bluuebunny/crossref_metadata_2025_split huggingface dataset:
WiStress
Authors: Ha Unsoo , Madani Sohrab , Adib Fadel 
Published: September 2021

Stress plays a critical role in our lives, impacting our productivity and our long-term physiological and psychological well-being. This has motivated the development of stress monitoring solutions to better understand stress, its impact on productivity and teamwork, and help users adapt their habits toward more sustainable stress levels. However, today's stress monitoring solutions remain obtrusive, requiring active user participation (e.g., self-reporting), interfering with people's daily activities, and often adding more burden to users looking to reduce their stress.
In this paper, we introduce WiStress, the first system that can passively monitor a user's stress levels by relying on wireless signals. WiStress does not require users to actively provide input or to wear any devices on their bodies. It operates by transmitting ultra-low-power wireless signals and measuring their reflections off the user's body. WiStress introduces two key innovations. First, it presents the first machine learning network that can accurately and robustly extract heartbeat intervals (IBI's) from wireless reflections without constraints on a user's daily activities. Second, it introduces a stress classification framework that combines the extracted heartbeats with other wirelessly captured stress-related features in order to infer a subject's stress level. We built a prototype of WiStress and tested it on 22 different subjects across different environments in both stress-induced and free-living conditions. Our results demonstrate that WiStress has high accuracy (84%-95%) in inferring a person's stress level in a fully-automated way, paving the way for ubiquitous sensing systems that can monitor stress and provide feedback to improve productivity, health, and well-being.
Overcoming Acquired Epigenetic Resistance to BTK Inhibitors
Authors: Shaffer Arthur L. , Phelan James D. , Wang James Q. , Huang DaWei , Wright George W. , Kasbekar Monica , Choi Jaewoo , Young Ryan M. , Webster Daniel E. , Yang Yandan , Zhao Hong , Yu Xin , Xu Weihong , Roulland Sandrine , Ceribelli Michele , Zhang Xiaohu , Wilson Kelli M. , Chen Lu , McKnight Crystal , Klumpp-Thomas Carleen , Thomas Craig J. , Häupl Björn , Oellerich Thomas , Rae Zachary , Kelly Michael C. , Ahn Inhye E. , Sun Clare , Gaglione Erika M. , Wilson Wyndham H. , Wiestner Adrian , Staudt Louis M. 
Published: September 2021

Abstract

The use of Bruton tyrosine kinase (BTK) inhibitors to block B-cell receptor (BCR)–dependent NF-κB activation in lymphoid malignancies has been a major clinical advance, yet acquired therapeutic resistance is a recurring problem. We modeled the development of resistance to the BTK inhibitor ibrutinib in the activated B-cell (ABC) subtype of diffuse large B-cell lymphoma, which relies on chronic active BCR signaling for survival. The primary mode of resistance was epigenetic, driven in part by the transcription factor TCF4. The resultant phenotypic shift altered BCR signaling such that the GTPase RAC2 substituted for BTK in the activation of phospholipase Cγ2, thereby sustaining NF-κB activity. The interaction of RAC2 with phospholipase Cγ2 was also increased in chronic lymphocytic leukemia cells from patients with persistent or progressive disease on BTK inhibitor treatment. We identified clinically available drugs that can treat epigenetic ibrutinib resistance, suggesting combination therapeutic strategies.

Significance:
In diffuse large B-cell lymphoma, we show that primary resistance to BTK inhibitors is due to epigenetic rather than genetic changes that circumvent the BTK blockade. We also observed this resistance mechanism in chronic lymphocytic leukemia, suggesting that epigenetic alterations may contribute more to BTK inhibitor resistance than currently thought.
See related commentary by Pasqualucci, p. 555.
This article is highlighted in the In This Issue feature, p. 549
Spatial Variability of Diapycnal Mixing in the South China Sea Inferred from Density Overturn Analysis
Authors: Lu Yuan-Zheng , Cen Xian-Rong , Guo Shuang-Xi , Qu Ling , Huang Peng-Qi , Shang Xiao-Dong , Zhou Sheng-Qi 
Published: September 2021

AbstractThe nominal spatial distribution of diapycnal mixing in the South China Sea (SCS) is obtained with Thorpe-scale analysis from 2004 to 2020. The inferred dissipation rate ε and diapycnal diffusivity Kz between 100 and 1500 m indicated that the strongest mixing occurred in the Luzon Strait and Dongsha Plateau regions, with ε ~ 3.0 × 10−8 W kg−1 (εmax = 5.3 × 10−6 W kg−1) and Kz ~ 3.5 × 10−4 m2 s−1 (Kzmax = 4.2 × 10−2 m2 s−1). The weakest mixing occurred in the thermocline of the central basin, with ε ~ 6.2 × 10−10 W kg−1 and Kz ~ 3.7 × 10−6 m2 s−1. The ε and Kz in the continental slope indicated that the mixing in the northern part [O(10−8) W kg−1 and O(10−4) m2 s−1, respectively] was comparatively stronger than that in the Xisha and Nansha regions [O(10−9) W kg−1 and O(10−5) m2 s−1, respectively]. The Kz in the continental slope region (200–2000 m) decayed at a closed rate from the ocean bottom to the main thermocline when the measured depth D was normalized by the ocean depth H as D/H, whether in the shallow or deep oceans. The diapycnal diffusivity was parameterized as Kz = 3.3 × 10−4[1 + (1 − D/H)/0.22]−2 − 6.0 × 10−6 m2 s−1. The vertically integrated energy dissipation was nominally 15.8 mW m−2 for all data and 25.6 mW m−2 for data at stations H < 2000 m. This was about one order of magnitude higher than that in the open oceans (3.0–3.3 mW m−2), which confirmed the active mixing state in the SCS.
Our experience of operated pediatric ureteropelvic junction obstruction patients
Authors: Muradi Teymursha , Turkyilmaz Zafer , Karabulut Ramazan , Sonmez Kaan , Kaya Cem , Polat Fazli , Basaklar Abdullah Can 
Published: September 2021

Aims: Ureteropelvic junction obstruction (UPJO) may originate from extrinsic or intrinsic causes in children. The aim of this study is to present preoperative and postoperative data of our patients operated for UPJO. Methods: A total of 64 patients who underwent open pyeloplasty were investigated retrospectively. They were evaluated in terms of demographically, clinics, hydronephrosis, differential renal functions (DRFs), half-time tracer clearance (½TC), and histopathologic results. Patients’ numerical results were stated as mean ± standard deviation (SD). Results: Male gender was more prevalent ( n = 47, 73.4%) and mean age at surgery was 46.87 months. UPJO was located at the left side in 56.3% ( n = 36), and at the right side in 39.1% ( n = 25) of patients. It was bilateral in 4.7% ( n = 3). Hydronephrosis was found antenatally in 68.8% ( n = 44) of patients. The mean preoperative DRF was 49.7% (21–78%) and mean postoperative DRF was 49.2% (20–56%). Mean renal scintigraphic t1/2 was >20 min for all patients. The mean AP diameter was 21.58 mm (10–62 mm). Muscular hypertrophy was the most common pathological finding, mean length of excised segment was 10.26 mm (3–40 mm). Crossing vessel (CV) was detected in 17.18% ( n = 11). The CV was statistically associated with increased age of operation, left side, and female gender. Statistically significant hydronephrosis was found in non-CV patients. Re-operation was required in seven patients (7.8%). Conclusions: Intrinsic pathologies are more seen in the etiology of UPJO patients with antenatal diagnosis and this group needs operation at an earlier age. However, CV is found more commonly in patients who are diagnosed and operated at older ages.
Generalized Anxiety Disorder 7-Item (GAD-7) Scores in Medically Authorized Cannabis Patients—Ontario and Alberta, Canada
Authors: Lee Cerina , Round Jessica M. , Hanlon John G. , Hyshka Elaine , Dyck Jason R.B. , Eurich Dean T. 
Published: September 2021

Objectives Despite increasing rates of legalization of medical cannabis worldwide, the current evidence available on its effect on mental health outcomes including anxiety is of mixed results. This study assesses the effect of medical cannabis on generalized anxiety disorder 7-item (GAD-7) scores in adult patients between 2014 and 2019 in Ontario and Alberta, Canada. Methods An observational cohort study of adults authorized to use medical cannabis. The GAD-7 was administered at the time of the first visit to the clinic and subsequently over the follow-up time period of up to 3.2 years. Overall changes in GAD-7 scores were computed (mean change) and categorized as: no change (<1 point); improvement; or worsening—over time. Results A total of 37,303 patients had initial GAD-7 scores recorded and 5,075 (13.6%) patients had subsequent GAD-7 follow-up scores. The average age was 54.2 years (SD 15.7 years), 46.0% were male, and 45.6% noted anxiety symptoms at the baseline. Average GAD-7 scores were 9.11 (SD 6.6) at the baseline and after an average of 282 days of follow-up (SD 264) the average final GAD-7 score recorded was 9.04 (SD 6.6): mean change −0.23 (95% CI, −0.28 to −0.17, t[5,074]: −8.19, p-value <0.001). A total of 4,607 patients (90.8%) had no change in GAD-7 score from their initial to final follow-up, 188 (3.7%) had a clinically significant decrease, and 64 (1.3%) noted a clinically significant increase in their GAD-7 scores. Conclusions Overall, there was a statistically significant decrease in GAD-7 scores over time (in particular, in the 6–12-month period). However, this change did not meet the threshold to be considered clinically significant. Thus, we did not detect clinical improvements or detriment in GAD-7 scores in medically authorized cannabis patients. However, future well-controlled clinical trials are needed to fully examine risks or benefits associated with using medical cannabis to treat anxiety conditions.
Relationship Between Nutrition Intake and Outcome After Subarachnoid Hemorrhage: Results From the International Nutritional Survey
Authors: Badjatia Neeraj , Ryan Alice , Choi H. Alex , Parikh Gunjan Y. , Jiang Xuran , Day Andrew G. , Heyland Daren K. 
Published: September 2021

Background: A previous study suggested an association between low caloric intake(CI), negative nitrogen balance, and poor outcome after subarachnoid hemorrhage(SAH). Objective of this multinational, multicenter study was to investigate whether clinical outcomes vary by protein intake(PI) or CI in SAH patients adjusting for the nutritional risk as judged by the modified NUTrition Risk in the Critically Ill (mNUTRIC) score. Methods: The International Nutrition Survey(INS) 2007-2014 was utilized to describe the characteristics, outcomes and nutrition use. A subgroup of patients from 2013 and 2014(when NUTRIC score was captured) examined the association between CI and PI and time to discharge alive(TTDA) from hospital using Cox regression models, adjusting for nutrition risk classified by the mNUTRIC score as low(0-4) or high(5-9). Results: There were 489 SAH patients(57% female with a mean ± SD age 57.5 ± 13.9 years, BMI of 25.9 ± 5.3 kg/m2 and APACHE-2 score 19.4 ± 7.0. Majority(85%) received enteral nutrition(EN) only, with a time to initiation of EN of 35.4 ± 35.2 hours. 64% had EN interrupted. Patients received a CI of 14.6 ± 7.1 calories/kg/day and PI 0.7 ± 0.3 grams/kg/day corresponding to 59% and 55% of total prescribed CI and PI respectively. In the 2013 and 2014 subgroup there were 226 SAH patients with a mNUTRIC score of 3.4 ± 1.8. Increased CI and PI were associated with faster TTDA among high mNUTRIC patients(HR per 20% of prescription received = 1.34[95% CI,1.03 -1.76] for CI and 1.44[1.07 -1.93] for PI), but not low mNUTRIC patients(CI: HR = 0.95[0.77 -1.16] PI:0.95[0.78 -1.16]). Conclusions: Results from this multicenter study found that SAH patients received under 60% of their prescribed CI and PI. Further, achieving greater CI and PI in hi risk SAH patients was associated with improved TTDA. mNUTRIC serves to identify SAH patients that benefit most from artificial nutrition and efforts to optimize protein and caloric delivery in this subpopulation should be maximized.
The influence of race on parental beliefs and concerns during an autism diagnosis: A mixed-method analysis
Authors: Azad Gazi , Holingue Calliope , Pfeiffer Danika , Dillon Emily , Reetzke Rachel , Kalb Luke , Menon Deepa , Hong Ji Su , Landa Rebecca 
Published: September 2021

The purpose of this mixed-method study was to examine racial differences in parental beliefs and concern about autism spectrum disorder (ASD) versus clinical judgment. The sample included 489 children with ASD undergoing their first ASD evaluation. Parent belief that their child had ASD was highest among parents of White children. White children whose parents believed the child had ASD had lower ASD severity. Parents of Black/African American and Hispanic children were more likely to report communication concerns than parents of White children. Parental concern about social communication was related to higher ASD severity for Hispanic children. Implications for diagnostic processes are discussed. Lay abstract The goal of this study was to examine if there were differences between races in parental concern and belief about autism spectrum disorder (ASD) and the perspectives of clinicians. We studied 489 children with ASD who were having their first evaluation at an ASD clinic. Parents of White children most often believed that their child had ASD. However, White children whose parents believed the child had ASD were less severe in their symptoms. Parents of Black/African American or Hispanic children were more likely to have concerns about communication than parents of White children. In Hispanic families, parental concern about social communication was related to more severe symptoms in children. We discuss the implications of our findings for diagnosis.
Functioning of children and adolescents with Down syndrome and the association with environmental barriers and facilitators during the COVID-19 pandemic
Authors: Brugnaro Beatriz Helena , de Camargo Olaf Kraus , Corsi Carolina , de Campos Ana Carolina , Fernandes Gesica , Pavão Silvia Letícia , Rocha Nelci Adriana Cicuto Ferreira 
Published: September 2021

Purpose: To compare functioning and environmental aspects before and during physical distancing (DPD) and to determine which social, physical, behavioral and functioning aspects of DPD are correlated. Methods: Sixteen parents of children/adolescents with Down syndrome (11.38 ± 3.00 years) were surveyed before and DPD. Paired t-tests were used to compare functioning and environmental aspects before and DPD and chi-square tests were used to test associations. Results: There were increases in the frequency (p < 0.001) and involvement (p = 0.01) in home participation and on the impact, noticed by the parents, of the possibility of child to participate in daily activities (p = 0.036), as well as a reduction in social supports perceived by caregivers (p = 0.049). An association was found between the child’s socio-emotional difficulties symptoms and practice of physical activity (p = 0.043) and with parents’ satisfaction with the level of child’s home participation (p = 0.042). Conclusion: Functioning can be affected in either positive or negative ways.
Surgical Precision and Efficiency of a Novel Electromagnetic System Compared to a Robot-Assisted System in Percutaneous Pedicle Screw Placement of Endo-LIF
Authors: Xu Derong , Ma Xuexiao , Xie Lei , Zhou Chuanli , Kong Biao 
Published: September 2021

Study Design: Retrospective database study. Objectives: To compare the accuracy and safety of 2 types of a computer-assisted navigation system for percutaneous pedicle screw placement during endoscopic lumbar interbody fusion. Methods: From May 2019 to January 2020, data of 56 patients who underwent Endo-LIF with a robot-assisted system and with an electromagnetic navigation system were compared. The pedicles in all patients were subjected to postoperative CT scan to assess screw correction by measuring the perpendicular distance between the pedicle cortical wall and the screw surface. The registration and matching time, guide-wire insertion time, the entire surgery time, and X-ray exposure time were recorded. Results: In the robot-assisted group, 25 cases with 100 percutaneous pedicle screws were included, and the excellent and good rate was 95%. In the electromagnetic navigation group, 31 cases with 124 screws were included, and the excellent rate was 97.6%. There was no statistical difference between the two groups ( P > 0.05). The registration time and the total time for the surgery also showed no statistical differences ( P > 0.05). The main difference between the two groups was the guide-wire insertion time and the X-ray exposure time ( P < 0.05). Conclusions: Both electromagnetic navigation and robot-assisted are safe and efficient for percutaneous pedicle screw placement. Electromagnetic navigation system has obvious advantages over robot-assisted in terms of faster guide-wire placement and less X-ray exposure. Robot-assisted for percutaneous pedicle screw placement offers a preoperative planning system and a stable registration system, with obvious drawbacks of a strict training curve.
Mandatory Prescription Limits and Opioid Use After Anterior Cruciate Ligament Reconstruction
Authors: Kamaci Saygin , Ozdemir Erdi , Utz Christopher , Colosimo Angelo 
Published: September 2021

Background: Because of the need for perioperative pain management, orthopaedic surgeons play an important role in opioid use. Purpose/Hypothesis: To evaluate the impact of opioid-limiting legislation on postoperative opioid use and pain-related complications after anterior cruciate ligament reconstruction (ACLR). The hypothesis was that the opioid-limiting legislation would reduce postoperative opioid use after ACLR. Study Design: Cohort study; level of evidence, 3. Methods: We retrospectively reviewed patients who underwent ACLR 1 year before and 1 year after Ohio's opioid-limiting legislation, which was passed in August 2017. Clinicians were prohibited from prescribing more than 30 morphine milligram equivalents (MMEs) per day, with a maximum duration of 7 days for adults. The Ohio Automated Rx Reporting System database and patients’ medical charts were reviewed for prescriptions of all controlled substances (oral oxycodone, hydrocodone, morphine, codeine, tramadol, and hydromorphone) filled from 30 days before and 90 days after ACLR. The total number of postoperative prescriptions, total MMEs, the number of pills in each patient’s prescription, and pain-related complications (emergency department visits, office calls for pain control issues, unplanned readmissions, unplanned surgeries, and provider notes indicating opioid prescription refill demands) were evaluated. Results: A total of 243 patients (127 prelegislation, 116 postlegislation) were included in the study. There were no significant differences in demographics or preoperative opioid use between the study groups. The number of pills prescribed initially decreased by 34% after legislation (63.5 ± 16.7 [prelegislation] vs 42 ± 15.7 pills [postlegislation]; P < .001). Correspondingly, there was a significant decrease in total quantity of initial prescriptions in the postlegislation period (474.6 ± 123.8 vs 310.7 ± 115.3 MMEs; P < .001). The number of documented pain medication refill demands and pain-related complications did not increase in the postlegislation period (42 prelegislation vs 43 postlegislation; P = .514). Preoperative opioid use was the strongest predictor of opioid-refill demand (odds ratio, 4.19 [95% CI, 1.76-9.99]; P = .001). Conclusion: After the Ohio legislation was passed limiting opioid prescription, there was a significant reduction in opioids provided for patients undergoing ACLR. In spite of this decrease, no rebound increase in refill demands or postoperative pain-related complications were observed.
What Mother, Midwives, and Traditional Birth Helper Said About Early Initiation of Breastfeeding in Buginese-Bajo Culture
Authors: Syam Azniah , Abdul-Mumin Khadizah H. , Iskandar Imelda 
Published: September 2021

Introduction The aim of this study is to investigate how mothers, families, midwives, and traditional birth attendants in the Buginese-Bajo culture understanding breastfeeding and early initiation of breastfeeding (EIBF). Also to assess what support mothers receive from families, midwives, and traditional birth attendants during pregnancy, birth, and EIBF. Methods This qualitative study included 21 subjects (11 pregnant women, three midwives, and seven traditional birth attendants). Recorded interviews with the three groups of participants were transcribed verbatim and analyzed separately, using latent content analysis. The study started in December 2014 and ended in July 2015. Results Some mothers understood the meaning of EIBF, but engaged in it for different reasons. The midwives interpreted the principle of EIBF differently from a duration perspective. Traditional birth attendants explained it as a way to strengthen the relationship between mothers, and babies; they believed that prolonging breastfeeding until 2 years would change babies into caring children. According to them, this skin-to-skin contact has been practice for a century by traditional birth helpers. The philosophy of breastfeeding, according to the Buginese-Bajo, is creating “ peru” relationships for mothers and babies each other for their whole lives. Conclusion These findings show a connection between established science and cultural beliefs. The concept of peru is the central philosophy to be achieved in EIBF. Breast-feeding's psychological value is known and passed from generation to generation; this essential fact needs to be preserved as local capital for changing breastfeeding behavior. The government should pay more attention to this opportunity to increase awareness and promote breastfeeding behavior changes.
Effect of Detailed OSCE Score Reporting on Learning and Anxiety in Medical School
Authors: Daniels Vijay J. , Ortiz Silvia , Sandhu Gurtej , Lai Hollis , Yoon Minn N. , Bulut Okan , Hillier Tracey 
Published: September 2021

Introduction There is growing literature on increasing feedback from Objective Structured Clinical Examinations (OSCEs) and one approach is a score report. The purpose of this study was to implement and evaluate a score report for a second and fourth-year medical school OSCE. Methods We developed an electronic OSCE score report that displayed comments and performance by domain within and across stations (checklist items and rating scales were tagged to each domain). Our initial pilot released the score report after pass/fail decisions but subsequent iterations released the score report the same day as the exam. Our evaluation approach included both student surveys and focus groups. Results Students felt the OSCE score report was accurate, identified strengths and weaknesses, and would likely cause them to take future action, with second-year students more likely to act on the report than fourth year students. The thematic analysis revealed barriers and enablers to utilizing feedback as well as the power of the score report to reduce anxiety. Conclusions Our OSCE score report was simple to develop and implement the same day as an OSCE with an overall positive response from students with respect to accuracy and ability to use the information for future learning.