The challenge of differentiating vaso-occlusive crises from osteomyelitis in children with sickle cell disease and bone pain: A 15-year retrospective review

Purpose The paediatric sickle cell disease (SCD) osteomyelitis (OM) incidence is 0.3% to 12%. Differentiating vaso-occlusive crises (VOC) from OM is a diagnostic challenge, with limited evidence guiding management. We present a 15-year review of a paediatric sickle cell cohort. We aim to identify OM incidence and provide a management protocol for these children presenting with bone pain. Methods A prospective database of children with haemoglobinopathies (2002 to 2017) was analyzed for temperature, C-reactive protein (CRP) and white cell count (WCC) on admission as well as imaging, treatment and cultures. OM diagnosis was supported by imaging and blood cultures. VOC was defined as bone pain that improved without antibiotics. Results Over 15 years, 96 children with SCD presented 358 times to hospital. Empirical antibiotics were given in 308 presentations. There were five cases of OM (1.4%); two acute and three chronic. In all, 50 presentations of VOC were identified. No significant differences in age were noted between the OM and VOC group. Temperature and CRP were significantly elevated in the OM group with no significant difference in WCC. Cultures were only positive in the chronic OM admissions. There were no cases of septic arthritis. No surgical intervention was required. Conclusion In children with SCD presenting with persistent bone pain, fever, elevated CRP and WCC, OM should be suspected and prompt antibiotic treatment started. Our treatment pathway was successful avoiding OM in 98.6% and septic arthritis in 100%. Further research on novel biological markers distinguishing OM from VOC should be investigated. Level of Evidence II

Speaker Sex Perception from Spontaneous and Volitional Nonverbal Vocalizations.

In two experiments, we explore how speaker sex recognition is affected by vocal flexibility, introduced by volitional and spontaneous vocalizations. In Experiment 1, participants judged speaker sex from two spontaneous vocalizations, laughter and crying, and volitionally produced vowels. Striking effects of speaker sex emerged: For male vocalizations, listeners' performance was significantly impaired for spontaneous vocalizations (laughter and crying) compared to a volitional baseline (repeated vowels), a pattern that was also reflected in longer reaction times for spontaneous vocalizations. Further, performance was less accurate for laughter than crying. For female vocalizations, a different pattern emerged. In Experiment 2, we largely replicated the findings of Experiment 1 using spontaneous laughter, volitional laughter and (volitional) vowels: here, performance for male vocalizations was impaired for spontaneous laughter compared to both volitional laughter and vowels, providing further evidence that differences in volitional control over vocal production may modulate our ability to accurately perceive speaker sex from vocal signals. For both experiments, acoustic analyses showed relationships between stimulus fundamental frequency (F0) and the participants' responses. The higher the F0 of a vocal signal, the more likely listeners were to perceive a vocalization as being produced by a female speaker, an effect that was more pronounced for vocalizations produced by males. We discuss the results in terms of the availability of salient acoustic cues across different vocalizations

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency–Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research