bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infodemic: what physician leaders learned during the COVID-19 outbreak: a qualitative study
Authors: Tham Kum-Ying , Lu Qinghui , Teo Winnie 
Published: July 2020

BackgroundEffective crisis leadership is dependent on the key tasks of sense-making, decision-making, meaning-making, learning and crisis termination. While instant messaging and social media provided abundant and powerful sources of information during the COVID-19 pandemic, the infodemic—an overabundance of information, some of which is inaccurate—has also complicated the tasks of crisis leadership.MethodsA qualitative study was undertaken, using semistructured interviews with physician leaders in the hospital dealing with majority of Singapore’s COVID-19 cases. Participants were asked about how they used digital communication tools in their leadership roles before and during the outbreak, and their reflections on the use of these tools. Interviews were audio-recorded, transcribed, coded and subjected to inductive thematic analysis.ResultsTwenty-four physician leaders described the adaptations to crisis leadership tasks using digital communication tools. While these tools were useful for rapid collective sense-making, meaning-making was the most challenging because information was posted by others who were faster, competed with their ability to create nuanced versions of a coherent narrative for stakeholders. Leaders also shared the need to balance their relationship with their smartphone and use digital tools to communicate purpose and meaning to and with their staff when face-to-face meetings are not possible.ConclusionsThe COVID-19 infodemic has disrupted the key tasks of crisis leadership. For each task leaders on the front line can adopt measures to harness the power of and minimise the risk of damage by instant messaging. Infodemic management must be explicitly included in crisis management training for leaders.
Who may benefit from lower dosages of intravenous tissue plasminogen activator? Results from a cluster data analysis
Authors: Dong Yi , Han Ye , Shen Haipeng , Wang Yilong , Ma Frank , Li Hao , Wang Yongjun , Dong Qiang 
Published: July 2020

BackgroundThe risk of symptomatic intracranial haemorrhage (sICH) after thrombolysis is low but severe. Lower dose of alteplase may reduce the risk of sICH. We aim to identify subsets of patients who could beneﬁt from lower dose of alteplase compared with standard dose.MethodsData from two observational registries were pooled together. A total of 3479 patients who had acute ischaemic stroke were entered into the interaction tree model. The response variable was the rate of sICH per the definition of the National Institute of Neurological Disorders and Stroke Study. Clinical improvement was measured by the National Institutes of Health Stroke Scale (NIHSS) and defined as NIHSS 0 or 1 or an improvement of more than 4 points (within 7 days or at discharge). Rare event logistic regression was performed to analyse the OR of safety outcome.ResultsTo optimise the interaction effect between tissue plasminogen activator (tPA) dosage (standard/lower) and patient subgroups, three subgroups based on the severity of stroke were identified: (1) NIHSS ≤4, (2) NIHSS between 5 and 14, and (3) NIHSS ≥15. The estimated difference of OR of having sICH was 2.71 (95% CI 0.80 to 7.69, p=0.10) for mild, 0.13 (95% CI 0.02 to 0.68, p=0.01) for moderate, and 0.65 (95% CI 0.19 to 2.55, p=0.52) for severe, respectively. In addition, patients who had moderate stroke treated with lower dose had comparable efficacy outcome (OR 1.23, 95% CI 0.71 to 2.13, p=0.45).ConclusionOur analysis demonstrated that in patients who had moderate stroke, lower doses of alteplase are associated with significant sICH reduction and non-inferior performance in efficacy, compared with those in the standard dose group.Trial registration numberThe TIMS-China was a national prospective stroke registry on thrombolytic therapy using intravenous tPA in patients who had acute ischaemic stroke. The results were initially published in 2012 without a clinical trial registration number. The Shanghai Stroke Service System was registered atwww.clinicaltrial.gov(NCT02735226).
Direct CP violation in $$D^+ \rightarrow K^0({\bar{K}}^0) \pi ^+$$ decays as a probe for new physics
Authors: Delepine David , Faisel Gaber , Ramirez Carlos A. 
Published: July 2020

Abstract
In this paper we investigate CP violation in charged decays of D meson. Particularly, we study the direct CP asymmetry of the Cabibbo favored non-leptonic $$D^+ \rightarrow {\bar{K}}^0 \pi ^+$$D+→K¯0π+ and the doubly Cabibbo-suppressed decay mode $$D^+ \rightarrow K^0 \pi ^+$$D+→K0π+ within standard model, two Higgs doublet model with generic Yukawa structure and left right symmetric models. In the standard model, we first derive the contributions from box and di-penguin diagrams contributing to their amplitudes which are relevant to the generation of the weak phases essential for non-vanishing direct CP violation. Then, we show that the generated phases are so tiny leading to null direct CP asymmetries of both decay modes. Regarding the two Higgs doublet model with generic Yukawa structure, after taking into account all constraints on the parameter space of the model, we show that the weak phases of the amplitudes can be enhanced compared to the standard model ones. However, the enhancement is still not enough to have sizable direct CP asymmetries. Finally, within left right symmetric models, we find that $$|A^{SM+LR}_{CP} (D^+ \rightarrow {\bar{K}}^0 \pi ^+)|\lesssim \mathcal {O}(10^{-3})$$|ACPSM+LR(D+→K¯0π+)|≲O(10-3) after respecting all relevant constraints on the parameter space of the model.
The uneasy coexistence of predators and pathogens
Authors: Eilersen Andreas , Sneppen Kim 
Published: July 2020

Abstract.
Disease and predation are both highly important in ecology, and pathogens with multiple host species have turned out to be common. Nonetheless, the interplay between multi-host epidemics and predation has received relatively little attention. Here, we analyse a model of a predator-prey system with disease in both prey and predator populations and determine reasonable parameter values using allometric mass scaling relations. Our analysis focuses on the possibility of extinction events rather than the linear stability of the model equations, and we derive approximate relations for the parameter values at which we expect these events to occur. We find that if the predator is a specialist, epidemics frequently drive the predator species to extinction. If the predator has an additional, immune prey species, predators will usually survive. Coexistence of predator and disease is impossible in the single-prey model. We conclude that for the prey species, carrying a pathogen can be an effective weapon against predators, and that being a generalist is a major advantage for a predator in the event of an epidemic affecting the prey or both species.

Graphical abstract
T-Cell Dynamics in Chronic Lymphocytic Leukemia under Different Treatment Modalities
Authors: Vardi Anna , Vlachonikola Elisavet , Papazoglou Despoina , Psomopoulos Fotis , Kotta Kostantia , Ioannou Nikolaos , Galigalidou Chrysi , Gemenetzi Katerina , Pasentsis Kostantinos , Kotouza Maria , Koravou Evdoxia , Scarfó Lydia , Iskas Michail , Stavroyianni Niki , Ghia Paolo , Anagnostopoulos Achilles , Kouvatsi Anastasia , Ramsay Alan G. , Stamatopoulos Kostas , Chatzidimitriou Anastasia 
Published: July 2020

AbstractPurpose:Using next-generation sequencing (NGS), we recently documented T-cell oligoclonality in treatment-naïve chronic lymphocytic leukemia (CLL), with evidence indicating T-cell selection by restricted antigens.Experimental Design:Here, we sought to comprehensively assess T-cell repertoire changes during treatment in relation to (i) treatment type [fludarabine-cyclophosphamide-rituximab (FCR) versus ibrutinib (IB) versus rituximab-idelalisib (R-ID)], and (ii) clinical response, by combining NGS immunoprofiling, flow cytometry, and functional bioassays.Results:T-cell clonality significantly increased at (i) 3 months in the FCR and R-ID treatment groups, and (ii) over deepening clinical response in the R-ID group, with a similar trend detected in the IB group. Notably, in constrast to FCR that induced T-cell repertoire reconstitution, B-cell receptor signaling inhibitors (BcRi) preserved pretreatment clones. Extensive comparisons both within CLL as well as against T-cell receptor sequence databases showed little similarity with other entities, but instead revealed major clonotypes shared exclusively by patients with CLL, alluding to selection by conserved CLL-associated antigens. We then evaluated the functional effect of treatments on T cells and found that (i) R-ID upregulated the expression of activation markers in effector memory T cells, and (ii) both BcRi improved antitumor T-cell immune synapse formation, in marked contrast to FCR.Conclusions:Taken together, our NGS immunoprofiling data suggest that BcRi retain T-cell clones that may have developed against CLL-associated antigens. Phenotypic and immune synapse bioassays support a concurrent restoration of functionality, mostly evident for R-ID, arguably contributing to clinical response.
Feasibility testing of a supported education programme for students with severe mental disorders
Authors: Reddy Annapally Sadananda , Jagannathan Aarti , Kishore M. T. , Daliboina Muralidhar , Kumar Channaveerachari Naveen 
Published: July 2020

Introduction: Most supported education studies stop at discussing the academic problems of students with severe mental diseases (SMDs) without going into testing of appropriate and culturally relevant supported education interventions required for academic reintegration of students with SMDs. In this context, the researcher felt the need to test the feasibility of a need-based supported education programme (SEP) for students with SMDs to help them achieving higher education goals. Methodology: This study was reviewed and approved by the Institute’s Ethics Committee (NIMHANS) and it was also registered in the Clinical Trials Registry – India (CTRI): CTRI/2018/07/014828. The study used mixed (qualitative and quantitative) research methodology with a combined approach of Action Research and Case Study in providing SEP to students with SMDs. Fourteen ( n = 14) students who enrolled into the SEP were assessed on their self-esteem, sense of mastery, helping factors, needs and outcomes met from SEP. The SEP was provided for up to a maximum of 1 year based on the academic reintegration needs of the student. Results: The results indicated that there was a significant reduction in hindering factors (χ2 = 9.41, p < .01) and increase in helping factors (χ2 = 6.49, p < .05) and self-esteem (χ2 = 10.3, p < .01) over the period of 1 year of the study. Qualitative results further reiterated increase in helping factors along with positive outcomes such as enhanced primary and secondary support, reasonable accommodation at academic institutions, individual behavioural changes in academics and increased awareness and knowledge about mental illness and welfare benefits. Conclusion: The SEP was found to be feasible qualitatively and quantitatively in helping the students with SMDs to reintegrate into academics, improving their self-esteem, reducing their hindering factors, and improving their support system and helping factors.
Needs-driven skill training for surgical residents: our first experience in a low-/middle-income country
Authors: Agrawal Vikesh , Agarwal Pawan , Acharya Himanshu , Sharma Dhananjaya 
Published: July 2020

Traditional Halstead teaching, which is time- and opportunity-dependent, has often been replaced by ‘boot’ camps which involve expensive modules and are usually a grand one-time event. This does not suit the complex teaching and learning needs of low- and middle-income countries (LMICs). We studied the impact of a needs-driven surgical training course implemented instead. The course was taken by 17 first-year residents of surgery, and included a pre-course knowledge assessment test, pre-test skills assessment, as well as post-test assessment and feedback impressions. Mean post-test scores improved significantly ( P < 0.05) in all eight skills areas, though only 7 (44.11%) scored ≥80% in tests after the course, but all 17 in theoretical and clinical skills. There was strong agreement over all six points that the needs-driven course was of benefit. Our short and intensive needs-driven skills video training course for surgical residents fills the gap in skills development for general surgery residents.
Localization of TRPA1 channels and characterization of TRPA1 mediated responses in dural and pial arteries in vivo after intracarotid infusion of Na2S
Authors: Hansted Anna Koldbro , Jensen Lars Jørn , Olesen Jes , Jansen-Olesen Inger 
Published: July 2020

Background The Transient Receptor Potential Ankyrin 1 (TRPA1) channel might play a role in migraine. However, different mechanisms for this have been suggested. The purpose of our study was to investigate the localization and significance of TRPA1 channels in rat pial and dural arteries. Methods Immunofluorescence microscopy was used to localize TRPA1 channels in dural arteries, pial arteries, dura mater and trigeminal ganglion. The genuine closed cranial window model was used to examine the effect of Na2S, a donor of the TRPA1 channel opener H2S, on the diameter of pial and dural arteries. Further, we performed blocking experiments with TRPA1 antagonist HC-030031, calcitonin gene-related peptide (CGRP) receptor antagonist olcegepant and KCa3.1 channel blocker TRAM-34. Results TRPA1 channels were localized to the endothelium of both dural and pial arteries and in nerve fibers in dura mater. Further, we found TRPA1 expression in the membrane of trigeminal ganglia neuronal cells, some of them also staining for CGRP. Na2S caused dilation of both dural and pial arteries. In dural arteries, this was inhibited by HC-030031 and olcegepant. In pial arteries, the dilation was inhibited by TRAM-34, suggesting involvement of the KCa3.1 channel. Conclusion Na2S causes a TRPA1- and CGRP-dependent dilation of dural arteries and a KCa3.1 channel-dependent dilation of pial arteries in rats.
Patient-level Characteristics and Inequitable Access to Inpatient Electroconvulsive Therapy for Depression: A Population-based Cross-sectional Study: Caractéristiques au niveau du patient et accès inéquitable à la thérapie électroconvulsive pour patients hospitalisés
Authors: Kaster Tyler S. , Blumberger Daniel M. , Gomes Tara , Sutradhar Rinku , Dasklakis Zafiris J. , Wijeysundera Duminda N. , Vigod Simone N. 
Published: July 2020

Objective: A variety of patient characteristics drive the use of electroconvulsive therapy (ECT) in depression. However, the extent to which each characteristic influences the receipt of ECT, and whether they are appropriate, is unknown. The aim of this study is to identify patient-level characteristics associated with receiving inpatient ECT for depression. Method: We identified all psychiatric inpatients with a major depressive episode admitted to hospital ≥3 days in Ontario, Canada (2009 to 2017). The association between patient-level characteristics at admission and receipt of inpatient ECT was determined using logistic regression, where a generalized estimating equations approach accounted for repeat admissions. Results: The cohort included 53,174 inpatients experiencing 75,429 admissions, with 6,899 admissions involving ECT (9.2%). Among demographic factors, age was most associated with ECT—younger adults had reduced (OR = 0.30, 95%CI, 0.24 to 0.37; 18 to 25 years) while older adults had increased (OR = 3.08, 95%CI, 2.41 to 3.93; 85+ years) odds compared to middle-aged adults (46 to 55 years). The likelihood of ECT was greater for individuals who were married/partnered, had postsecondary education, and resided in the highest neighborhood income quintile. Among clinical factors, illness polarity was most associated with receiving ECT—bipolar depression had reduced odds of receiving ECT (OR = 0.62, 95%CI, 0.57 to 0.69) The likelihood of receiving ECT was greater in psychotic depression, more depressive symptoms, and incapable to consent to treatment and was reduced with comorbid substance use disorders and several medical comorbidities. Conclusions: Nearly 1 in 10 admissions for depression in Ontario, Canada, involve ECT. Many clinical factors associated with receiving inpatient ECT were concordant with clinical guidelines; however, nonclinical factors associated with its use warrant investigation of their impact on equitable access to ECT.
Antenatal screening for Down’s syndrome: Revised nuchal translucency upper truncation limit due to improved precision of measurement
Authors: Vale Stephen H , Huttly Wayne J , Wald Nicholas J 
Published: July 2020

Objective To determine whether the improved precision of nuchal translucency (NT) measurement used in antenatal screening for Down’s syndrome observed over time as evidenced by a decrease in the multiple of the median (MoM) standard deviation requires a modification to the NT MoM truncation limits to maintain accurate risk estimation. Methods Probability plots were derived from the measurements of NT MoM values used in a 2018 audit of 22,362 unaffected pregnancies. The plots were used to determine whether the NT MoM upper truncation limit should be lowered. Validation plots were used to assess the screening accuracy of Down’s syndrome risk estimates calculated from observed NT MoM values in the 22,362 unaffected pregnancies and 69 Down’s syndrome pregnancies for original and revised NT MoM truncation limits. Results Probability plots indicated that with improved precision of NT measurements, there was deviation from a Gaussian distribution at less high MoM values than with less precise measurements. Validation plots showed that using the current NT MoM upper truncation limit of 2.5 MoM with improved precision NT measurements overestimates the Down’s syndrome risk (median risk in highest risk category expressed as an odds was 53.3:1 and observed prevalence was 1:1.1). The large discrepancy was corrected by changing the NT upper truncation limit to 2.0 MoM (median risk in highest risk category expressed as an odds was 1:1.78 and observed prevalence 1:2.7). Conclusion The NT MoM upper truncation limit should be reduced from 2.5 to 2.0 MoM.
Magnetic Resonance Imaging and Outcomes of Osteochondral Lesions of the Talus Associated With Ankle Fractures
Authors: Özcan Seçkin , Koçkara Nizamettin , Camurcu Yalkın , Yurten Hakan 
Published: July 2020

Background: Osteochondral lesions of the talus (OCLTs) secondary to ankle fractures have previously been reported in the literature. However, no study has evaluated OCLTs using magnetic resonance imaging (MRI) following ankle fracture treatment. The purpose of our study was to investigate accompanying OCLTs in patients with an ankle fracture and evaluate its relationship with the clinical outcomes. Methods: Fifty-six patients with ankle fractures who were treated with either a nonoperative or operative method at our center between June 2016 and February 2017 were included in this prospective comparative study (37 men and 19 women; mean age, 44.6 ± 13 years; range, 20-65 years). The mean American Orthopaedic Foot & Ankle Society (AOFAS) scores were used to evaluate the clinical results in all patients in the second month and second year. The second-month ankle MR images were evaluated for OCLTs in all patients. Thirty patients were treated operatively and 26 nonoperatively. Results: Accompanying OCLTs were detected in 19 of 56 patients (34%). Our results showed no statistically significant association between OCLT and fracture type, as well as the treatment type. In the second postoperative month, the mean AOFAS scores were 87.2 ± 10.8 and 77.6 ± 12.0 in patients with and without OCLTs, respectively ( P = .005). In the second postoperative year, the mean AOFAS scores were 81.3 ± 6.8 and 86.2 ± 8.4 in patients with and without OCLTs, respectively ( P = .031). The mean AOFAS score significantly decreased in the OCLT group in the second-year control, whereas a significant increase was observed in patients without OCLTs ( P = .026 and P < .001, respectively). Conclusion: According to our results, the accompanying OCLTs were found in one-third of patients treated for ankle fractures. We observed a significant correlation between OCLT presence and the AOFAS score. According to the AOFAS score, OCLTs statistically significantly affected clinical results at 2 years. Level of Evidence: Level II, prospective comparative study.
Standardized scleral buckling approach in the management of noncomplex primary rhegmatogenous retinal detachment
Authors: Radice Paolo , Carini Elisa , Seidenari Patrizio , Govetto Andrea 
Published: July 2020

Purpose: To analyze the anatomical and functional outcomes of a standardized scleral buckling approach in patients with noncomplex primary rhegmatogenous retinal detachment (RRD). Methods: Retrospective institutional case series of 135 eyes of 131 patients diagnosed with noncomplex primary RRD. All patients underwent scleral buckling surgery with the placement of an encircling 5 mm oval sponge at 15 ± 2 mm posteriorly from the limbus, cryopexy, subretinal fluid drainage, and air tamponade. Results: Final anatomical success at 12 months was achieved in all 135 eyes (100%). Primary anatomical surgical success was obtained in 127 out of 135 eyes (94%), while re-detachment occurred in eight out of 135 cases (6%). Primary anatomical success was significantly lower in pseudophakic eyes ( p < 0.001). At the end of the follow-up period, no vision loss was observed in any patient and both sphere and cylinder refraction shift was mild. There was a low rate of postoperative complications. Nine out of 135 eyes (6.6%) developed full thickness macular hole, whether in 24 out of 135 eyes (17.8%) epiretinal membrane development was noticed. Conclusion: A standardized scleral buckling approach for primary noncomplex RRD may be effective. The technique is reproducible, easier, and quicker to perform if compared to classic scleral buckling procedures, suggesting that it may represent a valuable surgical option. Special care is needed in the management of pseudophakic RRD due to higher risk of RRD recurrence.