bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood use and transfusion needs at a large health care system in Washington state during the SARS‐CoV‐2 pandemic
Authors: Pagano Monica B. , Cataife Guido , Fertrin Kleber Yotsumoto , Gernsheimer Terry , R. Hess John , Staley Elizabeth , Clark Christine , Senn Nina , Tuott Erin , C. Tsang Hamilton
Published: August 2020

Background

This report evaluates hospital blood use trends during the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic, and identifies factors associated with the need for transfusion and risk of death in patients with coronavirus 2019 (COVID‐19).

Methods

Overall hospital blood use and medical records of adult patients with COVID‐19 were extracted for two institutions. Multivariate logistic regression models were conducted to estimate associations between the outcomes transfusion and mortality and patient factors.

Results

Daily blood use decreased compared to pre–COVID‐19 levels; the effect was more significant for platelets (29% and 34%) compared to red blood cells (25% and 20%) at the two institutions, respectively. Surgical and oncologic services had a decrease in average daily use of platelets of 52% and 30%, and red blood cells of 39% and 25%, respectively. A total of 128 patients with COVID‐19 were hospitalized, and 13 (10%) received at least one transfusion due to anemia secondary to chronic illness (n = 7), recent surgery (n = 3), and extracorporeal membrane oxygenation (n = 3). Lower baseline platelet count and admission to the intensive care unit were associated with increased risk of transfusion. The blood group distribution in patients with COVID‐19 was 37% group O, 40% group A, 18% group B, and 5% group AB. Non–type O was not associated with increased risk of mortality.

Conclusion

The response to the SARS‐CoV‐2 pandemic included changes in routine hospital operations that allowed for the provision of a sufficient level of care for patients with and without COVID‐19. Although blood type may play a role in COVID‐19 susceptibility, it did not seem to be associated with patient mortality.
Clinical outcome in 23 dogs with exocrine pancreatic carcinoma
Authors: Pinard Christopher J. , Hocker Samuel E. , Weishaar Kristen M.
Published: August 2020

Exocrine pancreatic carcinoma is uncommon in the dog and the veterinary literature surrounding the disease is minimal. Twenty‐three cases of canine exocrine pancreatic carcinoma were reviewed in a retrospective manner to obtain information on clinical presentation, behaviour and survival associated with the disease. Presenting clinical signs were nonspecific and included anorexia, lethargy, vomiting and abdominal pain. The overall median survival time was only 1 day but was confounded by the large number of dogs that were euthanized shortly after diagnosis. Metastatic disease was detected in 78% of cases at the time of diagnosis, attesting to the aggressive nature of the disease. Neither lymph node metastasis, tumour size nor tumour location had an impact on overall survival. Only one patient was a previous diabetic who is contrary to reports of the disease in people and felines. This retrospective study reaffirms the need for early detection measures to optimize disease control. However, the benefits of therapy with surgery or radiation and adjuvant chemotherapy remain to be elucidated in dogs with exocrine pancreatic carcinoma.
Open trial of Bruton’s tyrosine kinase inhibitor (PRN1008) in the treatment of canine pemphigus foliaceus
Authors: Goodale Elizabeth C. , White Stephen D. , Bizikova Petra , Borjesson Dori , Murrell Dedee F. , Bisconte Angelina , Francesco Michelle , Hill Ronald J. , Masjedizadeh Mohammad , Nunn Philip , Gourlay Steven G. , Jordan Tyler J.M. , Emery Carolyn B. , Outerbridge Catherine A.
Published: August 2020

Contexte

La BTK (Bruton’s tyrosine kinase) est une importante voie de signal des cellules B. L'efficacité des inhibiteurs de BTK (BTKi) a été rapportée dans les maladies auto‐immunes chez l'homme. Le pemphigus foliacé (cPF) est la dermatose auto‐immune la plus fréquente chez le chien.

Objectifs

Déterminer l'innocuité et l'efficacité de BTKi PRN 1008 dans le traitement de cPF.

Sujets

Quatre chiens de propriétaires.

Matériels et méthodes

Quatre chiens diagnostiqués PF ont reçus BTKi PRN 1008. Les doses initiales étaient approximativement de 15 mg/kg une fois par jour, augmenté à deux fois par jour si une réponse inadéquate était observée. Le traitement a été poursuivi pendant 20 semaines, avec essai de diminution à un jour sur deux. Les chiens ont été suivis avec une numération formule, biochimie complète et analyses urinaires et évalués avec une version modifiée de cPDAI (human Pemphigus Disease Activity Index). Les titres d'immunoglobulines (Ig) G anti‐desmocolline 1 (DSC‐1) et desmogléine‐1 (DSG‐1) ont été réalisés avant et après traitement. Le médicament lié à la cible a été mesuré dans les cellules mononuclées sanguines périphériques (PBMC).

Résultats

Les quatre chiens ont montré une diminution des lésions et du score cPDAI au cours des deux premières semaines de traitement. Trois chiens ont continués à s'améliorer jusqu'à guérison presque complète à la semaine 20, à chaque point, trois réponses ont été considérées "bonne" et une "faible". Les dosages quotidiens finaux étaient dans les valeurs 17‐33 mg/kg. Les titres d'IgG anti‐DSC‐1 ont diminués drastiquement chez un chien, étaient non détectable pour deux et étaient non interprétable pour un chien. Aucun chien n'avait d'IgG détectable à DSG1. Un effet indésirable possible a été observé chez un chien.

Conclusions et importance clinique

BTK1 PRN 1008 en monothérapie pourrait avoir des effets bénéfiques dans certains cas de cPF.
Effect of partial vs complete circumferential epitendinous suture placement on the biomechanical properties and gap formation of canine cadaveric tendons
Authors: Duffy Daniel J. , Chang Yi‐Jen , Fisher Matthew B. , Moore George E.
Published: August 2020

Objective

To determine the effect of partial vs complete circumferential epitendinous suture (ES) placement in addition to a core suture on the biomechanical strength and gapping characteristics of repaired canine tendinous constructs.

Study design

Ex vivo, biomechanical study.

Sample population

Thirty‐six canine superficial digital flexor tendons.

Methods

Superficial digital flexor tendons were randomly assigned to three groups (n = 12), sharply transected and repaired with a core locking‐loop suture with Group 1 a partial circumferential ES, 180° on the palmar side; Group 2 a complete circumferential ES, 360° and double knotting technique; or Group 3 a complete circumferential ES, 360° and single knotting technique. After preloading, constructs were distracted to monotonic failure. Failure mode, gap formation, yield, peak, and failure forces were analyzed.

Results

Mean yield (group 1 = 68.6 N, group 2 = 106.5 N, group 3 = 114 N, P < .013), peak (group 1 = 92.8 N, group 2 = 134.6 N, group 3 = 147.3 N; P < .001), and failure (group 1 = 88.7 N, group 2 = 133.0 N, group 3 = 145.5 N, P < .001) loads differed between groups. No difference in yield (P = .874), peak (P = .434), or failure load (P = .434) was detected between complete circumferential ES groups. Force to create 1‐mm (P < .001) and 3‐mm (P < .038) gap formation was greater in specimens with complete vs partial circumferential ES placement. Complete circumferential ES repairs failed primarily by suture pull‐through compared with suture breakage in most partial circumferential ES constructs.

Conclusion

Addition of a complete circumferential ES with a single or double knotting technique increased the biomechanical strength of normal tendon repairs while reducing gap formation compared with partial ES placement alone.

Clinical significance

Complete circumferential ES is recommended over partial ES placement.
MEMORY ALTERING TECHNOLOGIES AND THE CAPACITY TO FORGIVE: WESTWORLD AND VOLF IN DIALOGUE
Authors: Marvin Michelle A.
Published: August 2020

I explore the impact of memory altering technologies in the science fiction drama (2016–2020) in order to show that unreconciled altered traumatic memory may lead to a dystopian breakdown of society. I bring Miroslav Volf's theological perspectives on memory into conversation with the plot of Westworld in order to reveal connections between memory altering technologies and humanity's responsibility to remember rightly. Using Volf's theology of remembering as an interpretive lens, I analyze characters’ inability to remember rightly while recalling partial memories of their trauma. In virtue of this examination, I contend that memory altering technologies may inhibit individuals from relational processes of healing, such as forgiveness. Consequently, I argue that this study leads to a richer understanding of the potential that memory altering technologies have for undermining humanity's ability to interact in a relational capacity, specifically in terms of forgiveness.
Peripheral chemoresponsiveness during exercise in male athletes with exercise‐induced arterial hypoxaemia
Authors: Granger Emily A. , Cooper Trevor K. , Hopkins Susan R. , McKenzie Donald C. , Dominelli Paolo
Published: August 2020

New Findings

What is the central question of this study?

Do highly trained male endurance athletes who develop exercise‐induced arterial hypoxaemia (EIAH) demonstrate reduced peripheral chemoresponsiveness during exercise?

What is the main finding and its importance?

Those with the lowest arterial saturation during exercise have a smaller ventilatory response to hypercapnia during exercise. There was no significant relationship between the hyperoxic ventilatory response and EIAH. The findings suggest that peripheral chemoresponsiveness to hypercapnia during exercise could play a role in the development of EIAH. The findings improve our understanding of the mechanisms that contribute to EIAH.

Exercise‐induced arterial hypoxaemia (EIAH) is characterized by a decrease in arterial oxygen tension and/or saturation during whole‐body exercise, which may in part result from inadequate alveolar ventilation. However, the role of peripheral chemoresponsiveness in the development of EIAH is not well established. We hypothesized that those with the most severe EIAH would have an attenuated ventilatory response to hyperoxia and hypercapnia during exercise. To evaluate this, on separate days, we measured ventilatory sensitivity to hyperoxia and separately hypercapnia at rest and during three different exercise intensities (25, 50% of and ventilatory threshold (∼67% of )) in 12 males cyclists ( = 66.6 ± 4.7 ml kg−1 min−1). Subjects were divided into two groups based on their end‐exercise arterial oxygen saturation (ear oximetry, ): a normal oxyhaemoglobin saturation group (NOS,  = 93.4 ± 0.4%, n = 5) and a low oxyhaemoglobin saturation group (LOS,  = 89.9 ± 0.9%, n = 7). There was no difference in (66.4 ± 2.9 vs. 66.8 ± 6.0 ml kg−1 min−1, respectively, P = 0.9), peak ventilation during maximal exercise (182 ± 15 vs. 197 ± 32 l min−1, respectively, P = 0.36) or ventilatory response to hyperoxia (P = 0.98) at any exercise intensity between NOS and LOS groups. However, those in the LOS group had a significantly lower ventilatory response to hypercapnia (P = 0.004, (η2 = 0.18). There was also a significant relationship between the mean hypercapnic response and end‐exercise (r = 0.75, P = 0.009) but not between the mean hyperoxic response and end‐exercise (r = 0.21, P = 0.51). A blunted hypercapnic ventilatory response may contribute to EIAH in highly trained men due to a failure to increase ventilation sufficiently to offset exercise‐induced gas exchange impairments.
Promoting Physical Activity and Executive Functions Among Children: A Cluster Randomized Controlled Trial of an After-School Program in Australia
Authors: Veldman Sanne L.C. , Jones Rachel A. , Stanley Rebecca M. , Cliff Dylan P. , Vella Stewart A. , Howard Steven J. , Parrish Anne-Maree , Okely Anthony D.
Published: August 2020

Background: The aim of this study was to examine the efficacy of an embedded after-school intervention, on promoting physical activity and academic achievement in primary-school-aged children. Methods: This 6-month, 2-arm cluster randomized controlled trial involved 4 after-school centers. Two centers were randomly assigned to the intervention, which involved training the center staff on and implementing structured physical activity (team sports and physical activity sessions for 75 min) and academic enrichment activities (45 min). The activities were implemented 3 afternoons per week for 2.5 hours. The control centers continued their usual after-school care practice. After-school physical activity (accelerometry) and executive functions (working memory, inhibition, and cognitive flexibility) were assessed pre- and postintervention. Results: A total of 60 children were assessed (7.7 [1.8] y; 50% girls) preintervention and postintervention (77% retention rate). Children in the intervention centers spent significantly more time in moderate to vigorous physical activity (adjusted difference = 2.4%; 95% confidence interval, 0.6 to 4.2; P = .026) and scored higher on cognitive flexibility (adjusted difference = 1.9 units; 95% confidence interval, 0.9 to 3.0; P = .009). About 92% of the intervention sessions were implemented. The participation rates varied between 51% and 94%. Conclusion: This after-school intervention was successful at increasing moderate to vigorous physical activity and enhancing cognitive flexibility in children. As the intervention was implemented by the center staff and local university students, further testing for effectiveness and scalability in a larger trial is required.
Endosymbionts of Metazoans Dwelling in the PACManus Hydrothermal Vent: Diversity and Potential Adaptive Features Revealed by Genome Analysis
Authors: Li Leilei , Wang Minxiao , Li Lifeng , Du Zengfeng , Sun Yan , Wang Xiaocheng , Zhang Xin , Li Chaolun
Published: August 2020

Deep-sea hydrothermal vents are dominated by several invertebrate species. The establishment of symbiosis has long been thought to be the key to successful colonization by these sedentary species in such harsh environments. However, the relationships between symbiotic bacteria and their hosts and their role in environmental adaptations generally remain unclear. In this paper, we show that the distribution of three host species showed characteristic niche partitioning in the Manus Basin, giving us the opportunity to understand how they adapt to their particular habitats. This study also revealed three novel genomes of symbionts from the snails of
A. boucheti
. Combined with a data set on other ectosymbiont and free-living bacteria, genome comparisons for the snail endosymbionts pointed to several genetic traits that may have contributed to the lifestyle shift of
Epsilonproteobacteria
into the epithelial cells. These findings could increase our understanding of invertebrate-endosymbiont relationships in deep-sea ecosystems.
Targeted Metagenomics Offers Insights into Potential Tick-Borne Pathogens
Authors: Thoendel Matthew
Published: August 2020

Tick-borne disease pathogen identification remains a diagnostic challenge due to the multiple tests necessary for diagnosis. Targeted metagenomic sequencing is an evolving method to detect multiple different pathogens with a single test. In this issue of the
Journal of Clinical Microbiology
, L. Kingry, S. Sheldon, S. Oatman, B. Pritt, et al. (J Clin Microbiol 58:e00147-20, 2020,
https://doi.org/10.1128/JCM.00147-20
) explore 16S rRNA gene-targeted metagenomics to identify bacterial pathogens in 881 of more than 13,000 specimens submitted for tick-borne pathogen testing, giving new insights into suspected tick-borne pathogens.
Supplemental Material: High-precision geochronology requires that ultrafast mantle-derived magmatic fluxes built the transcrustal Bear Valley Intrusive Suite, Sierra Nevada, California, USA
Authors: Klein Benjamin , al. et
Published: August 2020

Zircon U-Pb and Hf data tables, concordia diagrams, detailed analytical methods and sample descriptions, and additional discussion of mixing calculations and interpretation of zircon ages.
Palivizumab’s real-world effectiveness: a population-based study in Ontario, Canada, 1993–2017
Authors: Fitzpatrick Tiffany , McNally James Dayre , Stukel Therese A , Kwong Jeffrey C , Wilton Andrew S , Fisman David , Guttmann Astrid
Published: August 2020

Objective

To evaluate the effectiveness of two palivizumab programmes targeting high-risk infants, defined by prematurity, diagnosis of comorbidities and geography, and assess potential disparities by neighbourhood income.

Design

Controlled, interrupted time series.

Setting

Ontario, Canada.

Patients

We used linked health and demographic administrative databases to identify all children born in hospitals 1 January 1993 through 31 December 2016. Follow-up ended at the earliest of second birthday or 30 June 2017.

Intervention

Palivizumab-eligibility: child was born very preterm and ≤6 months old during respiratory syncytial virus (RSV) season; <24 months old with significant chronic lung or congenital heart disease; or ≤6 months, born preterm or residents of remote regions.

Main outcome

Severe RSV-related illness, defined as hospitalisation or death with a diagnosis of bronchiolitis, RSV pneumonia or RSV.

Results

3 million births and 87 000 RSV-related events were identified. Over the study period, rates of severe RSV-related illness declined 65.4% among the highest risk group, eligible infants <6 months (230.6 to 79.8 admissions per 1000 child-years). Relative to changes among ineligible infants <6 months, rates dropped 10.4% (95% CI −18.6% to 39.4%) among eligible infants immediately following introduction of a national palivizumab programme in 1998. Initially, rates were considerably higher among infants from low-income neighbourhoods, but income-specific rates converged over time among eligible infants <6 months; such convergence was not seen among other children.

Conclusions

Incidence of severe RSV-related illness declined over the study period. While we cannot attribute causality, the timing and magnitude of these declines suggest impact of palivizumab in reducing RSV burden and diminishing social inequities among palivizumab-eligible infants.
Haemorrhagic encephalitis in the garb of scrub typhus
Authors: Gaba Saurabh , Garg Swati , Gupta Monica , Gupta Rekha
Published: August 2020

A 19-year-old girl presented with fever, headache, vomiting and drowsiness. She had grade 1 papilloedema and neck rigidity but no focal deficits or seizures. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis, slightly elevated protein and normal glucose. MRI of the brain showed a hyperintense lesion in left ganglio-capsular region on the fluid attenuation inversion recovery sequence with perilesional oedema and mild midline shift. Haemorrhage was seen in the region on susceptibility weighted imaging . The patient was thoroughly investigated for known causes of meningoencephalitis, but the diagnosis of scrub typhus was delayed till the 10th day of illness. She was treated with doxycycline for 2 weeks and had marked improvement, both clinically and radiologically. Literature review has revealed that although meningoencephalitis in scrub typhus is not uncommon, such atypical lesions on brain MRI are a rarity. Serial imaging was performed to document the disease progression and resolution on treatment.
Pulmonary embolism as the primary presentation of IgA vasculitis
Authors: Mosalem Osama , Hernandez Garcilazo Nora , Saleh Yehia , Abu Rous Fawzi
Published: August 2020

A 47-year-old man presented to the emergency department with acute onset of dyspnoea and a week history of painful erythematous rash on both of his legs. CT angiogram of the chest showed saddle pulmonary embolism resulting in right ventricular strain and obstructive shock. Due to the atypical nature of his skin rash, a skin biopsy from one of these lesions was done and came consistent with the diagnosis of IgA vasculitis.
Tracheal swab from front of neck airway for SARS-CoV-2; a bronchial foreign body
Authors: Hussain Mohammed Hassan , Siddiqui Saad , Mahmood Sara , Valsamakis Theodoros
Published: August 2020

We report the case of a bronchial foreign body, following a tracheostomy site swab for SARS-CoV-2, aiming to raise awareness and vigilance. A qualified nurse was performing a routine SARS-CoV-2 swab on a 51-year-old woman, fitted with a tracheostomy in the recent past following a craniotomy. This was part of the discharging protocol to a nursing home. During the sampling, part of the swab stylet snapped and was inadvertently dropped through the tracheostomy site. Initial CT imaging was reported as showing no signs of a foreign body but some inflammatory changes. Bedside flexible endoscopy through the tracheostomy site revealed the swab in a right lobar bronchus. This was subsequently removed by flexible bronchoscopy. This case highlights the need for clear guidance on how samples for SARS-CoV-2 are taken from patients with front of neck airways (laryngectomy/tracheοstomy) and the potential pitfalls involved.
Analysis of change in patient-reported outcome measures with floor and ceiling effects using the multilevel Tobit model: a simulation study and an example from a National Joint Register using body mass index and the Oxford Hip Score
Authors: Sayers Adrian , Whitehouse Michael R , Judge Andrew , MacGregor Alex J , Blom Ashley W , Ben-Shlomo Yoav
Published: August 2020

Objectives

This study has three objectives. (1) Investigate the association between body mass index (BMI) and the efficacy of primary hip replacement using a patient-reported outcome measure (PROMs) with a measurement floor and ceiling, (2) Explore the performance of different estimation methods to estimate change in PROMs score following surgery using a simulation study and real word data where data has measurement floors and ceilings and (3) Lastly, develop guidance for practising researchers on the analysis of PROMs in the presence of floor and ceiling effects.

Design

Simulation study and prospective national medical device register.

Setting

National Register of Joint Replacement and Medical Devices.

Methods

Using a Monte Carlo simulation study and data from a national joint replacement register (162 513 patients with pre- and post-surgery PROMs), we investigate simple approaches for the analysis of outcomes with floor and ceiling effects that are measured at two occasions: linear and Tobit regression (baseline adjusted analysis of covariance, change-score analysis, post-score analysis) in addition to linear and multilevel Tobit models.

Primary outcome

The primary outcome of interest is change in PROMs from pre-surgery to 6 months post-surgery.

Results

Analysis of data with floor and ceiling effects with models that fail to account for these features induce substantial bias. Single-level Tobit models only correct for floor or ceiling effects when the exposure of interest is not associated with the baseline score. In observational data scenarios, only multilevel Tobit models are capable of providing unbiased inferences.

Conclusions

Inferences from pre- post-studies that fail to account for floor and ceiling effects may induce spurious associations with substantial risk of bias. Multilevel Tobit models indicate the efficacy of total hip replacement is independent of BMI. Restricting access to total hip replacement based on a patients BMI can not be supported by the data.
Barriers in accessing HIV care for Francophone African, Caribbean and Black people living with HIV in Canada: a scoping review
Authors: Djiadeu Pascal , Yusuf Abban , Ongolo-Zogo Clémence , Nguemo Joseph , Odhiambo Apondi J , Mukandoli Chantal , Lightfoot David , Mbuagbaw Lawrence , Nelson LaRon E
Published: August 2020

Introduction

In 2001, 50%–55% of French-speaking minority communities did not have access to health services in French in Canada. Although Canada is officially a bilingual country, reports indicate that many healthcare services offered in French in Anglophone provinces are insufficient or substandard, leading to healthcare discrepancies among Canada’s minority Francophone communities.

Objectives

The primary aim of this scoping systematic review was to identify existing gaps in HIV-care delivery to Francophone minorities living with HIV in Canada.

Study design

Scoping systematic review.

Data sources

Search for studies published between 1990 and November 2019 reporting on health and healthcare in Francophone populations in Canada. Nine databases were searched, including Medline, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, the National Health Service Economic Development Database, Global Health, PsychInfo, PubMed, Scopus and Web of Science.

Study selection

English or French language studies that include data on French-speaking people with HIV in an Anglophone majority Canadian province.

Results

The literature search resulted in 294 studies. A total of 230 studies were excluded after duplicates were removed. The full texts of 43 potentially relevant papers were retrieved for evaluation and data extraction. Forty-one studies were further excluded based on failure to meet the inclusion criteria leaving two qualitative studies that met our inclusion criteria. These two studies reported on barriers on access to specialised care by Francophone and highlighted difficulties experienced by healthcare professionals in providing quality healthcare to Francophone patients in Ontario and Manitoba.

Conclusion

The findings of this scoping systematic review highlight the need for more HIV research on linguistic minority communities and should inform health policymaking and HIV/AIDS community organisations in providing HIV care to Francophone immigrants and Canadians.
Prevalence of anxiety and depressive symptoms among emergency physicians in Libya after civil war: a cross-sectional study
Authors: Elhadi Muhammed , Khaled Ala , Malek Ans Bassam , El-Azhari Ahmed El-Alem , Gwea Ahmed Zakaria , Zaid Ahmed , Elturki Salman Mabruk , Aburgegah Ahmed , Abu Ageila Munir Ahmed K , Alhadi Abdulmueti , Albashkar Hafed Abdulwahhab , Alshareef Aliyah Mustafa , Ben Nama Adel Basher , Sahboun Nizar Aljarboue Mohammed , Ahmed Hazem
Published: August 2020

Objectives

We aimed to identify the prevalence of depression and anxiety among physicians working in the emergency departments of nine tertiary care centres in Libya.

Design

This was a cross-sectional study.

Setting

Nine main tertiary centres in Libya

Participants

Emergency department doctors were surveyed between December 2018 and February 2019.

Intervention

The standardised Hospital Anxiety and Depression Scale (HADS) was selected as a measurement tool for analysing anxiety and depression symptoms; a HADS score of 8 indicated anxiety as well as depression symptoms. The primary outcomes were anxiety and depression, which were tabulated with independent sociodemographic variables. χ2 tests were conducted to compare the prevalence of anxiety and depression between the groups. Statistical analysis was performed using SPSS V.25.

Results

A total of 108 out of 150 (72%) emergency physicians from all levels participated in the study and took the survey. The emergency physicians had a mean±SD age of 31.2±4.5 years, and were predominantly males (74 out of 108, 68.5%). Overall, 49 (45.4%) physicians reached the cut-off score to define both depression and anxiety (ie, a score ≥8). In terms of violence, 71 (65.7%) reported incidents of verbal violence, while 26 (24.1%) reported physical violence or abuse by militias. In addition, 28 reported being threatened by militias.

Conclusion

The high prevalence rate of anxiety and depression is of concern, and the high rate of physical and verbal abuse highlights the range of abuse endured by doctors in Libya. Therefore, screening for anxiety and depression at regular intervals is needed to avoid the deterioration of mental health, which can increase the risk of suicide and dropping out, and decrease the level of healthcare for patients.
Validation of the National Emergency Department Overcrowding Score (NEDOCS) in a UK non-specialist emergency department
Authors: Hargreaves Duncan , Snel Sophie , Dewar Colin , Arjan Khushal , Parrella Piervirgilio , Hodgson Luke Eliot
Published: August 2020

Introduction

Emergency department (ED) crowding has significant adverse consequences, however, there is no widely accepted tool to measure it. This study validated the National Emergency Department Overcrowding score (NEDOCS) (range 0–200 points), which uses routinely collected ED data.

Methods

This prospective single-centre study sampled data during four periods of 2018. The outcome against which NEDOCS performance was assessed was a composite of clinician opinion of crowding (physician and nurse in charge). Area under the receiver operating characteristic curves (AUROCs) and calibration plots were produced. Six-hour stratified sampling was added to adjust for temporal correlation of clinician opinion. Staff inter-rater agreement and NEDOCS association with opinion of risk, safety and staffing levels were collected.

Results

From 905 sampled hours, 448 paired observations were obtained, with the ED deemed crowded 18.5% of the time. Inter-rater agreement between staff was moderate (weighted kappa 0.57 (95% CI 0.56 to 0.60)). AUROC for NEDOCS was 0.81 (95% CI 0.77 to 0.86). Adjusted for temporal correlation, AUROC was 0.80 (95% CI 0.73 to 0.88). At a cut-off of 100 points sensitivity was 75.9% (95% CI 65.3% to 84.6%), specificity 72.1% (95% CI 67.1% to 76.6%), positive predictive value 38.2% (95% CI 30.7% to 46.1%) and negative predictive value 92.9% (95% CI 89.3% to 95.6%). NEDOCS underpredicted clinical opinion on Calibration assessment, only partially correcting with intercept updating. For perceived risk of harm, safety and insufficient staffing, NEDOCS AUROCs were 0.71 (95% CI 0.61 to 0.82), 0.71 (95% CI 0.63 to 0.80) and 0.70 (95% CI 0.64 to 0.76), respectively.

Conclusions

NEDOCS demonstrated good discriminatory power for clinical perception of crowding. Prior to implementation, determining individual unit ED cut-off point(s) would be important as published thresholds may not be generalisable. Future studies could explore refinement of existing variables or addition of new variables, including acute physiological data, which may improve performance.
Comparison of the efficacy of ketamine– propofol versus sodium thiopental–fentanyl in sedation: a randomised clinical trial
Authors: Bahreini Maryam , Talebi Garekani Mostafa , Sotoodehnia Mehran , Rasooli Fatemeh
Published: August 2020

Background

Many sedative regimens have been studied with controversial efficiencies. This study tried to assess the desirable and adverse effects of sodium thiopental–fentanyl (TF) with ketamine–propofol (KP) for procedural sedation and analgesia in the emergency department.

Methods

After signing written consent, patients were enrolled in this randomised double-blind trial to receive either KP or TF to reach the desired sedation level. The respiratory and haemodynamic complications, nausea and vomiting, recovery agitation, patient recall and satisfaction, provider satisfaction and recovery time were compared.

Results

Of the participants, 47 in the KP group and 49 in the TF group were enrolled. The mean and SD scores were 6.91±1.93 and 8.34±1.25 for patients’ satisfaction and 7.55±1.54 and 8.65±1.00 for satisfaction of physicians performing the procedures in TF and KP groups, respectively (p=0.000). Moreover, 39 (79.59%) and 18 (38.29%) of patients declared that they had recalled the procedures in the TF and KP groups, respectively (p=0.000). Transient hypoxia was reported in 2.1% and 8.1% in the KP and TF groups leading to perform 4.2% vs 8.1% airway manoeuvres, respectively, without the need for endotracheal intubation or further admission.

Conclusions

KP and TF combinations were effectively comparable although KP resulted in higher patient and provider satisfaction. This study did not detect a difference regarding adverse respiratory or haemodynamic effects. It is estimated that the TF combination can be potent and efficacious with possible low adverse events in procedural sedation.
Epileptic seizures of suspected autoimmune origin: a multicentre retrospective study
Authors: Bozzetti Silvia , Rossini Fabio , Ferrari Sergio , Delogu Rachele , Cantalupo Gaetano , Marchioretto Fabio , Zanette Giampietro , Zanoni Tiziano , Turatti Marco , Vitale Giuseppina , Cadaldini Morena , Rossi Francesca , Di Tizio Luca , Zuco Carmela , Maniscalco Giorgia Teresa , Soldani Fabio , Monaco Salvatore , Trinka Eugen , Hoeftberger Romana , Mariotto Sara
Published: August 2020

Objective

To analyse autoantibody status in a well-defined European multicentre cohort of patients with epilepsy of unknown aetiology and to validate the recently proposed Antibody Prevalence in Epilepsy (APE2) and Response to ImmunoTherapy in Epilepsy (RITE2) scores.

Methods

We retrospectively collected clinical and paraclinical data of 92 patients referred to the Neurology Units of Verona and Salzburg between January 2014 and July 2019 with new-onset epilepsy, status epilepticus or chronic epilepsy of unknown aetiology. Fixed and live cell-based assays, tissue-based assays, immunoblot, and live rat hippocampal cell cultures were performed in paired serum/cerebrospinal fluid (CSF) to detect antineuronal and antiglial antibodies. The APE2 and RITE2 scores were then calculated and compared with clinical and laboratory data.

Results

Autoantibodies were detected in 29/92 patients (31.5%), with multiple positivity observed in 6/29 cases. The APE2 score (median 5, range 1–15) significantly correlated with antibody positivity (p=0.014), especially for the presence of neuropsychiatric symptoms (p<0.01), movement disorders (p<0.01), dysautonomia (p=0.03), faciobrachial dyskinesias (p=0.03) and cancer history (p<0.01). Status epilepticus was significantly more frequent in antibody-negative patients (p<0.01). Among the items of the RITE2 score, early initiation of immunotherapy correlated with a good treatment response (p=0.001), whereas a cancer history was significantly more common among non-responders (p<0.01). Persistence of neuropsychiatric symptoms and seizures correlated with antiepileptic maintenance after at least 1 year.

Conclusions

This is the first study that independently validates the APE2 and RITE2 scores and includes the largest cohort of patients whose paired serum and CSF samples have been tested for autoantibodies possibly associated with autoimmune epilepsy.
Deformation of Tianjin soft clay and corresponding micromechanism under cyclic loading
Authors: Lei Huayang , Liu Min , Jiang Yan , Sun Xiaofang
Published: August 2020

The deformation of soft clays under cyclic loading is controlled by microfabric changes. Cyclic triaxial tests, scanning electron microscopy (SEM), and mercury intrusion porosimetry (MIP) were conducted to investigate the deformation and the corresponding micromechanism under cyclic loading. The correlations between the microparameters and deformation of Tianjin soft clay are discussed. The deformation increases linearly in the initial compression stage (number of cycles, N < 500), at a decreasing rate in the later shearing stage (N < 5000), and eventually stabilizes when the cyclic stress ratio (CSR) is 0.30. The probability entropy of both the soil particles and pores have a weak correlation with the deformation on the whole, reflecting a fluctuation within a small range in the initial compression stage. The correlations between the median pore diameter, median particle diameter, and specific surface area and the deformation are validated by using the gray correlation method. More specifically, the specific surface area and the deformation are highly correlated in the initial compression deformation stage. The median pore diameter and median particle diameter are highly correlated with deformation in the later shearing deformation stage.
Totally umbilical hypersurfaces of Spinc manifolds carrying special spinor fields
Authors: Große Nadine , Nakad Roger
Published: August 2020

Under some dimension restrictions, we prove that totally umbilical hypersurfaces of Spin[Formula: see text] manifolds carrying a parallel, real or imaginary Killing spinor are of constant mean curvature. This extends to the Spin[Formula: see text] case the result of Kowalski stating that, every totally umbilical hypersurface of an Einstein manifold of dimension greater or equal to [Formula: see text] is of constant mean curvature. As an application, we prove that there are no extrinsic hypersheres in complete Riemannian [Formula: see text] manifolds of non-constant sectional curvature carrying a parallel, Killing or imaginary Killing spinor.
Continuity of the solution to the even Lp Minkowski problem for 0 < p < 1 in the plane
Authors: Wang Hejun , Lv Yusha
Published: August 2020

This paper concerns the continuity of the solution to the even [Formula: see text] Minkowski problem in the plane. When [Formula: see text], it is proved that the weak convergence of the even [Formula: see text] surface area measures implies the convergence of the corresponding convex bodies in the Hausdorff metric. Moreover, the continuity of the solution to the even [Formula: see text] Minkowski problem with respect to [Formula: see text] is also obtained.
On Crossed Product Algebras over Henselian Valued Fields
Authors: Bennis Driss , Mounirh Karim
Published: August 2020

Let D be a tame central division algebra over a Henselian valued field E, [Formula: see text] be the residue division algebra of D, [Formula: see text] be the residue field of E, and n be a positive integer. We prove that Mn([Formula: see text]) has a strictly maximal subfield which is Galois (resp., abelian) over [Formula: see text] if and only if Mn(D) has a strictly maximal subfield K which is Galois (resp., abelian) and tame over E with ΓK ⊆ ΓD, where ΓK and ΓD are the value groups of K and D, respectively. This partially generalizes the result proved by Hanke et al. in 2016 for the case n = 1.
Special Mappings with Central Values on Prime Rings
Authors: El Mir H. , Mamouni A. , Oukhtite L.
Published: August 2020

In this paper we investigate commutativity of prime rings with involution ∗ of the second kind in which endomorphisms satisfy certain algebraic identities. Furthermore, we provide examples to show that the various restrictions imposed by the hypotheses of our theorems are not superfluous.
Planar Lyapunov Algebras
Authors: Mencinger Matej , Zalar Borut
Published: August 2020

We study complex involutive algebras generated by a single nonselfadjoint idempotent and use them to construct a family of algebras, which we call planar Lyapunov algebras. As our main result, we prove that every 2-dimensional commutative real algebra whose homogeneous Riccati differential equation is stable at the origin must be isomorphic either to an algebra with zero multiplication or to some planar Lyapunov algebra.
The Realization Problem for Discrete Morse Functions on Trees
Authors: Liu Yuqing , Scoville Nicholas A.
Published: August 2020

We introduce a new notion of equivalence of discrete Morse functions on graphs called persistence equivalence. Two functions are considered persistence equivalent if and only if they induce the same persistence diagram. We compare this notion of equivalence to other notions of equivalent discrete Morse functions. Then we compute an upper bound for the number of persistence equivalent discrete Morse functions on a fixed graph and show that this upper bound is sharp in the case where our graph is a tree. This is a version of the “realization problem” of the persistence map. We conclude with an example illustrating our construction.
On a New Extension of the Zero-Divisor Graph
Authors: Cherrabi A. , Essannouni H. , Jabbouri E. , Ouadfel A.
Published: August 2020

In this paper, we introduce a new graph whose vertices are the non-zero zero-divisors of a commutative ring R, and for distincts elements x and y in the set Z(R)* of the non-zero zero-divisors of R, x and y are adjacent if and only if xy = 0 or x + y ∈ Z(R). We present some properties and examples of this graph, and we study its relationship with the zero-divisor graph and with a subgraph of the total graph of a commutative ring.
The Spectrum of a Rational Function
Authors: Najib Salah
Published: August 2020

Let k be an infinite field, [Formula: see text] be a finite set of k, and Q ∈ k[x] (with x = (x1, …, xn) and n ≥ 2) be a nonconstant polynomial. The main goal of this paper is to construct a polynomial P(x) ∈ k[x] with suitably large partial degrees in x1, …, xn−1 such that P and Q are coprime, and P − aQ is reducible for all a in [Formula: see text].
A Note on z-Ideals and z°-Ideals of the Formal Power Series Rings and Polynomial Rings in an Infinite Set of Indeterminates
Authors: Maatallah Ahmed , Benhissi Ali
Published: August 2020

Let A be a ring. In this paper we generalize some results introduced by Aliabad and Mohamadian. We give a relation between the z-ideals of A and those of the formal power series rings in an infinite set of indeterminates over A. Consider A[[XΛ]]3 and its subrings A[[XΛ]]1, A[[XΛ]]2, and A[[XΛ]]α, where α is an infinite cardinal number. In fact, a z-ideal of the rings defined above is of the form I + (XΛ)i, where i = 1, 2, 3 or an infinite cardinal number and I is a z-ideal of A. In addition, we prove that the same condition given by Aliabad and Mohamadian can be used to get a relation between the minimal prime ideals of the ring of the formal power series in an infinite set of indeterminates and those of the ring of coefficients. As a natural result, we get a relation between the z°-ideals of the formal power series ring in an infinite set of indeterminates and those of the ring of coefficients.
On Modules Satisfying the Descending Chain Condition on Cyclic Submodules
Authors: Kourki Farid , Tribak Rachid
Published: August 2020

A module satisfying the descending chain condition on cyclic submodules is called coperfect. The class of coperfect modules lies properly between the class of locally artinian modules and the class of semiartinian modules. Let R be a commutative ring with identity. We show that every semiartinian R-module is coperfect if and only if R is a T-ring. It is also shown that the class of coperfect R-modules coincides with the class of locally artinian R-modules if and only if 𝔪/𝔪2 is a finitely generated R-module for every maximal ideal 𝔪 of R.
Influence of the Processing on the Ionic Conductivity of Solid-State Hybrid Electrolytes Based on Glass-Ceramic Particles Dispersed in PEO with LiTFSI
Authors: Samsinger R. F. , Schopf S. O. , Schuhmacher J. , Treis P. , Schneider M. , Roters A. , Kwade A.
Published: August 2020

For the first time, glass-ceramic particles (LATP and LLZO) have been processed with both a tumbling-mixer and a kneader on semi-industrial scale. Although sintered LATP and LLZO discs reveal a statistically negligible ionic interface resistance to PEO with LiTFSI, the total conductivity of dispersed particles within a PEO-LiTFSI matrix is only slightly enhanced at 80 °C. However, for a tumbling mixing process, SEM investigations prove insufficient contact of particles within the matrix as well as agglomerates, cracks and voids. With the shear intensive kneader, dense and homogeneous samples were obtained. Compared to nanometer-sized SiO2 particles, the LATP filler enable an increase of the ionic conductivity of the hybrid PEO system by a factor of about two. These finding help to overcome solvent-based mixing processes that may cause uncontrolled decomposition and surface reactions of filler particles thereby changing microscopic conduction mechanisms in the hybrid electrolytes.
Density Functional Theory Study of the Initial Stages of Cl-Induced Degradation of α-Cr2O3 Passive Film
Authors: Oware Sarfo Kofi , Murkute Pratik , Isgor O. Burkan , Zhang Yongfeng , Tucker Julie , Árnadóttir Líney
Published: August 2020

The ion exchange and point defect models are two prominent models describing the role of anions, such as chlorides, in the degradation of passive oxide films. Here the thermodynamic feasibility of critical steps of Cl-induced degradation of a hydroxylated α-Cr2O3 (0001) surface, as proposed by these two models, are studied. Both models begin with Cl substitution of surface OH and H2O, which becomes less favorable with increasing Cl coverage. The initial stages of Cl-induced breakdown of the α-Cr2O3 depend on Cl coverage and the presence of O vacancy near the surface as follows: (1) neither Cl insertion (supporting the ion exchange model) nor Cr vacancy formation (supporting the point defect model) is feasible at low Cl coverages except in the presence of O vacancies near the surface, where Cl insertion is thermodynamically feasible even at low coverages, (2) in the absence of O vacancies, Cr vacancy formation becomes feasible from 10/12 ML onwards whereas Cl insertion by exchange with subsurface OH only becomes feasible at full coverage. This implies that at higher coverages Cl-induced degradation first initiatesthrough a vacancy formation mechanism, but both insertion and vacancy formation would be feasible at full coverage.
(ECS Meeting PRiME 2020) High TEC copper to connect copper bond pads for low temperature wafer bonding
Authors: Tran Anh Van Nhat , Kondo Kazuo , Hirato Tetsuji
Published: August 2020

Copper to copper wafer hybrid bonding is the most promising technology for three-dimensional (3D) integration. In the hybrid bonding process, two silicon wafers are aligned and contacted. At room temperature, these aligned copper pads contain radial-shaped nanometer-sized hollows due to the dishing effect induced by chemical-mechanical polishing (CMP). These wafers are annealed for copper to expand and connect upper and lower pads. This copper expansion is key to eliminate the radial-shaped hollows and make copper pads contacted. Therefore, in this research, we investigated the new high thermal expansion coefficient (TEC) electrodeposited copper to eliminate dishing hollows at lower temperature than that with conventional copper using the combination of new additive A and three other additives. The TEC of new electrodeposited copper is 25.2 x 10-6 oC-1, 46% higher than conventional copper and the calculated contact area of copper surface at 250oC with 5 nm dishing depth is 100%.
Intelligent Medical Auxiliary Diagnosis Algorithm Based on Improved Decision Tree
Authors: Wei Yuntao , Wang Xiaojuan , Li Meishan
Published: August 2020

In order to address the problem of low ability of intelligent medical auxiliary diagnosis (IMAD), an IMAD based on improved decision tree is proposed. Firstly, the constraint parameter model of IMAD is constructed. Secondly, according to the physiological indexes of IMAD, the independent variables and dependent variables of auxiliary diagnosis are constructed, the quantitative recurrent analysis of IMAD is carried out by using regression analysis method, the data analysis model of IMAD is constructed, and the adaptive classification and recognition of IMAD are carried out. Finally, the attribute feature quantity of IMAD with pathological characteristics is extracted, and the improved decision tree model is used to realize intelligent medical auxiliary, assist in the optimal decision of diagnosis, and realize the effective classification and recognition of pathological characteristics. The results show that this method has better decision-making ability and better classification performance for IMAD, which improves the intelligence and accuracy of intelligent medical auxiliary diagnosis.