bluuebunny/crossref_metadata_2025 huggingface dataset:
3D simulations of inertial confinement fusion implosions part 2: systematic flow anomalies and impact of low modes on performances in OMEGA experiments
Authors: Colaïtis A , Igumenshchev I V , Turnbull D P , Shah R , Edgell D , Mannion O M , Stoeckl C , Jacob-Perkins D W , Shvydky A , Janezic R , Kalb A , Cao D , Forrest C J , Kwiatkowski J , Regan S P , Theobald W , Goncharov V N , Froula D
Published: November 2022

We present the first 3D radiation-hydrodynamic simulations of directly driven inertial confinement fusion implosions with an inline package for polarized crossed-beam energy transfer, which were used to assess the impact of the current distributed polarization rotators (DPRs) on OMEGA as well as other known sources of asymmetry. Applied to OMEGA implosions, the simulations predict bang times with no need for ad hoc multipliers, as well as yields—if you separately account for the impacts of imprint and fuel age. The magnitude of the flow is well reproduced when the low mode sources are large, whereas the modeling of the stalk is thought to be required to match the flow magnitude in the remaining cases. For the cases explored in more detail, polarized cross-beam energy transfer (CBET)—the only known systematic drive asymmetry, brought the results closest to the measured flow vectors. The remaining discrepancies are shown to be stemming from the limited knowledge of the laser pointing modes. For typical current levels of beam mispointing, power imbalance, target offset, and asymmetry caused by polarized CBET, low modes degrade the yield by more than 40%. The current strategy of attempting to compensate the mode-1 asymmetry with a preimposed target offset recovers only about one-third of the losses caused by the low modes due to the dynamic nature of the multiple asymmetries and the presence of low modes other than l = 1. Therefore, addressing the root causes of the drive asymmetries is apt to be more beneficial. To that end, one possible solution to the specific issue of polarized CBET (10 µm DPRs) is shown to work well.
Modeling and identification of nonlinear hysteresis behavior of piezoelectric actuators using a computationally efficient phenomenological model and modified cuckoo search algorithm
Authors: Xie Xingyang , Cui Yuguo , Yu Yang , Chen Pan
Published: November 2022

Hysteresis, an intrinsic characteristic of piezoelectric (PZT) actuators, has been demonstrated to dramatically reduce the capability and stability of the system. This paper proposes a novel computationally efficient model to describe nonlinear and hysteresis behaviors of PZT actuators. First of all, the model parameters are analyzed to investigate their effects on the output response. Then, a modified cuckoo search algorithm is used to identify the model parameters, without falling into the local optimum problems through introducing adaptive egg discovery probability and step length control factor. Further, the performance of the proposed model is validated using experimental data, via the comparison with classical Bouc-Wen and Prandtl-Ishlinskii hysteresis models. Finally, the rate-dependence of the parameters of proposed model is analyzed, which contributes to a generalized hysteresis model for the compensation control application of PZT actuators.
Time-varying spectrum of the random string*
Authors: Galleani L , Cohen L
Published: November 2022

We consider the response of a finite string to white noise and obtain the exact time-dependent spectrum. The complete exact solution is obtained, that is, both the transient and steady-state solution. To define the time-varying spectrum we ensemble average the Wigner distribution. We obtain the exact solution by transforming the differential equation for the string into the phase space differential equation of time and frequency and solve it directly. We also obtain the exact solution by an impulse response method which gives a different form of the solution. Also, we obtain the time-dependent variance of the process at each position. Limiting cases for small and large times are obtained. As a special case we obtain the results of van Lear Jr and Uhlenbeck and Lyon. A numerical example is given and the results plotted.
Dark matter pollution in the Diffuse Supernova Neutrino Background
Authors: Bell Nicole F. , Dolan Matthew J. , Robles Sandra
Published: November 2022

The Hyper-Kamiokande (HyperK) experiment is expected to precisely measure the Diffuse Supernova Neutrino Background (DSNB). This requires that the backgrounds in the relevant energy range are well understood. One possible background that has not been considered thus far is the annihilation of low-mass dark matter (DM) to neutrinos. We conduct simulations of the DSNB signal and backgrounds in HyperK, and quantify the extent to which DM annihilation products can pollute the DSNB signal. We find that the presence of DM could affect the determination of the correct values of parameters of interest for DSNB physics, such as effective neutrino temperatures and star formation rates. While this opens the possibility of simultaneously characterising the DNSB and discovering dark matter via indirect detection, we argue that it would be hard to disentangle the two contributions due to the lack of angular information available at low energies.
A new error-monitoring brain–computer interface based on reinforcement learning for people with autism spectrum disorders
Authors: Pires Gabriel , Cruz Aniana , Jesus Diogo , Yasemin Mine , Nunes Urbano J , Sousa Teresa , Castelo-Branco Miguel
Published: November 2022

Objective. Brain–computer interfaces (BCIs) are emerging as promising cognitive training tools in neurodevelopmental disorders, as they combine the advantages of traditional computerized interventions with real-time tailored feedback. We propose a gamified BCI based on non-volitional neurofeedback for cognitive training, aiming at reaching a neurorehabilitation tool for application in autism spectrum disorders (ASDs). Approach. The BCI consists of an emotional facial expression paradigm controlled by an intelligent agent that makes correct and wrong actions, while the user observes and judges the agent’s actions. The agent learns through reinforcement learning (RL) an optimal strategy if the participant generates error-related potentials (ErrPs) upon incorrect agent actions. We hypothesize that this training approach will allow not only the agent to learn but also the BCI user, by participating through implicit error scrutiny in the process of learning through operant conditioning, making it of particular interest for disorders where error monitoring processes are altered/compromised such as in ASD. In this paper, the main goal is to validate the whole methodological BCI approach and assess whether it is feasible enough to move on to clinical experiments. A control group of ten neurotypical participants and one participant with ASD tested the proposed BCI approach. Main results. We achieved an online balanced-accuracy in ErrPs detection of 81.6% and 77.1%, respectively for two different game modes. Additionally, all participants achieved an optimal RL strategy for the agent at least in one of the test sessions. Significance. The ErrP classification results and the possibility of successfully achieving an optimal learning strategy, show the feasibility of the proposed methodology, which allows to move towards clinical experimentation with ASD participants to assess the effectiveness of the approach as hypothesized.
Spectral broadening from turbulence in multiscale lower hybrid current drive simulations
Authors: Biswas Bodhi , Bonoli Paul , Ram Abhay , White Anne
Published: November 2022

The scattering of lower hybrid (LH) waves due to scrape-off layer filaments is investigated. It is revealed that scattering can account for the LH spectral gap without any ad hoc modification to the wave-spectrum. This is shown using a multiscale simulation approach which allows, for the first time, the inclusion of full-wave scattering physics in ray-tracing/Fokker–Planck calculations. In this approach, full-wave scattering probabilities are calculated for a wave interacting with a statistical ensemble of filaments. These probabilities are coupled to ray-tracing equations using radiative transfer theory. This allows the modeling of scattering along the entire ray-trajectory, which can be important in the multi-pass regime. Simulations are conducted for LH current drive (LHCD) in Alcator C-Mod, resulting in excellent agreement with experimental current and hard x-ray profiles. A region in filament parameter space is identified in which the impact of scattering on LHCD is saturated. Such a state coincides with experimental LHCD measurements, suggesting saturation indeed occurs in C-Mod, and therefore the exact statistical properties of the filaments are not important.
Modelling of ohmic startup and runaway electron formation in support of JT-60SA initial operation
Authors: Matsuyama A. , Wakatsuki T. , Inoue S. , Yamamoto Y. , Yoshida M. , Urano H.
Published: November 2022

The plasma startup with ITER-relevant sub-mPa neutral pressures in the JT-60SA superconducting tokamak is studied using a zero-dimensional (0D) power balance model for the plasma burn-through phase. In the ohmic startup scenario assumed here, the lower limit of the operational neutral pressure is determined by the condition for the Townsend avalanche at a high

E

/

p

limit, whereas the upper limit depends on the available ohmic heating power for the burn-through with the base power supply (PS) of the superconducting coils, corresponding to 0.2–0.3 V m−1. The operational conditions that lead to RE generation are evaluated to mitigate the risk of RE discharges. The simulation shows that startup REs are generated during the temperature rise immediately after the burn-through under relatively low-density conditions, and then the RE current value is gradually increased in balance with the RE loss processes on the timescale of I

p
ramp-up. Therefore, it is expected that REs can be avoided or mitigated if the electron density during the early build-up phase is tuned by a combination of prefill gas and additional fuelling. However, a startup with an excessive prefill gas will lose the margin of the density control, and a full RE discharge can be triggered when the plasma burn-through fails owing to a high concentration of impurities such as oxygen, if the operational point is marginal to the burn-through limit. The present modelling work implies that preparing the operation with sufficient margins against the failure of impurity burn-through is important for mitigating the risk of unintended plasma termination. Although the carbon wall environment may have a lower risk of RE generation, to alleviate the operational uncertainties of the new device, strategies for expanding the operational window are also discussed in support of JT-60SA initial operation.
A Dynamic Scheduling Algorithm Based on Endogenous Security
Authors: Miao Weiwei , Zeng Zeng , Zhang Rui , Xi Zesheng
Published: November 2022

Endogenous security enables the network to have its own immunity against various known and unknown attacks. The redundant executive scheduling strategy is an important link, which determines the security and reliability of the architecture. The existing scheduling strategy lacks consideration of scheduling time and the number of executors, and does not flexibly utilize attack feedback information. They are relatively simple and lack of security to a certain extent. Based on this, this paper proposes a dynamic scheduling algorithm by introducing the consideration of scheduling attributes and historical attack information. Firstly, a scheduling trigger based on the joint control of working time and abnormal feedback is designed. Then, the dynamic calculation formulas under different attack scenarios are constructed by using historical attack feedback information. Finally, a complete scheduling scheme is proposed. Experiments show that the dynamic performance of the algorithm is better than the fixed strategy. In addition, the algorithm improves the utilization of the actuator and achieves a good balance between reliability and efficiency.
Research on conformance test sequence generation of the communication unit adaptation specification protocol
Authors: Zhu Zixu , Ju Hanji , Li Dan , Qie Shuang , Du Yina , Wu Zhongxing
Published: November 2022

The communication unit adaptation specification protocol of the customer-side energy measuring equipment and its conformance test is important for realizing massive equipment access to the energy internet flexibly and efficiently. The conformance test of communication protocol is the key to generating complete and efficient test sequences. In allusion to the problem of conformance test sequence generation of communication unit adaptation specification protocol, the paper first formally describes the protocol based on a finite state machine, and then further carries out the research on conformance test sequence generation based on T method, U method and U+ method. The results show that the test sequence generated by U+ method has the ability of state verification and the length is 22.1% shorter than that of U method. Its redundancy is slightly less than that of T method and the error detection ability is much better. Therefore, U+ method is more suitable for the conformance test sequence generation of communication unit adaptation specification protocol.
Nitrogen solubility test under different pressures and temperatures for nitrogen-sealed transformers
Authors: Li Jiansheng , Yang Xiaoping , Wang Shengquan
Published: November 2022

The 35kV nitrogen sealed transformers are widely used due to its excellent explosion-proof performance. But for higher voltage transformers, the nitrogen solubility under different temperatures and pressures is unknown, which restricts the design of nitrogen layer volume. In this paper, a nitrogen solubility test platform is built. And the nitrogen solubility in insulating oil under different oil temperatures and nitrogen pressures is obtained. Besides, the relationship between pressure, temperature and nitrogen solubility is established, which provides an important basis for transformer design.
Rare desynchronization events in power grids: on data implementation and dimensional reductions
Authors: Ritmeester Tim , Meyer-Ortmanns Hildegard
Published: November 2022

We discuss the frequency of desynchronization events in power grids for realistic data input. We focus on the role of time correlations in the fluctuating power production and propose a new method for implementing colored noise that reproduces non-Gaussian data by means of cumulants of data increment distributions. Our desynchronization events are caused by overloads. We extend known and propose different methods of dimensional reduction to considerably reduce the high-dimensional phase space and to predict the rare desynchronization events with reasonable computational costs. The first method splits the system into two areas, connected by heavily loaded lines, and treats each area as a single node. The second method considers a separation of the timescales of power fluctuations and phase angle dynamics and completely disregards the latter. The fact that this separation turns out to be justified, albeit only to exponential accuracy in the strength of fluctuations, means that the number of rare events does not sensitively depend on inertia or damping for realistic heterogeneous parameters and long correlation times. Neither does the number of desynchronization events automatically increase with non-Gaussian fluctuations in the power production as one might have expected. On the other hand, the analytical expressions for the average time to desynchronization depend sensitively on the finite correlation time of the fluctuating power input.
Active particles using reinforcement learning to navigate in complex motility landscapes
Authors: Monderkamp Paul A , Schwarzendahl Fabian Jan , Klatt Michael A , Löwen Hartmut
Published: November 2022

As the length scales of the smallest technology continue to advance beyond the micron scale it becomes increasingly important to equip robotic components with the means for intelligent and autonomous decision making with limited information. With the help of a tabular Q-learning algorithm, we design a model for training a microswimmer, to navigate quickly through an environment given by various different scalar motility fields, while receiving a limited amount of local information. We compare the performances of the microswimmer, defined via time of first passage to a target, with performances of suitable reference cases. We show that the strategy obtained with our reinforcement learning model indeed represents an efficient navigation strategy, that outperforms the reference cases. By confronting the swimmer with a variety of unfamiliar environments after the finalised training, we show that the obtained strategy generalises to different classes of random fields.
The electrostatic equilibrium problem for classical discrete orthogonal polynomials
Authors: Rutka Przemysław , Smarzewski Ryszard
Published: November 2022

We present two types of generic difference characterizations of zeros of the classical discrete orthogonal polynomials associated with a discrete weight function satisfying a difference equation of the Pearson type. These characterizations use either the total forward or modified partial central difference operators of discrete discriminants, which approximate the total electrostatic energy of the system of

n
n

unit charges moving freely on an interval in presence of external potential given by the iterated discrete weight.
On the decay property of the cubic fourth-order Schrödinger equation
Authors: Yu Xueying , Yue Haitian , Zhao Zehua
Published: November 2022

In this short paper, we prove that the solution of the cubic fourth-order Schrödinger equation (4NLS) on

R

d

\mathbb {R}^d

(

5
≤
d
≤
8

5 \leq d \leq 8

) enjoys the same decay property as its linear solution does. This result is proved via a bootstrap argument based on the corresponding global result by Pausader [J. Funct. Anal. 256 (2009), pp. 2473–2517]. This result can be extended to more general dispersive equations (including some more 4NLS models) with scattering asymptotics.
On upper bounds for the first ℓ²-Betti number
Authors: Feldkamp Carsten , Kionke Steffen
Published: November 2022

This article presents a method for proving upper bounds for the first

ℓ
2

\ell ^2

-Betti number of groups using only the geometry of the Cayley graph. As an application we prove that Burnside groups of large prime exponent have vanishing first

ℓ
2

\ell ^2

-Betti number.

Our approach extends to generalizations of

ℓ
2

\ell ^2

-Betti numbers that are defined using characters. We illustrate this flexibility by generalizing results of Peterson-Thom on q-normal subgroups to this setting.
Local statistics for zeros of Artin-Schreier 𝐿-functions
Authors: Entin Alexei , Pirani Noam
Published: November 2022

We study the local statistics of zeros of

L
L

-functions attached to Artin-Scheier curves over finite fields. We consider three families of Artin-Schreier

L
L

-functions: the ordinary, polynomial (the

p
p

-rank 0 stratum) and odd-polynomial families. We compute the 1-level zero-density of the first and third families and the 2-level density of the second family for test functions with Fourier transform supported in a suitable interval. In each case we obtain agreement with a unitary or symplectic random matrix model.
Outcomes of bariatric surgery in patients with inflammatory bowel disease from a French nationwide database
Authors: Corbière Lisa , Scanff Alexandre , Desfourneaux Véronique , Merdrignac Aude , Ingels Anne , Thibault Ronan , Bouguen Guillaume , Bergeat Damien
Published: November 2022

Background

The outcomes of bariatric surgery (BS) in patients with chronic inflammatory bowel disease (IBD) remain rarely described. We aimed to evaluate the 90-day morbidity and mortality rates, and the risk of IBD complications 2 years after BS.

Method

Patients from the French Programme de Médicalisation des Systèmes d’Information (PMSI) database who underwent a primary BS between 2016 and 2018 were included. We identified patients with a previous diagnosis of IBD. Postoperative 90-day (POD90) morbidity and mortality rates were compared between the two groups. The evolution of IBD was followed 2 years after BS.

Results

Between 2016 and 2018, 138 980 patients underwent primary BS, including 587 patients with IBD: 326 (55.5 per cent) with Crohn’s disease (CD) and 261 (44.5 per cent) with ulcerative colitis (UC). The preferred surgical technique was sleeve gastrectomy, especially in the IBD group (81.1 per cent), followed by gastric bypass (14.6 per cent). Patients with IBD had more comorbidities (Charlson Comorbidity Index of 1 or more, hypertension, and diabetes; P < 0.001) than those without IBD. The POD90 mortality rate did not differ between the two groups (0.049 per cent in the IBD group versus 0 per cent in the non-IBD group), but more unscheduled rehospitalizations at POD90 were observed in patients with IBD (6.0 per cent versus 3.7 per cent; P = 0.004). Two years after BS, 86 patients (14.6 per cent) in the IBD group had at least one unplanned readmission for the management of their IBD; 15 patients stayed for 3 or more days. After multivariable analysis, patients with CD had an independent elevated risk of IBD-related unplanned readmissions 2 years after BS versus UC (adjusted odds ratio 1.90, 95 per cent c.i. 1.22 to 2.97; P = 0.005).

Conclusion

In a highly selected cohort of patients with well-controlled IBD, BS did not result in added mortality or morbidity. A point of vigilance must be underlined regarding BS in patients with CD.
IBC-Ox26 Concomitant hiatal hernia repair during bariatric surgery: is it the reinforcement making the difference?
Authors: Boru C , Iossa A , Silecchia G
Published: November 2022

Background

Concomitant hiatal hernia repair (HHR) in patients who undergo bariatric surgery (BS) is under debate.

Aims

To evaluate on long-term the safety and efficacy of posterior cruroplasty (PC), simple or reinforced with a biosynthetic, absorbable mesh, performed during BS. Primary endpoint: PC's failure, defined as symptomatic HH recurrence, nonresponding to conservative treatment and requiring revisional surgery.

Methods

The prospective database of 1948 patients undergoing BS in a center of excellence between 2011-2020 was searched. Intraoperative measurement of the hiatal surface area (HSA) was performed routinely.

Results

268 patients undergone BS and concomitant HHR (13.7%). Simple PC (group A, 165 patients) was performed during 137 sleeve gastrectomies LSG, 5 re- sleeves and 23 gastric bypasses LGB; mean BMI 43.4 ± 5.8 kg/m2, HSA mean size 3.4 ± 2 cm2. Reinforced PC (group B) was performed in 102 cases: 64 primary LSG, 23 LGB and 15 revisions of LSG; mean BMI 44.6 ± 7.7 kg/m2, HSA mean size 6.7 ± 2 cm2. PC's failure, with intrathoracic migration (ITM) was encountered in 12 cases (7.5%) of simple vs. only 4 cases (3.9%) of reinforced PC (p=0.23); hence, a repeat, reinforced PC and LGB was performed in all cases. No mesh-related complications were registered perioperatively or after long-term follow-up (mean 61 months), minimum 12 months. Only one case of cardiac metaplasia was detected 4 years postoperatively; conversion to LGB, with reinforced redo of the PC was performed. The Cox hazard analysis showed that the use of more than four stitches for cruroplasty represents a negative factor on recurrence (HR = 8; p < 0.05).

Conclusions

Our results support the use of bioabsorbable, synthetic mesh as reinforcement of HH > 4 cm2 in obese patients during BS, showing excellent recurrence rate results (4%). Accurate patients’ and technique's selection, combined with PC (simple or reinforced) ensure effectiveness and safety, with a combined rate of failure (HH recurrence) at 4 years of 6.0%.
IBCOx-9 Enhanced Recovery After Metabolic Surgery: Results of a De Novo Program for Same-day Cases in a Free-standing Ambulatory Surgical Center
Authors: Billing P , Billing J , Balee S
Published: November 2022

Background

Metabolic Surgery (MS) is commonly performed in a hospital setting. Same-day case (SDC) MS has not been performed due to concern for patient safety and complications after discharge. Procedures performed in ambulatory surgical centers (ASC) provide several advantages over hospital-based surgery by improving patient experience, decreasing hospital acquired infections, decreasing cost, and increasing access to MS. We previously reported our experience with performing 2,534 patients who underwent sleeve gastrectomy (SG) in an ASC. The ability to replicate this program validates the safety of Enhanced Recovery After Metabolic Surgery (ERAMS) protocols. We have replicated the SDC program with a new team in a new facility using previously established ERAMS protocols.

Objective

To report safe and effective protocols for same-day metabolic surgery.

Setting

Free-standing ASC,

Methods

Data was collected retrospectively for all patients undergoing MS from June 2019 - December 2019, n = 18. Revisional procedures were not excluded from this study. Patients were excluded from the ASC criteria if they weighed >400 pounds, if anticipated surgery time was > 2 hours, if the patient had impaired mobility limiting early ambulation, if they had chronic obstructive pulmonary disease, severe sleep apnea or moderate cardiac risk. All surgeries were performed laparoscopically using a 38 French Bougie, staple line was initiated 4 cm from the pylorus. No buttress material was used. The upper 3 cm of the staple line was oversewn. Intraoperative blood pressure was raised 20 mm Hg to identify bleeding along the staple line. Drains were not routinely used. Patients were given 3-4 liters of intravenous fluid prior to discharge. Patients were discharged once ASC discharge criteria was met: ambulating, voiding, tolerating fluids, pain and nausea controlled and normal vital signs.

Results

Mean age was 41.3 years (21-70). Mean preoperative body mass index (BMI) was 43.2 (32-55). Mean operative time was 88.1 minutes (54-146). Average length of stay at the ASC was 386.7 minutes (165-547). There were no re-admissions, re-operations, or direct transfers from the ASC to the hospital. One patient was seen in the emergency department (ED) within 30 days (postoperative day 3) for anxiety and dysphagia. She was discharged from the ED after negative studies. Seventeen patients had SG. Four had concomitant hiatal hernia pairs. One had concomitant liver biopsy. Two patients were revisional: one patient had a previous gastric band; one patient had previous banded sleeve gastrectomy.

Conclusion

With an experienced metabolic surgeon, appropriate protocols, and a consistent operative team, MS can be performed safely as a SDC in a free-standing ASC on selective patients.
IBC-Ox24 Routine Oversewing of Staple Lines to Prevent Leaks is Unnecessary in Patients with Normal Iintraoperative Indocyanine Green (ICG) Perfusion Studies Undergoing Sleeve Gastrectomy
Authors: Billy H , Simpson T
Published: November 2022

Anastomotic staple line leaks following laparoscopic sleeve gastrectomy is a devastating complication. Gastric ischemia and poor tissue perfusion has been hypothesized to be a contributing factor. Various interventions including oversewing of staple lines are commonly used hoping to decrease staple line leaks. Indocyanine green (ICG) can be used to assess bowel perfusion and anastomotic viability following laparoscopic surgery. 50 consecutive patients underwent laparoscopic sleeve gastrectomy utilizing intravenous administration of ICG to assess tissue perfusion and the need for staple line oversewing.

Methods

50 consecutive patients undergoing laparoscopic sleeve gastrectomy were studied intraoperatively after completion of sleeve gastrectomy using intravenous administration of ICG. 7.5 mg of ICG was administered intravenously. Arterial perfusion and end stage tissue perfusion of the completed sleeve gastrectomy was then evaluated. Vascular arterial inflow of the gastric cardia, body and antrum was carefully evaluated both anteriorly and posteriorly for evidence of delayed tissue perfusion or tissue ischemia.

Results

In all cases the staple line was examined for staple line formation and evidence of poor tissue perfusion using ICG. Both anterior and posterior evaluation was performed of the distal esophagus, gastric cardia, gastric body and antrum. Absence of tissue perfusion in the resected gastric body was used as a comparison control in all cases. ICG perfusion of the gastric cardia, body and antrum was found to be excellent and brisk in all patients. There were no areas of decreased perfusion or tissue ischemia. Oversewing of the staple line was avoided in all cases. Hemostatic clips were deployed as needed for staple line bleeding until there was no evidence of bleeding on visual inspection and final ICG administration. Patients were followed for evidence of leakage or obstruction for 30 days following completion of the sleeve gastrectomy. There were no leaks, there were no deaths. There were no obstructions and no readmissions. There were no complications related to administration of ICG. Average operative time was 48.7 minutes.

Conclusions

Our series of 50 consecutive sleeve gastrectomies utilizing ICG to assess for tissue perfusion demonstrated no evidence of tissue perfusion deficiencies along the staple line or at the angle of His. Staple line oversewing was not used in any patients. Staple line oversewing in cases without evidence of tissue perfusion deficits on ICG evaluation following sleeve gastrectomy is unnecessary. Further multicenter studies and prospective randomized series are necessary to confirm these initial findings.
Targeting aberrant dendritic integration to treat cognitive comorbidities of epilepsy
Authors: Masala Nicola , Pofahl Martin , Haubrich André N , Sameen Islam Khondker Ushna , Nikbakht Negar , Pasdarnavab Maryam , Bohmbach Kirsten , Araki Kunihiko , Kamali Fateme , Henneberger Christian , Golcuk Kurtulus , Ewell Laura A , Blaess Sandra , Kelly Tony , Beck Heinz
Published: November 2022

Memory deficits are a debilitating symptom of epilepsy, but little is known about mechanisms underlying cognitive deficits. Here, we describe a Na+ channel-dependent mechanism underlying altered hippocampal dendritic integration, degraded place coding and deficits in spatial memory.

Two-photon glutamate uncaging experiments revealed a marked increase in the fraction of hippocampal first-order CA1 pyramidal cell dendrites capable of generating dendritic spikes in the kainate model of chronic epilepsy. Moreover, in epileptic mice dendritic spikes were generated with lower input synchrony, and with a lower threshold. The Nav1.3/1.1 selective Na+ channel blocker ICA-121431 reversed dendritic hyperexcitability in epileptic mice, while the Nav1.2/1.6 preferring anticonvulsant S-Lic did not. We used in vivo two-photon imaging to determine if aberrant dendritic excitability is associated with altered place-related firing of CA1 neurons. We show that ICA-121431 improves degraded hippocampal spatial representations in epileptic mice. Finally, behavioural experiments show that reversing aberrant dendritic excitability with ICA-121431 reverses hippocampal memory deficits.

Thus, a dendritic channelopathy may underlie cognitive deficits in epilepsy and targeting it pharmacologically may constitute a new avenue to enhance cognition.
Household- Versus Incentive-Based Contact Investigation for Tuberculosis in Rural South Africa: A Cluster-Randomized Trial
Authors: Hanrahan Colleen F , Nonyane Bareng Aletta Sanny , Lebina Limakatso , Mmolawa Lesego , Siwelana Tsundzukani , West Nora S , Albaugh Nicholas , Martinson Neil , Dowdy David W
Published: November 2022

Background

Household contact investigation for people newly diagnosed with tuberculosis (TB) is poorly implemented, particularly in low- and middle-income countries. Conditional cash incentives may improve uptake.

Methods

We conducted a pragmatic, cluster-randomized, crossover trial of 2 TB contact investigation approaches (household-based and incentive-based) in 28 public primary care clinics in South Africa. Each clinic used 1 approach for 18 months, followed by a 6-month washout period, after which the opposite approach was used. Fourteen clinics were randomized to each approach. In the household-based arm, we conducted TB screening and testing of contacts at the household. In the incentive-based arm, both index patients and ≤10 of their close contacts (either within or outside the household) were given small cash incentives for presenting to study clinics for TB screening. The primary outcome was the number of people with incident TB who were diagnosed and started on treatment at study clinics.

Results

From July 2016 to January 2020, we randomized 28 clinics to each study arm, and enrolled 782 index TB patients and 1882 contacts in the household-based arm and 780 index patients and 1940 contacts in the incentive-based arm. A total of 1413 individuals started on TB treatment in the household-based arm and 1510 in the incentive-based arm. The adjusted incidence rate ratio of TB treatment initiation in the incentive- versus household-based arms was 1.05 (95% confidence interval: .97–1.13).

Conclusions

Incentive-based contact investigation for TB has similar effectiveness to traditional household-based approaches and may be a viable alternative or complementary approach to household-based investigation.
Novel histologic score predicts recurrent intestinal metaplasia after successful endoscopic eradication therapy
Authors: Triggs Joseph R , Krogh Katrina , Simon Violette , Krause Amanda , Kaplan Jeffrey B , Yang Guang-Yu , Wani Sachin , Kahrilas Peter J , Pandolfino John , Komanduri Srinadh
Published: November 2022

Endoscopic eradication therapy (EET) is an effective treatment for Barrett’s esophagus (BE); however, disease recurrence remains problematic requiring surveillance post-treatment. While data regarding predictors of recurrence are limited, uncontrolled reflux may play a significant role. Our aim was to develop a scoring system based on histopathologic reflux in surveillance biopsies following EET to identify patients at high risk for recurrence of BE. Patients were identified from two centers in the treatment with resection and endoscopic ablation techniques for BE consortium. Hematoxylin and eosin-stained slides of surveillance biopsies post-EET were assessed for histologic changes associated with reflux from a cohort of patients who also underwent pH-metry (derivation cohort). We developed a novel scoring system (Recurrent Epithelial Changes from Uncontrolled Reflux [RECUR]) composed of dilated intercellular spaces, epithelial ballooning, basal cell hyperplasia, and parakeratosis, to identify patients with abnormal esophageal acid exposure. This scoring system was then used to grade surveillance biopsies from patients with or without recurrence of BE following EET (validation cohort). Of 41 patients in the derivation cohort, 19.5% had abnormal acid exposure times (AET) while on proton pump inhibitor therapy. The mean (SD) RECUR score for patients with AET <4% was 4.0 (1.6), compared with 5.5 (0.9) for AET ≥4% (P = 0.015). In the validation cohort consisting of 72 patients without recurrence and 64 patients with recurrence following EET, the RECUR score was the only significant predictor of recurrence (odds ratio: 1.36, 95% confidence interval: 1.10–1.69, P = 0.005). Histologic grading of surveillance biopsies using the RECUR scoring system correlates with BE recurrence following EET.
Management of comatose survivors of out-of-hospital cardiac arrest in Europe: current treatment practice and adherence to guidelines. A joint survey by the Association for Acute CardioVascular Care (ACVC) of the ESC, the European Resuscitation Council (ERC), the European Society for Emergency Medicine (EUSEM), and the European Society of Intensive Care Medicine (ESICM)
Authors: Jorge-Perez Pablo , Nikolaou Nikolaos , Donadello Katia , Khoury Abdo , Behringer Wilhelm , Hassager Christian , Boettiger Bernd , Sionis Alessandro , Nolan Jerry , Combes Alain , Quinn Tom , Price Susanna , Grand Johannes
Published: November 2022

Aims

International guidelines give recommendations for the management of comatose out-of-hospital cardiac arrest (OHCA) survivors. We aimed to investigate adherence to guidelines and disparities in the treatment of OHCA in hospitals in Europe.

Methods and results

A web-based, multi-institutional, multinational survey in Europe was conducted using an electronic platform with a predefined questionnaire developed by experts in post-resuscitation care. The survey was disseminated to all members of the societies via email, social media, websites, and newsletters in June 2021. Of 252 answers received, 237 responses from different units were included and 166 (70%) were from cardiac arrest centres. First-line vasopressor used was noradrenaline in 195 (83%) and the first-line inotrope was dobutamine in 148 (64%) of the responses. Echocardiography is available 24/7 in 204 (87%) institutions. Targeted temperature management was used in 160 (75%) institutions for adult comatose survivors of OHCA with an initial shockable rhythm. Invasive or external cooling methods with feedback were used in 72 cardiac arrest centres (44%) and 17 (24%) non-cardiac arrest centres (P < 0.0003). A target temperature between 32 and 34°C was preferred by 46 centres (21%); a target between 34 and 36°C by 103 centres (52%); and <37.5°C by 35 (16%). Multimodal neuroprognostication was poorly implemented and a follow-up at 3 months after discharge was done in 71 (30%) institutions.

Conclusion

Post-resuscitation care is not well established and varies among centres in European hospitals. Cardiac arrest centres have a higher coherence with guidelines compared with respondents from non-cardiac arrest centres. The overall inconsistency in approaches and deviation from recommendations could be a focus for improvement.
Structural control within flawed rock specimens under external loading as visualized through repeating nucleation on multiple sites by acoustic emission (AE)
Authors: Xiong Qiquan , Lin Qing , Hampton Jesse C
Published: November 2022

The behaviour of discontinuities in rock mass have been experimentally investigated extensively for decades by a type of laboratory analogue of flawed rock specimens, taking the artificially prepared flaw(s) as the analogue of rock mass discontinuity(ies). The role of macroscale flaw(s) as controlling structure has been generally neglected. Here, we conduct detailed characterizations of the acoustic emission (AE) from the rock fracture process on the pre-flawed specimens under loading. Though the same phenomena from the literature can be reproduced within our tests, detailed spatial-temporal investigation on the AE events at the nucleation point suggests a different physical interpretation. Artificial flaw(s) play a non-negligible role as a controlling structure for the following rock fracture process including a series of nucleation points alteration via stress transfer. The interlocking parallelogram (IP) control and single-large-structural (SLS) control are two fundamental mechanisms initiated by the artificial flaws. Each of these two mechanisms are observed under a wide range of flaw settings and can potentially coexist within the across length scales. The scale-invariance feature is observed to be fundamentally different within the scale of specimens under SLS and/or IP control, suggesting the incompleteness at the specimen-scale for IP control. Therefore, no ‘fracture coalescence’ zone can be separately investigated without considering its external rock fracture evolution and confirming scale-invariance. Therefore, structural controlling mechanisms must be considered due to the pattern and AE characterization results.
2021 AAR Presidential Address: “Religion, Inequality, and the Will ‘to Stop’”
Authors: Frederick Marla
Published: November 2022

Rising social inequality defines much of our world today, evidenced not only by the disproportionate effects of poverty and climate change but also by the uneven impact of the global pandemic on resourced and under-resourced communities. As scholars, we understand that religion often plays the role of both hero and villain in our efforts to live justly in the world. Navigating the lived effects of global supremacies can motivate collective action or forms of existential denial that reproduce the status quo. This address asks not what religion can help us do but rather what religion might help us cease to do, “to Stop” and re-evaluate.
HIV-1 resistance genotyping by ultra-deep sequencing and 6-month virological response to first-line treatment
Authors: Raymond Stéphanie , Jeanne Nicolas , Nicot Florence , Dimeglio Chloé , Carcenac Romain , Harter Agnès , Ranger Noémie , Martin-Blondel Guillaume , Delobel Pierre , Izopet Jacques
Published: November 2022

Objectives

To evaluate the routine use of the Sentosa ultra-deep sequencing (UDS) system for HIV-1 polymerase resistance genotyping in treatment-naïve individuals and to analyse the virological response (VR) to first-line antiretroviral treatment.

Methods

HIV drug resistance was determined on 237 consecutive samples from treatment-naïve individuals using the Sentosa UDS platform with two mutation detection thresholds (3% and 20%). VR was defined as a plasma HIV-1 virus load <50 copies/mL after 6 months of treatment.

Results

Resistance to at least one antiretroviral drug with a mutation threshold of 3% was identified in 29% and 16% of samples according to ANRS and Stanford algorithms, respectively. The ANRS algorithm also revealed reduced susceptibility to at least one protease inhibitor (PI) in 14.3% of samples, to one reverse transcriptase inhibitor in 12.7%, and to one integrase inhibitor (INSTI) in 5.1%. For a mutation threshold of 20%, resistance was identified in 24% and 13% of samples according to ANRS and Stanford algorithms, respectively. The 6 months VR was 87% and was similar in the 58% of patients given INSTI-based treatment, in the 16% given PI-based treatment and in the 9% given NNRTI-based treatment. Multivariate analysis indicated that the VR was correlated with the baseline HIV virus load and resistance to at least one PI at both 3% and 20% mutation detection thresholds (ANRS algorithm).

Conclusions

The Vela UDS platform is appropriate for determining antiretroviral resistance in patients on a first-line antiretroviral treatment. Further studies are needed on the use of UDS for therapeutic management.
One foot in the online gig economy: Coping with a splitting professional identity
Authors: Yao Yao
Published: November 2022

As the online gig economy diffuses into professional fields, more workers now engage in online platforms alongside traditional offline practice. How do concurrent online and offline works challenge professional identity and how do workers cope with the challenges? This study inductively explores a qualitative dataset of lawyers who worked in online platform-based and conventional offline legal services at the same time. I found that the common features of online gig work (e.g. accessibility and affordability for customers, ratings, and reviews of workers) result in contradictions with traditional legal work in terms of work content and client relations. These differences caused an emerging split in lawyers’ professional identity—the coexistence of two somewhat contradictory sub-identities. The lawyers coped with the professional identity split in one of two ways: 1) alleviating the experienced severity of the split by using the tactics of framing and distancing from online work and tailoring online work content; 2) reconciling the split by reframing professional ideals based on their new understanding of being lawyers obtained from online work. Individual differences in professional identity constructed in traditional practice were found to underlie this identity dynamic: the lawyers’ expertise specialization and customer orientation explained the strength of professional split, and those who believed that the profession is highly dynamic and will experience dramatic future changes were inclined to reconcile professional identity split.
The importance of appropriate processing and direct microscopic examination for the timely diagnosis and management of invasive infections caused by filamentous fungi
Authors: Borman Andrew M , Mohammed Shakeel , Palmer Michael D , Childs Nicola , Johnson Elizabeth M
Published: November 2022

The gold standard for diagnosis of invasive fungal infections caused by filamentous fungi remains the visualization of fungal elements in fluids, and biopsy/tissue collected from a normally sterile body site. Parallel recovery of viable fungus from the sample subsequently permits antifungal susceptibility testing of the individual isolate. Central to both processes is the appropriate processing of tissue specimens to avoid damaging fungal elements and optimize viable organism recovery. Historically, mycologists have proposed that homogenization (grinding or bead-beating) of tissue should be avoided in cases of suspected fungal infection as it likely damages hyphae, instead preferring to chop tissue into small portions (dicing) for direct microscopic examination and culture. Here, we have compared the two processes directly on material from clinical patient cases of mucoromycosis and invasive aspergillosis. Representative portions of fresh biopsy samples were processed in parallel either by chopping (dicing) in the mycology reference laboratory or by bead-beating in the adjoining general microbiology laboratory. Aliquots of the samples were then cultured under identical conditions and subjected to direct microscopic examination. The results demonstrated that tissue homogenization significantly reduced (i) organism recovery rates in cases of both mucoromycosis and invasive aspergillosis and (ii) the number of fungal elements detectable upon direct microscopic examination. To our knowledge, this is the first study to directly compare these alternative processing methods and despite only employing a limited number of samples the data presented here, provide support for the perceived mycological wisdom that homogenization of tissue samples should be avoided when filamentous fungal infections are suspected.