bluuebunny/crossref_metadata_2025 huggingface dataset:
Using the Responsible Suicide Reporting Model to increase adherence to global media reporting guidelines
Authors: Duncan Sallyanne , Luce Ann
Published: August 2020

Numerous guidelines on responsible reporting of suicide are available to journalists globally, offering advice on best practice regarding approaches and suitability of content. Whilst their advice is compelling and legitimate, their use is uneven at best. With a suicide death every 40 seconds worldwide, it is imperative journalists understand and recognise the best ethical practices in order to report suicide responsibly. To address these shortcomings, the authors present a model for responsible suicide reporting (RSR) that is grounded in news-work and embeds media reporting guidelines within journalistic storytelling practices. The RSR model consists of a typology of suicide narratives and ‘othering’, ethical rules and a standard of moderation. Methodologically, these typologies emerged from analysis of 159 suicide news stories published in 2018–19, with particular focus on adherence and non-adherence to global media reporting guidelines. We posit through the process of producing stories using the RSR model, journalists should interact more effectively with critical risk factors for example, stigmatisation, copycat effects, harmful speculation, highlighted by media reporting guidelines.
Mutual learning on the local level: The Swiss Red Cross and the Village Health Committees in the Kyrgyz Republic
Authors: Isabekova Gulnaz
Published: August 2020

The importance of mutual learning between providers and recipients of development assistance has been emphasised for decades. Nevertheless, its practical implementation remains limited, primarily due to organisational issues and unequal power relations in development aid. Using the ‘design-thinking’ approach, this study demonstrates the possibility of mutual learning utilising the example of the Swiss Red Cross and the Village Health Committees in the Kyrgyz Republic. Based on the related project documentation and interviews with relevant partners, this article provides an insight into the factors enabling mutual learning in practice. It suggests that decentralisation of the organisation, its leadership and response to failures, continuous contact between provider and recipient of development assistance, and emphasis on local expertise contribute to learning. Although context-specific, these findings are essential to understanding the mutual learning in general and taking this phenomenon from theory to practice.
Pulsing and pedestrian life: ideology in motion in Mitzpe Ramon, Israel
Authors: Weinreb Amelia Rosenberg
Published: August 2020

This article examines what I call ‘pulsing’ – visible surges of pedestrian activity. It applies a selection of Torsten Hägerstrand’s time-geographic vocabulary in an ethnographic case-study of Mitzpe Ramon, a small Negev Desert town in Israel, illustrating how various spatio-temporal constraints shape flows of walking at daily, weekly, and annual scales. Pulsing, I argue, simply but powerfully communicates when events of collective interest occur, where, for which groups, and at what volumes. Pulsing embodies cultural practices through mobilities, and shapes community norms. Extending beyond this particular example, I also suggest that the concept of pulsing advances understandings of synchrony and synchory in collective pedestrianism and mobilities more broadly, including pilgrimage, urban rhythms, commuter patterns, periodicity, rush hours, and the filling and emptying of public space.
Hierarchical approach for uncertainty quantification and reliability assessment of guided wave-based structural health monitoring
Authors: Yue Nan , Aliabadi M.H.
Published: August 2020

In this article, a hierarchical approach is proposed for the design and assessment of a guided wave-based structural health monitoring system for the detection and localisation of barely visible impact damage in composite airframe structures. The hierarchical approach provides a systemic and practical way to establish guided wave-based structural health monitoring systems for different structures in the presence of uncertainties and to quantify system performance. The proposed approach is carried out in four steps: (1) determine optimal sensor placement for the target structure and its plausible impact scenarios, (2) set detection threshold for global damage index based on the noise level present in the required environmental and operations conditions, (3) detect damage in critical locations and quantify detection performance by calculating the probability of detection, probability of false alarm and detection accuracy and (4) locate the detected damage while also quantifying the accuracy of location estimation and the probability of correctly indicating if the damage is in an area critical to the integrity of the structure. The proposed approach is demonstrated in aircraft carbon fibre-reinforced polymer structures from coupon level (simple flat panels) to sub-component level (large flat panel with multiple carbon fibre-reinforced polymer stringers and aluminium frames) for the detection and localisation of barely visible impact damage.
Experiences of Buruli Ulcer Patients Following Discharge in the Greater Accra Region of Ghana
Authors: Menlah Awube , Appiah Evans Osei , Boahemaa Maame Kodua
Published: August 2020

Buruli ulcer (BU) is one of the skin diseases that causes physical deformity, loss of function of the affected part, social stigmatization, and financial burden to individuals affected. Annually, an approximated 6000 cases of BU are reported worldwide especially from West Africa, Central Africa, and Asia. The aim of the study was to assess the experiences of BU patients in the Greater Accra Region of Ghana following discharge from the hospital. The study employed a qualitative descriptive phenomenological approach using snowballing sampling technique to sample 15 participants from the Greater Accra Region of Ghana who have been treated and discharged home. Data were collected through face-to-face interviews that was later transcribed and coded using qualitative content analysis. Findings from this study revealed that individuals with BU goes through several challenges during admission and after discharge including feeling of embarrassment, financially handicapped, and marital conflicts. The study concluded that BU has not been totally eradicated from the country, hence must be given the attention it deserves to help individuals cope better.
Leading through agonistic conflict: Contested sense-making in national political arenas
Authors: Hartley Jean , Stansfield Annette
Published: August 2020

This article examines the social processes of political leadership in situations of contest and conflict, taking place within a key and long-established democratic institution, the UK Parliament. The empirical focus is on leadership in House of Commons select committees, which are concerned with holding the government to account. Headlines and media scrutiny, combined with internal challenge from the cross-party mix of politicians on the committees and a range of external stakeholders, create leadership challenges for committee chairs. The study is of two committee inquiries led by the same committee chair, which occurred concurrently and in real time, thereby providing a rare comparative study of leadership through the same leader at the same time but with different leadership challenges. Rather than shying away from conflict, as does much of the leadership literature, this research highlights how leaders who actively engage in challenge and conflict can build a degree of shared purpose among diverse groups of stakeholders. It examines and combines, in theory elaboration, two theories relevant to understanding these leadership processes: agonistic pluralism with its role in creating respectful conflictual consensus, and the theory of sense-making and sense-giving. The two cases (the two inquiries) had different trajectories and reveal how the chair recognised and dealt with conflict to achieve sense-making outcomes across divergent interests and across political parties. There are implications not only for understanding political leadership but also more widely for leadership where there are diverse and sometimes conflicting interests.
Structure and Historicity of Cultural Tastes. Uses of Multiple Correspondence Analysis and Sociological Theory on Age: The Case of Music and Movies
Authors: Glevarec Hervé , Cibois Philippe
Published: August 2020

The sociology of cultural tastes and practices seeks, on the one hand, to show how tastes and practices are structured, and on the other hand, to explain them. For this purpose, multivariate analysis, and in particular, multiple correspondence analysis (MCA), has been chosen as the preferred statistical method to support a theory of ‘homology’ between ‘social position’ and preferences. This article reassesses the initial interpretation offered by Bourdieu of the two factor spaces of ‘dominant’ and ‘petit-bourgeois’ tastes in Distinction (1979) and discusses how MCA is used in the sociology of culture as ‘structural homology’, especially one-dimensionally (single-axis reduction) and positionally, without the inclusion of the age variable. The two ways of considering the effect of age are either by excluding it a priori (‘omitted axis’) or by not theorizing it (‘descriptive axis’). We show, using data from the 2008 French Cultural Practices survey on tastes in music and movies, how a factor analysis that incorporates age outlines a generational and historical structuring of tastes. We explain the different dimensions of age in terms of cultural practices and we interpret the level of education in terms of knowledge. The article advocates a model for the interpretation of tastes that is no longer based on the structure of capital, but rather on cultural history and specific competences.
Analyses of case-based surveillance data on malaria in pregnancy in Plateau State, Nigeria 2013–2017
Authors: Iyare Osarhiemen , Adebowale Ayo Stephen , Umeokonkwo Chukwuma David , Bamgboye Eniola Adetola , Gobir Abdullahi Abdulrazaq , Chikan Jiwok Joseph , Dahiru Tukur , Ajayi IkeOluwapo Oyeneye
Published: August 2020

Background:

Malaria in pregnancy accounts for 11% of maternal death in Nigeria. Plateau State has a low uptake of intermittent preventive treatment of malaria among women attending antenatal care.

Objectives:

This study examined the trend and made projections of reported cases of malaria in pregnancy in Plateau State.

Methods:

Data were extracted from the state disease surveillance system from January 2013 to December 2017. Reported cases of malaria in pregnancy within the 5 years under investigation were retrieved, merged and sorted by month of reporting and Local Government Area (LGA). Prevalence was calculated yearly for each LGA in Plateau State using Geographic Information System. Seasonal variation and projection were based on a multiplicative time series model.

Results:

In total, 62,997 cases of malaria in pregnancy were retrieved. Prevalence was 6.9% in 2013 and increased to 15.1% in 2017. Higher prevalence was observed in Wase, Kanam and Shendam LGAs. A cyclical trend with highest number of malaria in pregnancy cases was found within the third quarter of all the years. Within the 5 years, there was higher seasonal variation for quarters three (1.209834) and one (1.099711). The highest number of cases of malaria in pregnancy was likely to occur in the third quarter, while the least was found in the second quarter. The projected numbers of malaria in pregnancy cases are 20,121, 22,593 and 25,064 for year 2018, 2019 and 2020, respectively, and the highest number of cases occurs in the third quarter.

Conclusion:

Malaria in pregnancy follows an increasing trend in Plateau State, with greatest severity in the third quarter of the year. An effective intervention strategy against malaria among pregnant women is advocated.
Illustrative Case Series and Narrative Review of Therapeutic Failure of Immunotherapy for Allergic Rhinitis
Authors: Campisi Lisa , Yong Patrick F. K. , Kasternow Bogumila , Karim Mohammed Yousuf
Published: August 2020

This is a series of 4 cases (3 therapeutic failure and 1 early relapse) in adult patients treated with allergen immunotherapy (AIT) for allergic rhinitis (AR) in our immunotherapy clinic, which treats 110 new patients per year. AIT includes both subcutaneous and sublingual routes. The current national/international AIT recommendations and the literature have been searched to identify guidance for the optimal management of therapeutic failure of AIT in AR. There is scant information available to support clinicians when treatment failure and/or intolerable side effects occur. The importance is highlighted for developing the guidance and evidence base for the benefit of this patient subgroup. The potential strategies that clinicians have proposed are discussed in this article, though it is acknowledged that these are mostly not evidence-based.
MiR-4668 as a Novel Potential Biomarker for Eosinophilic Esophagitis
Authors: Bhardwaj Neeti , Sena Maria , Ghaffari Gisoo , Ishmael Faoud
Published: August 2020

Introduction

Eosinophilic esophagitis (EoE) is a clinico-pathological diagnosis characterized by esophageal dysfunction and eosinophilic infiltration of the esophagus. Demonstration of esophageal eosinophilia (more than 15 eosinophils/hpf) in biopsy specimen obtained by esophagogastroduodenoscopy (EGD) continues to be the gold standard for diagnosis and monitoring of response to therapy. There is a growing necessity for non-invasive biomarkers that can accurately diagnose this condition and assess response to therapy. While microRNAs (miRNA) are being investigated in allergic diseases, including EoE, not many studies have explored the role of salivary miRNAs in EoE. MiR-4668-5p is a particularly interesting candidate, as it is predicted to regulate TGF-beta signaling and has not previously been identified as a target in any allergy disease. We sought to further investigate the role of miR-4668 as a biomarker to characterize and monitor response to treatment with swallowed topical glucocorticoids.

Methods

After IRB approval, twenty-two adult patients with EoE were randomly enrolled to provide a saliva sample before and after 2 months of swallowed fluticasone therapy. Differences of miRNA expression before and after treatment were analyzed by paired T-test. A significance cutoff of <0.05 was used for all analyses.

Results

Expression of miR-4668 was higher in EoE vs. non-EoE subjects. The level of miR-4668 decreased in all subjects except one, with a mean fold change 0.49 ± 0.25. There was an association between miRNA expression and number of positive aeroallergens. The miR-4668 high group had a higher number of positive aeroallergen tests, while the miR-4668 low group had a greater number of subjects with drug allergies.

Conclusions

In this study, we identified that salivary miRNAs may serve as biomarkers to characterize EoE and response to topical corticosteroids. We specifically identified miR-4668 as a novel potential biomarker, which was not previously discovered as a target in EoE or any other allergic disease.
IEP/Transition Planning Participation Among Students With the Most Significant Cognitive Disabilities: Findings From NLTS 2012
Authors: Johnson David R. , Thurlow Martha L. , Wu Yi-Chen , LaVelle John M. , Davenport Ernest C.
Published: August 2020

This study used data from the National Longitudinal Transition Study 2012 (NLTS 2012) to explore the individualized education program (IEP)/transition planning participation and role of students with the most significant cognitive disabilities, compared to students with other disabilities. We viewed students with the most significant cognitive disabilities as those included in three disability categories— autism, intellectual disability, and multiple disabilities—who took an alternate assessment. The study also included an analysis of student’s participation in relation to their functional, communication, and self-advocacy skills, and student–teacher relationships. Although students with the most significant cognitive disabilities experienced greater limitations overall, students with other disabilities were experiencing similar challenges. Implications for practice were discussed from the lens of student engagement, self-determination, and student’s leadership role.
Does the Position of Cage Affect the Clinical Outcome of Lateral Interbody Fusion in Lumbar Spinal Stenosis?
Authors: Qiao Guangxi , Feng Min , Liu Jian , Wang Xiaodong , Ge Miao , Yang Bin , Yue Bin
Published: August 2020

Study Design:

A retrospective study.

Objective:

This study aims to identify the ideal cage position in lateral lumbar interbody fusion (LLIF) and to investigate if the posterior instrumentation would affect the indirect decompression.

Methods:

Patients underwent 2-stage surgeries: stage I was LLIF and stage II was percutaneous pedicle screws fixation after 1 week. Anterior disc height (ADH), posterior disc height (PDH), left and right foraminal height (FH), and segmental angle (SA) were measured on lateral computed tomography reconstructions. The cross-sectional area of the thecal sac (CSA) was determined by the outlined area of the thecal sac on a T2-weighted axial magnetic resonance imaging. The patients were subgroups according to the cage position: the anterior (cage located at the anterior 1/3 of disc space) and posterior groups (cage located at the posterior 2/3 of disc space). P values <.05 were considered significant.

Results:

This study included 46 patients and 71 surgical levels. After stage I LLIF, significant increase in ADH, PDH, bilateral FH was found in both 2 subgroups, as well as the CSA (all Ps < .01). SA increased 2.84° ± 3.2° in the anterior group after stage I LLIF and increased 0.81° ± 3.1° in the posterior group ( P = .013). After stage II surgery, SA was similar between the anterior and posterior groups ( P = .20).

Conclusion:

The anteriorly placed cage may provide better improvement of anterior disc height and segmental angle after stand-alone LLIF surgery. After the second stage posterior instrumentation, the cage position would not affect the segmental angle or foraminal height.
Does Time From Injury to Surgery Affect Outcomes After Surgical Repair of Partial and Complete Proximal Hamstring Ruptures?
Authors: Shambaugh Braidy C. , Wuerz Thomas H. , Miller Suzanne L.
Published: August 2020

Background:

No previous study has compared the outcomes of repair for partial and complete proximal hamstring ruptures at various intervals after the injury.

Purpose:

The primary aim was to determine whether time from injury to surgery affected outcomes after primary repair of partial and complete proximal hamstring ruptures. The secondary aim was to assess patients’ experiences from initial evaluation to finding a treating surgeon.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Records from 2007 to 2016 from a single surgeon’s practice were reviewed. A total of 124 proximal hamstring repair procedures in 121 patients were identified. There were 92 patients who completed questionnaires: a custom survey, the standard Lower Extremity Functional Scale (LEFS), a custom LEFS, the standard Marx activity scale, a custom Marx activity scale, and the University of California Los Angeles (UCLA) activity score. Results were analyzed for partial and complete repair procedures performed at ≤3 weeks, ≤6 weeks, and >6 weeks after the injury.

Results:

The mean follow-up was 43 months (median, 38 months). Of 93 repair procedures reviewed, 51% (9/28 partial; 38/65 complete), 79% (16/28 partial; 57/65 complete), and 22% (12/28 partial; 8/65 complete) were performed at ≤3 weeks, ≤6 weeks, and >6 weeks, respectively. At those various intervals, no statistical difference was found in standard LEFS, custom LEFS, standard Marx, custom Marx, or UCLA scores. Female sex, older age, and body mass index >30 kg/m2 were negative predictors of outcome measures. When repaired >6 weeks after the injury, a greater percentage of patients reported weakness of the operative leg compared with the contralateral side (partial tears: 6.3% vs 25%, respectively; complete tears: 24.6% vs 50%, respectively) in addition to greater sitting intolerance (partial tears: 0% vs 25%, respectively; complete tears: 7.1% vs 12.5%, respectively). Patients repaired >6 weeks after the injury visited, on average, 2.6 practitioners before an evaluation by the treating surgeon compared with 1.6 treated surgically at ≤6 weeks ( P = .008).

Conclusion:

Patients with proximal hamstring repair performed in the acute and chronic settings can expect successful outcomes but may experience more subjective weakness and difficulty with prolonged sitting when the repair is performed >6 weeks after the injury. Patients faced challenges in receiving the correct diagnosis and referral to an appropriate treating surgeon, emphasizing the need for an increased awareness of the injury.
Minimally Invasive Tissue Sampling in Preterm Deaths: A Validation Study
Authors: Hailu Rahell , Desta Tigist , Bekuretsion Yonas , Bezabih Messele , Alemu Addisu , Bekele Tiruzer , Abebe Bewketu , Asefa Mesfin , Tigabu Zemene , Girma Yonas , Eshetu Beza , Abayneh Mahlet , Mekasha Amha , Nigussie Assaye Kassie , McClure Elizabeth M , Goldenberg Robert L , Muhe Lulu M
Published: August 2020

Uncertainty about the causes of neonatal deaths impedes achieving global health targets to reduce mortality. Complete diagnostic autopsy (CDA) is the gold standard to determine cause of death. However, it is often difficult to perform in high-burden, low-income settings. Validations of more feasible methods to determine cause of death are needed. This prospective, multi-center study in Ethiopia assessed the validity of the minimally invasive tissue sampling (MITS) approach to contribute to causes of death in preterm neonates compared to CDA. The MITS and CDA of 105 cases were reviewed. The MITS sampling success for lungs and liver was 100% and 84%, respectively. The kidney and brain had sampling successes of 58% each. MITS showed good agreement with CDA for the diagnosis of hyaline membrane disease (kappa = 0.78), and moderate to substantial agreement for pneumonia and pulmonary hemorrhage (kappa = 0.59 and 0.68, respectively). Even though CDA is the gold standard in identifying the cause of death, we believe that the MITS method can be a useful alternative method in supporting determination of cause of death in low-resource settings.
Survival and quality of life after early discharge in low-risk pulmonary embolism
Authors: Barco Stefano , Schmidtmann Irene , Ageno Walter , Anušić Toni , Bauersachs Rupert M. , Becattini Cecilia , Bernardi Enrico , Beyer-Westendorf Jan , Bonacchini Luca , Brachmann Johannes , Christ Michael , Czihal Michael , Duerschmied Daniel , Empen Klaus , Espinola-Klein Christine , Ficker Joachim H. , Fonseca Cândida , Genth-Zotz Sabine , Jiménez David , Harjola Veli-Pekka , Held Matthias , Iogna Prat Lorenzo , Lange Tobias J. , Lankeit Mareike , Manolis Athanasios , Meyer Andreas , Münzel Thomas , Mustonen Pirjo , Rauch-Kroehnert Ursula , Ruiz-Artacho Pedro , Schellong Sebastian , Schwaiblmair Martin , Stahrenberg Raoul , Valerio Luca , Westerweel Peter E. , Wild Philipp S. , Konstantinides Stavros V.
Published: August 2020

Introduction

Early discharge of patients with acute low-risk pulmonary embolism requires validation by prospective trials with clinical and quality-of-life outcomes.

Methods

The multinational Home Treatment of Patients with Low-Risk Pulmonary Embolism with the Oral Factor Xa Inhibitor Rivaroxaban (HoT-PE) single-arm management trial investigated early discharge followed by ambulatory treatment with rivaroxaban. The study was stopped for efficacy after the positive results of the predefined interim analysis at 50% of the planned population. The present analysis includes the entire trial population (576 patients). In addition to 3-month recurrence (primary outcome) and 1-year overall mortality, we analysed self-reported disease-specific (Pulmonary Embolism Quality of Life (PEmb-QoL) questionnaire) and generic (five-level five-dimension EuroQoL (EQ-5D-5L) scale) quality of life as well as treatment satisfaction (Anti-Clot Treatment Scale (ACTS)) after pulmonary embolism.

Results

The primary efficacy outcome occurred in three (0.5%, one-sided upper 95% CI 1.3%) patients. The 1-year mortality was 2.4%. The mean±sdPEmb-QoL decreased from 28.9±20.6% at 3 weeks to 19.9±15.4% at 3 months, a mean change (improvement) of −9.1% (p<0.0001). Improvement was consistent across all PEmb-QoL dimensions. The EQ-5D-5L was 0.89±0.12 at 3 weeks after enrolment and improved to 0.91±0.12 at 3 months (p<0.0001). Female sex and cardiopulmonary disease were associated with poorer disease-specific and generic quality of life; older age was associated with faster worsening of generic quality of life. The ACTS burden score improved from 40.5±6.6 points at 3 weeks to 42.5±5.9 points at 3 months (p<0.0001).

Conclusions

Our results further support early discharge and ambulatory oral anticoagulation for selected patients with low-risk pulmonary embolism. Targeted strategies may be necessary to further improve quality of life in specific patient subgroups.
A Fast Route Towards Freestanding Single-Crystalline Oxide Thin Films by Using YBa2Cu3O7-x as a Sacrificial Layer
Authors: Chang Yao-Wen , Wu Ping-Chun , Yi Jhih-Bang , Liu Yu-Chen , Chou Yi , Chou Yi-Chia , Yang Jan-Chi
Published: August 2020

Researchers have long been seeking multifunctional materials that can be adopted for next-generation nanoelectronics, and which, hopefully, are compatible with current semiconductor processing for further integration. Along this vein, complex oxides have gained numerous attention due to their versatile functionalities. Despite the fact that unbounded potential of complex oxides has been examined over the past years, one of the major challenges lies in the direct integration of these functional oxides onto existing devices or targeted substrates that are inherently incompatible in terms of oxide growth. To fulfill this goal, freestanding processes have been proposed, in which wet etching of inserted sacrificial layers is regarded as one of the most efficient ways to obtain epitaxial high-quality thin films. In this study, we propose using an alternative oxide, YBa2Cu3O7 (YCBO), as a sacrificial layer, which can be easily dissolved in light hydrochloric acid in a more efficient way, while protecting selected complex oxides intact. The high epitaxial quality of the selected complex oxide before and after freestanding process using YBCO as a sacrificial layer is comprehensively studied via a combination of atomic force microscopy, X-ray diffraction, transmission electron microscopy, and electrical transports. This approach enables direct integration of complex oxides with arbitrary substrates and devices and is expected to offer a faster route towards the development of low-dimensional quantum materials.
Nano-clays as Potential Pseudo-antibodies for COVID-19
Authors: Abduljauwad Sahel N. , Habib Taimur , Ahmed Habib-ur-Rehman
Published: August 2020

Despite several efforts, the development of an effective vaccine for COVID-19 may take a much longer time. Traditional/natural medicine, already experienced by humans, could be an earlier solution. Considering the research team’s experience in using nano-clays as high-affinity material for cancer metastasis, melanoma treatment, and bone regeneration, we propose to use these nano-clays for the prevention/treatment of COVID-19. Owing to high affinity, nano-clays would capture the viruses before the latter get engaged with human hACE2. In this study, molecular-level simulations and modeling of the interaction of coronavirus spike and hACE2 proteins were performed with and without nano-clays. The results showed a very high level of affinity/cohesiveness among SARS-CoV-2 spike and nano-clays as compared to the one between the former and hACE2. We premise that these nano-clays since already being used as drug carriers could also be injected as “clays-alone” medicine. Recommendations have also been provided for future in vitro and in vivo studies.
binomialRF: interpretable combinatoric efficiency of random forests to identify biomarker interactions
Authors: Rachid Zaim Samir , Kenost Colleen , Berghout Joanne , Chiu Wesley , Wilson Liam , Zhang Hao Helen , Lussier Yves A.
Published: August 2020

Background

In this era of data science-driven bioinformatics, machine learning research has focused on feature selection as users want more interpretation and post-hoc analyses for biomarker detection. However, when there are more features (i.e., transcripts) than samples (i.e., mice or human samples) in a study, it poses major statistical challenges in biomarker detection tasks as traditional statistical techniques are underpowered in high dimension. Second and third order interactions of these features pose a substantial combinatoric dimensional challenge. In computational biology, random forest (RF) classifiers are widely used due to their flexibility, powerful performance, their ability to rank features, and their robustness to the “P > > N” high-dimensional limitation that many matrix regression algorithms face. We propose binomialRF, a feature selection technique in RFs that provides an alternative interpretation for features using a correlated binomial distribution and scales efficiently to analyze multiway interactions.

Results

In both simulations and validation studies using datasets from the TCGA and UCI repositories, binomialRF showed computational gains (up to 5 to 300 times faster) while maintaining competitive variable precision and recall in identifying biomarkers’ main effects and interactions. In two clinical studies, the binomialRF algorithm prioritizes previously-published relevant pathological molecular mechanisms (features) with high classification precision and recall using features alone, as well as with their statistical interactions alone.

Conclusion

binomialRF extends upon previous methods for identifying interpretable features in RFs and brings them together under a correlated binomial distribution to create an efficient hypothesis testing algorithm that identifies biomarkers’ main effects and interactions. Preliminary results in simulations demonstrate computational gains while retaining competitive model selection and classification accuracies. Future work will extend this framework to incorporate ontologies that provide pathway-level feature selection from gene expression input data.
Characteristics and outcomes of patients with dyspnoea as the main symptom, assessed by prehospital emergency nurses- a retrospective observational study
Authors: Kauppi Wivica , Herlitz Johan , Magnusson Carl , Palmér Lina , Axelsson Christer
Published: August 2020

Background

Dyspnoea (breathing difficulty) is among the most commonly cited reasons for contacting emergency medical services (EMSs). Dyspnoea is caused by several serious underlying medical conditions and, based on patients individual needs and complex illnesses or injuries, ambulance staff are independently responsible for advanced care provision. Few large-scale prehospital studies have reviewed patients with dyspnoea. This study aimed to describe the characteristics and final outcomes of patients whose main symptom was classified as dyspnoea by the prehospital emergency nurse (PEN).

Methods

This retrospective observational study included patients aged > 16 years whose main symptom was dyspnoea. All the enrolled patients were assessed in the south-western part of Sweden by PENs during January and December, 2017. Of 7260 assignments (9% of all primary missions), 6354 fulfilled the inclusion criteria. Analysis was performed using descriptive statistics, and the tests used were odds ratios and Kaplan-Meier analysis.

Results

The patients mean age was 73 years, and approximately 56% were women. More than 400 different final diagnostic codes (International Statistical Classification of Diseases and Related Health Problems [ICD]-10th edition) were observed, and 11% of the ICD-10 codes denoted time-critical conditions. The three most commonly observed aetiologies were chronic obstructive pulmonary disease (20.4%), pulmonary infection (17.1%), and heart failure (15%). The comorbidity values were high, with 84.4% having previously experienced dyspnoea. The overall 30-day mortality was 11.1%. More than half called EMSs more than 50 h after symptom onset.

Conclusions

Among patients assessed by PENs due to dyspnoea as the main symptom there were more than 400 different final diagnoses, of which 11% were regarded as time-critical. These patients had a severe comorbidity and 11% died within the first 30 days.
Association of household income with home-based rehabilitation and home help service utilization among long-term home care service users
Authors: Tsuchiya-Ito Rumiko , Ishizaki Tatsuro , Mitsutake Seigo , Hamada Shota , Yoshie Satoru , Iijima Katsuya , Tamiya Nanako
Published: August 2020

Background

To examine the association of household income with home-based rehabilitation and home help services in terms of service utilization and expenditures.

Methods

A secondary data analysis of cross-sectional design was conducted using long-term care (LTC) insurance claims data, medical claims data, and three types of administrative data. The subjects comprised LTC insurance beneficiaries in Kashiwa city, Japan, who used long-term home care services in the month following care needs certification. Household income was the independent variable of interest, and beneficiaries were categorized into low-income or middle/high-income groups based on their insurance premiums. Using a two-part model, the odds ratios (ORs) and 95% confidence intervals (CIs) for the utilization of home-based rehabilitation and home help services in the month following care needs certification were estimated using logistic regression analysis, and the risk ratios (RRs) of service expenditures were estimated using a generalized linear model for gamma-distributed data with a log-link function.

Results

Among 3770 subjects, 681 (18.1%) used home-based rehabilitation and 1163 (30.8%) used home help services. There were 1419 (37.6%) low-income subjects, who were significantly less likely to use (OR: 0.813; 95%CI: 0.670–0.987) and spend on (RR: 0.910; 95%CI: 0.829–0.999) home-based rehabilitation services than middle/high-income subjects. Conversely, low-income subjects were significantly more likely to use (OR: 1.432; 95%CI: 1.232–1.664) but less likely to spend on (RR: 0.888; 95%CI: 0.799–0.986) home help services than middle/high-income subjects.

Conclusion

Household income was associated with the utilization of long-term home care services. To improve access to these services, the LTC insurance system should examine ways to decrease the financial burden of low-income beneficiaries and encourage service utilization.
Interleukin-8 is not a predictive biomarker for the development of the acute promyelocytic leukemia differentiation syndrome
Authors: Yamamoto de Almeida Luciana , Pereira-Martins Diego Antonio , Lima Ana Sílvia Gouvêa , Baggio Márcia Sueli , de Araujo Koury Luisa Corrêa , Lange Ana Paula , Bassi Sarah Cristina , Scheucher Priscila Santos , Rego Eduardo Magalhães
Published: August 2020

Background

Differentiation syndrome (DS) is the main life-threatening adverse event that occurs in acute promyelocytic leukemia (APL) patients treated with all-trans retinoic acid (ATRA). Cytokine imbalances have been reported to play role during the developing of acute promyelocytic leukemia differentiation syndrome (APL-DS). However, the relationship between the plasma cytokine levels and their prognostic value for the prediction of DS developing in patients with APL during the treatment with ATRA and anthracyclines has not been previously reported.

Methods

In this study, we followed an APL cohort (n = 17) over 7 days of ATRA therapy in DS (n = 6) and non-DS groups (n = 11). Interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12p70 and TNF-α were measured in the peripheral blood plasma from 17 patients with APL and 11 healthy adult controls by using the cytometric bead array method.

Results

In non-DS patients, IL-8 plasma levels were significantly reduced in the seventh day of ATRA treatment (34.16; 6.99 to 147.11 pg mL− 1 in D0 vs. 10.9; 0 to 26.81 pg mL− 1 in D7; p = 0.02) whereas their levels did not discriminate between DS and non-DS development during the entire induction period (all p > 0.05 in D0, D3, and D7). No significant differences were found in IL-6 levels between groups (p > 0.05 in D0-D7). Other cytokines tested were all undetectable in patients with APL or healthy controls.

Conclusions

We demonstrated that the modulation of IL-8 following ATRA treatment may occur regardless of the development of DS and, therefore, does not appear to be a predictive biomarker to monitor the APL-DS.
Ab-externo drainage with continuous anterior chamber infusion for non-resolving exudative retinal detachment: a case report
Authors: Simunovic Matthew P. , Shao Emily H. , Osaadon Perach
Published: August 2020

Background

Drainage of exudative retinal detachment may be necessary for either therapeutic or diagnostic purposes (or both). Here, we describe an external drainage technique for non-resolving vision-threatening exudative retinal detachment which combines the advantages of internal drainage (widefield viewing and intraocular pressure control using continuous anterior chamber infusion) with those of external drainage (drainage of sub-retinal fluid without vitrectomy).

Case presentation

To illustrate this technique, we present a 13-year-old girl with macula-off exudative retinal detachment secondary to Vogt-Koyanagi-Harada syndrome, which was unresponsive to aggressive medical management. External drainage was undertaken using widefield viewing and chandelier illumination. Intraocular pressure was maintained with an anterior chamber infusion. Near-complete drainage of sub-retinal fluid was achieved, and retinal reattachment was maintained at 6 months postoperatively, with a corresponding improvement in visual acuity from 20/63 to 20/40.

Conclusions

External drainage under chandelier-assisted viewing at the surgical microscope with anterior chamber infusion offers the ergonomic and optical advantages of the surgical microscope and widefield visualisation, continuous IOP control and drainage of sub-retinal fluid without the need for pars plana vitrectomy.
Social determinants of mental health care systems: intensive community based Care in the Veterans Health Administration
Authors: Bhalla Ish P. , Stefanovics Elina A. , Rosenheck Robert A.
Published: August 2020

Background

Since deinstitutionalization in the 1950s–1970s, public mental health care has changed its focus from asylums to general hospitals, outpatient clinics and specialized community-based programs addressing both clinical and social determinants of mental health. Analysis of the place of community-based programs within a comprehensive health system such as the Veterans Health Administration (VHA) may illuminate the role of social forces in shaping contemporary public mental health systems.

Methods

National VHA administrative data were used to compare veterans who exclusively received outpatient clinic care to those receiving four types of specialized community-based services, addressing: 1) functional disabilities from severe mental illness (SMI), 2) justice system involvement, 3) homelessness, and 4) vocational rehabilitation. Bivariate comparisons and multinomial logistic regression analyses compared groups on demographics, diagnoses, service use, and psychiatric prescription fills.

Results

An hierarchical classification of 1,386,487 Veterans who received specialty mental health services from VHA in Fiscal Year 2012, showed 1,134,977 (81.8%) were seen exclusively in outpatient clinics; 27,931 (2.0%) received intensive SMI-related services; 42,985 (3.1%) criminal justice services; 160,273 (11.6%) specialized homelessness services; and 20,921 (1.5%) vocational services. Compared to those seen only in clinics, veterans in the four community treatment groups were more likely to be black, diagnosed with HIV and hepatitis, had more numerous substance use diagnoses and made far more extensive use of mental health outpatient and inpatient care.

Conclusions

Almost one-fifth of VHA mental health patients receive community-based services prominently addressing major social determinants of health and multimorbid substance use disorders.
Effectiveness of technology-enhanced teaching and assessment methods of undergraduate preclinical dental skills: a systematic review of randomized controlled clinical trials
Authors: Khalaf Khaled , El-Kishawi Mohamed , Mustafa Shahd , Al Kawas Sausan
Published: August 2020

Background

To investigate the effectiveness of technology-enhanced teaching and assessment methods of undergraduate preclinical skills in comparison to conventional methods.

Methods

A comprehensive search strategy was implemented using both manual and electronic search methods, including PubMed, Wiley, ScienceDirect, SCOPUS, and the Cochrane Central Register of Controlled Trials. The search and selection of articles that met the inclusion criteria were carried out in duplicates. A Cochrane data extraction form for RCTs was used to extract the relevant information from all included articles. Risk of bias of all included articles was assessed independently by two authors using the Cochrane risk of bias tool.

Results

A total of 19 randomized controlled clinical trials met the inclusion criteria and were included in this review. The majority of the studies included in this review have a high risk of bias mainly due to incomplete data, lack of blinding of the examiners, and due to other biases, such as small sample sizes, not accounting for additional hours of training, and the lack of calibration of examiners grading the preparations. Conflicting results were reported in the included studies with regards to whether there were differences between the intervention and control groups in the outcome measure of quality of students’ performance. A meta-analysis could not be done for this study due to the heterogeneity among the included studies.

Conclusions

Technology-enhanced teaching and assessment tools used in preclinical skills training of undergraduate dental students have the potential to improve students’ performance. However, due to the conflicting outcomes reported in the 19 studies included in this systematic review and their high risk of bias, better quality studies are required to find a definitive answer to the research question of this systematic review.
Withholding and withdrawal of life-sustaining treatments in intensive care units in Lebanon: a cross-sectional survey of intensivists and interviews of professional societies, legal and religious leaders
Authors: El Jawiche Rita , Hallit Souheil , Tarabey Lubna , Abou-Mrad Fadi
Published: August 2020

Background

Little is known about the attitudes and practices of intensivists working in Lebanon regarding withholding and withdrawing life-sustaining treatments (LSTs). The objectives of the study were to assess the points of view and practices of intensivists in Lebanon along with the opinions of medical, legal and religious leaders regarding withholding withdrawal of life-sustaining treatments in Lebanese intensive care units (ICU).

Methods

A web-based survey was conducted among intensivists working in Lebanese adult ICUs. Interviews were also done with Lebanese medical, legal and religious leaders.

Results

Of the 229 survey recipients, 83 intensivists completed it, i.e. a response rate of (36.3%). Most respondents were between 30 and 49 years old (72%), Catholic Christians (60%), anesthesiologists (63%), working in Beirut (47%). Ninety-two percent of them were familiar with the withholding and withdrawal concepts and 80% applied them. Poor prognosis of the acute and chronic disease and futile therapy were the main reasons to consider withholding and withdrawal of treatments. Ninety-five percent of intensivists agreed with the “Principle of Double Effect” (i.e. adding analgesia and or sedation to patients after the withholding/withdrawal decisions in order to prevent their suffering and allow their comfort, even though it might hasten the dying process). The main withheld therapies were vasopressors, respiratory assistance and CPR. Most of the respondents reported the decision was often to always multidisciplinary (92%), involving the family (68%), and the patient (65%), or his advance directives (77%) or his surrogate (81%) and the nurses (78%). The interviewees agreed there was a law governing withholding and withdrawal decisions/practices in Lebanon. Christians and Muslim Sunni leaders declared accepting those practices (withholding or withdrawing LSTs from patients when appropriate).

Conclusion

Withholding and withdrawal of LSTs in the ICU are known concepts among intensivists working in Lebanon and are being practiced. Our results could be used to inform and optimize therapeutic limitation in ICUs in the country.
2000-year-old pathogen genomes reconstructed from metagenomic analysis of Egyptian mummified individuals
Authors: Neukamm Judith , Pfrengle Saskia , Molak Martyna , Seitz Alexander , Francken Michael , Eppenberger Partick , Avanzi Charlotte , Reiter Ella , Urban Christian , Welte Beatrix , Stockhammer Philipp W. , Teßmann Barbara , Herbig Alexander , Harvati Katerina , Nieselt Kay , Krause Johannes , Schuenemann Verena J.
Published: August 2020

Background

Recent advances in sequencing have facilitated large-scale analyses of the metagenomic composition of different samples, including the environmental microbiome of air, water, and soil, as well as the microbiome of living humans and other animals. Analyses of the microbiome of ancient human samples may provide insights into human health and disease, as well as pathogen evolution, but the field is still in its very early stages and considered highly challenging.

Results

The metagenomic and pathogen content of Egyptian mummified individuals from different time periods was investigated via genetic analysis of the microbial composition of various tissues. The analysis of the dental calculus’ microbiome identified Red Complex bacteria, which are correlated with periodontal diseases. From bone and soft tissue, genomes of two ancient pathogens, a 2200-year-oldMycobacterium lepraestrain and a 2000-year-old human hepatitis B virus, were successfully reconstructed.

Conclusions

The results show the reliability of metagenomic studies on Egyptian mummified individuals and the potential to use them as a source for the extraction of ancient pathogen DNA.