bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subspecialization in Family Medicine: Opinions, Preferences, and Practices of Family Physicians in Saudi Arabia
Authors: AlAteeq Mohammed A. , AlJoudi Abdullah S. , AlKhadli Yahia M. 
Published: December 2020

Objective In recent years, family medicine (FM) has shown many changes, including the development of sub-specialization. This study aimed to explore the opinions, preferences, and practices of Saudi family physicians with regard to sub-specialization within family practice. Methods This cross-sectional study was conducted from January to May 2018. Data were collected from 561 Saudi FM board-certified physicians and family medicine residents from all over SA via personal emails using a self-administered questionnaire consisting of questions aimed at examining participants’ opinions, preferences, and practices with regard to sub-specialization in family practice. Results Only 48 family doctors (20.2%) had the qualification of subspecialist. Diabetology was the most common clinical subspecialty. The majority of participants agreed with the statements in favor of sub-specialization in FM. About 73% approved of the idea of sub-specialization in FM, while 89% thought that sub-specialization would provide a source of expertise within the FM context. The most stated reasons to go for FM subspecialties were to earn more experience (65.1%), gain some sense of control of huge knowledge and skills of FM (53.7%), and earning extra money (47.8%). Conclusions This study revealed that majority of certified family physicians and FM residents in SA have positive attitude towards sub-specialization in FM and support the idea of sub-specialization to be practiced within the context of FM
Brief EcoMeditation Associated With Psychological Improvements: A Preliminary Study
Authors: Church Dawson , Stapleton Peta , Sabot Debbie 
Published: December 2020

Background A growing body of clinical research attests to the psychological and physiological benefits of meditation. EcoMeditation is a non-pharmacological therapeutic approach used to promote health and well-being, comprising four evidence-based techniques: The Quick Coherence Technique for regulating heart rate variability (HRV), Emotional Freedom Techniques (EFT), mindfulness, and neurofeedback. Objectives This study investigated changes in psychological symptoms of anxiety, depression, posttraumatic stress disorder (PTSD), pain, and happiness following a one-day EcoMeditation training workshop delivered in a large-group format and at 3-months post-intervention. Methods A convenience sample of 208 participants (137 women, 71 men) aged between 21 and 87 years ( M = 55.4 years; SD = 12.8 years) attended a one-day EcoMeditation training workshop. Participants completed a pen-and-paper survey pre-workshop and post-workshop, and an online survey three months following the EcoMeditation intervention. Results Post-workshop results revealed significant reductions in anxiety (−23.4%, p <  .001), depression (−15.8%, p =  .011), PTSD (−11.8%, p <  .001), and pain (−18.5%, p <  .001), while happiness scores increased significantly (+8.9%, p <  .001). At 3-month follow-up, one-way repeated-measures ANOVA ( N =  65) found significant decreases in anxiety between pre-test and post-test, and pain between pre-intervention and 3-month follow-up. Differences in depression and PTSD scores were not significant over time. Happiness scores significantly increased from pre-test to 3-month follow-up. However, post-hoc analyses suggested that the final sample size was inadequate to detect significant differences between time points. Conclusion Findings provide preliminary support for EcoMeditation as a brief group-based stress reduction intervention with benefits for improved psychological functioning.
Impact of surgical clothing and footwear on operating room contamination during standstill and intraoperative stepping motion
Authors: Tateiwa Toshiyuki , Masaoka Toshinori , Ishida Tsunehito , Shishido Takaaki , Takahashi Yasuhito , Yamamoto Kengo 
Published: December 2020

Background: In view of preventing surgical site infection (SSI) in the orthopedic operating room (OR), evidence concerning types of footwear and clothing is limited. This study aimed to investigate how different footwear and clothing affect the cleanliness of the OR environment. Methods: The airborne dust concentration in a bioclean room (NASA class 100) was measured around an operator by using a handheld particle counter under the following conditions: (I) wearing a sterilized full-type space suit with OR dedicated clean sandals; (II) wearing a sterilized full-type space suit with non-dedicated (outside) shoes or severely contaminated outside shoes with surgical glove powder (2 µm mean particle size); and (III) wearing an unsterilized medical scrub uniform with OR dedicated sandals. The participant was standing still or stepping in place at 1 Hz during the testing. Results: The concentrations of airborne dusts in the operative field were independent of footwear and clothing types under the stand-still condition. However, these values significantly increased 1.96- to 16.23-fold after simple stepping motion in all the test conditions, and often became dissatisfaction level with the NASA100 requirement for the OR cleanliness. The worst contamination occurred when an operator wore the powder-contaminated shoes and also the unsterilized scrub uniform. Conclusion: The present study showed that the stepping motion triggered a considerable contamination in the operative field (beyond the level of NASA100 threshold) particularly when an operator used the outside shoes or unsterilized scrub uniform. Therefore, these results tell us that the one-footwear system (i.e., no use of OR dedicated clean shoes) and unsterilized scrub are likely to be a potential risk factor for SSI. Nevertheless, further studies are necessary to conclude the real efficacy of OR dedicated shoes and sterilized clothes on the SSI prevention.
Immunodeficiency and bone marrow failure with mosaic and germline TLR8 gain of function
Authors: Aluri Jahnavi , Bach Alicia , Kaviany Saara , Chiquetto Paracatu Luana , Kitcharoensakkul Maleewan , Walkiewicz Magdalena A. , Putnam Christopher D. , Shinawi Marwan , Saucier Nermina , Rizzi Elise M. , Harmon Michael T. , Keppel Molly P. , Ritter Michelle , Similuk Morgan , Kulm Elaine , Joyce Michael , de Jesus Adriana A. , Goldbach-Mansky Raphaela , Lee Yi-Shan , Cella Marina , Kendall Peggy L. , Dinauer Mary C. , Bednarski Jeffrey J. , Bemrich-Stolz Christina , Canna Scott W. , Abraham Shirley M. , Demczko Matthew M. , Powell Jonathan , Jones Stacie M. , Scurlock Amy M. , De Ravin Suk See , Bleesing Jack J. , Connelly James A. , Rao V. Koneti , Schuettpelz Laura G. , Cooper Megan A. 
Published: December 2020

Abstract
Inborn errors of immunity (IEI) are a genetically heterogeneous group of disorders with a broad clinical spectrum. Identification of molecular and functional bases of these disorders is important for diagnosis, treatment, and an understanding of the human immune response. We identified 6 unrelated males with neutropenia, infections, lymphoproliferation, humoral immune defects, and in some cases bone marrow failure associated with 3 different variants in the X-linked gene TLR8, encoding the endosomal Toll-like receptor 8 (TLR8). Interestingly, 5 patients had somatic variants in TLR8 with &lt;30% mosaicism, suggesting a dominant mechanism responsible for the clinical phenotype. Mosaicism was also detected in skin-derived fibroblasts in 3 patients, demonstrating that mutations were not limited to the hematopoietic compartment. All patients had refractory chronic neutropenia, and 3 patients underwent allogeneic hematopoietic cell transplantation. All variants conferred gain of function to TLR8 protein, and immune phenotyping demonstrated a proinflammatory phenotype with activated T cells and elevated serum cytokines associated with impaired B-cell maturation. Differentiation of myeloid cells from patient-derived induced pluripotent stem cells demonstrated increased responsiveness to TLR8. Together, these findings demonstrate that gain-of-function variants in TLR8 lead to a novel childhood-onset IEI with lymphoproliferation, neutropenia, infectious susceptibility, B- and T-cell defects, and in some cases, bone marrow failure. Somatic mosaicism is a prominent molecular mechanism of this new disease.
Comparative in vitro analysis of inhibition of rhinovirus and influenza virus replication by mucoactive secretolytic agents and plant extracts
Authors: Walther Christin , Döring Kristin , Schmidtke Michaela 
Published: December 2020

Abstract
Background
Rhinoviruses and influenza viruses cause millions of acute respiratory infections annually. Symptoms of mild acute respiratory infections are commonly treated with over-the-counter products like ambroxol, bromhexine, and N-acetyl cysteine, as well as of thyme and pelargonium extracts today. Because the direct antiviral activity of these over-the-counter products has not been studied in a systematic way, the current study aimed to compare their inhibitory effect against rhinovirus and influenza virus replication in an in vitro setting.

Methods
The cytotoxicity of ambroxol, bromhexine, and N-acetyl cysteine, as well as of thyme and pelargonium extracts was analyzed in Madin Darby canine kidney (MDCK) and HeLa Ohio cells. The antiviral effect of these over-the-counter products was compared by analyzing the dose-dependent inhibition (i) of rhinovirus A2- and B14-induced cytopathic effect in HeLa Ohio cells and (ii) of influenza virus A/Hong Kong/68 (subtype H3N2)- and A/Jena/8178/09 (subtype H1N1, pandemic)-induced cytopathic effect in MDCK cells at non-cytotoxic concentrations. To get insights into the mechanism of action of pelargonium extract against influenza virus, we performed time-of-addition assays as well as hemagglutination and neuraminidase inhibition assays.

Results
N-acetyl cysteine, thyme and pelargonium extract showed no or only marginal cytotoxicity in MDCK and HeLa Ohio cells in the tested concentration range. The 50% cytotoxic concentration of ambroxol and bromhexine was 51.85 and 61.24 μM, respectively. No anti-rhinoviral activity was detected at non-cytotoxic concentrations in this in vitro study setting. Ambroxol, bromhexine, and N-acetyl cysteine inhibited the influenza virus-induced cytopathic effect in MDCK cells no or less than 50%. In contrast, a dose-dependent anti-influenza virus activity of thyme and pelargonium extracts was demonstrated. The time-of addition assays revealed an inhibition of early and late steps of influenza virus replication by pelargonium extract whereas zanamivir acted on late steps only. The proven block of viral neuraminidase activity might explain the inhibition of influenza virus replication when added after viral adsorption.

Conclusion
The study results indicate a distinct inhibition of influenza A virus replication by thyme and pelargonium extract which might contribute to the beneficial effects of these plant extracts on acute respiratory infections symptoms.
Hedge effectiveness of put replication, gold, and oil on ASEAN-5 equities
Authors: Robiyanto Robiyanto , Nugroho Bayu Adi , Handriani Eka , Huruta Andrian Dolfriandra 
Published: December 2020

AbstractThe previous studies have shown that capital market integration has increased in the ASEAN-5, implying that investors making investment diversification across ASEAN capital markets could only earn limited diversification advantages. To diversify their portfolios, equity investors must find other assets. The main focus of this research is to analyze the effectiveness of put replication, gold, and oil on hedge equities in the ASEAN-5 (Indonesia, Malaysia, Singapore, Thailand, and the Philippines). Protective put strategy, DCC-GARCH, and Markowitz optimization are used to measure hedge effectiveness, risk-adjusted-performance such as Sharpe ratio, drawdown, and Omega ratio. The result reveals that gold is a cheaper hedge than oil and oil-hedged strategy is more expensive in ASEAN-5 compared to oil exporting nations. Also, investors with big exposure to the oil-related portfolio should diversify to Philippine equity. From hedging effectiveness and risk-adjusted-performance perspectives, oil is less attractive than money market instruments and gold. This study also implies that risk-averse investors should prefer to put replication or guaranteed financial products compared to commodities-hedged strategy.
Management of 3 Cases of Pheochromocytoma During the COVID-19 Pandemic in New York City: Lessons Learned
Authors: Japp Emily A , Leiter Amanda , Tsomos Effie A , Reda Sarah A , Levine Alice C 
Published: December 2020

Abstract
The COVID-19 crisis placed a pause on surgical management of nonemergency cases of pheochromocytoma, and it was essential for endocrinologists to provide both resourceful and safe care. At the Mount Sinai Hospital in New York City during the peak of the pandemic, we encountered 3 patients with pheochromocytoma and mild symptoms that were medically managed for a prolonged period of time (7-18 weeks) prior to adrenalectomy. Patients were monitored biweekly via telemedicine, and antihypertensive medications were adjusted according to signs, symptoms, and adrenergic profiles. These cases demonstrate that prolonged medical management prior to surgery is feasible and effective in pheochromocytoma patients with mild symptoms and well-controlled blood pressures.
Exploring Factors Associated With Morbidity and Mortality in Patients With Do-Not-Resuscitate Orders: A National Surgical Quality Improvement Program Database Analysis Within Surgical Groups
Authors: Cobert Julien , Lerebours Reginald , Peskoe Sarah B. , Gordee Alexander , Truong Tracy , Krishnamoorthy Vijay , Raghunathan Karthik , Mureebe Leila 
Published: December 2020

BACKGROUND:
Anesthesiologists caring for patients with do-not-resuscitate (DNR) orders may have ethical concerns because of their resuscitative wishes and may have clinical concerns because of their known increased risk of morbidity/mortality. Patient heterogeneity and/or emphasis on mortality outcomes make previous studies among patients with DNR orders difficult to interpret. We sought to explore factors associated with morbidity and mortality among patients with DNR orders, which were stratified by surgical subgroups.

METHODS:
Exploratory retrospective cohort study in adult patients undergoing prespecified colorectal, vascular, and orthopedic surgeries was performed using the American College of Surgeons National Surgical Quality Improvement Program Participant Use File data from 2010 to 2013. Among patients with preoperative DNR orders (ie, active DNR order written in the patient’s chart before surgery), factors associated with 30-day mortality, increased length of stay, and inpatient death were determined via penalized regression. Unadjusted and adjusted estimates for selected variables are presented.

RESULTS:
After selection as above, 211,420 patients underwent prespecified procedures, and of those, 2755 (1.3%) had pre-existing DNR orders and met above selection to address morbidity/mortality aims. By specialty, of these patients with a preoperative DNR, 1149 underwent colorectal, 870 vascular, and 736 orthopedic surgery. Across groups, 36.2% were male and had a mean age 79.9 years (range 21–90). The 30-day mortality was 15.4%–27.2% and median length of stay was 6–12 days. Death at discharge was 7.0%, 13.1%, and 23.0% in orthopedics, vascular, and colorectal patients with a DNR, respectively. The strongest factors associated with increased odds of 30-day mortality were preoperative septic shock in colorectal patients, preoperative ascites in vascular patients, and any requirement of mechanical ventilation at admission in orthopedic patients.

CONCLUSIONS:
In patients with DNR orders undergoing common surgical procedures, the association of characteristics with morbidity and mortality varies in both direction and magnitude. The DNR order itself should not be the defining measure of risk.
Tumour-directed microenvironment remodelling at a glance
Authors: Boyle Sarah T. , Johan M. Zahied , Samuel Michael S. 
Published: December 2020

ABSTRACT
The tissue microenvironment supports normal tissue function and regulates the behaviour of parenchymal cells. Tumour cell behaviour, on the other hand, diverges significantly from that of their normal counterparts, rendering the microenvironment hostile to tumour cells. To overcome this problem, tumours can co-opt and remodel the microenvironment to facilitate their growth and spread. This involves modifying both the biochemistry and the biophysics of the normal microenvironment to produce a tumour microenvironment. In this Cell Science at a Glance article and accompanying poster, we outline the key processes by which epithelial tumours influence the establishment of the tumour microenvironment. As the microenvironment is populated by genetically normal cells, we discuss how controlling the microenvironment is both a significant challenge and a key vulnerability for tumours. Finally, we review how new insights into tumour–microenvironment interactions has led to the current consensus on how these processes may be targeted as novel anti-cancer therapies.
Aberrant cytoplasmic localization of ARID1B activates ERK signaling and promotes oncogenesis
Authors: Animireddy Srinivas , Kavadipula Padmavathi , Kotapalli Viswakalyan , Gowrishankar Swarnalata , Rao Satish , Bashyam Murali Dharan 
Published: December 2020

ABSTRACT
The ARID1B (BAF250b) subunit of the human SWI/SNF chromatin remodeling complex is a canonical nuclear tumor suppressor. We employed in silico prediction, intracellular fluorescence and cellular fractionation-based subcellular localization analyses to identify the ARID1B nuclear localization signal (NLS). A cytoplasm-restricted ARID1B-NLS mutant was significantly compromised in its canonical transcription activation and tumor suppressive functions, as expected. Surprisingly however, cytoplasmic localization appeared to induce a gain of oncogenic function for ARID1B, as evidenced from several cell line- and mouse xenograft-based assays. Mechanistically, cytoplasm-localized ARID1B could bind c-RAF (RAF1) and PPP1CA causing stimulation of RAF–ERK signaling and β-catenin (CTNNB1) transcription activity. ARID1B harboring NLS mutations derived from tumor samples also exhibited aberrant cytoplasmic localization and acquired a neo-morphic oncogenic function via activation of RAF–ERK signaling. Furthermore, immunohistochemistry on a tissue microarray revealed significant correlation of ARID1B cytoplasmic localization with increased levels of active forms of ERK1 and ERK2 (also known as MAPK3 and MAPK1) and of β-catenin, as well as with advanced tumor stage and lymph node positivity in human primary pancreatic tumor tissues. ARID1B therefore promotes oncogenesis through cytoplasm-based gain-of-function mechanisms in addition to dysregulation in the nucleus.
This article has an associated First Person interview with the first author of the paper.
Perturbation Approach for NMR Signals with Infinite-Order Corrections and Its Application to Solid-State MAS INADEQUATE Spectra Exhibiting Auto-Correlation Peaks due to Chemically-Equivalent Spin Pairs: Analogy to Renormalization Theory
Authors: Nakai Toshihito 
Published: December 2020

Abstract
A perturbation approach comprehending infinite-order corrections is proposed so that NMR signals may be simulated without approximations. The present theoretical treatments based on Average Hamiltonian Theory put all the perturbative corrections into several tentative variables and eventually replace them by values resulting from experiments, as the renormalization theory does. The Hamiltonian for strongly-coupled two-spin-1/2 systems and the time evolutions of their coherences are analytically expressed using the proposed theory. The double-quantum excitation functions in 29Si solid-state MAS INADEQUATE measurements are observed for a zeolite sample and reproduced using the formula derived from the present theory. Thereby, it is proved to be possible to determine the internal spin interaction parameters including the J couplings between chemically-equivalent nuclei hidden in solution-state NMR spectroscopy, in addition to the parameters reflecting the high-order solid-state effects.
Estimation of the radiation dose for dental spectral cone-beam CT
Authors: Orhan Kaan , Pauwels Ruben , Chen Yi , Song Dandan , Jacobs Reinhilde 
Published: December 2020

Objectives: The purpose of this study was to estimate the radiation dose for a dental spectral cone-beam CT (SCBCT) unit at different scanning parameters. Methods: Radiation dose measurements were performed for a commercially available dental SCBCT. Scans were obtained at different exposure times and fields of view (FOV), both for non-spectral (25×18 cm, 14×18 cm, 14×12 cm, 9×9 cm, 6×6 cm) and spectral modes (14×18 cm, 14×12 cm, 9×9 cm, 6×6 cm) with the tube voltage alternating between 80 and 110 kV for spectral mode, and fixed at 110 kV for non-spectral mode. An ion chamber was used for air kerma and dose area product (DAP) measurements. The effective dose was estimated based on the mAs using previously published logarithmic curves for CBCT units with a similar X-ray spectrum. Results: The adult effective dose, in non-spectral mode, was 44-269 µSv for small FOVs, 131-336 µSv for the medium FOV, and 163-476 µSv for the large FOV. In spectral mode, the estimated adult effective doses were 96-206 µSv for small, 299 µSv for medium and 372 µSv for large FOV protocols. Paediatric effective doses were estimated to be 75% higher than corresponding adult doses. Conclusion: SCBCT showed comparable doses with other CBCT devices, but DAP values were generally above currently published DRLs. Spectral imaging might allow for artefact reduction at comparable dose levels, which should be assessed in further image quality studies at both a technical and diagnostic levels.
Development and validation of two new image receptor-holding devices for overlapping reduction of proximal surfaces in bitewing radiography: a preclinical study
Authors: Cascante-Sequeira Deivi , Gaêta-Araujo Hugo , Peroni Leonardo Vieira , Oliveira-Santos Christiano , Haiter-Neto Francisco 
Published: December 2020

Objective: To create and validate two new Image Receptor-Holding devices (IRHDs) to reduce proximal surfaces overlapping in bitewing radiography in comparison to a regular well-established and commercially available IRHD. Methods: Two IRHDs for bitewing radiographs with a wedge on the biting surface were designed and 3D-printed. These IRHDs, with a large wedge (Pr-Lw) and small wedge (Pr-Sw), were compared with a regular commercially available IRHD (Rinn XCP®) during image acquisition of bitewing radiographs of four posterior regions (one upper region and three lower regions) in two dry skulls and mandibles. A total of 156 interproximal regions on bitewing radiographs were radiographed by 13 oral radiology graduate students and independently assessed by two oral radiologists (10 years of experience). IRHDs were compared by Cochran’s Q test regarding the number of overlapped proximal surfaces in the acquired radiographs with a significance level of 5%. Results: The observers were in perfect agreement (κ = 1.0) to classify the proximal surfaces overlapping. The Pr-Lw IRHD presented the lowest number of surfaces overlapping (19.2%) followed by the Pr-Sw IRHD (48.1%) and the XCP®IRHD with the highest surfaces overlapping (71.2%). The Pr-Lw IRHD surfaces overlapping was statistically different from the XCP IRHD (p < 0.001), and the Pr-Sw IRHD (p = 0.014). Conclusions: The Pr-Lw IRHD demonstrated the most efficient performance in overlapping surfaces reduction, compared with the Pr-Sw IRHD and the XCP® IRHD in adult dry skulls and mandibles.