bluuebunny/crossref_metadata_2025_split huggingface dataset:
Craniofacial Trauma Due to Stone-pelting – Patterns of Injury and Management
Authors: Arya Saurabh , Jose Anson , Rangan N. Mohan 
Published: October 2020

Aim:
The aims of the study were to elucidate the pattern of stone-pelting induced cranio-facial injuries and to document soft and hard tissue injuries, their management, and complications.

Methods:
A retrospective descriptive study was conducted using a sample of patients reporting to our department in the years 2015 to 2020. Cranio-facial injuries were assessed for soft and hard tissue injuries, including tissue loss, and corresponding management. Follow up ranged from 18 ± 6 months. & A standardized surgical regime was followed for patient management, which included primary survey, debridement of wounds, and routine primary repair of soft tissue. Bony defect reconstruction was performed by open reduction and internal fixation. Cranial bone was used as split calvarial graft in postcraniectomy cranioplasty procedures, which were performed after 6 months. Local flaps were used for the reconstruction of soft tissue defects.

Results:
Being a military hospital, majority of cases fell in the 20 to 30 age group with a male preponderance. The etiology in all cases was stone-pelting. Among cranio-facial injuries, cranial vault injuries and mid-face injuries (71%) were most prevalent, mandibular fractures (24%) and remaining were soft tissue injuries (5%). & Frontal & parietal bone injuries were seen in 23.6% cases (n = 9) and orbito-zygomatic complex injuries were seen in (36.8%) cases (n = 14). Isolated blow-out fractures were seen in 4 patients of our series. 52.6% of patients of our series suffered associated soft tissue injuries to the head, face, and neck region. The most common cause of injury was due to the direct impact of stone hitting the mid-face/cranial vault and the most common pattern of injury was gross comminution of the skeleton. & 2 patients suffered ocular injuries that required management and 6 patients of our series who suffered head injuries to the cranium required a secondary cranioplasty procedure (n = 4) &The most commonly used technique for treatment was open reduction internal fixation, which was used in 89% of patients. Soft-tissue injuries overall occurred most frequently on the forehead, nose, lips, and chin which was managed by primary suturing.

Conclusions:
Cranial vault injuries & orbito-zygomatic complex fractures are most commonly seen in patients with stone-pelting injuries. Early management of such injuries improves outcomes in terms of function and restitution of preinjury skeleton structure. The most common patterns seen is gross comminution to the cranio-facial skeleton that can be treated with immediate primary wound repair after meticulous wound debridement and open reduction and internal fixation. Importance of stone-pelting as a cause of craniofacial injuries is highlighted as it leads to significant disruption of craniofacial skeleton.
Safe at the Plate: Acute Assessment and Management of Baseball-Related Craniofacial Injuries by On-Field Personnel
Authors: Sprau Annelise C. , Slavin Benjamin R. , Pierrot Randall G. , Weber Lee E. , Figueroa Javier M. , Jagid Jonathan R. , Thaller Seth R. 
Published: October 2020

Introduction:
Long regarded as “America's Past Time”, over 8.6 million children partake in organized and recreational baseball. Although improved equipment has reduced contemporary injury rates, nearly half of pediatric baseball injuries requiring hospitalization are due to craniofacial trauma. Sideline personnel at the youth levels, often without advanced medical training, frequently act as first-responders in instances of acute craniofacial injury.

Methods:
An IRB-approved survey was distributed nationally to target field personnel working at youth, high school, collegiate, and professional baseball levels. Survey items included: comfort in assessing subtypes of acute craniofacial trauma (loss of consciousness (LOC), skull injury, orbital injury, nasal injury, and dental injury) via Likert scale, years of medical training, presence of an emergency action plan (EAP), and access to higher level care from emergency medical services (EMS) or a nearby hospital.

Results:
When comparing the amateur and professional cohorts, the respondents from professional teams were significantly more confident in assessing LOC (P = 0.001), skull injury (P < 0.001), orbital injury (P < 0.001), nasal injury (P < 0.001), and dental injury (P < 0.001). The professional teams had significantly more years of first aid training (P < 0.0001) and were significantly more likely to have an EAP (P < 0.0001). Professional teams also had a significantly higher average of reported craniofacial incidents (P = 0.0279).

Conclusion:
The authors identified a significant disparity in comfort level between amateur and professional baseball field personnel for identifying and managing acute craniofacial trauma. Based on these findings, the authors were able to develop a rudimentary tool for on-field personnel to effectively assess and manage craniofacial injuries.
Association of Medical Students' Stress and Coping Skills With Simulation Performance
Authors: Anton Nicholas E. , Rendina Megan A. , Hennings Julie M. , Stambro Ryan , Stanton-Maxey Katie J. , Stefanidis Dimitrios 
Published: October 2020

Introduction
Medical students are vulnerable to experience stress, as they are routinely confronted with stressors. Acute stress can reduce students' performance on examinations, and chronic stress can contribute to cognitive disorders. Conversely, stress coping skills can reduce trainees' anxiety. Thus, stress coping skills may help students manage stress effectively and better maintain clinical performance. The goal of this study was to assess the relationship between medical students' stress, workload, stress coping skills, performance-enhancing mental skills, and clinical performance during a simulated clinical scenario.

Methods
During their surgery clerkship rotation, third-year medical students participated in a simulated scenario designed to assess their ability to care for an acutely ill surgical patient. Participants' physiological stress was assessed using heart rate (HR) monitors during the simulation, their perceived stress using the State-Trait Anxiety Inventory, and workload using the NASA–Task Load Index immediately after. Clinical performance was assessed using a global rating scale. Stress coping skills were also assessed. The relationship between performance, stress level, workload, and coping skills was examined.

Results
Forty-one third-year medical students voluntarily participated in the study. Participants' clinical performance was negatively correlated with perceived stress and workload during the scenario (P < 0.05). A stepwise linear regression model revealed that higher HR was the main predictor of poorer clinical performance (P < 0.05).

Conclusions
In this study, medical students' HR was associated with poorer performance during a simulated clinical scenario. Adaptive stress coping skills may allow medical students to manage stressful situations and better maintain performance.
The Impact of Telemedicine Adoption on a Multidisciplinary Bariatric Surgery Practice During the COVID-19 Pandemic
Authors: Brown Andrew M. , Ardila-Gatas Jessica , Yuan Victoria , Devas Nina , Docimo Salvatore , Spaniolas Konstaninos , Pryor Aurora D. 
Published: October 2020

Objective:
This study aims to show how full-time telemedicine adoption has impacted patient visit volume and attendance in a comprehensive metabolic and weight loss center.

Summary Background Data:
Elective surgical practices have been profoundly impacted by the global COVID-19 pandemic, leading to a rapid increase in the utilization of telemedicine. The abrupt initiation of audio-video telehealth visits for all providers of a multidisciplinary clinic on March 19th 2020 provided unique circumstances to assess the impact of telemedicine.

Methods:
Data from the clinical booking system (new patient and follow-up visits) for all clinical provider types of the multidisciplinary metabolic center from the pre-telehealth, post-telehealth, and a 2019 comparative period were retrospectively reviewed and compared. The primary outcome is the change in patient visit volume for all clinical providers from before to after the initiation of telemedicine for both new patient, and follow-up visits.

Results:
There were a total of 506 visits (162 new patient visits, and 344 follow-ups) in the pre-telehealth period, versus 413 visits (77 new patient visits, and 336 follow-ups) during the post-telehealth period. After telehealth implementation, new visits for surgeons decreased by 75%. Although follow-up visits decreased by 55.06% for surgeons, there was an increase by 27.36% for advanced practitioners. When surgeons were separated from other practitioners, their follow-up visit rate decrease by 55.06%, compared to a 16.08% increase for the group of all other practitioners (P < 0.0001). Dietitians experienced higher rates of absenteeism with new patient visits (10.00% vs 31.42%, P = 0.0128), whereas bariatricians experienced a decrease in follow-up visit absenteeism (33.33% vs 0%, P = 0.0093).

Conclusions:
Although new patient visit volume fell across the board, follow-up visits increased for certain nonsurgical providers. This provides a template for adoption of a multidisciplinary telehealth clinic in a post-pandemic world.
Effectiveness and Safety of Combining Tofacitinib with a Biologic in Patients with Refractory Inflammatory Bowel Diseases
Authors: Alayo Quazim A. , Khatiwada Aava , Patel Anish , Zulfiqar Maria , Gremida Anas , Gutierrez Alexandra , Rood Richard P. , Ciorba Matthew A. , Christophi George , Deepak Parakkal 
Published: October 2020

ABSTRACT AND KEY WORDSBackgroundOne therapeutic option with limited data among patients with active moderate-to-severe ulcerative colitis (UC) and Crohn’s disease (CD) despite biologic monotherapy is using a combination of a biologic with Tofacitinib (TBT). Our aim was to examine the effectiveness and safety of TBT in this subset of patients.MethodsData of IBD patients at 2 referral centers on TBT were extracted. The primary outcome was clinical response (>50% reduction in symptoms) at week 8 and/or 16 determined by Physician Global Assessment. Secondary outcome was clinical remission (resolution of symptoms), corticosteroid-free clinical response and remission, normalization of CRP and endoscopic/radiographic response and remission. Adverse events (AEs) including any abnormal lipid profile or surgical complications were also assessed.ResultsThirty-five patients (25UC, 10CD) were included. Biologics combined with tofacitinib were vedolizumab (68.6%), ustekinumab (17.1%), and infliximab (14.3%) and the median follow-up duration was 4 months. A majority (57.2%) had failed at least two biologics prior to starting TBT. At weeks 8 and/or 16, 37.1% achieved clinical response with 5.7% in clinical remission. Among the 23 patients with endoscopically/radiographically active disease at baseline, 56.5% had endoscopic/radiographic response and 34.8% achieved remission. Three AEs occurred in 2 (5.7%) patients, with an IR of 20.5 (15.0–47.2)/100PYF. No VTE and herpes zoster was reported.ConclusionsTBT is effective at inducing endoscopic/radiographic response and a modest clinical response in UC and CD patients with active clinical symptoms despite prior biologic monotherapy. No new safety signals were detected beyond those reported with tofacitinib monotherapy.
Differentially expressed genes reflect disease-induced rather than disease-causing changes in the transcriptome
Authors: Porcu Eleonora , Sadler Marie C. , Lepik Kaido , Auwerx Chiara , Wood Andrew R. , Weihs Antoine , Ribeiro Diogo M. , Bandinelli Stefania , Tanaka Toshiko , Nauck Matthias , Völker Uwe , Delaneau Olivier , Metspalu Andres , Teumer Alexander , Frayling Timothy , Santoni Federico A. , Reymond Alexandre , Kutalik Zoltán 
Published: October 2020

AbstractComparing transcript levels between healthy and diseased individuals allows the identification of differentially expressed genes, which may be causes, consequences or mere correlates of the disease under scrutiny. Here, we propose a bi-directional Transcriptome-Wide Mendelian Randomization (TWMR) approach that integrates summary-level data from GWAS and whole-blood eQTLs in a MR framework to investigate the causal effects between gene expression and complex traits.Whereas we have previously developed a TWMR approach to elucidate gene expression to trait causal effects, here we are adapting the method to shed light on the causal imprint of complex traits on transcript levels. We termed this new approach reverse TWMR (revTWMR). Integrating bi-directional causal effects between gene expression and complex traits enables to evaluate their respective contributions to the correlation between gene expression and traits. We uncovered that whole blood gene expression-trait correlation is mainly driven by causal effect from the phenotype on the expression rather than the reverse. For example, BMI- and triglycerides-gene expression correlation coefficients robustly correlate with trait-to-expression causal effects (r=0.09, P=1.54×10−39 and r=0.09, P=1.19×10−34, respectively), but not detectably with expression-to-trait effects.Genes implicated by revTWMR confirmed known associations, such as rheumathoid arthritis and Crohn’s disease induced changes in expression of TRBV and GBP2, respectively. They also shed light on how clinical biomarkers can influence their own levels. For instance, we observed that high levels of high-density lipoprotein (HDL) cholesterol lowers the expression of genes involved in cholesterol biosynthesis (SQLE, FDFT1) and increases the expression of genes responsible for cholesterol efflux (ABCA1, ABCG1), two key molecular pathways in determining HDL levels. Importantly, revTWMR is more robust to pleiotropy than polygenic risk score (PRS) approaches which can be misled by pleiotropic outliers. As one example, revTWMR revealed that the previously reported association between educational attainment PRS and STX1B is exclusively driven by a highly pleiotropic SNP (rs2456973), which is strongly associated with several hematological and anthropometric traits.In conclusion, our method disentangles the relationship between gene expression and phenotypes and reveals that complex traits have more pronounced impact on gene expression than the reverse. We demonstrated that studies comparing the transcriptome of diseased and healthy subjects are more prone to reveal disease-induced gene expression changes rather than disease causing ones.
From multiplex serology to serolomics – a novel approach to the antibody response against the SARS-CoV-2 proteome
Authors: Butt Julia , Murugan Rajagopal , Hippchen Theresa , Olberg Sylvia , van Straaten Monique , Wardemann Hedda , Stebbins Erec , Kräusslich Hans-Georg , Bartenschlager Ralf , Brenner Hermann , Laketa Vibor , Schöttker Ben , Müller Barbara , Merle Uta , Waterboer Tim 
Published: October 2020

ABSTRACTBackgroundThe emerging SARS-CoV-2 pandemic entails an urgent need for specific and sensitive high-throughput serological assays to assess SARS-CoV-2 epidemiology. We therefore aimed at developing a fluorescent-bead based SARS-CoV-2 multiplex serology assay for detection of antibody responses to the SARS-CoV-2 proteome.MethodsProteins of the SARS-CoV-2 proteome and protein N of SARS-CoV-1 and common cold Coronaviruses (ccCoVs) were recombinantly expressed inE. colior HEK293 cells. Assay performance was assessed in a Covid-19 case cohort (n=48 hospitalized patients from Heidelberg) as well as n=85 age- and sex-matched pre-pandemic controls from the ESTHER study. Assay validation included comparison with home-made immunofluorescence and commercial Enzyme-linked immunosorbent (ELISA) assays.ResultsA sensitivity of 100% (95% CI: 86%-100%) was achieved in Covid-19 patients 14 days post symptom onset with dual sero-positivity to SARS-CoV-2 N and the receptor-binding domain of the spike protein. The specificity obtained with this algorithm was 100% (95% CI: 96%-100%). Antibody responses to ccCoVs N were abundantly high and did not correlate with those to SARS-CoV-2 N. Inclusion of additional SARS-CoV-2 proteins as well as separate assessment of immunoglobulin (Ig) classes M, A, and G allowed for explorative analyses regarding disease progression and course of antibody response.ConclusionThis newly developed SARS-CoV-2 multiplex serology assay achieved high sensitivity and specificity to determine SARS-CoV-2 sero-positivity. Its high throughput ability allows epidemiologic SARS-CoV-2 research in large population-based studies. Inclusion of additional pathogens into the panel as well as separate assessment of Ig isotypes will furthermore allow addressing research questions beyond SARS-CoV-2 sero-prevalence.
PERFORMANCE EVALUATION OF A SARS-COV-2 RAPID ANTIGENTEST: TEST PERFORMANCE IN THE COMMUNITY IN THE NETHERLANDS
Authors: Van der Moeren N. , Zwart V.F. , Lodder E.B. , Van den Bijllaardt W. , Van Esch H.R.J.M. , Stohr J.J.J.M. , Pot J. , Welschen I. , Van Mechelen P.M.F. , Pas S.D. , Kluytmans J.A.J.W. 
Published: October 2020

AbstractObjectivesThis study was primarily conducted to evaluate clinical sensitivity and specificity of the SARS-CoV-2 rapid antigen test ‘BD Veritor System for Rapid Detection of SARS-CoV-2’ (VRD) compared to real time reverse transcriptase polymerase chain reaction (qRT-PCR). Furthermore, the VRD sensitivity for different Ct-value groups (Ct <20; Ct 20-25, Ct 25-30 and Ct ≥30) and different intervals since symptom onset (< 7 days; ≥ 7 days) were examined.DesignProspective performance evaluation study.SettingMunicipal Health Service (GGD) COVID-19 test centres in West-Brabant, the NetherlandsParticipantsIn order to evaluate clinical specificity, 352 symptomatic adults (≥18 years) who presented at a participating GGD test centre for a COVID-19 test between September 28 and October 7 2020 were included. In order to evaluate clinical sensitivity, 123 symptomatic adults (≥18 years) who were tested positive with qRT-PCR in a participating GGD test centre between September 26 and October 6 were included.ResultsAn overall clinical specificity of 100% (95%CI: 98.9%-100%) and sensitivity of 80.7% (95% CI: 73,2%-86,9%) was found for the VRD compared to qRT-PCR. Sensitivity was the highest for low Ct-value categories and for specimen obtained within the first days after disease onset. For specimen obtained within 7 days after onset of symptoms, the overall sensitivity was 91.0% (95% CI: 82,4%-96,3%) and 98,6% (95% CI: 92,3%-100%) for samples with qRT-PCR Ct-value beneath 30.ConclusionThe VRD is a promising diagnostic test for COVID-19 community screening for symptomatic individuals within 7 days after symptom onset in function of disease control. The clinical sensitivity was highest when viral load was high, which correlated with the duration of symptoms. Further research on practical applicability and the optimal position of the test within the current testing landscape is needed.
Extending the range of COVID-19 risk factors in a Bayesian network model for personalised risk assessment
Authors: Prodhan Georgina , Fenton Norman 
Published: October 2020

AbstractA need is emerging for individuals to gauge their own risks of coronavirus infection as it becomes apparent that contact tracing to contain the spread of the virus is not working in many societies. This paper presents an extension of an existing Bayesian network model for an application in which people can add their own personal risk factors to calculate their probability of exposure to the virus and likely severity if they do catch the illness. The data need not be shared with any central authority. In this way, people can become more aware of their individual risks and adjust their behaviour accordingly, as many countries prepare for a second wave of infections or a prolonged pandemic. This has the advantage not only of preserving privacy but also of containing the virus more effectively by allowing users to act without the time lag of waiting to be informed that a contact has been tested and confirmed COVID-19 positive. Through a nuanced assessment of individual risk, it could also release many people from isolation who are judged highly vulnerable using cruder measures, helping to boost economic activity and decrease social isolation without unduly increasing transmission risk. Although much has been written and reported about single risk factors, little has been done to bring these factors together in a user-friendly way to give an overall risk rating. The causal probabilistic model presented here shows the power of Bayesian networks to represent the interplay of multiple, dependent variables and to predict outcomes. The network, designed for use in the UK, is built using detailed data from government and health authorities and the latest research, and is capable of dynamic updates as new information becomes available. The focus of the paper is on the extended set of risk factors.
Saliva as a testing sample for SARS-CoV-2 detection by RT-PCR in low prevalence community settings
Authors: Gavars Didzis , Gavars Mikus , Perminov Dmitry , Stasulans Janis , Stana Justine , Metla Zane , Pavare Jana , Tauckels Eriks , Gulbis Egils , Dumpis Uga 
Published: October 2020

AbstractObjectivesThe number of COVID-19 cases is increasing globally and there is an urgency for a simple non-invasive method for the detection of SARS-CoV-2. Our study aimed to demonstrate that saliva can be used as a specimen for SARS-CoV-2 detection notably for the screening of extensive population groups via pooling.MethodsTo demonstrate that saliva is an appropriate specimen for SARS-CoV-2 detection a field study including 3,660 participants was performed between September 29 and October 1, 2020. We collected paired nasopharyngeal/oropharyngeal swabs (NPS) and saliva specimens and processed them within 24 hours of collection. We performed 36 serial measurements of 8 SARS-CoV-2 positive saliva samples to confirm the stability of the specimen and completed 37 pools of saliva samples by adding one positive specimen per pool.ResultsSaliva specimens were stable for testing for up to 24 hours. Overall, 44 salival samples (1.2%) tested positive for SARS-CoV-2 during the field study. The results of saliva samples were consistent with those obtained from NPS from the same patient with 90% sensitivity (95% CI 68.3%-98.7%) and 100% specificity during the first two weeks after the onset of symptoms. Using pooling strategy 796 RT-PCR tests were performed. All pools showed 100% positivity in different pooling proportions.ConclusionsOur findings demonstrate that saliva is an appropriate specimen for pooling and SARS-CoV-2 screening with accurate diagnostic performance. Patient-performed simple specimen collection allows testing an extensive number of people rapidly, obtaining results of the spread of SARS-CoV-2 and allowing authorities to take timely measures.