bluuebunny/crossref_metadata_2025_split huggingface dataset:
What Is Your Reality? Virtual, Augmented, and Mixed Reality in Plastic Surgery Training, Education, and Practice
Authors: Lee Gordon K. , Moshrefi Shawn , Fuertes Victor , Veeravagu Laksman , Nazerali Rahim , Lin Samuel J. 
Published: November 2020

Summary:
Virtual reality and other technological advancements both inside and outside the operating room have shown an exponential increase in the past two decades. Surgical technique and finesse in delicate procedures have become ever more important, and the onus is on plastic surgeons and plastic surgery residents to meet these needs to provide the best outcomes possible to patients. The ability to learn, simulate, and practice operating in a fashion that poses no harm to any patient is truly a gift from technology to surgery that any surgeon could benefit from, whether trainee or attending. This application of technology and simulation has been demonstrated in other fields such as in the airline industry with flight simulation. The ability to learn, synthesize, and incorporate learned materials and ideas through virtual, augmented, and mixed reality tools offers a great opportunity to put our field at the forefront of a paradigm shift in surgical education. The critical utility of digital education could not be further emphasized any more than in the unfortunate and infrequent situation of a worldwide pandemic. This article reviews some of the important recent technologies that have developed and their applications in plastic surgery education and offers a look into what we can expect in the future.
Caring for Family Caregivers: Perceptions of CARE Act Compliance and Implementation
Authors: Rodakowski Juleen , Leighton Cassandra , Martsolf Grant R. , James A. Everette 
Published: November 2020

Background:
The Caregiver Advise, Record, Enable (CARE) Act encourages inclusion of family caregivers in the hospitalization process for patients. Translating the state laws into meaningful changes within the health care delivery system can be challenging and requires time. This study sought to examine early compliance with and implementation of the CARE Act reported by hospitals in the Commonwealth of Pennsylvania.

Methods:
We sent an online survey to hospital executives in Pennsylvania in 2017. Descriptive statistics were computed to examine hospital characteristics and used to assess compliance and implementation of the CARE Act tenets.

Results:
Most hospitals reported that changes have been and are being made to comply with the CARE Act (90.9%). Hospital executives reported that the family caregiver designation is available in 63.6% of the hospitals and notification of patient discharge is available in 45.5%. Hospital executives reported that family caregiver education and instruction is occurring in 31.8% of all inpatient stays. Hospital executives indicated that they are still developing processes to comply with the legislation and to integrate family caregivers into hospital systems and processes.

Conclusions:
Our findings suggest that hospitals are complying with the legislation, while fully operationalizing the components of the CARE Act is a work in progress.
Impact of County Health Rankings on Nationwide Liver Transplant Outcomes
Authors: Niazi Shehzad K. , Vargas Emily , Spaulding Aaron , Crook Julia , Keaveny Andrew P. , Schneekloth Terry , Rummans Teresa , Taner C. Burcin 
Published: November 2020

Background.
There is limited information concerning whether social determinants of health affect postliver transplant (LT) outcomes. This study aims to understand to what extent the health of LT recipients’ counties of residence influence long-term LT outcomes.

Methods.
We used the United Network for Organ Sharing data to identify adult LT recipients transplanted between January 2010 and June 2018. Patient-level data were matched to county-level County Health Ranking (CHR) data using transplant recipient zip code, and nationwide CHRs were created. Mixed-effects Cox proportional hazards models were used to examine associations between CHRs and graft and patient survival post-LT.

Results.
Health outcomes rank was significantly associated with posttransplant graft and patient survival, with worst tertile counties showing a 13% increased hazard of both graft failure and patient mortality compared to the best tertile counties.

Conclusions.
Although county health is associated with LT outcomes, it also appears that LT recipient selection is effective at mitigating major disparities based on county of residence and helps yield equitable outcomes in this respect.
Neuroimaging Correlates of Lateralized Rhythmic Delta Activity, Lateralized Periodic Discharges, and Generalized Rhythmic Delta Activity on EEG in Critically Ill Patients
Authors: Alzawahmah Mohamed , Fong Michael W.K. , Gilmore Emily J. , Hirsch Lawrence J. 
Published: November 2020

Purpose:
The neuroimaging correlates of lateralized rhythmic delta activity (LRDA) are not well defined, and imaging findings between different epileptiform patterns have seldom been compared directly.

Methods:
Patients were retrospectively selected from a critical care EEG database between December 2014 and December 2017. Patients were included if they had greater than 6 hours of continuous EEG that contained LRDA, lateralized periodic discharges LPDs), or generalized rhythmic delta activity (GRDA) and had an MRI within 48 hours of the EEG. Clinical, EEG, and MRI characteristics were collected and compared.

Results:
All the following results showed statistical significance between the groups: Patients with GRDA were more likely to have a normal MRI (LRDA, 0%; LPDs, 0.8%; GRDA, 17.3%), although the majority were abnormal. In patients with LRDA and LPDs, the MRI abnormalities were much more likely lateralized to one side, whereas in those with GRDA, they were more likely to have bilateral or multifocal abnormalities. Across all groups most abnormalities were acute, although this proportion was higher in patients with LRDA and LPDs compared with that in those with GRDA (LRDA, 91.3%; LPDs, 86.0%; GRDA, 70.4%). An MRI abnormality that was concordant with the side of LRDA was present in 66.3%, with 17.3% having discordant findings. These were similar in patients with LPDs (concordant 67.4%; discordant 11.6%).

Conclusions:
Patients with LRDA had a similarly high rate of acute focal abnormalities ipsilateral to the EEG pattern compared with those with LPDs. Patients with GRDA were more likely to have a normal MRI, but the majority of patients with GRDA still had acute focal findings.
An improved statistical approach for reconstructing past climates from biotic assemblages
Authors: Liu Mengmeng , Prentice Iain Colin , ter Braak Cajo J. F. , Harrison Sandy P. 
Published: November 2020

Quantitative reconstructions of past climates are an important resource for evaluating how well climate models reproduce climate changes. One widely used statistical approach for making such reconstructions from fossil biotic assemblages is weighted averaging partial least-squares regression (WA-PLS). There is however a known tendency for WA-PLS to yield reconstructions compressed towards the centre of the climate range used for calibration, potentially biasing the reconstructed past climates. We present an improvement of WA-PLS by assuming that: (i) the theoretical abundance of each taxon is unimodal with respect to the climate variable considered; (ii) observed taxon abundances follow a multinomial distribution in which the total abundance of a sample is climatically uninformative; and (iii) the estimate of the climate value at a given site and time makes the observation most probable, i.e. it maximizes the log-likelihood function. This climate estimate is approximated by weighting taxon abundances in WA-PLS by the inverse square of their climate tolerances. We further improve the approach by considering the frequency (
fx
) of the climate variable in the training dataset. Tolerance-weighted WA-PLS with
fx
correction greatly reduces the compression bias, compared with WA-PLS, and improves model performance in reconstructions based on an extensive modern pollen dataset.
Two mutations in the SARS-CoV-2 spike protein and RNA polymerase complex are associated with COVID-19 mortality risk
Authors: Hahn Georg , Wu Chloe M. , Lee Sanghun , Hecker Julian , Lutz Sharon M. , Haneuse Sebastien , Qiao Dandi , DeMeo Dawn , Choudhary Manish C. , Etemad Behzad , Mohammadi Abbas , Esmaeilzadeh Elmira , Cho Michael H. , Tanzi Rudolph E. , Li Jonathan Z. , Randolph Adrienne G. , Laird Nan M. , Weiss Scott T. , Silverman Edwin K. , Ribbeck Katharina , Lange Christoph 
Published: November 2020

AbstractBackgroundSARS-CoV-2 mortality has been extensively studied in relation to host susceptibility. How sequence variations in the SARS-CoV-2 genome affect pathogenicity is poorly understood. Whole-genome sequencing (WGS) of the virus with death in SARS-CoV-2 patients is one potential method of early identification of highly pathogenic strains to target for containment.MethodsWe analyzed 7,548 single stranded RNA-genomes of SARS-CoV-2 patients in the GISAID database (Elbe and Buckland-Merrett, 2017; Shu and McCauley, 2017) and associated variants with reported patient’s health status from COVID-19, i.e. deceased versus non-deceased. We probed each locus of the single stranded RNA of the SARS-CoV-2 virus for direct association with host/patient mortality using a logistic regression.ResultsIn total, evaluating 29,891 loci of the viral genome for association with patient/host mortality, two loci, at 12,053bp and 25,088bp, achieved genome-wide significance (p-values of 4.09e-09 and 4.41e-23, respectively).ConclusionsMutations at 25,088bp occur in the S2 subunit of the SARS-CoV-2 spike protein, which plays a key role in viral entry of target host cells. Additionally, mutations at 12,053bp are within the ORF1ab gene, in a region encoding for the protein nsp7, which is necessary to form the RNA polymerase complex responsible for viral replication and transcription. Both mutations altered amino acid coding sequences, potentially imposing structural changes that could enhance viral infectivity and symptom severity, and may be important to consider as targets for therapeutic development. Identification of these highly significant associations, unlikely to occur by chance, may assist with COVID-19 early containment of strains that are potentially highly pathogenic.
Use of alternative RNA storage and extraction reagents and development of a hybrid PCR-based method for SARS-CoV-2 detection
Authors: Yang Julie , Salfati Elias , Kao Damian , Mihaylova Yuliana 
Published: November 2020

AbstractThe COVID-19 pandemic has presented multiple healthcare challenges, one of which is adequately meeting the need for large-scale diagnostic testing. The most commonly used assays for detection of SARS-CoV-2, including those recommended by the Center for Disease Control and Prevention (CDC), rely on a consistent set of core reagents. This has put a serious strain on the reagent supply chain, resulting in insufficient testing. It has also led to restricted animal testing, even though there are now multiple reports of animals, particularly cats, ferrets and minks, contracting the disease. We aimed to address the diagnostic bottleneck by developing a PCR-based SARS-CoV-2 detection assay for cats (and, potentially, other animals) which avoids the use of most common reagents, such as collection kits optimized for RNA stabilization, RNA isolation kits and TaqMan-based RT-PCR reagents. We demonstrated that an inexpensive solid-phase reversible immobilization (SPRI) method can be used for RNA extraction from feline samples collected with DNAGenotek’s ORAcollect RNA OR-100 and PERFORMAgene DNA PG-100 sample collection kits, optimized for RNA or DNA stabilization, respectively. We developed a dual method SARS-CoV-2 detection assay relying on SYBR RT-PCR and Sanger sequencing, using the same set of custom synthesized oligo primers. We validated our test’s specificity with a commercially available SARS-CoV-2 plasmid positive control, as well as two in-house positive control RNA samples. Our assay’s sensitivity was determined to be 10 viral copies per reaction. Our results suggest that a simple SPRI-dependent RNA extraction protocol and certain sample collection kits not specifically optimized for RNA stabilization could potentially be used in cases where reagent shortages are hindering adequate COVID-19 testing. These ‘alternative’ reagents could be used in combination with our COVID-19 testing method, which relies on inexpensive and readily available SYBR RT-PCR and non-fluorescent PCR reagents. Depending on the detection goals and the laboratory setup available, the SYBR RT-PCR method and the Sanger sequencing based method can be used alone or in conjunction, for improved accuracy. Although the test is intended for animal use, it is, in theory, possible to use it with human samples, especially those with higher viral loads.
Maternal obesity before pregnancy predicts offspring blood pressure at 18 years of age: A causal mediation analysis
Authors: Brunton Nicole , Dufault Brenden , Dart Allison , Azad Meghan B. , McGavock Jonathan M 
Published: November 2020

ABSTRACTImportanceHypertension is the second most common pediatric chronic disease in Westernized countries. Understanding the natural history of hypertension is key to identifying prevention strategies.ObjectiveExamine the relationship between maternal pre-pregnancy body mass index (BMI) and offspring blood pressure at 18 years and the mediating role of growth throughout childhood and adolescence.Design, Setting, and ParticipantsWe performed multivariable regression and causal mediation analyses within 3217 mother - offspring pairs from the Avon Longitudinal Study of Parents and Children (ALSAPC) prospective birth cohort. Latent trajectory analysis (LTA) was used to quantify the mediating variable of offspring BMI from 7 to 18 years of age.ExposuresThe main exposure was maternal pre-pregnancy BMI. Analyses were adjusted for relevant confounders including maternal education, maternal blood pressure, and weeks gestation at delivery.Main Outcomes and MeasuresThe main outcome was offspring blood pressure at 18 years of age categorized as normal (SBP < 120 mmHg or DBP < 80mmHg) or elevated (SBP ≥ 120 mmHg or DBP ≥ 80 mmHg) as per the 2017 American Academy of Pediatrics guidelines.ResultsAt 18 years of age, among 3217 offspring, 676 (21%) were overweight or obese, 865 (27%) had elevated blood pressure, and 510 (16%) were hypertensive. LTA identified five distinct offspring BMI trajectories. Multivariate logistic regression revealed that for every 1 unit increase in maternal BMI the risk of elevated blood pressure at 18 years of age increased by 5% (aOR: 1.05, 95% CI: 1.03 – 1.07; p <0.001) and this effect was reduced after adjusting for offspring BMI trajectory (aOR: 1.03, 95% CI: 1.00 – 1.05; p = 0.017). Causal mediation analysis confirmed offspring BMI trajectory as a mediator accounting for 46% of the total effect of maternal BMI on elevated offspring blood pressure (aOR 1.22; 95% CI: 1.07-1.39).Conclusion and RelevanceMaternal BMI prior to pregnancy is associated with an increased risk of elevated blood pressure in offspring at 18 years of age and is mediated, in part, by offspring BMI trajectory throughout childhood and adolescence.
HIV status alters disease severity and immune cell responses inβvariant SARS-CoV-2 infection wave
Authors: Karim Farina , Gazy Inbal , Cele Sandile , Zungu Yenzekile , Krause Robert , Bernstein Mallory , Ganga Yashica , Rodel Hylton , Mthabela Ntombifuthi , Mazibuko Matilda , Khan Khadija , Muema Daniel , Ramjit Dirhona , Ndung’u Thumbi , Hanekom Willem , Gosnell Bernadett I. ,   COMMIT-KZN Team, Lessells Richard , Wong Emily , de Oliveira Tulio , Moosa Mahomed-Yunus S. , Lustig Gila , Leslie Alasdair , Kløverpris Henrik , Sigal Alex 
Published: November 2020

AbstractThere are conflicting reports on the effects of HIV on COVID-19. Here we analyzed disease severity and immune cell changes during and after SARS-CoV-2 infection in 236 participants from South Africa, of which 39% were people living with HIV (PLWH), during the first and second (βdominated) infection waves. The second wave had more PLWH requiring supplemental oxygen relative to HIV negative participants. Higher disease severity was associated with low CD4 T cell counts and higher neutrophil to lymphocyte ratios (NLR). Yet, CD4 counts recovered and NLR stabilized after SARS-CoV-2 clearance in wave 2 infected PLWH, arguing for an interaction between SARS-CoV-2 and HIV infection leading to low CD4 and high NLR. The first infection wave, where severity in HIV negative and PLWH was similar, still showed some HIV modulation of SARS-CoV-2 immune responses. Therefore, HIV infection can synergize with the SARS-CoV-2 variant to change COVID-19 outcomes.
Systematic Review of Studies on Telomere Lengths in Patients with Multiple Sclerosis
Authors: Bühring Jan , Hecker Michael , Fitzner Brit , Zettl Uwe Klaus 
Published: November 2020

AbstractBACKGROUNDTelomeres are protective cap structures at the end of chromosomes that are essential for maintening genomic stability. Accelerated telomere shortening is related to premature cellular senescence. Shortened telomere lengths (TL) have been implicated in the pathogenesis of various chronic immune-mediated and neurological diseases.OBJECTIVEWe aimed to systematically review the current literature on the association of TL as a measure of biological age and multiple sclerosis (MS).METHODSA comprehensive literature search was conducted to identify original studies that presented data on TL in samples from MS patients. Quantitative and qualitative information was extracted from the articles to summarize and compare the studies.RESULTSA total of 51 articles were screened, and 7 of them were included in this review. In 6 studies, average TL were analyzed in peripheral blood cells, whereas in one study, bone marrow-derived cells were used. Four of the studies reported significantly shorter leukocyte TL in at least one MS subtype in comparison to healthy controls (p=0.003 in meta-analysis). Shorter telomeres in MS patients were found to be associated, independently of age, with greater disability, lower brain volume, increased relapse rate and more rapid conversion from relapsing to progressive MS. However, it remains unclear how telomere attrition in MS may be linked to oxidative stress, inflammation and age-related disease processes.CONCLUSIONSDespite few studies in this field, there is substantial evidence on the association of TL and MS. Variability in TL appears to reflect heterogeneity in clinical presentation and course. Further investigations in large and well-characterized cohorts are warranted. More detailed studies on TL of individual chromosomes in specific cell types may help to gain new insights into the pathomechanisms of MS.HighlightsThe relationship between aging and the pathophysiology and course of MS is not fully understoodWe have identified seven studies that analyzed telomere lengths (TL) in patients with MSOur meta-analysis revealed significantly shorter leukocyte TL in MS patients compared to healthy controlsThere is evidence that individual variability in biological aging reflects clinical heterogeneity in MSThe potential use of TL as a biomarker of age-related disease mechanisms deserves further investigation
Rapid Microscopic Fractional Anisotropy Imaging via an Optimized Kurtosis Formulation
Authors: Arezza N. J. J. , Tse D. H. Y. , Baron C. A. 
Published: November 2020

AbstractWater diffusion anisotropy in the human brain is affected by disease, trauma, and development. Microscopic fractional anisotropy (μFA) is a diffusion MRI (dMRI) metric that can quantify water diffusion anisotropy independent of neuron fiber orientation dispersion. However, there are several different techniques to estimate μFA and few have demonstrated full brain imaging capabilities within clinically viable scan times and resolutions. Here, we present an optimized spherical tensor encoding (STE) technique to acquire μFA directly from the 2nd order cumulant expansion of the dMRI signal (i.e. diffusion kurtosis) which requires fewer powder-averaged signals than other STE fitting techniques and can be rapidly computed. We found that the optimal dMRI parameters for white matter μFA imaging were a maximum b-value of 2000 s/mm2 and a ratio of isotropic to linear tensor encoded acquisitions of 1.7 for our system specifications. We then compared two implementations of the direct approach to the well-established gamma model in 4 healthy volunteers on a 3 Tesla system. One implementation of the direct cumulant approach used mean diffusivity (D) obtained from a 2nd order fit of the cumulant expansion, while the other used a linear estimation of D from the low b-values. Both implementations of the direct approach showed strong linear correlations with the gamma model (ρ=0.97 and ρ=0.90) but mean biases of −0.11 and −0.02 relative to the gamma model were also observed, respectively. All three μFA measurements showed good test-retest reliability (ρ≥0.79 and bias=0). To demonstrate the potential scan time advantage of the direct approach, 2 mm isotropic resolution μFA was demonstrated over a 10 cm slab using a subsampled data set with fewer powder-averaged signals that would correspond to a 3.3-minute scan. Accordingly, our results introduce an optimization procedure that has enabled clinically relevant, nearly full brain μFA in only several minutes.HighlightsDemonstrated method to acquire optimal parameters for regression μFA imagingμFA measured using an optimized linear regression method at 3TFirst μFA comparison between direct regression approach and the gamma modelBoth approaches correlated strongly in white matter in healthy volunteersNearly full brain μFA demonstrated in a 3.3-minute scan at 2 mm isotropic resolution
The sensitivity of SARS-CoV-2 antigen tests in the view of large-scale testing
Authors: Drevinek Pavel , Hurych Jakub , Kepka Zdenek , Briksi Ales , Kulich Michal , Zajac Miroslav , Hubacek Petr 
Published: November 2020

AbstractObjectivesAntigen tests have recently emerged as an interesting alternative to SARS-CoV-2 diagnostic PCR, thought to be valuable especially for the screening of bigger communities. To check appropriateness of the antigen based testing, we determined sensitivity of two point-of-care antigen tests when applied to a cohort of COVID-19 symptomatic, COVID-19 asymptomatic and healthy persons.MethodsWe examined nasopharyngeal swabs with antigen test 1 (Panbio Covid-19 Ag Rapid Test, Abbott) and antigen test 2 (Standard F Covid-19 Ag FIA, SD Biosensor). An additional nasopharyngeal and oropharyngeal swab of the same individual was checked with PCR (Allplex SARS-nCoV-2, Seegene). Within a 4-day period in October 2020, we collected specimens from 591 subjects. Of them, 290 had COVID-19 associated symptoms.ResultsWhile PCR positivity was detected in 223 cases, antigen test 1 and antigen test 2 were found positive in 148 (sensitivity 0.664, 95% CI 0.599 - 0.722) and 141 (sensitivity 0.623, 95% CI 0.558 - 0.684) patients, respectively. When only symptomatic patients were analysed, sensitivity increased to 0.738 (95% CI 0.667 - 0.799) for the antigen test 1 and to 0.685 (95% CI 0.611 - 0.750) for the antigen test 2. The substantial drop in sensitivity to 12.9% (95% CI 0.067 - 0.234) was observed for samples with the PCR threshold cycle above > 30.ConclusionsLow sensitivity of antigen tests leads to the considerable risk of false negativity. It is advisable to implement repeated testing with high enough frequency if the antigen test is used as a frontline screening tool.