bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment for chronic hepatitis E virus infection: A systematic review and meta‐analysis
Authors: Gorris Myrte , van der Lecq Bernice M. , van Erpecum Karel J. , de Bruijne Joep
Published: December 2020

Hepatitis E virus infection can cause chronic hepatitis in immunocompromised patients with significant chance of progressive fibrosis and possibly cirrhosis. The aim of this systematic review was to summarize the efficacy and safety of the various treatment options for chronic hepatitis E. We performed a systematic literature search. The primary outcome measure was a sustained virological response (SVR). Secondary end points were rapid virological response (RVR), relapse rates, side effects and adverse events. Forty‐four articles were included with a total of 582 patients. Reduction of immunosuppressive medication induced viral clearance in 55/174 (32%) of the patients. Meta‐analysis of 395 patients showed a pooled SVR rate of 78% (95‐CI 72%–84%) after ribavirin treatment. Twenty‐five per cent of the patients obtained a RVR, whereas a relapse occurred in 18% of the patients. Anaemia during treatment led to dose reduction, use of erythropoietin and/or blood transfusion in 37% of the patients. A second treatment attempt with ribavirin led to a SVR in 39/51 (76%) of the patients. Pegylated interferon‐alpha was administered to 13 patients and SVR was obtained in 85%. Two patients (15%) suffered from acute transplant rejection during treatment with interferon. In conclusion, reduction of immunosuppressive medication and treatment with ribavirin is safe, generally well tolerated and induced viral clearance in 32% and 78% of patients, respectively. Therefore, ribavirin should be considered as first treatment step for chronic hepatitis E. Treatment with pegylated interferon‐alpha increases the risk of transplant rejection and should therefore be administered with great caution.
Hepatitis E‐Associated Hospitalizations in the United States: 2010–2015 and 2015–2017
Authors: Wasuwanich Paul , Ingviya Thammasin , Thawillarp Supharerk , Teshale Eyasu H. , Kamili Saleem , Crino Jude P. , Scheimann Ann O. , Argani Cynthia , Karnsakul Wikrom
Published: December 2020

Hepatitis E is considered rare in the United States (US) despite its widespread occurrence in Asian and African countries. The objective of this study was to describe the characteristics of hepatitis E‐related pregnancies and acute‐on‐chronic liver failure and analyse trends for hepatitis E diagnosis among hospitalized patients in the US. We examined data from the 2010–2017 National Inpatient Sample from Healthcare Cost and Utilization Project to determine mortality, morbidity, pregnancy diagnoses, chronic liver disease diagnoses, and other conditions during hospitalization. Data were extracted for hospitalizations with hepatitis E as defined by ICD‐9 codes 070.43 and 070.53 and ICD‐10 code B17.2. Of 208,462,242 hospitalizations from 2010–2015, we identified 960 hepatitis E hospitalizations. The hospitalization rate of hepatitis E was 3.7 per 10 million in 2010 and 6.4 per 10 million in 2015 (β = 0.60, p = 0.011). From 2015 to 2017, the hospitalization appeared to increase with slope (β) of 0.50. Among those hospitalizations, 34 (4%) died and 85 (9%) had acute‐on‐chronic liver failure. Ninety‐five (10%) had a diagnosis of pregnancy, there were no reports of maternal or foetus/neonate deaths, but there was a high proportion of adverse events for both during hospitalization. Having a chronic liver disease was associated with hepatic coma diagnosis (OR = 10.94, p = 0.002). Although the hospitalization rate of hepatitis E in the US is low, it appears to be increasing over time. Further studies are necessary in order to conclude a causal association of hepatitis E with adverse events and mortalities in pregnancy and chronic liver disease in the US.
Entrustment decisions and the clinical team: A case study of early clinical students
Authors: Pinilla Severin , Kyrou Alexandra , Maissen Norina , Klöppel Stefan , Strik Werner , Nissen Christoph , Huwendiek Sören
Published: December 2020

Purpose

Clinical learning contexts influence how medical students engage with entrustment decisions. However, it is unclear how students and health care team members perceive the entrustment decision process. This study explored which factors students and team members consider relevant to entrustment decisions in early clinical rotations.

Methods

The authors conducted a case study at an academic teaching hospital, interviewing 28 medical students and four health care team members during the clerkship year. Within a social constructivist epistemology, we explored students’ and health care team members’ perceptions of ad hoc entrustment decisions using semi‐structured interviews. Transcripts from the interviews and notes from feedback rounds with students were used for analysis.

Results

Medical students in their core clerkship year perceived clinical residents as critical educational gatekeepers and key facilitators of entrustment decisions. Another important theme emerged around students’ motivation, initiative and willingness to engage with the health care team and patients. Students actively engaged in trust formation processes with different health care team members. The entrustment decision process was perceived as multilateral and dynamic, involving all health care team members and patients. Multiple entrusting supervisors for clerkship students, including nurses and psychologists, emerged from our interview data. They assumed an active role in negotiating entrustment decisions both with and for clerkship students, either facilitating or hindering opportunities. The entrustment decisions emerged as a result of a multifaceted supervisor network interaction.

Conclusions

Supervising residents’ ability to integrate students into clinical teams seems to be a critical factor in facilitating entrustment opportunities for clinical activities. Students’ active management of informal supervisor networks of health care team members and these team members’ willingness to assume responsibility for the students’ education emerged as relevant aspects for ad hoc entrustment. Our data suggest that supervision from different health professionals is beneficial for clinical education of medical students and merits further exploration.
Hop stunt viroid: A polyphagous pathogenic RNA that has shed light on viroid–host interactions
Authors: Marquez‐Molins Joan , Gomez Gustavo , Pallas Vicente
Published: December 2020

Taxonomy

Hop stunt viroid (HSVd) is the type species of the genus Hostuviroid (family Pospiviroidae). The other species of this genus is Dahlia latent viroid, which presents an identical central conserved region (CCR) but lacks other structural hallmarks present in Hop stunt viroid. HSVd replication occurs in the nucleus through an asymmetric rolling‐circle model as in the other members of the family Pospiviroidae, which also includes the genera Pospiviroid, Cocadviroid, Apscaviroid, and Coleoviroid.

Physical properties

Hop stunt viroid consists of a single‐stranded, circular RNA of 295–303 nucleotides depending on isolates and sequence variants. The most stable secondary structure is a rod‐like or quasi‐rod‐like conformation with two characteristic domains: a CCR and a terminal conserved hairpin similar to that of cocadviroids. HSVd lacks a terminal conserved region.

Hosts and symptoms

HSVd infects a very broad range of natural hosts and has been reported to be the causal agent of five different diseases (citrus cachexia, cucumber pale fruit, peach and plum apple apricot distortion, and hop stunt). It is distributed worldwide.

Transmission

HSVd is transmitted mechanically and by seed.
The not‐so‐rare absent RAIR: Internal anal sphincter achalasia in a review of 1072 children with constipation undergoing high‐resolution anorectal manometry
Authors: Baaleman Desiree F. , Malamisura Monica , Benninga Marc A. , Bali Neetu , Vaz Karla H. , Yacob Desale , Di Lorenzo Carlo , Lu Peter L.
Published: December 2020

Background

Our objective is to describe the prevalence of patients with internal anal sphincter achalasia (IASA) without Hirschsprung disease (HD) among children undergoing anorectal manometry (ARM) and their clinical characteristics.

Methods

We performed a retrospective review of high‐resolution ARM studies performed at our institution and identified patients with an absent rectoanal inhibitory reflex (RAIR). Clinical presentation, medical history, treatment outcomes, and results of ARM and other diagnostic tests were collected. We compared data between IASA patients, HD patients, and a matched control group of patients with functional constipation (FC).

Key results

We reviewed 1,072 ARMs and identified 109 patients with an absent RAIR, of whom 28 were diagnosed with IASA. Compared to patients with FC, patients with IASA had an earlier onset of symptoms and were more likely to have abnormal contrast enema studies. Compared to patients with HD, patients with IASA were more likely to have had a normal timing of meconium passage, a later onset of symptoms, and were diagnosed at an older age. At the latest follow‐up, the majority of patients diagnosed with IASA (54%) were only using oral laxatives. Over half of patients with IASA had been treated with anal sphincter botulinum toxin injection, and 55% reported a positive response.

Conclusions and Inferences

Patients diagnosed with IASA may represent a more severe patient population compared to patients with FC, but have a later onset of symptoms compared to patients with HD. They may require different treatments for their constipation and deserve further study.
Thiamine deficiency disorders: a clinical perspective
Authors: Smith Taryn J. , Johnson Casey R. , Koshy Roshine , Hess Sonja Y. , Qureshi Umar A. , Mynak Mimi Lhamu , Fischer Philip R.
Published: December 2020

Thiamine is an essential water‐soluble vitamin that plays an important role in energy metabolism. Thiamine deficiency presents many challenges to clinicians, in part due to the broad clinical spectrum, referred to as thiamine deficiency disorders (TDDs), affecting the metabolic, neurologic, cardiovascular, respiratory, gastrointestinal, and musculoskeletal systems. Concurrent illnesses and overlapping signs and symptoms with other disorders can further complicate this. As such, TDDs are frequently misdiagnosed and treatment opportunities missed, with fatal consequences or permanent neurologic sequelae. In the absence of specific diagnostic tests, a low threshold of clinical suspicion and early therapeutic thiamine is currently the best approach. Even in severe cases, rapid clinical improvement can occur within hours or days, with neurological involvement possibly requiring higher doses and a longer recovery time. Active research aims to help better identify patients with thiamine‐responsive disorders and future research is needed to determine effective dosing regimens for the various clinical presentations of TDDs. Understanding the clinical diagnosis and global burden of thiamine deficiency will help to implement national surveillance and population‐level prevention programs, with education to sensitize clinicians to TDDs. With concerted effort, the morbidity and mortality related to thiamine deficiency can be reduced.
Trends in mortality rates for oral and oropharyngeal cancer in Spain, 1979–2018
Authors: Duran‐Romero Antonio Jose , Infante‐Cossio Pedro , Pereyra‐Rodriguez Jose‐Juan
Published: December 2020

Objective

To analyse mortality rate trends in Spain for oral cavity and oropharyngeal cancer (OCOPC) from 1979 to 2018, evaluating differences between oral cavity cancer (OCC) and oropharyngeal cancer (OPC).

Materials and Methods

Death certificates and mid‐year population data were collected from the Spanish National Statistics Institute. Age‐standardized mortality rates were calculated using the direct method. Joinpoint regressions were used to identify significant changes in mortality trends. Independent effects of age, period and cohort (APC) were estimated.

Results

A total of 52,057 deaths were registered from OCOPC, 38,988 from OCC and 13,069 from OPC between 1979 and 2018. While OCC mortality rates declined, OCOPC rates increased slightly and OPC significantly. OCC and OPC mortality reached their highest values between 1979 and 1992, when OCC rates began to decrease in males and OPC levelled off until 2018. Lip cancer suffered the highest drop. APC models showed a mortality increase in males and females from 40 to 45 and 50 to 55 years of age, respectively.

Conclusions

Favourable OCC mortality trends was plausibly influenced by decreased tobacco/alcohol consumption, while OPC rise was probably associated with increased human papillomavirus infection. The importance of closely monitoring these cancers by age group, sex and location, and continuing with preventive measures against known risk factors, is highlighted.
Adverse reactions to 1% cyclopentolate eye drops in children: an analysis using logistic regression models
Authors: Imai Toshihiro , Hasebe Satoshi , Furuse Takashi , Morisawa Shin , Hasebe Kayoko , Nagata Yuka , Tokutake Tomoki , Moriyama Yumiko
Published: December 2020

Purpose

To determine the frequency, symptoms and risk factors for adverse reactions to two‐times instillation of 1% cyclopentolate in children.

Study design

Prospective, observational study.

Methods

The subjects were 646 patients who underwent cycloplegic refraction with cyclopentolate (mean age; 7.0 ± 3.5 years, age range; 0–15 years). Five minutes after instillation of 0.4% oxybuprocaine hydrochloride, a 1% cyclopentolate eye drop was instilled twice, with an interval of 10 min. Fifty minutes later, two certified orthoptists evaluated adverse reactions using a questionnaire and interviewed the patients' guardians. The relationship between the adverse reaction rates and age, gender, additional instillation, complications of the central nervous system (CNS), time of day and season were analysed using binominal and polytomous logistic regression models.

Results

The overall frequency of adverse reactions was 18.3% (118/646 patients). The main symptoms included conjunctival injection (10.5%, 68/646), drowsiness (6.8%, 44/646) and facial flush (2.2%, 14/646). The odds ratio (OR) of conjunctival injection increased with patient’s age (p < 0.05), in boys (p < 0.01) and in winter (p < 0.001). In contrast, the OR of drowsiness decreased with age (p < 0.001). Facial flush was observed mostly in children younger than 4 years. CNS complications were not a significant risk factor for any of the symptoms.

Conclusions

Adverse reactions to 1% cyclopentolate eye drops were more frequent than previously expected, but all were mild and transient. The probability of each symptom was associated with a clear age‐specific trend.
Identification and fine mapping of a candidate gene for oil yellow leaf 2 conferring yellow leaf phenotype in maize
Authors: Yuan Guangsheng , Tang Changxiao , Li Yucui , Chen Benfang , He Hui , Peng Hua , Zhang Yanling , Gou Caiming , Zou Chaoying , Pan Guangtang , Zhang Zhiming
Published: December 2020

Leaf colour is an important agronomic trait for studying molecular mechanisms in chlorophyll biosynthesis and chloroplast development. Here, a novel mutant oil yellow leaf 2 (Oy2) with a typical yellow leaf phenotype at the seedling stage was identified from the mutant population derived from the maize inbred line RP125. Compared with wild type, Oy2 mutant displays decreased chlorophyll content, reduced photosynthetic capacity and impaired chloroplast structure, which is likely controlled by a single recessive gene. The Oy2 locus was then delimited into a 117 kb region on chromosome 5 harbouring four genes, amongst which the gene Zm00001d013013, encoding a magnesium chelatase subunit D, was identified as the only candidate gene associated with Oy2 mutant phenotype. Moreover, the expression levels of candidate gene Oy2 and genes associated with chlorophyll biosynthesis and photosynthesis were tested by RNA‐seq and qRT‐PCR, implying that the causal gene Oy2 playing a critical role in chlorophyll synthesis. Taken together, we propose that the causal gene Oy2 highly associated with the yellow leaf phenotype may be helpful in elucidating photosynthetic pigments biosynthesis and chloroplast development in maize.
Wood development regulators involved in apical growth in Pinus canariensis
Authors: Chano V. , Sobrino‐Plata J. , Collada C. , Soto A.
Published: December 2020

The shoot apical meristem is responsible of seasonal length increase in plants. In woody plants transition from primary to secondary growth is also produced during seasonal apical growth. These processes are controlled by different families of transcription factors.

Levels of transcriptomic activity during apical growth were measured by means of a cDNA microarray designed from sequences related to meristematic activity in Pinus canariensis. The identification of differentially expressed genes was performed using a time‐course analysis.

A total of 7170 genes were differentially expressed and grouped in six clusters according to their expression profiles. We identified master regulators, such as WUSCHEL‐like HOMEOBOX (WOX), to be involved in the first stages of apical development, i.e. growth of primary tissues, while other transcription factors, such as Class III HOMEODOMAIN‐LEUCINE ZIPPER (HD‐ZIP III) and KNOTTED‐like (KNOX) and BEL1‐like (BELL) HOMEODOMAIN proteins, were found to be induced during last stages of apical seasonal development, already with secondary growth.

Our results reveal the main expression patterns of these genes during apical development and the transition from primary to secondary stem growth. In particular, the regulatory factors identified play key roles in controlling stem architecture and constitute candidate genes for the study of other development processes in conifers.
Should I Stay or Should I Go? Understanding How British and Indonesian Extremists Disengage and Why They Don't
Authors: Kenney Michael , Chernov Hwang Julie
Published: December 2020

This article compares how individuals from two different Salafi‐jihadi groups disengage from high‐risk activism and political violence. Drawing on original interviews, we explore the “push” and “pull” factors that influence our respondents' decisions to leave. We identify numerous push‐and‐pull factors that are consistent with previous research, including disagreements with group leaders over strategy and practices and educational and employment opportunities. We also contribute to existing research by including “persistent activists” in our sample who did not disengage. Surprisingly, these respondents remained in their groups despite experiencing some of the same push‐and‐pull factors as those who left. Including this variation allows us to separate necessary but insufficient conditions of disengagement from factors that exert a more profound impact. We highlight the influence of one key factor—and its absence—in our discussion: alternative social networks with supportive outsiders for those who left and the lack of such meaningful relationships for those who remained. We conclude by discussing the implications of our research for countering violent extremism.
Exploring diverse roles of micro RNAs in banana: Current status and future prospective
Authors: Bhakta Subham , Tak Himanshu , Ganapathi Thumballi R.
Published: December 2020

Micro RNAs (miRNAs) are 20–24 nucleotides long non‐coding RNA sequences identified and characterized in multiple plant and animal systems. miRNAs play multifarious roles ranging from plant development to stress tolerance by synchronizing physiological processes at the level of transcription and translation. Banana is a major horticultural crop with colossal production worldwide. Despite the recent encouraging developments, the information on functions of miRNAs in banana plants is still in its infancy. The available literature pertaining to miRNAs in banana plants hints towards their contribution as master regulators in crucial physiological processes for instance abiotic stress responses, pathogenic defence response, fruit ripening and so on. This review is focused on biogenesis of miRNAs, their identification and deciphering their respective roles in banana plants with special emphasis on abiotic stress responses, plant immune responses, fruit ripening and storage. Based on the prior reports, we identified a few miRNAs with prospective roles in stress tolerance and illustrated the potential applications of miRNAs in banana crop improvement utilizing recent biotechnological tools such as CRISPR cas9, RNAi and the nano particle based foliar spray of miRNAs. The review briefly explained the future directions in banana research with a special emphasis on miRNA regulatory networks and agronomic traits improvement. Finally, future domains in miRNA research in plants and their possible applications towards crop improvement in agriculture are described briefly.
The core of Katie Eriksson’s caritative caring theory – a qualitative study from a postdoctoral perspective
Authors: Fagerström Lisbeth Maria , Hemberg Jessica , Koskinen Camilla , Östman Lillemor , Näsman Yvonne , Nyholm Linda , Santamäki Fischer Regina
Published: December 2020

Background

For about 40 years, Katie Eriksson developed the caritative caring theory at Åbo Akademi University in Finland. However, a description regarding the most substantial concepts and the relationships between these is lacking and thus needs to be explored.

Aims

The aim of the study was twofold: to explore and describe central concepts in the development of caritative caring theory from a postdoctoral perspective and to uncover and explore the relationships between the concepts.

Methodology

The design of the study was qualitative with a mixed method approach. The material was collected from a postdoctoral group (n = 38) mainly through electronic questionnaires. The texts were interpreted through manifest and latent content analysis.

Findings

The analyses generated five main categories including subcategories. The main categories were ‘Caring’ ‘Ethos’, ‘Suffering’ ‘Health’ and ‘The human being’. The relation between the main concepts compiled as ‘A tentative synthesis of the main concepts and the relationships between them’.

Conclusion

This study contributes to an understanding of the most fundamental and valuable concepts in the development of caritative theory during its first 40 years according to postdoctoral researchers’ perspectives. This study also displays that the concepts ethos and caring have the strongest relationship followed by that between caring and health, indicating the inner core of ethos and love within caring which bears the potential of enhancing the patient’s well‐being and health.
Factors related to the discontinuation and mortality rates of a cardiac rehabilitation programme in patients with Chagas disease: a 6‐year experience in a Brazilian tertiary centre
Authors: Vieira Marcelo Carvalho , Mendes Fernanda de Souza Nogueira Sardinha , Mazzoli‐Rocha Flavia , Silva Rudson Santos , Viana Aline Maria Nunes , Frota Aline Xavier , da Silva Gilberto Marcelo Sperandio , da Silva Paula Simplício , Hasslocher‐Moreno Alejandro Marcel , Saraiva Roberto Magalhães , de Sousa Andrea Silvestre , Mediano Mauro Felippe Felix
Published: December 2020

Objectives

To describe the clinical and sociodemographic characteristics of participants as well as discontinuation and mortality rates in a cardiac rehabilitation programme (CRP) tailored to Chagas disease (CD).

Methods

Participants underwent functional capacity, anthropometry and cardiac function evaluations before beginning a CRP. Univariate and multivariate Cox proportional hazards models were performed to investigate the associations between clinical and sociodemographic characteristics at baseline with discontinuation rates and deaths.

Results

Forty‐two patients were enrolled in the CRP (61.9% men, mean age of 58.1 ± 11.8 years). During a median follow‐up period of 10.8 months, 74% discontinued and 14% died while enrolled in CRP. 34% of the patients who discontinued CRP died during follow‐up. White race (HR = 0.09; 95% CI 0.01–1.00), right ventricular systolic dysfunction (HR = 10.54; 95% CI 1.24–89.50) and oxygen pulse (HR = 0.69; 95% CI 0.48–0.99) were independently associated with death while enrolled in CRP. Married status (HR = 0.44; 95% CI 0.21–0.95) was independently associated with discontinuation rates from CRP. VO2 peak (HR = 0.85; 95% CI 0.74–0.98) and CRP discontinuation due to CD‐related reasons (HR = 8.33; 95% CI 1.91–36.27) were the variables independently associated with death after discontinuation of CRP.

Conclusion

In this population, sociodemographic aspects and severity of CD were important determinants of CRP discontinuation and mortality.
English in the socioeconomic advancement of Cambodian hotel workers
Authors: Lin Evangeline
Published: December 2020

This paper addresses the concept of developmental world Englishes by exploring the role of English in providing socioeconomic elevation for non‐elite communities in Cambodia. Contemporary Cambodia has seen the rise of English as the language of choice for international communication, resulting in English being viewed as a pathway for various opportunities and socioeconomic advancement. English language research has tended to focus on elite communities and contexts, and little is known outside of these domains. The present study discusses these issues from the perspectives of Cambodian hotel workers. The implications for what needs to be done in terms of English language education for non‐elite communities in Cambodia and other similar contexts are also discussed.
Rusland, onveranderlijk anders?
Authors:   Leuven University Press
Published: December 2020

Rond de eeuwwisseling liet Rusland de moeizame politieke en economische transitiejaren van de post-Sovjetperiode achter zich en veranderde het land in snel tempo. Patriottisme, respect voor tradities en het roemrijke verleden werden de voorbije jaren steeds prominenter vermeld als ‘waarden’ die de sterke Russische staat consolideren. Meer dan ooit wordt vandaag het belang van eigen verleden benadrukt, en meer dan ooit zet Rusland zich af tegen het normerende Westen. Continuïteit en contestatie. Is Rusland onveranderlijk anders? Dit is géén Poetinboek. Rusland wordt bestudeerd aan de hand van de kernbegrippen contestatie, traditionalisme en etatisme die cruciaal zijn om de geschiedenis, cultuur, en buitenlandse politiek van het land beter te kunnen begrijpen. Naast een cultuurhistorisch deel bevat het boek ook een luik met politiek-maatschappelijke bijdragen. Vanuit een interdisciplinair perspectief geven de auteurs hun visie op Rusland als land dat contesteert en gecontesteerd wordt, dat zo anders is door die mysterieuze Russische ‘Sonderweg’ maar zich tegelijk ook vaak conformeert. Rusland, onveranderlijk anders? is aanbevolen lectuur voor wie zich verder wil verdiepen in de Russische politiek, cultuur en geschiedenis.
Spectral tau algorithm for solving a class of fractional optimal control problems via Jacobi polynomials
Authors: Youssri Youssri H. , Abd-Elhameed Waleed M.
Published: December 2020

This paper is dedicated to analyzing and presenting an efficient numerical algorithm for solving a class of fractional optimal control problems (FOCPs). The basic idea behind the suggested algorithm is based on transforming the FOCP under investigation into a coupled system of fractional-order differential equations whose solutions can be expanded in terms of the Jacobi basis. With the aid of the spectral-tau method, the problem can be reduced into a system of algebraic equations which can be solved via any suitable solver. Some illustrative examples and comparisons are presented aiming to demonstrate the accuracy, applicability, and efficiency of the proposed algorithm.
Approximate controllability of nonlocal non-autonomous Sobolev type evolution equations
Authors: Meraj Arshi , Narain Pandey Dwijendra
Published: December 2020

The aim of this article is to investigate the existence of mild solutions as well as approximate controllability of non-autonomous Sobolev type differential equations with the nonlocal condition. To prove our results, we will take the help of Krasnoselskii fixed point technique, evolution system and controllability of the corresponding linear system.
A new auxiliary function approach for inequality constrained global optimization problems
Authors: Yilmaz Nurullah , Sahiner Ahmet
Published: December 2020

In this study, we deal with the nonlinear constrained global optimization problems. First, we introduce a new smooth exact penalty function for constrained optimization problems. We combine the exact penalty function with the auxiliary function in regard to constrained global optimization. We present a new auxiliary function approach and the adapted algorithm for solving  non-linear inequality constrained global optimization problems. Finally, we illustrate the efficiency of the algorithm on some numerical examples.
Some Hermite-Hadamard type inequalities for (P;m)-function and quasi m-convex functions
Authors: Kadakal Mahir
Published: December 2020

In this paper, we introduce a new class of functions called as (P;m)-function and quasi-m-convex function. Some inequalities of Hadamard's type for these functions are given. Some special cases are discussed. Results represent signicant renement and improvement of the previous results. We should especially mention that the denition of (P;m)-function and quasi-m-convexity are given for the first time in the literature and moreover, the results obtained in special cases coincide with thewell-known results in the literature.
Shape Optimization of Thermoacoustic Systems Using a Two-Dimensional Adjoint Helmholtz Solver
Authors: Falco Stefano , Juniper Matthew P.
Published: December 2020

Thermoacoustic instabilities, which arise due to the interaction between flames and acoustics, are sensitive to small changes to the system parameters. In this paper, we apply adjoint-based shape optimization to a 2D finite element Helmholtz solver to find accurately and inexpensively the shape changes that most stabilize a 2D thermoacoustic system in the linear regime. We examine two cases: a Rijke tube and a turbulent swirl combustor. Both systems exhibit an unstable longitudinal mode and we suppress the instability by slightly modifying the geometry. In the case of the turbulent swirl combustor, the sensitivities are higher in the plenum and in the burner than in the combustion chamber, mainly due to the effect of the mean temperature. In the cooler regions, the local wavelength is shorter, which means that geometry changes of a given distance have more influence than they do where the local wavelength is longer. This is the first time adjoint-based shape optimization is applied to 2D Helmholtz solvers in thermoacoustics, after being previously applied to low-order thermoacoustic networks. But Helmholtz solvers have an intrinsic advantage: they can handle complex geometries. The easy scalability of this method to complex 3D geometries makes this tool a strong candidate for the iterative design of thermoacoustically stable combustors.
The Impact of Pulmonary Rehabilitation on 24-Hour Movement Behavior in People With Chronic Obstructive Pulmonary Disease: New Insights From a Compositional Perspective
Authors: Burge Angela T. , Palarea-Albaladejo Javier , Holland Anne E. , Abramson Michael J. , McDonald Christine F. , Mahal Ajay , Hill Catherine J. , Lee Annemarie L. , Cox Narelle S. , Lahham Aroub , Moore Rosemary , Nicolson Caroline , O’Halloran Paul , Gillies Rebecca , Chastin Sebastien F.M.
Published: December 2020

Background: Physical activity levels are low in people with chronic obstructive pulmonary disease, and there is limited knowledge about how pulmonary rehabilitation transforms movement behaviors. This study analyzed data from a pulmonary rehabilitation trial and identified determinants of movement behaviors.Methods: Objectively assessed time in daily movement behaviors (sleep, sedentary, light-intensity physical activity, and moderate- to vigorous-intensity physical activity) from a randomized controlled trial (n = 73 participants) comparing home- and center-based pulmonary rehabilitation was analyzed using conventional and compositional analytical approaches. Regression analysis was used to assess relationships between movement behaviors, participant features, and response to the interventions.Results: Compositional analysis revealed no significant differences in movement profiles between the home- and center-based groups. At end rehabilitation, conventional analyses identified positive relationships between exercise capacity (6-min walk distance), light-intensity physical activity, and moderate- to vigorous-intensity physical activity time. Compositional analyses identified positive relationships between a 6-minute walk distance and moderate- to vigorous-intensity physical activity time, accompanied by negative relationships with sleep and sedentary time (relative to other time components) and novel relationships between body mass index and light-intensity physical activity/sedentary time.Conclusion: Compositional analyses following pulmonary rehabilitation identified unique associations between movement behaviors that were not evident in conventional analyses.
Neurocognitive dynamics of near-threshold voice signal detection and affective voice evaluation
Authors: Swanborough Huw , Staib Matthias , Frühholz Sascha
Published: December 2020

Detection of continuous voice-in-noise recruits a dynamic, auditory cortical-limbic network.
Efficient aortic lymphatic drainage is necessary for atherosclerosis regression induced by ezetimibe
Authors: Yeo Kim Pin , Lim Hwee Ying , Thiam Chung Hwee , Azhar Syaza Hazwany , Tan Caris , Tang Ya , See Wei Qiang , Koh Xuan Han , Zhao Ming Hao , Phua Meow Ling , Balachander Akhila , Tan Yingrou , Lim Sheau Yng , Chew Hui Shang , Ng Lai Guan , Angeli Veronique
Published: December 2020

The results show that a functional lymphatic drainage of the aorta is critical to inhibit atherosclerosis progression and mediate its regression.
Structures and an activation mechanism of human potassium-chloride cotransporters
Authors: Xie Yuan , Chang Shenghai , Zhao Cheng , Wang Feng , Liu Si , Wang Jin , Delpire Eric , Ye Sheng , Guo Jiangtao
Published: December 2020

The full-length structures of human KCCs in an autoinhibition state suggest a potential activation mechanism.
A fully biodegradable and self-electrified device for neuroregenerative medicine
Authors: Wang Liu , Lu Changfeng , Yang Shuhui , Sun Pengcheng , Wang Yu , Guan Yanjun , Liu Shuang , Cheng Dali , Meng Haoye , Wang Qiang , He Jianguo , Hou Hanqing , Li Huo , Lu Wei , Zhao Yanxu , Wang Jing , Zhu Yaqiong , Li Yunxuan , Luo Dong , Li Tong , Chen Hao , Wang Shirong , Sheng Xing , Xiong Wei , Wang Xiumei , Peng Jiang , Yin Lan
Published: December 2020

A biodegradable and self-electrified conduit device is achieved to offer postoperative electrical cues for nerve regeneration.
Quality of CD8
+
T cell immunity evoked in lymph nodes is compartmentalized by route of antigen transport and functional in tumor context
Authors: O’Melia M. J. , Rohner N. A. , Manspeaker M. P. , Francis D. M. , Kissick H. T. , Thomas S. N.
Published: December 2020

Nanoscale biomaterial tools reveal impacts of lymphatic mechanisms of transport on CD8
+
T cell immunity elicited in melanoma.
Development of an international standard set of patient-centred outcome measures for overall paediatric health: a consensus process
Authors: Algurén Beatrix , Ramirez Jessily P , Salt Matthew , Sillett Nick , Myers Stacie N , Alvarez-Cote Albie , Butcher Nancy J , Caneo Luiz F , Cespedes Jaime A , Chaplin John E , Ng Kee Chong , García-García Juan J , Hazelzet Jan A , Klassen Anne F , Turquetto Aida Luiza R , Mew Emma J , Morris Michael , Offringa Martin , O'Meara Matthew , Papp James M , Rodrigo Carlos , Switaj Timothy L , Valencia Mayer Catalina , Jenkins Kathy J
Published: December 2020

Objective

To develop an Overall Pediatric Health Standard Set (OPH-SS) of outcome measures that captures what matters to young people and their families and recognising the biopsychosocial aspects of health for all children and adolescents regardless of health condition.

Design

A modified Delphi process.

Setting

The International Consortium for Health Outcomes Measurement convened an international Working Group (WG) comprised of 23 international experts from 12 countries in the field of paediatrics, family medicine, psychometrics as well as patient advisors. The WG participated in 11 video-conferences, through a modified Delphi process and 9 surveys between March 2018 and January 2020 consensus was reached on a final recommended health outcome standard set. By a literature review conducted in March 2018, 1136 articles were screened for clinician and patient-reported or proxy-reported outcomes. Further, 4315 clinical trials and 12 paediatric health surveys were scanned. Between November 2019 and January 2020, the final standard set was endorsed by a patient validation (n=270) and a health professional (n=51) survey.

Results

From a total of 63 identified outcomes, consensus was formed on a standard set of outcome measures that comprises 10 patient-reported outcomes, 5 clinician-reported measures, and 6 case-mix variables. The four developmental age-specific packages (ie, 0–5, 6–12, 13–17, 18–24 years) include either five or six measures with an average time for completion of 20 min.

Conclusions

The OPH-SS is a starting point to drive value-based paediatric healthcare delivery from a global perspective for enhancing child and adolescent physical health and psychosocial well-being.
Goal-directed perfusion to reduce acute kidney injury after paediatric cardiac surgery (GDP-AKIp): study protocol for a prospective randomised controlled trial
Authors: Zhang Yan , Zhou Xiujuan , Wang Bo , Guo Lijuan , Zhou Ronghua
Published: December 2020

Introduction

Cardiac surgery-associated acute kidney injury (CS-AKI) occurs in up to 40%~60% of paediatric patients and increases postoperative morbidity and mortality. A goal-directed perfusion (GDP) strategy aimed at maintaining indexed oxygen delivery (DO2i) above the critical threshold (reported to be 260~300 mL/min/m2in adults) during cardiopulmonary bypass (CPB), is effective in reducing the incidence of CS-AKI. However, no clear standards of paediatric critical DO2i exist. Our prior prospective cohort study exploring the critical DO2i threshold during paediatric CPB has found the nadir DO2i <353 mL/min/m2was an independent risk predictor of CS-AKI. Based on this background, this trial is designed to further determine whether the implementation of the GDP initiative aimed at maintaining DO2i ≥360 mL/min/m2would reduce the rate of CS-AKI in paediatrics and improve clinical outcome.

Methods and analysis

This is a prospective, single-centre, randomised controlled trial. In total, 166 paediatric patients undergoing cardiac surgery will be randomly allocated to the GDP group or control group. Patients in the GDP arm will be treated with a GDP strategy during CPB aimed to maintain DO2i at ≥360 mL/min/m2(to ensure safely above the risk DO2i threshold we found). The perfusion strategy for patients in the control arm will be factored on body surface area and temperature. The primary outcome is the rate of postoperative CS-AKI (it is defined according to paediatric Risk, Injury, Failure, Loss of renal function and End-stage renal disease criteria). The secondary end points include: (1) the other oxygen metabolism parameters during CPB; (2) major complication and all-cause mortality (in-hospital or within 30 days postoperatively); (3) short-term clinical outcomes (ie, time to extubation, mechanical ventilation time, hospital stay).

Ethics and dissemination

The study has been approved by the Biomedical Research Ethics committee of West China Hospital of Sichuan University (approval number: 2019(863)). Results will be disseminated through peer-reviewed publications and conferences.

Trial registration number

ChiCTR2000029232.
Evidence for ethnic inequalities in mortality related to COVID-19 infections: findings from an ecological analysis of England
Authors: Nazroo James , Becares Laia
Published: December 2020

Objectives

In the absence of robust direct data on ethnic inequalities in COVID-19-related mortality in the UK, we examine the relationship between ethnic composition of an area and rate of mortality in the area.

Design

Ecological analysis of COVID-19-related mortality rates occurring by 24 April 2020 and ethnic composition of the population. Account is taken of age, population density, area deprivation and pollution.

Setting

Local authorities in England.

Results

For every 1% rise in proportion of the population who are ethnic minority, COVID-19-related deaths increased by 5·12, 95% CI (4·00 to 6·24), per million. This rise is present for each ethnic minority category examined, including the white minority group. The size of this increase is a little reduced in an adjusted model to 4·42, 95% CI (2·24 to 6·60), suggesting that some of the association results from ethnic minority people living in more densely populated, more polluted and more deprived areas.

This estimate suggests that the average England COVID-19-related death rate would rise by 25% in a local authority with two times the average number of ethnic minority people.

Conclusions

We find clear evidence that rates of COVID-19-related mortality within a local authority increases as the proportion of the population who are ethnic minority increases. We suggest that this is a consequence of social and economic inequalities driven by entrenched structural and institutional racism and racial discrimination. We argue that these factors should be central to any investigation of ethnic inequalities in COVID-19 outcomes.
Vital exhaustion in women with chest pain and no obstructive coronary artery disease: the iPOWER study
Authors: Bechsgaard Daria Frestad , Gustafsson Ida , Michelsen Marie Mide , Mygind Naja Dam , Pena Adam , Suhrs Hannah Elena , Bove Kira , Hove Jens Dahlgaard , Prescott Eva
Published: December 2020

Background

More than half of women with symptoms suggestive of myocardial ischaemia have no obstructive coronary artery disease (CAD), yet they face a higher risk of cardiovascular mortality and morbidity. Both vital exhaustion (VE) and depression have been linked to adverse cardiovascular prognosis in patients with CAD. We aimed to assess whether symptomatic women with no obstructive CAD are more vitally exhausted compared with asymptomatic women. Furthermore, we investigated the overlap between the constructs of VE and depression.

Methods

Prevalence and burden of VE was assessed in symptomatic women with no obstructive CAD (n=1.266) and asymptomatic women (n=2.390). Among symptomatic women, we also assessed chest pain characteristics and symptoms of Hospital Anxiety and Depression Questionnaire.

Findings

Median (IQR) VE score was 4 (1-9) and 2 (0–5) in symptomatic and asymptomatic women, respectively (age adjusted, p<0.001). The risk of severe VE was significantly higher in symptomatic women compared with asymptomatic women (OR 3.3, 95% CI 2.5 to 4.4), independent of age and risk factors, and was associated with symptom severity. VE and depression scores were correlated but principal component cluster analysis (PCCA) showed clear distinctiveness between the two constructs.

Conclusions

Women with chest pain and no obstructive CAD are more vitally exhausted compared with asymptomatic women. PCCA showed that VE is distinct from depression in symptomatic women.

Clinical implications

Mental health screening focusing on depressive symptomatology in women with chest pain presenting with symptoms of mental and physical exhaustion may overlook VE in these patients.
Associations between socioeconomic deprivation and pharmaceutical prescribing in primary care in England
Authors: Mooney Jessica , Yau Roger , Moiz Haseeb , Kidy Farah , Evans Andrew , Hillman Sarah , Todkill Dan , Shantikumar Saran
Published: December 2020

Background

Socioeconomic deprivation is associated with health inequality. Previous studies have described associations between primary care prescribing rates and deprivation for individual drugs or drug classes. We explore the correlation between socioeconomic deprivation and the rate of prescribing of individual pharmaceutical drugs, and drug classes, in primary care in England, to identify prescribing inequalities that would require further investigation.

Methods

In this cross-sectional study, national primary care prescribing data, by primary care practice, were retrieved for the calendar year 2019 in England. Socioeconomic deprivation was quantified using the Index of Multiple Deprivation (IMD) score. Correlations were calculated using Spearman's rank correlation coefficient (ρ), adjusting for practice list size and demographics, with a Bonferroni-corrected p value threshold of 5×10−5.

Results

We included 1.05 billion prescription items dispensed from 6896 England practices. 142/206 (69%) drug classes and 505/774 (65%) drugs were significantly correlated with IMD score (p<5×10−5). Of the 774 included drugs, 31 (4%) were moderately positively associated with IMD score (ρ>0.4). Only one was moderately negatively correlated with IMD score (ρ<−0.4), suggesting higher prescribing rates in more affluent areas. The drug classes most strongly associated with IMD score included opioid and non-opioid analgesics, antipsychotics and reflux medications. Drug classes most strongly associated with affluence included epinephrine, combined oral contraceptives and hormone replacement therapy.

Conclusion

We identify novel associations of prescribing with deprivation. Further work is required to identify the underlying reasons for these associations so that appropriate interventions can be formulated to address drivers of inequality.
Ammonia: what adult neurologists need to know
Authors: Meijer Rick , Vivekananda Umesh , Balestrini Simona , Walker Matthew , Lachmann Robin , Haeberle Johannes , Murphy Elaine
Published: December 2020

Hyperammonaemia is often encountered in acute neurology and can be the cause of acute or chronic neurological symptoms. Patients with hyperammonaemia may present with seizures or encephalopathy, or may be entirely asymptomatic. The underlying causes are diverse but often straightforward to diagnose, although sometimes require specialist investigations. Haemodialysis or haemo(dia)filtration is the first-line treatment for acute severe hyperammonaemia (of any cause) in an adult. Here we discuss our approach to adult patients with hyperammonaemia identified by a neurologist.
Young-onset frontotemporal dementia with FUS pathology
Authors: Gowell Matthew , Baker Ian , Ansorge Olaf , Husain Masud
Published: December 2020

Frontotemporal dementia (FTD) is an uncommon cause of behavioural change in adults under the age of 50. A 44-year-old man presented with progressive neuropsychiatric disturbance characterised by social withdrawal, apathy, loss of empathy, motor stereotypies and hyperorality. Cognitive testing identified severe impairment, including executive dysfunction. MR scan of the brain showed bilateral symmetrical frontal atrophy. There was no relevant family history, and targeted genetic testing for FTD-associated variants inMAPT,GRNandC9orf72genes proved negative. He became more withdrawn with disinhibited behaviour; his condition progressively worsened and he died 6 years later. The pathological diagnosis was frontotemporal lobar degeneration with fused-in-sarcoma (FUS) pathology, a rare sporadic cause of FTD, accounting for only 5%–10% of cases, its characteristic features including very young onset, motor stereotypies and hyperorality.