bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective Study of Epizootic Hemorrhagic Disease Virus and Bluetongue Virus Transmission in Captive Ruminants
Authors: Becker Michael E , Roberts Jonathan , Schroeder Megan E , Gentry Glen , Foil Lane D 
Published: February 2020

Abstract
Bluetongue virus (BTV) and epizootic hemorrhagic disease virus (EHDV) cause hemorrhagic disease (HD) in wild ruminants and bluetongue disease (BT) and epizootic hemorrhagic disease (EHD) in livestock. These viruses are transmitted by biting midges in the genus Culicoides (family Ceratopogonidae). Mortality from this disease can reach 90% in certain breeds of sheep and in white-tailed deer (Odocoileus virginianus). From January until December of 2012, we conducted a prospective study to determine the origin and routes of transmission of BTV and EHDV in captive deer and cattle. The objective was to determine the abundance of Culicoides spp. and BTV/EHDV infection prevalence in midges, cattle, and deer in an area experiencing an outbreak of BT and EHD. Agar gel immunodiffusion (AGID) tests to detect for EHDV and BTV antibodies were conducted on serum collected from cattle and deer, quantitative reverse transcriptase polymerase chain reaction (RT–qPCR) was utilized for BTV/EHDV RNA detection in tissues from dead deer, and CDC miniature black light traps baited with dry ice were deployed to capture insects. The AGID results showed 19 out of 29 cattle and 18 out of 58 white-tailed deer seroconverted for these viruses during the vector season. Tradition gel-based reverse transcriptase polymerase chain reaction was utilized to determine serotype. Sixteen cows were positive for EHDV-2, EHDV-6, or BTV-12 and 15 deer positive for EHDV-1, EHDV-6, or BTV-12. Specimens from 14 species of Culicoides (Dptera: Ceratopogonidae) (Culicoides arboricola Root and Hoffman, Culicoides biguttatus Coquillett, Culicoides crepuscularis Malloch, Culicoides debilipalpis Lutz, Culicoides furens Poey, Culicoides haematopotus Malloch, Culicoides hinmani Khalaf, Culicoides nanus Root and Hoffman, Culicoides neopulicaris Wirth, Culicoides paraensis Goeldi, Culicoides stellifer Coquillet, Culicoides variipennis Coquillet, Culicoides villosipennis Root and Hoffman, and Culicoides venustus Hoffman) were captured and tested for BTV and EHDV using RT-qPCR assays. BTV viral nucleic acid was detected in three pools from three different species of midges: C. crepuscularis, C. debilipalpis, and C. stellifer.
Parapharyngeal schwannoma—a challenging case report
Authors: Ferreira Ângela , Dionísio Sílvia , Ventura Eduardo , Saleiro Rute , Monteiro Carlos 
Published: February 2020

Abstract
Parapharyngeal space primary neoplasias are infrequent findings in clinics, and schwannoma derived from a peripheral nerve is even rarer in this anatomic area [1]. The presented case is a patient who was referred to our department with a 3 months progressive soft palate enlargement without related symptoms. The challenge, in these cases, due to the anatomic complex area, is to catch a suitable approach to remove the tumor, according to dimension and surrounding structures. Prognosis and follow-up will depend on histopathologic evaluation.
Case Comment: Re D (A Child) [2019] UKSC 42
Authors: Keene Alex Ruck , Xu Xinyu 
Published: February 2020

Abstract
How (if at all) can the right to liberty of a child under Article 5 European Convention on Human Rights (‘ECHR’) be balanced against the rights of parents, enshrined both at common law and under Article 8 ECHR? Is there a limit to the extent to which parents can themselves, or via others, seek to impose restrictions upon their disabled child’s liberty so as to secure their child’s interests? This case considers the answers to these questions given by and the implications of the decision of the Supreme Court in September 2019 in Re D (A Child) [2019] UKSC 42.
An interpretable low-complexity machine learning framework for robust exome-based in-silico diagnosis of Crohn’s disease patients
Authors: Raimondi Daniele , Simm Jaak , Arany Adam , Fariselli Piero , Cleynen Isabelle , Moreau Yves 
Published: February 2020

Abstract
Whole exome sequencing (WES) data are allowing researchers to pinpoint the causes of many Mendelian disorders. In time, sequencing data will be crucial to solve the genome interpretation puzzle, which aims at uncovering the genotype-to-phenotype relationship, but for the moment many conceptual and technical problems need to be addressed. In particular, very few attempts at the in-silico diagnosis of oligo-to-polygenic disorders have been made so far, due to the complexity of the challenge, the relative scarcity of the data and issues such as batch effects and data heterogeneity, which are confounder factors for machine learning (ML) methods. Here, we propose a method for the exome-based in-silico diagnosis of Crohn’s disease (CD) patients which addresses many of the current methodological issues. First, we devise a rational ML-friendly feature representation for WES data based on the gene mutational burden concept, which is suitable for small sample sizes datasets. Second, we propose a Neural Network (NN) with parameter tying and heavy regularization, in order to limit its complexity and thus the risk of over-fitting. We trained and tested our NN on 3 CD case-controls datasets, comparing the performance with the participants of previous CAGI challenges. We show that, notwithstanding the limited NN complexity, it outperforms the previous approaches. Moreover, we interpret the NN predictions by analyzing the learned patterns at the variant and gene level and investigating the decision process leading to each prediction.
What Variables Correlate With Different Clinical Outcomes of Abusive Head Injury?
Authors: Ajmera Sonia , Motiwala Mustafa , Weeks Matt , Oravec Chesney S , Hersh David S , Fraser Brittany D , Vaughn Brandy , Klimo Paul 
Published: February 2020

Abstract

BACKGROUND
The spectrum of injury severity for abusive head trauma (AHT) severity is broad, but outcomes are unequivocally worse than accidental trauma. There are few publications that analyze different outcomes of AHT.

OBJECTIVE
To determine variables associated with different outcomes of AHT.

METHODS
Patients were identified using our AHT database. Three different, but not mutually exclusive, outcomes of AHT were modeled: (1) death or hemispheric stroke (diffuse loss of grey-white differentiation); (2) stroke(s) of any size; and (3) need for a neurosurgical operation. Demographic and clinical variables were collected and correlations to the 3 outcomes of interest were identified using bivariate and multivariable analysis.

RESULTS
From January 2009 to December 2017, 305 children were identified through a prospectively maintained AHT database. These children were typically male (60%), African American (54%), and had public or no insurance (90%). A total of 29 children (9.5%) died or suffered a massive hemispheric stroke, 57 (18.7%) required a neurosurgical operation, and 91 (29.8%) sustained 1 or more stroke. Death or hemispheric stroke was statistically associated with the pupillary exam (odds ratio [OR] = 45.7) and admission international normalized ratio (INR) (OR = 17.3); stroke was associated with the pupillary exam (OR = 13.2), seizures (OR = 14.8), admission hematocrit (OR = 0.92), and INR (9.4), and need for surgery was associated with seizures (OR = 8.6).

CONCLUSION
We have identified several demographic and clinical variables that correlate with 3 clinically applicable outcomes of abusive head injury.
Adherence to national paediatric bronchiolitis management guidelines and impact on emergency department resource utilization
Authors: Maki Kate , Azizi Hawmid , Hans Prabhjas , Doan Quynh 
Published: February 2020

Abstract

Objective
To evaluate the association between the use of nonrecommended pharmacology (salbutamol and corticosteroids) per national bronchiolitis guidelines, either during the index visit or at discharge, and system utilization measures (frequency of return visits [RTED] and on paediatric emergency department [PED] length of stay [LOS]).

Study Design
We conducted a retrospective case control study of 185 infants (≤12 months old) who presented to the PED between December 2014 and April 2017 and discharged home with a clinical diagnosis of bronchiolitis. Inclusion criteria included ≥ 1 viral prodromal symptom and ≥ 1 physical exam finding of respiratory distress. Cases were defined as infants who had ≥ 1 RTED within 7 days of their index visit and controls were matched for age and acuity but without RTED. Logistic regression analysis and multivariable linear regression were used to assess the odds of RTED and PED LOS associated with nonadherence to pharmaceutical recommendations per AAP and CPS bronchiolitis guidelines.

Results
Use of nonrecommended pharmacology per national bronchiolitis guidelines was documented among 39% of the 185 study participants. Adjusting for acuity of index visit, age, severe tachypnea, oxygen desaturation, and dehydration, use of nonrecommended pharmacology was not associated with RTED (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.47 to 2.03). Use of salbutamol and corticosteroids, however, were each independently associated with increased PED LOS (58.3 minutes [P=0.01] and 116.7 minutes [P&lt;0.001], respectively).

Conclusion
Nonadherence to the pharmaceutical recommendations of national bronchiolitis guidelines was not associated with RTED but salbutamol and corticosteroid use increased PED LOS.
Passion and Melancholy: Julian of Norwich’s Medical Hermeneutic
Authors: Lucas Hannah 
Published: February 2020

Abstract
This paper examines Julian of Norwich’s representation of the Passion of Christ in her Revelation of Love, proposing that Julian reads the body of Christ through a medical hermeneutic which echoes vernacular texts of the spiritual ‘remedy’ genre. The essay’s overarching argument is that Julian’s engagement with humoral theory positions her as a participant in an emerging collective imaginary of vernacular medicine, related to the translation and transmission of medical texts in the late fourteenth and early fifteenth centuries. Comparing the Latin and Middle English versions of William Flete’s Remedies Against Temptations and related works, I examine how this spiritual-medical discourse is expressed in vernacular texts contemporary to Julian’s life. I then consider Julian’s own sophisticated invocation of medical theory and practice in her description of the Passion, where she deploys diagnostic markers to depict an ‘ex-sanguination’ of Christ’s perfect disposition. These markers serve to reify the traditional figure of the ‘Man of Sorrows’ with a portrayal of Christ’s body as melancholic, a humoral affliction which reiterates both his suffering and his ‘love-longing’ for humanity. Finally, I show how this medical account functions in Julian’s optimistic theology, offering a reminder of the eternal presence of God’s love even in times of pain and disease.
Population Genomic Screening of All Young Adults in a Health-Care System: A Cost-Effectiveness Analysis
Authors: Zhang Lei , Bao Yining , Riaz Moeen , Tiller Jane , Liew Danny , Zhuang Xun , Amor David J. , Huq Aamira , Petelin Lara , Nelson Mark , James Paul A. , Winship Ingrid , McNeil John J. , Lacaze Paul 
Published: February 2020

(Abstracted from Genet Med 2019;21:1958–1968)
It is generally accepted that genetic screening has the potential to prevent disease through early identification. The authors suggest that one cost-effective way to implement genetic screening into a single-payer or state-funded health care system is a combined genetic screening approach—one that tests for multiple conditions concurrently—versus individual targeted testing.
What Does Context Have to Do With Anything? A Study of Professional Identity Formation in Physician-Trainees Considered Underrepresented in Medicine
Authors: Wyatt Tasha R. , Rockich-Winston Nicole , Taylor Taryn R. , White DeJuan 
Published: February 2020

Purpose
Research on professional identity formation has largely ignored how race, ethnicity, and the larger sociohistorical context work to shape medical students’ professional identity. Researchers investigated how physician-trainees considered underrepresented in medicine (URM) negotiate their professional identity within the larger sociohistorical context that casts them in a negative light.

Method
In this qualitative study, 14 black/African American medical students were recruited from the Medical College of Georgia at Augusta University and Emory University College of Medicine between September 2018 and April 2019. Using constructive grounded theory and Swann’s model of identity negotiation, the authors analyzed interview data for how students negotiate their racial and professional identities within medical education.

Results
The results indicated that URM students were aware of the negative stereotypes ascribed to black individuals and the potential for the medical community to view them negatively. In response, students employed identity cues and strategies to bring the community’s perceptions in line with how they perceived themselves—black and a physician. Specifically, students actively worked to integrate their racial and professional identities by “giving back” to the African American community. Community-initiated mentoring from non-URM physicians helped to reify students’ hope that they could have a racialized professional identity.

Conclusions
Race, ethnicity, and the larger sociohistorical context is often overlooked in professional identity formation research, and this omission has resulted in an underappreciation of the challenges URM physicians’ experience as they develop a professional identity. Within the context of this study, findings demonstrated that black/African American physicians negotiated the formation of professional identity within a challenging sociohistorical context, which should be given greater consideration in related research.
Experiential Learning in Project-Based Quality Improvement Education: Questioning Assumptions and Identifying Future Directions
Authors: Goldman Joanne , Kuper Ayelet , Baker G. Ross , Bulmer Beverly , Coffey Maitreya , Jeffs Lianne , Shea Christine , Whitehead Cynthia , Shojania Kaveh G. , Wong Brian 
Published: February 2020

Purpose
Project-based experiential learning is a defining element of quality improvement (QI) education despite ongoing challenges and uncertainties. The authors examined stakeholders’ perceptions and experiences of QI project-based learning to increase understanding of factors that influence learning and project experiences.

Method
The authors used a case study approach to examine QI project-based learning in 3 advanced longitudinal QI programs, 2 at the University of Toronto and 1 at an academic tertiary-care hospital. From March 2016 to June 2017, they undertook 135 hours of education program observation and 58 interviews with learners, program directors, project coaches, and institutional leaders and reviewed relevant documents. They analyzed data using a conventional and directed data analysis approach.

Results
The findings provide insight into 5 key factors that influenced participants’ project-based learning experiences and outcomes: (1) variable emphasis on learning versus project objectives and resulting benefits, tensions, and consequences; (2) challenges integrating the QI project into the curriculum timeline; (3) project coaching factors (e.g., ability, capacity, role clarity); (4) participants’ differing access to resources and ability to direct a QI project given their professional roles; and (5) workplace environment influence on project success.

Conclusions
The findings contribute to an empirical basis toward more effective experiential learning in QI by identifying factors to target and optimize. Expanding conceptualizations of project-based learning for QI education beyond learner-initiated, time-bound projects, which are at the core of many QI educational initiatives, may be necessary to improve learning and project outcomes.
Usefulness of Parasternal Intercostal Muscle Ultrasound during Weaning from Mechanical Ventilation
Authors: Dres Martin , Dubé Bruno-Pierre , Goligher Ewan , Vorona Stefannie , Demiri Suela , Morawiec Elise , Mayaux Julien , Brochard Laurent , Similowski Thomas , Demoule Alexandre 
Published: February 2020

Abstract

Background
The assessment of diaphragm function with diaphragm ultrasound seems to bring important clinical information to describe diaphragm work and weakness. When the diaphragm is weak, extradiaphragmatic muscles may play an important role, but whether ultrasound can also assess their activity and function is unknown. This study aimed to (1) evaluate the feasibility of measuring the thickening of the parasternal intercostal and investigate the responsiveness of this muscle to assisted ventilation; and (2) evaluate whether a combined evaluation of the parasternal and the diaphragm could predict failure of a spontaneous breathing trial.

Methods
First, an exploratory evaluation of the parasternal in 23 healthy subjects. Second, the responsiveness of parasternal to several pressure support levels were studied in 16 patients. Last, parasternal activity was compared in presence or absence of diaphragm dysfunction (assessed by magnetic stimulation of the phrenic nerves and ultrasound) and in case of success/failure of a spontaneous breathing trial in 54 patients.

Results
The parasternal was easily accessible in all patients. The interobserver reproducibility was good (intraclass correlation coefficient, 0.77 (95% CI, 0.53 to 0.89). There was a progressive decrease in parasternal muscle thickening fraction with increasing levels of pressure support (Spearman ρ = −0.61 [95% CI, −0.74 to −0.44]; P < 0.0001) and an inverse correlation between parasternal muscle thickening fraction and the pressure generating capacity of the diaphragm (Spearman ρ = −0.79 [95% CI, −0.87 to −0.66]; P < 0.0001). The parasternal muscle thickening fraction was higher in patients with diaphragm dysfunction: 17% (10 to 25) versus 5% (3 to 8), P < 0.0001. The pressure generating capacity of the diaphragm, the diaphragm thickening fraction and the parasternal thickening fraction similarly predicted failure or the spontaneous breathing trial.

Conclusions
Ultrasound assessment of the parasternal intercostal muscle is feasible in the intensive care unit and provides novel information regarding the respiratory capacity load balance.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Open Reduction Is Associated With Greater Hazard of Early Reoperation After Internal Fixation of Displaced Femoral Neck Fractures in Adults 18–65 Years
Authors: Patterson Joseph T. , Ishii Keisuke , Tornetta Paul , Leighton Ross K. , Friess Darin M. , Jones Clifford B. , Levine Ari , Maclean Jeffrey J. , Miclau Theodore , Mullis Brian H. , Obremskey William T. , Ostrum Robert F. , Reid J. Spence , Ruder John A. , Saleh Anas , Schmidt Andrew H. , Teague David C. , Tsismenakis Antonios , Westberg Jerald R. , Morshed Saam 
Published: February 2020

Objectives:
To determine (1) which factors are associated with the choice to perform an open reduction and (2) by adjusting for these factors, if the choice of reduction method is associated with reoperation.

Design:
Retrospective cohort study with radiograph and chart review.

Setting:
Twelve Level 1 North American trauma centers.

Patients:
Two hundred thirty-four adults 18–65 years of age with an isolated, displaced, OTA/AO type 31-B2 or type 31-B3 femoral neck fracture treated with internal fixation with minimum of 6-month follow-up or reoperation. Exclusion criteria were pathologic fractures, associated femoral head or shaft fractures, and primary arthroplasty.

Intervention:
Open or closed reduction technique during internal fixation.

Main outcome:
Cox proportional hazard of reoperation adjusting for propensity score for open reduction based on injury, demographic, and medical factors. Reduction quality was assessed by 3 senior orthopaedic traumatologists as “acceptable” or “unacceptable” on AP and lateral postoperative radiographs.

Results:
Median follow-up was 1.5 years. One hundred six (45%) patients underwent open reduction. Reduction quality was not significantly affected by open versus closed approach (71% vs. 69% acceptable, P = 0.378). The propensity to receive an open reduction was associated with study center; younger age; male sex; no history of injection drug use, osteoporosis, or cerebrovascular disease; transcervical fracture location; posterior fracture comminution; and surgery within 12 hours. A total of 35 (33%) versus 28 (22%) reoperations occurred after open versus closed reduction (P = 0.056). Open reduction was associated with a 2.4-fold greater propensity-adjusted hazard of reoperation (95% confidence interval 1.3–4.4, P = 0.004). A total of 35 (15%) patients underwent subsequent total hip arthroplasty or hemiarthroplasty.

Conclusions:
Open reduction of displaced femoral neck fractures in nonelderly adults is associated with a greater hazard of reoperation without significantly improving reduction. Prospective randomized trials are indicated to confirm a causative effect of open versus closed reduction on outcomes after femoral neck fracture.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Use of Tranexamic Acid (TXA) in Neuromuscular Hip Reconstruction: Can We Alter the Need for Blood Transfusion?
Authors: Lins Laura A.B. , Miller Patricia E. , Samineni Aneesh , Watkins Colyn J. , Matheney Travis H. , Snyder Brian D. , Shore Benjamin J. 
Published: February 2020

Background:
Children with neuromuscular complex chronic conditions (NMCCC) frequently undergo hip reconstruction surgery requiring blood transfusion. The purpose of this study is to examine the efficacy of tranexamic acid (TXA) to reduce blood loss and transfusion requirement in NMCCC children undergoing hip reconstruction surgery.

Methods:
Children with NMCCC undergoing hip reconstruction surgery between 2013 and 2018 were identified. Two cohorts were identified: those who received TXA and those who did not. Patient and surgical characteristics between cohorts were used for propensity matching. Patients were matched on the basis of comorbid factors, bilateral involvement, pelvic osteotomy, open reduction, and surgeon. Comparative outcomes between cohorts were analyzed for intraoperative and postoperative blood loss and transfusion requirements and length of hospital stay (LOS).

Results:
A total of 166 patients underwent hip surgery at an average of 9.6 years (SD, 4.0). Propensity matching utilized 72% of the cohort including 47 TXA and 72 non-TXA subjects. There were no differences in patient or surgical characteristics across matched groups. Fifteen (15/47, 32%) TXA subjects required a postoperative blood transfusion compared with the 47% (34/72) of non-TXA subjects who required a transfusion and intraoperative transfusion rates were similar between the 2 groups. There was no significant difference in complication rate (TXA, 79%; non-TXA, 86%), reported estimated blood loss (median=200 mLfor both) or LOS (median=6 d for both). Hematocrit levels were slightly higher in TXA subjects intraoperatively (P=0.047), at the end of surgery (P=0.04), and for the overall lowest perioperative level (P=0.04). The overall percent loss of estimated blood volume was less for those who were given TXA compared with those who were not (P=0.001).

Conclusions:
The use of TXA during hip reconstruction surgery in NMCCC children significantly reduced the percent loss of estimated blood volume and postoperative transfusion rate. Further prospective multicenter studies are needed to verify the positive effects and safety of TXA in the setting of hip reconstruction surgery in NMCCC children.

Level of Evidence:
Level III—retrospective comparative study.