bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autonomic nervous system activity and the risk of nosocomial infection in critically ill patients with brain injury
Authors: Wirtz Mathijs R. , Moekotte Jiri , Balvers Kirsten , Admiraal Marjolein M. , Pittet Jean-Francois , Colombo Joe , Wagener Brant M. , Goslings J. Carel , Juffermans Nicole 
Published: November 2020

Abstract
Purpose
Nosocomial infection contributes to adverse outcome after brain injury. This study investigates whether autonomic nervous system activity is associated with a decreased host immune response in patients following stroke or traumatic brain injury (TBI).

Methods
A prospective study was performed in adult patients with TBI or stroke who were admitted to the Intensive Care Unit of our tertiary university hospital between 2013 and 2016. Heart rate variability (HRV) was recorded daily and assessed for autonomic nervous system activity. Outcomes were nosocomial infections and immunosuppression, which was assessed ex vivo using whole blood stimulations with plasma of patients with infections, matched non-infected patients and healthy controls.

Results
Out of 64 brain injured patients, 23 (36%) developed an infection during their hospital stay. The ability of brain injured patients to generate a host response to the bacterial endotoxin lipopolysaccharides (LPS) was diminished compared to healthy controls (p < 0.001). Patients who developed an infection yielded significantly lower TNF-α values (86 vs 192 pg/mL, p = 0.030) and a trend towards higher IL-10 values (122 vs 84 pg/mL, p = 0.071) following ex vivo whole blood stimulations when compared to patients not developing an infection. This decreased host immune response was associated with altered admission HRV values. Brain injured patients who developed an infection showed increased normalized high-frequency power compared to patients not developing an infection (0.54 vs 0.36, p = 0.033), whereas normalized low-frequency power was lower in infected patients (0.46 vs 0.64, p = 0.033).

Conclusion
Brain injured patients developing a nosocomial infection show parasympathetic predominance in the acute phase following brain injury, reflected by alterations in HRV, which parallels a decreased ability to generate an immune response to stimulation with LPS.
Role of organizations in preparedness and emergency response to flood disaster in Bangladesh
Authors: Hossain Babul 
Published: November 2020

AbstractThe present study is to know the role of organizations and make an assessment on their assistance regarding preparedness and emergency response of flood disaster affected people. This study has used a mixed-method approach. Flood-affected people were the respondents to evaluate the organizational role. The study reveals that before the flood in 2017 to minimize the loss and damages, the GOs play a very effective role concerning the arrangement of preparatory meetings and preparing shelter centers, and NGOs play a very useful role in making arrangements for awareness-building training. During the emergency period, the GOs played a comparatively better role in providing CI sheets, agricultural assistance and cash money as relief for establishing housing facilities and emergency support. The NGOs played relatively a better role in providing food, water, clothes, medicine, etc. This study put forward complications such as limited sanctions, disruption of communication, lack of awareness of sufferers, and overlapping. The findings of this study would be a significant for the disaster policymakers, and civil societies.
A giant pelvic solitary fibrous tumor with Doege–Potter syndrome successfully treated with transcatheter arterial embolization followed by surgical resection: a case report
Authors: Yuza Kizuki , Sakata Jun , Nagaro Hiroki , Ando Takuya , Hirose Yuki , Miura Kohei , Takizawa Kazuyasu , Kobayashi Takashi , Ichikawa Hiroshi , Hanyu Takaaki , Shimada Yoshifumi , Nagahashi Masayuki , Kosugi Shin-Ichi , Wakai Toshifumi 
Published: November 2020

Abstract
Background
Solitary fibrous tumor (SFT), a mesenchymal fibroblastic tumor with a hypervascular nature, rarely develops in the pelvis. Resection of a giant SFT occupying the pelvic cavity poses an increased risk of developing massive hemorrhage during resection, although surgical resection is the most effective treatment method for this tumor to achieve a potential cure. SFT rarely develops with Doege–Potter syndrome, which is known as a paraneoplastic syndrome characterized by non-islet cell tumor hypoglycemia (NICTH) secondary to SFT that secretes insulin-like growth factor-II (IGF-II). We present a case of a giant pelvic SFT with Doege–Potter syndrome, which was successfully treated with transcatheter arterial embolization (TAE) followed by surgical resection.

Case presentation
A 46-year-old woman presented with a disorder of consciousness due to refractory hypoglycemia. Images of the pelvis showed a giant and heterogeneously hypervascular mass displacing and compressing the rectum. Endocrinological evaluation revealed low serum levels of insulin and C-peptide consistent with NICTH. Angiography identified both the inferior mesenteric artery and the bilateral internal iliac artery as the main feeders of the tumor. To avoid intraoperative massive bleeding, super-selective TAE was performed for the tumor 2 days prior to surgery. Hypoglycemia disappeared after TAE. The tumor was resected completely, with no massive hemorrhage during resection. Histologically, it was diagnosed as IGF-II-secreting SFT. Partial necrosis of the rectum in the specimen was observed due to TAE. The patient was followed up for 2 years and no evidence of disease has been reported.

Conclusions
Preoperative angiography followed by TAE is an exceedingly helpful method to reduce intraoperative hemorrhage when planning to resect SFT occupying the pelvic cavity. Complications related to ischemia should be kept in mind after TAE, which needs to be planned within 1 or 2 days before surgery. TAE for tumors may be an option in addition to medical and surgical treatment for persistent hypoglycemia in Doege–Potter syndrome.
Feasibility of an app-based parent-mediated speech production intervention for minimally verbal autistic children: development and pilot testing of a new intervention
Authors: Saul Jo , Norbury Courtenay 
Published: November 2020

Abstract
Background
Training speech production skills may be a valid intervention target for minimally verbal autistic children. Intervention studies have explored various approaches albeit on a small scale and with limited experimental control or power. We therefore designed a novel app-based parent-mediated intervention based on insights from the video modelling and cued articulation literature and tested its acceptability and usage.

Methods
Consultation with the autism community refined the initial design and culminated in a pilot trial (n = 19) lasting 16 weeks. Participants were randomly allocated an intervention duration in an AB phase design and undertook weekly probes during baseline and intervention via the app. We evaluated the acceptability of the intervention via feedback questionnaires and examined the usability variables such as adherence to the testing and intervention schedule, time spent on the app and trials completed during the intervention phase.

Results
High acceptability scores indicated that families liked the overall goals and features of the app. Ten participants engaged meaningfully with the app, completing 82% of the test trials and uploading data in 61% of intervention weeks; however, of these, only three met the targeted 12.5 min of intervention per week.

Conclusion
We discuss the possible reasons for variability in usage data and how barriers to participation could be surmounted in the future development of this intervention.
A virtual teaching clinic for virtual care during the COVID-19 pandemic
Authors: He Xin , Shelden Daniel , Kraftson Andrew , Else Tobias , Auchus Richard J. 
Published: November 2020

AbstractThe COVID-19 pandemic has prompted the rapid transition of in-person outpatient care to telemedicine, and clinical training to remote learning. The endocrinology fellows at the University of Michigan maintain their own continuity-of-care clinics and rotate in the Ann Arbor Veterans Affairs (VA) Healthcare System. For these clinics, we sought to preserve patient staffing with expert attending physicians and continue the clinical training experience in a remote setting.We have adapted the online conferencing platform, Zoom, to integrate learners into a virtual teaching clinic environment. By using the Zoom “breakout room” feature, fellows are able to match staffing attending physicians to different patient cases, according to attending physicians’ areas of specialty. Similar to the traditional teaching clinic environment, our remote staffing strategy has ensured that fellows continue to provide excellent patient care and fulfill educational aims across our University and VA facilities.Outpatient clinics in other University of Michigan departments and other academic centers have inquired about or have begun utilizing our method. Even beyond COVID-19, our paradigm potentially provides a convenient virtual staffing platform to serve patient populations with geographic or transportation challenges. Following implementation, stakeholders can regularly evaluate the approach to continually improve both patient care and medical education.
Shifts in the global migration order and migration transitions in Europe: the cases of Turkey and Russia
Authors: Düvell Franck 
Published: November 2020

AbstractThis paper takes as a premise that world economics, world politics and global labour are changing and that whilst migration is a driver as well as a consequence of change it is changing, too. For long, conventional research focussed on north-north and south-north migrations, like across the Atlantic or from agricultural and industrialising to industrial countries. This was in part inspired by the economic and political dominance of the ‘global north’, but also driven by a western and Eurocentric bias. Meanwhile, a long period of economic and political transformations and turbulences gave rise to new economic powers, diversified the sending-receiving country matrix and thus fundamentally changed the determinants for international migration. I elaborate the concepts migration order and migration transition to argue that these are useful for analysing the changes in the configuration of sending, receiving and transit states. To illustrate the argument, this article takes Russia and Turkey and developments from the early 2000s as case studies and analyses the shifts in the regional and global migration flows.
Focus on the notice: evidence of spatial skills’ effect on middle school learning from a computer simulation
Authors: Epler-Ruths Colleen M. , McDonald Scott , Pallant Amy , Lee Hee-Sun 
Published: November 2020

AbstractThis article represents the findings from the qualitative portion of a mixed methods study that investigated the impact of middle school students’ spatial skills on their plate tectonics learning while using a computer visualization. Higher spatial skills have been linked to higher STEM achievement, while use of computer visualizations has mixed results for helping various students with different spatial levels. This study endeavors to better understand the difference between what high and low spatial-skilled middle school students notice and interpret while using a plate tectonic computer visualization. Also, we examine the differences in the quantity and quality of students’ spatial language. The collected data include student spatial scores, student interviews, screencasts, and online artifacts. The artifacts were students’ answers to questions inserted in an online curriculum (GEODE) with the embedded computer visualization (Seismic Explorer). Students were asked what they “noticed” during interviews and in the curriculum. Typed student answers and interviews were analyzed for types and quantity of spatial words. Analysis of typed answers and interviews indicated that there are differences in the number and types of spatial words used by high or low spatial students. Additionally, high spatial learners talk about depth, notice patterns in data and are more likely to make a hypothesis to explain what they see on the screen. Findings suggest that students go through an iterative cycle of noticing and interpreting when using a scientific model. Overall, results show a significant positive relationship between spatial skills and what students notice while learning plate tectonics. An explanation for the increased gain in plate tectonics comprehension is that students with higher spatial skills notice more, so they are able to interpret more details of the model. This finding implies that students with low spatial skills do not benefit as much from use of a computer visualization and will need more scaffolding in order to interpret details in the computer visualization.
Effects of cutting and sowing seeds of native species on giant ragweed invasion and plant diversity in a field experiment
Authors: Byun Chaeho , Choi Ho , Kang Hojeong 
Published: November 2020

AbstractBackgroundAmbrosia trifidais a highly invasive annual plant, but effective control methods have not been proposed. Among various eradication methods, cutting is a simple measure to control invasive plants, and sowing seeds of native plants may effectively increase biotic resistance to invasion. In this study, we conducted a field experiment with two treatments: cutting and sowing seeds of six native or naturalized plants.ResultsWe found a significantly lowerA. trifidaabundance after cutting than in the control (77% decrease). Sowing seeds of native species did not provide any additional benefit for the control ofA. trifida, but increased the importance values and diversity of other native vegetation. The abundance ofA. trifidawas negatively correlated with that of other plant taxa based on plant cover, biomass, and density. However, biotic resistance of sown plants was not effective to control invasion becauseA. trifidawas so competitive.ConclusionsWe concluded that cutting is an effective measure to controlAmbrosia trifidawhile sowing seeds of native plants can increase native plant diversity.
COVID-19 infection: epidemiological, clinical, and radiological expression among adult population
Authors: Ragab Eman , Mahrous Asrar Helal , El Sheikh Ghadeer Maher 
Published: November 2020

Abstract
Background
High-resolution computed tomography (HRCT) has proved to be an important diagnostic tool throughout the COVID-19 pandemic outbreaks. Increasing number of the infected personnel and shortage of real-time transcriptase polymerase chain reaction (RT-PCR) as well as its lower sensitivity made the CT a backbone in diagnosis, assessment of severity, and follow-up of the cases.

Results
Two hundred forty patients were evaluated retrospectively for clinical, laboratory, and radiological expression in COVID-19 infection. One hundred eighty-six non-severe cases with home isolation and outpatient treatment and 54 severe cases needed hospitalization and oxygen support. Significant difference between both groups was encountered regarding the age, male gender, > 38° fever, dyspnea, chest pain, hypertension, ≤ 93 oxygen saturation, intensive care unit (ICU) admission, elevated D-dimer, high serum ferritin and troponin levels, and high CT-severity score (CT-SS) of the severe group. CT-SS showed a negative correlation with O2 saturation and patients’ outcome (r − 0.73/p 0.001 and r − 0.56/p 0.001, respectively). Bilateral peripherally distributed ground glass opacities (GGOs) were the commonest imaging feature similar to the literature.

Conclusion
Older age, male gender, smoking, hypertension, low O2 saturation, increased CT score, high serum ferritin, and high D-dimer level are the most significant risk factors for severe COVID-19 pneumonia. Follow-up of the recovered severe cases is recommended to depict possible post COVID-19 lung fibrosis.
Central Nervous System Lymphomas
Authors: Grommes Christian 
Published: November 2020

ABSTRACT

PURPOSE OF REVIEW
Primary central nervous system (CNS) lymphoma is a rare, aggressive extranodal non-Hodgkin lymphoma confined to the brain, eyes, CSF, or spinal cord without systemic, non-CNS involvement. This article reviews the clinical presentation, imaging characteristics, diagnostic workup, novel pathophysiologic insights, and treatment of immunocompetent patients with primary CNS lymphoma.

RECENT FINDINGS
The prognosis of primary CNS lymphoma has significantly improved over the past few decades because of the introduction of and widespread use of high-dose methotrexate, which is now the backbone of all first-line combination chemotherapy treatments. Despite this progress, durable remission is still observed in only approximately 50% of patients. Novel insights into the pathophysiology of primary CNS lymphoma have identified the B-cell receptor pathway as well as the suppressed tumor immune microenvironment and immune evasion as key mechanisms in the pathogenesis of primary CNS lymphoma. Novel, small molecules and agents targeting these aberrant pathways have been introduced into clinical trials of recurrent/refractory primary CNS lymphomas. Agents such as the Bruton tyrosine kinase (BTK) inhibitor ibrutinib or immunomodulatory drugs such as lenalidomide and pomalidomide have shown promising response rates in the relapsed setting.

SUMMARY
Diagnosis of primary CNS lymphoma requires a high level of suspicion because clinical signs and deficits can vary and depend on the involved CNS compartments. Rapid initiation of therapy is essential for recovery and prognosis. The optimal treatment regimen has not been defined, but methotrexate-based chemotherapy regimens are considered the standard treatment approach for induction treatment. Novel, targeted agents have recently been introduced into the therapeutic arsenal.
Nonopioid GTS-21 Mitigates Burn Injury Pain in Rats by Decreasing Spinal Cord Inflammatory Responses
Authors: Zhou Yinhui , Leung-Pitt Yiuka , Deng Hao , Ren Yang , You Zerong , Kem William R. , Shen Shiqian , Zhang Wei , Mao Jianren , Martyn J. A. Jeevendra 
Published: November 2020

Background:
Burn injury (BI) pain consists of inflammatory and neuropathic components and activates microglia. Nicotinic alpha 7 acetylcholine receptors (α7AChRs) expressed in microglia exhibit immunomodulatory activity during agonist stimulation. Efficacy of selective α7AChR agonist GTS-21 to mitigate BI pain and spinal pain-mediators was tested.

METHODS:
Anesthetized rats after hind-paw BI received intraperitoneal GTS-21 or saline daily. Allodynia and hyperalgesia were tested on BI and contralateral paw for 21 days. Another group after BI receiving GTS-21 or saline had lumbar spinal cord segments harvested (day 7 or 14) to quantify spinal inflammatory-pain transducers or microglia activation using fluorescent marker, ionized calcium-binding adaptor protein (Iba1).

RESULTS:
BI significantly decreased allodynia withdrawal threshold from baseline of ~9–10 to ~0.5–1 g, and hyperalgesia latency from ~16–17 to ~5–6 seconds by day 1. Both doses of GTS-21 (4 or 8 mg/kg) mitigated burn-induced allodynia from ~0.5–1 to ~2–3 g threshold (P = .089 and P = .010), and hyperalgesia from ~5–6 to 8–9 seconds (P < .001 and P < .001) by day 1. The GTS-21 group recovered to baseline pain threshold by day 15–17 compared to saline-treated, where the exaggerated nociception persisted beyond 15–17 days. BI significantly (P < .01) increased spinal cord microgliosis (identified by fluorescent Iba1 staining), microglia activation (evidenced by the increased inflammatory cytokine), and pain-transducer (protein and/or messenger RNA [mRNA]) expression (tumor necrosis factor-α [TNF-α], interleukin-1β [IL-1β], nuclear factor-kappa B [NF-κB], interleukin-6 [IL-6], Janus-associated kinase signal transducer and activator of transcription 3 [JAK-STAT3], and/or N-methyl-d-aspartate receptor [NMDAR]). GTS-21 mitigated pain-transducer changes. The α7AChR antagonist methyllycaconitine nullified the beneficial effects of GTS-21 on both increased nociception and pain-biomarker expression.

CONCLUSIONS:
Nonopioid, α7AChR agonist GTS-21 elicits antinociceptive effects at least in part by decreased activation spinal-cord pain-inducers. The α7AChR agonist GTS-21 holds promise as potential therapeutic adjunct to decrease BI pain by attenuating both microglia changes and expression of exaggerated pain transducers.
Development and Evaluation of a Risk-Adjusted Measure of Intraoperative Hypotension in Patients Having Nonemergent, Noncardiac Surgery
Authors: Christensen Anna L. , Jacobs Ethan , Maheshwari Kamal , Xing Fei , Zhao Xiaohong , Simon Samuel E. , Domino Karen B. , Posner Karen L. , Stewart Alvin F. , Sanford Joseph A. , Sessler Daniel I. 
Published: November 2020

BACKGROUND:
Intraoperative hypotension is common and associated with organ injury and death, although randomized data showing a causal relationship remain sparse. A risk-adjusted measure of intraoperative hypotension may therefore contribute to quality improvement efforts.

METHODS:
The measure we developed defines hypotension as a mean arterial pressure <65 mm Hg sustained for at least 15 cumulative minutes. Comparisons are based on whether clinicians have more or fewer cases of hypotension than expected over 12 months, given their patient mix. The measure was developed and evaluated with data from 225,389 surgeries in 5 hospitals. We assessed discrimination and calibration of the risk adjustment model, then calculated the distribution of clinician-level measure scores, and finally estimated the signal-to-noise reliability and predictive validity of the measure.

RESULTS:
The risk adjustment model showed acceptable calibration and discrimination (area under the curve was 0.72 and 0.73 in different validation samples). Clinician-level, risk-adjusted scores varied widely, and 36% of clinicians had significantly more cases of intraoperative hypotension than predicted. Clinician-level score distributions differed across hospitals, indicating substantial hospital-level variation. The mean signal-to-noise reliability estimate was 0.87 among all clinicians and 0.94 among clinicians with >30 cases during the 12-month measurement period. Kidney injury and in-hospital mortality were most common in patients whose anesthesia providers had worse scores. However, a sensitivity analysis in 1 hospital showed that score distributions differed markedly between anesthesiology fellows and attending anesthesiologists or certified registered nurse anesthetists; score distributions also varied as a function of the fraction of cases that were inpatients.

CONCLUSIONS:
Intraoperative hypotension was common and was associated with acute kidney injury and in-hospital mortality. There were substantial variations in clinician-level scores, and the measure score distribution suggests that there may be opportunity to reduce hypotension which may improve patient safety and outcomes. However, sensitivity analyses suggest that some portion of the variation results from limitations of risk adjustment. Future versions of the measure should risk adjust for important patient and procedural factors including comorbidities and surgical complexity, although this will require more consistent structured data capture in anesthesia information management systems. Including structured data on additional risk factors may improve hypotension risk prediction which is integral to the measure’s validity.