bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of new digital technologies and telemedicine in pulmonary rehabilitation
Authors: Fekete Monika , Fazekas-Pongor Vince , Balazs Peter , Tarantini Stefano , Nemeth Anna N. , Varga Janos Tamas
Published: August 2021

Background

Asthma and chronic obstructive pulmonary diseases are conditions characterized by a variable progression. Some individuals experience longer asymptomatic periods while others acute worsening periods and/or exacerbations triggered by symptom multiplication factors. Medications are adjusted to the patients’ respiratory function, self-assessment of health and emerging certain physical changes. A more effective treatment may be applied by real-time data registered during the patient’s everyday life.

Aim and methods

Introducing new modern digital technology in pulmonary rehabilitation (PR) to help tracking the patients’ medication, thus we systematically reviewed the latest publications on telemedicine and pulmonary telerehabilitation.

Conclusion

The use of the latest digital technologies in PR is very exciting and offers great opportunities while treating patients affected by specific conditions. On the one hand, adherence to medication can be improved in patients with chronic respiratory diseases by using these new state of the art devices; on the other hand, digital devices will also be able to monitor various physiological parameters of patients during their usual everyday activities. Data can be stored on a smartphone and shared with the provider. Relying on this information, physicians will be able to tailor medications and dosage to the specific needs of individual patients. Telerehabilitation may be a sustainable solution to the growing burden of chronic respiratory disease worldwide. However, PR must keep its cornerstones, such as education and motivations, which are most successful when conducted in person. Many issues remain to be resolved in the future, e.g. cybersecurity while using smart devices since they offer unique opportunities for PR.
Extreme learning machine versus classical feedforward network
Authors: Markowska-Kaczmar Urszula , Kosturek Michał
Published: August 2021

Our research is devoted to answering whether randomisation-based learning can be fully competitive with the classical feedforward neural networks trained using backpropagation algorithm for classification and regression tasks. We chose extreme learning as an example of randomisation-based networks. The models were evaluated in reference to training time and achieved efficiency. We conducted an extensive comparison of these two methods for various tasks in two scenarios:$$\bullet$$∙using comparable network capacity and$$\bullet$$∙using network architectures tuned for each model. The comparison was conducted on multiple datasets from public repositories and some artificial datasets created for this research. Overall, the experiments covered more than 50 datasets. Suitable statistical tests supported the results. They confirm that for relatively small datasets, extreme learning machines (ELM) are better than networks trained by the backpropagation algorithm. But for demanding image datasets, like ImageNet, ELM is not competitive to modern networks trained by backpropagation; therefore, in order to properly address current practical needs in pattern recognition entirely, ELM needs further development. Based on our experience, we postulate to develop smart algorithms for the inverse matrix calculation, so that determining weights for challenging datasets becomes feasible and memory efficient. There is a need to create specific mechanisms to avoid keeping the whole dataset in memory to compute weights. These are the most problematic elements in ELM processing, establishing the main obstacle in the widespread ELM application.
Neuronal pentraxins as biomarkers of synaptic activity: from physiological functions to pathological changes in neurodegeneration
Authors: Gómez de San José Nerea , Massa Federico , Halbgebauer Steffen , Oeckl Patrick , Steinacker Petra , Otto Markus
Published: August 2021

The diagnosis of neurodegenerative disorders is often challenging due to the lack of diagnostic tools, comorbidities and shared pathological manifestations. Synaptic dysfunction is an early pathological event in many neurodegenerative disorders, but the underpinning mechanisms are still poorly characterised. Reliable quantification of synaptic damage is crucial to understand the pathophysiology of neurodegeneration, to track disease status and to obtain prognostic information. Neuronal pentraxins (NPTXs) are extracellular scaffolding proteins emerging as potential biomarkers of synaptic dysfunction in neurodegeneration. They are a family of proteins involved in homeostatic synaptic plasticity by recruiting post-synaptic receptors into synapses. Recent research investigates the dynamic changes of NPTXs in the cerebrospinal fluid (CSF) as an expression of synaptic damage, possibly related to cognitive impairment. In this review, we summarise the available data on NPTXs structure and expression patterns as well as on their contribution in synaptic function and plasticity and other less well-characterised roles. Moreover, we propose a mechanism for their involvement in synaptic damage and neurodegeneration and assess their potential as CSF biomarkers for neurodegenerative diseases.
50 Years on, w(h)ither the Ramsar convention? A case of institutional drift
Authors: Bridgewater Peter , Kim Rakhyun E.
Published: August 2021

Wetlands have declined in area and quality at an accelerating pace in the last 50 years. Yet, the last 50 years is when international attention has been focussed on wetlands through the Ramsar Convention. An analysis of how the convention has evolved over the past 50 years suggests it has been drifting away from its original mandate in a maladaptive manner, and this drift is a problem for achieving its original objectives. A review of the strategic plans of the convention revealed two key conditions for institutional drifting and the associated lack of success. The first condition lies in its unique situation as a non-UN convention, which reduces the convention’s visibility and interactivity with other biodiversity-related conventions, agencies, or programmes. The second condition is an increasing number of conventions dealing with biodiversity issues, all forcing the Ramsar Convention to seek different roles in an increasingly competitive institutional landscape. A more effective future for the convention arguably lies in reasserting its original mandate, but with cognisance of the changed environmental pressures of the twenty-first century. While this would narrow its increasingly broad focus, such a reorientation will allow wetlands and waterfowl to start a track to recovery, backed by active and focused Contracting Parties in a renewed international convention on wetland conservation, management, and sustainable use.
Cholesterol lowering drug use and breast cancer survival: the Multiethnic Cohort Study
Authors: Moksud Nafeesa , Loo Lenora W. M. , Yang Juan , Huang Chiung-Yu , Haiman Christopher A. , Le Marchand Loïc , Wilkens Lynne R. , Cheng Iona
Published: August 2021

Purpose

Prior studies conducted primarily in white populations have suggested that pre-diagnostic cholesterol lowering drugs (CLDs) improved survival among women with breast cancer (BC). However, this association had not been well characterized in diverse racial/ethnic populations. We investigated whether pre-diagnostic CLD use is associated with all-cause and BC-specific mortality among female BC cases of the Multiethnic Cohort (MEC).

Methods

CLD use was ascertained through questionnaires administered in 2003–2008. A total of 1448 incident BC cases were identified by linkage to SEER cancer registries in Hawaii and California from 2003 to 2014. Multivariable Cox regression was conducted to estimate hazard ratios (HR) and 95% confidence intervals (CI) of the associations of pre-diagnostic CLD use with all-cause and BC-specific mortality, adjusting for tumor characteristics, first course of treatment, health behaviors, co-morbidities, and demographics. Subgroup analyses by stage and hormone receptor status were conducted for all-cause mortality.

Results

There were 224 all-cause and 87 BC-specific deaths among the 1448 BC cases during a median follow-up of 4.5 years after diagnosis. Women with BC who ever used CLDs had a 27% lower hazard of all-cause mortality (HR 0.73, 95% CI 0.54–0.98) and 17% lower hazard of BC-specific mortality (HR 0.83, 95% CI 0.49–1.39) compared to never users. CLD use reduced mortality among women with advanced-stage tumors and hormone receptor-positive breast tumors (HR 0.54 95% CI 0.33–0.90; HR 0.69, 95% CI 0.48–0.99, respectively).

Conclusion

These findings demonstrate an improved survival associated with CLD use prior to diagnosis in a multiethnic population of women with BC.
Ligand binding: evaluating the contribution of the water molecules network using the Fragment Molecular Orbital method
Authors: Lukac Iva , Wyatt Paul G. , Gilbert Ian H. , Zuccotto Fabio
Published: August 2021

Water molecules play a crucial role in protein–ligand binding, and many tools exist that aim to predict the position and relative energies of these important, but challenging participants of biomolecular recognition. The available tools are, in general, capable of predicting the location of water molecules. However, predicting the effects of their displacement is still very challenging. In this work, a linear-scaling quantum mechanics-based approach was used to assess water network energetics and the changes in network stability upon ligand structural modifications. This approach offers a valuable way to improve understanding of SAR data and help guide compound design.
On some relations between ideals of nowhere dense sets in topologies on positive integers
Authors: Nowik Andrzej , Szyszkowska Paulina
Published: August 2021

We examine the ideals of nowhere dense sets in three topologies on the set of positive integers, namely Furstenberg’s, Rizza’s and the common division topology. We mainly concentrate on inclusions between these ideals, we present a diagram showing these and we explore all possible inclusions between them. We present a formula for the closure of a set in the common division topology. We answer a question posed by Kwela and Nowik (Topol Appl. 248:149–163, 2018) by constructing a set in $${{\mathcal {I}}}_G {\setminus } ({{\mathcal {I}}}_K \cup {{\mathcal {I}}}_F)$$

I
G

\

(

I
K

∪

I
F

)

. Therefore, the main diagram of comparison between the ideals of nowhere dense sets in various topologies from the article by M. Kwela and A. Nowik is completed.
Leontief Meets Markov: Sectoral Vulnerabilities Through Circular Connectivity
Authors: Wirkierman Ariel L. , Bianchi Monica , Torriero Anna
Published: August 2021

Economists have been aware of the mapping between an Input-Output (I-O, hereinafter) table and the adjacency matrix of a weighted digraph for several decades (Solow, Econometrica 20(1):29–46, 1952). An I-O table may be interpreted as a network in which edges measure money flows to purchase inputs that go into production, whilst vertices represent economic industries. However, only recently the language and concepts of complex networks (Newman 2010) have been more intensively applied to the study of interindustry relations (McNerney et al. Physica A Stat Mech Appl, 392(24):6427–6441, 2013). The aim of this paper is to study sectoral vulnerabilities in I-O networks, by connecting the formal structure of a closed I-O model (Leontief, Rev Econ Stat, 19(3):109–132, 1937) to the constituent elements of an ergodic, regular Markov chain (Kemeny and Snell 1976) and its chance process specification as a random walk on a graph. We provide an economic interpretation to a local, sector-specific vulnerability index based on mean first passage times, computed by means of the Moore-Penrose inverse of the asymmetric graph Laplacian (Boley et al. Linear Algebra Appl, 435(2):224–242, 2011). Traversing from the most central to the most peripheral sector of the economy in 60 countries between 2005 and 2015, we uncover cross-country salient roles for certain industries, pervasive features of structural change and (dis)similarities between national economies, in terms of their sectoral vulnerabilities.
Operators in pre-Riesz spaces: moduli and homomorphisms
Authors: Kalauch Anke , Stennder Janko , van Gaans Onno
Published: August 2021

We focus on two topics that are related to moduli of elements in partially ordered vector spaces. First, we relate operators that preserve moduli to generalized notions of lattice homomorphisms, such as Riesz homomorphisms, Riesz* homomorphisms, and positive disjointness preserving operators. We also consider complete Riesz homomorphisms, which generalize order continuous lattice homomorphisms. Second, we characterize elements with a modulus by means of disjoint elements and apply this result to obtain moduli of functionals and operators in various settings. On spaces of continuous functions, we identify those differences of Riesz* homomorphisms that have a modulus. Many of our results for pre-Riesz spaces of continuous functions lead to results on order unit spaces, where the functional representation is used.
Measuring Regional Performance in the Italian NHS: Are Disparities Decreasing?
Authors: Bruzzi Silvia , Ivaldi Enrico , Santagata Marta
Published: August 2021

Given the regional disparities that historically characterize the Italian context, in this paper we propose a framework to evaluate the regional health care systems’ performance in order to contribute to the debate on the relationship between decentralisation of health care and equity. To investigate the regional health systems performance, we refer to the OECD Health Care Quality Indicators project to construct of a set of five composite indexes. The composite indexes are built on the basis of the non-compensatory Adjusted Mazziotta-Pareto Index, that allows comparability of the data across units and over time. We propose three indexes of health system performance, namely Quality Index, Accessibility Index and Cost-Expenditure Index, along with a Health Status Index and a Lifestyles Index. Our framework highlights that regional disparities still persist. Consistently with the evidence at the institutional level, there are regions, particularly in Southern Italy, which record lower levels of performance with high levels of expenditure. Continuous research is needed to provide policy makers with appropriate data and tools to build a cohesive health care system for the benefit of the whole population. Even if future research is needed to integrate our framework with new indicators for the calculation of the indexes and with the identification of new indexes, the study shows that a scientific reflection on decentralisation of health systems is necessary in order to reduce inequalities.
Stressors and vulnerability during upper secondary school: subjective experiences of classroom climate and coping beliefs as predicting factors of school stress in Norway
Authors: Haugan Jan Arvid , Frostad Per , Mjaavatn Per-Egil
Published: August 2021

The present longitudinal study was designed to scrutinize how adolescents perceive their life in upper secondary schools in general, and how central aspects of their perceived classroom climate predicted their coping beliefs and experience of school stress in particular. The participants were 1215 students in upper secondary schools (grades 2 and 3) from one county in Norway. The data were analysed by means of structural equation modelling, and the findings reveal gender differences that need further investigation in future research. Our study indicates that a performance-oriented goal structure and social support from peers and teachers seem to be a potential risk factor and/or protective factor when it comes to adolescents’ development of coping beliefs and experiences of school stress, especially among girls.
Can imagination be unconscious?
Authors: Kind Amy
Published: August 2021

Our ordinary conception of imagination takes it to be essentially a conscious phenomenon, and traditionally that’s how it had been treated in the philosophical literature. In fact, this claim had often been taken to be so obvious as not to need any argumentative support. But lately in the philosophical literature on imagination we see increasing support for the view that imagining need not occur consciously. In this paper, I examine the case for unconscious imagination. I’ll consider four different arguments that we can find in the recent literature—three of which are based on cases and one that is based on considerations relating to action guidance. To my mind, none of these arguments is successful. I conclude that the case for postulating unconscious imagining has not yet been well motivated.
What are empirical consequences? On dispensability and composite objects
Authors: LeBrun Alex
Published: August 2021

Philosophers sometimes give arguments that presuppose the following principle: two theories can fail to be empirically equivalent on the sole basis that they present different “thick” metaphysical pictures of the world. Recently, a version of this principle has been invoked to respond to the argument that composite objects are dispensable to our best scientific theories. This response claims that our empirical evidence distinguishes between ordinary and composite-free theories, and it empirically favors the ordinary ones (Hofweber 2016, 2018). In this paper, I ask whether this response to the dispensability argument is tenable. I claim that it is not. This is because it presupposes an indefensible thesis about when two empirical consequences are distinct or the same. My argument provides some insight into what our empirical consequences are, and I conclude that empirical evidence is radically metaphysically neutral. This gives us some insight into the significant content of our scientific theories—the content that a scientific realist is committed to—and I show how this insight relates to questions about theoretical equivalence more broadly.
Neither Cronbach’s Alpha nor McDonald’s Omega: A Commentary on Sijtsma and Pfadt
Authors: Cho Eunseong
Published: August 2021

Sijtsma and Pfadt (2021) published a thought-provoking article on coefficient alpha. I make the following arguments against their work. 1) Kuder and Richardson (1937) deserve more credit for coefficient alpha than Cronbach (1951). 2) We should distinguish between the definition of reliability and its meaning. 3) We should be wary of overfitting in the use of FA reliability. 4) Our primary concern is to obtain accurate reliability estimates rather than conservative estimates. 5) Several reliability estimators, such as <mml:math xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mnf="http://cambridge.org/core/manifest" xmlns:cup="http://contentservices.cambridge.org" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:m="http://cambridge.org/core/metadata" xmlns:core="http://cambridge.org/core" xmlns:c="http://cambridge.org/core/content">λ2\documentclass[12pt]{minimal}
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\begin{document}$$\mu _{2}$$\end{document}, congeneric reliability and the Gilmer-Feldt coefficient are more accurate than coefficient alpha. 6) The name omega should not be used to refer to a specific reliability estimator.
Emergency medical admissions and COVID-19: impact on 30-day mortality and hospital length of stay
Authors: Conway Richard P. , Byrne Declan G. , O’Riordan Deirdre M. R. , Kent Brian D. , Kennedy Barry M. J. , Cheallaigh Clíona M. Ní , O’Connell Brian P. , Akasheh Nadim B. , Browne Joseph G. , Silke Bernard M.
Published: August 2021

Background

The COVID-19 pandemic has put considerable strain on healthcare systems.

Aim

To investigate the effect of the COVID-19 pandemic on 30-day in-hospital mortality, length of stay (LOS) and resource utilization in acute medical care.

Methods

We compared emergency medical admissions to a single secondary care centre during 2020 to the preceding 18 years (2002–2019). We investigated 30-day in-hospital mortality with a multiple variable logistic regression model. Utilization of procedures/services was related to LOS with zero truncated Poisson regression.

Results

There were 132,715 admissions in 67,185 patients over the 19-year study. There was a linear reduction in 30-day in-hospital mortality over time; over the most recent 5 years (2016–2020), there was a relative risk reduction of 36%, from 7.9 to 4.3% with a number needed to treat of 27.7. Emergency medical admissions increased 18.8% to 10,452 in 2020 with COVID-19 admissions representing 3.5%. 18.6% of COVID-19 cases required ICU admission with a median stay of 10.1 days (IQR 3.8, 16.0). COVID-19 was a significant univariate predictor of 30-day in-hospital mortality, 18.5% (95%CI: 13.9, 23.1) vs. 3.0% (95%CI: 2.7, 3.4)—OR 7.3 (95%CI: 5.3, 10.1). ICU admission was the dominant outcome predictor—OR 12.4 (95%CI: 7.7, 20.1). COVID-19 mortality in the last third of 2020 improved—OR 0.64 (95%CI: 0.47, 0.86). Hospital LOS and resource utilization were increased.

Conclusion

A diagnosis of COVID-19 was associated with significantly increased mortality and LOS but represented only 3.5% of admissions and did not attenuate the established temporal decline in overall in-hospital mortality.
Smart Grids and Machine Learning in Chinese and Western Intellectual Property Law
Authors: Papastefanou Stefan
Published: August 2021

Having huge power grids successfully integrate sustainable energy sources requires a smart and flexible power grid management system. Such smart systems have to adapt fast and accurately to a great amount of data input – a task which is made easier by applying modern machine learning technology. Solutions crafted by dynamic and powerful computing algorithms have the potential to surpass human cognitive capabilities. The question arises whether and how intellectual property law can be used to set the right incentives. This paper initially describes the basic functions of smart grids and the corresponding necessity of machine learning. Subsequently, it will analyze the current approaches of the most relevant patent offices in dealing with the challenges of AI-related smart grid inventions. Ultimately, it will be demonstrated that the contemporary discussions fail to focus on practical considerations of market entry possibilities that might be more promising than the approach of creating new exclusionary intellectual property rights.
Impact of hypogonadism on bone mineral density and vertebral fractures in HIV-infected men
Authors: Pezzaioli L. C. , Porcelli T. , Delbarba A. , Maffezzoni F. , Focà E. , Castelli F. , Cappelli C. , Ferlin A. , Quiros-Roldan M. E.
Published: August 2021

Purpose

Hypogonadism and osteoporosis are frequently reported in HIV-infected men and, besides multifactorial pathogenesis, they might be directly linked because of testicular involvement in bone health. We evaluated the prevalence of osteoporosis and vertebral fractures (VFs) in HIV-infected men, and assessed their relationship with gonadal function.

Methods

We enrolled 168 HIV-infected men (median age 53). Osteoporosis and osteopenia were defined with T-score ≤  – 2.5SD and T-score between  – 1 and  – 2.5SD, respectively. VFs were assessed by quantitative morphometric analysis. Total testosterone (TT), calculated free testosterone (cFT), Sex Hormone Binding Globulin (SHBG), Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) were obtained; overt hypogonadism was defined on symptoms and low TT or cFT, and classified into primary and secondary according to gonadotropins; compensated hypogonadism was defined as normal TT and cFT with high LH levels.

Results

Overall, osteoporosis and osteopenia were found in 87.5% of patients, and VFs were detected in 25% of them; hypogonadism was identified in 26.2% of cases. Osteoporotic patients had higher SHBG vs those with normal bone mineral density (BMD). Fractured patients were more frequently hypogonadal and with higher SHBG. SHBG showed negative correlation with both spine and femoral BMD, and positive correlation with VFs. In multivariate models, FSH showed negative impact only on femoral BMD, whereas older age and higher SHBG predicted VFs.

Conclusion

We found a high burden of bone disease and hypogonadism in HIV-infected men, and we showed that the impact of gonadal function on bone health is more evident on VFs than on BMD.
Physiological and biochemical responses to water deficit and recovery of two olive cultivars (Olea europaea L., Arbequina and Empeltre cvs.) under Mediterranean conditions
Authors: Melaouhi Amira , Baraza Elena , Escalona José M. , El-AouOuad Hanan , Mahjoub Imen , Bchir Amani , Braham Mohamed , Bota Josefina
Published: August 2021

The main objective of the present study was to evaluate the responses to water deficit stress and recovery capacity of young potted trees from two olive cultivars, Empeltre cv. and the widely planted Arbequina cv. The experiment was carried out under semiarid environmental conditions at the experimental field of the University of Balearic Islands in Mallorca, Spain. Two-year-old plants in 22 L pots were exposed to three water availability regimes (full capacity [FC]; 50% FC; 30% FC). Growth, gas exchange, intrinsic water use efficiency, C13 discrimination and biochemical parameters (total soluble sugars, proline, starch, total soluble protein, pigments and phenolic fraction) were evaluated. Plants were rewetted and assessed again after the re-watering period. Drought stress reduced photosynthesis, mainly by regulating stomatal conductance (gs). Arbequina cv. exhibited a more conservative water use strategy than Empeltre, with greater reductions in gs, accompanied by significant reductions in vegetative growth. Non-significant differences in intrinsic water use efficiency were observed between cultivars and treatments. However, C13 discrimination analysis showed better water use efficiency in Empeltre than Arbequina in all treatments. Water deficit stress caused an increase of proline and total soluble solids and a reduction of starch, total soluble protein and chlorophylls concentrations of both cultivars. Empeltre showed a higher total phenol concentration than Arbequina during non-water deficit stress conditions. Cultivar-specific differences in the mechanisms to deal with drought were observed. Empeltre cv. exhibits a higher capacity to tolerate drought and it continues growing under water stress and recovery.
Globalized Cross-Border Insolvency Law: The Roles Played by China
Authors: Zhang Zinian
Published: August 2021

This study empirically investigates China’s participation in the globalized cross-border insolvency collaboration system. It is the first time for the development of China’s cross-border insolvency law to be examined against the background of private international law on foreign judgment recognition and enforcement. The findings of this article reveal that foreign bankruptcy representatives face considerable difficulties in satisfying the treaty and reciprocity requirements when seeking judicial assistance from China, and that local protectionism in favour of China’s state-owned and state-linked companies undermines foreign bankruptcy representatives’ confidence in approaching China’s courts for support. Although there are several court recognitions of foreign bankruptcy judgments in China, this article finds that they are only used to acknowledge the legal status of foreign bankruptcy representatives to meet the demands of government authorities; Chinese courts have not taken a substantial step in recognizing a foreign bankruptcy judgment so as to bar individual creditors’ action in the interest of a foreign bankruptcy proceeding. On the contrary, for Chinese bankruptcy representatives seeking assistance abroad, they could take advantage of the liberal judicial infrastructure, especially of some advanced jurisdictions, to obtain recognition and relief.
Wer also erzählt Nietzsches Zarathustra?
Authors: Zittel Claus
Published: August 2021

Dass Also sprach Zarathustra einen Erzähler hat, wird meist übersehen. Der Beitrag arbeitet die unterschiedlichen Rollen und Funktionen des Erzählers in Nietzsches Hauptwerk heraus, diskutiert die damit verbundene Gattungsproblematik und fragt nach den Formen und Folgen eines Erzählens nach dem Tode Gottes. Es werden die unterschiedlichen Störungen in der Erzählordnung vorgeführt und diese im Licht einer chaotisch und kontingent gewordenen Moderne interpretiert.
Combined operation for coronary artery bypass grafting and mitral valve replacement; risk and outcome
Authors: Ahmed Okba F. , Kakamad Fahmi H. , Almudhaffar Saif S. , Hachim Rafid Hameed , Najar Kayhan A. , Salih Abdulwahid M. , Hussen Dahat A. , Mohammed Shvan H. , Mustafa Mohammed Q. , Mohammed Karukh K. , Omar Diyar A.
Published: August 2021

ABSTRACT

Introduction:

The combination of mitral valve replacement (MVR) with coronary artery bypass grafting (CABG) is generally thought to have a greater early and late mortality than either procedure alone. The aim of this study is to review single center experience for the concomitant MVR and CABG.

Patients and methods:

This is a single center, retrospective, single cohort study, composes of consecutive cases. It included all the cases of combined operation of MVR and CABG. The patients were followed up for a median duration of two years (six months to four years). The data were collected from hospital records and registers of hospital statistics. The followings were obtained; socio-demographic data, information regarding clinical courses, intraoperative findings, and post-operative follow up data.

Result:

The study included 72 cases, the mean age was 56 years, 38 of them (53%) were males and 34 (47%) were female. The most common comorbidity was hypertension which was found in 24 patients (33%). The mean preoperative ejection fraction was 59%. Twenty-two patients (30.6%) had single graft, 21 patients (29.2%) underwent 3-vessel grafting, 16 patients (22.2%) had 2-vessel grafting, and 13 cases (18.1%) underwent 4-vessel grafting. The CPB duration ranged from 108 to 280 min with a mean of 182 min and cross-clamp time ranged from 80 to 186 min with a mean of 122 min. The most common complication was plural effusion which occurred in 8 cases (11.1%) and managed by aspiration. Overall mortality was 8.3% (4 patients).

Conclusion:

CABG and chordal-sparing and posterior leaflet replacement has favorable outcome, as well as minimizes the need of redo surgery as in repair.one of the best options for CAD and sever MR.

Highlights
Isoscape Models of the Southern Ocean: Predicting Spatial and Temporal Variability in Carbon and Nitrogen Isotope Compositions of Particulate Organic Matter
Authors: St John Glew Katie , Espinasse Boris , Hunt Brian P. V. , Pakhomov Evgeny A. , Bury Sarah J. , Pinkerton Matt , Nodder Scott D. , Gutiérrez‐Rodríguez Andres , Safi Karl , Brown Julie C. S. , Graham Laura , Dunbar Robert B. , Mucciarone David A. , Magozzi Sarah , Somes Chris , Trueman Clive N.
Published: August 2021

Polar marine ecosystems are particularly vulnerable to the effects of climate change. Warming temperatures, freshening seawater, and disruption to sea‐ice formation potentially all have cascading effects on food webs. New approaches are needed to better understand spatiotemporal interactions among biogeochemical processes at the base of Southern Ocean food webs. In marine systems, isoscapes (models of the spatial variation in the stable isotopic composition) of carbon and nitrogen have proven useful in identifying spatial variation in a range of biogeochemical processes, such as nutrient utilization by phytoplankton. Isoscapes provide a baseline for interpreting stable isotope compositions of higher trophic level animals in movement, migration, and diet research. Here, we produce carbon and nitrogen isoscapes across the entire Southern Ocean (>40°S) using surface particulate organic matter isotope data, collected over the past 50 years. We use Integrated Nested Laplace Approximation‐based approaches to predict mean annual isoscapes and four seasonal isoscapes using a suite of environmental data as predictor variables. Clear spatial gradients in δ13C and δ15N values were predicted across the Southern Ocean, consistent with previous statistical and mechanistic views of isotopic variability in this region. We identify strong seasonal variability in both carbon and nitrogen isoscapes, with key implications for the use of static or annual average isoscape baselines in animal studies attempting to document seasonal migratory or foraging behaviors.
A Physical Interpretation of Recent Tropical Cyclone Post‐Landfall Decay
Authors: Phillipson L. M. , Toumi R.
Published: August 2021

The decay of landfalling tropical cyclones is important to the damage caused. We examine a simple physically based decay model of maximum surface winds driven by frictional turbulent drag and a modification accounting for partial to complete land roughness. The model fits an algebraic decay with a parameter determined by the ratio of the surface drag coefficient to the effective vortex depth. This parameter has been decreasing from 1980 to 2018. There is also a global mean increase of wind speed 24 h after landfall of +1.13 m/s per decade. We cannot exclude the possibility that this trend is driven by the initial wind speed increase, but it is most likely due to a slowing of the decay. This weaker decay amounts to an additional 7 h of gale force winds for a typical Category 1 at landfall.
Side Discharges From the Active Negative Leaders in a Positive Cloud‐To‐Ground Lightning Flash
Authors: Yuan Shanfeng , Jiang Rubin , Qie Xiushu , Wang Dongfang
Published: August 2021

We found two kinds of side breakdowns from the active horizontal negative channel in a positive cloud‐to‐ground flash. During the propagation of the negative leader in the field‐of‐view, some decayed negative branches were reactivated, and most of them promoted the propagation of advancing negative leaders. The reactivations extended outward from the edge of the negative leader channel with an average speed of 2.2 × 106 m s−1, but they produced no distinct VLF‐VHF radiations, as confirmed by the lightning mapping results. The reactivations of decayed negative branches were different from recoil leaders in the decayed negative leader because we deduce the outward breakdown has changed its polarity. In addition, the negative channel that induced a downward positive leader was hot and conductive, as revealed by its brightness. The results indicate that disconnection or current cutoff on the negatively charged lightning channel is unnecessary for the inception of a downward positive leader.
Constraining the Date of a Seasonally Ice‐Free Arctic Using a Simple Model
Authors: Bonan David B. , Schneider Tapio , Eisenman Ian , Wills Robert C. J.
Published: August 2021

State‐of‐the‐art climate models simulate a large spread in the projected decline of Arctic sea‐ice area (SIA) over the 21st century. Here we diagnose causes of this intermodel spread using a simple model that approximates future SIA based on present SIA and the sensitivity of SIA to Arctic temperatures. This model accounts for 70%–95% of the intermodel variance, with the majority of the spread arising from present‐day biases. The remaining spread arises from intermodel differences in Arctic warming, with some contribution from differences in the local sea‐ice sensitivity. Using observations to constrain the projections moves the probability of an ice‐free Arctic forward by 10–35 years when compared to unconstrained projections. Under a high‐emissions scenario, an ice‐free Arctic will likely (66% probability) occur between 2036 and 2056 in September and between 2050 and 2068 from July to October. Under a medium‐emissions scenario, the “likely” date occurs between 2040 and 2062 in September and much later in the 21st century from July to October.
Stochastic Simulation of the Suspended Sediment Deposition in the Channel With Vegetation and Its Relevance to Turbulent Kinetic Energy
Authors: Yang Liu , Huai Wenxin , Guo Yakun
Published: August 2021

The aquatic vegetation patch plays a significant role on sediment net deposition in the vegetated channels. Particularly, the flow is decelerated at the leading edge of a patch that tends to induce vertical updraft, that is, a diverging flow region, in which vegetation greatly affects the pattern of sediment net deposition. This study focuses on the simulation of the sediment net deposition in the whole vegetation patch region through an innovative random displacement model, a Lagrange method, with probability‐based boundary conditions, instead of the reflection or sorption boundary at the channel bottom. The probability model of deposition and resuspension is proposed according to the flow field characteristics in the different regions of the vegetation patch. The variation of the sediment deposition and resuspension with the turbulent kinetic energy is analyzed to illustrate the effect of the turbulence induced by vegetation, represented by the dimensionless turbulent kinetic energy (ψ), on the sediment deposition and resuspension. The sediment deposition predicted by the proposed model agrees well with the experimental measurements. Results show that the effect of vegetation on the sediment deposition and resuspension motions begins to prevail when the vegetation‐induced ψ is larger than its threshold, ψ

*
. The threshold of ψ is predicted to be within 6.8–10 according to the simulation results in this study. As the turbulent kinetic energy increases, the deposition probability decreases continuously when ψ > ψ

*
.
The Amyloid-β Pathway in Alzheimer’s Disease
Authors: Hampel Harald , Hardy John , Blennow Kaj , Chen Christopher , Perry George , Kim Seung Hyun , Villemagne Victor L. , Aisen Paul , Vendruscolo Michele , Iwatsubo Takeshi , Masters Colin L. , Cho Min , Lannfelt Lars , Cummings Jeffrey L. , Vergallo Andrea
Published: August 2021

Breakthroughs in molecular medicine have positioned the amyloid-β (Aβ) pathway at the center of Alzheimer’s disease (AD) pathophysiology. While the detailed molecular mechanisms of the pathway and the spatial-temporal dynamics leading to synaptic failure, neurodegeneration, and clinical onset are still under intense investigation, the established biochemical alterations of the Aβ cycle remain the core biological hallmark of AD and are promising targets for the development of disease-modifying therapies. Here, we systematically review and update the vast state-of-the-art literature of Aβ science with evidence from basic research studies to human genetic and multi-modal biomarker investigations, which supports a crucial role of Aβ pathway dyshomeostasis in AD pathophysiological dynamics. We discuss the evidence highlighting a differentiated interaction of distinct Aβ species with other AD-related biological mechanisms, such as tau-mediated, neuroimmune and inflammatory changes, as well as a neurochemical imbalance. Through the lens of the latest development of multimodal in vivo biomarkers of AD, this cross-disciplinary review examines the compelling hypothesis- and data-driven rationale for Aβ-targeting therapeutic strategies in development for the early treatment of AD.
Wnt/β-catenin signaling in cancers and targeted therapies
Authors: Yu Fanyuan , Yu Changhao , Li Feifei , Zuo Yanqin , Wang Yitian , Yao Lin , Wu Chenzhou , Wang Chenglin , Ye Ling
Published: August 2021

Wnt/β-catenin signaling has been broadly implicated in human cancers and experimental cancer models of animals. Aberrant activation of Wnt/β-catenin signaling is tightly linked with the increment of prevalence, advancement of malignant progression, development of poor prognostics, and even ascendence of the cancer-associated mortality. Early experimental investigations have proposed the theoretical potential that efficient repression of this signaling might provide promising therapeutic choices in managing various types of cancers. Up to date, many therapies targeting Wnt/β-catenin signaling in cancers have been developed, which is assumed to endow clinicians with new opportunities of developing more satisfactory and precise remedies for cancer patients with aberrant Wnt/β-catenin signaling. However, current facts indicate that the clinical translations of Wnt/β-catenin signaling-dependent targeted therapies have faced un-neglectable crises and challenges. Therefore, in this study, we systematically reviewed the most updated knowledge of Wnt/β-catenin signaling in cancers and relatively targeted therapies to generate a clearer and more accurate awareness of both the developmental stage and underlying limitations of Wnt/β-catenin-targeted therapies in cancers. Insights of this study will help readers better understand the roles of Wnt/β-catenin signaling in cancers and provide insights to acknowledge the current opportunities and challenges of targeting this signaling in cancers.
Clinical validation of a novel web-application for remote assessment of distance visual acuity
Authors: Thirunavukarasu Arun James , Mullinger Deborah , Rufus-Toye Remi Mohan , Farrell Sarah , Allen Louise E.
Published: August 2021

Background/Objectives

Ophthalmic disorders cause 8% of hospital clinic attendances, the highest of any specialty. The fundamental need for a distance visual acuity (VA) measurement constrains remote consultation. A web-application, DigiVis, facilitates self-assessment of VA using two internet-connected devices. This prospective validation study aimed to establish its accuracy, reliability, usability and acceptability.

Subjects/Methods

In total, 120 patients aged 5–87 years (median = 27) self-tested their vision twice using DigiVis in addition to their standard clinical assessment. Eyes with VA worse than +0.80 logMAR were excluded. Accuracy and test-retest (TRT) variability were compared using Bland–Altman analysis and intraclass correlation coefficients (ICC). Patient feedback was analysed.

Results

Bias between VA tests was insignificant at −0.001 (95% CI −0.017 to 0.015) logMAR. The upper limit of agreement (LOA) was 0.173 (95% CI 0.146 to 0.201) and the lower LOA −0.175 (95% CI −0.202 to −0.147) logMAR. The ICC was 0.818 (95% CI 0.748 to 0.869). DigiVis TRT mean bias was similarly insignificant, at 0.001 (95% CI −0.011 to 0.013) logMAR, the upper LOA was 0.124 (95% CI 0.103 to 0.144) and the lower LOA −0.121 (95% CI −0.142 to −0.101) logMAR. The ICC was 0.922 (95% CI 0.887 to 0.946). 95% of subjects were willing to use DigiVis to monitor vision at home.

Conclusions

Self-tested distance VA using DigiVis is accurate, reliable and well accepted by patients. The app has potential to facilitate home monitoring, triage and remote consultation but widescale implementation will require integration with NHS databases and secure patient data storage.
Using the IUCN Red List to map threats to terrestrial vertebrates at global scale
Authors: Harfoot Michael B. J. , Johnston Alison , Balmford Andrew , Burgess Neil D. , Butchart Stuart H. M. , Dias Maria P. , Hazin Carolina , Hilton-Taylor Craig , Hoffmann Michael , Isaac Nick J. B. , Iversen Lars L. , Outhwaite Charlotte L. , Visconti Piero , Geldmann Jonas
Published: August 2021

The Anthropocene is characterized by unparalleled human impact on other species, potentially ushering in the sixth mass extinction. Yet mitigation efforts remain hampered by limited information on the spatial patterns and intensity of the threats driving global biodiversity loss. Here we use expert-derived information from the International Union for Conservation of Nature Red List on threats to 23,271 species, representing all terrestrial amphibians, birds and mammals, to generate global maps of the six major threats to these groups: agriculture, hunting and trapping, logging, pollution, invasive species, and climate change. Our results show that agriculture and logging are pervasive in the tropics and that hunting and trapping is the most geographically widespread threat to mammals and birds. Additionally, current representations of human pressure underestimate the overall pressure on biodiversity, due to the exclusion of threats such as hunting and climate change. Alarmingly, this is particularly the case in areas of the highest biodiversity importance.
Mapping single-cell data to reference atlases by transfer learning
Authors: Lotfollahi Mohammad , Naghipourfar Mohsen , Luecken Malte D. , Khajavi Matin , Büttner Maren , Wagenstetter Marco , Avsec Žiga , Gayoso Adam , Yosef Nir , Interlandi Marta , Rybakov Sergei , Misharin Alexander V. , Theis Fabian J.
Published: August 2021

Large single-cell atlases are now routinely generated to serve as references for analysis of smaller-scale studies. Yet learning from reference data is complicated by batch effects between datasets, limited availability of computational resources and sharing restrictions on raw data. Here we introduce a deep learning strategy for mapping query datasets on top of a reference called single-cell architectural surgery (scArches). scArches uses transfer learning and parameter optimization to enable efficient, decentralized, iterative reference building and contextualization of new datasets with existing references without sharing raw data. Using examples from mouse brain, pancreas, immune and whole-organism atlases, we show that scArches preserves biological state information while removing batch effects, despite using four orders of magnitude fewer parameters than de novo integration. scArches generalizes to multimodal reference mapping, allowing imputation of missing modalities. Finally, scArches retains coronavirus disease 2019 (COVID-19) disease variation when mapping to a healthy reference, enabling the discovery of disease-specific cell states. scArches will facilitate collaborative projects by enabling iterative construction, updating, sharing and efficient use of reference atlases.