bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abrupt and Severe Obsessive-Compulsive Disorder in an 11-Year-Old Girl—PANDAS/PANS Syndrome: An Entity to be Considered—Management Implications : “[RETRACTED]”
Authors: Khodayar-Pardo Parisá , Álvarez-Bravos Laura 
Published: April 2020

CASE:An 11-year-old preadolescent girl was taken to the pediatric emergency room by her parents because of emotional overload.Her clinical history started 3 weeks before the visit, coinciding with a self-limited gastrointestinal infection affecting the whole family. Her obsessive behavior first appeared in the school setting; she tried to write perfectly, needing to make repeated corrections and ripping out multiple sheets from her notebooks when she made mistakes. She quickly developed new obsessions in diverse areas that progressively took over her life. When crossing the street, she initially avoided stepping on the zebra crossing lines, which recently progressed to needing to be carried across the pedestrian crossings, becoming greatly distressed if her parents refused. She also developed symmetry compulsions, requiring others to participate in them to avoid frustrating her, for example, asking anyone who touched her clothes to repeat the action for a similar length of time on the opposite side with a perfect symmetry, adopting the same position like a mirror image. There were no superstitions or psychotic features associated with these behaviors. The rituals progressively affected all areas of life (school, family, and friends) and had become highly maladaptive. Being aware of the peculiarity of her symptoms, at school, she tried unsuccessfully to hide them, feeling increasingly anxious.On the day of the hospital visit, she felt so overwhelmed by distress and the need for rituals that she was unable to get out of bed to go to school, describing a compulsion to rearrange the sheets and pillows in a specific way that was impossible to achieve. Her concerned parents decided to take her to hospital.
Radiofrequency Treatment of Labia Minora and Majora: A Minimally Invasive Approach to Vulva Restoration
Authors: Dayan Erez , Ramirez Henry , Theodorou Spero 
Published: April 2020

Summary:
Labiaplasty has rapidly increased in popularity over the past 5 years.Traditional labiaplasty is associated with potential complications, such as dehiscence, hematoma, flap necrosis, narrowed introitus, pain, and asymmetry. Minimally invasive techniques such as radiofrequency (RF) have emerged as viable alternatives to traditional labiaplasty through a temperature-controlled bipolar mechanism to heat tissues to target temperatures of 40°C–45°C. This controlled energy delivery leads to an inflammatory cascade initiating neocollagenesis, angiogenesis, and elastogenesis over the coming 3–4 months. A single surgeon series of labia minora and majora treatment by RF (InMode, Lake Forrest, Calif.) was reviewed between April 2018–October 2018. Demographic data were collected as well grade of hypertrophy (pre/posttreatment), number of vaginal deliveries, and reason for treatment. Procedural parameters were recorded, including internal/external temperatures, total energy used, and time of treatment. All adverse events were recorded. Objective and subjective data points were obtained in the form of patient surveys and photographic evaluation by lay persons as well as plastic surgeons objective to the treatment. Ten consecutive patients were treated with bipolar RF (InMode, Lake Forrest, Calif.) between April 2018–October 2018. Mean age was 44 (29–54). Average number of pregnancies was 2 (STD 1.1). Three patients were treated for aesthetic concerns, 3 for functional complaints, and 4 desired improvement in both. Overall graded improvement in labia size/contour was +50% (STD ±15.3). Patient satisfaction scale data demonstrated 9.5/10 (±1.7). All patients (10/10) stated that they would undergo treatment again. In all cases, the surgeon observed tightening of the clitoral hood, introitus, forchett, as well as improved distribution of dark pigmentation of the labia minora. There were no significant complications and no need for additional procedures. Average recovery time was 14 days (STD 2.2). Treatment of labia hyperplasia and laxity with bipolar RF may potentially fill a treatment gap of women seeking aesthetic and functional improvements without surgical labiaplasty. A powered prospective randomized double-blinded study is needed to further elucidate the role of this technology.
Does Realism Matter? A Randomized Controlled Trial Comparing Models for Medical Student Suture Education
Authors: Blau Jared A. , Shammas Ronnie L. , Anolik Rachel A. , Avashia Yash J. , Krucoff Kate B. , Zenn Michael R. 
Published: April 2020

Background:
We hypothesized that medical students trained in suturing using high-fidelity models (cadaveric tissue) would demonstrate greater proficiency when compared with those trained using low-fidelity models (synthetic tissue).

Methods:
Forty-three medical students were randomized into 2 groups. Group 1 consisted of students taught to perform simple interrupted sutures using synthetic tissue, and group 2 consisted of those taught using human cadaveric tissue. Suturing proficiency was measured pre- and postinstruction using the Global Rating Scale and by measuring suture accuracy. Perceived confidence in suturing was measured on a scale of 0–100.

Results:
Perceived confidence was measured as an average of 8.26 out of 100 pretraining and significantly improved after training (56.91 out of 100); however, there was no significant difference when comparing confidence between groups posttraining (57.65 cadaveric versus 56.05 synthetic; P = 0.78), nor in the measured confidence change pre- and posttraining (P = 0.53). Posttraining, participants displayed a significant improvement in the number of adequately placed sutures; however, there was no significant difference posttraining when comparing groups (2.43 cadaveric versus 2.75 synthetic; P = 0.48). The change in adequate suture placement pre- and posttraining did not reach statistical significance between groups (P = 0.27). After instruction, participants demonstrated a significant improvement in total suture performance scores; however, there was no significant difference when comparing groups (30.04 cadaveric versus 29.80 synthetic; P = 0.90), nor in the total change pre- and posttraining (P = 0.74).

Conclusions:
Training medium fidelity (tissue versus synthetic) does not significantly influence a student’s overall suturing performance. However, formal instruction significantly improves objective competence and perceived confidence. Regardless of the model, surgical departments should emphasize medical student exposure to basic surgical skills education.
Intraoperative Near-infrared Spectroscopy Correlates with Skin Flap Necrosis: A Prospective Cohort Study
Authors: Hill William F. , Webb Carmen , Monument Michael , McKinnon Gregory , Hayward Victoria , Temple-Oberle Claire 
Published: April 2020

Background:
Skin flap necrosis (SFN) is a morbid complication that is disfiguring, leads to acute and chronic wound issues, often requires further surgery, and can delay adjuvant chemotherapy. Although most surgeons rely on the clinical examination, near-infrared (NIR) spectroscopy can extrapolate tissue oxygenation and may serve as an important tool to assess flap perfusion intraoperatively. This cohort study was undertaken to evaluate the capacity of NIR spectroscopy to detect clinically relevant differences in tissue perfusion intraoperatively.

Methods:
Patients undergoing oncologic resection of breast cancer, sarcomas, and cutaneous tumors requiring flap reconstruction (local, regional, or free) between January 2018 and January 2019 were analyzed in this study. Clinicians were blinded to device tissue oxygen saturation (StO2) measurements taken intraoperatively after closure and at follow-up appointments in the first 30 days. Measurements were categorized as (1) control areas not affected by the procedure, (2) areas at risk, and (3) areas of necrosis. These areas were retrospectively demarcated by 2 blinded assessors on follow-up images and transposed onto anatomically correlated intraoperative StO2 measurements. Mean StO2 values were compared using a single-sample t test and analysis of variance (ANOVA) to determine differences in oxygenation.

Results:
Forty-two patients were enrolled, and 51 images were included in the analysis. Oncologic procedures were predominantly breast (22), postextirpative melanoma (13), and sarcoma (3) reconstructions. Flap reconstruction involved 30 regional skin flaps, 3 pedicled flaps, and 3 free flaps. Nine patients (20.9%) and 11 surgical sites developed SFN. Mean intraoperative StO2 measurements for control areas, areas at risk, and areas of SFN were 74.9%, 71.1%, and 58.3%, respectively. Relative to control areas, mean intraoperative StO2 measurements were lower by 17.5% (P = 0.01) in ultimate areas of SFN and in areas at risk by 5.8% (P = 0.003). Relative to areas at risk, mean StO2 measurements from areas of ultimate SFN were lower by 8.3% (P = 0.04).

Conclusion:
These preliminary data suggest that measuring skin flap tissue oxygenation intraoperatively, with NIR spectroscopy, can differentiate objective variations in perfusion that are associated with clinical outcomes.
African Americans have a distinct clinical and histologic profile with lower prevalence of NASH and advanced fibrosis relative to Caucasians
Authors: Satapathy Sanjaya K. , Marella Hemnishil K. , Heda Rajiv P. , Ganguli Surosree , Kirthi Reddy Yala , Podila Pradeep S.B. , Clark Ian , Maliakkal Benedict 
Published: April 2020

Background and Aims
Racial/ethnic disparities have been reported in the prevalence of nonalcoholic fatty liver disease (NAFLD). Thus, we aimed to understand the inter-ethnic clinical, biochemical, and histological differences in a large cohort of Caucasians and African-Americans (AA).

Methods
Laboratory and liver biopsy data of 942 NAFLD patients were retrospectively analyzed. Nine hundred seven patients were included in the analysis: 677 (74.6%) Caucasians and 230 (25.3%) AA.

Results
AA had higher mean BMI compared to Caucasians (42.6 ± 9.5 vs. 39 ± 8.6 kg/m2). The prevalence of nonalcoholic steatohepatitis (NASH), defined by NAFLD activity score (NAS . 5), was higher in the Caucasians (n = 67) compared to AA (n = 7) (9.8% vs. 3%, P = 0.0007). One hundred fifteen patients (12.8%) had advanced fibrosis: 109 (16.2%) Caucasians and six (2.6%) AA. No AA patients had stage 4 fibrosis or cirrhosis. Multivariate logistic regression analysis revealed advanced fibrosis was significantly associated with age at liver biopsy (OR 1.03, 95% CI 1.0.1.1, P = 0.017, lower platelet count (OR 0.99, 95% CI 0.98.0.99, P = <0.0001), AST/ALT ratio (OR 5.19, 95% CI 2.9.9.2, P <0.0001) and Caucasian race (OR 7.49, 95% CI 2.53.22.2, P = 0.0003). Advanced fibrosis in AA was predicted by lower platelet count and AST/ALT ratio. Whereas Advanced fibrosis in Caucasians was predicted by age at biopsy, lower platelet count and AST/ALT ratio.

Conclusion
The AA have a distinct clinical and histologic phenotype. Caucasians have a significantly greater proportion of
NASH and are eight times more likely to develop advanced fibrosis than AA.
Controlled Avalanche – A Regulated Voluntary Exposure Approach for Addressing Covid-19
Authors: Klement Eyal , Klement Alon , Chinitz David , Harel Alon , Fattal Eyal , Klausner Ziv 
Published: April 2020

AbstractBackgroundThe ongoing Covid-19 pandemic has driven many countries to take radical suppression measures. While reducing mortality, these measures result in severe economic repercussions, and inhibit the development of herd immunity. Until an effective vaccine will be available, we propose an alternative approach, akin to avalanche control at ski resorts, a practice which intentionally triggers small avalanches in order to prevent a singular catastrophic one. Its main goal is to approach herd immunity faster than the current alternatives, with lower mortality rates and lower demand for critical health-care resources. According to this approach, individuals whose probability of developing serious health conditions is low (i.e. 20-49 years old with no comorbidities) will be offered the option to be voluntarily exposed to the virus under controlled supervision, and will then be issued ‘immunity certificates’ if they are confirmed to have developed SARS-CoV-2 antibodies.MethodsUsing a compartmental model we examine the implications of the controlled avalanche (CA) strategy over the population in Israel. We compare four scenarios: in two scenarios the CA program is applied to the low-risk population (with the rest of the population subject to mitigation measures), followed by mitigation for the entire population or by uncontrolled spread. These are compared to mitigated and uncontrolled scenarios without the CA program. We discuss the economic, ethical and public health implications of the CA strategy.FindingsWe show that compared to mitigation of the entire population, the CA strategy reduces the overall mortality by 43%, reduces the maximum number of people in need for ICUs by 62% and decreases the time required for release of 50% of the low-risk population by more than 2 months.InterpretationThis study suggests an ethically acceptable practice, that enables reaching herd immunity faster than the current alternatives, with low mortality and minimal economic damage.
The Contribution of Age Structure to the Number of Deaths from Covid-19 in the UK by Geographical Units
Authors: Kulu Hill , Dorey Peter 
Published: April 2020

AbstractThis study investigates the contribution of population age structure to mortality from Covid-19 in the UK by geographical units. We project death rates at various spatial scales by applying data on age-specific fatality rates to the area’s population by age and sex. Our analysis shows a significant variation in the projected death rates between the constituent countries of the UK, between its regions and within regions. First, Scotland and Wales have higher projected fatality levels from Covid-19 than England, whereas Northern Ireland has lower rate. Second, the infection fatality rates are projected to be substantially higher in small towns and rural areas than those in large urban areas. Third, our analysis shows that within urban regions there are also ‘pockets’ of high projected death rates. Overall, the areas with high and low fatality rates tend to cluster because of the high residential separation of different population age-groups in the UK. Our analysis also reveals that the Welsh-, Gaelic- and Cornish-speaking communities with relatively old populations are likely to experience heavy population losses if the virus spreads widely across the UK.
A Novel Heuristic Global Algorithm to Predict the COVID-19 Pandemic Trend
Authors: Asteris Panagiotis G. , Douvika Maria , Karamani Christina , Skentou Athanasia , Daras Tryfon , Cavaleri Liborio , Armaghani Danial Jahed , Chlichlia Katerina , Zaoutis Theoklis E. 
Published: April 2020

SummaryMathematical models are useful tools to predict the course of an epidemic. A heuristic global Gaussian-function-based algorithm for predicting the COVID-19 pandemic trend is proposed for estimating how the temporal evolution of the pandemic develops by predicting daily COVID-19 deaths, for up to 10 days, starting with the day the prediction is made. The validity of the proposed heuristic global algorithm was tested in the case of China (at different temporal stages of the pandemic). The algorithm was used to obtain predictions in six different locations: California, New York, Iran, Sweden, the United Kingdom, and the entire United States, and in all cases the prediction was confirmed. Our findings show that this algorithm offers a robust and reliable method for revealing the temporal dynamics and disease trends of SARS-CoV-2, and could be a useful tool for the relevant authorities in settings worldwide.
Evaluating the different control policies for COVID-19 between mainland China and European countries by a mathematical model in the confirmed cases
Authors: Lin Feng , Huang Yi , Zhang Huifang , He Xu , Yin Yonghua , Liu Jiaxin 
Published: April 2020

AbstractThis study focuses on evaluating the different policies of controlling the outbreak of COVID-19 in mainland China and in some European countries. The study is based on mathematical model which is a modified susceptible-infected-recovered (SIR) model. The model takes death and recovery into consideration which in convenience is called the susceptible-infected-recovered-death (SIRD) model. The criterion for the recovered patients is assumed by COVID-19 nucleic acid testing negative. The mathematical model is constructed by retrospective study. Determination of the parameters in the model is based on the epidemic bulletin supplied by the Chinese Center for Disease Control and Prevention (CDC) and National Health Commission of the People’s Republic of China (NHC) from Jan 16 2020 to Mar 5 2020. The data cover the date when the epidemic situation is reported and the data showed that the epidemic situation is almost under control in China. The mathematical model mainly simulates the active cases and the deaths during the outbreak of COVID-19. Then apply the mathematical model to simulate the epidemic situations in Italy and Spain, which are suffering the outbreak of COVID-19 in Europe. The determination of the parameters for the 2 European countries is based on the data supplied by Worldometers. By comparing the difference of the parameters based on the same mathematical model, it is possible to evaluate the different policies in different countries. It turns out that the relatively easing control policies might lead to rapid spread of the disease.
The proportion of deaths cases in confirmed patients of COVID-19 is still increasing for cumulative cases reported up to 25 April 2020
Authors: Scheuerl Thomas 
Published: April 2020

AbstractIn this work I analyse how proportions of fatal cases after COVID-19 infection change since outbreak of the disease. Using publicity available data I model the change in deaths probability from day 30 of outbreak until 25 April 2020. The global trend is that the proportion of fatal cases is still increasing and that many countries have not yet reached the maximum deaths proportion. However, there are visual differences between countries and in some countries the proportions are clearly below or above the global trend. A positive correlation between deaths cases and recorded infections indicates that a higher infection number results in increased mortality numbers.
The current COVID-19 wave will likely be mitigated in the second-line European countries
Authors: Soubeyrand S. , Ribaud M. , Baudrot V. , Allard D. , Pommeret D. , Roques L. 
Published: April 2020

AbstractObjectiveCountries presently apply different strategies to control the COVID-19 outbreak. Differences in population structures, decision making, health systems and numerous other factors result in various trajectories in terms of mortality at country scale. Our objective in this manuscript is to disentangle the future ofsecond-lineEuropean countries (i.e. countries that present, today, a moderate death rate) with respect to the current COVID-19 wave.MethodWe propose a data-driven approach, grounded on a mixture model, to forecast the dynamics of the number of deaths from COVID-19 in a given focal country using data from countries that areahead in timein terms of COVID-19-induced mortality. In this approach, the mortality curves of ahead-in-time countries are used to build predictors, which are then used as the components of the mixture model. This approach was applied to eight second-line European countries (Austria, Denmark, Germany, Ireland, Poland, Portugal, Romania and Sweden), using Belgium, France, Italy, Netherlands, Spain, Switzerland, United Kingdom as well as the Hubei province in China to build predictors. For this analysis, we used data pooled by the Johns Hopkins University Center for Systems Science and Engineering.ResultsIn general, the second-line European countries tend to follow relatively mild mortality curves (typically, those of Switzerland and Hubei) rather than fast and severe ones (typically, those of Spain, Italy, Belgium, France and the United Kingdom). From a methodological viewpoint, the performance of our forecasting approach is about 80% up to 8 days in the future, as soon as the focal country has accumulated at least two hundreds of deaths.DiscussionOur results suggest that the continuation of the current COVID-19 wave across Europe will likely be mitigated, and not as strong as it was in most of the front-line countries first impacted by the wave.
Why does COVID-19 case fatality rate vary among countries?
Authors: Sorci Gabriele , Faivre Bruno , Morand Serge 
Published: April 2020

SummaryBackgroundWhile the epidemic of SARS-CoV-2 is spreading worldwide, there is much concern over the mortality rate that the infection induces. Available data suggest that COVID-19 case fatality rate varies temporally (as the epidemic progresses) and spatially (among countries). Here, we attempted to identify key factors possibly explaining the variability in case fatality rate across countries.MethodsWe used data on the temporal trajectory of case fatality rate provided by the European Center for Disease Prevention and Control, and country-specific data on different metrics describing the incidence of known comorbidity factors associated with an increased risk of COVID-19 mortality at the individual level (Institute for Health Metrics and Evaluation). We also compiled data on demography, economy and political regimes for each country.FindingsWe first showed that temporal trajectories of case fatality rate greatly vary among countries. We found no evidence for association between comorbidities and case fatality rate at the country level. Case fatality rate was negatively associated with number of hospital beds x1,000 inhabitants. We also report evidence suggesting an association between case fatality rate and the political regime, with democracies suffering from the highest mortality burden, compared to autocratic regimes. However, most of the among-country variance in case fatality rate remained unexplained.InterpretationOverall, these results emphasize the role of socio-economic and political factors as possible drivers of COVID-19 case fatality rate at the country level.FundingNone.