bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Inactive Platelet-rich Plasma at Different Injection Time on Prefabricated Flap Viability in Rabbits
Authors: Zhang Hua , Zhang Tiran , Chen Hongbo , Zeng Yan , Su Zhiguo , Fan Jincai 
Published: May 2021

Purpose
To evaluate the effect of inactive form of platelet-rich plasma (PRP) at different injection time on the prefabricated flap viability in rabbits.

Methods
A thoracodorsal artery vascular bundle prefabricated flap was established on the back of 30 healthy male New Zealand white rabbits by 2 phases of operations. A total of 60 sides were randomly divided into the experimental side and the control side. The experimental side was injected with autologous inactive PRP around the thoracodorsal vascular bundle, and the control side was injected with the same amount of normal saline. According to preoperative (group A), intraoperative (group B), and postoperative (group C) injection of PRP, 30 rabbits were divided into 3 groups of 10 each. Histological and immunohistochemical observation, vascular density measurement, and lead oxide angiography were used to compare the differences in the survival of prefabricated flaps between the 3 groups of rabbits injected with inactive PRP at different injection time.

Results
The flap survival ratio, microvessels density, vascular endothelial growth factor and vascular endothelial growth factor receptor 2 expression of PRP injection side were significantly improved compared with the control side. In the comparison of 3 injection time groups, we found that group A and group B could achieve better results, and especially group B had the most significant effect on the revascularization and flap viability.

Conclusion
Autologous inactive PRP can promote the survival of the prefabricated flap, and the intraoperative injection can significantly improve the survival rate of the prefabricated flap. It provides a theoretical guidance for obtaining a larger area of prefabricated axial flap in clinical practice.
Soft-Attention Improves Skin Cancer Classification Performance
Authors: Datta Soumyya Kanti , Shaikh Mohammad Abuzar , Srihari Sargur N , Gao Mingchen 
Published: May 2021

AbstractIn clinical applications, neural networks must focus on and highlight the most important parts of an input image. Soft-Attention mechanism enables a neural network to achieve this goal. This paper investigates the effectiveness of Soft-Attention in deep neural architectures. The central aim of Soft-Attention is to boost the value of important features and suppress the noise-inducing features. We compare the performance of VGG, ResNet, Inception ResNet v2 and DenseNet architectures with and without the Soft-Attention mechanism, while classifying skin lesions. The original network when coupled with Soft-Attention outperforms the baseline[16] by 4.7% while achieving a precision of 93.7% on HAM10000 dataset [25]. Additionally, Soft-Attention coupling improves the sensitivity score by 3.8% compared to baseline[31] and achieves 91.6% on ISIC-2017 dataset [2]. The code is publicly available at github1.
Differential overlap in human and animal fecal microbiomes and resistomes in rural versus urban Bangladesh
Authors: Swarthout Jenna M. , Fuhrmeister Erica R. , Hamzah Latifah , Harris Angela R. , Ahmed Mir A. , Gurley Emily S. , Satter Syed M. , Boehm Alexandria B. , Pickering Amy J. 
Published: May 2021

AbstractBackgroundLow- and middle-income countries (LMICs) bear the largest mortality burden due to antimicrobial-resistant infections. Small-scale animal production and free-roaming domestic animals are common in many LMICs, yet data on zoonotic exchange of gut bacteria and antimicrobial resistance genes (ARGs) in low-income communities are sparse. Differences between rural and urban communities in population density, antibiotic use, and cohabitation with animals likely influence the frequency of transmission of gut bacterial communities and ARGs between humans and animals. Here, we determined the similarity in gut microbiomes, using 16S rRNA gene amplicon sequencing, and resistomes, using long-read metagenomics, between humans, chickens, and goats in rural compared to urban Bangladesh.ResultsGut microbiomes were more similar between humans and chickens in rural (where cohabitation is more common) compared to urban areas, but there was no difference for humans and goats. Urbanicity did not impact the similarity of human and animal resistomes; however, ARG abundance was higher in urban animals compared to rural animals. We identified substantial overlap of ARG alleles in humans and animals in both settings. Humans and chickens had more overlapping ARG alleles than humans and goats. All fecal hosts carried ARGs on contigs classified as potentially pathogenic bacteria – including Escherichia coli, Campylobacter jejuni, Clostridiodes difficile, and Klebsiella pneumoniae.ConclusionsWhile the development of antimicrobial resistance in animal gut microbiomes and subsequent transmission to humans has been demonstrated in intensive farming environments and high-income countries, evidence of zoonotic exchange of antimicrobial resistance in LMIC communities is lacking. This research provides genomic evidence of overlap of antimicrobial resistance genes between humans and animals, especially in urban communities, and highlights chickens as important reservoirs of antimicrobial resistance. Chicken and human gut microbiomes were more similar in rural Bangladesh, where cohabitation is more common. Incorporation of long-read metagenomics enabled characterization of bacterial hosts of resistance genes, which has not been possible in previous culture-independent studies using only short-read sequencing. These findings highlight the importance of developing strategies for combatting antimicrobial resistance that account for chickens being reservoirs of ARGs in community environments, especially in urban areas.
Longitudinal changes in home-based arts engagement during and following the first national lockdown due to the COVID-19 pandemic in the United Kingdom
Authors: Bu Feifei , Mak Hei Wan , Bone Jessica K , Fancourt Daisy 
Published: May 2021

AbstractAimsThis study aimed to examine potential heterogeneity in longitudinal changes in home-based arts engagement during the first national lockdown and following gradual easing of restrictions in the UK. Further, it sought to explore factors that were associated with patterns of longitudinal changes in home-based arts engagement.MethodsData were from the UCL COVID-19 Social Study. The analytical sample consisted of 29,147 adults in the UK who were followed up for 22 weeks from 21st March to 21st August 2020. Data were analysed using growth mixture models.ResultsOur analyses identified five classes of growth trajectories. There were two stable classes showing little change in arts engagement over time (64.4% in total), two classes showing initial increases in arts engagement followed by declines as restrictions were eased (29.8%), and one class showing slight declines during strict lockdown followed by an increase in arts engagement after the easing of restrictions (5.9%). A range of factors were found to be associated with class membership of these arts engagement trajectories, such as age, gender, education, income, employment status, and health.ConclusionsThere is substantial heterogeneity in longitudinal changes in home-based arts engagement. For participants whose engagement changed over time, growth trajectories of arts engagement were related to changes in lockdown measures. These findings suggest that some individuals may have drawn on the arts when they needed them the most, such as during the strict lockdown period, even if they usually had lower levels of arts engagement before the pandemic. Overall, our results indicate the importance of promoting arts engagement during pandemics and periods of lockdown as part of public health campaigns.
Controlling risk of SARS-CoV-2 infection in essential workers of enclosed food manufacturing facilities
Authors: Sobolik Julia S. , Sajewski Elizabeth T. , Jaykus Lee-Ann , Cooper D. Kane , Lopman Ben A. , Kraay Alicia NM. , Ryan P. Barry , Leon Juan S. 
Published: May 2021

AbstractThe SARS-CoV-2 global pandemic poses significant health risks to workers who are essential to maintaining the food supply chain. Using a quantitative risk assessment model, this study characterized the impact of risk reduction strategies for controlling SARS-CoV-2 transmission (droplet, aerosol, fomite-mediated) among front-line workers in a representative enclosed food manufacturing facility. We simulated: 1) individual and cumulative SARS-CoV-2 infection risks from close contact (droplet and aerosols at 1-3m), aerosol, and fomite-mediated exposures to a susceptible worker following exposure to an infected worker during an 8h-shift; and 2) the relative reduction in SARS-CoV-2 infection risk attributed to infection control interventions (physical distancing, mask use, ventilation, surface disinfection, hand hygiene). Without mitigation measures, the SARS-CoV-2 infection risk was largest for close contact (droplet and aerosol) at 1m (0.96, 95%CI: 0.67–1.0). In comparison, risk associated with fomite (0.26, 95%CI: 0.10–0.56) or aerosol exposure alone (0.05, 95%CI: 0.01–0.13) at 1m distance was substantially lower (73-95%). At 1m, droplet transmission predominated over aerosol and fomite-mediated transmission, however, this changed by 3m, with aerosols comprising the majority of the exposure dose. Increasing physical distancing reduced risk by 84% (1 to 2m) and 91% (1 to 3m). Universal mask use reduced infection risk by 52-88%, depending on mask type. Increasing ventilation (from 0.1 to 2-8 air changes/hour) resulted in risk reductions of 14-54% (1m) and 55-85% (2m). Combining these strategies, together with handwashing and surface disinfection, resulted in <1% infection risk. Current industry SARS-CoV-2 risk reduction strategies, particularly when bundled, provide significant protection to essential food workers.Significance StatementUsing mathematical modeling, we find that workers in enclosed food manufacturing facilities are at higher risk of SARS-CoV-2 infection from close contact transmission (exposure to large droplets and small aerosol particles) than fomite transmission. Thus, strategies protecting workers should prioritize close contact transmission pathways, such as physical distancing, universal mask use, and room air changes, with surface disinfection (reducing fomite transmission) and handwashing of secondary importance. Our work supports current international (EU-OSHA), domestic (FDA, OSHA), and food industry-standard guidance for managing COVID-19 transmission in essential workers in the food manufacturing sector. Although our model was designed for an indoor food manufacturing setting, it can be readily adapted to other indoor environments and infectious respiratory pathogens.
Rapidly emerging SARS-CoV-2 B.1.1.7 sub-lineage in the United States of America with spike protein D178H and membrane protein V70L mutations
Authors: Shen Lishuang , Bard Jennifer Dien , Triche Timothy J. , Judkins Alexander R. , Biegel Jaclyn A. , Gai Xiaowu 
Published: May 2021

AbstractThe SARS-CoV-2 B.1.1.7 lineage is highly infectious and as of April 2021 accounted for 92% of COVID-19 cases in Europe and 59% of COVID-19 cases in the U.S. It is defined by the N501Y mutation in the receptor binding domain (RBD) of the Spike (S) protein, and a few other mutations. These include two mutations in the N terminal domain (NTD) of the S protein, HV69-70del and Y144del (also known as Y145del due to the presence of tyrosine at both positions). We recently identified several emerging SARS-CoV-2 variants of concerns, characterized by Membrane (M) protein mutations, including I82T and V70L. We now identify a sub-lineage of B.1.1.7 that emerged through sequential acquisitions of M:V70L in November 2020 followed by a novel S:D178H mutation first observed in early February 2021. The percentage of B.1.1.7 isolates in the U.S. that belong to this sub-lineage increased from 0.15% in February 2021 to 1.8% in April 2021. To date this sub-lineage appears to be U.S.-specific with reported cases in 31 states, including Hawaii. As of April 2021 it constituted 36.8% of all B.1.1.7 isolates in Washington. Phylogenetic analysis and transmission inference with Nextstrain suggests this sub-lineage likely originated in either California or Washington. Structural analysis revealed that the S:D178H mutation is in the NTD of the S protein and close to two other signature mutations of B.1.1.7, HV69-70del and Y144del. It is surface exposed and may alter NTD tertiary configuration or accessibility, and thus has the potential to affect neutralization by NTD directed antibodies.
The landscape of COVID-19 vaccination among healthcare workers at the first round of COVID-19 vaccination in China: willingness, acceptance and self-reported adverse effects
Authors: Ye Xinxin , Ye Wan , Yu Jinyue , Gao Yuzhen , Ren Ziyang , Chen Lanzhen , Dong Ao , Yi Qian , Zhan Chenju , Lin Yanni , Wang Yangxin , Huang Simin , Song Peige 
Published: May 2021

AbstractBackgroundThe COVID-19 vaccines have been developed in a wide range of countries. This study aims to examine factors influencing vaccination rate and willingness to vaccinate against COVID-19 among Chinese healthcare workers (HCWs).MethodsFrom 3rd February to 18th February, 2021, an online cross-sectional survey was conducted among HCWs to investigate factors associated with the acceptance and willingness of COVID-19 vaccination. Socio-demographic characteristics and the acceptance of COVID-19 vaccination among Chinese HCWs were evaluated.ResultsA total of 2156 HCWs from 21 provinces in China responded to this survey (response rate: 98.99%)), among whom 1433 (66.5%) were vaccinated at least one dose. Higher vaccination rates were associated with older age (40-50 years vs. less than 30 years, OR=1.63, 95%CI: 1.02-2.58; >50 years vs. 30 years, OR=1.90, 95%CI: 1.02-3.52), working as a clinician (OR=1.54, 95% CI: 1.05-2.27), having no personal religion (OR=1.35, 95%CI: 1.06-1.71), working in a fever clinic (OR=4.50, 95%CI:1.54-13.17) or higher hospital level (Municipal vs. County, OR=2.01, 95%CI: 1.28-3.16; Provincial vs. County, OR=2.01, 95%CI: 1.25-3.22) and having knowledge training of vaccine (OR=1.67, 95%CI:1.27-2.22), family history for influenza vaccination (OR=1.89, 95%CI:1.49-2.35) and strong familiarity with the vaccine (OR=1.43, 95%CI:1.05-1.95) (All P<0.05). Strong willingness for vaccination was related to having a working in midwestern China (OR=1.89, 95%CI:1.24-2.89), considerable knowledge of the vaccine (familiar vs. not familiar, OR=1.67, 95%CI: 1.17-2.39; strongly familiar vs. not familiar, OR=2.47, 95%CI: 1.36-4.49), knowledge training of vaccine (OR=1.61, 95%CI: 1.05-2.48) and strong confidence in the vaccine (OR=3.84, 95%CI: 2.09-7.07).ConclusionPersonal characteristics, working environments, familiarity and confidence in the vaccine were related to vaccination rates and willingness to get vaccinated among healthcare workers. Results of this study could provide evidence for the government to improve vaccine coverage by addressing vaccine hesitancy in the COVID-19 pandemic and future public health emergencies.
Irremediable psychiatric suffering in the context of medical assistance in dying: a qualitative study
Authors: van Veen Sisco M.P. , Ruissen Andrea M. , Beekman Aartjan T.F. , Evans Natalie , Widdershoven Guy A.M. 
Published: May 2021

AbstractBackgroundEstablishing irremediability is a central challenge in determining the appropriateness of medical assistance in dying (MAID) for patients with a psychiatric disorder. The objective of this study is to learn how experienced psychiatrists define irremediable psychiatric suffering (IPS) in the context of MAID and what challenges they face while establishing IPS.MethodsIn a qualitative study, we performed 11 in-depth interviews with psychiatrists who have experience assessing IPS in the context of MAID.ResultsAlthough determining IPS is, essentially, a prospective assessment, psychiatrists mostly rely on retrospective dimensions, such as the history of failed treatments, when defining IPS. When establishing IPS, psychiatrists face diagnosis and treatment challenges. The main challenge regarding diagnosis is that patients requesting MAID are often diagnosed with more than one psychiatric disorder. Important treatment related challenges are: assessing the quality of past treatments, establishing the limits of approaches that aim to alter the patient’s perception, and managing ‘treatment fatigue’ and treatment refusal.InterpretationIPS is mostly defined in terms of failed past treatments. Challenges regarding diagnosis and treatment complicate the process of establishing IPS. The finding that most patients are diagnosed with more than one psychiatric disorder calls for a critical appraisal of the due diligence procedure for MAID. In response to the challenges related to treatment, intersubjective clinical criteria for IPS in the context of MAID should be developed. Also, further investigation of the concept of ‘treatment fatigue’ in psychiatry may provide insight into why patients requesting MAID.Registrationthis study was preregistered under osf.io/2jrnd.
Long-term symptoms after SARS-CoV-2 infection in school children: population-based cohort with 6-months follow-up
Authors: Radtke Thomas , Ulyte Agne , Puhan Milo A , Kriemler Susi 
Published: May 2021

ABSTRACTAlthough long COVID in children exists, it is still unclear to what extent children are affected. The Ciao Corona study is a longitudinal cohort investigating SARS-CoV-2 seroprevalence and clustering of cases among around 2500 children and adolescents (hereafter referred to as children) from 55 randomly selected primary and secondary schools in the canton of Zurich in Switzerland. Between June 2020 and April 2021, we completed three testing phases where we collected venous blood for serological analysis and asked about symptoms with online questionnaires. We compared children who tested positive for SARS-CoV-2 antibodies in October/November 2020 with those who tested negative. Children who were seronegative in October/November 2020 and seroconverted or were not retested in March/April 2021 were excluded from the analysis (n=256). In March-May 2021 we assessed the presence of symptoms occurring since October 2020, lasting for at least 4 weeks, and persisting for either >4 weeks or >12 weeks. Overall, 1355 of 2503 children with a serology result in October/November 2020 and follow up questionnaire in March-May 2021 were included. Among seropositive and seronegative 6-to 16-year-old children, 9% versus 10% reported at least one symptom beyond 4 weeks, and 4% versus 2% at least one symptom beyond 12 weeks. None of the seropositive children reported hospitalization after October 2020. This study suggests a low prevalence of symptoms compatible with long COVID in a randomly selected population-based cohort of children followed over 6 months after serological testing.
Pre-Exposure Prophylaxis with Various Doses of Hdroxychloroquine among high-risk COVID 19 Healthcare Personnel: CHEER randomized controlled trial
Authors: Syed Fibhaa , Arif Mohammad Ali , Niazi Rauf , Baqar Jaffer Bin , Hashmi Ume Laila , Batool Sadia , Ashraf Sadia , Arshad Junaid , Musarrat Saira 
Published: May 2021

AbstractBackgroundPre-exposure prophylaxis (PrEP) is a promising strategy to break the chain of transmission of novel coronavirus (2019-nCoV).AimsThis trial aimed to evaluate the safety and efficacy of PrEP with various doses of HCQ against a placebo among high-risk healthcare providers (HCPs).MethodsA phase II, randomized, placebo-controlled trial was conducted at a tertiary care hospital. A total of 228 HCPs were screened, we included 200 subjects with no active or past SARS-CoV-2 infection. Subjects of experimental groups 1-3 received HCQ in various doses and those in the control group received placebo. The study outcomes in terms of safety and efficacy were monitored. Participants exhibiting COVID-19 symptoms were tested for SARS-CoV-2 during the study and also by the end of the 12th week, with PCR or IgM and IgG serology.ResultsOverall, 146 of 200 participants reported exposure to a confirmed COVID-19 case in the first month, 189 in the 2nd month and 192 were exposed by the 12th week of the study. Moreover, the precautionary practices, i.e. use of personal protective equipment (PPE), significantly varied; initially more than 80% of the exposed HCPs weren’t ensuring the PPE used by the patients treated by them. However, it gradually developed with the increasing knowledge of the virus. As far as safety is concerned, mild treatment-related side effects were observed among the interventional and placebo arm patients. While none of the participants were critical, and a few had mild illness by the end of the 12th week, requiring only outpatient observation with no hospitalization. There was no significant clinical benefit of PrEP with HCQ as compared to placebo (p>0.05).ConclusionIt is concluded from the study findings that the PrEP HCQ does not significantly prevent illness compatible with COVID-19 or confirmed infection among high-risk HCPs.
Application of BRACE Method to Address Treatment Selection Bias in Observational Data
Authors: Williamson Casey W. , Nelson Tyler , Thompson Caroline A. , Vitzthum Lucas K. , Zakeri Kaveh , Riviere Paul , Bryant Alex K. , Sharabi Andrew B. , Zou Jingjing , Mell Loren K. 
Published: May 2021

ABSTRACTBackgroundCancer treatments can paradoxically appear to reduce the risk of non-cancer mortality in observational studies, due to residual confounding from treatment selection bias. Here we apply a novel method, Bias Reduction through Analysis of Competing Events (BRACE), to reduce bias in the presence of residual confounding.MethodsWe studied 36630 prostate cancer patients, 4069 lung cancer patients, and 7117 head/neck cancer patients, using the Veterans Affairs Informatics and Computing Infrastructure database. We estimated effects of intensive treatment (prostate: prostatectomy vs. radiotherapy; lung: lobectomy vs. sublobar resection or radiotherapy; head/neck: radiotherapy with concurrent cisplatin and/or multiagent induction vs. radiotherapy with or without alternative systemic therapy) on cancer-specific mortality, non-cancer mortality, and overall survival (OS), using both multivariable Cox (MVA) and propensity score (inverse probability treatment weighting (IPTW)) models. Next, we applied the BRACE method to adjust for residual confounding, based on the observed treatment effect on competing event and relative event hazards.ResultsFor each cohort, intensive treatment was associated with significantly reduced hazards for cancer-specific mortality, non-cancer mortality, and OS. Compared to the results for MVA and IPTW models, hazard ratios (95% confidence intervals) for the effect of intensive treatment on OS were attenuated in each cohort after applying BRACE: (prostate-MVA: 0.75 (0.71, 0.80), IPTW: 0.73 (0.66, 0.75), BRACE: 0.98 (0.95, 1.00); lung-0.79 (0.68, 0.91), 0.79 (0.66, 0.89), BRACE: 0.81 (0.65, 0.94); head/neck-0.71 (0.66, 0.76), 0.70 (0.66, 0.76), BRACE: 0.81 (0.76, 0.86)). BRACE estimates were similar to findings from meta-analyses and randomized trials.ConclusionsWe found evidence of residual confounding in several observational cohorts after applying standard methods, which were mitigated after applying BRACE. Application of this method could provide more reliable estimates and inferences when residual confounding is identified and represents a novel approach to improving the validity of outcomes research.