bluuebunny/crossref_metadata_2025_split huggingface dataset:
Designing a Clerkship Curriculum for Medical Students in Clinical and Medical Informatics in the Electronic Medical Record Era
Authors: Chartash David , Finnell John T 
Published: April 2021

AbstractIntroductionThe nature of practice in clinical and medical informatics has changed since the last recommended incorporation of the field into undergraduate medical education in 1998. The Regenstrief Institute and Indiana University have been offering a clerkship in clinical and medical informatics since 2008, and post-graduate medical education since the early 1970s.MethodsDrawing on this existing educational program and the expertise at the institute, we developed a clerkship elective to support medical students in learning about the subspecialty in practice, as well as the state of the art in research. Student evaluation of the clerkship and satisfaction with curricular design elements was measured.ResultsA modular inverted classroom curriculum was designed and implemented using learning management systems and instructional technology available at Indiana University. Students were satisfied with the clerkship, and explicitly understood how curricular design contributed to their understanding of material. The curriculum was found flexible for multiple levels of learners, particularly those with advanced mastery of technical skills.DiscussionThis curriculum, and its packaged content to be imported into common learning management systems, offers a state of the art introduction to clinical and medical informatics for medical students, which supports student success and preferences during their clerkship elective period.Educational ObjectivesBy the end of this activity, learners will be able to:’Articulate the scope of clinical and medical informatics within medicineDescribe a problem pertinent to their clinical interests, and how a solution can be supported by health information technology, as well as more generally be assessed using clinical outcome measuresDemonstrate a knowledge of terminologies and standards found in clinical medicine, as well how they integrate to define and describe diseaseDemonstrate an understanding of clinical decision making and the evaluation of discrete choice problems
Effects of bariatric surgery on functional connectivity of the reward and default mode network: a pre-registered analysis
Authors: Heinrichs Hannah S. , Beyer Frauke , Medawar Evelyn , Prehn Kristin , Ordemann Jürgen , Flöel Agnes , Witte A. Veronica 
Published: April 2021

AbstractObesity imposes serious health risks and involves alterations in resting-state functional connectivity of brain networks involved in eating behavior. Bariatric surgery is an effective treatment, but its effects on functional connectivity are still under debate. In this pre-registered study, we aimed to determine the effects of bariatric surgery on major resting-state brain networks (reward and default mode network) in a longitudinal controlled design. 33 bariatric surgery patients and 15 obese waiting-list control patients (37 females; aged 44.15 ± 11.86 SD years (range 21-68)) underwent magnetic resonance imaging at baseline, after 6 and 12 months. We conducted a pre-registered whole-brain time-by-group interaction analysis, and a time-by-group interaction analysis on within-network connectivity (https://osf.io/f8tpn/, https://osf.io/59bh7/). In exploratory analyses, we investigated the effects of weight loss and head motion. Bariatric surgery compared to waiting did not significantly affect functional connectivity (FWE-corrected p > 0.05), neither whole-brain nor within-network. In exploratory analyses, surgery-related BMI decrease (FWE-corrected p = 0.041) and higher average head motion (FWE-corrected p = 0.021) resulted in significantly stronger connectivity of the reward network with medial posterior frontal regions. This pre-registered well-controlled study did not support a strong effect of bariatric surgery, compared to waiting, on major resting-state brain networks after 6 months. Exploratory analyses indicated that head motion might have confounded the effects. Data pooling and more rigorous control of within-scanner head motion during data acquisition are needed to substantiate effects of bariatric surgery on brain organization.
Donor race has no role in predicting allograft and patient survival among kidney transplant recipients
Authors: Chong Kelly , Litvinovich Igor , Chen Shan Shan , Zhu Yiliang , Argyropoulos Christos , Ng Yue-Harn 
Published: April 2021

AbstractA heated debate in creatinine-based estimated glomerular filtration rate (eGFR) calculation is the inclusion of race alongside biological factors, such as age and gender. Similarly, the race variable was included in the calculation of the Kidney Donor Risk Index (KDRI) as deceased donor kidneys from black donors have historically been shown to be associated with lower allograft or patient survival. Given the current climate of uncertainty with the use of race in nephrology, we sought to answer the question of whether removing the donor race variable from the KDRI would alter its validity to assess allograft and patient survival. Our modeling and analysis showed that removing donor race from the original KDRI did not alter the overall model predictability of allograft failure or patient mortality. Clinical risk factors included in the KDRI have largely accounted for differential risk between black and other donors. Adding donor race into the KDRI only shifts how risk is attributed to these clinical risk factors, without yielding better prediction of outcomes than the model without race.
Effect of Tocilizumab on “ventilator free days” composite outcome in SARS-CoV-2 patients. A retrospective competing risk analysis
Authors: Mady Ahmed F. , Abdulrahman Basheer , Ramadan Omar E. , Mumtaz Shahzad A. , Al-Odat Mohammed A. , Kuhail Ahmed , Altoraifi Rehab , Alshae Rayan , Alharthy Abdulrahman M. , Karakitsos Dimitrios , Aletreby Waleed Th. 
Published: April 2021

AbstractBackgroundSARS-CoV-2 infection demonstrates a wide range of severity, the more severe cases demonstrate a cytokine storm with elevated serum interleukin-6, hence IL-6 receptor antibody Tocilizumab was tried for the management of severe cases.ObjectivesThe effect of Tocilizumab treatment on the composite outcome of ventilator free days, among critically ill SARS-CoV-2 patients.MethodRetrospective observational propensity score matching study, comparing mechanically ventilated patients upon ICU admission who received Tocilizumab to a control group. Utilizing competing risk analysis method, and reporting sub-distributional hazard ratio of a composite outcome of ventilator free days at day 28.Results29 patients in the intervention group were compared to 29 patients in the control group. Matched groups were similar at base line. The primary outcome of ventilator free days was higher in the intervention group (SHR 2.7, 95% CI: 1.2 – 6.3; p = 0.02), crude ICU mortality rate was not different between Tocilizumab and control groups (37.9% versus 62% respectively, p = 0.1), actual ventilator free days were significantly longer in Tocilizumab group (mean difference 4.7 days, 95% CI 1.1 – 8.3; p = 0.02). Sensitivity analysis by Cox regression showed a significantly lower hazard ratio of death in Tocilizumab group (HR 0.49, 95% CI: 0.25 – 0.97; p = 0.04). While there was no difference in grown positive cultures among groups (55.2% in Tocilizumab group versus 34.5% in the control, 95% CI of difference: −7.11% to 54.4%; p = 0.1).ConclusionTocilizumab may improve the composite outcome of ventilator free days at day 28 among mechanically ventilated SARS-CoV-2 patients, it is associated with significantly longer actual ventilator free days, and insignificantly lower mortality and superinfection.
Intensity of home-based telework and work engagement during the COVID-19 pandemic
Authors: Nagata Tomohisa , Nagata Masako , Ikegami Kazunori , Hino Ayako , Tateishi Seiichiro , Tsuji Mayumi , Matsuda Shinya , Fujino Yoshihisa , Mori Koji ,   for the CORoNaWork project
Published: April 2021

AbstractObjectiveThe present study examined the relationship between the intensity of home-based telework and work engagement.MethodsThis cross-sectional study using a self-administrated questionnaire survey was conducted from December 22 to 25, 2020, in Japan. The subjects were asked single-item questions about the intensity of telework and three-item questions about work engagement using the Utrecht Work Engagement Scale. Coefficients were estimated using a multilevel regression model nested by prefecture of residence and adjusted for covariates.ResultsHigh-intensity (four or more days per week) telework was not associated with high work engagement for men or women. In contrast, low and moderate intensity (three days per week to once per month) were associated with high work engagement. The results were consistent when stratified by sex.ConclusionsReasonable-intensity telework may have beneficial effects on work engagement.Clinical SignificanceThis study revealed that a reasonable intensity of telework may have beneficial effects on work engagement. A reasonable intensity is defined as low (once per week to once per month) or moderate intensity (two to three days per week) for both men and women.
Brain age prediction using fMRI network coupling in youths and associations with psychiatric symptoms
Authors: Lund Martina J. , Alnæs Dag , de Lange Ann-Marie , Andreassen Ole A. , Westlye Lars T. , Kaufmann Tobias 
Published: April 2021

AbstractObjectiveMagnetic resonance imaging (MRI) has shown that estimated brain age is deviant from chronological age in various common brain disorders. Brain age estimation could be useful for investigating patterns of brain maturation and integrity, aiding to elucidate brain mechanisms underlying these heterogeneous conditions. Here, we examined functional brain age in two large samples of children and adolescents and its relation to mental health.MethodsWe used resting-state fMRI data from the Philadelphia Neurodevelopmental Cohort (PNC; n=1126, age range 8-22 years) to estimate functional connectivity between brain networks, and utilized these as features for brain age prediction. We applied the prediction model to 1387 individuals (age range 8-22 years) in the Healthy Brain Network sample (HBN). In addition, we estimated brain age in PNC using a cross-validation framework. Next, we tested for associations between brain age gap and various aspects of psychopathology and cognitive performance.ResultsOur model was able to predict age in the independent test samples, with a model performance of r=0.54 for the HBN test set, supporting consistency in functional connectivity patterns between samples and scanners. Linear models revealed a significant association between brain age gap and psychopathology in PNC, where individuals with a lower estimated brain age, had a higher overall symptom burden. These associations were not replicated in HBN.DiscussionOur findings support the use of brain age prediction from fMRI-based connectivity. While requiring further extensions and validations, the approach may be instrumental for detecting brain phenotypes related to intrinsic connectivity and could assist in characterizing risk in non-typically developing populations.
Higher Relative Viral Load Excretion Determined by Normalised Threshold Crossing Value in Acute Cases infected with the B.1.1.7 Lineage VOC 202012/01 (Using S gene target failure as a Proxy) When Compared to other Circulating Lineages in Wales
Authors: Couzens Anastasia , Murrell Isa , Gifford Laura , Johns Ben , Pheasant Kathleen , Turner Luke , Evans Jonathan , Moore Catherine 
Published: April 2021

AbstractSince the emergence of SARS-CoV-2, global monitoring of the virus using whole genome sequencing has identified mutations occurring across the viral genome. Whilst the majority have little impact on the virus, they are used effectively to monitor the movement of the virus globally and to inform locally on transmission chains.In late 2020, a variant of SARS-CoV-2 (B.1.1.7 - VOC 202012/01) was identified in the UK with a distinct constellation of mutations, including in the spike gene that increased transmissibility. A deletion in spike also affected one of the screening qPCR tests being used in the UK outside of Wales, causing a failure to detect the target. This quickly became a surrogate marker for the variant to allow rapid monitoring of the virus as it seeded into new regions of the UK.A screening study using this assay as a proxy marker, was undertaken to understand the prevalence of the variant in Wales. Secondary analysis of a screening qPCR that didn’t target the S gene and also included an endogenous control, was also performed to understand viral load excretion in those infected with the variant compared to other circulating lineages. Using a combination of analytical methods based on the Ct values of two gene targets normalised against the endogenous control, there was a difference in the excreted viral load. Those with the variant excreting more virus than those not infected with the variant. Supporting not only increased infectivity but offering a plausible reason why increased transmission was associated with this particular variant.Whilst there are limitations in this study, the method using Ct as a proxy for viral load can be used at the population level to determine differences in viral excretion kinetics associated with different variants.
Effect of introducing interprofessional education concepts on students of various healthcare disciplines in the United Arab Emirates
Authors: Zaher Shroque , Otaki Farah , Zary Nabil , Marzouqi Amina Al , Radhakrishnan Rajan 
Published: April 2021

AbstractBackgroundThe value of interprofessional education (IPE) in nurturing healthcare professionals and shaping their professional identities and attitudes towards interdisciplinary teamwork and collaboration is established in the literature. It is an emerging concept in the Middle East and North Africa region and is new to the United Arab Emirates (UAE).PurposeTo investigate the effect of one of the first experiences of IPE in the UAE, which was designed in alignment with the principles of the Situated Learning Theory, on students of various healthcare disciplines readiness for interprofessional learning and collaboration.MethodsA pre-post intervention quantitative research design was adopted for this study to assess the effectiveness of the intervention in raising the level of readiness for interprofessional work among the participants. The participants included students of medicine, pharmacy, nursing, and physiotherapy. Readiness for Interprofessional Learning Scale (RIPLS) was used as the pre- and post-intervention assessments; data was analysed using SPSS.ResultsThe IPE intervention under investigation significantly increased the level of readiness to engage in cross-disciplinary learning and collaboration among participating health professions’ students. In terms of the subscales, the participants’ openness to engage in teamwork was raised and their professional identity was fostered. Yet, no statistical significance around clarity of roles and responsibilities was detected.ConclusionIPE interventions hold the potential to significantly increase receptiveness to cross-disciplinary learning and collaboration among health professions’ students. The findings of this study encourage other universities in the MENA region to adopt IPE to improve future health professionals’ capacity to develop shared understanding and mutual respect within cross-disciplinary teams, which ultimately feed into improved quality of care and patient outcome.
Energy Insecurity Influences Urban Outdoor Air Pollution Levels during COVID-19 Lockdown in South-Central Chile
Authors: Martinez-Soto Aner , Avendaño-Vera Constanza , Boso Alex , Hofflinger Alvaro , Shupler Matthew 
Published: April 2021

AbstractIntroductionIn south-central Chile, outdoor air pollution primarily originates as household air pollution from wood burning for heating. The effect of COVID-19 lockdowns on ambient air pollution levels in urban south-central Chile may therefore be different from trends observed in cities where transportation and industrial emission sources dominate.MethodsThis quasi-experimental study compares hourly fine (PM2.5) and coarse (PM10) particulate matter measurements from six air monitoring stations (three reference grade beta attenuation monitors and three low-cost SPS30 sensors) in commercial and low or middle-income residential areas of Temuco and Padre Las Casas, Chile between March-September 2019 and 2020 (spanning COVID-19 lockdown).ResultsIn Padre Las Casas, average outdoor PM2.5 concentrations peaked above 100 ug/m3 from 8-10 pm during winter (May-August) 2019 and 2020, when wood burning is common. During COVID-19 lockdown, average monthly ambient PM2.5 concentrations in a commercial and middle-income residential area of Temuco were up to 50% higher (12 µg/m3 to 18 µg/m3) and 59% higher (22 µg/m3 to 35 µg/m3) than 2019 levels, respectively. Conversely, PM2.5 levels decreased by up to 52% (43 µg/m3 to 21 µg/m3) in low-income neighborhoods. The night-time (8 pm-9 am) mass percent of PM10 that was PM2.5 during strict quarantine (April 2020) increased by 48% above April 2017-2019 proportions (50% to 74%) in a commercial area of Temuco.ConclusionsWood burning for home heating was responsible for a significantly higher proportion of ambient PM2.5 pollution in commercial areas and middle-income neighborhoods of Temuco during COVID-19 lockdown, compared to winter months in 2019. Constrastingly, energy insecure households likely refrained from wood heating during lockdown, leading to PM2.5 concentration declines. To reduce the double burden of ambient air pollution and energy insecurity in south-central Chile, affordability of clean heating fuels (e.g. electricity, liquefied petroleum gas) should be a policy priority.
CERC-002, a human anti-LIGHT mAb reduces respiratory failure and death in hospitalized COVID-19 ARDS patients
Authors: Perlin David S. , Neil Garry A. , Anderson Colleen , Zafir-Lavie Inbal , Roadcap Lori , Raines Shane , Ware Carl F. , Wilkins H. Jeffrey 
Published: April 2021

AbstractBackgroundSevere COVID-19 infection is associated with dysregulated immune response which, in a substantial minority of patients, results in cytokine release syndrome (CRS) and acute respiratory distress syndrome (ARDS). Inhibition of cytokines or cytokine-associated signal transduction is a promising strategy to ameliorate ARDS associated with CRS. We and others have previously shown that serum free LIGHT (TNFSF14) levels are markedly elevated in patients with COVID-19 pneumonia/ARDS10,11, suggesting that LIGHT neutralization may offer therapeutic benefit to COVID-19 ARDS patients.MethodsWe conducted a randomized, double-blind, placebo-controlled, multi-center, proof-of-concept clinical trial of CERC-002 in adults with mild to moderate ARDS associated with COVID-19 (n=83). Enrolled patients received a single dose of CERC-002 or placebo, in addition to standard of care that included high dose corticosteroids. The primary efficacy endpoint was alive and free of respiratory failure status through Day 28. Secondary outcomes included alive status at Day 28, free of invasive ventilation through Day 28, and serum free LIGHT levels.ResultsIn patients hospitalized with COVID-19 associated pneumonia and mild to moderate (ARDS), CERC-002 increased the rate of alive and free of respiratory failure status through Day 28 as compared to placebo (83.9% vs 64.5%; p=0.044). Efficacy was highest in the prespecified subgroup of patients 60 years old and older (76.5% vs 47.1%; p=0.042), the population most vulnerable to severe complications and death with COVID-19 infection. Through both the initial 28-day and 60-day follow-up periods, reductions of approximately 50% in mortality were observed for CERC-002 compared to placebo (7.7% vs 14.3% at Day 28 and 10.8% vs 22.5% at Day 60). Importantly, this improvement was incremental to standard of care including high dose steroids and remdesivir 88.0% and 57.8%, respectively). In addition, serum LIGHT levels but not IL-6 levels were markedly reduced in patients treated with CERC-002.ConclusionsThe data presented herein demonstrate that CERC-002 markedly reduces the risk of respiratory failure and death incremental to standard of care including high dose corticosteroids and reduces LIGHT levels in patients with COVID-19 ARDS. (ClinicalTrials.gov number NCT04412057).
Understanding how Victoria, Australia gained control of its second COVID-19 wave
Authors: Trauer James M , Lydeamore Michael J , Dalton Gregory W , Pilcher David , Meehan Michael T , McBryde Emma S , Cheng Allen C , Sutton Brett , Ragonnet Romain 
Published: April 2021

AbstractVictoria has been Australia’s hardest hit state by the COVID-19 pandemic, but was successful in reversing its second wave of infections through aggressive policy interventions. The clear reversal in the epidemic trajectory combined with information on the timing and geographical scope of policy interventions offers the opportunity to estimate the relative contribution of each change. We developed a compartmental model of the COVID-19 epidemic in Victoria that incorporated age and geographical structure, and calibrated it to data on case notifications, deaths and health service needs according to the administrative divisions of Victoria’s healthcare, termed clusters. We achieved a good fit to epidemiological indicators, at both the state level and for individual clusters, through a combination of time-varying processes that included changes to case detection rates, population mobility, school closures, seasonal forcing, physical distancing and use of face coverings. Estimates of the risk of hospitalisation and death among persons with disease that were needed to achieve this close fit were markedly higher than international estimates, likely reflecting the concentration of the epidemic in groups at particular risk of adverse outcomes, such as residential facilities. Otherwise, most fitted parameters were consistent with the existing literature on COVID-19 epidemiology and outcomes. We estimated a significant effect for each of the calibrated time-varying processes on reducing the risk of transmission per contact, with broad estimates of the reduction in transmission risk attributable to seasonal forcing (27.8%, 95% credible interval [95%CI] 9.26-44.7% for mid-summer compared to mid-winter), but narrower estimates for the individual-level effect of physical distancing of 12.5% (95%CI 5.69-27.9%) and of face coverings of 39.1% (95%CI 31.3-45.8%). That the multi-factorial public health interventions and mobility restrictions led to the dramatic reversal in the epidemic trajectory is supported by our model results, with the mandatory face coverings likely to have been particularly important.