bluuebunny/crossref_metadata_2025 huggingface dataset:
Processing by RNase 1 forms tRNA halves and distinct Y RNA fragments in the extracellular environment
Authors: Nechooshtan Gal , Yunusov Dinar , Chang Kenneth , Gingeras Thomas R
Published: June 2020

Extracellular RNAs participate in intercellular communication, and are being studied as promising minimally invasive diagnostic markers. Several studies in recent years showed that tRNA halves and distinct Y RNA fragments are abundant in the extracellular space, including in biofluids. While their regulatory and diagnostic potential has gained a substantial amount of attention, the biogenesis of these extracellular RNA fragments remains largely unexplored. Here, we demonstrate that these fragments are produced by RNase 1, a highly active secreted nuclease. We use RNA sequencing to investigate the effect of a null mutation of RNase 1 on the levels of tRNA halves and Y RNA fragments in the extracellular environment of cultured human cells. We complement and extend our RNA sequencing results with northern blots, showing that tRNAs and Y RNAs in the non-vesicular extracellular compartment are released from cells as full-length precursors and are subsequently cleaved to distinct fragments. In support of these results, formation of tRNA halves is recapitulated by recombinant human RNase 1 in our in vitro assay. These findings assign a novel function for RNase 1, and position it as a strong candidate for generation of tRNA halves and Y RNA fragments in biofluids.
RNA aptamer capture of macromolecular complexes for mass spectrometry analysis
Authors: Ray Judhajeet , Kruse Angela , Ozer Abdullah , Kajitani Takuya , Johnson Richard , MacCoss Michael , Heck Michelle , Lis John T
Published: June 2020

Specific genomic functions are dictated by macromolecular complexes (MCs) containing multiple proteins. Affinity purification of these complexes, often using antibodies, followed by mass spectrometry (MS) has revolutionized our ability to identify the composition of MCs. However, conventional immunoprecipitations suffer from contaminating antibody/serum-derived peptides that limit the sensitivity of detection for low-abundant interacting partners using MS. Here, we present AptA–MS (aptamer affinity–mass spectrometry), a robust strategy primarily using a specific, high-affinity RNA aptamer against Green Fluorescent Protein (GFP) to identify interactors of a GFP-tagged protein of interest by high-resolution MS. Utilizing this approach, we have identified the known molecular chaperones that interact with human Heat Shock Factor 1 (HSF1), and observed an increased association with several proteins upon heat shock, including translation elongation factors and histones. HSF1 is known to be regulated by multiple post-translational modifications (PTMs), and we observe both known and new sites of modifications on HSF1. We show that AptA–MS provides a dramatic target enrichment and detection sensitivity in evolutionarily diverse organisms and allows identification of PTMs without the need for modification-specific enrichments. In combination with the expanding libraries of GFP-tagged cell lines, this strategy offers a general, inexpensive, and high-resolution alternative to conventional approaches for studying MCs.
NF1 optic pathway glioma: analyzing risk factors for visual outcome and indications to treat
Authors: Azizi Amedeo A , Walker David A , Liu Jo-Fen , Sehested Astrid , Jaspan Timothy , Pemp Berthold , Simmons Ian , Ferner Rosalie , Grill Jacques , Hargrave Darren , Driever Pablo Hernáiz , Evans D Gareth , Opocher Enrico ,   SIOPE NF1 OPG Nottingham, UK, Workshop 2014
Published: June 2020

Background

The aim of the project was to identify risk factors associated with visual progression and treatment indications in pediatric patients with neurofibromatosis type 1 associated optic pathway glioma (NF1-OPG).

Methods

A multidisciplinary expert group consisting of ophthalmologists, pediatric neuro-oncologists, neurofibromatosis specialists, and neuro-radiologists involved in therapy trials assembled a cohort of children with NF1-OPG from 6 European countries with complete clinical, imaging, and visual outcome datasets. Using methods developed during a consensus workshop, visual and imaging data were reviewed by the expert team and analyzed to identify associations between factors at diagnosis with visual and imaging outcomes.

Results

Eighty-three patients (37 males, 46 females, mean age 5.1 ± 2.6 y; 1–13.1 y) registered in the European treatment trial SIOP LGG-2004 (recruited 2004–2012) were included. They were either observed or treated (at diagnosis/after follow-up).

In multivariable analysis, factors present at diagnosis associated with adverse visual outcomes included: multiple visual signs and symptoms (adjusted odds ratio [adjOR]: 8.33; 95% CI: 1.9–36.45), abnormal visual behavior (adjOR: 4.15; 95% CI: 1.20–14.34), new onset of visual symptoms (adjOR: 4.04; 95% CI: 1.26–12.95), and optic atrophy (adjOR: 3.73; 95% CI: 1.13–12.53). Squint, posterior visual pathway tumor involvement, and bilateral pathway tumor involvement showed borderline significance. Treatment appeared to reduce tumor size but improved vision in only 10/45 treated patients. Children with visual deterioration after primary observation are more likely to improve with treatment than children treated at diagnosis.

Conclusions

The analysis identified the importance of symptomatology, optic atrophy, and history of vision loss as predictive factors for poor visual outcomes in children with NF1-OPG.
Validation and Optimization of Barrow Neurological Institute Score in Prediction of Adverse Events and Functional Outcome After Subarachnoid Hemorrhage—Creation of the HATCH (Hemorrhage, Age, Treatment, Clinical State, Hydrocephalus) Score
Authors: Hostettler Isabel Charlotte , Sebök Martina , Ambler Gareth , Muroi Carl , Prömmel Peter , Neidert Marian Christoph , Richter Johannes Konstantin , Pangalu Athina , Regli Luca , Germans Menno Robbert
Published: June 2020

BACKGROUND

The Barrow Neurological Institute (BNI) score, measuring maximal thickness of aneurysmal subarachnoid hemorrhage (aSAH), has previously shown to predict symptomatic cerebral vasospasms (CVSs), delayed cerebral ischemia (DCI), and functional outcome.

OBJECTIVE

To validate the BNI score for prediction of above-mentioned variables and cerebral infarct and evaluate its improvement by integrating further variables which are available within the first 24 h after hemorrhage.

METHODS

We included patients from a single center. The BNI score for prediction of CVS, DCI, infarct, and functional outcome was validated in our cohort using measurements of calibration and discrimination (area under the curve [AUC]). We improved it by adding additional variables, creating a novel risk score (measure by the dichotomized Glasgow Outcome Scale) and validated it in a small independent cohort.

RESULTS

Of 646 patients, 41.5% developed symptomatic CVS, 22.9% DCI, 23.5% cerebral infarct, and 29% had an unfavorable outcome. The BNI score was associated with all outcome measurements. We improved functional outcome prediction accuracy by including age, BNI score, World Federation of Neurologic Surgeons, rebleeding, clipping, and hydrocephalus (AUC 0.84, 95% CI 0.8-0.87). Based on this model we created a risk score (HATCH—Hemorrhage, Age, Treatment, Clinical State, Hydrocephalus), ranging 0 to 13 points. We validated it in a small independent cohort. The validated score demonstrated very good discriminative ability (AUC 0.84 [95% CI 0.72-0.96]).

CONCLUSION

We developed the HATCH score, which is a moderate predictor of DCI, but excellent predictor of functional outcome at 1 yr after aSAH.
Optical Coherent Tomography Predicts Long-Term Visual Outcome of Pituitary Adenoma Surgery: New Perspectives From a 5-Year Follow-up Study
Authors: Chung Young Soo , Na Minkyun , Yoo Jihwan , Kim Woohyun , Jung In-Ho , Moon Ju Hyung , Lee Junwon , Kim Sun Ho , Kim Eui Hyun
Published: June 2020

BACKGROUND

Compressive optic neuropathy is the most common indication for transsphenoidal surgery for pituitary adenomas. Optical coherence tomography (OCT) is a useful visual assessment tool for predicting postoperative visual field recovery.

OBJECTIVE

To analyze visual parameters and their association based on long-term follow-up.

METHODS

Only pituitary adenoma patients with abnormal visual field defects were selected. A total of 188 eyes from 113 patients assessed by visual field index (VFI) and 262 eyes from 155 patients assessed by mean deviation (MD) were enrolled in this study. Postoperative VFI, MD, and retinal nerve fiber layer (RNFL) thickness were evaluated and followed up. After classifying the patients into normal (>5%) and thin (<5%) RNFL groups, we investigated whether preoperative RNFL could predict visual field outcomes. We also observed how RNFL changes after surgery on a long-term basis.

RESULTS

Both preoperative VFI and MD had a linear proportional relationship with preoperative RNFL thickness. Sustained improvement of the visual field was observed after surgery in both groups, and the degree of improvement over time in each group was similar. RNFL thickness continued to decrease until 36 mo after surgery (80.2 ± 13.3 μm to 66.6 ± 11.9 μm) while visual field continued to improve (VFI, 61.8 ± 24.5 to 84.3 ± 15.4; MD, −12.9 ± 7.3 dB to −6.3 ± 5.9 dB).

CONCLUSION

Patients with thin preoperative RNFL may experience visual recovery similar to those with normal preoperative RNFL; however, the probability of normalized visual fields was not comparable. RNFL thickness showed a strong correlation with preoperative visual field defect. Long-term follow-up observation revealed a discrepancy between anatomic and functional recovery.
Impact of Intraoperative Magnetic Resonance Imaging and Other Factors on Surgical Outcomes for Newly Diagnosed Grade II Astrocytomas and Oligodendrogliomas: A Multicenter Study
Authors: Yahanda Alexander T , Patel Bhuvic , Shah Amar S , Cahill Daniel P , Sutherland Garnette , Honeycutt John , Jensen Randy L , Rich Keith M , Dowling Joshua L , Limbrick David D , Dacey Ralph G , Kim Albert H , Leuthardt Eric C , Dunn Gavin P , Zipfel Gregory J , Leonard Jeffrey R , Smyth Matthew D , Shah Mitesh V , Abram Steven R , Evans John , Chicoine Michael R
Published: June 2020

BACKGROUND

Few studies use large, multi-institutional patient cohorts to examine the role of intraoperative magnetic resonance imaging (iMRI) in the resection of grade II gliomas.

OBJECTIVE

To assess the impact of iMRI and other factors on overall survival (OS) and progression-free survival (PFS) for newly diagnosed grade II astrocytomas and oligodendrogliomas.

METHODS

Retrospective analyses of a multicenter database assessed the impact of patient-, treatment-, and tumor-related factors on OS and PFS.

RESULTS

A total of 232 resections (112 astrocytomas and 120 oligodendrogliomas) were analyzed. Oligodendrogliomas had longer OS (P < .001) and PFS (P = .01) than astrocytomas. Multivariate analyses demonstrated improved OS for gross total resection (GTR) vs subtotal resection (STR; P = .006, hazard ratio [HR]: .23) and near total resection (NTR; P = .02, HR: .64). GTR vs STR (P = .02, HR: .54), GTR vs NTR (P = .04, HR: .49), and iMRI use (P = .02, HR: .54) were associated with longer PFS. Frontal (P = .048, HR: 2.11) and occipital/parietal (P = .003, HR: 3.59) locations were associated with shorter PFS (vs temporal). Kaplan-Meier analyses showed longer OS with increasing extent of surgical resection (EOR) (P = .03) and 1p/19q gene deletions (P = .02). PFS improved with increasing EOR (P = .01), GTR vs NTR (P = .02), and resections above STR (P = .04). Factors influencing adjuvant treatment (35.3% of patients) included age (P = .002, odds ratio [OR]: 1.04) and EOR (P = .003, OR: .39) but not glioma subtype or location. Additional tumor resection after iMRI was performed in 105/159 (66%) iMRI cases, yielding GTR in 54.5% of these instances.

CONCLUSION

EOR is a major determinant of OS and PFS for patients with grade II astrocytomas and oligodendrogliomas. Intraoperative MRI may improve EOR and was associated with increased PFS.
Sovereign debt restructuring and growth
Authors: Forni Lorenzo , Palomba Geremia , Pereira Joana , Richmond Christine
Published: June 2020

This paper studies the relation between sovereign debt restructurings with external private creditors and growth during the period 1970–2010. We find that, while growth generally declines in the aftermath of a sovereign debt restructuring, agreements that allow countries to exit a default spell (final restructurings) are associated with improving growth. The difference can be significant. In general, three years after restructuring, growth is about 5% lower compared to countries that did not face restructuring over the same period. The exception is for final restructurings, which result in positive growth in the years immediately after the restructuring. Final restructurings are associated with larger debt reliefs, and we show that post-restructuring growth is higher in countries that exit final restructurings with relatively low debt levels.
UHT Metamorphism Peaking Above 1100 °C with Slow Cooling: Insights from Pelitic Granulites in the Jining Complex, North China Craton
Authors: Wang Bin , Wei Chun-Jing , Tian Wei , Fu Bin
Published: June 2020

The peak temperature and duration of ultrahigh-temperature (UHT) metamorphism are critical to identify and understand its tectonic environment. The UHT metamorphism of the Jining complex in the Khondalite Belt, North China Craton is controversial on the peak temperature, time and tectonic setting. A representative sapphirine-bearing granulite sample is selected from the classic Tianpishan outcrop for addressing the metamorphic evolution and timing. The rock is markedly heterogeneous on centimetre scale and can be divided into melanocratic domains rich in sillimanite (MD-s) or rich in orthopyroxene (MD-o), and leucocratic domains (LD). On the basis of detailed petrographic analyses and phase equilibria modelling using THERMOCALC, all three types of domains record peak temperatures of 1120–1140 °C and a series of post-peak cooling stages at 0·8–0·9 GPa to the fluid-absent solidus (∼890 °C), followed by sub-solidus decompression. The peak temperature for MD-s is constrained by the coexistence of sillimanite-I + sapphirine + spinel + quartz, where sillimanite-I contains densely exsolved aciculae of hematite, yielding reintegrated Fe2O3 contents up to 2·1–2·3 wt %. The post-peak cooling evolution involves the sequential appearance of K-feldspar, sillimanite-II + garnet, orthopyroxene and biotite, where sillimanite-II is exsolution-free and contains variable Fe2O3 contents of 1·3–1·8 wt %. The peak temperature for MD-o is constrained by the sapphirine + orthopyroxene assemblage, where orthopyroxene has a maximum AlIV of 0·22 (Al2O3 = 9·5 wt %) in the core. The cooling evolution involves the sequential appearance of K-feldspar, garnet and biotite, and the decreasing AlIV (0·22→0·17) from core to rim in orthopyroxene. The peak temperature for LD is constrained by the inferred K-feldspar-absent assemblage and the maximum anorthite content of 0·11 in K-feldspar. The cooling evolution involves the crystallization of segregated melts, exsolution of supra-solvus ternary feldspars and growth of biotite. The Al in orthopyroxene, Fe2O3 in sillimanite and anorthite in K-feldspar are good indicators for constraining extreme UHT conditions although they depend differently on bulk-rock compositions. In-situ SHRIMP U–Pb dating of metamorphic zircon indicates that the UHT metamorphism may have occurred at >1·94 Ga and the cooling under UHT conditions lasted over 40 Ma. The extreme UHT metamorphism in the Jining complex is interpreted to be triggered by the advective heating of intraplate hyperthermal mafic magmas together with a plume-related hot mantle upwelling, following an orogenic crustal thickening event.
Racialized Discourse in Seattle Rental Ad Texts
Authors: Kennedy Ian , Hess Chris , Paullada Amandalynne , Chasins, Sarah
Published: June 2020

Racial discrimination has been a central driver of residential segregation for many decades, in the Seattle area as well as in the United States as a whole. In addition to redlining and restrictive housing covenants, housing advertisements included explicit racial language until 1968. Since then, housing patterns have remained racialized, despite overt forms of racial language and discrimination becoming less prevalent. In this paper, we use Structural Topic Models (STM) and qualitative analysis to investigate how contemporary rental listings from the Seattle-Tacoma Craigslist page differ in their description based on neighborhood racial composition. Results show that listings from White neighborhoods emphasize trust and connections to neighborhood history and culture, while listings from non-White neighborhoods offer more incentives and focus on transportation and development features, sundering these units from their surroundings. Without explicitly mentioning race, these listings display racialized neighborhood discourse that might impact neighborhood decision-making in ways that contribute to the perpetuation of housing segregation.
Functional organization of the insula in men and women with obstructive sleep apnea during Valsalva
Authors: Pal Amrita , Ogren Jennifer A , Aguila Andrea P , Aysola Ravi , Kumar Rajesh , Henderson Luke A , Harper Ronald M , Macey Paul M
Published: June 2020

Study Objectives

Obstructive sleep apnea (OSA) patients show impaired autonomic regulation, perhaps related to functional reorganization of the insula, which in healthy individuals shows sex-specific anterior and right dominance during sympathetic activation. We examined insular organization of responses to a Valsalva maneuver in OSA with functional magnetic resonance imaging (fMRI).

Methods

We studied 43 newly diagnosed OSA (age mean ± SD: 46.8 ± 8.7 years; apnea-hypopnea index (AHI) ± SD: 32.1 ± 20.1 events/hour; 34 males) and 63 healthy (47.2 ± 8.8 years; 40 males) participants. Participants performed four 18-second Valsalva maneuvers (1-minute intervals, pressure ≥ 30 mmHg) during scanning. fMRI time trends from five insular gyri—anterior short (ASG); mid short (MSG); posterior short (PSG); anterior long (ALG); and posterior long (PLG)—were assessed for within-group responses and between-group differences with repeated measures ANOVA (p < 0.05); age and resting heart rate (HR) influences were also assessed.

Results

Right and anterior fMRI signal dominance appeared in OSA and controls, with no between-group differences. Separation by sex revealed group differences. Left ASG anterior signal dominance was lower in OSA versus control males. Left ASG and ALG anterior dominance was higher in OSA versus control females. In all right gyri, only OSA females showed greater anterior dominance than controls. Right dominance was apparent in PSG and ALG in all groups; females showed right dominance in MSG and PLG. OSA males did not show PLG right dominance. Responses were influenced substantially by HR but modestly by age.

Conclusions

Anterior and right insular fMRI dominance appears similar in OSA versus control participants during the sympathetic phase of the Valsalva maneuver. OSA and control similarities were present in just males, but not necessarily females, which may reflect sex-specific neural injury.
Exposure to Food Insecurity during Adolescence and Educational Attainment
Authors: Heflin Colleen , Darolia Rajeev , Kukla-Acevedo Sharon
Published: June 2020

Previous research has documented the negative consequences of exposure to food insecurity over the early childhood period in terms of health and cognitive and behavioral outcomes, but less research has explored the consequences of exposure to food insecurity at other points in childhood. We examine the association between food insecurity during adolescence and educational attainment. We begin by exploring a conceptual framework for the potential mechanisms that might lead adolescents who experience food insecurity to have differential educational outcomes. Then, we use descriptive and regression analysis to see whether food insecurity is associated with lower educational attainment using data from the Panel Study of Income Dynamics Transition to Adulthood Survey. We find that exposure to food insecurity during adolescence predicts lower levels of educational attainment by reducing college attendance.
Relationship between Caregiver Depressive Symptoms and Child Asthma Medication Adherence: A Multilevel Analysis
Authors: Margolis Rachel H F , Bellin Melissa H , Tsoukleris Mona , Unick Jay , Kub Joan E , Butz Arlene M
Published: June 2020

Asthma morbidity and mortality are disproportionately higher among African American children. Medication adherence is essential for reducing adverse asthma outcomes in this population. Depressive symptoms, prevalent among mothers of children with asthma, have been linked to medication nonadherence. This longitudinal, multilevel analysis used data from a randomized clinical trial evaluating the efficacy of an environmental control educational intervention to evaluate the relationship between caregiver depressive symptoms (Center for Epidemiologic Studies Depression Scale) and caregiver-reported medication adherence (Medication Adherence Report Scale) in urban African American children with uncontrolled asthma (N = 208) at baseline, in six months, and in 12 months. Nearly a third (31.7%) of caregivers (97% female) had clinically significant depressive symptoms at baseline. A random intercept model showed that the within-caregiver effect of depression predicted lower medication adherence (β = –.079, p = .002) as did time (β = –.413, p < .001); the between-caregiver effect of depression did not (β = –.007, p = .77). Changes in a caregiver’s baseline level of depressive symptoms appear to have a stronger influence on medication adherence than mean level of depressive symptoms. Policy, practice, and further research should address maternal mental health as a key element in the life course of African American children with asthma.
Using a Trauma-Informed, Socially Just Research Framework with Marginalized Populations: Practices and Barriers to Implementation
Authors: Voith Laura A , Hamler Tyrone , Francis Meredith W , Lee Hyunjune , Korsch-Williams Amy
Published: June 2020

Social workers, including social work researchers, are called on to challenge social injustices and pursue social change. Research has shown a strong association between trauma and adversity and marginalized populations, exposing the unequal distribution of trauma and its effects throughout society. Given the focus on marginalized populations in social work, the social justice orientation of the field, and the intersection of trauma with marginalized populations, a framework to guide social work researchers in conducting trauma-informed, socially just research with marginalized populations is warranted. Therefore, this article provides a framework integrating trauma theory, trauma-informed principles, and intersectionality as a guide for social work research. The proposed framework is illustrated using a case study of low-income, predominantly African American men recruited from a criminal justice setting, acknowledging facilitators and barriers to implementation. The article concludes with a discussion of the implications for researchers and doctoral student training.
Carbapenem-Resistant Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit: Risk Factors for Mortality
Authors: Bor Meltem , Ilhan Ozkan
Published: June 2020

Aim

The aim of our study was to determine the factors associated with mortality in neonates with carbapenem-resistant Klebsiella pneumoniae (CRKP).

Material and methods

This retrospective, single-center study was conducted in the Neonatal Intensive Care Unit of Harran University Faculty of Medicine between January 2017 and July 2018 who had CRKP growth in their blood, urine or cerebrospinal fluid cultures. The discharged group was designated as the control group (Group 1), whereas the group that faced mortality was classified as the case group (Group 2). The demographic data, clinical findings and laboratory and microbiological results of the two groups were compared to identify risk factors.

Results

A total of 58 patients (36 in Group 1 and 22 in Group 2) exhibited CRKP growth during the study period. Low birth weight (p = 0.039), previous antifungal (p = 0.002) or amikacin use (p = 0.040), congenital anomalies (p = 0.002), total parenteral nutrition (TPN) administration (p = 0.002), surgery (p = 0.035), thrombocytopenia (p = 0.007), low platelet mass index (p = 0.011), elevated C-reactive protein (p = 0.004), high carbapenem minimum inhibitory concentration (MIC) (p = 0.029) and high amikacin MIC (p = 0.019) were associated with mortality. In a multivariate regression analysis, previous antifungal use (p = 0.028), congenital anomalies (p = 0.032) and TPN use (p = 0.013) were independent factors in predicting mortality.

Conclusion

Previous antifungal use, congenital anomalies and TPN use were found to be independent risk factors for mortality in neonates with CRKP infection.
Effectiveness of a Daily Rounding Checklist on Processes of Care and Outcomes in Diverse Pediatric Intensive Care Units Across the World
Authors: Kashyap Rahul , Murthy Srinivas , Arteaga Grace M , Dong Yue , Cooper Lindsey , Kovacevic Tanja , Basavaraja Chetak , Ren Hong , Qiao Lina , Zhang Guoying , Sridharan Kannan , Jin Ping , Wang Tao , Tuibeqa Ilisapeci , Kang An , Ravi Mandyam Dhanti , Ongun Ebru , Gajic Ognjen , Tripathi Sandeep ,   SCCM Discovery CERTAINp Collaborative Investigators, Murthy Srinivas , Jin Ping , Ren Hong , Kang An , Qiao Lina , Wang Tao , Zhang Guoying , Cooper Lindsey , Kovacevic Tanja , Mestrovic Julije , Polic Branka , Markic Josko , Sridharan Kannan , Tuibeqa IIisapeci , Sauduadua Laila , Basavaraja Chetak , Ravi Mandyam Dhanti , Devaraj Ellan , Ongun Ebru , Arteaga Grace M , Coville Hongchuan , Dong Yue , Fan Lei , Gajic Ognjen , Hong Bo , Hulyalkar Manasi , Kang An , Kashyap Rahul , Kaur Harsheen , Padhya Dipti , Sabov Moldovan , Suzuki Reina , Tripathi Sandeep
Published: June 2020

Background

Implementation of checklists has been shown to be effective in improving patient safety. This study aims to evaluate the effectiveness of implementation of a checklist for daily care processes into clinical practice of pediatric intensive care units (PICUs) with limited resources.

Methods

Prospective before–after study in eight PICUs from China, Congo, Croatia, Fiji, and India after implementation of a daily checklist into the ICU rounds.

Results

Seven hundred and thirty-five patients from eight centers were enrolled between 2015 and 2017. Baseline stage had 292 patients and post-implementation 443. The ICU length of stay post-implementation decreased significantly [9.4 (4–15.5) vs. 7.3 (3.4–13.4) days, p = 0.01], with a nominal improvement in the hospital length of stay [15.4 (8.4–25) vs. 12.6 (7.5–24.4) days, p = 0.055]. The hospital mortality and ICU mortality between baseline group and post-implementation group did not show a significant difference, 14.4% vs. 11.3%; p = 0.22 for each. There was a variable impact of checklist implementation on adherence to various processes of care recommendations. A decreased exposure in days was noticed for; mechanical ventilation from 42.6% to 33.8%, p < 0.01; central line from 31.3% to 25.3%, p < 0.01; and urinary catheter from 30.6% to 24.4%, p < 0.01. Although there was an increased utilization of antimicrobials (89.9–93.2%, p < 0.01).

Conclusions

Checklists for the treatment of acute illness and injury in the PICU setting marginally impacted the outcome and processes of care. The intervention led to increasing adherence with guidelines in multiple ICU processes and led to decreased length of stay.
Application of machine learning tools in classifying pedestrian crash types: A case study
Authors: Das Subasish , Le Minh , Dai Boya
Published: June 2020

Crash occurrence is a complex phenomenon, and crashes associated with pedestrians and bicyclists are even more complex. Furthermore, pedestrian- and bicyclist-involved crashes are typically not reported in detail in state or national crash databases. To address this issue, developers created the Pedestrian and Bicycle Crash Analysis Tool (PBCAT). However, it is labour-intensive to manually identify the types of pedestrian and bicycle crash from crash-narrative reports and to classify different crash attributes from the textual content of police reports. Therefore, there is a need for a supporting tool that can assist practitioners in using PBCAT more efficiently and accurately. The objective of this study is to develop a framework for applying machine-learning models to classify crash types from unstructured textual content. In this study, the research team collected pedestrian crash-typing data from two locations in Texas. The XGBoost model was found to be the best classifier. The high prediction power of the XGBoost classifiers indicates that this machine-learning technique was able to classify pedestrian crash types with the highest accuracy rate (up to 77% for training data and 72% for test data). The findings demonstrate that advanced machine-learning models can extract underlying patterns and trends of crash mechanisms. This provides the basis for applying machine-learning techniques in addressing the crash typing issues associated with non-motorist crashes.
Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study
Authors: Robba Chiara , Aspide Raffaele , Pegoli Marianna , Kondratyeva Ekaterina , Gritti Paolo , Fustini Marco F. , Battaglini Denise , Pelosi Paolo , Hutchinson Peter J. , Helmy Adel , Bortolotti Carlo , Zenesini Corrado , Bilotta Federico
Published: June 2020

Background:

The prevalence of pituitary dysfunction after aneurysmal subarachnoid hemorrhage (aSAH) remains incompletely elucidated. Furthermore, it is not clear whether these abnormalities impact patient outcomes. The aim of this study was to evaluate the prevalence of pituitary dysfunction after aSAH and its effect on outcomes.

Methods:

We carried out a prospective, cohort study including adult patients (18 y of age or older) with a diagnosis of aSAH who were admitted to the intensive care unit in 3 centers between January 2017 and January 2019. Exclusion criteria were previous hypopituitarism, hormonal replacement therapies for pituitary dysfunction or any corticosteroid treatment. Endocrine function was tested within the first 48 hours after aSAH onset (acute phase), after 1 to 3 weeks (subacute phase), and after 6 to 12 months (chronic phase). Clinical outcomes were assessed at 6 to 12 months using the modified Rankin Scale.

Results:

Fifty-six patients were included in the study; all were studied in the acute phase, 34 were studied in the subacute phase, and 49 in the chronic phase. Pituitary dysfunction was identified in 92.3% (95% confidence interval; [CI]: 86.6%-98.0%) of cases in the acute phase, in 83.3% (95% CI: 70.8%-95.8%) in the subacute phase, and in 83.3% (95% CI: 72.7%-93.9%) of cases in the chronic phase. The most commonly identified abnormality was dysfunction of the pituitary-gonadal axis. There was no correlation between pituitary dysfunction and clinical outcome.

Conclusion:

Pituitary dysfunction is common after aSAH, but does not affect 6 to 12-month clinical outcomes.
Selection Criteria for Cochlear Implantation in the United Kingdom and Flanders: Toward a Less Restrictive Standard
Authors: van der Straaten Tirza F. K. , Briaire Jeroen J. , Vickers Deborah , Boermans Peter Paul B. M. , Frijns Johan H. M.
Published: June 2020

Objectives:

The impact of the newly introduced cochlear implantation criteria of the United Kingdom and Flanders (Dutch speaking part of Belgium) was examined in the patient population of a tertiary referral center in the Netherlands. We compared the patients who would be included/excluded under the new versus old criteria in relation to the actual improvement in speech understanding after implantation in our center. We also performed a sensitivity analysis to examine the effectiveness of the different preoperative assessment approaches used in the United Kingdom and Flanders.

Design:

The selection criteria were based on preoperative pure-tone audiometry at 0.5, 1, 2, and 4 kHz and a speech perception test (SPT) with and without best-aided hearing aids. Postoperatively, the same SPT was conducted to assess the benefit in speech understanding.

Results:

The newly introduced criteria in Flanders and the United Kingdom were less restrictive, resulting in greater percentages of patients implanted with CI (increase of 30%), and sensitivity increase of 31%. The preoperative best-aided SPT, used by both countries, had the highest diagnostic ability to indicate a postoperative improvement of speech understanding. We observed that patient selection was previously dominated by the pure-tone audiometry criteria in both countries, whereas speech understanding became more important in their new criteria. Among patients excluded by the new criteria, seven of eight (the United Kingdom and Flanders) did exhibit improved postoperative speech understanding.

Conclusions:

The new selection criteria of the United Kingdom and Flanders led to increased numbers of postlingually deafened adults benefitting from CI. The new British and Flemish criteria depended on the best-aided SPT with the highest diagnostic ability. Notably, the new criteria still led to the rejection of candidates who would be expected to gain considerably in speech understanding after implantation.
Vestibular Function in Children With a Congenital Cytomegalovirus Infection: 3 Years of Follow-Up
Authors: Dhondt Cleo , Maes Leen , Rombaut Lotte , Martens Sarie , Vanaudenaerde Saartje , Van Hoecke Helen , De Leenheer Els , Dhooge Ingeborg
Published: June 2020

Objectives:

Congenital cytomegalovirus (cCMV) infection is the most common nongenetic cause of sensorineural hearing loss in children. Due to the close anatomical relationship between the auditory and the vestibular sensory organs, cCMV can also be an important cause of vestibular loss. However, the prevalence and nature of cCMV-induced vestibular impairment is still underexplored. The aim of this study was to investigate the occurrence and characteristics of vestibular loss in a large group of cCMV-infected children, representative of the overall cCMV-population.

Design:

Ninety-three children (41 boys, 52 girls) with a confirmed diagnosis of cCMV were enrolled in this prospective longitudinal study. They were born at the Ghent University Hospital or referred from another hospital for multidisciplinary follow-up in the context of cCMV. The test protocol consisted of regular vestibular follow-up around the ages of 6 months, 1 year, 2 years, and 3 years with the video Head Impulse Test, the rotatory test, and the cervical Vestibular Evoked Myogenic Potential test.

Results:

On average, the 93 patients (52 asymptomatic, 41 symptomatic) were followed for 10.2 months (SD: 10.1 mo) and had 2.2 examinations (SD: 1.1). Seventeen (18%) patients had sensorineural hearing loss (7 unilateral, 10 bilateral). Vestibular loss was detected in 13 (14%) patients (7 unilateral, 6 bilateral). There was a significant association between the occurrence of hearing loss and the presence of vestibular loss (p < 0.001), with 59% (10/17) vestibular losses in the group of hearing-impaired children compared to 4% (3/76) in the group of normal-hearing subjects. In the majority of the cases with a vestibular dysfunction (85%, 11/13), both the semicircular canal system and the otolith system were affected. The remaining subjects (15%, 2/13) had an isolated semicircular canal dysfunction. Sixty-one patients already had at least one follow-up examination. Deterioration of the vestibular function was detected in 6 of them (10%, 6/61).

Conclusions:

cCMV can impair not only the auditory but also the vestibular function. Similar to the hearing loss, vestibular loss in cCMV can be highly variable. It can be unilateral or bilateral, limited or extensive, stable or progressive, and early or delayed in onset. As the vestibular function can deteriorate over time and even normal-hearing subjects can be affected, vestibular evaluation should be part of the standard otolaryngology follow-up in all children with cCMV.
Technical note: bone marrow aspirate needle to assist in-situ screw fixation of slipped capital femoral epiphysis
Authors: Watkins Colyn J. , Novais Eduardo
Published: June 2020

Slipped capital femoral epiphysis (SCFE) is characterized by posterior and inferior displacement of the capital femoral epiphysis in relationship to the metaphysis. Although universally accepted as a treatment modality for SCFE, in-situ pinning may be technically challenging in obese adolescents with large body habitus. Adequate screw position is important to achieve stabilization of the epiphysis and to allow closure of the growth plate. During the surgical procedure of in-situ pinning, it is crucial to obtain not only a perfect starting point but also an appropriate trajectory. However, creating a perfect entry point in obese patients with a large thigh may be troublesome. Often the pediatric orthopedic surgeon is faced with intraoperative challenges for screw placement including, but not limited to, the guidewire skiving down anteriorly on the metaphysis, and bending of the guidewire due to a large body habitus when the hip is positioned to obtain a lateral radiograph. We have used a bone marrow biopsy needle as an adjunct for placement of the guidewire during in-situ pinning for SCFE. This technical trick describes our method of using a bone marrow biopsy needle to ease the placement of a guidewire during in-situ pinning.
Somatostatin analogs in pregnant patients with neuroendocrine tumor
Authors: Meoni Giulia , Giommoni Elisa , Petreni Paolo , Pillozzi Serena , Mazzoni Francesca , Pellegrini Elisa , Brugia Marco , Lunghi Alice , Muto Andrea , Antonuzzo Lorenzo
Published: June 2020

Somatostatine analogs (SSAs) are currently indicated in the treatment of acromegaly and neuroendocrine tumors (NETs). Actually, pregnancy in patients with acromegaly and NETs does not represent an exceptional event because reproductive behavior has changed in the last decades and patients with NETs show more frequently long-term survival. The safety profile of SSAs during pregnancy is still controversial. Concerning acromegaly, based on case reports and series, SSAs administration during pregnancy seems to be relatively well tolerated. Concerning patients with NETs, up to date only one patient with NET receiving SSA during pregnancy has been reported in literature. We report two cases of gastroenteropancreatic-NET patients receiving SSA lanreotide for the entire course of their pregnancy, with favorable outcomes for both mothers and babies. Our experience supports the possibility to continue safely SSA lanreotide during pregnancy in patients with NET.
Using Research Electronic Data Capture for Longitudinal Assessment Among Older Adults With Diabetes Enhances Real-Time Data Collection
Authors: Zhu Bingqian , Feng Tienan , Izci-Balserak Bilgay
Published: June 2020

The aim of this study was to provide evidence on the application of Research Electronic Data Capture for collecting repeated data during a 7-day period among older adults. Fifty-seven adults (≥50 years) with type 2 diabetes were recruited. Participants completed one sleep diary upon awaking and one self-care diary before going to bed each day for 7 days. The diaries were administered via the Research Electronic Data Capture Web-based system and were completed via participants' own electronic devices. Objective compliance rate, time used to complete each diary, and participant experience were described. Approximately 80% (n = 45) of the participants used Research Electronic Data Capture. Among these participants, the noncompliance rate ranged between 0% and 8.9% for the sleep diary and 0% and 13.1% for the self-care diary. Participants spent 4.2 to 8.7 minutes on the sleep diary and 3.5 to 7.1 minutes on the self-care diary. It took the participants a longer time to complete the diaries during the first day than during the following 6 days. Few participants reported technical issues or felt inconvenient or stressful with completing the Research Electronic Data Capture diaries. Overall, the compliance rates were high. Completing the diaries was not time-consuming and participants were largely satisfied with the Research Electronic Data Capture data collection. Research Electronic Data Capture has aided the longitudinal data collection. With adequate training, Research Electronic Data Capture is an efficient tool to collect repeated data among older adults and thus is recommended for future research.
Type I Diabetes Self-management With Game-Based Interventions for Pediatric and Adolescent Patients
Authors: Rewolinski Jennifer A. , Kelemen Arpad , Liang Yulan
Published: June 2020

Type 1 diabetes is a disease with a peak diagnosis between the ages of 10 and 14 and carries with it required intensive lifestyle changes. Disease self-management is essential for adequate metabolic control to prevent acute and long-term complications. Yet common methods of diabetes self-management education, such as lectures or pamphlets, lead to low knowledge, engagement, and clinical outcomes. Game-based learning has led to increased motivation, engagement, and productivity overall with substantial increases in self-management of chronic diseases in children. The purpose of this article is to review and synthesize literature on the impact on self-management knowledge, behavior, and engagement of the game-based interventions of serious games and gamification for children and adolescents with type 1 diabetes. Nine studies were reviewed. Results showed statistically significant differences in knowledge, behavior, and engagement in response to the game-based interventions. Knowledge outcomes were found most significant in serious game interventions, while behavioral outcomes were predominantly found in gamification/serious game combination interventions. Findings also reveal there was inconsistent use of theories for game development and moderate to low quality of evidence across studies. While the nine studies reviewed strongly demonstrate the potential of game-based tools to significantly improve type 1 diabetes self-management care, further studies with expanded and more rigorous study parameters are recommended before an outright change in practice may be applied. The potential impact of the clinical nurse leader in the use and research of game-based interventions is also discussed.
Climate change, air pollution, and allergic respiratory diseases: a call to action for health professionals
Authors: Deng Shi-Zhou , Jalaludin Bin B. , Antó Josep M. , Hess Jeremy J. , Huang Cun-Rui
Published: June 2020

Rising emissions of greenhouse gases in the atmosphere have warmed the planet substantially and are also accompanied by poor air quality. The increased prevalence of allergic airway disease worldwide can be partially attributed to those global environmental changes. Climate change and air pollution pose adverse impacts on respiratory allergies, and that the mechanisms are complex and interactive. Adverse weather conditions, such as extreme temperatures, can act directly on the respiratory tract to induce allergic respiratory illnesses. Thunderstorms and floods can alter the production and distribution of aeroallergens while wildfires and dust storms increase air pollution, and therefore indirectly enhance health risks. Concentrations of particulate matter and ozone in the air have been projected to increase with climate warming and air stagnation, and the rising temperatures and CO2 increase pollen, molds, and spores, which escalate the risk of allergic respiratory diseases. The synergistic effects of extreme heat and aeroallergens intensify the toxic effect of air pollutants, which in turn augment the allergenicity of aeroallergens. With the Earth's climate change, migration of humans and plants shift the living environments and allergens of susceptible people. Urban residents are exposed to multiple factors while children are sensitive to environmental exposure. Since climate change may pose many unexpected and persistent effects on allergic respiratory diseases, health professionals should advocate for effective mitigation and adaptation strategies to minimize its respiratory health effects.
Health effects of air pollution: a Southern European perspective
Authors: Viegi Giovanni , Baldacci Sandra , Maio Sara , Fasola Salvatore , Annesi-Maesano Isabella , Pistelli Francesco , Carrozzi Laura , La Grutta Stefania , Forastiere Francesco
Published: June 2020

Objective

To summarize the main updated evidence about the health effects of air pollution, with a special focus on Southern Europe.

Data sources

Literature was obtained through PubMed Central and the official websites of European Agencies and Scientific Societies.

Study selection

Recent shreds of evidence about the health effects of air pollution coming from international reports and original research were collected and described in this review.

Results

Air pollution is an avoidable risk factor that causes a huge burden for society, in terms of death, health disorders, and huge socio-economic costs. The southern European countries face a more threatening problem because they experience the effects of both anthropogenic pollutants and natural dusts (particulate matter [PM]). The European Environment Agency reported the number of premature deaths in the 28 countries of the European Union attributable to air pollutant exposure in the year 2016: 374,000 for PM2.5, 68,000 for nitrogen dioxide, and 14,000 for ozone. In Italy, time series and analytical epidemiological studies showed increased cardio-respiratory hospital admissions and mortality, as well as increased risk of respiratory diseases in people living in urban areas.

Conclusions

Based on abundant evidence, the World Health Organization, which hosts the Global Alliance against Chronic Respiratory Diseases (GARD), the scientific respiratory societies, and the patients’ associations, as well as others in the health sector, must increase their engagement in advocacy for clean air policies.
MEK inhibitors combined with programmed cell death-1 blockade immunotherapy for metastatic uveal melanoma: is it warranted?
Authors: Zanella Anais , Doussot Alexandre , Puzenat Eve , Aubin François , Nardin Charlée
Published: June 2020

In the setting of metastatic uveal melanoma (mUM), prognosis is dismal and treatment options are limited. MEK inhibition using selumetinib has led to promising results with improved progression-free survival. While immune checkpoint inhibitors such as programmed cell death-1 (PD-1) blockade therapy (anti-PD-1) has shown discrete efficacy in mUM, combining MEK inhibitors (MEKi) to anti-PD-1 might be an option as such combinations have shown synergistic efficacy in metastatic cutaneous melanoma. We report here and discuss our experience in three patients who received this combination in the absence of suitable alternative treatment. The efficacy was difficult to assess due to early severe toxicities (pneumonitis and Takotsubo syndrome). This case series highlights the need to evaluate the safety and efficacy of new treatment options such as MEKi and anti-PD-1 for mUM.