bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence/potential risk factors for motoric cognitive risk and its relationship to falls in elderly Chinese people: a cross‐sectional study
Authors: Yuan Jing‐lin , Zhao Rui‐xue , Ma Ya‐jun , Li Xiao‐dong , Zhou Xiao‐mei , Wang Xiao‐feng , Jiang Xiao‐yan , Li Shu‐juan
Published: April 2021

Background and purpose

Motoric cognitive risk syndrome (MCR) is characterized by slow walking speed and subjective memory complaints (SMCs). This study investigated the prevalence and potential risk factors of MCR and its association with falls in Chinese community‐dwelling older adults.

Methods

The analysis was based on data from the Rugao Longevity and Aging Study (RuLAS). MCR was defined as the presence of both SMCs and slow walking speed in participants free of major neurocognitive disorders. SMCs were determined according to a positive answer to the question ‘Do you feel you have more problems with memory than most?’ in the 15‐item Geriatric Depression Scale. Slow walking speed was defined as one standard deviation or more below the mean value for patients’ age and sex. Data on falls were derived from a standardized questionnaire.

Results

The prevalence of SMCs, slow walking speed and MCR in the RuLAS cohort (N = 1592) was 51.9%, 15.6% and 8.3%, respectively. After adjusting for other covariates, an occupation of farming (odds ratio [OR] 2.358, 95% confidence interval [CI] 1.007–5.521, p = 0.048), history of cerebrovascular disease (OR 2.215, 95% CI 1.032–4.752, p = 0.041) and hospitalization (OR 2.008, 95% CI 1.120–3.602, p = 0.019) were risk factors for MCR. Binary logistic regression analysis indicated that the risk of falls was increased by MCR (OR 1.547, 95% CI 1.009–2.371), SMC (OR 1.308, 95% CI 1.003–1.707) and slow walking speed (OR 1.442, 95% CI 1.030–2.017).

Conclusions

Early identification of potential risk factors of MCR can prevent the occurrence of adverse health events such as falls in the elderly.
What it takes to have a successful new Blue Card scheme: The practitioner's viewpoint
Authors: Antoons Jo , Ghimis Andreia
Published: April 2021

The future skills and labour workforce shortages, together with the demographic challenges, and the economic impact of the COVID‐19 sanitary crisis will increase the EU's need for highly skilled migration. In this comment, we argue that a successful reform of the EU Blue Card scheme should include more flexible eligibility criteria, process facilitations and generous intra‐EU mobility provisions not only for business travel, but also for short‐term work and, in some cases, for movement to a second Member State for employment purposes. Parallel national schemes should be allowed for those that do not qualify for the EU Blue Card scheme. Without these essential changes the administrative cost and time invested into reforming the current schemes at EU and national level will not bring about the expected positive impact on EU's attractiveness for highly skilled third‐country nationals.
Therapist Adherence to Two Treatments for Adolescent Suicide Risk: Association to Outcomes and Role of Therapeutic Alliance
Authors: Ibrahim Maliha , Levy Suzanne , Gallop Bob , Krauthamer Ewing Stephanie , Hogue Aaron , Chou Jessica , Diamond Guy
Published: April 2021

In psychotherapy research, adherence refers to the extent to which therapists deliver a treatment as intended. This study examined whether therapist adherence to two different manualized treatments was associated with improved client outcomes and whether the association was moderated by therapeutic alliance. The study sample included 320 video recordings of therapy sessions from 118 cases in a randomized controlled trial (RCT) comparing attachment‐based family therapy (ABFT) with family‐enhanced nondirective supportive therapy (FE‐NST). Recordings were selected from early, middle, and late stages of treatment. The adherence measure consisted of 24 items representing essential therapist interventions from both treatments. Trained raters coded tapes from both therapies. Adolescent self‐report of alliance was measured at session 4. Adherence to ABFT was associated with a significant increase in family cohesion at mid‐treatment but not at posttreatment. Adherence to FE‐NST was significantly associated with an increase in suicide ideation posttreatment. Using therapeutic alliance as a moderator, adherence to ABFT was significantly associated with a reduction in suicide ideation, family conflict, and higher client satisfaction posttreatment. Alliance did not positively affect the association of FE‐NST adherence to outcomes. Findings suggest that adherence to ABFT interventions may be better linked to treatment outcomes when adolescents feel a strong alliance with their therapist. Implications for future research and therapist training are explored.
Death domain fold proteins in immune signaling and transcriptional regulation
Authors: Huoh Yu‐San , Hur Sun
Published: April 2021

Death domain fold (DDF) superfamily comprises of the death domain (DD), death effector domain (DED), caspase activation recruitment domain (CARD), and pyrin domain (PYD). By utilizing a conserved mode of interaction involving six distinct surfaces, a DDF serves as a building block that can densely pack into homomultimers or filaments. Studies of immune signaling components have revealed that DDF‐mediated filament formation plays a central role in mediating signal transduction and amplification. The unique ability of DDFs to self‐oligomerize upon external signals and induce oligomerization of partner molecules underlies key processes in many innate immune signaling pathways, as exemplified by RIG‐I‐like receptor signalosome and inflammasome assembly. Recent studies showed that DDFs are not only limited to immune signaling pathways, but also are involved with transcriptional regulation and other biological processes. Considering that DDF annotation still remains a challenge, the current list of DDFs and their functions may represent just the tip of the iceberg within the full spectrum of DDF biology. In this review, we discuss recent advances in our understanding of DDF functions, structures, and assembly architectures with a focus on CARD‐ and PYD‐containing proteins. We also discuss areas of future research and the potential relationship of DDFs with biomolecular condensates formed by liquid–liquid phase separation (LLPS).
Prevalence, clinical features, and esophagogastroduodenoscopy (EGD) findings of non‐Helicobacter pylori Helicobacter infection: A study of 50 cases at a single facility in Japan
Authors: Tsukadaira Toshihisa , Hayashi Seiichi , Ota Hiroyoshi , Kobayashi Natsuko , Sekiguchi Yasuhiro , Kodaira Himiko , Matsumoto Takehisa , Horiuchi Kazuki , Negishi Tatsuya , Kurahashi Mari
Published: April 2021

Background and aim

There are only a few reports of non‐Helicobacter pylori Helicobacter (NHPH) gastritis in Japanese patients. We aimed to examine its prevalence, clinical features, and esophagogastroduodenoscopy (EGD) findings based on 50 patients encountered in one facility.

Materials and methods

Subjects were all patients who had undergone gastric mucosal biopsy endoscopically at Kenwakai Hospital for approximately 10 years. NHPH infection was diagnosed by microscopic findings of Giemsa staining performed on all specimens. PCR analysis of urease genes was performed to detect and identify NHPH, when informed consent was obtained. Helicobacter pylori‐diagnostic tests were also performed. NHPH‐infected patients were questioned about symptoms and animal contact.

Results

NHPH gastritis was found in 50 of 3847 patients (1.30%). The percentage increased to 3.35% (30 of 896 patients) in the latter 2 years and 4 months with increasing recognition of its characteristic endoscopic findings by endoscopists. PCR analysis, performed in 30 patients, detected NHPH in 28 patients: 26 as Helicobacter suis and 2 as Helicobacter heilmanii/Helicobacter ailurogastricus. Helicobacter pylori‐diagnostic tests were almost negative. However, anti‐H. pylori antibody showed high‐negative titer (3.0–9.9 U/ml) in 12. Of 50 patients (consisting of 49 men and 1 woman), almost all were asymptomatic, and 25 were keeping pets. Regarding EGD findings, in all 50 patients, “crack‐like mucosa” and/or nodular gastritis was noted in gastric antrum, and regular arrangement of collecting venules (RAC) was noted in gastric corpus. None of the patients infected with NHPH were co‐infected with H. pylori.

Conclusions

The prevalence was finally estimated to be approximately 3.35%. Helicobacter suis was the most common NHPH species. “Crack‐like mucosa” and/or nodular gastritis in gastric antrum, RAC in gastric corpus, and H. pylori‐negativity by H. pylori‐diagnostic tests especially containing a high‐negative titer of anti‐H. pylori antibody may indicate NHPH infection.
Maximizing the impact of exposure to scientific role models: Testing an intervention to increase science identity among adolescent girls
Authors: Merritt Sally K. , Hitti Aline , Van Camp Amanda R. , Shaffer Emily , Sanchez Michelle H. , O'Brien Laurie T.
Published: April 2021

A field experiment tested an intervention to maximize the impact of a science outreach program by encouraging early adolescent girls (N = 240, Mage =12) to adopt female role models. Girls participated in workshops led by female role models who were scientific experts in their field. Afterward, they were randomly assigned to choose and write about their favorite workshop leader or to write about the first workshop leader. We hypothesized that the intervention would benefit girls who chose and wrote about a favorite leader. However, girls in both conditions experienced significant increases in science identity. Girls demonstrated strong role model identification with the workshop leaders; moreover, role model identification was associated with increases in science identity. Girls in the chosen leader condition focused on her competence and supportiveness more than girls in the assigned leader condition. There was no difference in science identity between girls from well‐represented and underrepresented minority (URM) ethnic groups in scientific fields. URM girls, surprisingly, identified more with the workshop leader than well‐represented girls. Science workshops led by female role models with relevant expertise may facilitate science identification among early adolescent girls from diverse ethnic backgrounds.
The habitat amount hypothesis predicts that fragmentation poses a threat to biodiversity: A reply to Fahrig
Authors: Saura Santiago
Published: April 2021

In Saura (Journal of Biogeography, 48, 11–22, 2021), I showed that the habitat amount hypothesis (HAH) has been considerably misinterpreted in several ways. In her response to my findings, Fahrig (Journal of Biogeography, 2021) admits that some predictions that were previously attributed to the HAH do not logically derive from it. She has however one main objection to my conclusions: that there are some cases where the HAH predicts higher site‐level species richness with more fragmentation in a region. I here explain why this is a partial and questionable observation that distracts and potentially misleads our understanding of the HAH predictions. It does not appropriately represent the fundamental and overwhelming negative effects of fragmentation on site‐level species richness that are predicted by the HAH. The HAH predicts that the highest site‐level species richness in a region will happen when all habitat is found in a single and compact habitat patch. Any departure from this zero‐fragmentation case, as well as any additional increase in the number, isolation, elongation or perforation of patches per se, will always have negative effects on site‐level species richness according to the HAH. I more briefly discuss a relatively minor comment by Fahrig on the possible slopes of the species–area relationship when the HAH holds. I conclude that the views and interpretations that have prevailed since the HAH was proposed—that the HAH negates the importance of fragmentation—can no longer be maintained. The HAH predicts that habitat configuration matters for conservation and that fragmentation is a threat to biodiversity.
Retrospective analysis of clinicopathological characteristics of 19 ovarian juvenile granulosa cell tumor cases
Authors: Ndhlovu Elijah , Liu Lili , Dai Jun , Dong Xiyuan , Zhang Wen , Chen Biao
Published: April 2021

Aim

To describe the clinical and pathological characteristics, diagnosis, treatment, and outcomes of juvenile granulosa cell tumor (JGCT).

Methods

We retrospectively analyzed the data of 19 patients with histopathologically confirmed juvenile granulosa cell tumors treated in two medical centers in Wuhan city of China between 1999 and 2019.

Results

Totally, 19 patients were included during the period. The median age at diagnosis was 8.25 years (range, 0.25–28 years). The most common clinical presentation was abdominal pain, five out of 10 prepubertal children presented with precocious puberty. Three patients underwent radical surgery (including total hysterectomy, bilateral salpingo‐oophorectomy, omentectomy, and pelvic and para‐aortic lymphadenectomy), the other 16 patients had fertility‐sparing surgery (cystectomy or ipsilateral salpingo‐oophorectomy with or without omentectomy and lymphadenectomy). Eighteen patients had the international federation of gynecology and obstetrics (FIGO) stage I tumors, one patient had FIGO stage II disease. Twelve patients received postoperative adjuvant chemotherapy. The median follow‐up time from the time of diagnosis was 35 months (range, 13–250 months). One patient experienced relapse and died of the disease 32 months after the initial diagnosis. Eighteen patients were alive and had not experienced recurrence during the follow‐up period. The reproductive age patients that received fertility‐sparing surgery had regular menstruation.

Conclusions

A majority of JGCTs are diagnosed as FIGO stage I tumors and have favorable clinical outcomes. Adjuvant chemotherapy seems to improve outcomes for patients with advanced‐stage JGCTs; however, the value of chemotherapy in stage Ic patients is still unknown. Fertility sparing surgery should be considered in young patients who wish to bear children.
Conservation genomics of a critically endangered brown seaweed
Authors: Mamo Lea T. , Wood Georgina , Wheeler David , Kelaher Brendan P. , Coleman Melinda A.
Published: April 2021

Seaweeds provide valuable ecosystem services, but many are undergoing global decline due to climate and anthropogenic stressors. The brown macroalga, Nereia lophocladia (hereafter called Nereia), is among only a handful of seaweeds globally to be listed as critically endangered and is only described from two known locations, but there exists little knowledge about this species. Here, we combine field surveys to verify the distribution of Nereia, with cutting‐edge genomics to determine genetic diversity and population structure, and inform ongoing conservation actions. We expand Nereia's known distribution from one to seven locations along a 70‐km long coastal stretch in New South Wales but reveal small population sizes at some sites (as few as 8 individuals despite extensive searching). A total of 1,261 genome‐wide SNPs were retained from 70 individuals after filtering, and 304 outlier loci under putative selection were detected by one of three methods. Populations showed low genetic diversity (mean expected heterozygosity HE = 0.055 ± 0.014) and high levels of inbreeding within populations (mean FIS = 0.721 ± 0.085), along with high genetic differentiation among sites (mean FST = 0.276), which may increase susceptibility to future environmental change and decrease the species' ability to recover after loss. Given these findings, we recommend the consideration of both in situ and ex situ conservation measures for Nereia, as well as further research into the species' ecology and biology. Nereia remains of conservation concern and its listing as critically endangered is justified until further investigation elucidates the full distribution and adaptive capacity of the species.
Repressor for hire! The vital roles of TOPLESS‐mediated transcriptional repression in plants
Authors: Plant Alastair Robert , Larrieu Antoine , Causier Barry
Published: April 2021

Transcriptional corepressors play important roles in establishing the appropriate levels of gene expression during growth and development. The TOPLESS (TPL) family of corepressors are critical for all plant life. TPLs are involved in numerous developmental processes and in the response to extrinsic challenges. As such these proteins have been the focus of intense study since Long and colleagues first described the TPL corepressor in 2006. In this review we will explore the evolutionary history of these essential plant‐specific proteins, their mechanism of action based on recent structural analyses, and the myriad of pathways in which they function. We speculate how relatively minor changes in the peptide sequence of transcriptional regulators allowed them to recruit TPL into new processes, driving innovation and resulting in TPL becoming vital for plant development.
A Little Bit Pregnant? Productive Ambiguity and Fertility Research
Authors: Bell Suzanne O. , Fissell Mary E.
Published: April 2021

Fertility researchers rely upon a simple binary: pregnant versus not pregnant. However, this conceptualization does not capture many women's experiences, both historically and in numerous settings today. We suggest that pregnancy status may be a much more ambiguous state, and that such ambiguity is often productive for women. Building a culturally sensitive understanding of what we are calling “productive ambiguity” can foster more rigorous studies of fertility that better capture potential pregnancy and the range of post‐coital fertility‐inhibiting actions women take, both intentionally and not. In this paper, we aim to: 1) describe the ambiguity that exists around pregnancy; 2) explain the ways in which this ambiguity is productive for women; 3) analyze two concrete examples of such ambiguity in practice: the case of menstrual regulation and the unexpected conceptual overlaps between contraception and early abortion in a variety of settings, and finally; 4) suggest ways that this more nuanced understanding might inform fertility research, including abortion measurement research. We combine recent qualitative and quantitative data with historical sources to analyze the cultural logics and power dynamics of this ambiguity.
Cerebrovascular function response to prolonged sitting combined with a high‐glycemic index meal: A double‐blind, randomized cross‐over trial
Authors: Burnet Kathryn , Blackwell Jade , Kelsch Elizabeth , Hanson Erik D. , Stone Keeron , Fryer Simon , Credeur Daniel , Palta Priya , Stoner Lee
Published: April 2021

Acute prolonged sitting leads to cerebrovascular disruptions. However, it is unclear how prolonged sitting interacts with other common behaviors, including high‐ (HGI) and low‐glycemic index (LGI) meals. Using a double‐blind randomized cross‐over design, this study evaluated the effects of prolonged (3 hr) sitting, with a high‐ (HGI; GI: 100) or low‐glycemic index (LGI; GI: 19) meal on total brain blood flow (QBrain) and executive function. Eighteen young, healthy, active participants (22.6 [3.1] y, 33% F, 24.3 [3.7] kg/m2) sat for 3 hr after consuming an HGI or LGI meal. Using Doppler ultrasound to measure internal carotid (ICA) and vertebral (VA) artery blood flow, QBrain was calculated: (ICA blood flow + VA blood flow) × 2. Executive function was assessed using the Stroop Test and Trail Making Test—Part B. Brain fog was measured using a modified Borg Category Scale with Ratio properties (CR10). Following 3 hr of sitting, there was a significant decrease in QBrain with time (p = .001, ES = −0.26), though there were nonsignificant interaction (p = .216) and condition effects (p = .174). Brain fog increased (p = .024, ES = 0.27) and Stroop reaction time worsened with time (p = .001, ES: −0.40), though there were nonsignificant condition effects for brain fog (p = .612) and the Stroop test (p = .445). There was a nonsignificant condition effect (p = .729) for the Trail Making Test—Part B, but completion time improved with time (p = .001, ES = −0.40). In conclusion, 3 hr of prolonged sitting decreases QBrain and executive function independent of glycemic index in young, healthy adults.
A qualitative study portraying nurses’ perspectives on transitional care between intensive care units and hospitals wards
Authors: Herling Suzanne Forsyth , Brix Helene , Andersen Lise , Jensen Liz Daugaard , Handesten Rie , Knudsen Heidi , Bove Dorthe Gaby
Published: April 2021

Introduction

The transition process from the intensive care unit (ICU) to hospital ward may impact the illness trajectory and compromise the continuity of safe care for ICU survivors. ICU and ward nurses are involved with the transition and are responsible for the quality of the transitional care.

Aim

The aim was to explore ICU and ward nurses’ views on assignments in relation to patients’ transition between ICU and hospital ward.

Methods

We conducted a qualitative study with 20 semi‐structured interviews with ICU nurses and ward nurses and analysed data by content analysis.

Setting

A university hospital with 690 beds and an 11‐bed mixed medical/surgical ICU.

Findings

The overarching themes were (1) ‘Ritual of hand over’ with the categories: (a) ‘Ready, able and willing’, (b) ‘Transfer of responsibility’ and (c) ‘Nice to know versus need to know’ and (2) ‘From lifesaving care to rehabilitative care’ with the categories: (a) ‘Complex care needs persist’, (b) ‘Fight or flight mode’ and (c) ‘“Weaning” the family’.

Nurses were highly focused on the ritual of the actual handover of the patient and discussed readiness as an indicator of quality and the feeling of passing on the responsibility. Nurses had different opinions on what useful knowledge was and thus necessary to communicate during handover. Although patients’ complex care needs may not have been resolved when exiting the ICU, ward nurses had to receive patients in a setting where nurses were mostly comfortable within their own specialty – this was worrying for both type of nurses. Patients could enter the ward very exhausted and weak or in ‘fight mode’ and demand rehabilitation at a pace the ward was not capable of delivering. ICU nurses encouraged families to be demanding after the ICU stay, and ward nurses asked them to trust them and steep back.
Fatty acid desaturase activity in mature red blood cells and implications for blood storage quality
Authors: Thomas Tiffany , Cendali Francesca , Fu Xiaoyun , Gamboni Fabia , Morrison Evan J. , Beirne Jonathan , Nemkov Travis , Antonelou Marianna H. , Kriebardis Anastasios , Welsby Ian , Hay Ariel , Dziewulska Karolina H. , Busch Michael P. , Kleinman Steven , Buehler Paul W. , Spitalnik Steven L. , Zimring James C. , D'Alessandro Angelo
Published: April 2021

Background

Increases in the red blood cell (RBC) degree of fatty acid desaturation are reported in response to exercise, aging, or diseases associated with systemic oxidant stress. However, no studies have focused on the presence and activity of fatty acid desaturases (FADS) in the mature RBC.

Study design and methods

Steady state metabolomics and isotope‐labeled tracing experiments, immunofluorescence approaches, and pharmacological interventions were used to determine the degree of fatty acid unsaturation, FADS activity as a function of storage, oxidant stress, and G6PD deficiency in human and mouse RBCs.

Results

In 250 blood units from the REDS III RBC Omics recalled donor population, we report a storage‐dependent accumulation of free mono‐, poly‐(PUFAs), and highly unsaturated fatty acids (HUFAs), which occur at a faster rate than saturated fatty acid accumulation. Through a combination of immunofluorescence, pharmacological inhibition, tracing experiments with stable isotope‐labeled fatty acids, and oxidant challenge with hydrogen peroxide, we demonstrate the presence and redox‐sensitive activity of FADS2, FADS1, and FADS5 in the mature RBC. Increases in PUFAs and HUFAs in human and mouse RBCs correlate negatively with storage hemolysis and positively with posttransfusion recovery. Inhibition of these enzymes decreases accumulation of free PUFAs and HUFAs in stored RBCs, concomitant to increases in pyruvate/lactate ratios. Alterations of this ratio in G6PD deficient patients or units supplemented with pyruvate‐rich rejuvenation solutions corresponded to decreased PUFA and HUFA accumulation.

Conclusion

Fatty acid desaturases are present and active in mature RBCs. Their activity is sensitive to oxidant stress, storage duration, and alterations of the pyruvate/lactate ratio.
Study on Controllable Thickness and Flatness of Wafer-Scale Nickel Shim in Precision Electroforming Process: Simulation and Validation
Authors: Zhang Honggang , Zhang Nan , Fang Fengzhou
Published: April 2021

A new approach to precision electroforming of a wafer scale nickel shim using a rotating cathode with an auxiliary cathode mask is developed to improve thickness uniformity and flatness. The effects of critical process parameters, including cathode rotating speed, cathode mask size, and current density, on the thickness uniformity and flatness of electroformed nickel shim are systematically studied based on experiments and simulations. The results show that the thickness uniformity of the deposits is highly dependent on the current density distribution, where a cathode mask can effectively tune electrical field lines and induce a more uniform current density distribution. The simulations and experimental results consistently agree that a minimum thickness nonuniformity of 8% and below 1% on the wafer with a diameter of 80 mm and 40 mm, respectively, can be achieved using a mask with a 70 mm opening size. However, for flatness, the cathode rotating speed influences the surface warpage due to the intrinsic stress. It is also found that the gradient current density can significantly reduce the intrinsic stress with better flatness. The best flatness is controlled below 47 µm and 32 µm on the wafer with diameters of 80 mm and 40 mm, respectively, under the synergistic effect of optimal cathode rotating speed (30 rpm) and gradient current density.
Goal-Directed Design Agents: Integrating Visual Imitation With One-Step Lookahead Optimization for Generative Design
Authors: Raina Ayush , Puentes Lucas , Cagan Jonathan , McComb Christopher
Published: April 2021

Engineering design problems often involve large state and action spaces along with highly sparse rewards. Since an exhaustive search of those spaces is not feasible, humans utilize relevant domain knowledge to condense the search space. Deep learning agents (DLAgents) were previously introduced to use visual imitation learning to model design domain knowledge. This note builds on DLAgents and integrates them with one-step lookahead search to develop goal-directed agents capable of enhancing learned strategies for sequentially generating designs. Goal-directed DLAgents can employ human strategies learned from data along with optimizing an objective function. The visual imitation network from DLAgents is composed of a convolutional encoder–decoder network, acting as a rough planning step that is agnostic to feedback. Meanwhile, the lookahead search identifies the fine-tuned design action guided by an objective. These design agents are trained on an unconstrained truss design problem modeled as a sequential, action-based configuration design problem. The agents are then evaluated on two versions of the problem: the original version used for training and an unseen constrained version with an obstructed construction space. The goal-directed agents outperform the human designers used to train the network as well as the previous feedback-agnostic versions of the agent in both scenarios. This illustrates a design agent framework that can efficiently use feedback to not only enhance learned design strategies but also adapt to unseen design problems.
A Sequential Sampling Generation Method for Multi-Fidelity Model Based on Voronoi Region and Sample Density
Authors: Liu Yin , Li Kunpeng , Wang Shuo , Cui Peng , Song Xueguan , Sun Wei
Published: April 2021

Multi-fidelity surrogate model-based engineering optimization has received much attention because it alleviates the computational burdens of expensive simulations or experiments. However, due to the nonlinearity of practical engineering problems, the initial sample set selected to produce the first set of data will almost inevitably miss certain features of the landscape, and thus, the construction of a useful surrogate often requires further, judicious infilling of some new samples. Sequential sampling strategies used to select new infilling samples during each iteration can gradually extend the data set and improve the accuracy of the initial model with an acceptable cost. In this paper, a sequential sampling generation method based on the Voronoi region and the sample density (SSGM-VRDS) is proposed. First, with a Monte Carlo-based approximation of a Voronoi tessellation for region division, Pearson correlation coefficients and cross-validation (CV) are employed to determine the candidate Voronoi region for infilling a new sample. Then, a relative sample density is defined to identify the position of the new infilling point at which the sample is the sparsest within the selected Voronoi region. A correction of this density is carried out concurrently through an expansion coefficient. The proposed method is applied to three numerical functions and a lightweight design problem via finite element analysis (FEA). Results suggest that the SSGM-VRDS strategy has outstanding effectiveness and efficiency in selecting a new sample for improving the accuracy of a surrogate model, as well as practicality for solving practical optimization problems.
Design and Development of a Tracked Robot to Increase Bulk Density of Flax Fibers
Authors: Galati Rocco , Mantriota Giacomo , Reina Giulio
Published: April 2021

This article presents an integrated mechanics study for the design and the development of a service tracked robot able to move inside a truck container and roll over flax raw material by compressing it to increase its overall bulk density. A series of flax material properties have been used to properly characterize the robot’s locomotion parameters and to obtain an optimal ground pressure and a correct floating capacity over the material. First, the performance of the proposed robot is evaluated in an emulated container. Then, results acquired during compression tests in a real scenario are provided to demonstrate the effectiveness of the developed robot for industrial applications.
Computer Aided Tolerance Analysis of Parts and Assemblies
Authors: Scott R. T. , Gabriele G. A.
Published: April 2021

An exact constraint scheme based on the physical contacting constraints of real part mating features is used to represent the process of assembling the parts. To provide useful probability information about how assembly dimensions are distributed when the parts are assembled as intended, the real world constraints that would prevent interference are ignored.

This work addresses some limitations in the area of three dimensional assembly tolerance analysis. As a result of this work, the following were demonstrated: 1. Assembly of parts whose assembly mating features are subjected to variation; 2. Assemble parts using a real world set of exact constraints; 3. Provide probability distributions of assembly dimensions.
Development of an ultrasound level meter for use in occupational safety and health
Authors: Wächtler Moritz , Rust Marvin , Wolff Andrea , Kling Christoph
Published: April 2021

The widespread use of ultrasound techniques throughout industry causes many workers to be exposed to airborne ultrasound at their workplaces. To measure and assess the exposure to airborne ultrasound at these workplaces, devices are required that allow reliable measurements of ultrasound levels and support occupational safety and health measures. However, the sound level meters available to date do not meet these requirements. Therefore, a research prototype of a sound level meter covering audible and ultrasonic frequencies was developed, paying particular attention to the suitability of the components in terms of their acoustical characteristics (such as directional patterns) in the ultrasonic frequency range. The prototype was tested based on the international standard for sound level meters IEC 61672-1, with extensions regarding the signal frequencies used. The results revealed that the sound level meter developed is suitable for application at most workplaces exposed to ultrasound, as reflected by, e.g., its frequency range (at least up to 47 kHz), upper level limits (up to 160 dB SPL), and measurement uncertainty (k = 2, GUM) of 1.15 dB. The prototype developed allows measurement and assessment of exposure at workplaces for occupational safety and health purposes. Moreover, it can serve as a basis for future developments of commercial ultrasound level meters.
Biological Evaluation and Mechanistic Studies of Quinolin-(1
H
)-Imines as a New Chemotype against Leishmaniasis
Authors: Gomes-Alves Ana Georgina , Duarte Margarida , Cruz Tânia , Castro Helena , Lopes Francisca , Moreira Rui , Ressurreição Ana S. , Tomás Ana M.
Published: April 2021

Leishmaniasis is one of the most challenging neglected tropical diseases and remains a global threat to public health. Currently available therapies for leishmaniases present significant drawbacks and are rendered increasingly inefficient due to parasite resistance, making the need for more effective, safer, and less expensive drugs an urgent one.
Melting the
eis
: Nondetection of Kanamycin Resistance Markers by Routine Diagnostic Tests and Identification of New
eis
Promoter Variants
Authors: Ley Serej D. , Pillay Samantha , Streicher Elizabeth M. , van der Heijden Yuri F. , Sirgel Frederik , Derendinger Brigitta , de Kock Marianna , Gagneux Sébastien , Warren Robin M. , Theron Grant , de Vos Margaretha
Published: April 2021

Eis
promoter mutations can confer reduced
Mycobacterium tuberculosis
kanamycin susceptibility. GenoType MTBDR
sl,
a widely used assay evaluating this region, wrongly classified 17/410 isolates as
eis
promoter wild type.
SARS-CoV-2 E Gene Variant Alters Analytical Sensitivity Characteristics of Viral Detection Using a Commercial Reverse Transcription-PCR Assay
Authors: Tahan Stephen , Parikh Bijal A. , Droit Lindsay , Wallace Meghan A. , Burnham Carey-Ann D. , Wang David
Published: April 2021

Diagnostic assays for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are essential for patient management, infection prevention, and the public health response for coronavirus disease 2019 (COVID-19). The efficacy and reliability of these assays are of paramount importance in both tracking and controlling the spread of the virus.
Metagenomic Sequencing as a Pathogen-Agnostic Clinical Diagnostic Tool for Infectious Diseases: a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies
Authors: Govender Kumeren N. , Street Teresa L. , Sanderson Nicholas D. , Eyre David W.
Published: April 2021

Metagenomic sequencing is frequently claimed to have the potential to revolutionize microbiology through rapid species identification and antimicrobial resistance (AMR) prediction. We assess the progress toward these developments.
Complete Genome Sequences of Two Corynebacterium macginleyi Strains Isolated from Infectious Keratitis
Authors: Sagerfors Susanna , Poehlein Anja , Söderquist Bo , Brüggemann Holger
Published: April 2021

Corynebacterium macginleyi
is a slow-growing, lipid-requiring bacterium that may cause ocular infections. Here, we report the complete genome sequences of two strains, T160811 and T180208, isolated from infectious keratitis. The two genomes consist of circular chromosomes of 2,431,961 bp and 2,481,998 bp, respectively, and contain high numbers of repetitive elements.
Primary thyroid leiomyosarcoma: a diagnostic and therapeutic challenge
Authors: Bashir Mohammed Talha , Bradish Tom , Rasul Usman , Shakeel Muhammad
Published: April 2021

Leiomyosarcoma is a malignant mesenchymal tumour of smooth muscle origin. It is extremely rare as a primary thyroid cancer with only 33 cases previously described in the literature. We present the case of a 69-year-old Caucasian man who presented with a 5-month history of left cervical lymphadenopathy and a suspicious mass in the left thyroid lobe on ultrasound scan. Left hemithyroidectomy confirmed the diagnosis of leiomyosarcoma. A review of current understanding and approaches to management of this rare condition are discussed.
Case of flank pain from ureteral injury after lumbar laminectomy
Authors: Huned Daanesh , Kumaran Arjunan , Lee Lui Shiong , Tiwari Raj Vikesh
Published: April 2021

We present a case of an iatrogenic complete left proximal ureteric injury after a lumbar 1 laminectomy and intradural tumour excision and lumbar 4/5 transforaminal lumbar interbody fusion. Initial management included a percutaneous nephrostomy for urinary diversion followed by definitive urinary reconstruction with an ileal ureter.
Dilated choroidal veins and their role in recurrences of myopic macular neovascularisations
Authors: Xie Shiqi , Du Ran , Fang Yuxin , Onishi Yuka , Igarashi Tae , Takahashi Hiroyuki , Kamoi Koju , Ohno-Matsui Kyoko
Published: April 2021

Aim

To determine whether there is a correlation between the presence of macular dilated choroidal vein (DCV) and the recurrence of myopic macular neovascularisation (MNV) after antivascular endothelial growth factor (VEGF) treatment.

Methods

Medical records of 168 eyes of 163 patients with myopic MNV were reviewed for the presence of macular DCV and episodes of recurrences. A macular DCV was defined as a choroidal vein whose diameter was 2× larger than the adjacent veins coursing in the macular area of 5.5 mm diameter.

Results

Macular DCV existed in 47 (28%) of the eyes with myopic MNV. 70 eyes (41.7%) had recurrence during a mean follow-up period of 52.5±23.0 months. Recurrence was found in 28 of the 47 eyes (59.6%) with DCV, which was significantly more frequent than the 42 of the 121 eyes (34.7%) without DCV (p=0.003). Cox model analysis showed that macular DCV was an independent risk factor (HR: 2.0, 95% CI 1.1 to 3.5) for recurrence. The recurrence rate was significantly higher in eyes with DCV within the first 2 years after the onset than in eyes without DCV.

Conclusions

Macular DCVs may be indicators of a more aggressive phenotype of eyes with myopic MNV. These eyes need careful monitoring after anti-VEGF therapies.
Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine
Authors: Phylactou Maria , Li Ji-Peng Olivia , Larkin Daniel F P
Published: April 2021

Aim

We report two cases of endothelial corneal allograft rejection following immunisation with SARS-CoV-2 messenger RNA (mRNA) vaccine BNT162b2 and describe the implications for management of transplant recipients postvaccination for COVID-19.

Methods

A 66-year-old woman with Fuchs endothelial corneal dystrophy (FECD) and a unilateral Descemet’s membrane endothelial keratoplasty (DMEK) transplant received COVID-19 mRNA vaccine BNT162b2 14 days post-transplant. Seven days later, she presented with symptoms and signs of endothelial graft rejection. An 83-year-old woman with bilateral DMEK transplants for FECD 3 and 6 years earlier developed simultaneous acute endothelial rejection in both eyes, 3 weeks post second dose of COVID-19 mRNA vaccine BNT162b2. Rejection in both cases was treated successfully with topical corticosteroids.

Conclusions

We believe this is the first report of temporal association between corneal transplant rejection following immunisation against COVID-19 and the first report of DMEK rejection following any immunisation. We hypothesise that the allogeneic response may have been initiated by the host antibody response following vaccination. Clinicians and patients should be aware of the potential of corneal graft rejection associated with vaccine administration and may wish to consider vaccination in advance of planned non-urgent keratoplasties. Patients should be counselled on the symptoms and signs that require urgent review to allow early treatment of any confirmed rejection episode.
Protocol for establishing an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) for integrating care of communicable and non-communicable diseases using tuberculosis and diabetes as a case study
Authors: Mpagama Stellah G , Ramaiya Kaushik , Lillebæk Troels , Mmbaga Blandina T , Sumari-de Boer Marion , Ntinginya Nyanda Elias , Alffenaar Jan-Willem , Heysell Scott K , Bygbjerg Ib C , Christensen Dirk L
Published: April 2021

Introduction

Most sub-Saharan African countries endure a high burden of communicable infections but also face a rise of non-communicable diseases (NCDs). Interventions targeting particular epidemics are often executed within vertical programmes. We establish an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) model with three domains; stepwise training approach, integration of communicable and NCDs and a learning system. The model aims to shift traditional vertical programmes to an adaptive diseases management approach through integrating communicable and NCDs using the tuberculosis (TB) and diabetes mellitus (DM) dual epidemic as a case study. We aim to describe the ADEPT protocol with underpinned implementation and operational research on TB/DM.

Methods and analysis

The model implement a collaborative TB and DM services protocol as endorsed by WHO in Tanzania. Evaluation of the process and outcomes will follow the logic framework. A mixed research design with both qualitative and quantitative approaches will be used in applied research action. Anticipated implementation research outcomes include at the health facilities level for organising TB/DM services, pathways of patients with TB/DM seeking care in different health facilities, factors in service delivery that need deimplementation and the ADEPT model implementation feasibility, acceptability and fidelity. Expected operational research outcomes include additional identified patients with dual TB/DM, the prevalence of comorbidities like hypertension in patients with TB/DM and final treatment outcomes of TB/DM including treatment-related complications. Findings will inform the future policies and practices for integrating communicable and NCDs services.

Ethics and dissemination

Ethical approval was granted by The National Research Health Ethical Committee (Ref-No. NIMR/HQ/R.8a/Vol.IX/2988) and the implementation endorsed by the government authorities. Findings will be proactively disseminated through multiple mechanisms including peer-reviewed journals, and engagement with various stakeholders’ example in conferences and social media.
Exploring spatial variation in BCG vaccination among children 0–35 months in Ethiopia: spatial analysis of Ethiopian Demographic and Health Survey 2016
Authors: Agegnehu Chilot Desta , Alem Adugnaw Zeleke
Published: April 2021

Objective

Tuberculosis is a major public health problem and is the second leading cause of death worldwide. BCG vaccination is a life-saving and important part of standard tuberculosis control measures, particularly in Ethiopia where tuberculosis is endemic. The End Tuberculosis Strategy targets of 2020 have not been achieved. Exploring spatial variations in BCG vaccination among children is vital to designing and monitoring effective intervention programmes. Therefore, this study aimed to explore the spatial variation in BCG vaccination among children in Ethiopia.

Design

Cross-sectional study design.

Setting

Ethiopia.

Participants

Children aged 0–35 months.

Primary outcome

BCG vaccination coverage.

Methods

Data from the 2016 Ethiopian Demographic and Health Survey were used and a total of 4453 children aged 0–35 months were included. Spatial autocorrelation analysis, cluster and outlier analysis, hotspot analysis, spatial interpolation, and spatial scan statistics were carried out to identify geographical risk areas for BCG vaccine utilisation. ArcGIS V.10.6 and SaTScan V.9.6 statistical software were employed to explore spatial pattern and significant hotspot areas for BCG vaccination among children.

Results

BCG vaccination was spatially clustered in Ethiopia at the regional level (Global Moran’s I=0.516, p<0.001). A total of 51 most likely clusters of low BCG vaccination were identified in the Somali and Afar regions (log-likelihood ratio=136.58, p<0.001). Significant secondary clusters were also identified in North West Gambela, South Amhara, South West Addis Ababa, North East Southern Nations, Nationalities, and People’s Region, and South West Oromia.

Conclusion

A low probability of receiving BCG vaccination was found among children in the Somali and Afar regions. Therefore, these areas should be given attention when designing effective immunisation strategies to improve BCG vaccination among children in order to reduce the burden of tuberculosis in Ethiopia.
Efficacy of an implementation package on documentation of central venous catheter insertions: an observational study
Authors: Linné Erik , Adrian Maria , Bentzer Peter , Kander Thomas
Published: April 2021

Background

Proper documentation of central venous catheter (CVC) insertions in electronic healthcare records is the basis for good follow-up and quality assurance. We have noted serious deficiencies in the documentation of CVC insertions and introduced an implementation package with the purpose of increasing the completeness of this documentation. The aim of the present study was to estimate the effect of the implementation package by assessing the proportion of missing data before and after the introduction of the implementation package.

Methods

In this single centre observational study, data from CVC insertion templates in a common electronic health record were extracted and analysed after introducing the implementation package. The package included adoption of new local CVC-directions, a new updated CVC-insertion template in the regional common electronic health record and a review of all CVC-insertion templates with a reminder to the inserting physician to supplement missing data. The proportion of terms with missing data was reviewed and also compared with the proportion of missing data in a study prior to the introduction of the package.

Results

In total, 7126 CVC-insertion templates were included. Of these 5539 (78%) were without missing data for any of the 13 predefined variables. Completed insertion templates for three common terms increased from 38% prior to the introduction of the implementation package to 93%, which represents an absolute reduction for missing data of 55% (95% CI 53% to 56%, p<0.0001).

Conclusion

The implementation package was highly effective in increasing the proportion of fully documented CVC insertions.