A common framework to situate digital and physical traces in time

In this article, three main approaches to situate forensic traces in time were revisited under the prism of the Sydney Declaration and adapted to be applicable to a large range of physical and digital traces. The first approach is based on time tags which are time-based characteristics produced as the result of an activity at a specific time. They can either be directly related to time (i.e., time stamps) or indirectly (i.e., time indicators). While relatively straightforward, time tags require scientific knowledge to be correctly interpreted and to account for the risks of desynchronisation, anomalies and manipulation. The second approach is based on time dynamics and aim at measuring changes that occur as a function of time, such as caesium pulsation (i.e., on which international atomic time is based) or body cooling after death (i.e., from which time since death can be inferred). However, time dynamics phenomena are generally also influenced by other case-specific factors (e.g., environmental factors), and thus more difficult to reliably implement in practice. Finally, the third approach relies on relative sequences, using information unrelated to time, such as relative positions or dynamics of traces at the scene. As each approach has its potential and limitations, a combination of traces from different (both material and digital) sources and approaches is recommended to answer time questions in practice (When? How long? In which succession?) and enhance the reliability of the dating endeavours. It is strongly recommended to consider the principles of the Sydney Declaration when implementing or developing dating methods, as they point at potential issues that are often forgotten in forensic research and practice, such as uncertainties linked to the concept of trace, scene investigation, the asymmetry of time, the importance of context and the multiplicity of purposes. Future research should focus on improving the reliability of these dating approaches by combining and systematising their usage in investigative practice, as well as in broader intelligence processes.

The late origins of the timeline, or: three paradoxes explained

We are all used to drawing straight lines to represent time, and above them, we plot historical events or physical or economic data. What to us is a self-evident convention, is however of an astonishingly recent date: it emerged only in the second half of the eighteenth century. To us, this late date seems paradoxical and cries out for an explanation. How else did earlier periods measure change, if not as a function of time? it will be argued that since Antiquity, time was taken to measure change, and change to occur in space. 'Our' idea of representing time as an independent dimension would have seemed aberrant. But then, a second issue arises. Did not medieval natural philosophers employ timelines, Oresme's diagram of the mean speed theorem being the most famous case? However, as will be shown, our interpretation of his diagram is probably wrong. This insight, in turn, takes care of a third paradox, namely Galileo's initial inability to represent the law of free fall correctly. This article will document that the timeline first emerged in the late sixteenth century in works on chronology, made its first appearance in physics in Galileo's diagrams, and had its general breakthrough in the eighteenth century.

Longitudinal NGAL and cystatin C plasma profiles present a high level of heterogeneity in a mixed ICU population

BACKGROUND

NGAL and Cystatin C (CysC) as biomarkers for the early detection of AKI are subject to both pathophysiological, as well as patient related heterogeneity. The aim of this study was to investigate the timeline of plasma levels of NGAL and CysC during the first seven days of ICU admission in a mixed ICU population and to relate these to AKI severity during ICU stay. Via these means we aimed to bring clarity to the previously reported heterogeneity of these renal biomarkers.

METHODS

Prospective Observation Cohort. Consecutive patients admitted to adult ICU at an academic hospital in the Netherlands between 18-02-2014 and 31-03-2014 were included. Urine output, serum creatinine, plasma NGAL and CysC were recorded during the first seven days of ICU admission. Biomarker expression was analyzed based on KDIGO score and time of AKI diagnosis.

RESULTS

335 patients were included, 110 met KDIGO criteria for AKI. NGAL and CysC plasma levels were higher in AKI patients compared to non-AKI, high variability in individual values resulted in 56% of AKI patients having a false negative, and 32% of non-AKI patients having a false positive. Individual biomarker levels were variable, and no pattern based on KDIGO score was observed.

CONCLUSIONS

Plasma NGAL and CysC as biomarkers for the early AKI detection may be subject to pathophysiological, and patient related heterogeneity. Further understanding of individual biomarker profiles may help in their application amongst mixed ICU populations.

TRIAL REGISTRATION

The need for informed consent was waived by the Institutional Ethical Review Board of the University Medical Center Groningen (METc 2013 - 174) by Prof. dr. W.A. Kamps on May 17th 2013.

Depth profiles of microplastics in sediments from inland water to coast and their influential factors

Microplastics, plastic particles with a size smaller than 5 mm, are widely observed in the global environments and pose a growing threat as they accumulate and affect the environments in numerous ways. These particles can be transported from inland water to coast and disperse from surface water to deep sediments, especially the latter, while knowledge of the hidden microplastics in sediment layers is still lacking. Understanding the characteristics and behavior of microplastics in deep sediments from inland water to coast is crucial for estimating the present and future global plastic budget from land to seas. Herein, present knowledge of microplastic sedimentation from inland water to coast is reviewed, with a focus on the physical characteristics of microplastics and environmental factors that affect sedimentation. The abundance, shape, composition, and timeline of microplastics in sediment layers in rivers, floodplains, lakes, estuaries and coastal wetlands are presented. The abundance of microplastics in sediment layers varies across sites and may exhibit opposite trends along depth, and generally the proportion of relatively small microplastics increases with depth, while less is known about the vertical trends in the shape and composition of microplastics. Timeline of microplastics is generally linked to the sedimentation rate, which varies from millimeters to centimeters per year in the reviewed studies. The spatiotemporal characteristics of microplastic sedimentation depend on the settling and erosion of microplastics, which are determined by two aspects, microplastic characteristics and environmental factors. The former aspect includes size, shape and density influenced by aggregation and biofouling, and the latter includes dynamic forces, topographic features, bioturbation and human activities. The comprehensive review of these factors highlights the needs to further quantify the characteristics of microplastic sedimentation and explore the role of these factors in microplastic sedimentation on various spatiotemporal scales.

Cytopathology fellowship recruitment: historical context, current state, and future considerations

Fellowship recruitment and retention of a skilled workforce is one of the biggest challenges that not only cytopathology is facing but that the field of pathology in general is being confronted with. There have long been issues with the fellowship recruitment process for both applicants and fellowship directors, including pressure to move the application process earlier and earlier and frustrations stemming from applicants needing to determine different individual timelines and program requirements. The unified timeline for fellowship recruitment was established as an attempt to standardize the recruitment process and to address the key issues of the push for earlier and earlier decision-making, which placed significant anxiety on trainees, as well as the burden on programs of more unexpected openings. While institution of the unified timeline has had many successes, there have been problems as well. Here, we discuss the multifaceted and intertwined factors that affect fellowship recruitment with a review of the historical context and the current setting and with an eye towards future directions. In the end, the issues we are currently facing are complex and there is likely no perfect solution to fixing an inherently broken system. However, the ultimate goal should be in better supporting our trainees' development and promoting a more fair and equitable recruitment process. Only by working together can we optimize the process for both applicants and programs alike.

Return to sports after ankle reconstruction with tendon grafts in chronic lateral ankle instability: A systematic review and meta-analysis

Purpose

Anatomic reconstruction using grafts is being performed more frequently in athletes experiencing recurrent chronic lateral ankle instability (CLAI). The purpose of the study was to systematically review the current literature to determine the rates of return to sports (RTS) along with timing in patients with CLAI undergoing ligament reconstruction.

Methods

The databases PubMed, Scopus, Cochrane, and Embase were searched based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles quoting on the return to sports rate after lateral ankle reconstruction were included. The rates of return to any sports, return to pre-injury sports, and return to competitive sports along with the timing of return were evaluated and a proportion meta-analysis was performed.

Results

A total of 720 patients in 20 studies met our inclusion criteria. The RTS rates for any sports were 95.3%, and 84.3% for pre-injury sports The average time taken for return to sports was 17 weeks. Postoperative functional outcomes, ankle stability, and ROM were significantly improved in comparison to preoperative status.

Conclusion

The RTS rates following lateral ankle reconstruction in CLAI showed a high return to any sports, but moderate to high rates for the pre-injury or competitive level of sports.

Level of evidence

Level of evidence II.

Analyses of associated factors with concomitant meniscal injury and irreparable meniscal tear at primary anterior cruciate ligament reconstruction in young patients

Purpose

Although several factors related to the concomitant meniscal injury at anterior cruciate ligament reconstruction (ACL-R) have been investigated in a general population, few studies have identified the risk factors of meniscal tear severity in young patients in which the majority of ACL tears occur. The purpose of this study was to analyze the associated factors with meniscal injury and irreparable meniscal tear and the timeline for medial meniscal injury at ACL-R in young patients.

Methods

A retrospective analysis of young patients (13 to 29 years of age) who underwent ACL-R by a single surgeon from 2005 to 2017 was conducted. Predictor variables (age, sex,body mass index [BMI], time from injury to surgery [TS], and pre-injury Tegner activity level) for meniscal injury and irreparable meniscal tear were analyzed with multivariate logistic.

Results

Four hundred and seventy-three consecutive patients with an average of 31.2 months post-operative follow-up were enrolled in this study. The risk factors for medial meniscus injury were TS (<= 3 months) (odds ratio [OR], 3.915; 95% CI, 2.630-5.827; P < .0001) and higher BMI (OR, 1.062; 95% CI, 1.002-1.125; P = 0.0439). The presence of irreparable medial meniscal tears correlated with higher BMI (OR, 1.104; 95% CI, 1.011-1.205; P = 0.0281).

Conclusion

An increased time from ACL tear to surgery of 3 months was strongly associated with an increased risk of medial meniscus injury, but not related to irreparable medial meniscal tear at primary ACL reconstruction in young patients.

Level of Evidence

Level IV.

Assessment of care timelines in intestinal malrotation with volvulus: A retrospective chart review

BACKGROUND

Patients with intestinal malrotation with volvulus (MWV) may suffer bowel ischemia, which can be correlated with the timing of surgical intervention. The purpose of this study was to identify and assess time-blocks in the care of patients from initial physician assessment (IPA) to surgical intervention to highlight potential opportunities for improvement.

METHODS

Retrospective chart review of patients with MWV presenting to McMaster Children's Hospital between January 1st, 2000 and December 31st, 2020 (n = 31). Demographic data and time-blocks of care were identified and analyzed (p < 0.05 considered significant). All times were reported as medians.

RESULTS

22 males (71%) and 9 females (29%) were identified; median age was 9.8 d. IPA to incision was 10.7hrs and surgical consult to incision was 3.4hrs. Time to incision for patients <1 y was not significantly different than those >1 y (10.5hrs vs 10.7hrs, p = 0.737). The use of ultrasound did not significantly affect time to incision (7.9hrs vs 12.0hrs, p = 0.128). For patients requiring resection or having pan-necrosis there was no significant difference in time from IPA (10.9hrs vs 10.5hrs, p = 0.238) or surgical consult to incision (4.0hrs vs 3.3hrs, p = 0.808).

CONCLUSION

Time from IPA to surgical consult and time from surgical consult to surgical intervention represented the largest proportions of time. Age, use of ultrasound, and need for resection or having pan-necrosis did not significantly affect the time to incision. This data may be used to inform opportunities for expediting the management of patients with MWV once they have presented to a physician.

LEVEL OF EVIDENCE

III.

A study of the MAYV replication cycle: Correlation between the kinetics of viral multiplication and viral morphogenesis

Mayaro virus (MAYV) is mainly found in Central and South America and causes a febrile illness followed by debilitating arthritis and arthralgia similar to chikungunya virus (CHIKV). Infection leads to long-term sequelae with a direct impact on the patient's productive capacity, resulting in economic losses. Mayaro fever is a neglected disease due to the limited epidemiological data. In Brazil, it is considered a potential public health risk with the number of cases increasing every year. Most of our knowledge about MAYV biology is inferred from data obtained from other alphaviruses as well as more recent studies on MAYV. Here, we analyzed the kinetics of viral replication through standard growth curves, quantification of intracellular and extracellular particles, and RNA quantification. We compared transmission electron microscopy data during different stages of infection. This approach allowed us to establish a chronological order of events during MAYV replication and its respective timepoints including cell entry through clathrin-mediated endocytosis occurring at 15-30 min, genome replication at 2-3 h, morphogenesis at 4 hpi, and release at 4-6 hpi. We also present evidence of uncharacterized events such as ribosome reorganization as well as clusters of early viral precursors and release through exocytosis in giant forms. Our work sheds new and specific light on the MAYV replication cycle and may contribute to future studies on the field.

The dynamics and the timeline of speciation in the gall-forming aphid Geoica spp. within and among Pistacia host tree species

Trees of the genus Pistacia serve as obligate hosts for gall-forming aphids (Hemiptera, Aphididae, Fordini). Each aphid species induces a characteristic gall on a single Pistacia host species. The genus Geoica (Fordini) induce similar spherical closed galls on the lower side of the leaflet's midvein, on different Pistacia species. Two species of Pistacia trees that harbor Geoica galls grow naturally in Israel: P. palaestina and P. atlantica. We analyzed the phylogeny and the genetic structure of the Geoica species complex in Israel, and assessed the genetic differentiation and the level of host plant specificity of the aphids between P. atlantica and P. palaestina. We found that the splitting of the genus between P. atlantica and P. palaestina is estimated to have occurred 24-25 Ma (the Oligocene/Miocene boundary). Five different haplotypes suggesting five different species have been further speciating among Geoica spp., galling on P. atlantica, and an additional three species, on P. palaestina.

Dataset: COVID-19 epidemic policy and events timeline (Sweden)

The Swedish approach to managing the 2020-2021 COVID-19 pandemic has received significant attention in international scholarly work and press. For this dataset, we have reviewed governmental and media archives to build a detailed timeline that chronicles significant policies, interventions, and events in the Swedish management of COVID-19. The dataset contains summary descriptions of what took place, when it happened, and who the principal actors involved were. Links to primary sources are provided for each entry. Because of the level of detail and saturation, the dataset offers a detailed account of Swedish pandemic governance and will benefit anyone working on Swedish pandemic management or doing comparative work between Sweden and other jurisdictions.

The timeline of mentalization: Distinguishing a two-phase process from mind detection to mind attribution

Mentalization is the ability to perceive other people's mental states. This research aimed to deepen our understanding of the underlying mechanisms while also exploring the timeline of the mentalization process. Two studies were conducted in which participants' electrophysiological activity was measured while elaborating Black and White (Study 1), or Italian (ingroup) and Romanian (outgroup), human and doll-like faces (Study 2). Moreover, in Study 2 the presented faces differed in their Facial Width-to-Height Ratio. Subsequently, an Implicit Mind Attribution Test (IMAT) measured the strength of the association of the same ingroup and outgroup human stimuli with mind and body-related words. Two different phases in the time course of the mentalization process emerged. An early ERP component (N170) indicated a first difference between doll-like, mindless and human, mindful targets, while a later ERP component (P300) represented the second stage of mentalization. In this stage, outgroup doll-like faces were elaborated more similarly to the outgroup human faces compared to the same stimuli of the ingroup. Moreover, only a positive correlation between the P300 and the IMAT emerged indicating that the differences in this later ERP component were related with an implicit behavioral measure of mind attribution. These results stipulate the timeline of the mentalization process that is defined by an initial moment of mind detection, in which mindful and mindless stimuli are differentiated for the first time, and a second phase of mind attribution, where the interplay of perceptual and contextual information determine the extraction of a mind from a face.

Cytopathology fellowship recruitment: Has the time come to consider a unified approach?

INTRODUCTION

Cytopathology (CYP) fellowship training is a critical component of maintaining a skilled group of cytopathologists. For years, the recruitment process for CYP fellowship programs has remained unchanged, with individual programs outlining their own requirements and timeline, and applicants bearing the cost of travel and dealing with the variable processes outlined by individual programs. However, there has been renewed interest in analyzing the recruitment process for CYP fellowships to look for areas of potential improvement and uniformity.

METHODS

With the goal of gauging the interest of CYP fellowship program directors (PDs) in a more unified approach to recruitment or a formal match process, the ASC Cytopathology Program Directors Committee (CPDC) surveyed PDs via SurveyMonkey and organized special webinars with polling over a 4-year time frame (2017-2021), and examined Qualtrics survey data collected by the American Board of Pathology (ABPath) in 2020.

RESULTS

The response rate for PDs was greatest in a formal survey by the ABPath (66 respondents; 71% of PDs) conducted in 2020, and lower for an ASC survey in 2021 (61 respondents, 66% of PDs) and 2017 (19 respondents; 21% of PDs) and two recent ASC webinars (10 and 26 respondents; 11% and 28% of PDs). Support for a fellowship match process varied from 29% to 77%, respondent uncertainty ranged from 13% to 50%, and a lack of support ranged from 10% to 60%. In aggregate, approximately 56% of respondents would be in favor of a more standardized process. Recently, after hearing about other fellowships experimenting with a standardized process, the interest in a unified approach doubled from approximately 29% to 60%, and the percentage of PDs with uncertainty decreased from 50% to 26%. In the most recent follow up survey, interest reached the highest level of 77% among PDs.

CONCLUSIONS

Herein we present several years of feedback from the CYP fellowship PD community regarding a more standardized approach to CYP fellowship recruitment, culminating in the latest survey with 77% of CYP fellowship PDs expressing interest. Thus, details about what a unified timeframe may look like for CYP fellowships is presented to show how this may improve the recruitment process for the mutual benefit for programs and applicants.

Timelines and rebleeds in patients admitted into neurosurgical care for aneurysmal subarachnoid haemorrhage

Background

Mortality and morbidity of aneurysmal subarachnoid haemorrhage (aSAH) remain high, and prognosis is influenced by multiple non-modifiable factors such as aSAH severity. By analysing the chronology of aSAH management, we aim at identifying modifiable factors with emphasis on the occurrence of rebleeds in a setting with 24/7 surgical and endovascular availability of aneurysm repair and routine administration of tranexamic acid.

Methods

Retrospective analysis of institutional quality registry data of aSAH cases admitted into neurosurgical care during the time period 01 January 2013–31 December 2017. We registered time and mode of aneurysm repair, haemorrhage patterns, course of treatment, mortality and functional outcome. Rebleeding was scored along the entire timeline from ictus to discharge from the primary stay.

Results

We included 544 patients (368, 67.6% female), aged 58 ± 14 years (range 1–95 years). Aneurysm repair was performed in 486/544 (89.3%) patients at median 7.4 h after arrival and within 3, 6, 12 and 24 h in 26.8%, 44.7%, 73.0% and 96.1%, respectively. There were circadian variations in time to repair and in rebleeds. Rebleeding prior to aneurysm repair occurred in 9.7% and increased with aSAH severity and often in conjunction with patient relocations or interventions. Rebleeds occurred more often during surgical repair outside regular working hours, whereas rebleeds after repair (1.8%) were linked to endovascular repair.

Conclusions

The risk of rebleed is imminent throughout the entire timeline of aSAH management even with ultra-early aneurysm repair. Several modifiable factors can be linked to the occurrence of rebleeds and they should be identified and optimised within neurosurgical departments.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00701-020-04673-3.

Right, left and cilia: How asymmetry is established

The initial breaking of left-right (L-R) symmetry in the embryo is controlled by a motile-cilia-driven leftward fluid flow in the left-right organiser (LRO), resulting in L-R asymmetric gene expression flanking the LRO. Ultimately this results in left- but not right-sided activation of the Nodal-Pitx2 pathway in more lateral tissues. While aspects of the initial breaking event clearly vary between vertebrates, events in the Lateral Plate Mesoderm (LPM) are conserved through the vertebrate lineage. Evidence from model systems and humans highlights the role of cilia both in the initial symmetry breaking and in the ability of more lateral tissues to exhibit asymmetric gene expression. In this review we concentrate on the process of L-R determination in mouse and humans.

Effect of different rehabilitation training timelines to prevent shoulder dysfunction among postoperative breast cancer patients: study protocol for a randomized controlled trial

Introduction

Due to advancements in treatment, the survival of breast cancer (BC) patients has significantly improved. Improving the postoperative quality of life has become a widespread concern for patients and doctors. At present, the staged rehabilitation training program for postoperative BC patients has been recognized. However, there is not yet a consensus about the optimal time to initiate rehabilitation training. We designed this study to investigate the optimal intervention times for postoperative BC patients to begin different stages of rehabilitation.

Design

This is a randomized controlled trial. Female participants with BC who are scheduled to undergo mastectomy, including unilateral total breast or breast-conserving surgery plus axillary lymph node dissection, will be enrolled in this study. The intervention includes the following: 200 participants will be allocated using a 1:1:1:1 ratio to the A, B, C, and D groups, which have four different rehabilitation timelines for four phases of rehabilitation exercises. A therapist will evaluate the patient’s overall health and then adjust the training intensity before initiating training. The assessments include upper limb mobility, grip, limb circumference, postoperative drainage volume (PDV), and pain. The training will last for 12 weeks, and patients will undergo follow-up twice within 6 weeks after discharge. Outcomes include the following: Constant-Murley Score (CMS) is the primary parameter. European Organization Research and Treatment of Cancer Quality of Life Questionnaire-BR23 (EORTC QLQ-BR23), SF-36, range of motion (ROM), strength, grip, circumference, PDV, and pain are the secondary parameters. All enrolled subjects will be assessed at 1 day, 3 days, 1 week, and 2, 3, 6, 9, 12, and 18 weeks after the surgery.

Discussion

This is a randomized controlled trial to evaluate the effect of different rehabilitation training timelines to prevent shoulder dysfunction among postoperative patients with BC. If the results are confirmed, this study will establish an optimal timeline for postoperative BC rehabilitation.

Trial registration

ClinicalTrials.gov NCT03658265. Registered on September 2018.

Vaccines for COVID-19: The current state of play

There is a strong consensus globally that a COVID-19 vaccine is likely the most effective approach to sustainably controlling the COVID-19 pandemic. An unprecedented research effort and global coordination has resulted in a rapid development of vaccine candidates and initiation of trials. Here, we review vaccine types, and progress with 10 vaccine candidates against SARS-CoV-2 - the virus that causes COVID-19 - currently undergoing early phase human trials. We also consider the many challenges of developing and deploying a new vaccine on a global scale, and recommend caution with respect to our expectations of the timeline that may be ahead.

Origin and evolution of jasmonate signaling

Jasmonate (JA) signaling is a key mediator of plant development and defense which arose during plants transition from an aqueous to terrestrial environment. Elucidating the evolution of JA signaling is important for understanding plant development, defense, and production of specialized metabolites. The lineage of key protein domains characterizing JA signaling factors was traced to identify the origins of CORONITINE INSENSITIVE 1 (COI1), JASMONATE ZIM-DOMAIN (JAZ), NOVEL INTERACTOR OF JAZ, MYC2, TOPLESS, and MEDIATOR SUBUNIT 25. Charophytes do not possess genes encoding key JA signaling components, including COI1, JAZ, MYC2, and the JAZ-interacting bHLH factors, yet their orthologs are present in bryophytes. TIFY family genes were found in charophyta and chlorophya algae. JAZs evolved from ZIM genes of the TIFY family through changes to several key amino acids. Dating placed the origin of JA signaling 515 to 473 million years ago during the middle Cambrian to early Ordovician periods. This time is known for rapid biodiversification and mass extinction events. An increased predation from the diversifying and changing fauna may have driven evolution of JA signaling and plant defense.

Development of a Multinational Clinical Practice Guideline: A Practical Structured Procedure

INTRODUCTION

The development of a clinical guideline is a challenging process. National and international organizations have established a variety of approaches, grading systems, evaluation scales, and voting modes; however, a practical description which illustrates all steps from starting the initiative to publication and dissemination of the guideline is usually not provided. We describe a structured guideline procedure that can be adjusted to the requirements of other multinational guidelines.

METHODS

A group of European specialist gastroenterological societies and national societies initiated a guideline for the use of breath tests in gastroenterology. A balance between scientific evidence and clinical experience was achieved by involving European specialist societies and physicians from 18 European countries. For persons contributing to the guideline process, different levels of involvement were defined. The tasks were assigned to different groups of persons, which formed scientific institutions.

RESULTS

We describe organizational structures and institutions, the stepwise approach, and illustrate the multistep guideline development procedure in a flowchart diagram that shows workflow and assigned responsibilities and provides details for the execution of each step, including timelines. The process is split into 4 phases: foundation, preparation, voting, and publication.

DISCUSSION

This structured procedure of a gastroenterological clinical practice guideline can serve as a blueprint for future multinational guideline initiatives and may aid future attempts to standardize and harmonize guideline development processes in gastroenterology and in other medical fields. Although the described procedure is for a diagnostic guideline, it may also be appropriate for therapeutic guidelines by adjusting the acceptance criteria for recommendations.

Helicobacter pylori infection: Beyond gastric manifestations

Helicobacter pylori (H. pylori) is a bacterium that infects more than a half of world’s population. Although it is mainly related to the development of gastroduodenal diseases, several studies have shown that such infection may also influence the development and severity of various extragastric diseases. According to the current evidence, whereas this bacterium is a risk factor for some of these manifestations, it might play a protective role in other pathological conditions. In that context, when considered the gastrointestinal tract, H. pylori positivity have been related to Inflammatory Bowel Disease, Gastroesophageal Reflux Disease, Non-Alcoholic Fatty Liver Disease, Hepatic Carcinoma, Cholelithiasis, and Cholecystitis. Moreover, lower serum levels of iron and vitamin B12 have been found in patients with H. pylori infection, leading to the emergence of anemias in a portion of them. With regards to neurological manifestations, a growing number of studies have associated that bacterium with multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, and Guillain-Barré syndrome. Interestingly, the risk of developing cardiovascular disorders, such as atherosclerosis, is also influenced by the infection. Besides that, the H. pylori-associated inflammation may also lead to increased insulin resistance, leading to a higher risk of diabetes mellitus among infected individuals. Finally, the occurrence of dermatological and ophthalmic disorders have also been related to that microorganism. In this sense, this minireview aims to gather the main studies associating H. pylori infection with extragastric conditions, and also to explore the main mechanisms that may explain the role of H. pylori in those diseases.

Retinal ischemia triggers early microglia activation in the optic nerve followed by neurofilament degeneration

Retinal ischemia leads to an early severe damage of the retina and thus plays an important role in eye diseases such as angle-closure glaucoma or retinal vascular occlusion. In retinal diseases, there is common sense about the affection of the optic nerve by ischemic injury. However, the exact dynamic processes of this optic nerve degeneration are mainly unclear. In this study, retinal ischemia was induced in one eye of Brown-Norway rats by raising the intraocular pressure 60 min to 140 mmHg followed by natural reperfusion. Optic nerves were analyzed at six different points in time: 2, 6, 12, and 24 h as well as 3 and 7 days after ischemic injury. Cell infiltration and moreover signs of tissue demyelination and dissolution were noticed in optic nerves 7 days after ischemia (hematoxylin & eosin: p < 0.001, luxol fast blue: p = 0.04). Although microglial activation was verified already from 12 h on after ischemia (p = 0.030), the beginning of a structural degeneration of the neurofilament was seen at 3 days (p = 0.02). Interestingly, proliferative microglia were present later on (7 days: p = 0.017). At this point, the number of total microglia was also increased in ischemic nerves (p = 0.003). Concluding, our data indicate that not only retinal tissue is affected by an ischemia, the optic nerve also demonstrates progressive damage. Interestingly, a microglia activation was noted days before structural damage became visible.

Radiographic timelines for pediatric healing fractures: a systematic review

Skeletal fractures, a common injury in physically abused children, often go undetected and untreated for significant lengths of time and are sometimes incidentally discovered radiographically. Our objective was to review current literature for scientific studies of pediatric fracture healing with associated timelines. We conducted a search of Embase, EBSCOhost, MEDLINE (PubMed), and Web of Science for literature published from the earliest available up to August 2018. We evaluated the included articles for quality, with consideration for use in clinical and forensic settings. Of a total of 313 full-text articles evaluated, 10 met study inclusion criteria. The patient age range among studies was 0-17 years, with children younger than 1 year included in the majority of studies. The fracture locations included in studies were primarily fractures of the upper limb and pectoral girdle, followed by fractures of the lower limb. The radiographic features of healing varied greatly among the studies. Timelines of common fracture healing variables differed significantly among studies. Scientific, radiographic studies of pediatric fracture healing are limited. Gaps in knowledge regarding fracture healing highlight the need for future research and validation studies. Fracture healing timelines derived from existing timelines should be used with caution.

Trends in clinical features of novel coronavirus disease (COVID-19): A systematic review and meta-analysis of studies published from December 2019 to February 2020

BACKGROUND

Since novel coronavirus disease (COVID-19) emerged, various clinical features of COVID-19 have been reported.

METHODS

We conducted a systematic review of published studies reporting the clinical features of COVID-19. Two investigators independently searched PubMed (December 2019-February 2020) for eligible articles. A meta-analysis was performed to measure the frequencies of clinical outcomes and symptoms of COVID-19. A stratified analysis was conducted according to the timeline of outbreak and exposure histories: Group I, most patients were exposed to the Hunan seafood wholesale market and lived in Wuhan, Hubei province; Group II, patients lived in Hubei province but were not directly exposed to the market; and Group III, patients lived outside Hubei.

RESULTS

Thirteen studies, all from China, were eligible. The estimated mortality rate among all studies was 2.12%, but that in Group I was 8.66%. The incidence of acute respiratory distress syndrome in Group I was 20.00%. Both fever and cough were major symptoms, and their frequencies were higher in Group I than in Groups II and III, while the frequency of diarrhea in Group I was lower than that in Group III. The estimated frequency of dyspnea in Group I was 37.18%, while those in Groups II and III were 16.95% and 7.03%, respectively.

CONCLUSIONS

The trends in the clinical features of COVID-19 changed from December 2019 to February 2020. During this observation period, as the infection continued to spread, the clinical conditions for majority of patients became less severe with the changes in the route of transmission.

Iconic Visualization of Sickle Cell Patients Current and Past Health Status

Rapid access to patient overall health status is essential for a physician during a medical consultation. The use of a HIS for the management of neonatal screening and follow-up of sickle cell disease patients at CERPAD in the Saint-Louis region of Senegal leads the patient electronic records growing in volume and complexity. To facilitate access to relevant information and shortens the time required to analyze and understand these clinical data, an original solution is to set up a data visualization system. In this article, we propose the integration of two iconic visualization tools into the SIMENS-CERPAD module designed for sickle cell screening and healthcare. The two tools use the VCM iconic language and consist of a simplified anatomical schema showing the current health status of the patient and a timeline to visualize its temporal evolution.

Heimdall, a Computer Program for Electronic Health Records Data Visualization

INTRODUCTION

Electronic health records (EHR) comprehend structured and unstructured data, that are usually time dependent, enabling the use of timelines. However, it is often difficult to display all data without inducing information overload. In both clinical usual care and medical research, users should be able to quickly find relevant information, with minimal cognitive overhead. Our goal was to devise simple visualization techniques for handling medical data in both contexts.

METHODS

An abstraction layer for structured EHR data was devised after an informal literature review and discussions between authors. The "Heimdall" prototype was developed. Two experts evaluated the tool by answering 5 questions on 24 clinical cases.

RESULTS

Temporal data was abstracted in three simple types: events, states and measures, with appropriate visual representations for each type. Heimdall can load and display complex heterogeneous structured temporal data in a straightforward way. The main view can display events, states and measures along a shared timeline. Users can summarize data using temporal, hierarchical compression and filters. Default and custom views can be used to work in problem- oriented ways. The evaluation found conclusive results.

CONCLUSION

The "Heimdall" prototype provides a comprehensive and efficient graphical interface for EHR data visualization. It is open source, can be used with an R package, and is available at https://koromix.dev/files/R.

Context matters: Using mixed methods timelines to provide an accessible and integrated visual for complex program evaluation data

The need for conducting evaluations which reflect of the influence of context on complex programs is increasingly recognized in the field of evaluation. Better data visualization techniques for connecting context with program evaluation data are needed. We share our experience developing a mixed methods timeline to visualize complexity and context with evaluation data. Mixed methods timelines provide a meaningful way to show change over time in both a visually stimulating and accessible format for evaluation audiences. This paper provides an innovative example of using mixed methods timelines to integrate evaluation data with key program activities and milestones, while also showing internal and external contextual influences in one cohesive visual. We present methods and best practices for collecting contextual data and for incorporating a variety of data sources into such a visual. We discuss several strategies to collect and organize context related data including: qualitative interviews, program materials, narrative reports, and member checking with stakeholders and staff. Gathering multiple perspectives is essential to better capture the multi-layered elements of program activities and context.

Drug induced parkinsonism: Symptomatic beyond 22 months

We report 2 cases of drug induced Parkinsonism followed longitudinally that remained symptomatic 22 and 27 months after stopping causative agents with normal dopamine ioflupane iodine-123 (DaT) single-photon emission computed tomography (SPECT) scans at 8 and 16 months.

Timeline of functional recovery after hip fracture in seniors aged 65 and older: a prospective observational analysis

We investigated the timeline of functional recovery after hip fracture over 12 months in adults age ≥ 65 years using objective lower extremity function tests and subjective physical functioning. Objective functional recovery was largely complete in the first 6 months, whereas subjective recovery improved up to 9 months after hip fracture.

INTRODUCTION

Hip fractures are a major cause of loss of function among seniors. We assessed the timeline of objective and subjective functional recovery after hip fracture.

METHODS

We conducted a prospective observational secondary analysis of a 1-year clinical trial on vitamin D and home exercise treatment and complications after hip fracture among 173 patients age ≥ 65 years (mean age 84 years; 79.2% women; 77.4% community-dwelling) conducted from January 2005 through December 2007. Lower extremity function (Timed Up and Go test (TUG), knee extensor and flexor strength) and grip strength was assessed at baseline and at 6 and 12 months follow-up. Subjective physical functioning was assessed using the SF-36 questionnaire also at 3 and 9 months follow-up. Multivariable-adjusted repeated-measures models were used to assess the timeline of functional recovery in the total population and in subgroups of patients.

RESULTS

Lower extremity function including TUG (- 61.1%), knee extensor (+ 17.6%), and knee flexor (+ 11.6%) strength improved significantly in the first 6 months (P < 0.001). However, between 6 and 12 months, there was no further significant improvement for any of the functional tests. Grip strength decreased from baseline to 6 months (- 7.9%; P < 0.001) and from 6 to 12 months (- 10.8%; P < 0.001). Subjective physical functioning improved from 3 to 9 months (+ 15.2%, P < 0.001), but no longer thereafter.

CONCLUSIONS

Functional recovery after hip fracture may be largely complete in the first 6 months for objective functional tests, whereas may extend up to 9 months for subjective recovery, with oldest-old, female, institutionalized, and cognitively impaired patients recovering most poorly.

CLINICAL TRIALS REGISTRY (ORIGINAL TRIAL)

NCT00133640.

Google timeline accuracy assessment and error prediction

Google Location Timeline, once activated, allows to track devices and save their locations. This feature might be useful in the future as available data for evidence in investigations. For that, the court would be interested in the reliability of this data. The position is presented in the form of a pair of coordinates and a radius, hence the estimated area for tracked device is enclosed by a circle. This research focuses on the assessment of the accuracy of the locations given by Google Location History Timeline, which variables affect this accuracy and the initial steps to develop a linear multivariate model that can potentially predict the actual error with respect to the true location considering environmental variables. The determination of the potential influential variables (configuration of mobile device connectivity, speed of movement and environment) was set through a series of experiments in which the true position of the device was recorded with a reference Global Positioning System (GPS) device with a superior order of accuracy. The accuracy was assessed measuring the distance between the Google provided position and the de facto one, later referred to as Google error. If this Google error distance is less than the radius provided, we define it as a hit. The configuration that has the largest hit rate is when the mobile device has GPS available, with a 52% success. Then the use of 3G and 2G connection go with 38% and 33% respectively. The Wi-Fi connection only has a hit rate of 7%. Regarding the means of transport, when the connection is 2G or 3G, the worst results are in Still with a hit rate of 9% and the best in Car with 57%. Regarding the prediction model, the distances and angles from the position of the device to the three nearest cell towers, and the categorical (non-numerical) variables of Environment and means of transport were taking as input variables in this initial study. To evaluate the usability of a model, a Model hit is defined when the actual observation is within the 95% confidence interval provided by the model. Out of the models developed, the one that shows the best results was the one that predicted the accuracy when the used network is 2G, with 76% of Model hits. The second model with best performance had only a 23% success (with the mobile network set to 3G).

Identifying the unmet information and support needs of women with autoimmune rheumatic diseases during pregnancy planning, pregnancy and early parenting: mixed-methods study

Background

Autoimmune rheumatic diseases (ARDs) such as inflammatory arthritis and Lupus, and many of the treatments for these diseases, can have a detrimental impact on fertility and pregnancy outcomes. Disease activity and organ damage as a result of ARDs can affect maternal and foetal outcomes. The safety and acceptability of hormonal contraceptives can also be affected. The objective of this study was to identify the information and support needs of women with ARDs during pregnancy planning, pregnancy and early parenting.

Methods

This mixed methods study included a cross-sectional online survey and qualitative narrative interviews. The survey was completed by 128 women, aged 18–49 in the United Kingdom with an ARD who were thinking of getting pregnant in the next five years, who were pregnant, or had young children (< 5 years old). The survey assessed quality-of-life and information needs (Arthritis Impact Measurement Scale Short Form and Educational Needs Assessment Tool), support received, what women found challenging, what was helpful, and support women would have liked. From the survey participants, a maximum variation sample of 22 women were purposively recruited for qualitative interviews. Interviews used a person-centered participatory approach facilitated by visual methods, which enabled participants to reflect on their experiences. Interviews were also carried out with seven health professionals purposively sampled from primary care, secondary care, maternity, and health visiting services.

Results

Survey findings indicated an unmet need for information in this population (ENAT total mean 104.85, SD 30.18). Women at the pre-conception stage reported higher needs for information on pregnancy planning, fertility, giving birth, and breastfeeding, whereas those who had children already expressed a higher need for information on pain and mobility. The need for high quality information, and more holistic, multi-disciplinary, collaborative, and integrated care consistently emerged as themes in the survey open text responses and interviews with women and health professionals.

Conclusions

There is an urgent need to develop and evaluate interventions to better inform, support and empower women of reproductive age who have ARDs as they navigate the complex challenges that they face during pregnancy planning, pregnancy and early parenting.

Electronic supplementary material

The online version of this article (10.1186/s41927-018-0029-4) contains supplementary material, which is available to authorized users.

Unstable acromioclavicular joint injuries: Is there really a difference between surgical management in the acute or chronic setting?

AIM

To compare the outcomes of unstable ACJ injuries managed with an arthroscopy-assisted anatomic reconstruction of the coracoclavicular (CC) ligaments in the acute and chronic setting.

METHODS

A retrospective revision was performed. The SF36, visual analog scale for pain, DASH questionnaire, constant score and the global satisfaction were assessed at the last follow-up visit.

RESULTS

22 patients were included. Results of the questionnaires assessed at the last follow-up visit showed no significant differences between the study groups.

CONCLUSION

Management of ACJ injuries in the acute or chronic setting may involve comparable outcomes if biological and mechanical aspects are considered.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Association of Family History of Epilepsy with Earlier Age Onset of Juvenile Myoclonic Epilepsy

OBJECTIVE

Juvenile myoclonic epilepsy (JME) is supposedly the most frequent subtype of idiopathic generalized epilepsies (IGE). The aim of this study was to determine the prevalence of JME and comparison of patients' demographics as well as timeline of the disease between positive family history epileptic patients (PFHE) and negative family history epileptic patients (NFHE) among sample of Iranian epileptic patients.

MATERIALS & METHODS

From Feb. 2006 to Oct. 2009, 1915 definite epileptic patients (873 females) referred to epilepsy clinics in Isfahan, central Iran, were surveyed and among them, 194 JME patients were diagnosed. JME was diagnosed by its specific clinical and EEG criteria. Patients were divided into two groups as PFHE and NFHE and data were compared between them.

RESULTS

JME was responsible for 10% (194 patients) of all types of epilepsies. Of JME patients, 53% were female. In terms of family history of epilepsy, 40% were positive. No significant differences was found between PFHE and NFHE groups as for gender (P>0.05). Age of epilepsy onset was significantly earlier in PFHE patients (15 vs. 22 yr, P<0.001). Occurrence of JME before 18 yr old among PFHE patients was significantly higher (OR=2.356, P=0.007).

CONCLUSION

A family history of epilepsy might be associated with an earlier age of onset in patients with JME.

Geographical and temporal distribution of basic research experiments in homeopathy

The database HomBRex (Homeopathy Basic Research experiments) was established in 2002 to provide an overview of the basic research already done on homeopathy (http://www.carstens-stiftung.de/hombrex). By this means, it facilitates the exploration of the Similia Principle and the working mechanism of homeopathy. Since 2002, the total number of experiments listed has almost doubled. The current review reports the history of basic research in homeopathy as evidenced by publication dates and origin of publications. In July 2013, the database held 1868 entries. Most publications were reported from France (n = 267), followed by Germany (n = 246) and India (n = 237). In the last ten years, the number of publications from Brazil dramatically increased from n = 13 (before 2004) to n = 164 (compared to n = 251 published in France before 2004, and n = 16 between 2004 and 2013). The oldest database entry was from Germany (1832).

Accelerated axon loss in MOG35-55 experimental autoimmune encephalomyelitis (EAE) in myelin-associated glycoprotein-deficient (MAGKO) mice

Myelin-associated glycoprotein (MAG) expressed by oligodendrocytes promotes the stability of axons but also impedes neural repair by inhibiting axon extension through lesioned white matter. We previously reported exacerbated axon losses in MAGKO as compared to wild type mice, 30days into experimental autoimmune encephalitis (EAE). Here, we report the time course of axon losses in EAE and show this occurs as early as 7days post-immunization, confirming MAG is protective against immune-mediated axon transection events. MAGKO mice also exhibit increased microglial activation prior to EAE, which is not seen in B4galnt1KO mice that also have axon loss, suggesting that the microglial activation may be a consequence of the loss of MAG inhibitory influence, and not a simple result of axonal degeneration.