bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors and outcomes of acute kidney injury during autologous stem cell transplantation in AL amyloidosis
Authors: Nader Ralph , Zhen Aileen , Angel-Korman Avital , Pavlovich Stephanie S , Pogrebinsky Alexander , Doros Gheorghe , Menn-Josephy Hanni , Stern Lauren , Sanchorawala Vaishali , Havasi Andrea 
Published: May 2021

Abstract

Background
Acute kidney injury (AKI) is a common complication after high-dose melphalan and autologous stem cell transplantation (HDM/SCT) in patients with light chain (AL) amyloidosis. However, its incidence, predictors and outcomes are not well known.

Methods
This observational study included 223 patients with AL amyloidosis who underwent HDM/SCT. AKI was defined as an increase in serum creatinine to ≥1.5 times the baseline occurring within the first 30 days of HDM/SCT.

Results
The median age was 58 years (range: 30–77). Kidney and cardiac involvement were present in 86.1% and 56.8%, respectively. The median estimated glomerular filtration rate (eGFR) was 83.5 mL/min/1.73 m2 (range: 9–213) and proteinuria was 2899 mg/day (range: 0–19 966). AKI occurred in 29.1% of patients. Dialysis was initiated in 15 patients (6.7%) and of these 12 (80%) were able to discontinue dialysis. Most of the episodes of AKI occurred within the first 2 weeks; with a median follow-up of 4.5 years (range: 0.1–16.5), AKI was associated with increased overall mortality [hazard rato (HR) = 4.53, 95% confidence interval (CI) 2–10.23]. The 10-year overall survival was 87.1% without AKI, versus 56.9% with AKI. AKI was also associated with an increased risk for end-stage kidney disease (ESKD) (HR = 4.6, 95% CI 1.44–14.38). The risk of developing ESKD at 10 years was 18.9% with AKI, versus 8.1% without AKI. Several risk factors were found and using multivariate logistic regression, a prediction model was developed that included three readily available variables: eGFR &lt;60 mL/min/1.73 m2, interventricular septal thickness in diastole &gt;12 mm and albumin &lt;3 g/dL. This model was able to predict AKI development with an area under the curve of 0.8.

Conclusions
AKI is common in the post-HDM/SCT period and it leads to increased risk for ESKD and death. Our prediction model is an easily deployable tool in clinical settings as part of the discussion with patients who are being prepared for HDM/SCT.
Spatial concordance of DNA methylation classification in diffuse glioma
Authors: Verburg Niels , Barthel Floris P , Anderson Kevin J , Johnson Kevin C , Koopman Thomas , Yaqub Maqsood M , Hoekstra Otto S , Lammertsma Adriaan A , Barkhof Frederik , Pouwels Petra J W , Reijneveld Jaap C , Rozemuller Annemieke J M , Beliën Jeroen A M , Boellaard Ronald , Taylor Michael D , Das Sunit , Costello Joseph F , Vandertop William Peter , Wesseling Pieter , de Witt Hamer Philip C , Verhaak Roel G W 
Published: May 2021

Abstract

Background
Intratumoral heterogeneity is a hallmark of diffuse gliomas. DNA methylation profiling is an emerging approach in the clinical classification of brain tumors. The goal of this study is to investigate the effects of intratumoral heterogeneity on classification confidence.

Methods
We used neuronavigation to acquire 133 image-guided and spatially separated stereotactic biopsy samples from 16 adult patients with a diffuse glioma (7 IDH-wildtype and 2 IDH-mutant glioblastoma, 6 diffuse astrocytoma, IDH-mutant and 1 oligodendroglioma, IDH-mutant and 1p19q codeleted), which we characterized using DNA methylation arrays. Samples were obtained from regions with and without abnormalities on contrast-enhanced T1-weighted and fluid-attenuated inversion recovery MRI. Methylation profiles were analyzed to devise a 3-dimensional reconstruction of (epi)genetic heterogeneity. Tumor purity was assessed from clonal methylation sites.

Results
Molecular aberrations indicated that tumor was found outside imaging abnormalities, underlining the infiltrative nature of this tumor and the limitations of current routine imaging modalities. We demonstrate that tumor purity is highly variable between samples and explains a substantial part of apparent epigenetic spatial heterogeneity. We observed that DNA methylation subtypes are often, but not always, conserved in space taking tumor purity and prediction accuracy into account.

Conclusion
Our results underscore the infiltrative nature of diffuse gliomas and suggest that DNA methylation subtypes are relatively concordant in this tumor type, although some heterogeneity exists.
Potential Use of Adjuvant Bacteriophage Therapy With Debridement, Antibiotics, and Implant Retention Surgery to Treat Chronic Prosthetic Joint Infections
Authors: Doub James B , Ng Vincent Y , Johnson Aaron , Amoroso Anthony , Kottilil Shyamasundaran , Wilson Eleanor 
Published: May 2021

Abstract
The number of arthroplasties conducted annually continues to increase; however, approximately 1%–2% of all knee and hip arthroplasties will become infected. These prosthetic joint infections are costly, difficult to treat, and cause significant morbidity and mortality as a direct result of conventional surgical and medical managements. In this perspective, we discuss factors that make these infections arduous to treat as well as the potential use of adjuvant bacteriophage therapy with debridement, antibiotics, and implant retention surgery to cure these infections without removing the infected prosthesis. We also provide rationale as to why future clinical trials evaluating this novel therapeutic will need to be designed as noninferiority trials, and we compare this approach to 2-stage revision surgery. If bacteriophage therapy continues to show effectiveness, this could revolutionize the treatment of prosthetic joint infections and pioneer new treatments for similar infections.
Remdesivir Versus Standard-of-Care for Severe Coronavirus Disease 2019 Infection: An Analysis of 28-Day Mortality
Authors: Olender Susan A , Walunas Theresa L , Martinez Esteban , Perez Katherine K , Castagna Antonella , Wang Su , Kurbegov Dax , Goyal Parag , Ripamonti Diego , Balani Bindu , De Rosa Francesco G , De Wit Stéphane , Kim Shin-Woo , Diaz George , Bruno Raffaele , Mullane Kathleen M , Lye David Chien , Gottlieb Robert L , Haubrich Richard H , Chokkalingam Anand P , Wu George , Diaz-Cuervo Helena , Brainard Diana M , Lee I-Heng , Hu Hao , Lin Lanjia , Osinusi Anu O , Bernardino Jose I , Boffito Marta 
Published: May 2021

Abstract

Background
Remdesivir is approved by the US Food and Drug Administration for the treatment of patients hospitalized with coronavirus disease 2019 (COVID-19) and has been shown to shorten time to recovery and improve clinical outcomes in randomized trials.

Methods
This was the final day 28 comparative analysis of data from a phase 3, randomized, open-label study comparing 2 remdesivir regimens (5 vs 10 days, combined for this analysis [remdesivir cohort]) and a real-world retrospective longitudinal cohort study of patients receiving standard-of-care treatment (nonremdesivir cohort). Eligible patients, aged ≥18 years, had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), oxygen saturation ≤94% on room air or required supplemental oxygen, with pulmonary infiltrates. Propensity score matching (up to 1:10 ratio) was used to ensure comparable populations. We assessed day 14 clinical recovery (determined using a 7-point ordinal scale) and day 28 all-cause mortality (coprimary endpoints).

Results
A total of 368 (remdesivir) and 1399 (nonremdesivir) patients were included in the matched analysis. The day 14 clinical recovery rate was significantly higher among the remdesivir versus the nonremdesivir cohort (65.2% vs 57.1%; odds ratio [OR], 1.49; 95% confidence interval [CI], 1.16–1.90; P = 0.002). The day 28 mortality rate was significantly lower in the remdesivir cohort versus the nonremdesivir cohort (12.0% vs 16.2%; OR, 0.67; 95% CI, 0.47–.95; P = .03).

Conclusions
Remdesivir was associated with significantly higher rates of day 14 clinical recovery, and lower day 28 mortality, compared with standard-of-care treatment in hospitalized patients with COVID-19. These data, taken together, support the use of remdesivir to improve clinical recovery and decrease mortality from SARS-CoV-2 infection.
Acute Liver Failure and Fever of Unknown Origin
Authors: Marryshow Terry A , McQuillen Daniel P , Wener Kenneth M , Freiman J Morgan 
Published: May 2021

Abstract
We describe a case of acute liver failure in a woman in whom a diagnosis was initially unable to be established. The patient rapidly deteriorated, requiring admission to the intensive care unit, and was placed under consideration for liver transplantation. On consultation with the infectious disease service, thorough history taking was performed that uncovered salient epidemiologic information pointing toward the eventual diagnosis of disseminated histoplasmosis. We discuss aspects of diagnosis and management, including the management of immune reconstitution syndrome which complicated treatment.
Prey selection of polar bears in Foxe Basin, NU, Canada: evidence of dietary flexibility in a specialized predator
Authors: Galicia M P , Thiemann G W , Dyck M G , Ferguson S H , Stirling I 
Published: May 2021

AbstractEcological flexibility of a species reflects its ability to cope with environmental change. Although polar bears (Ursus maritimus) are experiencing changes in foraging opportunities due to sea ice loss, regional prey availability and environmental conditions will influence the rate and severity of these effects. We examined changes in polar bear diet and the influence of sea ice characteristics in Foxe Basin over an 18-year period. We combined previous fatty acid data from bears harvested from 1999 to 2003 (n = 82) with additional data from 2010 to 2018 (n = 397). Polar bear diets were diverse; however, ringed seal (Pusa hispida) was the primary prey throughout the sample period. Prey contribution varied temporally and spatially, and by intrinsic factors, while the frequency of prey in diets varied over time suggesting that diet estimates reflect the variability in available prey. Bowhead whale (Balaena mysticetus), although still a minor dietary component, has more than doubled in frequency of occurrence in diets in recent years in association with increased scavenging opportunities. Higher dietary levels of beluga whale (Delphinapterus leucas) and harbour seal (Phoca vitulina) were linked to later breakup date suggesting heavier ice conditions may promote access to both prey species. The flexible foraging strategies of bears in Foxe Basin may help mitigate their vulnerability to changes in prey distribution and habitat conditions. Our results provide insights into the importance of alternative and supplemental food sources for polar bears during phenological changes in ice conditions that will likely have consequences to Arctic community structure as warming continues.
An assessment of the psychometric properties of the Stoplight Pain Scale in a Canadian paediatric emergency department
Authors: Ali Samina , Morrison Ellen , Shwetz Seyara , Yaskina Maryna , Rajagopal Manasi , Estey Andrea , Drendel Amy L 
Published: May 2021

Abstract

Objective
This study aimed to validate a novel, three faced, colour-coded, action-oriented tool: The Stoplight Pain Scale (SPS).

Methods
A prospective observational cohort study was conducted at a Canadian paediatric emergency department from November 2014 to February 2017. Patients aged 3 to 12 years and their caregivers were asked to rate pain using the SPS and the Faces Pain Scale-Revised (FPS-R). Pain was measured just before analgesia administration, 30 minutes after analgesia administration, and immediately following a painful procedure.

Results
A total of 227 patients were included; 26.9% (61/227) were 3 to 5 years old while 73.1% (166/227) were 6 to 12 years old. Using Cohen’s κ, agreement for SPS and FPS-R was ‘fair’ for children (0.28 [95% confidence interval {CI} 0.20 to 0.36]) and ‘poor’ for caregivers (0.14 [95% CI 0.07 to 0.21]), at initial measurement. The SPS had ‘fair’ agreement between child and caregiver scores, (0.37 [95% CI 0.27 to 0.47]), compared to FPS-R which showed ‘poor’ agreement (0.20 [95% CI 0.12 to 0.29]). Absolute agreement between child and caregiver SPS scores improved with repeat exposure; 30 minutes after analgesia administration, caregivers and children had fair agreement (κ=0.38, 95% CI 0.28 to 0.48); they had moderate agreement directly following painful procedures (κ=0.46, 95% CI 0.34 to 0.59). Overall, 72.4% (139/192) of children and 60.2% (118/196) of caregivers preferred SPS over FPS-R.

Conclusion
The SPS demonstrates fair agreement with FPS-R for children and fair-moderate agreement between children and caregivers; agreement improved with repeat use. The SPS is simple and easy to use; it may have a role in empowering direct child and family involvement in pain management.
Loss ofTHIN EXINE2disrupts multiple processes in the mechanism of pollen exine formation
Authors: Wang Rui , Dobritsa Anna A. 
Published: May 2021

AbstractExine, the sporopollenin-based outer layer of the pollen wall, forms through an unusual mechanism involving interactions between two anther cell types: developing pollen and tapetum. How sporopollenin precursors and other components required for exine formation are delivered from tapetum to pollen and assemble on the pollen surface is still largely unclear. Here, we characterized an Arabidopsis (Arabidopsis thaliana) mutant, thin exine2 (tex2), which develops pollen with abnormally thin exine. The TEX2 gene (also known as REPRESSOR OF CYTOKININ DEFICIENCY1 (ROCK1)) encodes a putative nucleotide–sugar transporter localized to the endoplasmic reticulum. Tapetal expression of TEX2 is sufficient for proper exine development. Loss of TEX2 leads to the formation of abnormal primexine, lack of primary exine elements, and subsequent failure of sporopollenin to correctly assemble into exine structures. Using immunohistochemistry, we investigated the carbohydrate composition of the tex2 primexine and found it accumulates increased amounts of arabinogalactans. Tapetum in tex2 accumulates prominent metabolic inclusions which depend on the sporopollenin polyketide biosynthesis and transport and likely correspond to a sporopollenin-like material. Even though such inclusions have not been previously reported, we show mutations in one of the known sporopollenin biosynthesis genes, LAP5/PKSB, but not in its paralog LAP6/PKSA, also lead to accumulation of similar inclusions, suggesting separate roles for the two paralogs. Finally, we show tex2 tapetal inclusions, as well as synthetic lethality in the double mutants of TEX2 and other exine genes, could be used as reporters when investigating genetic relationships between genes involved in exine formation.
The COVID-19 pandemic and its impact on mental health services: the provider perspective
Authors: Nair Sapna , Kannan Preethi , Mehta Kaustav , Raju Ananya , Mathew John , Ramachandran Padmavati 
Published: May 2021

ABSTRACT

Background
The impact of coronavirus disease 2019 on mental health of populations is in focus recently but few studies focus on service adaptations to ensure care provision for the mentally ill. In India, where community-based mental healthcare is led by non-government organizations (NGOs), this is a crucial time to gather evidence on how these organizations adapted to the challenges.

Methods
We explored provider perspectives in an NGO providing mental health services to communities using in-depth interviews and a focus group discussion to understand the impact on services and adaptations during the COVID 19 pandemic.

Results
Three elements of service provision were highlighted: established relationships with communities, responsiveness to the patient needs, and resilience in ensuring continuity. Responding to the end-to-end care needs of the clients and continual adaptations were vital for ensuring continued services. Telemedicine enabled expansion of service and clientele as well as efficiency, but there were issues of casualization of therapy and poor privacy.

Conclusions
The study provides an understanding of adaptations to ensure continuity of care to mentally ill during disruptions. Insights from strategies are crucial to help plan for resilient community-based mental health care services.
Trust registries, discretionary trusts and beneficial owners: a dubious gift from civil lawyers?
Authors: Glover John 
Published: May 2021

Abstract
Registries have lately been introduced in several jurisdictions for the purpose of identifying the beneficial owners of trust property. This article examines the design of the UK registry from an Australian perspective. Problems of coherence and over-inclusion are identified in the way that the registry applies to discretionary trusts. “Control over the trust” senses of “beneficial owner” are examined in the light of good drafting criteria and authoritative statements of trusts law. Whether legislation enacting the registry will withstand future judicial scrutiny is questioned.
A Veterans' Bachelor of Science in Nursing Initiative: Ten Valuable Tips
Authors: Cox Catherine Wilson , Wiersma Gretchen Michele 
Published: May 2021

Abstract
This article describes a funded grant project whereby 10 tips are shared for those considering starting a veterans' bachelor of science in nursing initiative: secure the support of the institution; establish a point person for the initiative; maximize student success resources; acknowledge past academic work and military experience; hire prior-service Armed Forces Nurse Corps officers as faculty; deliver training opportunities for nonmilitary faculty to learn about veterans; offer students the opportunity to learn and socialize with their noncivilian peers; capitalize on the assets veterans bring to the classroom; provide a structured learning environment; and generate data-based publications.
Promoting high-functioning mental health treatment teams in the context of low staffing ratios
Authors: Miller Christopher J. , Sullivan Jennifer L. , Harvey Kimberly L. L. , Williamson Alicia K. , Stadnick Nicole A. 
Published: May 2021

Background
Many previous studies of health care teamwork have taken place in clinical teams with high staffing ratios (i.e., high ratios of staff to patients).

Purpose
The aim of this study was to identify clinicians’ viewpoints of foundational resources necessary to support good team functioning in the context of low staffing ratios.

Methodology
We used administrative data, validated with local mental health chiefs, to identify mental health teams that had achieved high team functioning despite low staffing ratios in U.S. Department of Veterans Affairs medical centers. Guided by a recently developed model of team effectiveness, the Team Effectiveness Pyramid, we conducted qualitative interviews with 21 team members across three teams within two medical centers. Interview questions focused on the resources needed to support good team functioning despite low staffing ratios. We used directed content analysis to analyze results.

Results
We found there were several domains of relevant resources: material, staffing, temporal, organizational, and psychological. These represent an expansion of the domains originally included in the Team Effectiveness Pyramid.

Conclusions
Within the five domains, we identified key tensions to be addressed when forming teams, including the balances between providing care for new versus established patients, emphasizing shared caseloads within the team versus matching patients to clinicians based on individual expertise, and establishing reporting structures by clinical discipline versus team membership.

Practice Implications
Establishing high-functioning health care teams in the context of low staffing ratios requires attention to key resource domains and fundamental trade-offs in how teams are structured.
Caring for Pediatric Hidradenitis Suppurativa Patients in the Emergency Department
Authors: Patel Kavina , Leszczynska Maria , Peña-Robichaux Venessa , Diaz Lucia Z. 
Published: May 2021

Abstract
Hidradenitis suppurativa (HS) is a chronic and recurrent inflammatory skin condition resulting in the formation of nodules, sinus tracts, and abscesses in intertriginous areas. We provide recommendations for the management of children presenting to the emergency department with acute HS flares, based on a review of literature and insights from our own clinical experience. The purpose of the recommendations is to educate clinicians on specific considerations that should be made when caring for children with HS.
Cranial Suture Evaluation in Pediatric Head Trauma
Authors: Kriss Spencer , Morris James , Martich Vesna 
Published: May 2021

Objectives
Pediatric skull fracture association with the cranial sutures (crossing, widening, or contacting 2 or more cranial sutures) is suggestive of abusive injury. We studied the efficacy of head computed tomography (CT) versus skull radiographs in identifying pediatric skull fracture association with cranial sutures and reviewed head CT literature recommendations for pediatric head trauma.

Methods
Retrospective review was performed of skull radiographs and head CT at a tertiary care, free-standing children's hospital (2012–2019). Statistical 2-proportion Z test determined efficacy of head CT versus skull radiographs in assessing cranial suture involvement with fractures.

Results
Forty-seven children with 56 abusive skull fractures and 47 children with 54 accidental skull fractures were evaluated, ages 1 to 36 months. Of the 110 total skull fractures evaluated, 51 abusive and 41 accidental skull fractures had terminal ends contacting cranial sutures for a total of 92 (84%). Twelve abusive fractures (24%) crossed sutures; no accidental fractures crossed sutures (P < 0.01). Of the 12 abusive cases with skull fractures that crossed sutures, 7 were definitively identified only on CT (P < 0.01). Widened sutures were documented in 4 (8%) of the abusive cases with skull fracture; none in the accidental cases. All 4 of these cases were equally identified on both skull radiography and CT imaging. In 21 of 47 abusive versus 5 of 47 accidental cases, CT identified skull fractures lines that extended to cranial sutures that were not definitive on skull radiography (P = 0.00022).

Conclusions
Cranial suture involvement with pediatric skull fractures is common. Head CT significantly aided in the identification of skull fractures contacting and crossing cranial sutures in abusive cases, supporting eliminating concurrent skull radiographs.
Class-Modeling of Septic Shock With Hyperdimensional Computing
Authors: Watkinson Neftali , Givargis Tony , Joe Victor , Nicolau Alexandru , Veidenbaum Alexander 
Published: May 2021

AbstractSepsis arises when a patient’s immune system has an extreme reaction to an infection. This is followed by septic shock if damage to organ tissue is so extensive that it causes a total systemic failure. Early detection of septic shock among septic patients could save critical time for preparation and prevention treatment. Due to the high variance in symptoms and patient state before shock, it is challenging to create a protocol that would be effective across patients. However, since septic shock is an acute change in patient state, modeling patient stability could be more effective in detecting a condition that departs from it. In this paper we present a one-class classification approach to septic shock using hyperdimensional computing. We built various models that consider different contexts and can be adapted according to a target priority. Among septic patients, the models can detect septic shock accurately with 90% sensitivity and overall accuracy of 60% of the cases up to three hours before the onset of septic shock, with the ability to adjust predictions according to incoming data. Additionally, the models can be easily adapted to prioritize sensitivity (increase true positives) or specificity (decrease false positives).