bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Image Classification Based on Information Interaction Perception Mechanism
Authors: Wang Wei , Hu Yihui , Luo Yanhong , Wang Xin
Published: December 2021

Colorectal cancer originates from adenomatous polyps. Adenomatous polyps start out as benign, but over time they can become malignant and even lead to complications and death which will spread to adherent and surrounding organs over time, such as lymph nodes, liver, or lungs, eventually leading to complications and death. Factors such as operator’s experience shortage and visual fatigue will directly affect the diagnostic accuracy of colonoscopy. To relieve the pressure on medical imaging personnel, this paper proposed a network model for colonic polyp detection using colonoscopy images. Considering the unnoticeable surface texture of colonic polyps, this paper designed a channel information interaction perception (CIIP) module. Based on this module, an information interaction perception network (IIP‐Net) is proposed. In order to improve the accuracy of classification and reduce the cost of calculation, the network used three classifiers for classification: fully connected (FC) structure, global average pooling fully connected (GAP‐FC) structure, and convolution global average pooling (C‐GAP) structure. We evaluated the performance of IIP‐Net by randomly selecting colonoscopy images from a gastroscopy database. The experimental results showed that the overall accuracy of IIP‐NET54‐GAP‐FC module is 99.59%, and the accuracy of colonic polyp is 99.40%. By contrast, our IIP‐NET54‐GAP‐FC performed extremely well.
An Improved Brain MRI Classification Methodology Based on Statistical Features and Machine Learning Algorithms
Authors: Fayaz Muhammad , Qureshi Muhammad Shuaib , Kussainova Karlygash , Burkanova Bermet , Aljarbouh Ayman , Qureshi Muhammad Bilal
Published: December 2021

In this paper, we have proposed a novel methodology based on statistical features and different machine learning algorithms. The proposed model can be divided into three main stages, namely, preprocessing, feature extraction, and classification. In the preprocessing stage, the median filter has been used in order to remove salt-and-pepper noise because MRI images are normally affected by this type of noise, the grayscale images are also converted to RGB images in this stage. In the preprocessing stage, the histogram equalization has also been used to enhance the quality of each RGB channel. In the feature extraction stage, the three channels, namely, red, green, and blue, are extracted from the RGB images and statistical measures, namely, mean, variance, skewness, kurtosis, entropy, energy, contrast, homogeneity, and correlation, are calculated for each channel; hence, a total of 27 features, 9 for each channel, are extracted from an RGB image. After the feature extraction stage, different machine learning algorithms, such as artificial neural network,

k

-nearest neighbors’ algorithm, decision tree, and Naïve Bayes classifiers, have been applied in the classification stage on the features extracted in the feature extraction stage. We recorded the results with all these algorithms and found that the decision tree results are better as compared to the other classification algorithms which are applied on these features. Hence, we have considered decision tree for further processing. We have also compared the results of the proposed method with some well-known algorithms in terms of simplicity and accuracy; it was noted that the proposed method outshines the existing methods.
Septicemic Melioidosis Detection Using Support Vector Machine with Five Immune Cell Types
Authors: Xu Ke , Lian Fang , Quan Yunfan , Liu Jun , Yin Li , Li Xuexia , Tian Shen , Pei Hua , Xia Qianfeng
Published: December 2021

Melioidosis, caused by Burkholderia pseudomallei (B. pseudomallei), predominantly occurs in the tropical regions. Of various types of melioidosis, septicemic melioidosis is the most lethal one with a mortality rate of 40%. Early detection of the disease is paramount for the better chances of cure. In this study, we developed a novel approach for septicemic melioidosis detection, using a machine learning technique—support vector machine (SVM). Several SVM models were built, and 19 features characterized by the corresponding immune cell types were generated by Cell type Identification Estimating Relative Subsets Of RNA Transcripts (CIBERSORT). Using these features, we trained a binomial SVM model on the training set and evaluated it on the independent testing set. Our findings indicated that this model performed well with means of sensitivity and specificity up to 0.962 and 0.979, respectively. Meanwhile, the receiver operating characteristic (ROC) curve analysis gave area under curves (AUCs) ranging from 0.952 to 1.000. Furthermore, we found that a concise SVM model, built upon a combination of CD8+ T cells, resting CD4+ memory T cells, monocytes, M2 macrophages, and activated mast cells, worked perfectly on the detection of septicemic melioidosis. Our data showed that its mean of sensitivity was up to 0.976 while that of specificity up to 0.993. In addition, the ROC curve analysis gave AUC close to 1.000. Taken together, this SVM model is a robust classification tool and may serve as a complementary diagnostic technique to septicemic melioidosis.
Synthesis of Glycerol Carbonate from Glycerol and Dimethyl Carbonate Catalyzed by Solid Base Catalyst Derived from Waste Carbide Slag
Authors: Wang Jianye , Wang Zhu , Liu Haifeng , Wang Song , Sun Yifeng
Published: December 2021

Na2CO3 was loaded onto waste carbide slag (CS) by impregnation-calcination method to prepare the solid base catalyst, which was used to synthesize glycerol carbonate (GC) by the transesterification of glycerol with dimethyl carbonate (DMC). The prepared catalysts were characterized by a scanning electron microscope (SEM), thermogravimetric analysis (TGA), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and Brunner−Emmet−Teller (BET) techniques. The catalyst 15 wt.% Na2CO3-CS-800, which was prepared by impregnating CS to the Na2CO3 solution with the concentration of 15 wt.% weight of CS and calcined at 800°C for 3 hours, showed an excellent catalytic ability. When it was applied in the catalytic synthesis of GC, 98.1% glycerol conversion and 96.0% GC yield were achieved in 90 mins at 75°C with the catalyst dosage of 3 wt.% to total reactants and the DMC to glycerol molar ratio of 5. More importantly, the loading of Na2CO3 can effectively improve the reusability of catalyst. The 15 wt.% Na2CO3-CS-800 can still achieve 83.6% glycerol conversion and 80.5% GC yield after five-time reuse. Meanwhile, under the same reaction conditions, the CS-800, which was obtained by calcining CS at 800°C for 3 hours, experienced significant activity reduction with only 15.2% glycerol conversion and 14.1% GC yield after five-time reuse. FTIR and XRD characterization revealed that CO32- might play a key role in preserving active catalytic CaO component by forming protective CaCO3 shell on the catalyst surface.
ChartMaster: An End-to-End Method to Recognize, Redraw, and Redesign Chart
Authors: Zhang Lingmei , Wang Guangxia , Chen Lingyu
Published: December 2021

Chart is one kind of ubiquitous information, which is widely utilized and easy for people to understand. Due to there are so many different kinds and different styles of charts, it is not an easy task for a computer to recognize a chart, as well as to redraw the chart or redesign it. This study proposes a three-stage method to chart recognition: analyze the classification of charts, analyze the structure of charts, and analyze the content of charts. When classifying charts, we choose ResNet-50. When recognizing the structure and content of charts, we use different deep frameworks to extract key points based on different types of charts. Besides, we also introduce two datasets, UCCD and UCID, to train deep models to classify and recognize charts. Finally, we utilize some traditional geometric methods to obtain an original table of a chart, so we can redraw it.
Protective Effects of the Soluble Receptor for Advanced Glycation End‐Products on Pyroptosis during Myocardial Ischemia‐Reperfusion
Authors: Liu Yingming , Guo Xinying , Zhang Jie , Han Xuejie , Wang Hongxia , Du Fenghe , Zeng Xiangjun , Guo Caixia
Published: December 2021

Ischemia‐reperfusion injury (IRI) is an inevitable process when reperfusion therapy undergoes in acute myocardial infarction patients, which will lead to cardiac cell death. Many factors have been found to protect the myocardium, one of which was the soluble receptor for advanced glycation end‐products (sRAGE) that protected the myocardium from apoptosis and autophagy. However, pyroptosis is also an important form of cell death that occurs during ischemia‐reperfusion (I/R), whose critical molecule, NLR family pyrin domain containing 3 (NLRP3), was ever reported to be inhibited by sRAGE; therefore, it is hypothesized that sRAGE may decrease the cardiac pyroptosis induced by I/R. The results showed that sRAGE protected cardiomyocytes from I/R‐induced pyroptosis by decreasing the expression level of NLRP3, gasdermin D (GSDMD), interleukin‐1β (IL‐1β), and interleukin‐18 (IL‐18). Meanwhile, the results from primary cultured cardiomyocytes showed that the NF‐κB pathway mediated the effects of sRAGE on pyroptosis. Therefore, it is concluded that sRAGE protects the heart from pyroptosis through inhibiting the NF‐κB pathway during myocardial ischemia‐reperfusion.
Soleus H-Reflex Change in Poststroke Spasticity: Modulation due to Body Position
Authors: Qin Wenting , Zhang Anjing , Yang Mingzhen , Chen Chan , Zhen Lijun , Yang Hong , Jin Lingjing , Li Fang
Published: December 2021

Purpose. This study is aimed at exploring how soleus H-reflex change in poststroke patients with spasticity influenced by body position. Materials and Methods. Twenty-four stroke patients with spastic hemiplegia and twelve age-matched healthy controls were investigated. Maximal Hoffmann-reflex (Hmax) and motor potential (Mmax) were elicited at the popliteal fossa in both prone and standing positions, respectively, and the Hmax/Mmax ratio at each body position was determined. Compare changes in reflex behavior in both spastic and contralateral muscles of stroke survivors in prone and standing positions, and match healthy subjects in the same position. Results. In healthy subjects, Hmax and Hmax/Mmax ratios were significantly decreased in the standing position compared to the prone position (Hmax:

p
=
0.000

, Hmax/Mmax:

p
=
0.016

). However, Hmax/Mmax ratios were increased in standing position on both sides in poststroke patients with spasticity (unaffected side:

p
=
0.006

, affected side:

p
=
0.095

). The Hmax and Hmax/Mmax ratios were significantly more increased on the affected side than unaffected side irrespective of the position. Conclusions. The motor neuron excitability of both sides was not suppressed but instead upregulated in the standing position in subjects with spasticity, which may suggest that there was abnormal regulation of the Ia pathway on both sides.
Body Composition Characteristics of a Load-Capacity Model: Age-Dependent and Sex-Specific Percentiles in 5- to 17-Year-Old Children
Authors: Gätjens Isabel , Schmidt Steffen Christian Ekkehard , Plachta-Danielzik Sandra , Bosy-Westphal Anja , Müller Manfred James
Published: December 2021

Introduction: Body composition assessment is superior to the use of body mass index (BMI) to characterize the nutritional status in pediatric populations. For data interpretation, suitable reference data are needed; hence, we aimed to generate age-dependent and sex-specific body composition reference data in a larger population of children and adolescents in Germany. Methods: This is a cross-sectional study on a representative group of 15,392 5- to 17-year-old children and adolescents. Body composition was assessed by bioelectrical impedance analysis using a population-specific algorithm validated against air displacement plethysmography. Age- and sex-specific percentiles for BMI, fat mass index (FMI), fat-free mass index (FFMI), and a “load-capacity model” (characterized by the ratios of fat mass [FM]/ fatt-free mass [FFM] and FM/FFM2) were modeled using the LMS method. Results: BMI, FMI, FFMI, FM/FFM, and FM/FFM2 curves showed similar shapes between boys and girls with steady increases in BMI, FMI, and FFMI, while FM/FFM2-centiles decreased during early childhood and adolescence. Sex differences were observed in FMI and FM/FFM percentiles with increases in FMI up to age 9 years followed by a steady decrease in FM/FFM during and after puberty with a fast-growing FFMI up to age 17 in boys. The prevalence of low FFM relative to FM reached more than 60% in overweight children and adolescents. Conclusion: These pediatric body composition reference data enable physicians and public health scientists to monitor body composition during growth and development and to interpret individual data. The data point out to an early risk of sarcopenia in overweight children and adolescents.
Improving the Diagnosis and Treatment of Early Gastric Cancer in the West
Authors: Libânio Diogo , Ortigão Raquel , Pimentel-Nunes Pedro , Dinis-Ribeiro Mário
Published: December 2021

Gastric cancer is the third leading cause of cancer-related death. In Western countries, its lower prevalence and the absence of mass screening programmes contribute to late diagnosis and a slower implementation of minimally invasive treatments. A secondary prevention strategy through endoscopic surveillance of patients at high risk of intestinal-type gastric adenocarcinoma or by screening gastric cancer within colorectal screening programmes is cost-effective in intermediate-risk countries, though the identification of these patients remains challenging. Virtual chromoendoscopy with narrow-band imaging improves the accuracy of endoscopic diagnosis, significantly increasing the sensitivity for intestinal metaplasia while preserving specificity. Endoscopic grading of gastric intestinal metaplasia is feasible, correlates well with histological staging systems and also with gastric neoplasia risk and can be used to stratify risk. Endoscopic submucosal dissection (ESD) in the West achieves efficacy and safety outcomes similar to those reported for Eastern countries, and the long-term disease-specific survival is higher than 95%. A prospective comparative study with gastrectomy confirms its higher safety and its benefits concerning health-related quality of life. However, ESD is associated with a 5% risk of postprocedural bleeding and a 20% risk of non-curative resection. The knowledge of risk factors for adverse events and non-curative resection can improve patient selection. The risk of metachronous lesions after ESD is high (3–5% per year), and endoscopic surveillance is needed. The management of patients with non-curative resection can be optimized using risk scoring systems for lymph node metastasis.
No Local Birth Sex Ratio Changes following the August 2019 Shootings in Montgomery County, Ohio, and in El Paso County, Texas
Authors: Grech Victor , Scherb Hagen
Published: December 2021

Objective: In humans, males are born slightly in excess of females. Many factors have been shown to affect this ratio, including stressful events such as terrorist attacks. Two shootings occurred in early August 2019 in the Oregon District in Dayton, Montgomery County, Ohio, and in El Paso County, Texas, in the USA. This study was carried out in order to identify whether there were any effects on sex ratio at birth at the state or county level 3–5 months later. Subject and Methods: Births by sex, month of birth (2015–2019), and county were obtained for Ohio and Texas from the website of the Centers for Disease Control and Prevention. Ordinary linear logistic regression was used to assess the time trend in the probability of boys and to investigate changes in the trend functions. Poisson regression (SAS GENMOD) and linear logistic regression using SAS procedure LOGISTIC was applied. Results: This study analyzed 2,623,714 live births, 1,939,938 in Texas (sex odds [SO] 1.044) and 683,776 in Ohio (SO 1.045). The only significant effect noted was seasonality (month) at the state level. Conclusion: It has been postulated that male fetal loss in pregnant women during stressful periods may occur in accordance with the Trivers-Willard hypothesis. Several studies have found significant effects after terrorist attacks in the USA (as well as in other countries), but this study did not reveal such effects. This may be due to several reasons including underpowered datasets and the possibility that populations may be becoming relatively immured to these events.
New Association between Idiopathic Scoliosis and Luckenschadel Skull (Lacunar Skull)
Authors: Vehapoglu Aysel
Published: December 2021

Objective: Luckenschadel skull is a skull that is radiologically characterized by lacunae in the cranial vault. To date, although the association between neurological abnormalities and scoliosis is well recognized, no relationship between idiopathic scoliosis and a lacunar skull has been defined. We explored the incidence and time courses of lacunar skulls in patients with idiopathic scoliosis. Materials and Methods: Spinal X-rays of 3,170 children aged 6–16 years with idiopathic scoliosis evaluated from October 2010 to August 2020 were examined for the presence of an irregular inner calvarial table indicative of a Luckenschadel skull. A total of 1,760 (55.5%) of the 3,170 images included the skull. We also explored the frequency of intraspinal abnormalities in children with lacunar skull images who underwent spinal magnetic resonance imaging. Results: The study population consisted of 1,760 children, 1,203 girls (68.4%) and 557 (31.6%) boys. A total of 268 (15.2%) clearly evidenced lacunar skulls in their radiographs; 186 (69.4%) girls (11.3 ± 4.3 years) and 82 (30.6%) boys (12.6 ± 3.3 years). Two of the 56 patients (3.6%) who underwent spinal MRI had intraspinal abnormalities (isolated Chiari malformation-I). No additional neurological problems were detected in children with lacunar skulls. Conclusion: We conclude that the lacunar skull is very common in children with idiopathic scoliosis who lack any other neurological pathology. The lacunar skull does not disappear even in adolescence. Although previous publications have stated that lacunar skull disappears over time in radiographic images, we observed that it became more noticeable over time in children with scoliosis.
Carfilzomib Treatment Causes Molecular and Functional Alterations of Human Induced Pluripotent Stem Cell–Derived Cardiomyocytes
Authors: Forghani Parvin , Rashid Aysha , Sun Fangxu , Liu Rui , Li Dong , Lee Megan R. , Hwang Hyun , Maxwell Joshua T. , Mandawat Anant , Wu Ronghu , Salaita Khalid , Xu Chunhui
Published: December 2021

Background

Anticancer therapies have significantly improved patient outcomes; however, cardiac side effects from cancer therapies remain a significant challenge. Cardiotoxicity following treatment with proteasome inhibitors such as carfilzomib is known in clinical settings, but the underlying mechanisms have not been fully elucidated.

Methods and Results

Using human induced pluripotent stem cell‐derived cardiomyocytes (hiPSC‐CMs) as a cell model for drug‐induced cytotoxicity in combination with traction force microscopy, functional assessments, high‐throughput imaging, and comprehensive omic analyses, we examined the molecular mechanisms involved in structural and functional alterations induced by carfilzomib in hiPSC‐CMs. Following the treatment of hiPSC‐CMs with carfilzomib at 0.01 to 10 µmol/L, we observed a concentration‐dependent increase in carfilzomib‐induced toxicity and corresponding morphological, structural, and functional changes. Carfilzomib treatment reduced mitochondrial membrane potential, ATP production, and mitochondrial oxidative respiration and increased mitochondrial oxidative stress. In addition, carfilzomib treatment affected contractility of hiPSC‐CMs in 3‐dimensional microtissues. At a single cell level, carfilzomib treatment impaired Ca
2+
transients and reduced integrin‐mediated traction forces as detected by piconewton tension sensors. Transcriptomic and proteomic analyses revealed that carfilzomib treatment downregulated the expression of genes involved in extracellular matrices, integrin complex, and cardiac contraction, and upregulated stress responsive proteins including heat shock proteins.

Conclusions

Carfilzomib treatment causes deleterious changes in cellular and functional characteristics of hiPSC‐CMs. Insights into these changes could be gained from the changes in the expression of genes and proteins identified from our omic analyses.
Endovascular Thrombectomy in Young Patients With Stroke: A MR CLEAN Registry Study
Authors: Brouwer Josje , Smaal Johanna A. , Emmer Bart J. , de Ridder Inger R. , van den Wijngaard Ido R. , de Leeuw Frank-Erik , Hofmeijer Jeannette , van Zwam Wim H. , Martens Jasper M. , Roos Yvo B.W.E.M. , Majoie Charles B. , van Oostenbrugge Robert J. , Coutinho Jonathan M. ,   on behalf of the MR CLEAN Registry Investigators†
Published: December 2021

Background and Purpose:

Acute ischemic stroke due to large vessel occlusion is uncommon in young adults. We assessed stroke cause in young patients and compared their outcomes after endovascular thrombectomy with older patients.

Methods:

We used data (March 2014 until November 2017) of patients with an anterior circulation large vessel occlusion stroke from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a nationwide, prospective study on endovascular thrombectomy in the Netherlands. We compared young patients (18–49 years) with older patients (≥50 years). Outcomes included modified Rankin Scale score after 90 days (both shift and dichotomized analyses), expanded Thrombolysis in Cerebral Infarction score, and symptomatic intracranial hemorrhage. Analyses were adjusted for confounding.

Results:

We included 3256 patients, 310 (10%) were 18 to 49 years old. Young patients had lower median National Institutes of Health Stroke Scale scores (14 versus 16,
P
<0.001) and less cardiovascular comorbidities than older patients. Stroke etiologies in young patients included carotid dissection (16%), cardio-embolism (15%), large artery atherosclerosis (10%), and embolic stroke of undetermined source (31%). Clinical outcome was better in young than older patients (acOR for modified Rankin Scale shift: 1.8 [95% CI, 1.5–2.2]; functional independence [modified Rankin Scale score 0–2] 61 versus 39% [adjusted odds ratio, 2.1 [95% CI, 1.6–2.8]); mortality 7% versus 32%, adjusted odds ratio, 0.2 [95% CI, 0.1–0.3]). Symptomatic intracranial hemorrhage occurred less frequently in young patients (3% versus 6%, adjusted odds ratio, 0.5 [95% CI, 0.2–1.00]). Successful reperfusion (expanded Thrombolysis in Cerebral Infarction Score 2b-3) did not differ between groups. Onset to reperfusion time was shorter in young patients (253 versus 255 minutes, adjusted B in minutes 12.4 [95% CI, 2.4–22.5]).

Conclusions:

Ten percent of patients with acute ischemic stroke undergoing endovascular thrombectomy were younger than 50. Cardioembolism and carotid dissection were common underlying causes in young patients. In one-third of cases, no cause was identified, indicating the need for more research on stroke cause in young patients. Young patients had better prognosis and lower risk of symptomatic intracranial hemorrhage than older patients.
Comparison of Two Automated Computed Tomography Perfusion Applications to Predict the Final Infarct Volume After Thrombolysis in Cerebral Infarction 3 Recanalization
Authors: Muehlen Iris , Sprügel Maximilian , Hoelter Philip , Hock Stefan , Knott Michael , Huttner Hagen B. , Schwab Stefan , Kallmünzer Bernd , Doerfler Arnd
Published: December 2021

Background:

Several automated computed tomography perfusion software applications have been developed to provide support in the definition of ischemic core and penumbra in acute ischemic stroke. However, the degree of interchangeability between software packages is not yet clear. Our study aimed to evaluate 2 commonly used automated perfusion software applications (Syngo.via and RAPID) for the indication of ischemic core with respect to the follow-up infarct volume (FIV) after successful recanalization and with consideration of the clinical impact.

Methods:

Retrospectively, 154 patients with large vessel occlusion of the middle cerebral artery or the internal carotid artery, who underwent endovascular therapy with a consequent Thrombolysis in Cerebral Infarction 3 result within 2 hours after computed tomography perfusion, were included. Computed tomography perfusion core volumes were assessed with both software applications with different thresholds for relative cerebral blood flow (rCBF). The results were compared with the FIV on computed tomography within 24 to 36 hours after recanalization. Bland-Altman was applied to display the levels of agreement and to evaluate systematic differences.

Results:

Highest correlation between ischemic core volume and FIV without significant differences was found at a threshold of rCBF<38% for the RAPID software (
r
=0.89,
P
<0.001) and rCBF<25% for the Syngo software (
r
=0.87,
P
<0.001). Bland-Altman analysis revealed best agreement in these settings. In the vendor default settings (rCBF<30% for RAPID and rCBF<20% for Syngo) correlation between ischemic core volume and FIV was also high (RAPID:
r
=0.88, Syngo:
r
=0.86,
P
<0.001), but mean differences were significant (
P
<0.001). The risk of critical overestimation of the FIV was higher with rCBF<38% (RAPID) and rCBF<25% (Syngo) than in the default settings.

Conclusions:

By adjusting the rCBF thresholds, comparable results with reliable information on the FIV after complete recanalization can be obtained both with the RAPID and Syngo software. Keeping the software specific default settings means being more inclusive in patient selection, but forgo the highest possible accuracy in the estimation of the FIV.
Adherence to the EAT-Lancet Diet and Risk of Stroke and Stroke Subtypes: A Cohort Study
Authors: Ibsen Daniel B. , Christiansen Anne H. , Olsen Anja , Tjønneland Anne , Overvad Kim , Wolk Alicja , Mortensen Janne K. , Dahm Christina C.
Published: December 2021

Background and Purpose:

We investigated the association between adherence to the EAT-Lancet diet, a sustainable and mostly plant-based diet, and risk of stroke and subtypes of stroke in a Danish population. For comparison, we also investigated the Alternate Healthy Eating Index-2010 (AHEI).

Methods:

We used the Danish Diet, Cancer and Health cohort (n=55 016) including adults aged 50 to 64 years at baseline (1993–1997). A food frequency questionnaire was used to assess dietary intake and group participants according to adherence to the diets. Stroke cases were identified using a national registry and subsequently validated by review of medical records (n=2253). Cox proportional hazards models were used to estimate hazard ratios and 95% CIs for associations with the EAT-Lancet diet or the AHEI and risk of stroke and stroke subtypes.

Results:

Adherence to the EAT-Lancet diet was associated with a lower risk of stroke, although not statistically significant (highest versus lowest adherence: hazard ratio, 0.91 [95% CI, 0.76–1.09]). A lower risk was observed for AHEI (0.75 [95% CI, 0.64–0.87]). For stroke subtypes, we found that adherence to the EAT-Lancet diet was associated with a lower risk of subarachnoid hemorrhage (0.30 [95% CI, 0.12–0.73]), and the AHEI was associated with a lower risk of ischemic stroke (0.76 [95% CI, 0.64–0.90]) and intracerebral hemorrhage (0.58 [95% CI, 0.36–0.93]).

Conclusions:

Adherence to the EAT-Lancet diet in midlife was associated with a lower risk of subarachnoid stroke, and the AHEI was associated with a lower risk of total stroke, mainly ischemic stroke and intracerebral hemorrhage.
ALTERNATİF TURİZM KAPSAMINDA AROMATİK TURİZM VE GELİŞİMİ
Authors: CESUR Esra , ÖZER Çağla , ÇEKEN Hüseyin
Published: December 2021

Bu çalışmada, aromatik bitkilerden yararlanılarak otantik yaşamlara ve doğal ürünlere karşı olan ilginin artış göstermesiyle yeni belirginleşmeye başlayan ve literatürde herhangi bir kavramsal açıklaması bulunmayan aromatik turizm irdelenmiştir. Çalışmada, aromatik bitkiler ve bu bitkilerin turizm faaliyetlerinde kullanımından yola çıkılarak aromatik turizmin kapsamı belirlenmeye ve kavramsal çerçevesi oluşturulmaya çalışılmıştır. Yapılan kavramsal incelemeler sonucunda aromatik turizmin bir alternatif turizm türü olabileceği ve bu kapsamda değerlendirilebileceği belirlenmiştir. Aromatik turizmde, yörelerin doğal yapılarının mümkün olduğunca en yüksek hassasiyetle korunması, alternatif turizmin temel amacı olan mevcut kaynakların korunarak sürdürülebilir bir şekilde kullanılmasına hizmet etmektedir. Ayrıca, alternatif turizmde turistik ürünlerin çeşitlendirilme yoluna gidilerek mevsimsellik özelliği ortadan kaldırma ve turizm talebini daha dengeli hale getirme amacı bulunmaktadır. Söz konusu amacı gerçekleştirmede aromatik turizm, hem turistik ürün çeşitlendirmesine destek olmakta hem de mevcut turizm yörelerinin gelişmesini sağlamaktadır.
Design, Control, and Evaluation of Mixed-Order, Compact Spherical Loudspeaker Arrays
Authors: Riedel Stefan , Zotter Franz
Published: December 2021

Beamforming on the icosahedral loudspeaker (IKO), a compact, spherical loudspeaker array, was recently established and investigated as an instrument to produce auditory sculptures (i.e., 3-D sonic imagery) in electroacoustic music. Sound beams in the horizontal plane most effectively and expressively produce auditory objects via lateral reflections on sufficiently close walls and baffles. Can there be 3-D-printable arrays at drastically reduced cost and transducer count, but with similarly strong directivity in the horizontal plane? To find out, we adopt mixed-order Ambisonics schemes to control fewer, and predominantly horizontal, beam patterns, and we propose the 3|9|3 array as a suitable design, with beamforming crossing over to Ambisonics panning at high frequencies. Analytic models and measurements on hardware prototypes permit a comparison between the new design and the IKO regarding beamforming capacity. Moreover, we evaluate our 15-channel 3|9|3 prototype in listening experiments to find out whether the sculptural qualities and auditory object trajectories it produces are comparable to those of the 20-channel IKO.
The Interplay between Heritage Learners’ Prior Knowledge and Instruction on a Linguistically Complex Structure
Authors: Bowles Melissa A.
Published: December 2021

Current HL pedagogy recommends focus on form approaches (Beaudrie, Ducar, & Potowski, 2014; Kisselev, Dubinina, & Polinsky, 2020) but within this broad category there are many techniques. To date only a few studies have compared HL learning gains on explicit and implicit focus on form instruction, and these have found explicit instruction to be more beneficial. The present study isolated the role of rule presentation on learning gains by comparing Spanish HL learners in a Processing Instruction condition (n = 26) who received rule presentation and explicit information about the target structure (indicative and subjunctive in adverbial clauses of time) prior to structured input, to HL learners in a Structured Input condition (n = 16) who received only structured input. Pretest/posttest/delayed posttest comparisons revealed that both PI and SI resulted in lasting learning gains, as well as a complex interplay between learners’ initial knowledge of the structure and the type of instruction, such that learners with little or no initial knowledge benefited from rule presentation, whereas learners with greater initial knowledge did not. Furthermore, data from think-alouds and retrospective interviews shows that all learners did not process the instruction similarly, and pedagogical implications are discussed.
Code-Switching Knowledge as Heritage Grammar Attainment: A Case Study
Authors: Lipski John M.
Published: December 2021

This study examines sensitivity to putative grammatical constraints on intra-sentential code-switching, viewed as a relative measure of attainment in heritage bilingual grammars. This is exemplified by a series of interactive tasks carried out with heritage Portuguese speakers in Misiones Province, Argentina. The results demonstrate the viability of deploying a range of experimental techniques in field settings with heritage speakers who do not engage in habitual code switching.
A Man of Our Times: Muḥammad ibn Dāwūd al-Iṣbahānī’s Pioneering Vision of Male Love
Authors: Tobkin Jennifer
Published: December 2021

The ghazal chapters of Muḥammad b. Dāwūd al-Iṣbahānī’s poetry anthology Kitāb al-Zahrah include 109 brief poems attributed to baʿḍ ahl hādhā al-ʿaṣr (a Man of Our Times). Ibn Dāwūd has conventionally been assumed to be the author of these poems. The “Man of Our Times” poems stand out among ‘Abbāsid ghazal because of their focus on justice, their appeals to reason, and their depiction of brotherly friendship (ikhā’) imbued with passionate love (hawā). Moreover, their repurposing of motifs from the poetic canon, such as the lover’s desert wanderings and nature’s lamentation in sympathy with him, adds to their tone of erudition. This gives the impression that the relationship they describe is an intense friendship between educated men of similar age. As with other early ʿAbbāsid bodies of ghazal, the poems can be categorized according to rhetorical function. For the “Man of Our Times” poems, these subcategories are 1) personal messages, 2) aphorisms, 3) petitions for justice, 4) alienation narratives, and 5) urban narratives.
The Bear and the Dragon
Authors: Paige Tamsin Phillipa
Published: December 2021

Within the ideological confines of Western liberal democracies, two ‘truths’ are held to be self-evident: that Russia and China are opportunistic in their behaviour, and that this behaviour is strategic rather than sincere. This article is a short, empirical analysis of the justifications of Russia and China when determining a ‘threat to the peace’ in accordance with Article 39 of the Charter of the United Nations. Examining how Russia and China have justified their decisions where this concept was significantly under debate, I find that their behaviour is not as opportunistic as believed. Rather, it is consistent with ideals of pragmatism and state-centric interpretations of international law. I further suggest that the consistency of their approaches means it is of little consequence if their arguments are strategic in nature.
Preventing the Forcibly Displaced from Returning as Persecution and Inhumane Act under International Criminal Law and the Rome Statute
Authors: Katselli Proukaki Elena
Published: December 2021

Preventing the forcibly displaced from returning to the territory from which they were unlawfully expelled has not received adequate attention under international criminal law. This article addresses this gap by focusing on denial of return as a crime against humanity. It evaluates international criminal jurisprudence including the proceedings concerning the Rohingya and evolving human rights standards to show that prevention from returning is a serious and continuing denial of fundamental human rights which inflicts great suffering. As such, it may qualify as persecution and/or an inhumane act under the Rome Statute. The ramifications of this on the temporal and territorial jurisdiction of the International Criminal Court and the principle of legality are important especially in situations of protracted displacement. The article demonstrates that although criminalisation of denial of return is not a panacea, it is instrumental in tackling forced displacement which affects millions across the world.
Phylogeny, taxonomy and flower-breeding ecology of the Colocasiomyia cristata species group (Diptera: Drosophilidae), with descriptions of ten new species
Authors: TAKANO KOHEI TAKENAKA , GAO JIAN-JUN , HU YAO-GUANG , LI NAN-NAN , YAFUSO MASAKO , SUWITO AWIT , REPIN RIMI , PUNGGA RUNI ANAK SYLVESTER , MELENG PAULUS AK , KALIANG CLEMENT HET , CHONG LUCY , TODA MASANORI J.
Published: December 2021

The phylogeny of the Colocasiomyia cristata species group is reconstructed as a hypothesis, based on DNA sequences of two mitochondrial and six nuclear genes and 51 morphological characters. The resulting tree splits this species group into two clades, one of which corresponds to the colocasiae subgroup. Therefore, a new species subgroup named as the cristata subgroup is established for the other clade. Within the cristata subgroup, three subclades are recognized and each of them is defined as a species complex: the cristata complex composed of five species (including three new ones: C. kinabaluana sp. nov., C. kotana sp. nov. and C. matthewsi sp. nov.), the sabahana complex of two species (C. sabahana sp. nov. and C. sarawakana sp. nov.), and the xenalocasiae complex of five species (including C. sumatrana sp. nov. and C. leucocasiae sp. nov.). There are, however, three new species (C. ecornuta sp. nov., C. grandis sp. nov. and C. vieti sp. nov.) not assigned to any species complex. In addition, breeding habits are described for four cristata-subgroup species, each of which monopolizes its specific host plant. And, data of host-plant use are compiled for all species of the cristata group from records at various localities in the Oriental and Papuan regions. The evolution of host-plant selection and sharing modes is considered by mapping host-plant genera of each species on the phylogenetic tree resulting from the present study.
New species of Triplocania Roesler (Psocodea: ‘Psocoptera’: Ptiloneuridae) from Colombia and Peru
Authors: GONZÁLEZ-OBANDO RANULFO , CARREJO-GIRONZA NANCY , ALDRETE ALFONSO N. GARCÍA
Published: December 2021

Based on a survey of species of the genus Triplocania (Psocodea: ‘Psocoptera’) in forests of natural areas of Colombia and Peru, 18 species (14 from Colombia and 4 from Peru) were found, 16 of which are new to science and two correspond to males of Colombian species originally described from females (T. matildae González et al., 2017, and T. sarriae González et al., 2017). The new species, here described and illustrated are: T. altamira n. sp., T. antioquensis n. sp., T. antisuyuensis n. sp., T. atratoensis n. sp., T. caguanensis n. sp., T. caquetensis n. sp., T. einsteini n. sp., T. fabridiazi n. sp., T. galileii n. sp., T. hawkingi n. sp., T. mancocapaci n. sp., T. molanoi n. sp., T. nerudai n. sp., T. roesleri n. sp., T. tahuantisuyuensis n. sp., and T. yupanquii n. sp. The number of species of Triplocania is now raised to 118. To date, the highest number of species are found in Colombia, Brazil and Peru, with 59, 34 and 9 species respectively. An updated identification key to the species of Triplocania (males) is included, as well as a classification of the species in the genus.
Multidecadal Sea Level Rise in the Southeast Indian Ocean: The Role of Ocean Salinity Change
Authors: Lu Ying , Li Yuanlong , Duan Jing , Lin Pengfei , Wang Fan
Published: December 2021

Regional sea level rise in the southeast Indian Ocean (SEIO) exerts growing threats to the surrounding Australian and Indonesian coasts, but the mechanisms of sea level rise have not been firmly established. By analyzing observational datasets and model results, this study investigates multidecadal steric sea level (SSL) rise of the SEIO since the mid-twentieth century, underscoring a significant role of ocean salinity change. The average SSL rising rate from 1960 through 2018 was 7.4 ± 2.4 mm decade−1, and contributions of the halosteric and thermosteric components were ∼42% and ∼58%, respectively. The notable salinity effect arises primarily from a persistent subsurface freshening trend at 400–1000 m. Further insights are gained through the decomposition of temperature and salinity changes into the heaving (vertical displacements of isopycnal surfaces) and spicing (density-compensated temperature and salinity change) modes. The subsurface freshening trend since 1960 is mainly attributed to the spicing mode, reflecting property modifications of the Subantarctic Mode Water (SAMW) and Antarctic Intermediate Water (AAIW) in the southern Indian Ocean. Also noteworthy is a dramatic acceleration of SSL rise (20.3 ± 7.0 mm decade−1) since ∼1990, which was predominantly induced by the thermosteric component (16.3 ± 5.5 mm decade−1) associated with the heaving mode. Enhanced Ekman downwelling by surface winds and radiation forcing linked to global greenhouse gas warming mutually caused the depression of isopycnal surfaces, leading to the accelerated SSL rise through thermosteric effect. This study highlights the complexity of regional sea level rise in a rapidly changing climate, in which the role of ocean salinity is vital and time-varying.
On the Discrete Normal Modes of Quasigeostrophic Theory
Authors: Yassin Houssam , Griffies Stephen M.
Published: December 2021

The discrete baroclinic modes of quasigeostrophic theory are incomplete, and the incompleteness manifests as a loss of information in the projection process. The incompleteness of the baroclinic modes is related to the presence of two previously unnoticed stationary step-wave solutions of the Rossby wave problem with flat boundaries. These step waves are the limit of surface quasigeostrophic waves as boundary buoyancy gradients vanish. A complete normal-mode basis for quasigeostrophic theory is obtained by considering the traditional Rossby wave problem with prescribed buoyancy gradients at the lower and upper boundaries. The presence of these boundary buoyancy gradients activates the previously inert boundary degrees of freedom. These Rossby waves have several novel properties such as the presence of multiple modes with no internal zeros, a finite number of modes with negative norms, and the fact that their vertical structures form a basis capable of representing any quasigeostrophic state with a differentiable series expansion. These properties are a consequence of the Pontryagin-space setting of the Rossby wave problem in the presence of boundary buoyancy gradients (as opposed to the usual Hilbert-space setting). We also examine the quasigeostrophic vertical velocity modes and derive a complete basis for such modes as well. A natural application of these modes is the development of a weakly nonlinear wave-interaction theory of geostrophic turbulence that takes topography into account.
Hand Motion Analysis Illustrates Differences When Drilling Cadaveric and Printed Temporal Bone
Authors: Hochman Jordan B. , Pisa Justyn , Kazmerik Katrice , Unger Bertram
Published: December 2021

Objective:

Temporal bone simulation is now commonly used to augment cadaveric education. Assessment of these tools is ongoing, with haptic modeling illustrating dissimilar motion patterns compared to cadaveric opportunities. This has the potential to result in maladaptive skill development. It is hypothesized that trainee drill motion patterns during printed model dissection may likewise demonstrate dissimilar hand motion patterns.

Methods:

Resident surgeons dissected 3D-printed temporal bones generated from microCT data and cadaveric simulations. A magnetic position tracking system (TrakSTAR Ascension, Yarraville, Australia) captured drill position and orientation. Skill assessment included cortical mastoidectomy, thinning procedures (sigmoid sinus, dural plate, posterior canal wall) and facial recess development. Dissection was performed by 8 trainees (n = 5 < PGY3 > n = 3) using k-cos metrics to analyze drill strokes within position recordings. K-cos metrics define strokes by change in direction, providing metrics for stroke duration, curvature, and length.

Results:

T-tests between models showed no significant difference in drill stroke frequency (cadaveric = 1.36/s, printed = 1.50/s, P < .40) but demonstrate significantly shorter duration (cadaveric = 0.37 s, printed = 0.16 s, P < .01) and a higher percentage of curved strokes (cadaveric = 31, printed = 67, P < .01) employed in printed bone dissection. Junior staff used a higher number of short strokes (junior = 0.54, senior = 0.38, P < .01) and higher percentage of curved strokes (junior = 35%, senior = 21%, P < .01).

Conclusions:

Significant differences in hand motions were present between simulations, however the significance is unclear. This may indicate that printed bone is not best positioned to be the principal training schema.
Impact of Stress Ulcer Prophylaxis Discontinuation Guidance in Mechanically Ventilated, Critically Ill Patients: A Pre-Post Cohort Study
Authors: Jones Christopher A. , Betthauser Kevin D. , Lizza Bryan D. , Juang Paul A. , Micek Scott T. , Kollef Marin H.
Published: December 2021

Purpose:

Recent data highlight unclear efficacy and potential negative sequelae of stress ulcer prophylaxis (SUP) in the intensive care unit (ICU). Minimizing SUP exposure has pertinent clinical and other implications. This study assessed medication use and clinical outcomes before and after implementation of a practice guideline promoting early discontinuation of SUP in mechanically ventilated ICU patients.

Methods:

Retrospective, single-center, pre-post cohort study within a medical ICU at a large, academic medical center. Adult patients requiring mechanical ventilation and receiving SUP via a histamine-2 receptor antagonist (H2RA) or proton pump inhibitor (PPI) were eligible for inclusion. The clinical practice guideline was implemented on January 1, 2020. The impact of implementation was assessed via percent of patient-days with inappropriate SUP. Incidence of clinically important GI bleed was the primary safety outcome.

Results:

A total of 137 pre-guideline and 112 post-guideline patients were included. Comorbidity burden was similar between groups. A higher prevalence of baseline vasopressor receipt (39% vs 67%, P < .01) and acute kidney injury (56% vs 69%, P = .04) was observed in post-guideline patients. Post-guideline patients experienced a significantly lower percentage of patient-days of inappropriate SUP (25% vs 50%, P < .01) as well as higher rates of SUP discontinuation before extubation (71% vs 12%, P < .01) and during ICU stay (93% vs 50%, P < .01). Post-guideline patients observed a significantly lower incidence of SUP at hospital discharge (4% vs 35%, P < .01). No differences in bleeding outcomes were observed, though post-guideline patients experienced longer durations of mechanical ventilation, ICU stay, and hospital stay.

Conclusions:

Implementation of an early SUP discontinuation guideline was associated with significant improvements in SUP prescribing practices. Baseline differences between groups likely explain observed differences in clinical outcomes.
Formulary Drug Review: Belumosudil
Authors: Levien Terri L. , Baker Danial E.
Published: December 2021

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.
Book review: Parameswaran Iyer, Method in the Madness: Insights from My Career as an Insider-Outsider-Insider
Authors: Mishra Chitra
Published: December 2021

Parameswaran Iyer, Method in the Madness: Insights from My Career as an Insider-Outsider-Insider. Noida: HarperCollins, 2021, 274 pp., ₹370.00 (paperback), ISBN: 9789390327560.
Book review: Subhash Sharma, Development and its Discontent
Authors: Mishra Yatish
Published: December 2021

Subhash Sharma, Development and its Discontent. New Delhi: Rawat Publications, XIV+266 pp., ₹850.00, ISBN: 9788131607077.