bluuebunny/crossref_metadata_2025 huggingface dataset:
Recovering Frequencies of Known Haplotype Blocks From Single-Nucleotide Polymorphism Allele Frequencies
Authors: Pe’er Itsik , Beckmann Jacques S
Published: April 2021

Prospects for large-scale association studies rely on economical methods and powerful analysis. Representing available SNPs by small subsets and measuring allele frequencies on pooled DNA samples each improve genotyping cost effectiveness, while haplotype analysis may highlight associations in otherwise underpowered studies. This manuscript provides the mathematical framework to integrate these methodologies.
Association of Vaginal Microbiota With Signs and Symptoms of the Genitourinary Syndrome of Menopause Across Reproductive Stages
Authors: Shardell Michelle , Gravitt Patti E , Burke Anne E , Ravel Jacques , Brotman Rebecca M
Published: April 2021

The genitourinary syndrome of menopause (GSM) describes signs and symptoms resulting from effects of estrogen deficiency on the female genitourinary tract, including the vagina, labia, urethra, and bladder. Signs/symptoms associated with GSM may occur during any reproductive stage from multiple etiologies but are most common during menopause due to low estrogen. Vaginal microbiota, particularly Lactobacillus spp., are beneficial to the female genital tract; however, their abundance declines during menopause. We aimed to longitudinally assess vaginal microbiota characterized by 16S rRNA gene amplicon sequencing and GSM-associated endpoints across reproductive stages. In a 2-year cohort study of 750 women aged 35–60 years at enrollment and 2 111 semiannual person-visits, low-Lactobacillus vaginal microbiota communities were observed at 21.2% (169/798), 22.9% (137/597), and 49.7% (356/716) of person-visits among pre-, peri-, and postmenopausal women, respectively (p < .001). Compared to communities that have high Gardnerella vaginalis relative abundance and diverse anaerobes, the following communities were associated with a lower covariate-adjusted odds of vaginal atrophy: L crispatus-dominated communities among postmenopausal women (odds ratio [OR] = 0.25; 95% confidence interval [CI]: 0.08, 0.81), L gasseri/L jensenii (OR = 0.21; 95% CI: 0.05, 0.94) and L iners (OR = 0.21; 95% CI: 0.05, 0.85) among perimenopausal women, and L iners-dominated communities (OR = 0.18; 95% CI: 0.04, 0.76) among premenopausal women. Postmenopausal women with L gasseri/L jensenii-dominated communities had the lowest odds of vaginal dryness (OR = 0.36; 95% CI: 0.12, 1.06) and low libido (OR = 0.28; 95% CI: 0.10, 0.74). Findings for urinary incontinence were inconsistent. Associations of vaginal microbiota with GSM signs/symptoms are most evident after menopause, suggesting an avenue for treatment and prevention.
Diagnoses of Chronic Health Conditions and Change in Subjective Age: The Moderating Role of Chronological Age
Authors: Prasad Anyah , Miller Edward Alan , Burr Jeffrey A , Boerner Kathrin
Published: April 2021

Background and Objectives

Health is a predictor of subjective age, and although inconclusive, the strength of this association is not uniform across different age groups. This study investigates if new diagnoses of chronic health conditions are associated with a change in subjective age and if chronological age moderates this relationship.

Research Design and Methods

Using data from the Health and Retirement Study, residualized change regression analysis was performed for a sample of 5,158 respondents older than 50 years to examine their subjective age in 2014 relative to that reported in 2010. The main predictor was the number of chronic health conditions newly diagnosed between 2010 and 2014. Chronological age in 2010 was the moderator.

Results

Results showed that each new diagnosis of a chronic health condition was significantly associated with a 0.68-year increase in subjective age reported in 2014, compared to subjective age reported in 2010. However, this increase in subjective age was attenuated by 0.05 years for each additional year in 2010 chronological age.

Discussion and Implications

According to Social and Temporal Comparison theories, people compare themselves to their age peers and earlier selves. Given expectations for better health at younger chronological ages, being diagnosed with chronic health conditions may have a stronger association with subjective age among middle-aged persons when compared with older persons. The findings suggest that subjective age may be used as a screening tool to predict how chronic disease diagnosis may influence peoples’ sense of self, which in turn shapes future health.
Lamellar magnetism and exchange bias in billion-year-old metamorphic titanohematite with nanoscale ilmenite exsolution lamellae – III. Atomic-magnetic basis for experimental results
Authors: Robinson Peter , McEnroe S A , Harrison R J , Fabian K , Heidelbach F , Jackson M
Published: April 2021

Lamellar magnetism is a source of remanent magnetization in natural rocks different from common bulk magnetic moments in ferrimagnetic minerals. It has been found to be a source for a wide class of magnetic anomalies with extremely high Koenigsberger ratio. Its physical origin are uncompensated interface moments in contact layers of nanoscale ilmenite lamellae inside an hematite host, which also generate unusual low-temperature (low-T) magnetic properties, such as shifted low-T hysteresis loops due to exchange bias.

The atomic-magnetic basis for the exchange bias discovered in the hematite-ilmenite system is explored in a series of papers. In this third article of the series, simple models are developed for lamellae interactions of different structures when samples are either cooled in zero-field, or field-cooled in 5 T to temperatures below the ordering temperature of ilmenite. These models are built on the low-temperature measurements described earlier in Paper II. The important observations include: (i) the effects of lamellar shapes on magnetic coupling, (ii) the high-T acquisition of lamellar magnetism and low-T acquisition of magnetization of ilmenite lamellae, (iii) the intensity of lamellar magnetism and the consequent ilmenite magnetism in populations of randomly oriented crystals, (iv) lattice-preferred orientation of the titanohematite host crystal populations and (v) the effects of magnetic domain walls in the host on hysteresis properties. Based on exemplary growth models of lamellae with different geometries and surface couplings we here provide simple models to assess and explain the different observations listed above. Already the simplified models show that the shapes of the edges of ilmenite lamellae against their hematite hosts can control the degree of low-T coupling between ilmenite, and the lamellar magnetic moments. The models also explain certain features of the low-T exchange bias in the natural samples and emphasize the role of lattice-preferred orientation upon the intensity of remanent magnetization. The inverse link between ilmenite remanence and exchange-bias shift in bimodal low-T ilmenite lamellae is related to different densities of hematite domain walls induced by the clusters of ilmenite lamellae.
Disequilibrium macroeconometrics
Authors: Juselius Katarina
Published: April 2021

Inspired by the paper by Guzman and Stiglitz (2020, ‘Towards a dynamic disequilibrium theory with randomness,’ NBER Working Paper 27453), this article shows that cointegrated VAR (CVAR) analyses have for many years provided empirical underpinnings for most of the topics discussed in that paper. The CVAR takes the nonstationarity of economic data seriously; it allows explicitly for complex adjustment dynamics in the short run and the long run; it is able to describe self-reinforcing feedback mechanisms leading to multiple equilibria; it is able to handle extraordinary shocks to the system whether they are exogenously or endogenously induced; and it is able to accommodate sizeable crisis periods such as the Great Recession. The article discusses these issues and many more from a methodological, econometric, and empirical point of view and illustrates the ideas with an application to the Phillips curve with a Phelpsian natural rate based on US data.
The pleasure of writing, being published, appealing to readers, and contributing to the advancement of knowledge
Authors: Legendre Louis
Published: April 2021

In this Food for Thought, I use my experience of writing scientific publications to stress some aspects of the process that were especially significant for me, and from which I try to derive some general suggestions. These aspects include strong interactions (co-evolution) between paper writing and some of my research directions; the pleasure of writing with co-authors; writing as a tool of scientific creativity; long scientific quests through several publications; the importance of writing books, if possible starting early in the career; being published, reaching readers, and contributing to the advancement of knowledge; and giving in to the pleasure of writing. I explain that I often seized unexpected opportunities that led me to develop ideas and write publications that influenced the course of my career, but I do not necessarily suggest that anyone proceed as I did. My motivation was the enjoyment of exploring new topics, and I wholeheartedly recommend that everyone give in to the pleasure of writing.
New modeling approach for 4D printing by using kinetic components
Authors: Choi Woorim , Kim Dahong , Lee Sungjae , Lee Yong-Gu
Published: April 2021

The use of smart materials in three-dimensional (3D) printing incorporates a temporal dimension to the printed object in a technique that is aptly named four-dimensional (4D) printing. In most 4D designs, the smart material is used for the whole body of the object and the final configurations can be predicted with the aid of simulations. The motions of smart materials are non-linear and computationally expensive to predict even through advanced numerical solvers. To enable the ease of integration of smart materials to 3D printing, we introduce (i) standardized kinetic components made of smart materials that exhibit basic mechanical motions, such as bending and twisting, to be used as active components for mechanical assemblies with rigid parts; (ii) an open kinetic library concept where anyone can download data on kinetic components to use in their designs, as well as upload and share their own; and (iii) simulations based on the empirical method using the kinetic components in the assembly. We provide two design implementations that utilize the standardized kinetic components: an icosahedron and a mounting platform.
An empirical study of large, human biobanks: intellectual property policies and financial conditions for access
Authors: Jordan Matthew , Liddicoat Johnathon , Liddell Kathleen
Published: April 2021

Biobanks are repositories that collect, store and distribute large quantities of biological samples and associated data (collectively called biobank `material'). Although biobanks have different modes of operation, all face a variety of similar challenges. Some of these challenges, such as donor consent and privacy, have been rigorously debated, but comparatively less attention has been paid to biobanks' intellectual property (IP) practices. IP rights (particularly patents) are integral to the translation of research into clinically relevant outcomes and, therefore, are key features in the business models of many biobanks. As a foundation for such research, commentators have identified five IP clauses of interest: (i) non-obstruction clauses; (ii) march-in clauses; (iii) grant-back clauses; (iv) return-of-results clauses and (v) reach-through clauses (also commonly called `reach-through rights'). In the limited literature that discusses the five clauses, commentators have largely debated their advantages and disadvantages in the abstract. The IP terms that biobanks actually use have not been empirically examined, apart from some small case studies. In particular, no industry-wide evidence exists on three points of biobanks' IP practice: (i) if and how biobanks implement these five types of IP clauses, (ii) whether any norms or standards have emerged, and (iii) whether the norms and standards align with commentators' recommendations for using the five IP clauses. To address these three gaps, the authors conducted a systematic, global survey of the IP clauses used by large, human biobanks. The results indicate that biobanks draft bespoke policies to meet their own needs, and probably do so without knowledge of the gamut of IP terms available. This study also revealed that, in general, biobanks are using IP terms differently from the advice of the commentators. On reviewing the differences, we encourage the use of march-in and grant-back clauses, discourage biobanks from using redundant non-obstruction clauses, and call for more research on return-of-results clauses. We also encourage the use of reach-through clauses to claim royalties (not IP), but only in limited circumstances; for example, where user access fees do not cover a biobanks' operational costs.
Ecogeographic variation and taxonomic boundaries in Large Treeshrews (Scandentia, Tupaiidae:Tupaia tanaRaffles, 1821) from Southeast Asia
Authors: Juman Maya M , Woodman Neal , Olson Link E , Sargis Eric J
Published: April 2021

The Large Treeshrew, Tupaia tana Raffles, 1821, is a small mammal (~205 g) from Southeast Asia with a complicated taxonomic history. Currently, 15 subspecies are recognized from Borneo, Sumatra, and smaller islands, and many were originally differentiated based on minor pelage differences and small sample sizes. We explored intraspecific variation in T. tana using quantitative osteological data obtained from the hands and skulls of museum specimens. Multivariate analyses reveal extensive overlap among T. tana populations in morphospace, indicating that the majority of currently recognized subspecies are not morphometrically distinct. In contrast, the separation between Bornean and Sumatran populations of T. tana is sufficient to recognize them as different subspecies. Comparisons of Bornean specimens to those on small, offshore islands reveal that the latter average smaller body size. This pattern is inconsistent with Foster’s island rule, which predicts that island populations of small mammals (< 5 kg) will average larger body size relative to mainland forms. A similar lack of support for ecogeographic rules has been noted in T. glis (Diard, 1820), suggesting that these “rules” are poor predictors of geographic variation in treeshrews.
Primary localized amyloidosis causing urethral stricture disease: a mimicker of urothelial carcinoma
Authors: Singh Jas
Published: April 2021

We describe a case of mild lower urinary tract symptoms and microscopic hematuria in a 53-year-old-male with hypertension found to have urethral stricture disease suspicious for urothelial carcinoma. During the investigation, cystoscopy and biopsy demonstrated eosinophilic amyloid proteins consistent with primary localized urethral amyloidosis. No systemic evidence of amyloidosis was demonstrated. Following a trial of conservative management with serial dilatations, the patient elected to proceed with surgical management by anterior urethroplasty using an excision and primary anastomosis technique. The patient has done well with resolution of his symptoms and no further recurrence of urethral amyloid disease at ongoing follow up.
Search for gas accretion imprints in voids: II. The galaxy Ark 18 as a result of a dwarf–dwarf merger
Authors: Egorova Evgeniya S , Egorov Oleg V , Moiseev Alexei V , Saburova Anna S , Grishin Kirill A , Chilingarian Igor V
Published: April 2021

The low-mass low-surface brightness (LSB) disc galaxy Arakelian 18 (Ark 18) resides in the Eridanus void and because of its isolation represents an ideal case to study the formation and evolution mechanisms of such a galaxy type. Its complex structure consists of an extended blue LSB disc and a bright central elliptically shaped part hosting a massive off-centred star-forming clump. We present the in-depth study of Ark 18 based on observations with the SCORPIO-2 long-slit spectrograph and a scanning Fabry–Perot interferometer at the Russian 6-m telescope complemented by archival multiwavelength images and SDSS spectra. Ark 18 appears to be a dark matter dominated gas-rich galaxy without a radial metallicity gradient. The observed velocity field of the ionized gas is well described by two circularly rotating components moderately inclined with respect to each other and a possible warp in the outer disc. We estimated the age of young stellar population in the galaxy centre to be ∼140 Myr, while the brightest star-forming clump appears to be much younger. We conclude that the LSB disc is likely the result of a dwarf–dwarf merger with a stellar mass ratio of the components at least ∼5:1 that occurred earlier than 300 Myr ago. The brightest star-forming clump was likely formed later by accretion of a gas cloud.
Recovering the 21-cm signal from simulated FAST intensity maps
Authors: Yohana Elimboto , Ma Yin-Zhe , Li Di , Chen Xuelei , Dai Wei-Ming
Published: April 2021

The 21-cm intensity mapping (IM) of neutral hydrogen (H i) is a promising tool to probe the large-scale structures. Sky maps of 21-cm intensities can be highly contaminated by various foregrounds, such as Galactic synchrotron radiation, free–free emission, extragalactic point sources, and atmospheric noise. Here we present a model of foreground components and a method of removal, in particular to quantify the potential of the Five-hundred-meter Aperture Spherical radio Telescope (FAST) for measuring H i IM. We consider a 1-yr observational time with a survey area of $20\,000\, {\rm deg}^{2}$ to capture significant variations of the foregrounds across both the sky position and angular scales relative to the H i signal. We first simulate the observational sky and then employ the principal component analysis (PCA) foreground separation technique. We show that by including different foregrounds, and thermal and 1/f noises, the value of the standard deviation between the reconstructed 21-cm IM map and the input pure 21-cm signal is $\Delta T = 0.034\, {\rm mK}$, which is well under control. The eigenmode-based analysis shows that the underlying H i eigenmode is just less than the 1 per cent level of the total sky components. By subtracting the PCA-cleaned foreground + noise map from the total map, we show that PCA method can recover H i power spectra for FAST with high accuracy.
VVV-WIT-08: the giant star that blinked
Authors: Smith Leigh C , Koposov Sergey E , Lucas Philip W , Sanders Jason L , Minniti Dante , Udalski Andrzej , Evans N Wyn , Aguado David , Ivanov Valentin D , Saito Roberto K , Fraga Luciano , Pietrukowicz Pawel , Penoyre Zephyr , González-Fernández Carlos
Published: April 2021

We report the serendipitous discovery of a late-type giant star that exhibited a smooth, eclipse-like drop in flux to a depth of 97 per cent. Minimum flux occurred in 2012 April and the total event duration was a few hundred days. Light curves in V, I, and Ks from the Optical Gravitational Lensing Experiment and VISTA Variables in the Via Lactea surveys show a remarkably achromatic event. During 17 yr of observational coverage of this source only one such event was detected. The physical properties of the giant star itself appear somewhat unusual, which may ultimately provide a clue towards the nature of the system. By modelling the event as an occultation by an object that is elliptical in projection with uniform transparency, we place limits on its physical size and velocity. We find that the occultation is unlikely to be due to a chance alignment with a foreground object. We consider a number of possible candidates for the occulter, which must be optically thick and possess a radius or thickness in excess of 0.25 au. None are completely satisfactory matches to all the data. The duration, depth, and relative achromaticity of the dip mark this out as an exceptionally unusual event, whose secret has still not been fully revealed. We find two further candidates in the VVV survey and we suggest that these systems, and two previously known examples, may point to a broad class of long-period eclipsing binaries wherein a giant star is occulted by a circumsecondary disc.
X-ray spectral components of the blazar and binary black hole candidate OJ 287 (2005–2020)
Authors: Komossa S , Grupe D , Parker M L , Gómez J L , Valtonen M J , Nowak M A , Jorstad S G , Haggard D , Chandra S , Ciprini S , Dey L , Gopakumar A , Hada K , Markoff S , Neilsen J
Published: April 2021

We present a comprehensive analysis of all XMM–Newton spectra of OJ 287 spanning 15 yr of X-ray spectroscopy of this bright blazar. We also report the latest results from our dedicated Swift UVOT and XRT monitoring of OJ 287, which started in 2015, along with all earlier public Swift data since 2005. During this time interval, OJ 287 was caught in extreme minima and outburst states. Its X-ray spectrum is highly variable and encompasses all states seen in blazars from very flat to exceptionally steep. The spectrum can be decomposed into three spectral components: Inverse Compton (IC) emission dominant at low-state, supersoft synchrotron emission that becomes increasingly dominant as OJ 287 brightens, and an intermediately-soft (Γx = 2.2) additional component seen at outburst. This last component extends beyond 10 keV and plausibly represents either a second synchrotron/IC component and/or a temporary disc corona of the primary supermassive black hole (SMBH). Our 2018 XMM–Newton observation, quasi-simultaneous with the Event Horizon Telescope observation of OJ 287, is well described by a two-component model with a hard IC component of Γx = 1.5 and a soft synchrotron component. Low-state spectra limit any long-lived accretion disc/corona contribution in X-rays to a very low value of Lx/LEdd < 5.6 × 10−4 (for MBH, primary = 1.8 × 1010 M⊙). Some implications for the binary SMBH model of OJ 287 are discussed.
Partnering With State Health Departments to Address Injection-Related Infections During the Opioid Epidemic: Experience at a Safety Net Hospital
Authors: Burns Rebecca H , Pierre Cassandra M , Marathe Jai G , Ruiz-Mercado Glorimar , Taylor Jessica L , Kimmel Simeon D , Johnson Samantha L , Fukuda H Dawn , Assoumou Sabrina A
Published: April 2021

Massachusetts is one of the epicenters of the opioid epidemic and has been severely impacted by injection-related viral and bacterial infections. A recent increase in newly diagnosed human immunodeficiency virus (HIV) infections among persons who inject drugs in the state highlights the urgent need to address and bridge the overlapping epidemics of opioid use disorder (OUD) and injection-related infections. Building on an established relationship between the Massachusetts Department of Public Health and Boston Medical Center, the Infectious Diseases section has contributed to the development and implementation of a cohesive response involving ambulatory, inpatient, emergency department, and community-based services. We describe this comprehensive approach including the rapid delivery of antimicrobials for the prevention and treatment of HIV, sexually transmitted diseases, systemic infections such as endocarditis, bone and joint infections, as well as curative therapy for chronic hepatitis C virus in a manner that is accessible to patients on the addiction-recovery continuum. We also provide an overview of programs that provide access to medications for OUD, harm reduction services including overdose education, and distribution of naloxone. Finally, we outline lessons learned to inform initiatives in other settings.
Firsthand and Secondhand Exposure Levels of Maltol-Flavored Electronic Nicotine Delivery System Vapors Disrupt Amino Acid Metabolism
Authors: Jarrell Zachery R , Smith Matthew Ryan , He Xiaojia , Orr Michael , Jones Dean P , Go Young-Mi
Published: April 2021

Electronic nicotine delivery system (ENDS) use has become a popular, generally regarded as safe, alternative to tobacco use. The e-liquids used for ENDS vapor generation commonly contain flavoring agents, such as maltol, which have been subjected to little investigation of their effects on lung health from ENDS usage. In the present study, we examined the impacts of firsthand (3.9 mM) and secondhand (3.9 µM) exposure levels to maltol-flavored ENDS vapors on lung metabolism. Human lung bronchial epithelial cells were exposed to ENDS vapors using a robotic system for controlled generation and delivery of exposures, and the effects on metabolism were evaluated using high-resolution metabolomics. The results show that maltol in e-liquids impacts lung airway epithelial cell metabolism at both firsthand and secondhand exposure levels. The effects of maltol were most notably seen in amino acid metabolism while oxidative stress was observed with exposure to all ENDS vapors including e-liquids alone and maltol-contained e-liquids. Many effects of firsthand exposure were also observed with secondhand exposure, suggesting need for systematic investigation of both firsthand and secondhand effects of flavored ENDS vapors on lung metabolism and risk of lung disease.
Is mimicry a diversification-driver in ants? Biogeography, ecology, ethology, genetics and morphology define a second West-PalaearcticColobopsisspecies (Hymenoptera: Formicidae)
Authors: Schifani Enrico , Giannetti Daniele , Csősz Sándor , Castellucci Filippo , Luchetti Andrea , Castracani Cristina , Spotti Fiorenza A , Mori Alessandra , Grasso Donato A
Published: April 2021

The West-Palaearctic Colobopsis ant populations have long been considered a single species (Colobopsis truncata). We studied the diversity of this species by employing a multidisciplinary approach and combining data from our surveys, museum and private collections, and citizen science platforms. As a result, we have revealed the existence of a second species, which we describe as Colobopsis imitans sp. nov., distributed allopatrically from Co. truncata and living in the Maghreb, Sicily and southern Iberia. While the pigmentation of Co. truncata is reminiscent of Dolichoderus quadripunctatus, that of Co. imitans is similar to Crematogaster scutellaris, with which Co. imitans lives in close spatial association, and whose foraging trails it habitually follows, similar to Camponotus lateralis and other ant-mimicking ants. The isolation between Co. imitans and Co. truncata seems to have occurred relatively recently because of significant, yet not extreme, morphometric differentiation, and to mtDNA polyphyly. Both Co. imitans and Co. truncata appear to employ mimicry of an unpalatable or aggressive ant species as an important defensive strategy; this ‘choice’ of a different model species is motivated by biogeographic reasons and appears to act as a critical evolutionary driver of their diversification.
PHarmacist Avoidance or Reductions in Medical Costs in Patients Presenting the EMergency Department: PHARM-EM Study
Authors: Rech Megan A. , Adams William , Smetana Keaton S. , Gurnani Payal K. , Van Berkel Patel Megan A. , Peppard William J. , Hammond Drayton A. , Flannery Alexander H.
Published: April 2021

Objectives:

To comprehensively classify interventions performed by emergency medicine clinical pharmacists and quantify cost avoidance generated through their accepted interventions.

Design:

A multicenter, prospective, observational study was performed between August 2018 and January 2019.

Setting:

Community and academic hospitals in the United States.

Participants:

Emergency medicine clinical pharmacists.

Interventions:

Recommendations classified into one of 38 intervention categories associated with cost avoidance.

Measurements and Main Results:

Eighty-eight emergency medicine pharmacists at 49 centers performed 13,984 interventions during 917 shifts that were accepted on 8,602 patients and generated $7,531,862 of cost avoidance. The quantity of accepted interventions and cost avoidance generated in six established categories were as follows: adverse drug event prevention (1,631 interventions; $2,225,049 cost avoidance), resource utilization (628; $310,582), individualization of patient care (6,122; $1,787,170), prophylaxis (24; $22,804), hands-on care (3,533; $2,836,811), and administrative/supportive tasks (2,046; $342,881). Mean cost avoidance was $538.61 per intervention, $875.60 per patient, and $8,213.59 per emergency medicine pharmacist shift. The annualized cost avoidance from an emergency medicine pharmacist was $1,971,262. The monetary cost avoidance to pharmacist salary ratio was between $1.4:1 and $10.6:1.

Conclusions:

Pharmacist involvement in the care of patients presenting to the emergency department results in significant avoidance of healthcare costs, particularly in the areas of hands-on care and adverse drug event prevention. The potential monetary benefit-to-cost ratio for emergency medicine pharmacists is between $1.4:1 and $10.6:1.
A Machine Learning–Based Fall Risk Assessment Model for Inpatients
Authors: Liu Chia-Hui , Hu Ya-Han , Lin Yu-Hsiu
Published: April 2021

Falls are one of the most common accidents among inpatients and may result in extended hospitalization and increased medical costs. Constructing a highly accurate fall prediction model could effectively reduce the rate of patient falls, further reducing unnecessary medical costs and patient injury. This study applied data mining techniques on a hospital's electronic medical records database comprising a nursing information system to construct inpatient-fall-prediction models for use during various stages of inpatient care. The inpatient data were collected from 15 inpatient wards. To develop timely and effective fall prediction models for inpatients, we retrieved the data of multiple-time assessment variables at four points during hospitalization. This study used various supervised machine learning algorithms to build classification models. Four supervised learning and two classifier ensemble techniques were selected for model development. The results indicated that Bagging+RF classifiers yielded optimal prediction performance at all four points during hospitalization. This study suggests that nursing personnel should be aware of patients' risk factors based on comprehensive fall risk assessment and provide patients with individualized fall prevention interventions to reduce inpatient fall rates.
Midlevel Injectable Practice Patterns in Dermatology and Plastic Surgery Offices
Authors: Nesi Lauren , Belcher Matthew , Decker Ashley , Lawrence Naomi
Published: April 2021

BACKGROUND

There is limited knowledge on the extent physicians delegate cosmetic procedures to midlevel providers.

OBJECTIVE

To assess dermatology and plastic surgery practice patterns for the injections of neurotoxins and dermal fillers.

MATERIALS AND METHODS

Four hundred ninety-two dermatology and plastic surgery practices were identified from 10 major US metropolitan areas. These practices were contacted, and staff were asked a series of questions to best characterize the practice patterns in regard to who performs the injectables in the office.

RESULTS

Although most dermatology and plastic surgery practices had physicians as the only provider who gives injectables, 18.35% of dermatology and 25.4% of plastic surgery practices had nurse practioners and physician assistants giving injectables both with and without oversight of the supervising physician onsite.

CONCLUSION

In a large majority of both plastic surgery and dermatology practices, physicians exclusively perform injections of neurotoxins and fillers. For practices that allow midlevel providers to perform injectables, the level of physician supervision is variable. In a small percentage of plastic surgery practices, surveyed midlevel providers exclusively performed injectables.
Management of Urgency and Mixed Urinary Incontinence
Authors: Roberts Kasey , Mahajan Sangeeta
Published: April 2021

Urinary incontinence (UI) is a prevalent disorder that significantly affects quality of life. This article reviews management of urgency and mixed UI by breaking the management algorithm down into observation, lifestyle and behavioral changes, pharmacologic therapy, and procedural management. Stress UI is best managed with mid-urethral slings and is covered in other chapters. Behavioral and pharmacologic management are equally efficacious for urgency UI, but procedural therapy is superior. Mixed UI is conventionally treated by first managing whichever UI subtype is most bothersome. The management of overflow UI is directed at its underlying etiology: detrusor underactivity or bladder outlet obstruction.
Use of Telemedicine and Smart Technology in Obstetrics: Barriers and Privacy Issues
Authors: Eswaran Hari , Magann Everett F.
Published: April 2021

While telemedicine had been utilized in varying ways over the last several years, it has dramatically accelerated in the era of the COVID-19 pandemic. In this article we describe the privacy issues, in relation to the barriers to care for health care providers and barriers to the obstetric patient, licensing and payments for telehealth services, technological issues and language barriers. While there may be barriers to the use of telehealth services this type of care is feasible and the barriers are surmountable.
Diagnosis and Therapy of Infectious Encephalitis in Children: A Ten-Years Retrospective Study
Authors: Pata Davide , Buonsenso Danilo , Frasca Giampiero , Lazzareschi Ilaria , Salerno Gilda , Turriziani Colonna Arianna , Mariotti Paolo , Valentini Piero
Published: April 2021

Background:

Infectious encephalitis represents a rare but potentially severe clinical condition. However, limited international data are available in pediatric age.

Methods:

We conducted a retrospective study to review (a) the clinical presentation; (b) laboratory, radiology, and neurophysiology findings; (c) the correlations between these exams and outcome; and (d) the therapy performed.

Results:

Fifty-six patients were enrolled [22 female (39.6%), mean age 4.7 years, IQR 0.7–8.7 years], 19.6% presented neurologic sequelae. HSV was the single most frequently isolated pathogen (19.6%), although in most cases, the etiology remained undefined. 41.1% children presented prodromal before the development of neurologic signs. Fever was the most frequent constitutional symptom (83.9% of cases). Cerebrospinal fluid was normal in 48.5% of cases and electroencephalograpy in 24.5% cases. Brain computed tomography scans was normal in 33 (91.7%) cases, while cerebral magnetic resonance imaging (MRI) showed pathologic findings in 62.5% of cases. MRI was the only parameter associated with neurologic sequalae [P = 0.01; OR, 8.1 (95% CI: 1.52–42.84)].

Conclusions:

Pediatric encephalitis is a heterogeneous entity with nonspecific clinical and laboratory findings, with undefined etiologies in most times. MRI can play a primary role, both on a diagnostic and prognostic point-of-view, and its role should be implemented and made more accessible. Further studies are needed to define the exact role and timing of steroids.
Current Clinical Practices of Saudi Physiotherapists in Stroke Rehabilitation
Authors: Alatawi Salem F.
Published: April 2021

Background and Purpose:

Stroke is a major cause of disability and the third leading cause of death worldwide. Clinical practice guidelines for stroke rehabilitation identify stroke physiotherapists as an essential interdisciplinary team member to minimize residual impairments and disability, thereby improving the patient's ability to execute daily tasks. This article uses an existing American survey to compare Saudi physiotherapists' current practice and preferred interventions in stroke rehabilitation with their counterparts in other countries.

Method:

An electronic survey was sent between September and October 2020 to physiotherapists (n = 287) treating persons with stroke in Saudi Arabia. The questionnaire consisted of items related to stroke rehabilitation, including treatment approach, the goal of interventions, management of tone, facilitation of movement, function, and improved motor control. Chi-square tests (χ2) were used to test any associations between physiotherapists' responses with respect to their demographic characteristics. Quantitative data analysis was conducted using SPSS.

Results:

A total of 197 participants returned completed questionnaires (68.6%). Participants were asked which methods of stroke treatment they had practiced in their profession and which methods had been taught in school training. The Bobath/neurodevelopmental treatment (NDT) approach was the most commonly known approach in practice (77.66%), followed by the proprioceptive neuromuscular facilitation/Brunnstrom and motor relearning program (63.45%, 25.38%, respectively). The results showed a significant relationship between Saudi physiotherapists' current practice and the aim of treatment and function (P < .05). In general, respondents have agreed on preferred treatment approaches, with the majority referring to the Bobath/NDT method, although variation is observed between participants in some sections of the survey. The preferred treatment was based on the frequency of responses of the participants.

Discussion and Conclusion:

Variation has been observed between therapists regarding treatment applications in stroke rehabilitation. The current findings emphasize the need to investigate how and why practitioners use or do not use evidence in this area (such as national stroke guidelines). Future studies might need to engage Saudi stroke physiotherapists to find suitable ways to close the gap between the evidence for best practice and the use of evidence within day-to-day practices.
Gene-Environment Interactions Between Environmental Response Genes Polymorphisms and Mitochondrial DNA Copy Numbers Among Benzene Workers
Authors: Ji Buqiang , Xiao Long Yan , Ren Jing-Chao , Zhang Guang-Hui , Wang Yongbin , Dong Tingting , Li Jingzhi , Zhang Fengquan , Xia Zhao-Lin
Published: April 2021

Objective:

To determine the effect of mitochondrial DNA copy number (mtDNAcn) as a biomarker of benzene exposure.

Methods:

A total of 294 benzene-exposed workers and 102 controls were recruited. Biomarkers of mtDNAcn, cytokinesis-block micronucleus (MN) frequency, and peripheral blood white blood cells (WBC) were detected. Eighteen polymorphism sites in DNA damage repair and metabolic genes were analyzed.

Results:

Benzene exposure increased mtDNAcn and indicated a dose–response relationship (P < 0.001). mtDNAcn was negatively correlated with WBC count and DNA methylation and positively correlated with MN frequency. The AG type in rs1695 interacted with benzene exposure to aggravate mtDNAcn (β = 0.006, 95% CI: 0, 0.012, P = 0.050). rs13181, rs1695, rs1800975, and GSTM1 null were associated with benzene-induced mtDNAcn. Rs1695 interacted with benzene to increase mitochondrial damage.

Conclusions:

Benzene exposure increases mtDNAcn levels in benzene-exposed workers.
Identification of a novel mutation in congenital afibrinogenemia in Iranian patients
Authors: Nojehdeh Somayeh Takrim , Mojbafan Marzieh , Masoodifard Mahboobeh , Amini Masoume , Zeinali Sirous
Published: April 2021

Congenital afibrinogenemia is a rare autosomal recessive disorder that is caused by defects in the fibrinogen. Fibrinogen is a hexameric glycoprotein made of two pairs of three homologous polypeptide chains including Aα, Bβ, and γ that are encoded by three genes named FGA, FGB, and FGG. We aim to study four Iranian families who were referred to our lab for molecular diagnosis of afibrinogenemia. Genomic DNA was extracted from whole blood and Sanger sequencing was performed using primers for all exons and exon-intron junctions of FGA, FGB, and FGG genes. Pathogenicity of the variants was predicted using different in-silico tools and was interpreted according to the American College of Medical Genetics and Genomics guideline. We found three types of mutations in the studied families; two were in the FGA gene and one was in the FGB gene including a nonsense, a novel splicing mutation, and two deletion ones. The nonsense and the deletion mutations may cause a truncated protein and are likely pathogenic and pathogenic, respectively. The novel mutation of splicing found in the FGB gene is a pathogenic one and can break the wild-type acceptor site. Studying mutations in afibrinogenemia patients can expand our knowledge about this disease in Iran.
Evaluation of 4Ts score inter-rater agreement in patients undergoing evaluation for heparin-induced thrombocytopenia
Authors: Northam Kalynn A. , Parker William F. , Chen Sheh-Li , Cicci Jonathan D. , Lin Feng-Chang , Rollins-Raval Marian A. , Kasthuri Raj S.
Published: April 2021

The American Society of Hematology and American College of Chest Physicians heparin-induced thrombocytopenia guidelines recommend calculation of a pretest probability score prior to performing laboratory testing, and the 4Ts score is commonly used. Inter-rater agreement of the 4Ts score has been evaluated, but limited data are available regarding the reliability of the 4Ts score when performed by nonexpert clinicians. The purpose of this study was to Compare 4Ts scores calculated by medical teams to an expert. A single-center observational study was conducted in patients evaluated for heparin-induced thrombocytopenia over 24 months. The primary outcome was difference in mean 4Ts score calculated by the medical team compared with an expert. Secondary outcomes included inter-rater agreement in risk category assignment and the negative predictive value (NPV) of the 4Ts score. The mean total 4Ts score was significantly higher when calculated by the medical team compared with expert (4.16 ± 1.41 versus 3.42 ± 1.53; P < 0.001). There was slight agreement in risk category assignment (Cohen κ coefficient = 0.164; P = 0.005). The NPV of the 4Ts score was 0.949 (95% confidence interval 0.891–1.000) when calculated by the medical team and 0.927 (95% confidence interval 0.869–0.984) when calculated by expert. Total 4Ts scores calculated by the medical team were significantly higher with only slight inter-rater agreement compared with expert. The NPV of the 4Ts score when calculated by nonexperts may be lower than previously reported. The recommendation to forgo laboratory testing for low 4Ts score patients may need to be revisited.
Low-Level HIV RNA in Cerebrospinal Fluid and Neurocognitive Performance: A Longitudinal Cohort Study
Authors: Anderson Albert M. , Tang Bin , Vaida Florin , Mcclernon Daniel , Deutsch Reena , Cherner Mariana , Cookson Debra , Crescini Melanie , Grant Igor , Ellis Ronald J. , Letendre Scott L.
Published: April 2021

Background:

Cognitive complications persist in persons with HIV during suppressive antiretroviral therapy (ART). Low levels of HIV during ART could contribute to these complications. In this study, we measured cerebrospinal fluid (CSF) HIV using a single-copy assay (SCA) to investigate a possible relationship between low-level HIV and cognition.

Design/Methods:

SCA data were analyzed from 3 consecutively paired CSF–plasma specimens collected over a mean of 456 days from 96 participants on suppressive ART. Using mixed models, the presence of CSF HIV by SCA as a risk factor for worse neurocognitive performance was examined.

Results:

At baseline on the SCA, 45.8% of participants had detectable plasma HIV RNA (median 8 copies/mL and interquartile range = 3–17 among detectable values) and 17.7% had detectable CSF HIV RNA (median CSF concentration= 3 copies/mL and interquartile range= 2–13 among detectable values). The frequency of CSF HIV RNA detection declined over time in CSF (P = 0.018) with a trend toward decline in plasma (P = 0.064). Detectable CSF HIV RNA during the study was associated with worse performance in the domains of recall (P = 0.014) and motor (P = 0.040) and a trend with worse overall global performance (P = 0.078). Integrase inhibitor use, although very infrequent in this cohort, was associated with better performance in 2 domains.

Conclusions:

Low-level CSF HIV RNA declines with time but is associated with worse cognitive performance in 2 domains. Additional research is needed to better understand the relationship between HIV RNA persistence during long-term ART and central nervous system complications in persons with HIV.
The Risk of Infections Associated With JAK Inhibitors in Rheumatoid Arthritis
Authors: Alves Carlos , Penedones Ana , Mendes Diogo , Marques Francisco Batel
Published: April 2021

Background/Objective

The Janus kinases (JAKs) are cytoplasmic tyrosine kinases associated with membrane cytokine receptors that mediate signaling of multiple cytokines and growth factors, contributing to the pathogenesis of multiple autoimmune disorders. The JAK inhibitors are a new class of targeted therapies with proven efficacy in treating rheumatoid arthritis but are associated with an increased risk of infections. This study is aimed at comparing the relative safety of the different JAK inhibitors with regard to the risk of serious infections in patients with rheumatoid arthritis.

Methods

PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov were searched to identify randomized controlled trials evaluating the efficacy and safety of JAK inhibitors in patients with rheumatoid arthritis. The outcomes assessed were the risk of total and serious infections, tuberculosis, and herpes zoster. Sensitivity analysis disaggregated the results according to background therapy and licensed doses of JAK inhibitors.

Results

Thirty-seven randomized controlled trials that were included met the inclusion criteria. Compared with filgotinib, adalimumab (4.81; 95% confidence interval [CI], 1.39–16.66), etanercept (6.04; 95% CI, 1.79–20.37), peficitinib (7.56; 95% CI, 1.63–35.12), tofacitinib (4.29; 95% CI, 1.43–12.88), and upadacitinib (4.35; 95% CI, 1.46–13.00) have an increased risk of herpes zoster infection. Risk differences between the drugs became statistically nonsignificant when the sensitivity analysis was conducted.

Conclusions

The risk of infections seems to be similar among the currently approved JAK inhibitor drugs. Although the initial results suggested that filgotinib could have a reduced risk of herpes zoster, the sensitivity analyses did not support those findings.
Intersectionality and heart failure: what clinicians and researchers should know and do
Authors: Allana Saleema , Ski Chantal F. , Thompson David R. , Clark Alexander M.
Published: April 2021

Purpose of review

To review the application of intersectionality to heart failure. Intersectionality refers to the complex ways in which disenfranchisement and privilege intersect to reproduce and influence health and social outcomes.

Recent findings

Intersectionality challenges approaches that focus on a single or small number of socio-demographic characteristics, such as sex or age. Instead, approaches should take account of the nature and effects of a full range of socio-demographic factors linked to privilege, including: race and ethnicity, social class, income, age, gender identity, disability, geography, and immigration status. Although credible and well established across many fields – there is limited recognition of the effects of intersectionality in research into heart disease, including heart failure. This deficiency is important because heart failure remains a common and burdensome syndrome that requires complex pharmacological and nonpharmacological care and collaboration between health professionals, patients and caregivers during and at the end-of-life.

Approaches to heart failure clinical care should recognize more fully the nature and impact of patients’ intersectionality- and how multiple factors interact and compound to influence patients and their caregivers’ behaviours and health outcomes. Future research should explicate the ways in which multiple factors interact to influence health outcomes.