It is often assumed that people with high ability in a domain will be excellent raters of quality within that same domain. This assumption is an underlying principle of using raters for creativity tasks, as in the Consensual Assessment Technique. While several prior studies have examined expert-novice differences in ratings, none have examined whether experts ability to identify the quality of a creative product is being driven more by their ability to identify high quality work, low quality work, or both. To address this question, a sample of 142 participants completed individual difference measures and rated the quality of several sets of creative captions. Unbeknownst to the participants, the captions had been identified a prior by expert raters as being of particularly high or low quality. Hierarchical regression analyses revealed that after controlling for participants background and personality, those who scored significantly higher on any of three external measures of creativity also rated low-quality captions significantly lower than their peers; however, they did not rate the high-quality captions significantly higher. These findings support research in other domains suggesting that ratings of quality may be driven more by the lower end of the quality spectrum than the high end.

Previously we have shown that the combination of radiotherapy with human-umbilical-cord-derived mesenchymal stem-cell therapy significantly reduces the size of the xenotumours in mice, both in the directly irradiated tumour and in the distant non-irradiated tumour or in its metastasis. We have also shown that exosomes secreted from mesenchymal stem-cells pre-irradiated with 2 Gy are quantitatively, functionally and qualitatively different from the exosomes secreted from non-irradiated mesenchymal cells and also that proteins, exosomes and microvesicles secreted by mesenchymal cells suffer a dramatic change when cells are activated or non-activated, with the amount of protein present in the exosomes of the pre-irradiated cells being 1.5-fold times greater compared to those from non-irradiated cells. This finding correlates with a dramatic increase in the anti-tumour activity of the exosomes secreted by pre-irradiated mesenchymal-cells. After the proteomic analysis of the load of the exosomes released from both irradiated and non-irradiated cells, we conclude that annexin A1 is the most important and significant difference between the exosomes released by the cells in either status. Knowing the role of annexin A1 in the control of hypoxia and inflammation which is characteristic of acute-distress-respiratory syndrome, we have designed a hypothetical therapeutic strategy, based on the transplantation of mesenchymal stem cells stimulated with radiation, to alleviate the symptoms of patients who, due to pneumonia caused by COVID-19, require the care of an intensive care unit for patients with life-threatening conditions. With this hypothesis, we would seek to improve the patientsrespiratory capacity and increase the expectations of their cure.

PURPOSE The purpose of this study was to investigate the feasibility, safety and efficacy of intra-procedural contrast-enhanced ultrasound (CEUS) monitoring of the radiofrequency ablation (RFA) of liver cancers adjacent to gallbladder (GB) without GB isolation. MATERIALS AND METHODS From May 2016 to July 2017, patients with liver cancers adjacent to GB (10 mm) who intended to undergo ultrasound-guided RFA without GB isolation in our hospital were prospectively enrolled. During the RFA procedures, CEUS was employed to evaluate the therapeutic response and the perfusion of the intact GB wall. The outcomes of GB and liver cancers were followed up and recorded. RESULTS 23 patients (18 male, 5 female) with 23 liver cancers (mean 18 mm, range 8-34 mm) adjacent to GB were enrolled. There were 12 tumors that abutted the GB while 11 tumors located within 10 mm of the GB. After the RFA procedures, intra-procedural CEUS evaluation demonstrated the perfusion of the GB wall was intact in all 23 patients and technical success rate of RFA was 100% (23/23). According to the contrast-enhanced CT/MR one month after RFA, the technical efficacy rate was 100% (23/23). During the follow-up period (range: 12-23 months, median: 17 months), no local tumor progression occurred and no major complications arised. Overall survival at 1-year was 100%. Thickening of GB wall was detected in 11 patients. The thickness of GB wall returned to the pre-ablation level in five patients. CONCLUSION CEUS-monitored RFA of liver cancers adjacent to GB without GB isolation was feasible, safe and effective.

The 2019-nCoV is reported to share the same entry (ACE2) as SARS-CoV according to the updated findings. Analyzing the distribution and expression level of the route of coronavirus may help reveal underlying mechanisms of viral susceptibility and post-infection modulation. In this study, we found that the expression of ACE2 in healthy populations and patients with underlying diseases was not significantly different, suggesting relatively similar susceptibility, which was consistent with current clinical observations. Moreover, based on the expression of ACE2 in smoking individuals, we inferred that long-term smoking might be a risk factor for 2019-nCoV. Analyzing the ACE2 in SARS-CoV infected cells suggested that ACE2 was more than just a receptor but also participated in post-infection regulation, including immune response, cytokine secretion, and viral genome replication. We also constructed Protein-protein interaction (PPI) networks and identified hub genes in viral activity and cytokine secretion. Our findings could explain the clinical symptoms so far and help clinicians and researchers understand the pathogenesis and design therapeutic strategies for 2019-nCoV.

On 11 March 2020, a lockdown to limit the spread of COVID-19 was implemented in Denmark. The pandemic and the lockdown might have caused stress, depression, and anxiety in new mothers. Individuals with high resilience to stress may have been less affected. This study aimed to investigate if changes in perceived stress, anxiety, depression, and resilience from the second trimester until two months postpartum were different before and during the COVID-19 pandemic in Denmark in spring 2020. Pregnant women enrolled in an ongoing feasibility study completed an online questionnaire measuring perceived stress, depression, anxiety, and resilience in the second trimester and two months postpartum. Changes in scores between women completing the two-month postpartum questionnaire before (n = 26) or during (n = 47) the COVID-19 pandemic were calculated. No statistically significant differences in changes from baseline to follow-up between pre- and during-pandemic groups in Cohens Perceived Stress Scale (PSS), the Depression, Anxiety, Stress Scale (DASS), or the ConnorCDavidson Resilience Scale (CD-RISC) were found. Adjusted differences in group means were as follows: PSS: 0.70 (CI2.45; 3.85); DASS Stress: 0.76 (CI3.59; 2.08); DASS Anxiety: 0.47 (CI0.84; 1.77); DASS Depression: 0.88 (CI0.95; 2.71); and CD-RISC: 1.19 (CI3.16; 5.54). In conclusion, we did not find significant differences in the development of stress, depression, anxiety, or resilience before or during the Danish COVID-19 pandemic in spring 2020.

PURPOSE: To validate tools to identify patients at risk for perioperative complications to implement prehabilitation programmes in head and neck surgery (H&N). METHODS: Retrospective cohort including 128 patients submitted to H&N, with postoperative Intermediate Care Unit admittance. The accuracy of the risk calculators ASA, P-POSSUM, ACS-NSQIP and ARISCAT to predict postoperative complications and mortality was assessed. A multivariable analysis was subsequently performed to create a new risk prediction model for serious postoperative complications in our institution. RESULTS: Our 30-day morbidity and mortality were 45.3% and 0.8%, respectively. The ACS-NSQIP failed to predict complications and had an acceptable discrimination ability for predicting death. The discrimination ability of ARISCAT for predicting respiratory complications was acceptable. ASA and P-POSSUM were poor predictors for mortality and morbidity. Our new prediction model included ACS-NSQIP and ARISCAT (area under the curve 0.750, 95% confidence intervals: 0.63C0.87). CONCLUSION: Despite the insufficient value of these risk calculators when analysed individually, we designed a risk tool combining them which better predicts the risk of serious complications. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00405-020-06133-1) contains supplementary material, which is available to authorized users.

The COVID-19 pandemic has increased the need for mental health care despite novel barriers to services. Little is known about how the pandemic has affected mental health providers and their practice. In July 2020, we conducted a web-based survey of 500 licensed mental health providers to assess their employment and caseloads, logistics of care, quality of care, and patient-provider relationships and communication during the pandemic. Over 90% of providers reported changes to their employment (e.g., furloughs), with 64% no longer practicing. Providers who reported no longer practicing were older in age, racial minorities, served rural communities, worked in small clinics/provider networks, were social workers and marriage and family therapists, and relied on private insurance or out-of-pocket payment. Most practicing providers reported similar-to-increased caseloads (62%), new patients seeking services (67%), and appointment frequency (70%). Approximately 97% of providers used telemedicine, with 54% providing services mostly-to-exclusively via telemedicine. Most providers reported losing contact with patients deemed unstable (76%) or a danger to themselves/others (71%). Most providers reported maintained-to-improved quality of care (83%), patient-provider relationships (80%), and communication (80%). Results highlight concerns relating to mental health services during the pandemic, however practicing providers have demonstrated resilience to coordinate and provide high quality care.

The Roma or Gipsy population is the largest ethnic minority both in Europe and Hungary with a 10-15 years lower life expectancy and significantly worse health indicators than majority populations. The purpose of this exploratory study was to investigate a sensitive and controversial topic: the perspectives of healthcare staff about the presence and impacts of implicit bias in the Hungarian healthcare system towards Roma patients. Therefore, between June 2017 and May 2018 semi-structured interviews were conducted involving 13 healthcare professionals. Interview transcripts were coded and thematically analysed. The presence and occasional manifestation of prejudices against the Romas were noted by the interviewees, most commonly in the form of longer waiting time, comments or other meta-communicative tools. Study participants appeared to exclude a direct relationship between health providers' implicit bias and the lower quality of health services or the worse health status of Roma patients. However, as reported, indirect negative effects may occur in cases where a patient refrains from seeking care due to previous perceived or experienced discrimination. As barriers to effective patient-provider communication and cooperation, differences in culture, health-seeking behaviour and gaps between health literacy levels were emphasized. In terms of prevention, enhancing anti-discriminatory attitudes from early childhood within the families, the role of media in conveying unbiased information, increasing health awareness of the Roma people as well as educating healthcare providers on culture-related issues may be beneficial. Stress and burnout of healthcare professionals also need to be addressed as these may impact on the enactment of unconscious biases.

Within the realm of lysine methylation, the discovery of lysine methyltransferase (KMTs) substrates has been burgeoning because of established systematic substrate screening protocols. Here, we describe a protocol enabling the systematic identification of JmjC KDM substrate preference and in vitro substrates. Systematically designed peptide libraries containing methylated lysine residues are used to characterize enzyme-substrate preference and identify new candidate substrates in vitro. For complete details on the use and execution of this protocol, please refer to Hoekstra and Biggar (2021).

Gestational diabetes mellitus (GDM) is a common pregnancy complication which is normally diagnosed in the second trimester of gestation. With an increasing incidence, GDM poses a significant threat to maternal and offspring health. Therefore, we need a deeper understanding of GDM pathophysiology and novel investigation on the diagnosis and treatment for GDM. MicroRNAs (miRNAs), a class of endogenic small noncoding RNAs with a length of approximately 19-24 nucleotides, have been reported to exert their function in gene expression by binding to proteins or being enclosed in membranous vesicles, such as exosomes. Studies have investigated the roles of miRNAs in the pathophysiological mechanism of GDM and their potential as noninvasive biological candidates for the management of GDM, including diagnosis and treatment. This review is aimed at summarizing the pathophysiological significance of miRNAs in GDM development and their potential function in GDM clinical diagnosis and therapeutic approach. In this review, we summarized an integrated expressional profile and the pathophysiological significance of placental exosomes and associated miRNAs, as well as other plasma miRNAs such as exo-AT. Furthermore, we also discussed the practical application of exosomes in GDM postpartum outcomes and the potential function of several miRNAs as therapeutic target in the GDM pathological pathway, thus providing a novel clinical insight of these biological signatures into GDM therapeutic approach.

BACKGROUND: Drug repurposing aims to detect the new therapeutic benefits of the existing drugs and reduce the spent time and cost of the drug development projects. The synthetic repurposing of drugs may prove to be more useful than the single repurposing in terms of reducing toxicity and enhancing efficacy. However, the researchers have not given it serious consideration. To address the issue, a novel datamining method is introduced and applied to repositioning of drugs for hypertension (HT) which is a serious medical condition and needs some improved treatment plans to help treat it. RESULTS: A novel two-step data mining method, which is based on the If-Then association rules as well as a novel discrete optimization algorithm, was introduced and applied to the synthetic repurposing of drugs for HT. The required data were also extracted from DrugBank, KEGG, and DrugR+ databases. The findings indicated that based on the different statistical criteria, the proposed method outperformed the other state-of-the-art approaches. In contrast to the previously proposed methods which had failed to discover a list on some datasets, our method could find a combination list for all of them. CONCLUSION: Since the proposed synthetic method uses medications in small dosages, it might revive some failed drug development projects and put forward a suitable plan for treating different diseases such as COVID-19 and HT. It is also worth noting that applying efficient computational methods helps to produce better results.

HIGHLIGHTS: DAC can help deal with difficult to avoid emissions. Large-scale deployment of DAC requires serious government, private, and corporate support and investment particularly to offset the capital cost as well as operational costs. Further optimizations to the costs can be found in choice of energy source as well as advances in CO(2) capture technology such as high capacity and selectivity materials, faster reaction kinetics, and ease of reusability. ABSTRACT: Direct air capture (DAC) technologies are receiving increasing attention from the scientific community, commercial enterprises, policymakers and governments. While deep decarbonization of all sectors is required to meet the Paris Agreement target, DAC can help deal with difficult to avoid emissions (aviation, ocean-shipping, iron-steel, cement, mining, plastics, fertilizers, pulp and paper). While large-scale deployment of DAC discussions continues, a closer look to the capital and operational costs, different capture technologies, the choice of energy source, land and water requirements, and other environmental impacts of DAC are reviewed and examined. Cost per ton of CO(2) captured discussions of leading industrial DAC developers with their carbon capture technologies are presented, and their detailed cost comparisons are evaluated based on the choice of energy operation together with process energy requirements. Validation of two active plants net negative emission contributions after reducing their own carbon footprint is presented. Future directions and recommendations to lower the current capital and operational costs of DAC are given. In view of large-scale deployment of DAC, and the considerations of high capital costs, private investments, government initiatives, net zero commitments of corporations, and support from the oil companies combined will help increase carbon capture capacity by building more DAC plants worldwide. GRAPHIC ABSTRACT: [Image: see text]

Severe COVID-19 is rare in previously healthy individuals who are less than 50 years of age, affecting probably no more than 1 in 1,000 such infected individuals. We suggest that these patients may become critically ill because of monogenic inborn errors that disrupt protective immunity to SARS-CoV-2.

The whole world has witnessed an unimaginable, unforgettable medical disaster in the last 1 and 1/2 years in form of the demise of innumerable people due to the current pandemic of SARS COV-2. Despite several efforts to develop strong evidence-based effective and safe treatment regimens, the options remain very limited, to date. Vasoactive intestinal peptide (VIP) discovered as a gut peptide hormone in earlier days was found to have diversified physiological action with specific features of lung protection-related activities. It has a unique feature of binding to angiotensin-converting enzyme (ACE) receptor of Type II alveolar cell to which the COVID 19 virus also binds. Aviptadil as a synthetic VIP has already been proved to be an effective option in the treatment of severe respiratory failure due to sepsis and other related lung injuries. Interim analysis results of this drug use in respiratory failures caused by SARS COV-2 has evolved a new hope in regards to safety and efficacy. Final results from recently completed as well as currently, ongoing trials will clarify the class effect of this drug in the treatment of COVID 19 in the days to come.

In this worldwide spread of SARS-CoV-2 (COVID-19) infection, it is of utmost importance to detect the disease at an early stage especially in the hot spots of this epidemic. There are more than 110 Million infected cases on the globe, sofar. Due to its promptness and effective results computed tomography (CT)-scan image is preferred to the reverse-transcription polymerase chain reaction (RT-PCR). Early detection and isolation of the patient is the only possible way of controlling the spread of the disease. Automated analysis of CT-Scans can provide enormous support in this process. In this article, We propose a novel approach to detect SARS-CoV-2 using CT-scan images. Our method is based on a very intuitive and natural idea of analyzing shapes, an attempt to mimic a professional medic. We mainly trace SARS-CoV-2 features by quantifying their topological properties. We primarily use a tool called persistent homology, from Topological Data Analysis (TDA), to compute these topological properties. We train and test our model on the"SARS-CoV-2 CT-scan dataset"\citep{soares2020sars}, an open-source dataset, containing 2,481 CT-scans of normal and COVID-19 patients. Our model yielded an overall benchmark F1 score of $99.42\% $, accuracy $99.416\%$, precision $99.41\%$, and recall $99.42\%$. The TDA techniques have great potential that can be utilized for efficient and prompt detection of COVID-19. The immense potential of TDA may be exploited in clinics for rapid and safe detection of COVID-19 globally, in particular in the low and middle-income countries where RT-PCR labs and/or kits are in a serious crisis.

The myeloid C-type lectin dendritic cell-specific ICAM3-grabbing non-integrin (DC-SIGN, CD209) recognizes oligosaccharide ligands on clinically relevant pathogens (HIV, Mycobacterium, and Aspergillus). Alternative splicing and genomic polymorphism generate DC-SIGN mRNA variants, which have been detected at sites of pathogen entrance and transmission. We present evidence that DC-SIGN neck variants are expressed on dendritic and myeloid cells at the RNA and protein levels. Structural analysis revealed that multimerization of DC-SIGN within a cellular context depends on the lectin domain and the number and arrangement of the repeats within the neck region, whose glycosylation negatively affects oligomer formation. Naturally occurring DC-SIGN neck variants differ in multimerization competence in the cell membrane, exhibit altered sugar binding ability, and retain pathogen-interacting capacity, implying that pathogen-induced cluster formation predominates over the basal multimerization capability. Analysis of DC-SIGN neck polymorphisms indicated that the number of allelic variants is higher than previously thought and that multimerization of the prototypic molecule is modulated in the presence of allelic variants with a different neck structure. Our results demonstrate that the presence of allelic variants or a high level of expression of neck domain splicing isoforms might influence the presence and stability of DC-SIGN multimers on the cell surface, thus providing a molecular explanation for the correlation between DC-SIGN polymorphisms and altered susceptibility to HIV-1 and other pathogens.

AimsProlonged waiting times for admission to psychiatric hospital settings are a common and widespread issue. Delayed admissions may result in poorer outcomes due to prolonged mental suffering and delays in initiating treatment. Long waiting times also have a negative impact at a service level, impeding patient flow.National guidance has been recently updated, recommending that patient transfers to secure services take no longer than 28 days from referral. These transfers are frequently affected by delays in admission, possibly resulting in increased risk to patients, staff and the public.The aim of this project was to audit all referrals to Broadmoor High Secure Hospital in England within a one year period with special focus taken on calculating the time taken from referral to admission. We aimed to assess if there were any rate limiting steps which could be targeted to reduce time from referral to admission.MethodWe collected data and conducted a retrospective cohort review for all admissions from September 2019-September 2020. Where available, information was obtained for each step of the referrals process. Individual patient records were reviewed where required.Exclusion criteria: data withdrawn, transfers from other high secure services (HSS), incomplete data, MOJ instruction or urgent admission bypassing the process.Result18 cases were excluded as per exclusion criteria. 46 patients were included in the study. 16 referrals originated from medium secure psychiatric hospitals, and 30 from prison.The average time from referral to admission was 44.3 days. Admission of patients from MSUs was quicker, taking an average of 40.3 days when compared to prison referrals, which took 45.9 days.The breakdown of timings for each step in the referrals process was calculated to determine if a rate limiting step could be identified.On average it took 2.1 working days to allocate a case to a clinician, 7.6 days for an assessment, 9.2 days to complete a report and 3.5 days to submit this to the admissions panel. The mean time from referral to the date of the panel hearing was 22.5 working days, and admission took a further 21.8 days on average.ConclusionThe current average time to admission exceeds the new 28 day recommendation. This could both be due to the COVID-19 pandemic, and miscommunication about time targets. We will review the process and aim to reduce the time from referral to admission in line with new guidance.

Necrotizing Raynauds phenomenon is a vascular clinical syndrome characterized by vasospasm of distal resistance vessels, usually triggered by cold temperatures or by psychological conditions such as anxiety and stress. Pain is the first reported symptom, related to insufficient oxygen delivery to the extremities that leads to ischemia of the peripheral tissues. The initial treatment is conservative, but if the symptoms persist, necrosis and distal amputation can occur. In selected patients, neuromodulation with spinal cord stimulation (SCS) can be an effective treatment by reducing pain and amputation rate. Recent evidence suggests that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause endotheliopathy with microvascular and macrovascular thrombotic events and can present as a systemic inflammatory vascular disease. We present a case of a severe necrotizing Raynauds phenomenon successfully treated and controlled with SCS that abruptly reappeared during SARS-CoV-2 infection. The report of this case is suggestive for potential treatment in case of peripheral ischemia consequent to COVID-19 vasculopathy. The interaction between SCS and SARS-CoV-2-related endotheliopathy is unknown and would deserve further studies.

BACKGROUND Inflow into an aneurysm sac immediately following flow diverter (FD) treatment is an assumed cause of delayed aneurysmal rupture. The significance of delayed posttreatment residual flow occurring months after FD treatment is unknown. CASE DESCRIPTION A 76-year-old woman with a large intracranial aneurysm measuring 23.0 18.1 mm in the cavernous segment of the right internal carotid artery was treated with placement of a single FD (Pipeline Embolization Device, Covidien, Irvine, California, USA). Postprocedure digital subtraction angiography (DSA) demonstrated flow stagnation inside the aneurysm dome. The patient was discharged 9 days post procedure without new neurologic deficits. A 6-month follow-up DSA demonstrated delayed posttreatment residual flow into the aneurysm sac. Although she was scheduled for additional FD placement because of concern for aneurysmal rupture, the operation was not conducted due to an interim motor vehicle accident. Oral treatment with aspirin (100 mg/day) and clopidogrel (75 mg/day) was continued during her recovery. DSA performed 12 months post procedure showed that the aneurysm had completely thrombosed. CONCLUSIONS Our findings suggest that delayed post-treatment residual flow into an aneurysm may form part of the normal clinical course post FD placement and may not preclude eventual thrombosis of the aneurysm. Larger studies are needed to determine whether more frequent follow-up DSAs after FD placement are necessary and whether all patients exhibiting delayed post-treatment residual flow into an aneurysm require additional FD placement or if watchful waiting is a more suitable course.

OBJECTIVES: To survey a group of global pediatric otolaryngology specialists to assess their usage and access to personal protective equipment during the COVID-19 pandemic. METHODS: A survey of 13 questions was created collecting information on: basic demographics of practice, types of PPE used for procedures of varying aerosolization risk, access to positive air-purifying respirator (PAPR) and patient testing for SARS-CoV-2. Pediatric otolaryngologists were invited to complete the survey via Whatsapp?. RESULTS: 96 responses were collected from 17 different countries. N95 was the most commonly utilized PPE when dealing with COVID-19 patients (64.2% - 81.9% depending on aerosolization risk of the procedure). Significantly higher use of PAPR was noted in high-risk aerosolization generating medical procedures, when compared to other risks. Face covering was used consistently (91.6%). Most respondents (78.1%, n=75) had access to PAPR or had at least requested it. The majority of patients (56.2%, n=54) was being tested for SARS-CoV-2 prior to procedures performed in operating rooms (OR); whereas, only 1.1% (n=1) of clinic patients were tested for SARS-CoV-2 irrespective of the history or symptomatology. CONCLUSIONS: Most pediatric otolaryngologists used N95 and some form of face covering (eg. goggles, face shields) when dealing with patients with COVID-19 positive status. PAPR was used in situations of high aerosolization risk. Majority of respondents were screening all patients prior to procedures in the operating room.