bluuebunny/crossref_metadata_2025 huggingface dataset:
The Law of Minimum Vertical Dimension: Evidence for Improvement of Dental Occlusion
Authors: Silveira Silvana , Valerio Patricia , Machado Júnior Almiro J.
Published: October 2021

The law of minimum vertical dimension (MVD) states that “when the mandible moves to reach the maximum intercuspal position, this always involves bringing the mandible and maxilla as close together as possible.” Therefore, after the first occlusal contact is made, the MIP will be reached through reduction of the vertical dimension. Our objective of this study, through an integrative review of the literature review, was to determine whether ignoring this law is a factor that contributes to malocclusion, temporomandibular joint dysfunction, and recurrences of functional orthodontic and orthopedic treatments.We conducted a search of the literature in five of the main electronic scientific databases. The following medical subject heading terms were used in our search: centric relation, dental occlusion, malocclusion, vertical dimension, and mastication. We cross-referenced the descriptors in the following four groups: centric relation and maximum intercuspation; occlusal plane and malocclusion; neuro-occlusal rehabilitation; and vertical dimension and unilateral chewing. From this, we selected 277 potentially eligible articles. Out of these, 209 were excluded in accordance with the exclusion criteria already described. Thus, 65 studies were included in the qualitative synthesis.The articles were also classified according to their impact factor and degree of recommendation, in conformity with the table of the Oxford Centre for Evidence-Based Medicine. The scientific interest in the scope of the articles was also assessed by using three charts developed according to year and country of publication and the percentage of publication. Unilateral chewing creates a vicious cycle of damage that leads to an ever-increasing masticatory deficiency. Most of the articles chosen for this review confirmed that noncompliance with law of MVD was a predisposing factor in cases of relapse, in functional orthodontic and orthopedic treatments, as well as a causal factor in malocclusion and in functional and morphological TMJ dysfunctions.
Effect of Stress Generated by Occlusal Cyclic Force on Class I Bulk-Fill Composite Restoration Microleakage
Authors: Ritthiti Apirat , Sattabanasuk Vanthana , Karunratanakul Kavin , Senawongse Pisol
Published: October 2021

Objective This study aimed to evaluate the effects of different types and restorative techniques of Class I composite restorations with a single loading force on stress distribution and cyclic loading force on microleakage formation.

Materials and Methods Class I cavities were prepared in premolars with 4 mm depth and divided into six groups of different restorations with: (1) Filtek Z250; (2) a 3-mm-thick layer of Filtek Bulk Fill Flowable Restoration and covered with Z250; (3) a 1.5-mm-thick layer of flowable composite and covered with Z250; (4) lining all cavity with flowable composite and restored with Z250; (5) Filtek Bulk Fill Posterior Restoration; and (6) lining all cavity with flowable composite and restored with bulk-fill composite. The specimens with and without cyclic occlusal loading were subjected to microleakage observation. In addition, six different models of Class I restorations corresponding to the microleakage study were generated. Finite element analysis (FEA) was used to identify the stress distribution under a single loading force.

Statistical Analysis Data were statistically analyzed by two-way analysis of variance and multiple comparison. The significance level set at 0.05.

Results Cavity lining or restoration with flowable composite underneath conventional composite reduced stress on composite resin based on FEA (groups 2 and 3). The cyclic stress on composite increased microleakage. Restoration with flowable composite underneath conventional composite reduced the microleakage in Class I restoration (groups 2, 3, and 4).

Conclusion The most effective cavity lining with a flowable composite underneath conventional composite restoration was stress reduction under loading force resulting in microleakage reduction.
A sovereignist revolution? Italy’s foreign policy under the “Yellow–Green” government
Authors: Coticchia Fabrizio
Published: October 2021

In Italy, the Five Star Movement (M5S) and the Northern League (LN) formed a coalition government after the legislative elections of March 2018. What has been the actual impact of the populist executive in the Italian foreign policy? Relying on the (few) existing analyses that have developed specific hypotheses on the expected internationalrepercussions of populist parties-ruled governments, the paper examines Italy’s foreign policy under the Italian “Yellow–Green” cabinet (June 2018–August 2019). The manuscript advances three hypotheses. First, the foreign policy of the Conte’s government has been featured by a personalistic and a centralized decision-making process. Second, the Yellow-Green executive has adopted a vocal confrontational stance on the world stage, especially within multilateral frameworks, to “take back control” over national sovereignty. Third, such sovereignist foreign policy was largely symbolic because of “strategic” populist attitudes toward public opinion and due to domestic and international constraints. The manuscript—which is based on secondary and primary sources, such as interviews with former ministers, MPs, and diplomats—aims at offering a new perspective on populist parties and foreign policy, alimenting the rising debate on foreign policy change.
Impact of rooftop photovoltaic on energy demand of a building in a hot semi-arid climate
Authors: Sheikh Y. A. , Maqbool M. U. , Butt A. D. , Bhatti A. R. , Awan A. B. , Paracha K. N. , Khan M. M.
Published: October 2021

Solar energy is one of the most abundant and widely available renewable energy sources. It can be harnessed using photovoltaic panels on top of buildings to reduce dependence on the electrical grid and to achieve the status of net-zero energy building. However, the rooftop coverage by solar panels can modify the heat interface between the roof surface and its surrounding environment. This can alter a building's energy demand for heating, ventilation, and air conditioning. Such an impact on a building's energy demand is highly correlated with its roof structure and climate. In this work, three-dimensional distributed thermal models of the bare and photovoltaic added rooftop ensembles are developed to simulate the heat gain/loss associated with the roof structure for monthly mean diurnal cycles. This work considers the low-rise, high-density building style and hot semi-arid climate of Faisalabad, Pakistan to quantify the impact of a rooftop photovoltaic on the roof-related thermal load of a building. Results depict a 42.58% reduced heat loss from the photovoltaic added roof structure during winter and a 1.98% increase in heat gain during summer. This reduces the electricity demand for indoor heating during winter and slightly increases it for indoor cooling during summer. The obtained results prove the significance of this work and provide guidelines to energy policymakers, the construction industry, and energy consumers. Moreover, this work provides a better understanding of the building's energy demand for heating, ventilation, and air conditioning with a rooftop photovoltaic system and its net-zero energy requirements, which are pivotal for modern construction.
Scalable multiphoton quantum metrology with neither pre- nor post-selected measurements
Authors: You Chenglong , Hong Mingyuan , Bierhorst Peter , Lita Adriana E. , Glancy Scott , Kolthammer Steve , Knill Emanuel , Nam Sae Woo , Mirin Richard P. , Magaña-Loaiza Omar S. , Gerrits Thomas
Published: October 2021

The quantum statistical fluctuations of electromagnetic fields establish a limit, known as the shot-noise limit, on the sensitivity of optical measurements performed with classical technologies. However, quantum technologies are not constrained by this shot-noise limit. In this regard, the possibility of using every photon produced by quantum sources of light to estimate small physical parameters, beyond the shot-noise limit, constitutes one of the main goals of quantum optics. Here, we experimentally demonstrate a scalable protocol for quantum-enhanced optical phase estimation across a broad range of phases, with neither pre- nor post-selected measurements. This is achieved through the efficient design of a source of spontaneous parametric downconversion in combination with photon-number-resolving detection. The robustness of two-mode squeezed vacuum states against loss allows us to outperform schemes based on N00N states, in which the loss of a single photon is enough to remove all phase information from a quantum state. In contrast to other schemes that rely on N00N states or conditional measurements, the sensitivity of our technique could be improved through the generation and detection of high-order photon pairs. This unique feature of our protocol makes it scalable. Our work is important for quantum technologies that rely on multiphoton interference such as quantum imaging, boson sampling, and quantum networks.
In situ high-pressure nuclear magnetic resonance crystallography in one and two dimensions
Authors: Meier Thomas , Aslandukova Alena , Trybel Florian , Laniel Dominique , Ishii Takayuki , Khandarkhaeva Saiana , Dubrovinskaia Natalia , Dubrovinsky Leonid
Published: October 2021

Recent developments in in situ nuclear magnetic resonance (NMR) spectroscopy under extreme conditions have led to the observation of a wide variety of physical phenomena that are not accessible with standard high-pressure experimental probes. However, inherent di- or quadrupolar line broadening in diamond anvil cell (DAC)-based NMR experiments often limits detailed investigation of local atomic structures, especially if different phases or local environments coexist. Here, we describe our progress in the development of high-resolution NMR experiments in DACs using one- and two-dimensional homonuclear decoupling experiments at pressures up to the megabar regime. Using this technique, spectral resolutions of the order of 1 ppm and below have been achieved, enabling high-pressure structural analysis. Several examples are presented that demonstrate the wide applicability of this method for extreme conditions research.
Tiny Possum and the Migrating Moths
Authors: Murphy Julie , Clifford Ben
Published: October 2021

High in the Australian Alps, Possum needs to find enough food and shelter to survive the harsh alpine winter. She will spend months hibernating under a blanket of snow. Will she last through the year to successfully raise a new family?

The mountain pygmy-possum is small in size but huge in appeal! Once thought to be extinct, there are now around 2500 of these tiny survivors in the wild. They need snow and bogong moths to survive, and also the support of great conservation work.

Reading level varies from child to child, but we recommend this book for ages 6 to 9.
Systemic change and interactional motivation
Authors: Chen Jiajun
Published: October 2021

The paper focusses on the language-internal and -external motivations for the development of Chinese sentence-final particlebucheng. This particle, from an initial state as a negative verb string, developed into a sentence-final particle through intermediate adverbial stages, and was recruited to interpersonal functions in final position by the sixteenth century. Key motivating factors are identified for the expansion of its functional range, with particular attention to the development of the Written Vernacular in Early Modern Chinese and to interactional echoic contexts that contribute to the right-ward movement and thence the rise of the particle. Exploration of the diachronic development ofbuchengnot only expands the known inventory of morphosyntactic processes and linguistic contexts that give rise to pragmatic devices clause-finally but also yields a better understanding of the right-ward movement of lexemes towards clause-/utterance-final position.
Teaching linguistics through language construction
Authors: Köylü Yılmaz
Published: October 2021

This article details how introductory linguistics courses can increase student engagement and learning through a project-based approach, whereby the students first study the subfields of linguistics with a view to complete the main project of the course, namely to construct a novel language. I provide information from a semester-long course with specific project-based activities teachers could utilize in their classes. I also thoroughly examine the constructed language projects based on 33 student submissions in an introductory linguistics course in the US. The analysis indicates a high level of engagement and creativity by the students in creating a distinct orthography, phonetic, morphological, and syntactic rules and semantic properties for their constructed languages. The results from a 20-item questionnaire and student exit interviews indicate that the project-based approach adopted in the completion of their constructed languages proved effective in (a) improving student motivation and engagement; (b) helping students apply the knowledge of the material to carry out linguistic analysis; (c) enhancing students’ language learning skills; (d) encouraging them to study additional foreign languages; and finally (e) promoting linguistic diversity. Hence, as an innovative and effective method still in its infancy, project-based learning should be more widely implemented in linguistics instruction.
Tungsten/reduced activation ferritic–martensitic steel joints made with an Fe–Si–B amorphous filler
Authors: Wang Jianbao , Lian Youyun , Feng Fan , Liu Xiang , Chen Zhe , Wang Yingmin , Qiang Jianbing , Wei Mingyu
Published: October 2021

The joining of Tungsten (W) and reduced activation ferritic–martensitic steel (RAFMs) is crucial to the fabrication of divertors in future fusion reactors. In this work, an Fe75.0Si8.33B16.67 (at.-%) amorphous filler and iron interlayer are considered for brazing W and RAFMs. Crack-free joints in both the as-brazed and post joining heat treatment (PJHT) states have been obtained by short-time vacuum brazing at 1230°C. The bonding seams of the joints are composed of an α-Fe matrix, fine FeWB and Fe3B particles. The PJHT joint exhibits a high strength of 310 MPa and room temperature plasticity. The strong and tough joint would be appealing in its thermal cycling and thermal shock performance.
Myosin motors that cannot bind actin leave their folded OFF state on activation of skeletal muscle
Authors: Reconditi Massimo , Brunello Elisabetta , Fusi Luca , Linari Marco , Lombardi Vincenzo , Irving Malcolm , Piazzesi Gabriella
Published: October 2021

The myosin motors in resting skeletal muscle are folded back against their tails in the thick filament in a conformation that makes them unavailable for binding to actin. When muscles are activated, calcium binding to troponin leads to a rapid change in the structure of the actin-containing thin filaments that uncovers the myosin binding sites on actin. Almost as quickly, myosin motors leave the folded state and move away from the surface of the thick filament. To test whether motor unfolding is triggered by the availability of nearby actin binding sites, we measured changes in the x-ray reflections that report motor conformation when muscles are activated at longer sarcomere length, so that part of the thick filaments no longer overlaps with thin filaments. We found that the intensity of the M3 reflection from the axial repeat of the motors along the thick filaments declines almost linearly with increasing sarcomere length up to 2.8 µm, as expected if motors in the nonoverlap zone had left the folded state and become relatively disordered. In a recent article in JGP, Squire and Knupp challenged this interpretation of the data. We show here that their analysis is based on an incorrect assumption about how the interference subpeaks of the M3 reflection were reported in our previous paper. We extend previous models of mass distribution along the filaments to show that the sarcomere length dependence of the M3 reflection is consistent with <10% of no-overlap motors remaining in the folded conformation during active contraction, confirming our previous conclusion that unfolding of myosin motors on muscle activation is not due to the availability of local actin binding sites.
APMP Key comparison report of reference air kerma rate for HDR 192Ir brachytherapy sources (BIPM KCDB: APMP.RI(I)-K8)
Authors: Ishii J , Kurosawa T , Kato M , Toroi P , Chu W-H , Yi C-Y , Kim Y H , Seong Y M , Ngcezu S A , Mainegra-Hing E , Downtonf B , Dolah M T , Budiantari C T
Published: October 2021

Main text

The APMP/TCRI Dosimetry Working Group performed the APMP.RI(I)-K8 key comparison of the reference air kerma rate for high-dose-rate (HDR) 192Ir brachytherapy sources between 2016 and 2018. Eight laboratories, including seven national metrology institutes (NMIs), took part in the comparison. Two commercial well-type chambers were used as transfer instruments and circulated among the participants. The results showed that the maximum difference between the participants and the BIPM, evaluated using the comparison data of the linking laboratories NMIJ and NRC, was less than 4%. The degrees of equivalence for the participants were calculated, so that results for the six non-linking laboratories may be included in the Key Comparison Database (KCDB).

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database https://www.bipm.org/kcdb/.

The final report has been peer-reviewed and approved for publication by the CCRI, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Actuator placement optimization for guided waves based structural health monitoring using fibre Bragg grating sensors
Authors: Soman Rohan , Balasubramaniam Kaleeswaran , Golestani Ali , Karpiński Michał , Malinowski Pawel , Ostachowicz Wieslaw
Published: October 2021

Structural health monitoring (SHM) systems have a potential to reduce lifecycle costs of structures. They may be used for maintenance planning which reduces the maintenance cost as well as for lifetime extension. As a result, there is a lot of active research in the area for SHM of civil and mechanical structures. The SHM system should be low cost, suitable for continuous monitoring, able to detect small levels of damage. Guided waves (GW) based SHM techniques allow monitoring of large plate-like structures with few sensors and have been identified as the most promising of techniques for SHM. Several different actuators and sensors have been developed and used for the GW based SHM. FBG sensors due to their low weight, and ability to be multiplexed have been long thought to be an ideal sensors for SHM. The recent development of the edge filtering approach has increased their sensitivity to GW sensing and made them ideal sensors. Unfortunately the FBG sensors are passive sensors and show directional sensitivity. These operational constraints make extension of the earlier developed GW based SHM techniques for FBG sensors difficult. Recently the authors developed a technique for damage detection specifically designed for a network with FBG sensors. This paper develops a methodology for a design of an actuator-sensor (AS) network for improving the damage assessment capability using the developed method. The paper develops a two-step methodology for the optimization of actuator placement for an AS network with FBG sensors. In the first step the number of actuators needed for the optimization are determined based on actuator densities. Once the number of actuators is known, a genetic algorithm (GA) is developed for the optimization of the their positions. The cost function is developed based on two new metrics (namely coverage2—coverage with at least 2 AS pairs and coverageR—radial coverage based on edge reflections) which are defined by the application demand. The optimized placement is then used to successfully detect and localize the damage. The study also shows the merit in the use of the specific metrics and the sufficiency of the metrics developed for improving the damage detection capability of the specific method.
An N/D study of the S
11 channel πN scattering amplitude *
Authors: Li Qu-Zhi , Ma Yao , Niu Wen-Qi , Wang Yu-Fei , Zheng Han-Qing
Published: October 2021

Extensive dynamical

calculations are conducted in the study of

channel low energy

scatterings, based on various phenomenological model inputs of left cuts at the tree level. The subtleties of the singular behavior of the partial wave amplitude, at the origin of the complex

plane, are analysed in detail. Furthermore, it is found that the dispersion representation for the phase shift,

, must be modified in the case of

scatterings. An additional contribution from the dispersion integral exists, which approximately cancels the contribution of the two virtual poles located near the end points of the segment cut, induced by

channel nucleon exchanges. With limited reliance on the details of the dynamical inputs, the subthreshold resonance

survives.
Multifunctional optrode for opsin delivery, optical stimulation, and electrophysiological recordings in freely moving rats
Authors: Sharma Kirti , Jäckel Zoë , Schneider Artur , Paul Oliver , Diester Ilka , Ruther Patrick
Published: October 2021

Objective. Optogenetics involves delivery of light-sensitive opsins to the target brain region, as well as introduction of optical and electrical devices to manipulate and record neural activity, respectively, from the targeted neural population. Combining these functionalities in a single implantable device is of great importance for a precise investigation of neural networks while minimizing tissue damage. Approach. We report on the development, characterization, and in vivo validation of a multifunctional optrode that combines a silicon-based neural probe with an integrated microfluidic channel, and an optical glass fiber in a compact assembly. The silicon probe comprises an 11-µm-wide fluidic channel and 32 recording electrodes (diameter 30 µm) on a tapered probe shank with a length, thickness, and maximum width of 7.5 mm, 50 µm, and 150 µm, respectively. The size and position of fluidic channels, electrodes, and optical fiber can be precisely tuned according to the in vivo application. Main results. With a total system weight of 0.97 g, our multifunctional optrode is suitable for chronic in vivo experiments requiring simultaneous drug delivery, optical stimulation, and neural recording. We demonstrate the utility of our device in optogenetics by injecting a viral vector carrying a ChR2-construct in the prefrontal cortex and subsequent photostimulation of the transduced neurons while recording neural activity from both the target and adjacent regions in a freely moving rat for up to 9 weeks post-implantation. Additionally, we demonstrate a pharmacological application of our device by injecting GABA antagonist bicuculline in an anesthetized rat brain and simultaneously recording the electrophysiological response. Significance. Our triple-modality device enables a single-step optogenetic surgery. In comparison to conventional multi-step surgeries, our approach achieves higher spatial specificity while minimizing tissue damage.
Trade-off between stimulation focality and the number of coils in multi-locus transcranial magnetic stimulation
Authors: Nurmi Samuel , Karttunen Jere , Souza Victor H , Ilmoniemi Risto J , Nieminen Jaakko O
Published: October 2021

Objective. Coils designed for transcranial magnetic stimulation (TMS) must incorporate trade-offs between the required electrical power or energy, focality and depth penetration of the induced electric field (E-field), coil size, and mechanical properties of the coil, as all of them cannot be optimally met at the same time. In multi-locus TMS (mTMS), a transducer consisting of several coils allows electronically targeted stimulation of the cortex without physically moving a coil. In this study, we aimed to investigate the relationship between the number of coils in an mTMS transducer, the focality of the induced E-field, and the extent of the cortical region within which the location and orientation of the maximum of the induced E-field can be controlled. Approach. We applied convex optimization to design planar and spherically curved mTMS transducers of different E-field focalities and analyzed their properties. We characterized the trade-off between the focality of the induced E-field and the extent of the cortical region that can be stimulated with an mTMS transducer with a given number of coils. Main results. At the expense of the E-field focality, one can, with the same number of coils, design an mTMS transducer that can control the location and orientation of the peak of the induced E-field within a wider cortical region. Significance. With E-fields of moderate focality, the problem of electronically targeted TMS becomes considerably easier compared with highly focal E-fields; this may speed up the development of mTMS and the emergence of new clinical and research applications.
Looking beyond forest cover: an analysis of landscape-scale predictors of forest degradation in the Brazilian Amazon
Authors: Bourgoin Clément , Betbeder Julie , Le Roux Renan , Gond Valéry , Oszwald Johan , Arvor Damien , Baudry Jacques , Boussard Hugues , Le Clech Solen , Mazzei Lucas , Dessard Hélène , Läderach Peter , Reymondin Louis , Blanc Lilian
Published: October 2021

While forest degradation rates and extent exceed deforestation in the Brazilian Amazon, less attention is given to the factors controlling its spatial distribution. No quantified correlation exists between changes of forest structure due to anthropogenic disturbances and dynamics of land use and cover change occurring at broader spatial levels. This study examines the influence of multi-scale landscape structure factors (i.e. spatial composition, configuration and dynamic of land use/cover) on primary forest’s aboveground biomass (AGB), spanning from low to highly degraded, in Paragominas municipality (Pará state). We used random forest models to identify the most important landscape predictors of degradation and clustering methods to analyze their distribution and interactions. We found that 58% of the variance of AGB could be explained by metrics reflecting land use practices and agricultural dynamics around primary forest patches and that their spatial patterns were not randomly distributed. Forest degradation is mainly driven by fragmentation effects resulting from old deforestation and colonization events linked with cropland expansion (e.g. soybean and maize) coupled with high accessibility to market. To a lesser extent, degradation is driven by recent and ongoing (1985–2015) deforestation and fragmentation in slash-and-burn agricultural areas, characterized by heterogeneous mosaics of pastures and fallow lands combined with high use of fire. Our findings highlight the potential of landscape-level framework and remotely sensed land cover data for a thorough understanding of the distribution of forest degradation across human-modified landscapes. Addressing these spatial determinants by looking at agricultural dynamics beyond forest cover is necessary to improve forest management which has major implications for biodiversity, carbon and other ecosystem services.
The Innate Immune Response of Eusocial Hymenopterans to Viral Pathogen Challenge
Authors: Holmes V Renee , Johnston J Spencer
Published: October 2021

In recent years, insect immunology has expanded rapidly in research interest, and available literature has expanded in kind. Insects combat pathogens through a range of behavioral and physiological immune defenses. The need for robust immunity is especially important to eusocial insects; nestmate proximity increases exposure to and transmission of pathogens. Further, eusociality involves cohabitation of thousands of individuals with characteristically reduced genetic variability, in turn increasing susceptibility to epidemic disease outbreaks. To combat this, they have developed diverse responses to pathogens, including individual innate immune defenses, social immunity, and secretion of potent glandular chemicals. The range of immune responses is as diverse as the pathogens presenting the threat, and of these, viruses may present the greatest challenge. Social immunity employed by Hymenoptera and has been reviewed whereas a review has not been developed to our knowledge addressing innate immunity of eusocial Hymenopterans to viral pathogenic invaders. We argue that such a review is important to advancement of understanding of Hymenopteran biology and is critical to applied interests. We argue further that the implications of eusocial Hymenopteran innate immunity are far-reaching; their success is a source of both substantial economic loss in the case of invasive ants and significant economic gain in the case of the honey bee Apis mellifera.
Reconstructing Historical Exposures to Respirable Dust and Respirable Silica in the Taconite Mining Industry for 1955–2010
Authors: Shao Yuan , Hwang Jooyeon , MacLehose Richard F , Alexander Bruce H , Mandel Jeffrey H , Raynor Peter C , Ramachandran Gurumurthy
Published: October 2021

The goal of this study was to reconstruct the historical respirable silica (RS) and respirable dust (RD) exposures of workers in the Minnesota taconite industry from 1955 to 2010 as part of several epidemiological studies for assessing the association between exposure to components of taconite dusts and the development of respiratory diseases. A job-exposure matrix (JEM) was developed that uses 9127 RS and 19 391 RD occupational hygiene historical measurements. Historical RS and RD data were extracted from several sources and were grouped into seven mines and then into eight departments [Concentrating, Crushing, Janitor, Mining, Office/control room, Pelletizing, Shop (mobile), and Shop (stationary)]. Within each department, we applied a two-level random-intercept regression model which assumes that the natural log of Y (RD or RS concentration) changes over time at a constant rate. Among all predicted RD and RS values, we found that larger RD values were located in the following departments: Crushing, Concentrating, Pelletizing, and Shop (mobile). Larger RS values were located only in either Crushing or Shop (mobile). The annual rates of change for historical RD and RS exposures were between −3.3 and 3.2%. The silica percentage in the dust varied by mine/department with the highest value of 29.3% in Mine F (Crushing) and the lowest value of 2.1% in Mine B (Pelletizing). The predicted historical RD and RS arithmetic mean exposures ranged between <0.075 and 3.14 mg m−3, and between <0.005 and 0.36 mg m−3, respectively. The result of this study is a JEM by mine, department, and year for RD and RS for epidemiological studies.
Genetic mutation analysis of 22 patients with congenital absence of vas deferens: a single-center study
Authors: Tan Mao-Qing , Huang Wu-Jian , Lan Feng-Hua , Xu Yong-Jun , Zheng Mei-Yu , Tang Ying
Published: October 2021

Congenital absence of the vas deferens (CAVD), a congenital malformation of the male reproductive system, causes obstructive azoospermia and male infertility. Currently, the cystic fibrosis transmembrane conductance regulator (CFTR) has been recognized as the main pathogenic gene in CAVD, with some other genes, such as adhesion G-protein-coupled receptor G2 (ADGRG2), solute carrier family 9 isoform 3 (SLC9A3), sodium channel epithelial 1 subunit beta (SCNN1B), and carbonic anhydrase 12 (CA12), being candidate genes in the pathogenesis of CAVD. However, the frequency and spectrum of these mutations, as well as the pathogenic mechanisms of CAVD, have not been fully investigated. Here, we sequenced all genes with potentially pathogenic mutations using next-generation sequencing and verified all identified variants by Sanger sequencing. Further bioinformatic analysis was performed to predict the pathogenicity of mutations. We described the distribution of the p.V470M, poly-T, and TG-repeat CFTR polymorphisms and identified novel missense mutations in the CFTR and SLC9A3 genes, respectively. Taken together, we identified mutations in the CFTR, ADGRG2, SLC9A3, SCNN1B, and CA12 genes in 22 patients with CAVD, thus broadening the genetic spectrum of Chinese patients with CAVD.
Vocal embellishment in 18th-century Naples: solfeggio patterns in pre-composed cadenzas in sacred pieces by Gennaro and Gaetano Manna
Authors: Boaro Eric
Published: October 2021

The last 20 years have been crucial for 18th-century musicology. Robert Gjerdingen’s studies have focused on a key feature of 18th-century music that has completely changed our understanding of the Baroque repertory: schematic thinking. Yet discovering its traces still constitutes a demanding task. This article aims to contribute to and broaden this field of research by analysing a particular group of 18th-century Neapolitan manuscripts of sacred music through the lens of solfeggio. Related scores for the use of individual interpreters include summary annotations of pre-composed vocal cadenzas, perhaps added by the singers themselves. If analysed through solfeggio theory, it appears that these are built over simple solfeggio patterns, suggesting that early 18th-century Neapolitan vocal improvisation was conceived schematically. The article will substantiate this claim through three case studies in the form of sacred compositions by Gennaro and Gaetano Manna: ‘Et vos inferni furiae’, ‘O quam silva’ and the Oratorio a 4 per i morti (1770).
Impact of center-volume on outcomes in myocardial infarction complicated by cardiogenic shock – a CULPRIT-SHOCK sub-study
Authors: Clemmensen P , Schrage B N , Zeymer U , Montalecot G , Windecker S , Serpytis P , Stepinska J , Savonitto S , Desch S , Fuernau G , Huber K , Noc M , Ouarrak T , Blankenberg S , Thiele H ,   Culprit-Shock Investigators
Published: October 2021

Background

Little is known about the impact of center-volume on outcomes in acute myocardial infarction complicated by cardiogenic shock (AMI-CS). The aim of this study was to investigate the association between center-volume, treatment strategies and subsequent outcome in patients with AMI-CS.

Methods

In this subanalysis of the randomized CULPRIT-SHOCK trial, study sites were categorized based on the annual volume of AMI-CS into low/intermediate/high volume centers (<50; 50–100;>100 cases/year). Subjects from the study/compulsory registry with available volume data were included. Baseline/procedural characteristics, overall treatment and 1-year all-cause mortality were compared across categories.

Results

N=1032 patients were included in this study (537 treated at low-volume, 240 at intermediate-volume and 255 at high volume centers). Baseline risk profile of patients across the volume categories was similar, although high volume centers included more older patients. Low/intermediate-volume centers had more resuscitated patients (57.5%/58.8% vs. 42.2%; p<0.01), and more patients on mechanical ventilation in comparison to high volume centers. Mechanical circulatory support differed with more use in low/intermediate-volume centers and overall lower use in high-volume centers (30.7%/36.7% vs. 19.2%; p<0.001). There were no differences in reperfusion success despite considerable differences in adjunctive pharmacological/device therapies (figure 1). There was no difference in 1-year all-cause mortality across volume categories (51.1% vs. 56.5% vs. 54.4%; p=0.34).

Conclusion

In this study of patients with AMI-CS, considerable differences in adjunctive medical and mechanical support therapies was observed. However, we could not detect an impact of center volume on reperfusion success or mortality.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The CULPRIT-SHOCK trial was funded by European Union, Seventh Framework Programme (FP7/2007-2013) Grant agreement n°602202, German Heart Research Foundation Treatment according to center volumeLong-term survival
Underuse of reperfusiontherapy in STEMI with cardiogenic shock. Results of the EORP ACVC EAPCI STEMI registry of the ESC
Authors: Zeymer U , Ludman P , Danchin N , Kala P , Gale C , Maggioni A , Weidinger F
Published: October 2021

Aims

To determine the current state of the use of reperfusion and adjunctive therapies and in-hospital outcomes in ESC member and affiliated countries for patients with ST segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS).

Methods and results

ESC EORP prospective international cohort study of admissions with STEMI within 24 hours of symptom onset (196 centers; 26 ESC member and 3 affiliated countries). Of 11462 patients enrolled, 448 (3.9%) had CS. Patients without compared to patients with CS, more frequently received primary PCI (72.5% versus 65.2%) and fibrinolysis (19.0 versus 15.9%) and less frequently had no reperfusion therapy (8.5% versus 19.0%). Mechanical support devices (IABP 11.2%, ECMO 0.7%, other 1.1%) were used infrequently in CS. BARC 2–5 bleeding complications (10.1% versus 3.0%, p<0.01) and stroke (4.2% versus 0.9%, p<0.01) occurred more frequently in patients with CS. In-hospital mortality was ten-fold higher (35.5% versus 3.1%) in patients with CS. Mortality in patients with CS in the groups with PCI, fibrinolysis and no reperfusion therapy were 27.4%, 36.6% and 62.4%, respectively.

Conclusions

In this multi-national registry patients with STEMI complicated by CS less frequently receive reperfusion therapy than patients with STEMI without CS. Early mortality in patients with CS not treated with primary PCI is very high. Therefore strategies to improve clinical outcome in STEMI with CS are needed.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): ESC EORP
Racial disparities in the use of mechanical circulatory support devices in cardiogenic shock
Authors: Raheja H , Waheed M , Harris C , Patel N , Hashmi A , Kundal S , Patel J , Malik B , Frankel R , Shani J
Published: October 2021

Background

Racial bias has always been a concern for healthcare. Lack of guideline directed utilization of mechanical circulatory support (MCS) devices in cardiogenic shock (CS) may lead to implicit and racial bias.

Purpose

To identify the racial differences in the use of mechanical circulatory support in cardiogenic shock and its association with outcomes.

Methods

National Inpatient Database from 2015–2018 using ICD 10 codes was used. Patients >18 years of age admitted for cariogenic shock were included.

Results

Among 1,021,274 patients hospitalized for cardiogenic shock, overall MCS was utilized in 11.4% (N=116,539). Use of MCS for patients stratified by race was 12.2% white (N=85543), 8% Blacks (N=14688), 11.3% Hispanics (N=11067), 13.8% Asian (N=4417), 12.3% Native American (N=825). IABP was the most commonly used MCS device, followed by Impella, ECMO and LVAD. Overall odds of MCS insertion was significantly higher in white population [1.18 (1.13–1.23) <0.001] and significantly lower in Blacks [0.65 (0.61–0.69) <0.001] and Hispanics [0.89 (0.83–0.97) 0.004]. Among black patients with CS requiring MCS, odds of LVAD insertion were similar compared to other races [1.03 (0.89–1.19) 0.714], while odds of all other types of MCS devices including ECMO [0.83 (0.72–0.95) 0.009], IABP [0.63 (0.59–0.68) <0.001] and Impella [0.61 (0.54–0.70) <0.001] were significantly lower compared to other races. This trend also holds true for patients with CS associated with acute myocardial infarction. Among all patients with CS, the odds of mortality were significantly lower among white patients [0.92 (0.90–0.95) <0.001], on the contrary, odds of mortality were significantly higher in Blacks [1.06 (1.02–1.10) 0.001] and Asians [1.11 (1.02–1.20) 0.012]. Interestingly, when only comparing patients who underwent MCS utilization for CS, odds of mortality were similar in black population compared to other races. [1.03 (0.91–1.17) 0.636].

Conclusion(s)

There still exist significant racial differences in the use of mechanical circulatory devices for cardiogenic shock potentially leading to significantly higher mortality in black population compared to whites. This difference in mortality is mitigated with equal use of MCS devices in cardiogenic shock among all races.

Funding Acknowledgement

Type of funding sources: None.
Effectiveness of chest compressions skill training in the prone position: comparison of two methods
Authors: Peixoto E , Batista R E A , Okuno M F P , Baptista R C N , Campanharo C R V , Lopes J L
Published: October 2021

Introduction

The current pandemic caused by the new coronavirus (COVID-19), has become challenging for the health system.1 Pulmonary complication take patients to require ventilatory support and one of the interventions performed to improve then oxygenation is the prone position.2 In view of the current reality of patients with COVID-19 in a prone position, it is necessary to train cardiopulmonary resuscitation in this position.3 Purpose: To compare the effectiveness of two training methods, video and self-instructional guide, in the ability of chest compressions in prone position.

Methods

This is a randomized clinical trial. The sample consisted of nurses, nursing technicians, physiotherapists and residents of the intensive care and emergency unit of a public hospital. Randomization was performed in blocks of four using the Random @ system. Group 1 (G1) consisted of professionals who watched a validated video while practicing chest compression on a low-fidelity mannequin placed in the prone position. Group 2 (G2) consisted of professionals who practiced compression guided by a previously validated self-instructional guide. The study's outcome was the performance of chest compressions skills assessed before and after interventions, using a previously validated instrument. The study was approved by the Research Ethics Committee (no. 4.016.959).

Results

Ninety-one professionals participated in the study (45 from group 1 and 46 from group 2). It was observed that there was an improvement in hand positioning (G1 pre: 16 professionals correctly and post: 31 (p0.001); G2 pre: 20 correct and post: 20 (p0.781), of body positioning (G1 pre: 32 professionals hit and post: 41; G2 pre: 32 hit and post: 39) and the frequency of compressions G1 pre: 10 professionals hit and post: 19 (p0.017); G2 pre: 13 hit and post: 16 (p0.363)) after the interventions. Statistically, when applying the test within each group, a p-value of 0.0003 was obtained in G1 (video) and 0.512 in G2 (self-instructional guide). Thus, we can infer that only group 1 (video) had a change when we compared the two moments.

Conclusion

The video associated with simulation was more effective than the self-instructional guide and can be used as an attractive and dynamic teaching tool.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) CPR in prone position
Performance of risk scores for coronary artery disease in patients with chest pain in urgent primary care
Authors: Manten A , Kleton M , Smits I H , Rietveld R P , Lucassen W A M , Harskamp R E
Published: October 2021

Background and introduction

Chest pain is a common symptom for contacting out-of-hours primary care. One of the critical tasks of general practitioners (GPs) is to swiftly rule out possible life-threatening conditions. Easy-to-use clinical risk scores may help in adequate risk stratification.

Purpose

To evaluate the diagnostic performance of the Marburg Heart Score (MHS) [1], INTERCHEST [2], Gencer rule [3], and Bruins-Slot rule [4] and compare these scores with unaided clinical judgement among patients with chest pain who are evaluated in urgent primary care.

Methods

A retrospective, cohort study of patients aged ≥18 years who were evaluated for chest pain at a regional primary care facility in Alkmaar, the Netherlands. The reference standard for the diagnostic performance of risk scores and unaided GP assessment involved a composite endpoint of the occurrence of death from any cause, acute coronary syndrome or coronary revascularization (=major adverse cardiac events; MACE) up to six weeks after initial contact. Diagnostic test properties were evaluated using C-statistics, sensitivity, specificity, positive and negative predictive values (PPV/NPV) and referral rates.

Results

Out study population involved 664 consecutive patients, of whom 4.8% (n=32) had a MACE event. C-statistics were 0.85 [95%-confidence interval (CI): 0.78–0.92], 0.77 [95%-CI: 0.69–0.84], 0.72 [95%-CI: 0.63–0.81], and 0.72 [95%-CI: 0.63–0.81] for MHS, INTERCHEST, Gencer and Bruins-Slot respectively. Optimal diagnostic accuracy was found for MHS ≥2 (sensitivity=81.3%, specificity=67.1%, PPV=11.1%, NPV=98.6%), INTERCHEST ≥2 (sensitivity=87.5%, specificity=78.8%, PPV=17.3%, NPV=99.1%), Gencer ≥2 (sensitivity 84.4%, specificity=37.8%, PPV 6.4%, NPV=98.0%), and Bruins-Slot ≥2 (sensitivity=90.6%, specificity=40.8%, PPV=7.2%, NPV 98.9%). Physicians referred 157 patients (23.6%) and missed 6 out of 32 MACEs (sensitivity=81.3%, specificity=79.3%, PPV 16.6%, NPV 98.8%). Using INTERCHEST with a referral threshold of ≥2 points, 4 MACEs would have been missed and 162 patients (24.4%) referred. The other risk scores resulted in far higher referral rates.

Conclusion

The currently available clinical risk scores are safe for use in a low-risk population of patients with chest pain, but do not outperform unaided clinical judgement. Only the INTERCHEST score appears to somewhat improve risk stratification.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMW-HGOG Components clinical decision rulesPerformance risk scores regarding MACE
Comparison of risk prediction models in infarct-related cardiogenic shock
Authors: Freund A , Poess J , De Waha-Thiele S , Meyer-Saraei R , Fuernau G , Zeymer U , Feistritzer H J , Rubini M , Oldroyd K , Windecker S , Montalescot G , Schneider S , Baran D , Desch S , Thiele H
Published: October 2021

Background

Several prediction models have been developed to allow accurate risk assessment and provide better treatment guidance in patients with infarct-related cardiogenic shock (CS). However, comparative data between these models are still scarce.

Objectives

To externally validate different risk prediction models in infarct-related CS and compare their predictive value in the early clinical course.

Methods

The Simplified Acute Physiology Score (SAPS)-II Score, the CardShock score, the IABP-SHOCK II score and the Society for Cardiovascular Angiography and Intervention (SCAI) classification were each externally validated in a total of 1055 patients with infarct-related CS enrolled into the randomized CULPRIT-SHOCK trial or the corresponding registry. Discriminative power was assessed by comparing area under the curves (AUC) in case of continuous scores.

Results

In direct comparison of the continuous scores in a total of 161 patients, the IABP-SHOCK II score revealed best discrimination (AUC=0.74), followed by the CardShock score (AUC=0.69) and the SAPS-II score, giving only moderate discrimination (AUC=0.63). All of the three scores revealed acceptable calibration by Hosmer-Lemeshow test. The SCAI classification as a categorical predictive model displayed good prognostic assessment for the highest risk group (stage E), but showed poor discrimination between stages C and D with respect to short-term-mortality.

Conclusion

Based on the present findings, the IABP-SHOCK II score appears to be the most suitable of the examined models for immediate risk prediction in infarct-related CS. Prospective evaluation of the models, further modification or even development of new scores might be necessary to reach higher levels of discrimination.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union, German Centre for Cardiovascular Research Survival probabilities continuous scoresSurvival probabilities SCAI