bluuebunny/crossref_metadata_2025_split huggingface dataset:
Additional prognostic value of heart rate reserve over left ventricular contractile reserve and coronary flow velocity reserve in diabetic patients with negative vasodilator stress echocardiography by regional wall motion criteria
Authors: Cortigiani Lauro , Ciampi Quirino , Carpeggiani Clara , Lisi Cristiano , Bovenzi Francesco , Picano Eugenio 
Published: November 2020

Abstract

Aims
In diabetic patients, a blunted left ventricular contractile reserve (LVCR) and/or a reduced coronary flow velocity reserve (CFVR) identify patients at higher risk in spite of stress echocardiography (SE) negative for ischaemia. Cardiac autonomic dysfunction contributes to risk profile independently of inducible ischaemia and can be assessed with heart rate reserve (HRR). We sought to assess the added prognostic value of HRR to LVCR and CFVR in diabetic patients with non-ischaemic SE.

Methods and results
Six-hundred and thirty-six diabetic patients (age 68 ± 9 years, 396 men, ejection fraction 58 ± 10%) with sinus rhythm on resting electrocardiogram underwent dipyridamole SE in a two-centre prospective study with assessment of wall motion, force-based LVCR (stress/rest ratio, normal value &gt; 1.1), CFVR of the left anterior descending coronary artery (stress/rest ratio, normal value &gt;2.0), and HRR (stress/rest ratio, normal value &gt;1.22). All-cause death was the only considered endpoint. During a median follow-up of 39 months, 94 (15%) patients died. Independent predictors of death were abnormal CFVR [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.0–2.52, P = 0.05], reduced LVCR (HR 1.76, 95% CI 1.15–2.69, P = 0.009), and blunted HRR (HR 1.92, 95% CI 1.24–2.96, P = 0.003). Eight-year death rate was 9% for patients with triple negativity (n = 252; 40%), 18% for those with single positivity (n = 216; 34%), 36% with double positivity (n = 124; 19%), and 64% for triple positivity (n = 44; 7%) (P &lt; 0.0001).

Conclusion
Diabetic patients with dipyridamole SE negative for ischaemia still may have a significant risk in presence of an abnormal LVCR and/or CFVR and/or HRR, which assess the underlying myocardial, microvascular, and cardiac autonomic dysfunction.

Clinical trials
Gov Identifier NCT 030.49995.
Coronary and cerebral thrombosis in a young patient after mild COVID-19 illness: a case report
Authors: Ranard Lauren S , Engel David J , Kirtane Ajay J , Masoumi Amirali 
Published: November 2020

Abstract

Background
COVID-19 has spread worldwide and has caused significant morbidity and mortality. Myocardial injury and thrombo-embolism are known complications for those with severe forms of disease. The incidence and risk factors for these complications for those patients who are asymptomatic or with mild forms of COVID-19 is unknown.

Case summary
In this report we describe the case of a 35-year-old man with no past cardiac history who presented with chest pain and a high-sensitivity troponin level of 386 ng/L in the context of an unspecified mild viral illness 1 month previously. Diagnostic evaluation revealed a new cardiomyopathy, left ventricular thrombus, and mid right coronary artery thrombosis. The coronary thrombosis was treated with thrombectomy. SARS-CoV-2 antibodies returned positive. He initially did well post-procedure; however, prior to discharge, he developed a second arterial thrombo-embolism event, a middle cerebral artery stroke. He was treated with thrombectomy and remains hospitalized.

Discussion
Recognition that mild COVID-19 can be complicated by subsequent cardiac injury and/or coagulopathy is important. As more people recover from this viral illness and return to normal activity levels, discussion among cardiac experts has begun regarding screening for occult myocardial injury in those who plan to resume competitive athletic activity. This case highlights the need for investigation regarding (i) the duration of thrombophilia after recovery from illness; (ii) the population that should receive thromboprophylaxis; and (iii) the duration of thromboprophylaxis therapy for COVID-19.
A case report of a large intracardiac thrombus in a COVID-19 patient managed with percutaneous thrombectomy and right ventricular mechanical circulatory support
Authors: Kaki Amir , Singh Hemindermeet , Cohen Gerald , Schreiber Theodore 
Published: November 2020

Abstract

Background
The coronavirus disease 2019 (COVID-19) has caused a global pandemic with an unprecedented burden on health and the economy worldwide. Although it primarily involves the respiratory tract system, cardiovascular complications, particularly arterial and venous thrombosis, are frequently reported and are associated with adverse outcomes.

Case summary
We describe the case of a 57-year-old female who presented with acute hypoxic respiratory failure and shock. She was found to have left lower extremity deep vein thrombosis and a suspected pulmonary embolism. A large mobile right atrial mass was found on echocardiogram. Given the large thrombus burden that portended an extremely high risk for embolization to the pulmonary arteries, emergent percutaneous aspiration of an organized thrombus (rather than thrombolysis) was performed using the AngioVac system (Angiodynamics Inc., Latham, NY, USA) complicated by haemodynamic collapse due to acute right ventricular failure. An Impella RP (Abiomed, Danvers, MA, USA) was then placed, with rapid stabilization of haemodynamics. The patient tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). She was treated with antimicrobial and systemic anticoagulation therapy. She was successfully weaned off the Impella RP on post-operative day 4 and was extubated on day 5. She was discharged on day 16 in a stable condition.

Discussion
Incident venous thrombo-embolism is frequently encountered in COVID-19 patients. We report the first case of a large intracardiac thrombus associated with SARS-CoV-2 infection managed successfully with percutaneous thrombectomy and right ventricular mechanical circulatory support.
Appendicular Muscle Physiology and Biomechanics inCrocodylus niloticus
Authors: Michel Krijn B , West Tim G , Daley Monica A , Allen Vivian R , Hutchinson John R 
Published: November 2020

AbstractArchosaurian reptiles (including living crocodiles and birds) had an explosive diversification of locomotor form and function since the Triassic approximately 250 million years ago. Their limb muscle physiology and biomechanics are pivotal to our understanding of how their diversity and evolution relate to locomotor function. Muscle contraction velocity, force, and power in extinct archosaurs such as early crocodiles, pterosaurs, or non-avian dinosaurs are not available from fossil material, but are needed for biomechanical modeling and simulation. However, an approximation or range of potential parameter values can be obtained by studying extant representatives of the archosaur lineage. Here, we study the physiological performance of three appendicular muscles in Nile crocodiles (Crocodylus niloticus). Nile crocodile musculature showed high power and velocity values—the flexor tibialis internus 4 muscle, a small “hamstring” hip extensor, and knee flexor actively used for terrestrial locomotion, performed particularly well. Our findings demonstrate some physiological differences between muscles, potentially relating to differences in locomotor function, and muscle fiber type composition. By considering these new data from a previously unstudied archosaurian species in light of existing data (e.g., from birds), we can now better bracket estimates of muscle parameters for extinct species and related extant species. Nonetheless, it will be important to consider the potential specialization and physiological variation among muscles, because some archosaurian muscles (such as those with terrestrial locomotor function) may well have close to double the muscle power and contraction velocity capacities of others.
Five Tips for Successful Conflict Negotiation in the Breast Imaging Workplace
Authors: Fishman Michael D C , Slanetz Priscilla J 
Published: November 2020

Abstract
Conflict in the workplace is inevitable and disruptive to the team dynamic, ultimately leading to suboptimal patient outcomes if not addressed. Especially in breast imaging, where an interprofessional team is commonplace, spending time to address conflict is critical to building and maintaining relationships among team members. Although institutions may adopt a just culture, workplace paradigms can be challenged when two or more team members encounter misunderstandings around work-related or personal issues. Multiple factors can contribute to promoting workplace conflict, including a toxic culture (the antithesis of just culture), ineffective leadership, hierarchy, unclear expectations or goals, pre-existing assumptions and beliefs, lack of effective communication, and low levels of trust. Developing skills to engage in the difficult conversations to address and resolve conflict are essential to create an efficient and effective team to care for patients. In this manuscript, we provide tips on how each of us can build skills in conflict management and resolution, illustrated in several vignettes. These tips provide practical advice, which ultimately will translate into allowing us to provide better patient care every day.
Improving Readiness: Preventive Maintenance of the Human Operating System that Drives Readiness and Lethality
Authors: Howell George 
Published: November 2020

ABSTRACT
Improving the readiness and lethality of the U.S. fighting forces has always been a key priority, and it received renewed emphasis in the National Defense Authorization Act of 2017. A major rearrangement of the Defense Health Agency and the Military Health System is ongoing with this emphasis. Although revising features to improve our military health service is essential, the health, well-being, and readiness of our people will also rely on the culture created at the Command level where soldiers, sailors, airmen and civilians operate daily. In alignment with our military health care community and in support of our renewed emphasis on warfighting readiness, USS Missouri began a journey to address foundational mindset that drives the core behaviors, training, and procedures of the submarine force and Naval Nuclear Propulsion Principles leading to enhanced readiness, resilience, and accountability.
Genomic mosaicism due to homoeologous exchange generates extensive phenotypic diversity in nascent allopolyploids
Authors: Wu Ying , Lin Fan , Zhou Yao , Wang Jie , Sun Shuai , Wang Bin , Zhang Zhibin , Li Guo , Lin Xiuyun , Wang Xutong , Sun Yue , Dong Qianli , Xu Chunming , Gong Lei , Wendel Jonathan F , Zhang Zhiwu , Liu Bao 
Published: November 2020

Abstract
Allopolyploidy is an important process in plant speciation, yet newly formed allopolyploid species typically suffer from extreme genetic bottlenecks. One escape from this impasse might be homoeologous meiotic pairing, during which homoeologous exchanges (HEs) generate phenotypically variable progeny. However, the immediate genome-wide patterns and resulting phenotypic diversity generated by HEs remain largely unknown. Here, we analyzed the genome composition of 202 phenotyped euploid segmental allopolyploid individuals from the fourth selfed generation following chromosomal doubling of reciprocal F1 hybrids of crosses between rice subspecies, using whole-genome sequencing. We describe rampant occurrence of HEs that, by overcoming incompatibility or conferring superiority of hetero-cytonuclear interactions, generate extensive and individualized genomic mosaicism across the analyzed tetraploids. We show that the resulting homoeolog copy number alteration in tetraploids affects known-function genes and their complex genetic interactions, in the process creating extraordinary phenotypic diversity at the population level following a single initial hybridization. Our results illuminate the immediate genomic landscapes possible in a tetraploid genomic environment, and underscore HE as an important mechanism that fuels rapid phenotypic diversification accompanying the initial stages of allopolyploid evolution.
Clinical course of COVID-19 infection in inflammatory rheumatological patients: a monocentric Belgian experience
Authors: Pistone Aureliano , Tant Laure , Soyfoo Muhammad S 
Published: November 2020

Abstract

Objective
Little is known about the incidence and consequences of coronavirus disease 2019 (COVID-19) infection in patients with rheumatic diseases. To improve our knowledge in this field, we collected data from patients with inflammatory rheumatic diseases who developed COVID-19 infection.

Methods
We performed a monocentric observational longitudinal study and collected data retrospectively from patients with inflammatory rheumatic diseases who developed a confirmed or suspected COVID-19 infection between 3 March and 10 June 2020.

Results
A total of 23 patients developed COVID-19 infection. Seven patients needed hospitalization [female 57%, mean age 59 +/− 9 years], and 16 patients were followed as outpatients [female 80%, mean age 50  +/− 14 years]. All hospitalized patients had more than one co-morbidity. At the time of infection, all patients were on immunosuppressive therapy consisting of either conventional synthetic DMARDs and/or biotherapy, with or without CSs. A minority received Corticoids (CSs) only. The most common symptoms of COVID-19-infected patients were fever, dyspnoea, cough and fatigue. PCR and chest CT were performed in all hospitalized patients to confirm the diagnosis (100% positive PCR, 71% positive CT). All outclinic patients were diagnosed clinically (confirmed by PCR in only one). The mean length of hospital stay was 21 +/− 19 days. Three patients developed an ARDS, including one who died.

Conclusion
A limited number of patients with inflammatory rheumatic diseases suffered from COVID-19 infection. Two patients needed mechanical ventilation and survived, whereas one patient died. All patients with a severe form of infection had at least one co-morbidity.
Emigration and Electoral Outcomes in Mexico: Democratic Diffusion, Clientelism, and Disengagement
Authors: Lu Yao , Villarreal Andrés 
Published: November 2020

AbstractDoes emigration deepen or depress democratic transitions in migrant-sending countries? This study examines the multifaceted and countervailing influences of migration on democratic outcomes in sending societies, as operationalized by electoral participation and competition. Drawing on longitudinal data compiled from several Mexican sources, we find that international migration, but not domestic migration, increases voter turnout and electoral competition in sending communities in Mexico. This pattern holds for low-to-moderate levels of emigration but is reversed for high levels of migration. The positive political impact of migration is limited to current emigration from communities of origin rather than return migration. Both documented and undocumented migration influence electoral outcomes, but the political impact of undocumented migration is more pronounced. These comparisons of different types of migration and different functional forms allow us to explore the mechanisms through which migration affects electoral outcomes. The results are consistent with several proposed mechanisms: migration-driven democratic diffusion, weakened clientelism, and disengagement. Overall, the findings demonstrate the value of integrating demographic processes into explanations of political change.
Cost-effectiveness of digital cognitive behavioral therapy (Sleepio) for insomnia: a Markov simulation model in the United States
Authors: Darden Michael , Espie Colin A , Carl Jenna R , Henry Alasdair L , Kanady Jennifer C , Krystal Andrew D , Miller Christopher B 
Published: November 2020

Abstract

Study Objectives
To examine the cost-effectiveness and potential net monetary benefit (NMB) of a fully automated digital cognitive behavioral therapy (CBT) intervention for insomnia compared with no insomnia treatment in the United States (US). Similar relative comparisons were made for pharmacotherapy and clinician-delivered CBT (individual and group).

Methods
We simulated a Markov model of 100,000 individuals using parameters calibrated from the literature including direct (treatment) and indirect costs (e.g. insomnia-related healthcare expenditure and lost workplace productivity). Health utility estimates were converted into quality-adjusted life years (QALYs) and one QALY was worth $50,000. Simulated individuals were randomized equally to one of five arms (digital CBT, pharmacotherapy, individual CBT, group CBT, or no insomnia treatment). Sensitivity was assessed by bootstrapping the calibrated parameters. Cost estimates were expressed in 2019 US dollars.

Results
Digital CBT was cost beneficial when compared with no insomnia treatment and had a positive NMB of $681.06 (per individual over 6 months). Bootstrap sensitivity analysis demonstrated that the NMB was positive in 94.7% of simulations. Relative to other insomnia treatments, digital CBT was the most cost-effective treatment because it generated the smallest incremental cost-effectiveness ratio (−$3,124.73).

Conclusions
Digital CBT was the most cost-effective insomnia treatment followed by group CBT, pharmacotherapy, and individual CBT. It is financially prudent and beneficial from a societal perspective to utilize automated digital CBT to treat insomnia at a population scale.
Building a custom high-throughput platform at the Joint Genome Institute for DNA construct design and assembly—present and future challenges
Authors: Blaby Ian K , Cheng Jan-Fang 
Published: November 2020

Abstract
The rapid design and assembly of synthetic DNA constructs have become a crucial component of biological engineering projects via iterative design–build–test–learn cycles. In this perspective, we provide an overview of the workflows used to generate the thousands of constructs and libraries produced each year at the U.S. Department of Energy Joint Genome Institute. Particular attention is paid to describing pipelines, tools used, types of scientific projects enabled by the platform and challenges faced in further scaling output.
Primary orbital ganglioneuroblastoma in a child
Authors: Zhang Yi , He Weimin 
Published: November 2020

Abstract

Rationale:
Ganglioneuroblastoma (GNB) is a transitional tumor of sympathetic origin that has never been described as primarily involving the orbit. Herein we report an extremely rare case of GNB with primary orbital involvement and its treatment strategies.

Patient concerns:
A 9-year-old girl presented with progressive and recurring right orbital mass for 2 years.

Diagnosis:
Computed tomography (CT) showed a well-defined, well-circumscribed, and homogeneous extraconal soft tissue mass occupying most of the right superior orbital area. Magnetic resonance imaging (MRI) revealed that there was a neoplasm of the right superior orbit molding around the globe with long T1 and T2 signals, and contrast-enhanced MR image showed a heterogeneous enhancement of the mass. Histopathologic examinations were performed after surgery and the characteristics were consistent with a diagnosis of GNB.

Interventions:
Surgery was performed and the mass was completely resected.

Outcomes:
Postoperatively, the patient was on a regular follow-up for 19 months and so far, has had no orbital mass recurrence.

Lessons:
Herein we present a rare case of GNB primarily involving the orbit, and the findings showed that GNB could originate from the orbit. The patient underwent surgical tumor resection. The histopathological and immunohistochemical features were consistent with the diagnosis of GNB. For this case, there was no recurrence for 19 months after complete surgical excision of the tumor; however, a regular long-term follow-up is required.
Patterns and Predictors of Incident Return to HIV Care Among Traced, Disengaged Patients in Zambia: Analysis of a Prospective Cohort
Authors: Beres Laura K. , Schwartz Sheree , Simbeza Sandra , McGready John , Eshun-Wilson Ingrid , Mwamba Chanda , Sikombe Kombatende , Topp Stephanie M. , Somwe Paul , Mody Aaloke , Mukamba Njekwa , Ehrenkranz Peter D. , Padian Nancy , Pry Jake , Moore Carolyn Bolton , Holmes Charles B. , Sikazwe Izukanji , Denison Julie A. , Geng Elvin 
Published: November 2020

Background:
Dynamic movement of patients in and out of HIV care is prevalent, but there is limited information on patterns of patient re-engagement or predictors of return to guide HIV programs to better support patient engagement.

Methods:
From a probability-based sample of lost to follow-up, adult patients traced by peer educators from 31 Zambian health facilities, we prospectively followed disengaged HIV patients for return clinic visits. We estimated the cumulative incidence of return and the time to return using Kaplan–Meier methods. We used univariate and multivariable Cox proportional hazards regression to conduct a risk factor analysis identifying predictors of incident return across a social ecological framework.

Results:
Of the 556 disengaged patients, 73.0% [95% confidence interval (CI): 61.0 to 83.8] returned to HIV care. The median follow-up time from disengagement was 32.3 months (interquartile range: 23.6–38.9). The rate of return decreased with time postdisengagement. Independent predictors of incident return included a previous gap in care [adjusted Hazard Ratio (aHR): 1.95, 95% CI: 1.23 to 3.09] and confronting a stigmatizer once in the past year (aHR: 2.14, 95% CI: 1.25 to 3.65). Compared with a rural facility, patients were less likely to return if they sought care from an urban facility (aHR: 0.68, 95% CI: 0.48 to 0.96) or hospital (aHR: 0.52, 95% CI: 0.33 to 0.82).

Conclusions:
Interventions are needed to hasten re-engagement in HIV care. Early and differential interventions by time since disengagement may improve intervention effectiveness. Patients in urban and tertiary care settings may need additional support. Improving patient resilience, outreach after a care gap, and community stigma reduction may facilitate return. Future re-engagement research should include causal evaluation of identified factors.
Physical and Mental Health Screening in a New York City HIV Cohort During the COVID-19 Pandemic: A Preliminary Report
Authors: Pizzirusso Maria , Carrion-Park Cira , Clark Uraina S. , Gonzalez Jairo , Byrd Desiree , Morgello Susan 
Published: November 2020

Background:
Mental health consequences of the COVID-19 pandemic have been observed. Psychiatric symptoms in people living with HIV, and their relationship to physical symptomatology and prior psychopathology, are not yet reported.

Setting:
An HIV cohort sheltering-in-place in New York City.

Methods:
Forty-nine participants in a longitudinal study were contacted by telephone in April 2020. A structured interview queried COVID-19-associated physical symptoms, and mental health screens were performed with the generalized anxiety disorder-2 (GAD-2) and patient health questionnaire-2 (PHQ-2). Prior medical and neuropsychiatric data were obtained from preceding study visits. Post-hoc analyses were performed.

Results:
The mean age of respondents was 62.1 years, 39% were women, and 35% African American, 37% Latinx, and 28% Caucasian. COVID-19-indicator symptoms were present in 69%; 41% had respiratory and 61% extra-pulmonary symptoms. Mental health symptoms were endorsed in 45% with PHQ-2 and 43% with GAD-2, although threshold for major depression was met in only 4% and for GAD in 14%. Higher PHQ scores were associated with respiratory symptoms, but not prior mood or anxiety disorders. GAD-2 scores were higher with past mood disorders, but not with prior anxiety disorders or respiratory symptoms.

Conclusions:
Physical symptoms were frequent and mild psychiatric symptoms were common, but serious anxiety and depression were not often endorsed by this group of people living with HIV at the acute height of the New York City COVID-19 pandemic. Reasons for this are unclear, as this preliminary report is descriptive in nature. Short- and long-term consequences of acute mental health symptoms require further study.