bluuebunny/crossref_metadata_2025_split huggingface dataset:
A new rhinoceros clade from the Pleistocene of Asia sheds light on mammal dispersals to the Philippines
Authors: Antoine Pierre-Olivier , Reyes Marian C , Amano Noel , Bautista Angel P , Chang Chun-Hsiang , Claude Julien , De Vos John , Ingicco Thomas 
Published: February 2021

AbstractRhinoceroses are among the most endangered mammalian species today. Their past diversity is well documented from the Eocene onward, although their evolutionary history is far from being fully understood. Here, we elucidate the systematic affinities of a Pleistocene rhinoceros species represented by a partial skeleton from 709 ± 68 kya archaeological deposits in Luzon Island, Philippines. We perform a comprehensive phylogenetic analysis, including all living species and a wide array of extinct rhinocerotid species. We confirm the early split between Elasmotheriinae and Rhinocerotinae at c. 35.5 Mya and constrain the divergence between recent Asian and African rhinoceroses at c. 24 Mya, with contrasting phenotypic evolutionary rates in Diceroti and Rhinoceroti. Dental features reveal the existence of an unsuspected Asian Pleistocene clade, referred to as Nesorhinus gen. nov.. It includes the rhinoceros from the Philippines and another extinct species from Taiwan, N. hayasakai. Nesorhinus is the sister-group to a cluster comprising Dicerorhinus and Rhinoceros. Our phylogenetic results strongly suggest an island-hopping dispersal for Nesorhinus, from the Asian mainland towards Luzon via Taiwan by the Late Miocene or later, and Pleistocene dispersals for representatives of Rhinoceros. Nesorhinus philippinensis would be the first perissodactyl species supporting the island-rule hypothesis, with decreased body weight and limb-bone robustness.
Removing Barriers: A Confidential Opt-Out Mental Health Pilot Program for Internal Medicine Interns
Authors: Major Ajay , Williams John G. , McGuire W. Cameron , Floyd Eleanor , Chacko Karen 
Published: February 2021

Problem
There are significant barriers for resident physicians seeking mental health care, including lack of time, cost, and concerns about confidentiality. The authors sought to improve access to mental health resources by addressing these barriers through the development of a confidential opt-out mental health pilot program for interns and to assess the feasibility, acceptability, and resident satisfaction with the program.

Approach
All internal medicine and internal medicine-pediatrics interns in the 2017–2018 residency class at the University of Colorado were enrolled in the confidential opt-out mental health program. Each intern was provided with an additional half-day off during their continuity clinic week, during which a mental health screening appointment at the campus health center with an in-network mental health provider was scheduled. All costs were covered by the residency program. An anonymous follow-up survey was sent to all interns to assess participation in the program and its perceived impact on their wellness.

Outcomes
Appointments were made for 80 interns: 23 (29%) attended the appointment, 45 (56%) opted out in advance, and 12 (15%) were no-shows. The total cost of the program was $940 or $11.75 per intern. Of the 41 interns who responded to the survey, 35 (85%) agreed the program should continue next year. The majority of interns felt the program positively affected their wellness regardless of whether they attended the appointment. Of the 16 interns who attended the appointment and completed the survey, 4 (25%) reported receiving additional mental health referrals or follow-up appointments.

Next Steps
This confidential opt-out mental health pilot program for interns was feasible, relatively low cost and simple to implement, and had positive impacts on self-reported wellness. Further study of interventions that remove barriers to accessing mental health care for residents is urgently needed.
Developmental-Behavioral Pediatrics 13 Years After the First Board Certification: Evolving Subspecialty
Authors: Roizen Nancy J. , Ruch-Ross Holly S. , Bauer Nerissa S. , Nielsen Britt A. , DeBattista Anne , Paul Linda B. , Bridgemohan Carolyn 
Published: February 2021

ABSTRACT:

Objective:
To examine and define the evolving subspecialty of developmental-behavioral pediatrics (DBP) by analyzing workforce surveys presubspecialty and postsubspecialty certification.

Methods:
In 2015, an electronic workforce survey was sent to the members of the American Academy of Pediatrics Section on DBP and Council on Children with Disabilities and the Society for DBP. Answers from the 1998 survey for respondents with subspecialty fellowship training were compared.

Results:
Compared with the 1998 group of 265 DBPs, the 368 DBPs in the 2015 group were older, more female, and more diverse. In both groups, ≥80% evaluated and treated autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and developmental delays, but significantly (p < 0.001) fewer cared for children with physical disabilities (e.g., cerebral palsy [58% to 41%], multihandicapped [53% to 39%], neonatal follow-up [47% to 31%], and spina bifida [26% to 13%]) and other disorders (e.g., failure to thrive and obesity/eating disorders [27% to 15%]). Time for new patient and return visits remained the same (1.5 hours and 0.7 hours). Pediatric generalists and family practice physicians initiated most referrals; fewer 2015 DBPs (p < 0.001) reported school districts (83% to 70%) and more reported pediatric subspecialty (57% to 77%; p < 0.001) referrals. Acknowledgment of the need for more community DBP specialists increased from 66% to 80% (p < 0.001).

Conclusion:
Survey data indicated that the workforce is aging and changing. ADHD, ASD, and developmental delays are solidifying as the defining clinical focus of DBP. Current trends can identify training needs, facilitate recruitment, and advocate for system change to support the DBP workforce to respond to the great need.
Older Spousal Dyads and the Experience of Recovery in the Year After Traumatic Brain Injury
Authors: Chhuom Tiffany W. , Thompson Hilaire J. 
Published: February 2021

ABSTRACT

BACKGROUND: Significant others of older persons with traumatic brain injury (TBI) may be more likely to face increased caregiving responsibilities, leading to increased relationship challenges. Relatively little is known about this cohort. The study aimed to describe the impact of experiencing a mild/moderate TBI on the older adult as well as the significant other in the year post injury. DESIGN AND METHODS: This is a multiple-case study using data from a larger parent study. Qualitative content analysis of interviews conducted at 1, 3, 6, and 12 months post injury with 3 dyads was performed (24 interviews) and included cross-case and cross-time comparisons. RESULTS: Dyads that included persons 65 years and older with a mild-moderate TBI and their significant others were enrolled (N = 3/6 individuals). The identified themes were struggling to accept limitations and acceptance, gratitude, fear and concern, frustration/anger/guilt/resentment, broader social support, emotional coping, and the presence or absence of broader social support. CONCLUSIONS: Feelings of hope, gratitude, and acceptance serve as vital ways for couples to continue toward a path of recovery and healing. Lack of social support was a stressor, creating a barrier to recovery. Significant others tended to focus on others versus self-care needs. Nurses should integrate social support and self-care into the assessment of the spousal dyad after TBI. These findings can also inform the development of support groups and case management models for both patients after TBI and their significant others.
Factors Associated With Emergency Department Length of Stay and In-hospital Mortality in Intracerebral Hemorrhage Patients
Authors: Davis Nicolle W. , Sheehan Tiffany O. , Guo Yi , Kelly Debra Lynch , Horgas Ann L. , Yoon Saunjoo L. 
Published: February 2021

ABSTRACT

BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) is a medical emergency that requires rapid identification and focused assessment early to ensure the best possible outcomes. The purpose of this study is to evaluate the associations between system and patient factors and emergency department (ED) length of stay and in-hospital mortality in patients given a diagnosis of ICH. METHODS: A sample of 3108 ICH patients was selected from a statewide administrative database for cross-sectional retrospective analysis. System characteristic (hospital stroke certification), patient characteristics (age, sex, and race), and covariate conditions (stroke severity and comorbidities) were analyzed using descriptive statistics and hierarchical logistic regression models to address the study questions. RESULTS: The mean ED length of stay is 2.9 ± 3 hours (range, 0-42 hours) before admission to an inpatient unit. Inpatient mortality is 14.9%. Stroke center certification (P < .000) and stroke severity (P ≤ .000) are significant predictors of ED length of stay, whereas age (P < .000), stroke severity (P < .000), comorbidities (P = .047), and ED length of stay (P = .04) are significant predictors of in-hospital mortality. Most notably, an ED length of stay of 3 hours or longer has a 37% increase in the odds of in-hospital mortality. CONCLUSION: Our findings support age, stroke severity, and ED length of stay as predictors of in-hospital mortality for ICH patients. The importance of timely admission to an inpatient unit is emphasized. Optimal systems of care and expedited inpatient admission are vital to reduce morbidity and mortality for ICH stroke patients.
Understanding Clinical Characteristics of Muscle Weakness
Authors: Bhimani Rozina , Punjani Bisma , Peden-McAlpine Cynthia 
Published: February 2021

ABSTRACT

BACKGROUND: Muscle weakness is a debilitating condition that can lead to frailty, falls, and functional decline. Muscle weakness is found across many diseases; therefore, understanding what constitutes this condition is paramount. The National Library of Medicine provides 2 definitions of muscle weakness, both from a disease perspective. These definitions are narrow and do not account for overlapping causes of muscle weakness. Nurses are holistic practitioners, so they need to understand the clinical characteristics of muscle weakness, regardless of underlying disease processes. METHODS: Secondary analysis of data from an earlier qualitative study. Using content analysis of transcripts of semistructured interviews with a multidisciplinary group of 12 experts in the management of muscle disorders, we identified characteristics of muscle weakness from the clinicians' perspectives. RESULTS: Muscle weakness has characteristics of debility, loss of function, and asymmetry. The characteristics of debility include lack of strength, atrophy, and fatigue. Muscle weakness does coexist with muscle tightness. CONCLUSIONS: The characteristics of muscle weakness identified in our study are markedly different from those included in National Library of Medicine definitions. As a condition, muscle weakness has both subjective and objective traits. Therefore, clinician assessment and patient input combined capture the comprehensive nature of muscle weakness. Nurses' awareness of what constitutes muscle weakness, regardless of diagnosis, is the first step in optimal management of this condition.
Postoperative Pain Management Is Influenced by Previous Cannabis Use in Neurosurgical Patients
Authors: Dupriest Kaitlyn , Rogers Kamryn , Thakur Barsha , Venkatachalam Aardhra M. , Stutzman Sonja E. 
Published: February 2021

ABSTRACT

BACKGROUND: Cannabis use for medical and recreational purposes is growing. Cannabis may have drug-drug interactions for managing pain, anxiety, and seizures. The research regarding cannabis use in patients with craniotomy surgeries is sparse and often conducted in states where cannabis use is legal. This study compared 24-hour postoperative craniotomy pain levels in patients who reported cannabis use in a state where cannabis is not yet legal. METHODS: This is an observational prospective, nonrandomized, pilot study of postoperative craniotomy patients. Patients were consented and given a one-time self-report questionnaire regarding postoperative pain, pain management method, type of pain medication used at home (including cannabis), route of administration, and frequency of use. Subjects scored pain on both the numeric rating scale and the visual analog scale. Demographic data were collected from the electronic medical record. RESULTS: Forty-five patients with a mean age of 57 years, 62% female, participated in this study. There were 33% who reported previous cannabis use. One-way analysis of variance showed a significant difference in the mean postoperative pain scores for the cannabis users (4.58) and nonusers (3.89; P = .0056). There was no significant difference between age (P = .1894) and adequacy of pain control (P = .6584) between users and nonusers. CONCLUSION: In this pilot study, a one-time survey in critical care on the sensitive topic of cannabis use is feasible and seems to generate honest responses. One-third of patients reported home use of cannabis in a state where cannabis is illegal.
What Are We Missing?
Authors: Loza-Avalos Sandra E. , Thompson Ella , Beulah Brianna , Murray Ashlee 
Published: February 2021

Objectives
Our study sought to explore and assess pediatric emergency department (ED) health care providers' knowledge, attitudes, and behaviors surrounding an existing intimate partner violence (IPV) screening program 4 years after initial implementation.

Methods
We used anonymous electronic surveys and telephone interviews to obtain provider perspectives using a mixed-methods analysis. We used χ2 tests to analyze the quantitative survey results, and an unstructured qualitative approach to analyze the telephone interviews.

Results
We analyzed 141 survey responses, which correlated to a response rate of about 35% of all the providers reached, and 20 telephone interviews. Our results demonstrate that pediatric ED providers have some knowledge of our existing caregiver IPV screening program in the pediatric ED and universally endorse routine caregiver IPV screening, which both are suggestive of postimplementation cultural shifts. However, reported provider behaviors still indicate selective/targeted screening. For example, many providers reported screening males and nontraditional caregivers less often compared with female caregivers. Reported barriers potentially explaining such screening habits mirror those in existing literature: patient acuity, time, multiple caregivers being present, and more.

Conclusions
Our study indicates that more research must be done to assess root causes of provider barriers to IPV screening in pediatric ED settings because trainings and a long-standing program do not seem to be changing screening practices. Addressing these issues may lead to truly sustainable and effective IPV screening programs in pediatric ED settings.
Naive human B cells engage the receptor binding domain of SARS-CoV-2, variants of concern, and related sarbecoviruses
Authors: Feldman Jared , Bals Julia , Altomare Clara G. , St. Denis Kerri , Lam Evan C. , Hauser Blake M. , Ronsard Larance , Sangesland Maya , Moreno Thalia Bracamonte , Okonkwo Vintus , Hartojo Nathania , Balazs Alejandro B. , Bajic Goran , Lingwood Daniel , Schmidt Aaron G. 
Published: February 2021

ABSTRACTExposure to a pathogen elicits an adaptive immune response aimed to control and eradicate. Interrogating the abundance and specificity of the naive B cell repertoire contributes to understanding how to potentially elicit protective responses. Here, we isolated naive B cells from 8 seronegative human donors targeting the SARS-CoV-2 receptor-binding domain (RBD). Single B cell analysis showed diverse gene usage with no restricted complementarity determining region lengths. We show that recombinant antibodies engage SARS-CoV-2 RBD, circulating variants, and pre-emergent coronaviruses. Representative antibodies signal in a B cell activation assay and can be affinity matured through directed evolution. Structural analysis of a naive antibody in complex with spike shows a conserved mode of recognition shared with infection-induced antibodies. Lastly, both naive and affinity-matured antibodies can neutralize SARS-CoV-2. Understanding the naive repertoire may inform potential responses recognizing variants or emerging coronaviruses enabling the development of pan-coronavirus vaccines aimed at engaging germline responses.One Sentence SummaryIsolation of antibody germline precursors targeting the receptor binding domain of coronaviruses.
Cardiac RyR N-terminal region biosensors for FRET-based high-throughput screening
Authors: Zhang Jingyan , Wong King Yuen Siobhan M. , Schwarz Jacob A. , Treinen Levy M. , Tung Ching-Chieh , Rebbeck Robyn T. , Berg Kaja , Svensson Bengt , Aldrich Courtney C. , Thomas David D. , Van Petegem Filip , Cornea Razvan L. 
Published: February 2021

AbstractThe N-terminal region (NTR) of the ryanodine receptor (RyR) calcium channels is critical to the regulation of Ca2+release during excitation-contraction coupling. NTR hosts numerous mutations linked to skeletal and cardiac myopathies (RyR1 and RyR2, respectively), highlighting its potential as therapeutic target. Here, we labeled the NTR of mouse RyR2 at subdomains A, B, and C with donor and acceptor pairs for fluorescence resonance energy transfer (FRET), obtaining two biosensors. Using fluorescence lifetime (FLT)-detection of intramolecular FRET, we developed high-throughput screening (HTS) assays with the biosensors to identify small-molecule modulators of RyR. We screened a 1280-compound validation library and identified several hits. Hits with saturable FRET dose-response profiles, and previously unreported effects on RyR activity, were further tested using [3H]ryanodine binding to isolated sarcoplasmic reticulum vesicles, to measure their effects on full-length RyR opening in its natural membrane environment. We identified three novel inhibitors of both RyR1 and RyR2, and two RyR1-selective inhibitors at nanomolar Ca2+. These compounds may function as inhibitors of leaky RyRs in muscle. Two of these hits activated RyR1 only at micromolar Ca2+, highlighting them as potential activators of excitation-contraction coupling. These results indicate that large-scale HTS using this platform can lead to compounds with potential for therapeutic development.
PROTOCOL: A cohort study examining the association between mirtazapine and mortality risk in adults with a diagnosis of depression
Authors: Joseph Rebecca M , Jack Ruth H , Morriss Richard , Knaggs Roger David , Hollis Chris , Hippisley-Cox Julia , Coupland Carol 
Published: February 2021

ABSTRACTThis protocol describes a cohort study comparing the risks of mortality and serious self-harm (suicide or near-fatal deliberate self-harm) between adults with depression prescribed mirtazapine, a selective serotonin reuptake inhibitor (SSRI), amitriptyline, or venlafaxine. The study is set within English primary care electronic health records from the Clinical Practice Research Datalink (CPRD) and covers the period 01 January 2005 – 30 November 2018. The study described uses an active comparator new user design: patients are included if they are first prescribed an SSRI before being prescribed mirtazapine, a different SSRI, amitriptyline, or venlafaxine as their second antidepressant. Patients are followed from the initial prescription for the second antidepressant until an outcome (mortality, serious self-harm), end of CPRD follow-up, or study end. Inverse probability of treatment weighting is used to account for confounding variables. The protocol was submitted to the CPRD Independent Scientific Advisory Committee for review and was approved in November 2019 (protocol number 19_241).
Genomic surveillance of SARS-CoV-2 during the first year of the pandemic in the Bronx enabled clinical and epidemiological inference
Authors: Fels J. Maximilian , Khan Saad , Forster Ryan , Skalina Karin A. , Sirichand Surksha , Fox Amy S. , Bergman Aviv , Mitchell William B. , Wolgast Lucia R. , Szymczak Wendy , Bortz Robert H. , Dieterle M. Eugenia , Florez Catalina , Haslwanter Denise , Jangra Rohit K. , Laudermilch Ethan , Wirchnianski Ariel S. , Barnhill Jason , Goldman David L. , Khine Hnin , Goldstein D. Yitzchak , Daily Johanna P. , Chandran Kartik , Kelly Libusha 
Published: February 2021

AbstractThe Bronx was an early epicenter of the COVID-19 pandemic in the USA. We conducted temporal genomic surveillance of SARS-CoV-2 genomes across the Bronx from March-October 2020. Although the local structure of SARS-CoV-2 lineages mirrored those of New York City and New York State, temporal sampling revealed a dynamic and changing landscape of SARS-CoV-2 genomic diversity. Mapping the trajectories of variants, we found that while some became ‘endemic’ to the Bronx, other, novel variants rose in prevalence in the late summer/early fall. Geographically resolved genomes enabled us to distinguish between cases of reinfection and persistent infection in two pediatric patients. We propose that limited, targeted, temporal genomic surveillance has clinical and epidemiological utility in managing the ongoing COVID pandemic.One sentence summaryTemporally and geographically resolved sequencing of SARS-CoV-2 genotypes enabled surveillance of novel genotypes, identification of endemic viral variants, and clinical inferences, in the first wave of the COVID-19 pandemic in the Bronx.
An optimized MRI and PET based clinical protocol for improving the differential diagnosis of Geriatric Depression and Alzheimer’s Disease
Authors: Emsell Louise , Vanhaute Heleen , Vansteelandt Kristof , De Winter François-Laurent , Christiaens Danny , Van den Stock Jan , Vandenberghe Rik , Van Laere Koen , Sunaert Stefan , Bouckaert Filip , Vandenbulcke Mathieu 
Published: February 2021

AbstractOBJECTIVEMRI derived hippocampal volume (HV) and amyloid PET may be useful clinical biomarkers for differentiating between geriatric depression and Alzheimer’s Disease (AD). Here we investigated the incremental value of HV and 18F-flutemetmol PET in tandem and sequentially to improve discrimination in unclassified participants.METHODTwo approaches were compared in 41 participants with geriatric depression and 27 participants with probable AD: (1) amyloid and HV combined in one model and (2) HV first and then amyloid.RESULTSBoth HV(χ2(1) = 6.46: p= 0.011) and amyloid (χ2(1) =11.03: p=0.0009) were significant diagnostic predictors of depression (sensitivity: 95%, specificity: 89%). (2) 51% of participants were correctly classified according to clinical diagnosis based on HV alone, increasing to 87% when adding amyloid data (sensitivity: 94%, specificity: 78%).CONCLUSIONHippocampal volume may be a useful gatekeeper for identifying depressed individuals at risk for AD who would benefit from additional amyloid biomarkers when available.