bluuebunny/crossref_metadata_2025 huggingface dataset:
Machine learning for early detection of sepsis: an internal and temporal validation study
Authors: Bedoya Armando D , Futoma Joseph , Clement Meredith E , Corey Kristin , Brajer Nathan , Lin Anthony , Simons Morgan G , Gao Michael , Nichols Marshall , Balu Suresh , Heller Katherine , Sendak Mark , O’Brien Cara
Published: April 2020

Objective

Determine if deep learning detects sepsis earlier and more accurately than other models. To evaluate model performance using implementation-oriented metrics that simulate clinical practice.

Materials and Methods

We trained internally and temporally validated a deep learning model (multi-output Gaussian process and recurrent neural network [MGP–RNN]) to detect sepsis using encounters from adult hospitalized patients at a large tertiary academic center. Sepsis was defined as the presence of 2 or more systemic inflammatory response syndrome (SIRS) criteria, a blood culture order, and at least one element of end-organ failure. The training dataset included demographics, comorbidities, vital signs, medication administrations, and labs from October 1, 2014 to December 1, 2015, while the temporal validation dataset was from March 1, 2018 to August 31, 2018. Comparisons were made to 3 machine learning methods, random forest (RF), Cox regression (CR), and penalized logistic regression (PLR), and 3 clinical scores used to detect sepsis, SIRS, quick Sequential Organ Failure Assessment (qSOFA), and National Early Warning Score (NEWS). Traditional discrimination statistics such as the C-statistic as well as metrics aligned with operational implementation were assessed.

Results

The training set and internal validation included 42 979 encounters, while the temporal validation set included 39 786 encounters. The C-statistic for predicting sepsis within 4 h of onset was 0.88 for the MGP–RNN compared to 0.836 for RF, 0.849 for CR, 0.822 for PLR, 0.756 for SIRS, 0.619 for NEWS, and 0.481 for qSOFA. MGP–RNN detected sepsis a median of 5 h in advance. Temporal validation assessment continued to show the MGP–RNN outperform all 7 clinical risk score and machine learning comparisons.

Conclusions

We developed and validated a novel deep learning model to detect sepsis. Using our data elements and feature set, our modeling approach outperformed other machine learning methods and clinical scores.
Phenology and Dispersal of the Wheat Stem Sawfly (Hymenoptera: Cephidae) Into Winter Wheat Fields in Nebraska
Authors: McCullough Chris T , Hein Gary L , Bradshaw Jeffrey D
Published: April 2020

Historically, the wheat stem sawfly, Cephus cinctus Norton was a pest in spring wheat-growing regions of the northern Great Plains. However, in the 1980s, it was found infesting winter wheat fields in Montana. Infestations were first detected in western Nebraska in the 1990s, and have since spread throughout the Nebraska Panhandle. Larval damage occurs from stem-mining, but stem girdling that results in lodged stems that are not harvested results in the greatest yield losses. The biology and phenology of the wheat stem sawfly are well described in the northern portion of its range, but they are lacking in Colorado, southeast Wyoming, and Nebraska. In this study, the phenology and dispersal of the wheat stem sawfly in Nebraska winter wheat fields is described using sweep net and larval sampling. During this 2-yr study, adult activity began on May 23 and ended on June 21. Adult sex ratios were 2.32 males per female in 2014 and 0.46 males per female in 2015. Both sexes demonstrated an edge effect within the wheat fields, with greater densities near the field edge. The edge effect was stronger for male wheat stem sawfly than females. Wheat stem sawfly larval density also had an edge effect, regardless of the density of female wheat stem sawfly present. This information will be useful for developing management plans for the wheat stem sawfly in Nebraska and neighboring regions.
“Physician’s prescriptions accurately prepared” - The Mid-Nineteenth-Century Prescription Books of Four Gloucester Chemists
Authors: Helm David P
Published: April 2020

Britain’s mid-nineteenth-century healthcare economy has often been described as a “medical marketplace” in which struggling doctors faced intense competition from a range of unqualified rivals. Chemists and druggists, who proliferated in industrial cities and supposedly prospered by exploiting the poor and the gullible, are widely regarded as having presented a serious threat to medical livelihoods. However, the activities of four Gloucester chemists show how the dispensing of medical prescriptions brought individual chemists and doctors closer together. Competition between chemists and druggists for this trade was intense and it was instrumental in establishing them as trusted community pharmacists and giving impetus to the process of professionalization.

Prescription books, an under-represented source in the literature, also show that customers for prescription medicines were surprisingly socially diverse and that most prescriptions were collected by women, with significant variation in dispensing activity through the week. This, and the volume of prescriptions being dispensed, suggest prescription medicines were regularly being used to treat chronic and less serious ailments, where collection could await normal shopping days. Significantly, prescriptions were the property of the patients and could be re-presented whenever they thought fit. For some patients, it thus effectively became an instrument of self-medication.
Particle diameter, signal-to-noise ratio and beam requirements for extended Rayleigh resolution measurements in the scanning electron microscope
Authors: Blackburn Arthur M , Sasaki Tomoyo
Published: April 2020

The extended Rayleigh resolution measure was introduced to give a generalized resolution measure that can be readily applied to imaging and resolving particles that have finite size. Here, we make a detailed analysis of the influence of the particle size on this resolution measure. We apply this to scanning electron microscopy, under simple assumption of a Gaussian electron beam intensity distribution and a directly proportional emitted signal yield without detailed consideration of scattering internal to the sample, other than being proportional to the sample thickness. From this, we produce beam-width normalized characteristics relating the particle diameter and resolution measure, while also taking consideration of the reduced signal yield that occurs from smaller particles. From our analysis of these characteristics, which we fit to experimental image data, we see that particle diameters <0.7 times the beam 1/e full width, d, give agreement better than 10% with the true extended Rayleigh resolution. Furthermore, we consider the signal current that must be collected to reliably distinguish between the mid-gap and peak intensity regions in the particle images. This leads to a practical guide that the signal-to-noise ratio (SNR) occurring between large area, continuous regions made of the same materials as the particle and background should typically be 10–30 times greater than the SNR that is desired to be achieved between the peak and mid-gap regions of just resolved adjacent identical particles having diameters in the size range 0.4–0.7d.
Motivations to Help: Local Volunteer Humanitarians in US Refugee Resettlement
Authors: Yarris Kristin Elizabeth , Garcia-Millan Brenda , Schmidt-Murillo Karla
Published: April 2020

Drawing on qualitative interviews conducted in 2017 with 29 volunteers in the US state of Oregon, in this article, we critically examine volunteers’ motivations to aid migrants and refugees in an overtly hostile political period. Our central aim is understanding what sustains local volunteer actions to offer welcome to refugees when state policies and practices are exclusionary and unwelcoming. Considering these community-based efforts as a form of volunteer humanitarianism, we discuss three central motivations for these efforts: first, personal and family histories connect volunteers in intimate ways to migrant and refugee struggles; second, volunteers are therefore affectively motivated to help, drawing on powerful emotions to sustain their efforts; and third, these local volunteer efforts strive to reimagine US citizenship and national belonging in more inclusionary ways.
Travel restrictions and infectious disease outbreaks
Authors: Vaidya Ria , Herten-Crabb Asha , Spencer Julia , Moon Suerie , Lillywhite Louis
Published: April 2020

Background

A key purpose of the International Health Regulations (IHR) is to prevent unwarranted interruptions to trade and travel during large and/or transnational infectious disease outbreaks. Nevertheless, such outbreaks continue to disrupt the travel industry. This aspect of the IHR has received little attention in the academic literature despite its considerable impact on affected States and commercial activity. This article outlines the challenges and gaps in knowledge regarding the relationship between outbreaks and the travel sector and discusses the opportunities for further research and policy work to overcome these challenges.

Methodology

We conducted a literature review on the relationship between outbreaks and travel restrictions, with a particular focus on the 2014–16 Ebola epidemic in West Africa. This review was complemented by an expert roundtable at Chatham House and further supported by case studies and qualitative interviews.

Results

Numerous travel stakeholders are affected by, and affect, large-scale infectious disease outbreaks. These stakeholders react in different ways: peer pressure plays an important role for both governments and the travel sector, and the reactions of the media and public influence and are influenced by these stakeholders. While various data sources on travel are available, and World Health Organization is mandated to work with States, there is no recognized coordinating body to disseminate timely, consistent, reliable and authoritative information and best practices to all stakeholders.

Conclusion

This article highlights the interdependent relationship between various travel stakeholders. The reasons for interruption of travel during the 2014–16 Ebola outbreak were complex, with decisions by States only partly contributing to the cessation. Decisions by non-state actors, particularly the travel industry itself, contributed significantly and were based on a variety of factors. Further research, analysis and policy development are required to mitigate the health and economic consequences of infectious disease outbreaks. Any further research will also need to take account of COVID-19 travel-related issues.
Diet assessments as a tool to control invasive species: comparison between Monk and Rose-ringed parakeets with stable isotopes
Authors: Borray-Escalante N A , Mazzoni D , Ortega-Segalerva A , Arroyo L , Morera-Pujol V , González-Solís J , Senar J C
Published: April 2020

Food is a main limiting factor for most populations. As a consequence, knowledge about the diet of invasive alien species determines the design of control measures. The Monk and Rose-ringed parakeets are two typical species of successful invasive parrots that are highly appreciated by people. Although some observations suggest that Monk parakeets rely on a higher percentage of anthropogenic food than Rose-ringed parakeets, no detailed quantitative data is available. The aim of this study was to compare the diet of the two parakeets using stable isotope analysis (SIA). We performed SIA of carbon and nitrogen in feathers collected in Barcelona, Spain. We also measured isotopic ratios for potential food sources. We reconstructed the diet of parakeets using Bayesian mixing models. The two species differed in the isotopic signatures of their feathers for both δ13C and δ15N. Diet reconstruction showed that Monk parakeets feed mainly on anthropogenic food (41.7%), herbaceous plants (26.9%) and leaves/seeds (22.2%), while Rose-ringed parakeets feed mainly on flowers/fruits (44.1%), anthropogenic food provided in the trap located at the museum (32.4%) and leaves/seeds (23.1%). The more detailed information we can obtain from the diet of these species is useful to develop more effective control measures for their populations. The Monk parakeet may be more susceptible to control through education local residents, given the greater use of anthropogenic food in this species compared to Rose-ringed parakeet. Our conclusions also indicate that SIA is a powerful tool in providing crucial information about the diet and informing measures to control invasive species.
Tardigrade abundance in relation to urbanisation and highly anthropogenic substrates
Authors: McCarthy Thomas , delBarco-Trillo Javier
Published: April 2020

Animals colonising urban environments are exposed to a series of novel stressors and ecological challenges, which can result in adaptations to alternative urban niches. Tardigrades are cosmopolitan invertebrates present in all types of ecosystems, including urban environments; and they can survive under extreme conditions, including periods of desiccation, thus allowing them to colonise novel harsh habitats. Tardigrades are thus a promising model to investigate the challenges and opportunities encountered by urban colonisers. Our aims were 1, to determine if tardigrade abundance in natural substrates (moss, lichen and leaf litter) differs between rural and urban sites and 2, to assess if tardigrades have successfully colonised urban substrates that are highly anthropogenic (road sediment, and material accumulated under cars and in wall crevices). Among natural substrates, we found fewer tardigrades in Cork city than in rural sites. However, in urban sites we found no differences between the number of tardigrades present in natural and anthropogenic substrates. In fact, the highest tardigrade abundances in urban samples were found in abiotic material accumulated in wall crevices. We conclude that even though urbanisation may restrict tardigrade abundance, this group of organisms can successfully colonise alternative urban substrates. More research is needed on the ability of tardigrades and other taxa to inhabit highly unusual and disturbed urban substrates effectively, and the adaptations that may take place when animals colonise such substrates.
Altering potato isoprenoid metabolism increases biomass and induces early flowering
Authors: Moehninsi  , Lange Iris , Lange B Markus , Navarre Duroy A
Published: April 2020

Isoprenoids constitute the largest class of plant natural products and have diverse biological functions including in plant growth and development. In potato (Solanum tuberosum), the regulatory mechanism underlying the biosynthesis of isoprenoids through the mevalonate pathway is unclear. We assessed the role of 3-hydroxy-3-methylglutaryl-CoA reductase (HMGR) homologs in potato development and in the metabolic regulation of isoprenoid biosynthesis by generating transgenic lines with down-regulated expression (RNAi-hmgr) or overexpression (OE) of one (StHMGR1 or StHMGR3) or two genes, HMGR and farnesyl diphosphate synthase (FPS; StHMGR1/StFPS1 or StHMGR3/StFPS1). Levels of sterols, steroidal glycoalkaloids (SGAs), and plastidial isoprenoids were elevated in the OE-HMGR1, OE-HMGR1/FPS1, and OE-HMGR3/FPS1 lines, and these plants exhibited early flowering, increased stem height, increased biomass, and increased total tuber weight. However, OE-HMGR3 lines showed dwarfism and had the highest sterol amounts, but without an increase in SGA levels, supporting a rate-limiting role for HMGR3 in the accumulation of sterols. Potato RNAi-hmgr lines showed inhibited growth and reduced cytosolic isoprenoid levels. We also determined the relative importance of transcriptional control at regulatory points of isoprenoid precursor biosynthesis by assessing gene–metabolite correlations. These findings provide novel insights into specific end-products of the sterol pathway and could be important for crop yield and bioenergy crops.
Recovering and rendering silenced experiences of genocides: Testimonial fragments of the Holocaust
Authors: Mihály Tóth Gábor
Published: April 2020

The experiences of murdered victims of Nazi persecutions perished with them. This article discusses how text and data mining technology has helped to recover fragments of these lost experiences out of 2,500 oral history interviews with survivors. This gave rise to Let them Speak, a data edition of Holocaust testimonies. The first part situates the challenge of revealing lost experiences in historiography, and argues that the experience of murdered victims can be reconstructed through the collective experience. The second part shows how text and data mining techniques assisted the author to identify some pieces of the collective experience. The third part presents how web technology and visualization are used to render pieces of the collective experience as testimonial fragments of the Holocaust.
An Example of 3-D Printing for Expeditionary Medicine: The Air Force Retractor
Authors: Chambers James A , Seastedt Kenneth P , Raymundo-Grinstead Jocelyn
Published: April 2020

Introduction

Future challenges for the U.S. Department of Defense (DoD) include operating in a contested environment against near-peer adversaries. Providing casualty care in an anti-access/area denial (A2/AD) region would be potentially challenged by impaired logistical ability to reconstitute supplies or adapt to evolving needs. Additive manufacturing (AM), also known as 3D printing, offers an ability to regenerate stocked items as well as modify them or even create novel products de novo.

Materials and Methods

This article discusses relevant technology and applications for deployed medical forces. Additionally, as proof of concept, we outline our design process for a novel 3D-printed surgical retractor.

Results

Our “Air Force Retractor” prototype highlights the potential of using AM to create or augment surgical instruments downrange.

Conclusions

This paper encourages further investigation of the use of AM/3D printing downrange to create surgical instruments and medical supplies in austere, A2/AD, and other logistically challenging environments. Not only would this support regeneration of supplies, but also modification and even creation of novel products to adapt to changing needs. If 3D files could be created of common surgical instruments for print on designated resins downrange, and FDA approval obtained, an online library of files could be created for easy access to DoD members across the globe to support our nation’s commitment to provide the best possible care for service members any time, any place.
Epidemiology of visceral mycoses in patients with acute leukemia and myelodysplastic syndrome: Analyzing the national autopsy database in Japan
Authors: Togano Tomiteru , Suzuki Yuhko , Nakamura Fumihiko , Tse William , kume Hikaru
Published: April 2020

Visceral mycoses (VM) are a deadly common infection in patients with acute leukemia and myelodysplastic syndrome (MDS). We retrospectively analyzed the data from the centralized “Annual Report of Autopsy Cases in Japan” that archives the national autopsy cases since 1989. Among the total of 175,615 archived autopsy cases, 7183 cases (4.1%) were acute leukemia and MDS patients. While VM was only found in 7756 cases (4.4% in total cases), we found VM had a disproportionally high prevalence among acute leukemia and MDS patients: 1562 VM cases (21.7%) and nearly sixfold higher in prevalence. Aspergillus spp. was the most predominant causative agent (45.0%), and Candida spp. was the second (22.7%) among confirmed single pathogen involved cases. The prevalence of Candida spp. infection decreased about 50% due to the widely use of fluconazole prophylaxis, which may skew toward doubling of the Mucormycetes incidence compared to 30 years ago. Complicated fungal infection (> one pathogen) was 11.0% in acute leukemia and MDS in 2015. It was 14.7 times higher than in other populations. Among 937 patients who received allogeneic hematopoietic cell transplantation (HCT), the prevalence of VM was 28.3% and 23.3% with GVHD. Aspergillus spp. was less prevalent, but Candida spp. was more associated with GVHD. Its prevalence remains stable. Although Aspergillus spp. was the primary causative agent, non-albicans Candida spp. was increasing as a breakthrough infection especially in GVHD cases. Complicated pathogen cases were more common in acute leukemia and MDS.
Galaxy formation with BECDM – II. Cosmic filaments and first galaxies
Authors: Mocz Philip , Fialkov Anastasia , Vogelsberger Mark , Becerra Fernando , Shen Xuejian , Robles Victor H , Amin Mustafa A , Zavala Jesús , Boylan-Kolchin Michael , Bose Sownak , Marinacci Federico , Chavanis Pierre-Henri , Lancaster Lachlan , Hernquist Lars
Published: April 2020

Bose–Einstein condensate dark matter (BECDM, also known as fuzzy dark matter) is motivated by fundamental physics and has recently received significant attention as a serious alternative to the established cold dark matter (CDM) model. We perform cosmological simulations of BECDM gravitationally coupled to baryons and investigate structure formation at high redshifts (z ≳ 5) for a boson mass m = 2.5 × 10−22 eV, exploring the dynamical effects of its wavelike nature on the cosmic web and the formation of first galaxies. Our BECDM simulations are directly compared to CDM as well as to simulations where the dynamical quantum potential is ignored and only the initial suppression of the power spectrum is considered – a warm dark matter-like (‘WDM’) model often used as a proxy for BECDM. Our simulations confirm that ‘WDM’ is a good approximation to BECDM on large cosmological scales even in the presence of the baryonic feedback. Similarities also exist on small scales, with primordial star formation happening both in isolated haloes and continuously along cosmic filaments; the latter effect is not present in CDM. Global star formation and metal enrichment in these first galaxies are delayed in BECDM/‘WDM’ compared to the CDM case: in BECDM/‘WDM’ first stars form at z ∼ 13/13.5, while in CDM star formation starts at z ∼ 35. The signature of BECDM interference, not present in ‘WDM’, is seen in the evolved dark matter power spectrum: although the small-scale structure is initially suppressed, power on kpc scales is added at lower redshifts. Our simulations lay the groundwork for realistic simulations of galaxy formation in BECDM.
Extensive Ethnolinguistic Diversity in Vietnam Reflects Multiple Sources of Genetic Diversity
Authors: Liu Dang , Duong Nguyen Thuy , Ton Nguyen Dang , Van Phong Nguyen , Pakendorf Brigitte , Van Hai Nong , Stoneking Mark
Published: April 2020

Vietnam features extensive ethnolinguistic diversity and occupies a key position in Mainland Southeast Asia. Yet, the genetic diversity of Vietnam remains relatively unexplored, especially with genome-wide data, because previous studies have focused mainly on the majority Kinh group. Here, we analyze newly generated genome-wide single-nucleotide polymorphism data for the Kinh and 21 additional ethnic groups in Vietnam, encompassing all five major language families in Mainland Southeast Asia. In addition to analyzing the allele and haplotype sharing within the Vietnamese groups, we incorporate published data from both nearby modern populations and ancient samples for comparison. In contrast to previous studies that suggested a largely indigenous origin for Vietnamese genetic diversity, we find that Vietnamese ethnolinguistic groups harbor multiple sources of genetic diversity that likely reflect different sources for the ancestry associated with each language family. However, linguistic diversity does not completely match genetic diversity: There have been extensive interactions between the Hmong-Mien and Tai-Kadai groups; different Austro-Asiatic groups show different affinities with other ethnolinguistic groups; and we identified a likely case of cultural diffusion in which some Austro-Asiatic groups shifted to Austronesian languages during the past 2,500 years. Overall, our results highlight the importance of genome-wide data from dense sampling of ethnolinguistic groups in providing new insights into the genetic diversity and history of an ethnolinguistically diverse region, such as Vietnam.
The regulation of acetylation and stability of HMGA2 via the HBXIP-activated Akt–PCAF pathway in promotion of esophageal squamous cell carcinoma growth
Authors: Wu Yue , Wang Xue , Xu Feifei , Zhang Lu , Wang Tianjiao , Fu Xueli , Jin Tianzhi , Zhang Weiying , Ye Lihong
Published: April 2020

High-mobility group AT-hook 2 (HMGA2) is an architectural transcription factor that plays essential roles in embryonic development and cancer progression. However, the mechanism of HMGA2 regulation remains largely uncharacterized. Here, we demonstrate that HMGA2 can be modulated by hepatitis B X-interacting protein (HBXIP), an oncogenic transcriptional coactivator, in esophageal squamous cell carcinoma (ESCC). HMGA2 expression was positively associated with HBXIP expression in clinical ESCC tissues, and their high levels were associated with advanced tumor stage and reduced overall and disease-free survival. We found that oncogenic HBXIP could posttranslationally upregulate HMGA2 protein level in ESCC cells. HBXIP induced HMGA2 acetylation at the lysine 26 (K26), resulting in HMGA2 protein accumulation. In this process, HBXIP increased the acetyltransferase p300/CBP-associated factor (PCAF) phosphorylation and activation via the Akt pathway, then PCAF directly interacted with HMGA2, leading to HMGA2 acetylation in the cells. HMGA2 K26 acetylation enhanced its DNA binding capacity and blocked its ubiquitination and then inhibited proteasome-dependent degradation. Functionally, HBXIP-stabilized HMGA2 could promote ESCC cell growth in vitro and in vivo. Strikingly, aspirin suppressed ESCC growth by inhibiting HBXIP and HMGA2. Collectively, our findings disclose a new mechanism for the posttranslational regulation of HMGA2 mediated by HBXIP in ESCC.
A multiple-response frequency-tagging paradigm measures graded changes in consciousness during perceptual filling-in
Authors: Davidson Matthew J , Graafsma Irene L , Tsuchiya Naotsugu , van Boxtel Jeroen
Published: April 2020

Perceptual filling-in (PFI) occurs when a physically present visual target disappears from conscious perception, with its location filled-in by the surrounding visual background. These perceptual changes are complete, near instantaneous, and can occur for multiple separate locations simultaneously. Here, we show that contrasting neural activity during the presence or absence of multi-target PFI can complement other findings from multistable phenomena to reveal the neural correlates of consciousness (NCC). We presented four peripheral targets over a background dynamically updating at 20 Hz. While participants reported on target disappearances/reappearances via button press/release, we tracked neural activity entrained by the background during PFI using steady-state visually evoked potentials (SSVEPs) recorded in the electroencephalogram. We found background SSVEPs closely correlated with subjective report, and increased with an increasing amount of PFI. Unexpectedly, we found that as the number of filled-in targets increased, the duration of target disappearances also increased, suggesting that facilitatory interactions exist between targets in separate visual quadrants. We also found distinct spatiotemporal correlates for the background SSVEP harmonics. Prior to genuine PFI, the response at the second harmonic (40 Hz) increased before the first (20 Hz), which we tentatively link to an attentional effect, while no such difference between harmonics was observed for physically removed stimuli. These results demonstrate that PFI can be used to study multi-object perceptual suppression when frequency-tagging the background of a visual display, and because there are distinct neural correlates for endogenously and exogenously induced changes in consciousness, that it is ideally suited to study the NCC.
Vacuum energy of the supersymmetric $\mathbb{C}P^{N-1}$ model on $\mathbb{R}\times S^1$ in the $1/N$ expansion
Authors: Ishikawa Kosuke , Okuto Morikawa , Shibata Kazuya , Suzuki Hiroshi
Published: April 2020

By employing the $1/N$ expansion, we compute the vacuum energy $E(\delta\epsilon)$ of the two-dimensional supersymmetric (SUSY) $\mathbb{C}P^{N-1}$ model on $\mathbb{R}\times S^1$ with $\mathbb{Z}_N$ twisted boundary conditions to the second order in a SUSY-breaking parameter $\delta\epsilon$. This quantity was vigorously studied recently by Fujimori et al. using a semi-classical approximation based on the bion, motivated by a possible semi-classical picture on the infrared renormalon. In our calculation, we find that the parameter $\delta\epsilon$ receives renormalization and, after this renormalization, the vacuum energy becomes ultraviolet finite. To the next-to-leading order of the $1/N$ expansion, we find that the vacuum energy normalized by the radius of the $S^1$, $R$, $RE(\delta\epsilon)$ behaves as inverse powers of $\Lambda R$ for $\Lambda R$ small, where $\Lambda$ is the dynamical scale. Since $\Lambda$ is related to the renormalized ’t Hooft coupling $\lambda_R$ as $\Lambda\sim e^{-2\pi/\lambda_R}$, to the order of the $1/N$ expansion we work out, the vacuum energy is a purely non-perturbative quantity and has no well-defined weak coupling expansion in $\lambda_R$.
The Essentials of the Helping Relationship between Social Workers and Clients
Authors: Sinai-Glazer Hagit
Published: April 2020

The helping relationship between a client and a practitioner is often described as the heart and soul in social work. This research explored the helping relationship between social workers and clients (the clients were mothers) in the context of public social services in Israel. The results presented here are part of a larger ethnographic study that included interviews with 14 social workers, 20 mothers who are clients, and extensive participant observations and textual analysis. Presented in this article are the results pertaining to the essential elements of the helping relationship as perceived by the research participants. Social workers and clients pointed to similar elements that comprise a good helping relationship: love and support; trust and feeling safe; listening and feeling understood; making an effort to help; humanness, compassion, and sensitivity; availability, continuity, and being there when needed; and chemistry. Participants’ accounts exemplify the importance and centrality of the helping relationship in social work. The article concludes with a discussion of the study’s implications for practice, policy, and research.
Developing external threats to offshore trusts: unexplained wealth orders and forfeiture of assets under the Forfeiture of Assets (Civil Proceedings) (Jersey) Law 2018
Authors: Alexander Stephen , Cook Mathew
Published: April 2020

In recent years, authorities’ toolkits have been growing with alternative methods to tackle corruption and money laundering, enabling them to attack assets held within onshore and offshore trusts. Two new tools being utilised in this regard are unexplained wealth orders (UWOs) and the non-conviction confiscation regime under the Forfeiture of Assets (Civil Proceedings) (Jersey) Law 2018 (FoAL 2018). Both may affect trusts established in Jersey. Cases have now come before the courts, testing the scope of each of these mechanisms and providing an insight into the courts’ approach to combatting financial crime by way of civil proceedings. The use of a UWO was challenged in the recent English Court of Appeal case of National Crime Agency v Hajiyeva1 and the AG v Ellis proceedings2 in Jersey involved the application of the FoAL 2018. We consider each of these mechanisms and the cases involved in turn below and discuss the impact of these developing tools on the Jersey trust industry.
Changes in Pain and Psychosocial Functioning and Transition to Chronic Pain in Pediatric Sickle Cell Disease
Authors: Sil Soumitri , Cohen Lindsey L. , Bakshi Nitya , Watt Amanda , Hathaway Morgan , Abudulai Farida , Dampier Carlton
Published: April 2020

Objectives:

This study aimed to: (1) examine changes in pain, psychosocial functioning, and health care utilization among children and adolescents with sickle cell disease (SCD) over a 2-year period and (2) identify baseline biopsychosocial variables associated with the development and maintenance of chronic SCD pain at follow-up.

Materials and Methods:

Forty-two youth (8 to 18 y old) with SCD completed a battery of self-report measures at baseline and 2-year follow-up. Analgesic, Anesthetic, and Addiction Clinical Trial Translational Innovations Opportunities and Networks and American Pain Society Pain Taxonomy (AAPT) diagnostic criteria were used to categorize patients into pain frequency groups at both timepoints: chronic (pain on most [≥15] d/mo for the past 6 mo, per AAPT diagnostic criteria), episodic (pain on 1 to 14 d/mo), or asymptomatic (0 d/mo).

Results:

At baseline, 31% (n=13) had chronic pain, 50% (n=21) episodic pain, and 19% (n=8) were asymptomatic. At follow-up, 40.5% (n=17) had chronic pain, 52.4% (n=22) episodic pain, and 7.1% (n=3) were asymptomatic. Between baseline and 2-year follow-up, 12% (n=5) developed chronic SCD pain. Depressive symptoms and admissions for pain significantly increased over time for youth with chronic pain (Ps<0.05). An interaction effect revealed that baseline pain groups differed in their change in pain intensity over time (P<0.01). Baseline psychosocial factors (ie, higher functional disability, greater depressive symptoms, higher pain catastrophizing, and lower quality of life) were significantly associated with chronic pain at follow-up.

Discussion:

Biopsychosocial factors may be associated with the development and maintenance of chronic SCD pain and their relative contributions warrant further study.
Do Levels of Stress Markers Influence the Retinal Nerve Fiber Layer Thickness in Young Adults?
Authors: Lee Samantha Sze-Yee , Sanfilippo Paul G. , Yazar Seyhan , Pennell Craig E. , Hewitt Alex W. , Wang Carol A. , Martin Wrivu N. , Mackey David A.
Published: April 2020

Precis:

Although mental or emotional stress may result raise in intraocular pressure (IOP) we found weak associations between endogenous stress markers concentrations and retinal nerve fiber layer (RNFL) thickness, thus limited evidence that stress affects retinal ganglion cells integrity.

Purpose:

Increased exposure to glucocorticoids is linked to elevated IOP, which is a risk factor for glaucoma. We explored the RNFL thickness for changes that may mimic preclinical glaucomatous changes, in relation to the hormonal stress response.

Materials and Methods:

Young healthy adults (n=863) underwent a Trier Social Stress Test. Endogenous plasma adrenocorticotropic hormone (ACTH) and cortisol were measured for those who provided biological samples, and adrenal sensitivity was calculated. On the basis of cortisol levels before and after the Trier Social Stress Test, participants were categorized into one of 3 stress response types: anticipatory-responders, reactive-responders, and nonresponders. Participants underwent an eye examination that included spectral-domain optical coherence tomography to measure peripapillary RNFL thickness.

Results:

Higher levels of ACTH were associated with thinner RNFL globally (P=0.009), and at the inferotemporal (P=0.015), superotemporal (P=0.044), and temporal sectors (P=0.046). Lower adrenal sensitivity was associated with thinner RNFL inferotemporally (P<0.001) and temporally (P=0.037). However, these effect sizes were small; for example, a 10 pg/mL increase in baseline ACTH was associated with only a 3 µm thinner RNFL. RNFL thickness was not associated with plasma cortisol levels and or significantly different between groups of acute stress response patterns.

Conclusions:

Although there was a link between ACTH or adrenal sensitivity and RNFL thickness, this association was weak and its clinical significance is unclear. Despite the close associations between levels of endogenous stress markers and IOP, we found limited evidence of a link to RNFL integrity.
A Novel α-Spectrin Pathogenic Variant in Trans to α-Spectrin LELY Causing Neonatal Jaundice With Hemolytic Anemia From Hereditary Pyropoikilocytosis Coexisting With Gilbert Syndrome
Authors: Suzuki Tomoko , Togawa Takao , Kanno Hitoshi , Ogura Hiromi , Yamamoto Toshiyuki , Sugiura Takahiro , Kouwaki Masanori , Saitoh Shinji
Published: April 2020

Hereditary pyropoikilocytosis is a subtype of hereditary elliptocytosis because of biallelic mutations of SPTA1, SPTB, and EPB41. The authors present a proband with neonatal jaundice and hemolytic anemia, with poikilocytosis in the blood film. Targeted next-generation sequencing identified Q267del trans to the αLELY allele in SPTA1. In addition, the proband presented coexisting Gilbert syndrome as determined by homozygous mutation of UGT1A1. Investigation of 13 relatives and his sibling revealed that only his sibling showed the same phenotype and genotype as the proband. This is the first report of molecular confirmation of coexisting hereditary pyropoikilocytosis and Gilbert syndrome and a novel mutation in SPTA1.
Clinic-level and individual-level factors that influence HIV viral suppression in adolescents and young adults: a national survey in Kenya
Authors: Njuguna Irene , Neary Jillian , Mburu Caren , Black Danae , Beima-Sofie Kristin , Wagner Anjuli D. , Mugo Cyrus , Evans Yolanda , Guthrie Brandon , Itindi Janet , Onyango Alvin , Oyiengo Laura , Richardson Barbra A. , Wamalwa Dalton , John-Stewart Grace
Published: April 2020

Objectives:

To determine clinic-level and individual-level correlates of viral suppression among HIV-positive adolescents and young adult (AYA) aged 10–24 years receiving antiretroviral treatment (ART).

Design:

Multilevel cross-sectional analysis using viral load data and facility surveys from HIV treatment programs throughout Kenya.

Methods:

We abstracted medical records of AYA in HIV care, analyzed the subset on ART for more than 6 months between January 2016 and December 2017, and collected information on services at each clinic. Multilevel logistic regression models were used to determine correlates of viral suppression at most recent assessment.

Results:

In 99 HIV clinics, among 10 096 AYA on ART more than 6 months, 2683 (27%) had unsuppressed viral load at last test. Among 16% of clinics, more than 80% of AYA were virally suppressed. Clinic-level correlates of individual viral suppression included designated adolescent spaces [aOR: 1.32, 95% CI (1.07–1.63)] and faster viral load turnaround time [aOR: 1.06 (95% CI 1.03–1.09)]. Adjusting for clinic-level factors, AYA aged 10–14 and 15–19 years had lower odds of viral suppression compared with AYA aged 20–24 years [aOR: 0.61 (0.54–0.69) and 0.59 (0.52–0.67], respectively. Compared with female patients, male patients had lower odds of viral suppression [aOR: 0.69 (0.62–0.77)]. Compared with ART duration of 6–12 months, ART for 2–5, above 5–10 or more than 10 years was associated with poor viral suppression (P < 0.001).

Conclusion:

Dedicated adolescent space, rapid viral load turnaround time, and tailored approaches for male individuals and perinatally infected AYA may improve viral suppression. Routine summarization of viral load suppression in clinics could provide benchmarking to motivate innovations in clinic-AYA and individual-AYA care strategies.
Brief report on combat trauma surgical training using a perfused cadaver model
Authors: Grabo Daniel , Polk Travis , Minneti Michael , Inaba Kenji , Demetriades Demetrios
Published: April 2020

BACKGROUND

Surgical combat casualty care presents difficult training challenges. Although several high-fidelity simulation (SIM) techniques have emerged, none are able to fully integrate the many intricacies involved in the care of a complex trauma patient. Herein, we report the use of perfused fresh human cadaver model for training and assessment of forward surgical teams (FSTs).

METHODS

Forward surgical teams attend a 4-day combat trauma surgical skills course including focused on trauma exposures. A half-day SIM involves the entire surgical team in four sequential surgical scenarios that involve the neck, chest, abdomen, and extremities, as well as airway management and resuscitation. Teams undergo immediate debriefing and videotape review of team dynamics and technical skills, as well as times to completion of critical interventions.

RESULTS

The data evaluated include five initial demonstration courses in which training metrics were available. Each team included both a junior and experienced surgeon, anesthesiologists, and surgical scrub technicians. As FSTs progressed through SIMs, they demonstrated improvements in team dynamics and technical skills evaluations. There was considerable variability in the times to completion of critical intervention, particularly for control of cardiac and vascular injuries.

CONCLUSION

Initial evaluations support the use of this novel perfused cadaver model for the training and evaluation of military FSTs. Preliminary data highlight the utility for open vascular, thoracic, and other high-acuity/low-volume procedures critical to combat casualty care. Larger studies are needed for model optimization and further validation of an objective structured technical assessment tool.

LEVEL OF EVIDENCE

Care management, level V.
Radial versus femoral arterial access for trauma endovascular interventions: A noninferiority study
Authors: Adnan Sakib M. , Romagnonli Anna N. , Elansary Noha N. , Martinson James R. , Madurska Marta J. , Dubose Joseph J. , Scalea Thomas M. , Morrison Jonathan J.
Published: April 2020

BACKGROUND

The majority of endovascular interventions for trauma are performed using transfemoral access (TFA). Transradial access (TRA) is a recently integrated alternative at the authors' institution. This noninferiority study compares the technical success and complication rate of TRA compared with TFA.

METHODS

All patients undergoing emergent endovascular interventions between March 2016 and March 2019 were identified from a prospectively maintained database. Data were collected on access type, complications, and procedural success. A noninferiority margin was established from previous randomized trials for technical success (0.475) and complications (0.015).

RESULTS

Over 3 years, 96 patients underwent TRA and 335 patients received TFA. The overall technical success rate was 98.1%, without significance based on access strategy (p = 0.078). All femoral arteries and 97.9% (n = 94) of radial arteries were accessed as intended. Complications occurred in 1.0% of TRA and 9.9% of TFA groups (p = 0.002). In the TFA group, complications included access site bleeding, hematoma, pseudoaneurysm, lower limb ischemia, and femoral artery thrombosis (n = 6, 14, 3, 3, and 4, respectively). In the TRA group, complications included radial artery thrombosis (n = 1). Transradial access procedural success and complication rate fell within the lower bound confidence interval of the noninferiority margin, demonstrated the noninferiority of TRA in this data set.

CONCLUSION

Transradial access in a cohort of trauma patients undergoing endovascular intervention does not appear to be inferior to TFA in relation to technical success and complications. For patients where groin access may be challenging, TRA is a useful, efficacious, and safe alternative. Longer-term study is required to fully characterize the advantages and disadvantages of TRA compared with TFA.

LEVEL OF EVIDENCE

Therapeutic V.
The shape of dendritic tips
Authors: Alexandrov Dmitri V. , Galenko Peter K.
Published: April 2020

The present article is focused on the shapes of dendritic tips occurring in undercooled binary systems in the absence of convection. A circular/globular shape appears in limiting cases of small and large Péclet numbers. A parabolic/paraboloidal shape describes the tip regions of dendrites whereas a fractional power law defines a shape behind their tips in the case of low/moderate Péclet number. The parabolic/paraboloidal and fractional power law shapes are sewed together in the present work to describe the dendritic shape in a broader region adjacent to the dendritic tip. Such a generalized law is in good agreement with the parabolic/paraboloidal and fractional power laws of dendritic shapes. A special case of the angled dendrite is considered and analysed in addition. The obtained results are compared with previous experimental data and the results of numerical simulations on dendritic growth.

This article is part of the theme issue ‘Patterns in soft and biological matters’.
How heterogeneity drives tumour growth: a computational study
Authors: Gomez Hector
Published: April 2020

Although cancerous tumours usually originate from a single cell, they normally evolve into a remarkably heterogeneous agglomeration of cells. Heterogeneity is a pervasive and almost universal feature of tumours, but its origin and consequences remain poorly understood. Tumour heterogeneity has been usually associated with poor prognosis, but a better understanding of it may lead to more personalized diagnosis and therapy. Here, we study tumour heterogeneity developing a computational model in which different cell subpopulations compete for space. The model suggests that aggressive tumour subpopulations may become even more aggressive when they grow with a non-aggressive subpopulation. The model also provides a mechanistic explanation of how heterogeneity drives growth. In particular, we observed that even a mild heterogeneity in the proliferation rates of different cell subpopulations leads to a much faster overall tumour growth when compared to a homogeneous tumour. The proposed model may be a starting point to study tumour heterogeneity computationally and to suggest new hypotheses to be tested experimentally.

This article is part of the theme issue ‘Patterns in soft and biological matters’.
Dynamics of particulate assemblages in metastable liquids: a test of theory with nucleation and growth kinetics
Authors: Alexandrova Irina V. , Alexandrov Dmitri V.
Published: April 2020

This manuscript is devoted to the nonlinear dynamics of particulate assemblages in metastable liquids, caused by various dynamical laws of crystal growth and nucleation kinetics. First of all, we compare the quasi-steady-state and unsteady-state growth rates of spherical crystals in supercooled and supersaturated liquids. It is demonstrated that the unsteady-state rates transform to the steady-state ones in a limiting case of fine particles. We show that the real crystals evolve slowly in a more actual case of unsteady-state growth laws. Various growth rates of particles are tested against experimental data in metastable liquids. It is demonstrated that the unsteady-state rates describe the nonlinear behaviour of experimental curves with increasing the growth time or supersaturation. Taking this into account, the crystal-size distribution function and metastability degree are analytically found and compared with experimental data on crystallization in inorganic and organic solutions. It is significant that the distribution function is shifted to smaller sizes of particles if we are dealing with the unsteady-state growth rates. In addition, a complete analytical solution constructed in a parametric form is simplified in the case of small fluctuations in particle growth rates. In this case, a desupercooling/desupersaturation law is derived in an explicit form. Special attention is devoted to the biomedical applications for insulin and protein crystallization.

This article is part of the theme issue ‘Patterns in soft and biological matters’.