bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lower abdominal and pelvic radiation and testicular germ cell tumor risk
Authors: Nead Kevin T. , Mitra Nandita , Weathers Benita , Pyle Louisa , Emechebe Nnadozie , Pucci Donna A. , Jacobs Linda A. , Vaughn David J. , Nathanson Katherine L. , Kanetsky Peter A. 
Published: November 2020

Background
Testicular germ cell tumor (TGCT) incidence has increased in recent decades along with the use and dose of diagnostic radiation. Here we examine the association between reported exposure to diagnostic radiation and TGCT risk.

Methods
We conducted a case-control study of men with and without TGCT recruited from hospital- and population-based settings. Participants reported on exposures to 1) x-ray or CT below the waist and 2) lower GI series or barium enema, which consists of a series of x-rays of the colon. We also derived a combined measure of exposure. We used logistic regression to determine the risk of developing TGCT according to categories of exposures (0, 1–2, or ≥3 exposures) and age at first exposure, adjusting for age, year of birth, race, county, body mass index at diagnosis, family history of TGCT, and personal history of cryptorchidism.

Results
There were 315 men with TGCT and 931 men without TGCT in our study. Compared to no exposures, risk of TGCT was significantly elevated among those reporting at least three exposures to x-ray or CT (OR≥3 exposures, 1.78; 95% CI, 1.15–2.76; p = 0.010), lower GI series or barium enema (OR≥3 exposures, 4.58; 95% CI, 2.39–8.76; p<0.001), and the combined exposure variable (OR≥3 exposures, 1.59; 95% CI, 1.05–2.42; p = 0.029). The risk of TGCT was elevated for those exposed to diagnostic radiation at age 0–10 years, compared to those first exposed at age 18 years or later, although this association did not reach statistical significance (OR, 2.00; 95% CI, 0.91–4.42; p = 0.086).

Conclusions
Exposure to diagnostic radiation below the waist may increase TGCT risk. If these results are validated, efforts to reduce diagnostic radiation doses to the testes should be prioritized.
Expression of signal-transducing adaptor protein-1 attenuates experimental autoimmune hepatitis via down-regulating activation and homeostasis of invariant natural killer T cells
Authors: Kashiwakura Jun-ichi , Saitoh Kodai , Ihara Takeru , Sasaki Yuto , Kagohashi Kota , Enohara Shiyo , Morioka Yuka , Watarai Hiroshi , Muromoto Ryuta , Kitai Yuichi , Iwabuchi Kazuya , Oritani Kenji , Matsuda Tadashi 
Published: November 2020

ObjectiveSignal-transducing adaptor protein (STAP) family members function as adaptor molecules and are involved in several events during immune responses. Notably however, the biological functions of STAP-1 in other cells are not known. We aimed to investigate the functions of STAP-1 in invariant natural killer T (iNKT) cells and iNKT cell-dependent hepatitis.MethodsWe employed concanavalin A (Con A)-induced hepatitis and α-galactosylceramide (α-GalCer)-induced hepatitis mouse models, both are models of iNKT cell-dependent autoimmune hepatitis, and STAP-1 overexpressing 2E10 cells to investigate the role of STAP-1 in iNKT cell activation in vivo an in vitro, respectively.ResultsAfter Con A- or α-GalCer-injection, hepatocyte necrotic areas and plasma alanine aminotransferase elevation were more severe in STAP-1 knockout (S1KO) mice and milder in lymphocyte-specific STAP-1 transgenic (S1Tg) mice, as compared to wild-type (WT) mice. Two events that may be related to Con A-induced and/or α-GalCer-induced hepatitis were influenced by STAP-1 manipulation. One is that iNKT cell populations in the livers and spleens were increased in S1KO mice and were decreased in S1Tg mice. The other is that Con A-induced interleukin-4 and interferon-γ production was attenuated by STAP-1 overexpression. These effects of STAP-1 were confirmed using 2E10 cells overexpressing STAP-1 that showed impairment of interleukin-4 and interferon-γ production as well as phosphorylation of Akt and mitogen-activated protein kinases in response to Con A stimulation.ConclusionsThese results conclude that STAP-1 regulates iNKT cell maintenance/activation, and is involved in the pathogenesis of autoimmune hepatitis.
High CSF thrombin concentration and activity is associated with an unfavorable outcome in patients with intracerebral hemorrhage
Authors: Krenzlin Harald , Frenz Christina , Schmitt Jan , Masomi-Bornwasser Julia , Wesp Dominik , Kalasauskas Darius , Kerz Thomas , Lotz Johannes , Alessandri Beat , Ringel Florian , Keric Naureen 
Published: November 2020

Background
The cerebral thrombin system is activated in the early stage after intracerebral hemorrhage (ICH). Expression of thrombin leads to concentration dependent secondary neuronal damage and detrimental neurological outcome. In this study we aimed to investigate the impact of thrombin concentration and activity in the cerebrospinal fluid (CSF) of patients with ICH on clinical outcome.

Methods
Patients presenting with space-occupying lobar supratentorial hemorrhage requiring extra-ventricular drainage (EVD) were included in our study. The CSF levels of thrombin, its precursor prothrombin and the Thrombin-Antithrombin complex (TAT) were measured using enzyme linked immune sorbent assays (ELISA). The oxidative stress marker Superoxide dismutase (SOD) was assessed in CSF. Initial clot size and intraventricular hemorrhage (IVH) volume was calculated based on by computerized tomography (CT) upon admission to our hospital. Demographic data, clinical status at admission and neurological outcome were assessed using the modified Rankin Scale (mRS) at 6-weeks and 6-month after ICH.

Results
Twenty-two consecutive patients (9 females, 11 males) with supratentorial hemorrhage were included in this study. CSF concentrations of prothrombin (p < 0.005), thrombin (p = 0.005) and TAT (p = 0.046) were statistical significantly different in patients with ICH compared to non-hemorrhagic CSF samples. CSF concentrations of thrombin 24h after ICH correlated with the mRS index after 6 weeks (r2 = 0.73; < 0.005) and 6 months (r2 = 0.63; < 0.005) after discharge from hospital. Thrombin activity, measured via TAT as surrogate parameter of coagulation, likewise correlated with the mRS at 6 weeks (r2 = 0.54; < 0.01) and 6 months (r2 = 0.66; < 0.04). High thrombin concentrations coincide with higher SOD levels 24h after ICH (p = 0.01).

Conclusion
In this study we found that initial thrombin concentration and activity in CSF of ICH patients did not correlate with ICH and IVH volume but are associated with a poorer functional neurological outcome. These findings support mounting evidence of the role of thrombin as a contributor to secondary injury formation after ICH.
Development and validation of a 30-day mortality index based on pre-existing medical administrative data from 13,323 COVID-19 patients: The Veterans Health Administration COVID-19 (VACO) Index
Authors: King Joseph T. , Yoon James S. , Rentsch Christopher T. , Tate Janet P. , Park Lesley S. , Kidwai-Khan Farah , Skanderson Melissa , Hauser Ronald G. , Jacobson Daniel A. , Erdos Joseph , Cho Kelly , Ramoni Rachel , Gagnon David R. , Justice Amy C. 
Published: November 2020

Background
Available COVID-19 mortality indices are limited to acute inpatient data. Using nationwide medical administrative data available prior to SARS-CoV-2 infection from the US Veterans Health Administration (VA), we developed the VA COVID-19 (VACO) 30-day mortality index and validated the index in two independent, prospective samples.

Methods and findings
We reviewed SARS-CoV-2 testing results within the VA between February 8 and August 18, 2020. The sample was split into a development cohort (test positive between March 2 and April 15, 2020), an early validation cohort (test positive between April 16 and May 18, 2020), and a late validation cohort (test positive between May 19 and July 19, 2020). Our logistic regression model in the development cohort considered demographics (age, sex, race/ethnicity), and pre-existing medical conditions and the Charlson Comorbidity Index (CCI) derived from ICD-10 diagnosis codes. Weights were fixed to create the VACO Index that was then validated by comparing area under receiver operating characteristic curves (AUC) in the early and late validation cohorts and among important validation cohort subgroups defined by sex, race/ethnicity, and geographic region. We also evaluated calibration curves and the range of predictions generated within age categories. 13,323 individuals tested positive for SARS-CoV-2 (median age: 63 years; 91% male; 42% non-Hispanic Black). We observed 480/3,681 (13%) deaths in development, 253/2,151 (12%) deaths in the early validation cohort, and 403/7,491 (5%) deaths in the late validation cohort. Age, multimorbidity described with CCI, and a history of myocardial infarction or peripheral vascular disease were independently associated with mortality–no other individual comorbid diagnosis provided additional information. The VACO Index discriminated mortality in development (AUC = 0.79, 95% CI: 0.77–0.81), and in early (AUC = 0.81 95% CI: 0.78–0.83) and late (AUC = 0.84, 95% CI: 0.78–0.86) validation. The VACO Index allows personalized estimates of 30-day mortality after COVID-19 infection. For example, among those aged 60–64 years, overall mortality was estimated at 9% (95% CI: 6–11%). The Index further discriminated risk in this age stratum from 4% (95% CI: 3–7%) to 21% (95% CI: 12–31%), depending on sex and comorbid disease.

Conclusion
Prior to infection, demographics and comorbid conditions can discriminate COVID-19 mortality risk overall and within age strata. The VACO Index reproducibly identified individuals at substantial risk of COVID-19 mortality who might consider continuing social distancing, despite relaxed state and local guidelines.
The clinical value of minimal invasive autopsy in COVID-19 patients
Authors: D’Onofrio Valentino , Donders Elena , Vanden Abeele Marie-Elena , Dubois Jasperina , Cartuyvels Reinoud , Achten Ruth , Lammens Martin , Dendooven Amelie , Driessen Ann , Augsburg Lukasz , Vanrusselt Jan , Cox Janneke 
Published: November 2020

Background
Minimally invasive autopsy (MIA) is a validated and safe method to establish the cause of death (COD), mainly in low-resource settings. However, the additional clinical value of MIA in Coronavirus disease (COVID-19) patients in a high-resource setting is unknown. The objective was to assess if and how MIA changed clinical COD and contributing diagnoses in deceased COVID-19 patients.

Methods and findings
A prospective observational cohort from April to May 2020 in a 981-bed teaching hospital in the epicenter of the COVID-19 pandemic in Belgium was established. Patients who died with either PCR-confirmed or radiologically confirmed COVID-19 infection were consecutively included. MIA consisted of whole-body CT and CT-guided Tru-Cut® biopsies. Diagnostic modalities were clinical chart review, radiology, microbiology, and histopathology which were assessed by two independent experts per modality. MIA COD and contributing diagnoses were established during a multi-disciplinary meeting. Clinical COD (CCOD) and contributing diagnosis were abstracted from the discharge letter. The main outcomes were alterations in CCOD and contributing diagnoses after MIA, and the contribution of each diagnostic modality. We included 18 patients, of which 7 after intensive care unit hospitalization. MIA led to an alteration in 15/18 (83%) patients. The CCOD was altered in 5/18 (28%) patients. MIA found a new COD (1/5), a more specific COD (1/5), a less certain COD (1/5), or a contributing diagnosis to be the COD (2/5). Contributing diagnoses were altered in 14/18 (78%) patients: 9 new diagnoses, 5 diagnoses dismissed, 3 made more specific, and 2 made less certain. Overall, histopathology contributed in 14/15 (93%) patients with alterations, radiology and microbiology each in 6/15 (40%), and clinical review in 3/15 (20%). Histopathology was deemed the most important modality in 10 patients, radiology in two patients, and microbiology in one patient.

Conclusion
MIA, especially histological examination, can add valuable new clinical information regarding the cause of death in COVID-19 patients, even in a high-resource setting with wide access to premortem diagnostic modalities. MIA may provide important clinical insights and should be applied in the current ongoing pandemic.

Trial registration
Clinicaltrials.gov identifier: NCT04366882
Lean Healthcare applied toward turning a Pharmacy Service Patient Centered
Authors: Zanotto Bruna Stella , Bittencourt Gabriela C. , Tortato Caroline , Martinbiancho Jacqueline K. , Chagas Janaína R. , Ruschel Karen Brasil , Etges Ana Paula , Polanczyk Carisi A. 
Published: November 2020

Introduction. Pharmaceutical service optimization requires a comprehensive understanding of resource usage. The aim of the study is to analyze how Lean Healthcare principles can contribute toward turning a pharmacy service patient-centered and value oriented.
Methods. Understand how clinical pharmacists’ resources are effectively used by patients in an academic hospital using lean tools, such as value stream mapping and activity designation matrix, determine the amount of time each professional is involved in specific activities, and identify activities that add value. The data were mainly obtained through interviews with professionals, time-motion observational studies, chronoanalysis and meetings with the head of the unit.
Results. A process flow map is designed for clinical pharmacy services, and it considers the relationship between the activities and their added value base. An exploration of the map shows that the activity “clinical rounds” is the most time consuming (27%) and not necessarily considered value-added by both parties (pharmacists staff and head of service). It is notable the opportunity the service has to prioritize the high-risk patients and to make a good time management; furthermore, activities that are of high value to patients are being performed and monitored by interns.
Conclusions. The role of pharmacists should evolve from now on to be congruent with the new realities of healthcare. When value is questioned, we are encouraged to reflect on the activities engaged in by professional pharmacists in a clinical/surgical unit of a hospital. Through these tools, we could infer how the system is engaged and how it can be transformed toward added value.
Lonely Young American: Queer Terrorist Recruitment and the Trope of the Child
Authors: McCann Bryan J. 
Published: November 2020

AbstractThe trope of the Child is contradictory and marked by considerable ambivalence. To reckon with the Child’s place in public culture is to bear witness to its myriad permutations. One such permutation presents itself in the story of “Alex,” a 23-year-old white U.S. American woman who nearly left her Washington State home to join the Islamic State (ISIS) after sustained online contact with several Caliphate members. Alex’s story is a representative anecdote regarding white civil society’s affective investments in and anxieties about the Child, and is strikingly homologous to popular narratives of online sexual predators who target children. Within the white Western heteronormative imaginary, the figures of the pedophile and the terrorist recruiter seek to defile the Child and, in so doing, undermine the normative foundations of white Western civil society. To mark the ISIS recruiter as a queer threat to the Child is to mobilize the latter in the service of Western hegemony and tether heteronormative notions of child and family to the politics of empire.
PROTOTYPE SISTEM PINTAR PENGELOLAAN TAMAN BUNGA BERBASIS TEKNOLOGI INTERNET OF THINGS (STUDI KASUS TAMAN KUPU-KUPU GITA PERSADA)
Authors: Nama Gigih Forda , Setia Harlika Nobra , Komarudin Muhammad , Muhammad Meizano Ardhi 
Published: November 2020

Usually the process of watering and monitoring of plants in the Gita Persada Butterfly Park in Lampung Province is carried out using conventional methods, this condition create many problems. The research aims is to create a prototype of flower garden application based on Internet of Things (IoT) technology. An application that can help relieve watering activities and monitoring with automated system developed by protoyping method, that consist of; communication stage, quick plan and modelling quick design, construction of prototype, and deployment delivery and feedback. This application use microcontroller Arduino Uno as the main controller, temperature sensor, air humidity (DHT11), soil humidity, ultrasonic sensors (HC-SR04) and application on smartphones android for monitoring. Data delivery between arduino devices, smartphones and databases using website service. There is a firebase library on website Service to connect to firebase. Data transmitted by the device arduino through the protocol http with the command get, send, and push, then received by website Service and forward to be saved on firebase. Based on the data obtained at the air temperature and humidity monitoring around the smart garden for 31 days from April 8 to May 8 , the lowest air temperature is 25°C at 08.00 WIB, 26 April and the highest air temperature 30 °C at 12.00 WIB, 19 April. The average air humidity value is at 95%.
Pretreatment of Oil Palm Empty Fruit Bunch (OPEFB) at Bench-Scale High Temperature-Pressure Steam Reactor for Enhancement of Enzymatic Saccharification
Authors: Sari Fahriya Puspita , Falah Faizatul , Anita Sita Heris , Ramadhan Kharisma Panji , Laksana Raden Permana Budi , Fatriasari Widya , Hermiati Euis 
Published: November 2020

Up scaling of biomass pretreatment from laboratory scale to a bench-scale reactor is one of important steps in the application of the pretreatment for pilot or commercial scale. This study reports the optimization of pretreatment conditions, namely reaction temperature and time, by one factor at a time (OFAT) method for the enhancement of enzymatic saccharification of oil palm empty fruit bunch (OPEFB). OPEFB was pretreated using high temperature-pressure steam reactor with different reaction temperatures (160, 170, 180, 190, 200 °C) and times (10, 20, 30, 40, 50 min). The effectiveness of the pretreatment was determined based on chemical compositions of untreated and pretreated OPEFB and sugar production from enzymatic saccharification of the pretreated OPEFB. Solubilized components in the water that generates the steam were also determined. Pretreatment at 180°C for 20 min provides the highest sugar yields (97.30% of glucose yield per initial cellulose and 88.86% of xylose yield per initial hemicellulose). At the optimum condition 34.9% of lignin and 30.75% of hemicellulose were successfully removed from the OPEFB and resulted in 3.43 delignification selectivity. The relationship between severity factor and by-products generated and the sugars obtained after enzymatic saccharification were discussed. The pretreated OPEFB at the optimum condition was also characterized for its morphological characteristic by scanning electron microscopy (SEM) and crystallinity by X-ray diffractometry (XRD) and then compared it with untreated one. The steam pretreatment caused some fiber disruptions with more defined and opened structures and increased of the crystallinity index (CrI) by 2.9% compared to the untreated OPEFB
Spike Train Coactivity Encodes Learned Natural Stimulus Invariances in Songbird Auditory Cortex
Authors: Theilman Brad , Perks Krista , Gentner Timothy Q. 
Published: November 2020

The capacity for sensory systems to encode relevant information that is invariant to many stimulus changes is central to normal, real-world, cognitive function. This invariance is thought to be reflected in the complex spatiotemporal activity patterns of neural populations, but our understanding of population-level representational invariance remains coarse. Applied topology is a promising tool to discover invariant structure in large datasets. Here, we use topological techniques to characterize and compare the spatiotemporal pattern of coactive spiking within populations of simultaneously recorded neurons in the secondary auditory region caudal medial neostriatum of European starlings (Sturnus vulgaris). We show that the pattern of population spike train coactivity carries stimulus-specific structure that is not reducible to that of individual neurons. We then introduce a topology-based similarity measure for population coactivity that is sensitive to invariant stimulus structure and show that this measure captures invariant neural representations tied to the learned relationships between natural vocalizations. This demonstrates one mechanism whereby emergent stimulus properties can be encoded in population activity, and shows the potential of applied topology for understanding invariant representations in neural populations.SIGNIFICANCE STATEMENTInformation in neural populations is carried by the temporal patterns of spikes. We applied novel mathematical tools from the field of algebraic topology to quantify the structure of these temporal patterns. We found that, in a secondary auditory region of a songbird, these patterns reflected invariant information about a learned stimulus relationship. These results demonstrate that topology provides a novel approach for characterizing neural responses that is sensitive to invariant relationships that are critical for the perception of natural stimuli.
Normal Tone-In-Noise Sensitivity in Trained Budgerigars despite Substantial Auditory-Nerve Injury: No Evidence of Hidden Hearing Loss
Authors: Henry Kenneth S. , Abrams Kristina S. 
Published: November 2020

Loss of auditory-nerve (AN) afferent cochlear innervation is a prevalent human condition that does not affect audiometric thresholds and therefore remains largely undetectable with standard clinical tests. AN loss is widely expected to cause hearing difficulties in noise, known as “hidden hearing loss,” but support for this hypothesis is controversial. Here, we used operant conditioning procedures to examine the perceptual impact of AN loss on behavioral tone-in-noise (TIN) sensitivity in the budgerigar (Melopsittacus undulatus; of either sex), an avian animal model with complex hearing abilities similar to humans. Bilateral kainic acid (KA) infusions depressed compound AN responses by 40–70% without impacting otoacoustic emissions or behavioral tone sensitivity in quiet. Surprisingly, animals with AN damage showed normal thresholds for tone detection in noise (0.1 ± 1.0 dB compared to control animals; mean difference ± SE), even under a challenging roving-level condition with random stimulus variation across trials. Furthermore, decision-variable correlations (DVCs) showed no difference for AN-damaged animals in their use of energy and envelope cues to perform the task. These results show that AN damage has less impact on TIN detection than generally expected, even under a difficult roving-level condition known to impact TIN detection in individuals with sensorineural hearing loss (SNHL). Perceptual deficits could emerge for different perceptual tasks or with greater AN loss but are potentially minor compared with those caused by SNHL.SIGNIFICANCE STATEMENTLoss of auditory-nerve (AN) cochlear innervation is a common problem in humans that does not affect audiometric thresholds on a clinical hearing test. AN loss is widely expected to cause hearing problems in noise, known as “hidden hearing loss,” but existing studies are controversial. Here, using an avian animal model with complex hearing abilities similar to humans, we examined for the first time the impact of an experimentally induced AN lesion on behavioral tone sensitivity in noise. Surprisingly, AN-lesioned animals showed no difference in hearing performance in noise or detection strategy compared with controls. These results show that perceptual deficits from AN damage are smaller than generally expected, and potentially minor compared with those caused by sensorineural hearing loss (SNHL).