of biological tear substitutes or topical secretagogues versus placebo or other topical dry eye treatments in adults with dry eye disease were identified from the MEDLINE, Embase, Scopus, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform databases. Pairwise meta-analysis and network meta-analysis were performed. Outcomes were ocular symptoms, ocular surface staining, tear break-up time, Schirmer test, and adverse events. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations approach.

Results:

Thirty-nine randomized controlled trials (3693 patients) were eligible. Using artificial tears as a reference, autologous platelet lysate was the most effective treatment for lowering ocular surface disease index (unstandardized mean difference [USMD] −31.85; 95% confidence interval [CI]: −43.19 to −20.51) and platelet rich plasma showed the most reduction in corneal fluorescein staining scores (standardized mean difference −2.52; 95% CI: −3.23 to −1.82). Cord blood serum was the most effective treatment for increasing tear break-up time (USMD 2.67; 95% CI: 0.53–4.82), and eledoisin was superior to others in improving Schirmer scores (USMD 2.28; 95% CI: 0.14–4.42). Most interventions did not significantly increase ocular adverse events compared with artificial tears.

Conclusions:

Biological tear substitutes, including autologous serum, autologous platelet lysate, platelet rich plasma, and cord blood serum, might be the most effective treatment among tear promotion eye drops in relieving dry eye symptoms without increasing adverse events. However, there remains uncertainty around these findings because of low/very low certainty of evidence.
Can We Reduce Overtreatment of Cervical High-Grade Squamous Intraepithelial Lesions?
Authors: Bradbury Melissa , Rabasa Jordi , Murcia Maria Teresa , Dinarès Maria Carme , Sainz Alex , Castellet Cristina , Pérez-Benavente Assumpció , Gil-Moreno Antonio , Centeno Cristina
Published: December 2021

Objective

The aim was to evaluate the cytology, colposcopic, and pathological factors associated with the absence of high-grade squamous intraepithelial lesion (HSIL)/cervical intraepithelial neoplasia (CIN) 2–3 lesion on loop electrosurgical excision procedure (LEEP) specimens in women with high-grade cytology and/or HSIL/CIN 2–3 biopsy and the risk of disease persistence/recurrence.

Materials and Methods

Two-center retrospective study of women undergoing LEEP for high-grade cervical disease between January 2014 and December 2019. Clinical, cytology, colposcopy, and pathology results were evaluated to identify independent predictive factors associated with CIN 1/negative LEEP results. Univariate and multivariate logistic regression models were performed. Follow-up data was evaluated to assess the risk of HSIL/CIN 2–3 persistence/recurrence.

Results

Six hundred thirty-nine of 801 women (79.8%) had high-grade cytology and 631 (78.8%) HSIL/CIN 2–3 biopsy. High-risk human papillomavirus test was positive in 98% of women. Loop electrosurgical excision procedure specimen showing CIN 1 or less was found in 27%–31%. Normal/low-grade colposcopy (odds ratio [OR] = 2.17, CI = 1.39–3.39, p = .001) and CIN 1/negative biopsy (OR = 3.25, CI = 2.12–4.99, p < .001) were predictors of negative/CIN 1 LEEP result in women with high-grade cytology. Normal/low-grade cytology (OR = 1.77, CI = 1.19–2.64, p = .005), normal/low-grade colposcopy (OR = 1.66, CI = 1.11–2.49, p = .013), and CIN 2 biopsy (OR = 2.75, CI = 1.73–4.39, p < .001) were predictors in women with HSIL/CIN 2–3 biopsy. Women with a negative/CIN 1 LEEP had lower recurrence/persistence than those with confirmed HSIL/CIN 2–3(1 vs 31, p = .002). Positive endocervical margin (OR = 2.85, CI = 1.10–7.36, p = .03) and high-risk human papillomavirus persistence (OR = 41.3, CI = 16–106.7, p < .01) were predictors of HSIL/CIN 2–3 persistence/recurrence.

Conclusions

A CIN 1/negative LEEP specimen in women with high-grade cytology and/or HSIL/CIN 2–3 biopsy is associated with negative/low-grade cytology, normal/low-grade colposcopic findings and CIN 2 biopsy result before treatment. The HSIL/CIN 2–3 disease persistence/recurrence is low when LEEP specimen does not confirm HSIL/CIN 2–3.