bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vitamin K & D Deficiencies Are Independently Associated With COVID-19 Disease Severity
Authors: Desai Ankita P , Dirajlal-Fargo Sahera , Durieux Jared C , Tribout Heather , Labbato Danielle , McComsey Grace A 
Published: July 2021

Abstract

Background
We investigated the association of vitamin K and vitamin D with coronavirus disease 2019 (COVID-19) outcomes.

Methods
Levels of inactive vitamin K–dependent dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP; marker of vitamin K status) and 25-hydroxyvitamin D (25(OH)D; vitamin D status) were measured in plasma samples from participants with confirmed acute COVID-19 and were age- and sex-matched to healthy controls. Unadjusted odds ratios and adjusted odds ratios (AORs) with 95% CIs were computed using cumulative logistic regression.

Results
One hundred fifty subjects were included, 100 COVID-19+ and 50 controls. The median age (interquartile range) was 55 (48–63) years, and 50% were females. Thirty-four percent had mild COVID-19 disease, 51% moderate disease, and 15% severe. Dp-ucMGP levels were higher (ie, worse K status) in COVID-19+ vs controls (776.5 ng/mL vs 549.8 ng/mL; P &lt; .0001) with similar 25(OH)D between groups (25.8 vs 21.9 ng/mL; P = .09). Participants who were vitamin D deficient (&lt;20 ng/mL) had the worse vitamin K status (dp-ucMGP &gt;780 ng/mL) and experienced the most severe COVID-19 outcomes. In adjusted models, every 1-unit increase in the log2 dp-ucMGP nearly doubled the odds of acute critical disease or death (AOR, 1.84; 95% CI, 1.01–3.45), and every 1-unit decrease in the natural log 25(OH)D was associated with &gt;3 times the likelihood of severe COVID-19 disease (AOR, 0.29; 95% CI, 0.11–0.67).

Conclusions
Early in acute COVID-19, both vitamin K and vitamin D deficiency were independently associated with worse COVID-19 disease severity, suggesting a potential synergistic interplay between these 2 vitamins in COVID-19.
Understanding the Psychophysiological Mechanisms Related to Widespread Pressure Pain Hyperalgesia Underpinning Carpal Tunnel Syndrome: A Network Analysis Approach
Authors: Liew Bernard X W , de-la-Llave-Rincón Ana I , Arias-Buría José L , Ortega-Santiago Ricardo , Fernández-de-las-Peñas César 
Published: July 2021

Abstract

Objective
Current evidence suggests that carpal tunnel syndrome (CTS) involves widespread pressure pain sensitivity as a manifestion of central sensitization. This study aimed to quantify mechanisms driving widespread pressure pain hyperalgesia in CTS by using network analysis.

Design
Cross-sectional.

Setting
Urban hospital.

Subjects
Women with CTS (n=120) who participated in a previous randomized clinical trial.

Methods
Pain intensity, related function, symptom severity, depressive levels, and pressure pain threshold (PPTs) over the median, radial, and ulnar nerves, as well as the cervical spine, the carpal tunnel, and the tibialis anterior, were collected. Network analysis was used to quantify the adjusted correlations between the modeled variables and to determine the centrality indices of each variable (i.e., the degree of connection with other symptoms in the network).

Results
The estimated network showed several local associations between clinical variables and the psychophysical outcomes separately. The edges with the strongest weights were those between the PPT over the median nerve and the PPT over the radial nerve (P=0.34), between function and depressive levels (P=0.30), and between the PPT over the carpal tunnel and the PPT over the tibialis anterior (P=0.29 ). The most central variables were PPT over the tibialis anterior (the highest Strength centrality) and PPT over the carpal tunnel (the highest Closeness and Betweenness centrality).

Conclusions
This is the first study to apply network analysis to understand the multivariate mechanisms of individuals with CTS. Our findings support a model in which clinical symptoms, depression, and widespread pressure pain sensitivity are connected, albeit within separate clusters. The clinical implications of the present findings, such as the development of treatments targeting these mechanisms, are also discussed.
The Proper Formulation of the Minimalist Theory of Truth
Authors: Schindler Thomas , Schlöder Julian J 
Published: July 2021

Abstract
Minimalism about truth is one of the main contenders for our best theory of truth, but minimalists face the charge of being unable to properly state their theory. Donald Davidson incisively pointed out that minimalists must generalize over occurrences of the same expression placed in two different contexts, which is futile. In order to meet the challenge, Paul Horwich argues that one can nevertheless characterize the axioms of the minimalist theory. Sten Lindström and Tim Button have independently argued that Horwich’s attempt to formulate minimalism remains unsuccessful. We show how to properly state Horwich’s axioms by appealing to propositional functions that are given by definite descriptions. Both Lindström and Button discuss proposals similar to ours and conclude that they are unsuccessful. Our new suggestion avoids these objections.
Federal Constitutional Values and Citizen Attitudes to Government: Explaining Federal System Viability and Reform Preferences in Eight Countries
Authors: Brown A J , Deem Jacob , Kincaid John 
Published: July 2021

AbstractThis study presents a measure of federal constitutional values as a dimension of federal political culture derived from four key features of federal systems. Tested in six federal and two non-federal countries, we find the measure is stable and taps enduring values, including confirmation that citizens who support devolutionary reform have stronger federal constitutional values. Defining federalism success as a system where citizens have strong federal constitutional values and high satisfaction with their current polycentric system, our results find Switzerland and Canada being the most viable, followed by the United States, Australia, and Germany, while Belgium is not very successful. In the non-federal countries, substantial support for devolution and possibly federalism is found in France, but devolution is more contested in the United Kingdom. The results affirm the importance of public attitudes and political culture in understanding the performance of federal political systems and public support for federalist-type reforms.
Academic human capital in universities: definition and proposal of a measurement scale
Authors: García-Carbonell Natalia , Guerrero-Alba Félix , Martín-Alcázar Fernando , Sánchez-Gardey Gonzalo 
Published: July 2021

AbstractAcademic human capital (AHC) is a key element in the explanation of scientific productivity. However, few studies have analysed this topic in the academic context, and their conclusions about composition and measurement remain ambiguous. This study proposes a measurement scale to assess AHC, following a systemic procedure composed of two steps: qualitative and quantitative phases. First, the Delphi technique was applied to reach a consensus on the AHC factors, resulting in a scale of 22 items. Second, exploratory and confirmatory factor analyses were conducted to determine the underlying factorial structure of the scale, using a sample of 2,223 researchers in Spanish universities. The results provided a five-dimensional structure of AHC, measuring the knowledge and abilities required to perform research activities, as well as skills related to the organisation of scientific processes, alertness to research opportunities, and the openness to provide and receive criticism. This study poses interesting challenges for knowledge management in universities.
Factors That Drive Annual Variation in Pediatric Elbow Fracture Occurrence, Severity, and Resource Utilization
Authors: Schultz Jacob D. , Rees Andrew B. , Wollenman Lucas C. , McKeithan Lydia J. , Tadepalli Vaibhav R. , Wessinger Bronson C. , Attipoe Graham , Gay James C. , Martus Jeffrey E. , Moore-Lotridge Stephanie N. , Schoenecker Jonathan G. 
Published: July 2021

Background:
Elbow fractures are the most common pediatric fractures requiring operative treatment. To date, few studies have examined what annual factors drive pediatric elbow fracture incidence and no studies have examined which annual factors drive elbow fracture severity or resource utilization. The goal of this study was to not only document the annual patterns of pediatric elbow fracture incidence and severity but also the impact of these patterns on resource utilization in the emergency department, emergency medical service transportation, and the operating room (OR).

Methods:
Retrospective cohort study of 4414 pediatric elbow fractures from a single tertiary hospital (2007 to 2017). Exclusion criteria included outside treatment or lack of diagnosis by an orthopaedist. Presentation information, injury patterns, transport, and treatment requirements were collected. Pearson correlations were used to analyze factors influencing fracture incidence, severity, and resource utilization.

Results:
Pediatric elbow fracture incidence positively correlated with monthly daylight hours, but significantly fewer elbow fractures occurred during summer vacation from school compared with surrounding in school months. While fewer overall fractures occurred during summer break, the fractures sustained were greater in severity, conferring higher rates of displacement, higher risk of neurovascular injury, and greater needs for emergency transportation and operative treatment. Yearly, elbow fractures required 320.6 OR hours (7.7% of all pediatric orthopaedic OR time and 12.3% of all pediatric orthopaedic operative procedures), 203.4 hospital admissions, and a total of 4753.7 miles traveled by emergency medical service transportation to manage. All-cause emergency department visits were negatively correlated with daylight hours, inversing the pattern seen in elbow fractures.

Conclusion:
Increased daylight, while school was in session, was a major driver of the incidence of pediatric elbow fractures. While summer vacation conferred fewer fractures, these were of higher severity. As such, increased daylight correlated strongly with monthly resource utilization, including the need for emergency transportation and operative treatment. This study provides objective data by which providers and administrators can more accurately allocate resources.

Level of Evidence:
Level III—Retrospective comparative study.
Outcomes and Complications in Management of Congenital Myopathy Early-Onset Scoliosis
Authors: Magee Lacey , Bram Joshua T. , Anari Jason B. , Ramo Brandon , Mayer Oscar H. , Matsumoto Hiroko , Brooks Jaysson T. , Andras Lindsay , Lark Robert , Fitzgerald Ryan , Truong Walter , Li Ying , Karlin Lawrence , Schwend Richard , Weinstein Stuart , Roye David , Snyder Brian , Flynn John M. , Oetgen Matthew , Smith John , Cahill Patrick J. 
Published: July 2021

Background:
Congenital myopathies (CMs) are complex conditions often associated with early-onset scoliosis (EOS). The purpose of this study was to investigate radiographic outcomes in CM patients undergoing EOS instrumentation as well as complications. Secondarily, we sought to compare these patients to a population with higher prevalence, cerebral palsy (CP) EOS patients.

Methods:
This is a retrospective study of a prospectively collected multicenter registry. The registry was queried for EOS patients with growth-sparing instrumentation (vertical expandable prosthetic titanium ribs, magnetically controlled growing rods, traditional growing rod, or Shilla) and a CM or CP diagnosis with minimum 2 years follow-up. Outcomes included major curve magnitude, T1-S1 height, kyphosis, and complications.

Results:
Sixteen patients with CM were included. Six (37.5%) children with CM experienced 11 complications by 2 years. Mean major curve magnitude for CM patients was improved postoperatively and maintained at 2 years (P<0.01), with no significant increase in T1-S1 height or maximum kyphosis(P>0.05). Ninety-seven patients with CP EOS were included as a comparative cohort. Fewer CP patients required baseline respiratory support compared with CM patients (20.0% vs. 92.9%, P<0.01). Fifty-four (55.7%) CP patients experienced a total of 105 complications at 2 years. There was no evidence that the risk of complication or radiographic outcomes differs between cohorts at 2 years, though CP EOS patients experienced significant improvement in all measurements at 2 years.

Conclusions:
EOS CM children face a high risk of complication after growing instrumentation, with similar curve correction and risk of complication to CP patients.

Level of Evidence:
Level III.
Caregiver Perspectives on a Child's Diagnosis of 3q29 Deletion: “We Can't Just Wish This Thing Away”
Authors: Glassford Megan R. , Purcell Ryan H. , Pass Sarah , Murphy Melissa M. ,   The Emory 3q29 Project,*, Bassell Gary J. , Mulle Jennifer G. 
Published: July 2021

ABSTRACT:

Objective:
Genetic diagnoses are increasingly common in cases of intellectual disability and developmental delay. Although ascertainment of a relatively common, well-studied variant may provide guidance related to treatments and developmental expectations, it is less clear how the diagnosis of a rare variant affects caregivers, especially when the phenotype may include later-onset manifestations such as psychosis. In this study, we sought to identify caregiver concerns in the first qualitative study to assess the psychosocial impact of diagnosis on caregivers of individuals with 3q29 deletion syndrome (3q29Del), which is associated with a 40-fold increase in risk for psychosis.

Methods:
Participants were recruited from the national 3q29Del registry housed at Emory University (3q29deletion.org). Fifteen participants completed a semistructured phone interview during which they were asked about their experiences before, during, and after their child received a diagnosis of 3q29Del. Interview responses were analyzed using the general inductive approach, and overarching themes were identified.

Results:
We identified the following overarching themes: difficult “diagnostic odyssey,” mixed feelings about diagnosis, frustration with degree of uncertainty, and importance of resources. Importantly, our data suggest that future risk for psychosis is often not disclosed by medical professionals, consistent with the experience of individuals with 22q11.2 deletion syndrome.

Conclusions:
These results highlight potential gaps in how caregivers are informed of risk for adult-onset conditions and indicate key caregiver concerns for consideration in the diagnosis of 3q29Del.
Nonvitamin K Antagonist Oral Anticoagulant in Patients With Venous Thromboembolism and Polycythemia Vera or Essential Thrombocythemia: A Cohort Study
Authors: Weronska Anna , Papuga-Szela Elżbieta , Broniatowska Elzbieta , Undas Anetta 
Published: July 2021

Abstract:
Thrombosis is the most common adverse event in patients with polycythemia vera (PV) and essential thrombocythemia (ET). Little is known about the use of nonvitamin K antagonist oral anticoagulants (NOACs) in patients with myeloproliferative neoplasms. We sought to evaluate the efficacy and safety of NOAC in a cohort of patients with PV and ET, who experienced venous thromboembolism (VTE). We enrolled 48 consecutive patients with PV (70.8%) and ET [median age 67.0 (interquartile range, 58.5–72.0) years], who experienced VTE. Patients received apixaban (39.6%), rivaroxaban (33.3%), or dabigatran (27.1%). During a median follow-up of 30 (interquartile range, 20.5–41.5) months, recurrent thrombotic events and bleeding were recorded. Four thrombotic events (3.3 per 100 patient-years) were reported. Three deep vein thrombosis episodes (2.5 per 100 patient-years) were experienced by 2 patients with PV, who received apixaban (5 mg bid) and dabigatran (150 mg bid), and 1 patient with ET, who received dabigatran (150 mg bid). One ischemic stroke occurred in a patient with PV on rivaroxaban (20 mg/d). There was 1 major bleeding (0.8 per 100 patient-years) in a patient with ET on dabigatran (150 mg bid) and 3 clinically relevant nonmajor bleeding (2.5 per 100 patient-years): 2 on rivaroxaban (20 mg/d) and 1 on apixaban (5 mg bid). We did not observe significant differences related to the type of NOAC. Three deaths (2.5 per 100 patient-years) unrelated to either VTE or bleeding were recorded. This study shows that NOACs may be effective and safe as secondary prevention of VTE in patients with myeloproliferative neoplasms.
Effects of Statins After Transcatheter Aortic Valve Implantation in Key Patient Populations
Authors: Fischer-Rasokat Ulrich , Renker Matthias , Bänsch Celine , Weferling Maren , Liebetrau Christoph , Herrmann Eva , Liakopoulos Oliver , Choi Yeong-Hoon , Hamm Christian W. , Kim Won-Keun 
Published: July 2021

Abstract:
Statin therapy after transcatheter aortic valve replacement (TAVI) is associated with better short-term and long-term outcomes. It is of interest to identify specific patient populations that may profit from statin therapy. In this retrospective, observational analysis of 2862 patients with symptomatic aortic stenosis after successful transfemoral TAVI, survival during a three-year observation period was characterized by Kaplan–Meier analyses according to statin therapy. Hazard ratios and potential interactions for specific subgroups of patients were determined by Cox regression analyses. At hospital discharge 1761 patients were on low-intensity or moderate-intensity statins, 246 patients were on high-intensity statins, and 855 patients did not take statins. Statin therapy adherence during the first 3 months post-TAVI was 91%. Mortality rates were 18.5%, 12.9%, and 6.9% for patients with no statin, low-intensity or moderate-intensity statins, and high-intensity statins (P < 0.001). Any statin therapy proved to be effective in patients in different classes of age, risk, and manifest cardiovascular disease and was independent of background medication. Statins were of particular benefit in high-risk patients with coronary artery disease [hazard ratio (HR) = 0.57], ejection fraction <40% (HR = 0.64), or low-flow low-gradient aortic stenosis (HR = 0.58) and showed additional benefit even in patients taking renin–angiotensin system blockers (HR = 0.74). Statins also reduced mortality in patients with malignant disease (HR = 0.47). Our analysis confirmed the beneficial effect of statins on survival after TAVI and documented this phenomenon in key patient subsets. The protective effect of statins in our study is consistent with the cardioprotective mechanisms but must be explained by other, yet undetermined pleiotropic effects of statins.
Deep learning-based natural language processing in ophthalmology: applications, challenges and future directions
Authors: Yang Lily Wei Yun , Ng Wei Yan , Foo Li Lian , Liu Yong , Yan Ming , Lei Xiaofeng , Zhang Xiaoman , Ting Daniel Shu Wei 
Published: July 2021

Purpose of review
Artificial intelligence (AI) is the fourth industrial revolution in mankind's history. Natural language processing (NLP) is a type of AI that transforms human language, to one that computers can interpret and process. NLP is still in the formative stages of development in healthcare, with promising applications and potential challenges in its applications. This review provides an overview of AI-based NLP, its applications in healthcare and ophthalmology, next-generation use case, as well as potential challenges in deployment.

Recent findings
The integration of AI-based NLP systems into existing clinical care shows considerable promise in disease screening, risk stratification, and treatment monitoring, amongst others. Stakeholder collaboration, greater public acceptance, and advancing technologies will continue to shape the NLP landscape in healthcare and ophthalmology.

Summary
Healthcare has always endeavored to be patient centric and personalized. For AI-based NLP systems to become an eventual reality in larger-scale applications, it is pertinent for key stakeholders to collaborate and address potential challenges in application. Ultimately, these would enable more equitable and generalizable use of NLP systems for the betterment of healthcare and society.
Defining Age-specific Relationships of Respiratory Syncytial Virus and Rhinovirus Species in Hospitalized Children With Acute Wheeze
Authors: Oo Stephen W.C. , Khoo Siew-Kim , Cox Des W. , Chidlow Glenys , Franks Kimberley , Prastanti Franciska , Bochkov Yury A. , Borland Meredith L. , Zhang Guicheng , Gern James E. , Smith David W. , Bizzintino Joelene A. , Laing Ingrid A. , Le Souëf Peter N. 
Published: July 2021

Background:
Acute wheezing is one of the most common hospital presentations for young children. Respiratory syncytial virus (RSV) and rhinovirus (RV) species A, B and the more recently described species C are implicated in the majority of these presentations. However, the relative importance and age-specificities of these viruses have not been defined. Hence, this study aimed to establish these relationships in a large cohort of prospectively recruited hospitalized children.

Methods:
The study cohort was 390 children 0–16 years of age presenting with acute wheezing to a children’s emergency department, 96.4% being admitted. A nonwheezing control population of 190 was also recruited. Nasal samples were analyzed for viruses.

Results:
For the first 6 months of life, RSV was the dominant virus associated with wheezing (P < 0.001). From 6 months to 2 years, RSV, RV-A and RV-C were all common but none predominated. From 2 to 6 years, RV-C was the dominant virus detected (50–60% of cases), 2–3 times more common than RV-A and RSV, RSV decreasing to be absent from 4 to 7 years. RV-B was rare at all ages. RV-C was no longer dominant in children more than 10 years of age. Overall, RV-C was associated with lower mean oxygen saturation than any other virus (P < 0.001). Controls had no clear age distribution of viruses.

Conclusion:
This study establishes a clear profile of age specificity of virus infections causing moderate to severe wheezing in children: RSV as the dominant cause in the first 6 months and RV-C in preschool-age children.
Force of lifelong crystalline lens growth: chronic traumatic mechanical insult to the choroid
Authors: Strenk Lawrence M. , Guo Suqin , Lu Kenneth , Werner Liliana , Strenk Susan A. 
Published: July 2021

Purpose:
To calculate the forces applied to the uvea and retina as a result of lifelong crystalline lens growth.

Design:
Retrospective study.

Setting:
MRI Research, Inc., Middleburg Heights, Ohio; Institute of Ophthalmology and Visual Science UMDNJ–New Jersey Medical School, Newark, New Jersey; USC Psychology University of Southern California, Los Angeles.

Methods:
Magnetic resonance images were acquired from 15 phakic/pseudophakic eye pairs in patients with cataract (ages 46 to 83 years). Choroidal lengths were measured. The forces required to produce differences between phakic/pseudophakic choroidal lengths were calculated.

Results:
The length of the choroid is greater in the phakic eye compared with the corresponding pseudophakic eye (n = 15), and this difference increases with age (P = .00006; power = 0.99). The corresponding choroidal strain also increases with age (P = .00003, power = 0.99) as do the forces required to produce such a change in choroidal length (P = .000008, power = 0.99).

Conclusions:
The authors theorize that lifelong crystalline lens growth applies a chronic, traumatic, mechanical insult to the uvea and retina. This previously unknown, ever-increasing, force appears to stretch the choroidal tissue and may be an intraocular pressure–independent modifiable risk factor for retinal disease. Implications exist for understanding the pathophysiology of retinal diseases in the aging eye that are often comorbid with cataracts, for example, glaucoma, macular degeneration, and diabetic retinopathy.