bluuebunny/crossref_metadata_2025 huggingface dataset:
Charged Domain Wall and Polar Vortex Topologies in a Room Temperature Magnetoelectric Multiferroic Thin Film
Authors: Moore Kalani , O'Connell Eoghan , Griffin Sinéad M. , Downing Clive , Colfer Louise , Schmidt Michael , Nicolosi Valeria , Bangert Ursel , Keeney Lynette , Conroy Michele
Published: September 2021

Multiferroic topologies are an emerging solution for future low-power magnetic nanoelectronics due to their combined tuneable functionality and mobility. Here, we show that in addition to being magnetoelectric multiferroic at room temperature, thin film Aurivillius phase Bi6TixFeyMnzO18 is an ideal material platform for both domain wall and vortex topology based nanoelectronic devices. Utilising atomic resolution electron microscopy, we reveal the presence and structure of 180˚ type charged head-to-head and tail-to-tail domain walls passing throughout the thin film. Theoretical calculations confirm the sub-unit cell cation site preference and charged domain wall energetics for Bi6TixFeyMnzO18. Finally, we show that polar vortex type topologies also form at out-of-phase boundaries of stacking faults when internal strain and electrostatic energy gradients are altered. This study could pave the way for controlled polar vortex topology formation via strain engineering in other multiferroic thin films. Moreover, these results confirm the sub-unit-cell topological features play an important role in controlling the charge and spin state of Aurivillius phase films and other multiferroic heterostructures.
Preoperative Ultrasound to Map the Three-dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty
Authors: Zhang Yu , Yao Yao , Wang Yexian , Zhuang Zaikai , Shen Ying , Jiang Qing , Chen Dongyang
Published: September 2021

Background：The postoperative complaints of hypoaesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients is not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty. Methods： A total of 59 patients ( 28 males and 31 females, age 69.0 ± 4.6 years，BMI 24.7 ± 3.0 kg/m2) were randomly allocated to the ultrasound group and 58 patients ( 28 males and 30 females, age 68.5 ± 4.5 years, BMI 24.8 ± 2.8 kg/m2) were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months post-surgery, the rate of LFCN injury and abnormal sensitive area were evaluated in both groups. Results： There was a significant consistency in gender, age and BMI of these two groups (P>0.05). Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8±2.6 (3.0 ~12.0) mm to 11.1±3.4 (4.0 ~17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3±4.6 (-5.0 ~10.0) mm at proximal part and -2.7±4.7 (-10.0 ~8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group were significantly lower than those in the control group (3.4% VS 25.9%, P=0.001, at 1 month; 3.4% VS 22.4%, P=0.005, at 3 months).Conclusions： LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN using preoperative ultrasound mapping could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided.
Expression of Slit and Robo During Remodeling of Corticospinal Tract in Cervical Spinal Cord in Middle Cerebral Artery Occlusion Rats
Authors: Ying Zhenhao , Wu Junxuan , Jiang Wenjun , Zhang Guoli , Zhu Weiming , Li Xin , Pang Xueyun , Liu Wei
Published: September 2021

Background: Slits and Robos were associated with the generation of axons of corticospinal tract during the corticospinal tract (CST) remodeling after the cerebral ischemic stroke (CIS). However, little is known about the mechanism of CST remodeling. In this study, we detected the expression of Slits and Robos in middle cerebral artery occlusion (MCAO) rats to investigate the roles of Slits and Robos in the CIS. Methods: MCAO model was established using modified Zea Longa method. Beam walking test (BWT) was conducted to evaluate the motor function. The images of the track of cortical spinal cord beam on day 7, 14 and 21 were observed by anterograde CST tracing. Biopinylated dextan amine (BDA) was used to mark CST anterogradely. Expression of GAP-43 mRNA and GAP-43 protein in cervical spinal cord was detected by Real-Time PCR and Western blot analysis, respectively. The expression of Slit1, Slit2 and Robo1 in cervical spinal cord was detected by immunofluorescence staining.Results: The scores in the model group were significantly reduced compared to sham-operation group on day 7 (P<0.001), 14 (P<0.001) and 21 (P<0.001), respectively. There was no significant difference in the score on day 7, 14 and 21 of the sham-operation groups (P>0.05). In contrast, significant increase was noticed in the scores in model group, presenting a time-dependent manner. More CST staining fibers could be observed at the degenerative side in the model group compared with that of the sham-operation group on day 21. GAP-43 mRNA expression in the model group showed significant increase compared to that of sham-operation group on day 14 (P=0.015) and 21 days (P=0.002). The expression of GAP-43 protein in model group showed significant increase compared to that of sham-operation group on day 14 (P=0.022) and day 21 (P=0.008), respectively. The expression of Slit1 and Slit2 showed increase on day 14 and day 21, while the expression of Robo1 showed significant decrease in MCAO rats.Conclusion: Up-regulation of Slit1 and Slit2 and the downregulation of Robo1 may be related to the axons of CST midline crossing in spinal cord of MCAO rat during the spontaneous recovery of impaired motor function.
Cultural Competence and Its Associated Factors Among Nurses Working in Tertiary Hospitals: A Cross-Sectional Study
Authors: Geleta Bonsa Amsalu , Radie Yosief Tsige , Areri Habtamu Abera
Published: September 2021

Background
Ethiopian nurses are facing a culturally diverse population predominantly due to the coexistence of multicultural and diverse ethnics in the country. This study aimed to assess the level of cultural competency and its associated factors among nurses working in tertiary hospitals of Addis Ababa, Ethiopia.
Methods
A cross-sectional study was conducted on nurses working in tertiary hospitals of Addis Ababa city from March 1 to April 30, 2018. A systematic random sampling technique was used to select 352 nurses. Data were collected using an English version self-administered cultural competence questionnaire for nurses scale. Data was entered into Epi data manager version 4.2.2 and exported to SPSS software version 20.0 and analyzed using descriptive statistics and inferential statistics.
Results
A total of 343 participants were involved in the study with a response rate of 97.4%. The overall cultural competence level of participants was low to moderate (1.94 ± 0.65) with the highest mean was scored for cultural sensitivity (2.54 ± 0.69) and the lowest mean was scored for cultural skill (1.62 ± 0.98). Participants’ age, religion, level of education, work experience, current role, spoken languages beside Amharic and English, previous cultural care education, work experience beside the current hospital, the experience of caring for diverse patients and availability of interpreter service were the factors significantly associated with cultural competence at p < 0.05.
Conclusion
The overall cultural competence of nurses was low to moderate and influenced by several factors. Therefore, nurses and other responsible bodies should struggle to improve the cultural competence of nurses. Furthermore, a national large-scale study with patient’s perspectives was recommended.
Impact of Web-Based Health Education on HPV Vaccination Uptake Among College Girl Students in Western and Northern China: A Follow-Up Study
Authors: Zhang Xi , Chen Hui , Zhou Jing , Li Jing , Huang Qian , Feng Xiao-yu
Published: September 2021

Objective: To investigate the knowledge of human papillomavirus (HPV) and HPV vaccines, HPV vaccination uptake, and vaccination willingness among female college students, and to explore the effect of a web-based educational intervention, immediately and at one month later, on HPV knowledge, vaccine acceptability and uptake among female college students in Western and Northern China. Methods: A web-based interventional follow-up study was conducted at two universities in Western and Northern China between February and April 2020. Female freshmen were required to complete an online questionnaire, and then eligible students were randomized into intervention and control group. Students in the intervention group received 7-days of web-based health education regarding HPV and HPV vaccines, while the control group received educational materials unrelated to HPV prevention. All students were asked to complete post-intervention questionnaire to assess their awareness, uptake, and willingness regarding HPV vaccination at a 7 days and 30 days interval, respectively. Differences between intervention and control groups were compared using the Chi-square test. Multivariable logistic regression was used to analyze the influencing factors of vaccination intentions. Results: A total of 967 participants were included in this study. Prior to the intervention, 63.8%, 66.3%, and 60.8% of students had heard of HPV, HPV-related diseases, and HPV vaccines, respectively. However, only 2.2% of students had reported to have been vaccinated, and 33.0% were willing to be vaccinated against HPV. After 7-days education, students in the intervention group had higher awareness and willingness of HPV vaccines than those in the control group. Major reasons that college female students do not accept HPV vaccines were the high cost (57.7%) and concerns about the adverse events (56.0%). School location, education background of parents, history of counseling about HPV vaccines, history of sexual behavior, and having heard of HPV vaccines are influencing factors on willingness to be vaccinated. Conclusion: The female college students’ HPV vaccination uptake is insufficient, and they have minimal detailed knowledge about HPV and its vaccines. Web-based health education on HPV vaccines is an easy, feasible, and effective way to improve the awareness and acceptance of HPV vaccination among female college students, but it has limited effect on improving HPV vaccination uptake.
Soil Loss and Erosion Potential Estimation of Jhimruk Watershed, Nepal
Authors: Pandey Parbati , Gurung Anup
Published: September 2021

The Revised Universal Soil Loss Equation (RUSLE) model was used in a Geographic Information System (GIS) to estimate the soil loss of the Jhimruk Watershed, Lumbini Province, Nepal. This research also aimed to calculate the erosional soil loss status of the local governments lying inside the watershed. For this, remote sensing data obtained from various sources were used to generate the factor maps to calculate the soil loss through RUSLE. A 13 year mean annual precipitation data from the 8 meteorological stations in and around the watershed was used to calculate the rainfall erosivity (R) factor. For the soil erodibility factor (K), the soil map of the watershed was clipped from the digital soil map of the world provided by FAO. Aster Digital Elevation Model of 30m resolution was used for the generation of LS factor map. For the computation of C-factor, the landcover map of the watershed produced in Arc GIS 10.2.1 through supervised classification of the Sentinal imagery of 10m resolution was used. The values were assigned based on the literatures in the case of C and P factors.The mean annual soil loss of the watershed was found to be 13.4 tons per hectare per year (t/ha/yr.). However, the soil loss was calculated to be as high as 182 t/ha/yr. 68.82% of the total area of the watershed lie under very low erosion class and thus have low conservation priority whereas 7.73 % of the total area lie under extremely high erosion class and thus have a conservation priority class of 1.The mean erosion rate from the barren land was found to be highest (23.179 t/ha/yr.) followed by agricultural (21.40 t/ha/yr.) and forest area had the lowest erosion rate i.e. 7.90 t/ha/yr.
Intravenous Ibuprofen 400 Versus 800 mg Every 6 Hours in Abdominal and Orthopedic Surgery: A Multicenter, Randomized Controlled Trial
Authors: Zhang Hong , Huang Ji-Han , Xu Hong-Meng , Chen Li , Zheng Hong , Hong Zheng-Hua , Chen Lei , Zhang Xi-Zhe , Liu Huai-Ping , Li Chao-Yu , Lu Qiu-Ye , Bai Yu-Jiang , Hu Zu-Rong , Zhang Ya-Kui , Ma Yong-Sheng , Zhou Xu-Yan , Feng Yi
Published: September 2021

Background: Multimodal postoperative analgesia with intravenous ibuprofen can reduce the consumption of opioids and reduce the postoperative pain intensity. Recommended dose in the USA and Europe is 800 mg every 6 hours for the management of moderate to severe postoperative pain. The purpose of this study was to investigate whether 800 mg is needed in the Chinese population.Methods: This is a multicenter, randomized, controlled multi-center trial. Adult patients (18-65 years of age) scheduled for abdominal or orthopedic surgery under general anesthesia with endotracheal intubation were eligible. Subjects were randomized at a ratio of 1:1:1 to receive ibuprofen at 400 or 800 mg or saline every 6 hours for 48 hours after the operation. All subjects received morphine access through patient-controlled intravenous analgesia (PCIA) device, which was set as background infusion rate 0.5 mg/h, bolus 1 mg, 5-minute lock interval and 20-mg 4-hour limit. The primary endpoint was morphine consumption within the first 24 hours after surgery. Results: A total of 396 patients were enrolled (180 men, 216 women; 46±12.4 years of age; 106 patients receiving abdominal surgery, and 290 patients receiving orthopedic surgery). The number of patients was 131 in the placebo group, 132 in the 400-mg group, and 133 in the 800-mg group. The 3 groups did not differ in age, sex, BMI and the type of surgery. Median 24-hour morphine consumption was 39.1 mg (IQR: 29.7, 61.7) mg in the placebo control, 29.8 mg (IQR: 24.3, 43.7) mg in the 400-mg group, and 28.0 mg (IQR: 24.1, 35.9) in the 800-mg group (P<0.001 for comparisons between placebo versus 400 and 800 mg ibuprofen). There was no significant difference between the two ibuprofen groups (P=0.125). Analgesia-related adverse events did not differ among the 3 groups.Conclusions: Intravenous ibuprofen at either 400 or 800 mg every 6 hours could reduce postoperative morphine consumption, with apparently equal efficacy in Chinese population.
Risk Factors Associated with Bedbug (Cimex spp.) Infestations Among Hong Kong Households: A Cross-Sectional Study
Authors: Fung Hin Chung Eddy , Wong Hung , Chiu Siu Wai , Hui Jerome Ho Lam , Lam Hon Ming , Chung Roger Yat-nork , Wong Samuel Yeung-shan , Chan Siu Ming
Published: September 2021

To investigate the risk factors associated with bedbug infestations among Hong Kong households, self-reported questionnaires in Chinese were distributed online between June 2019 to July 2020. The questionnaire collected data on participants’ sociodemographics, history of bedbug infestation, and housing situation. Among the 663 participants who completed the questionnaire, 422 (63.7%) have experienced bedbug infestations in the past year, they were concentrated around the Kowloon region. Weighted bivariate and multivariate binary logistic regression were performed to identify the statistically significant (p-value <0.05) factors associated with bedbug infestations. Bivariate analysis shows a positive correlation between the number of reported dilapidated housing features and bedbug infestation. For multivariate analysis, those aged 45-64 (OR=2.53, 95% CI 1.30-4.91), have primary education or below (OR=9.43, 95% CI 3.12-28.44), and monthly household income ≤HKD30,000 (OR=1.69, 95% CI 1.15-2.5) were more likely to have bedbug infestation compared to their respective reference groups, i.e., ≥65, tertiary education, and >HKD30,000; housing risk factors identified are living in subdivided flats (OR=16.53, 95% CI 1.01-269.72), crowded household (OR=1.55, 95% CI 1.06-2.28), having second-hand furniture (OR=2.97, 95% CI 1.16-7.58), housing cleanliness issues (OR=2.66, 95% CI 1.13-6.25), and presence of bedbugs in neighbouring residential units (OR=3.32, 95% CI 1.57-7.04) or on the streets (OR=1.9, 95% CI 1.12-3.23). This study has identified lower income, lower education level, crowded household, living in subdivided flats, and certain dilapidated housing features to be risk factors of bedbug infestations; efforts and policies should prioritise vulnerable groups and focus on addressing the housing risk factors identified in this study.
Results from the First Culturally Tailored, Multidisciplinary Diabetes Education in Lebanese Adults with Type 2 Diabetes: Effects on Self-Care and Metabolic Outcomes.
Authors: Sukkarieh-Haraty Ola , egede Leonard , Khazen George , AbiKharma Joelle , Farran Natali , Bassil Maya
Published: September 2021

Background: Diabetes self-management education (DSME) is an essential component of lifestyle management needed for diabetes care. Despite ranking second in the world in the prevalence of diabetes, there is no reported intervention addressing diabetes self-care in the Arab world This pilot-study tested the effect of culturally-tailored education targeting diabetes self-care on glycaemia and cardiovascular risk factors of Lebanese with type 2 diabetes (T2DM). Methods: A sample of 27 adults (Age: 61±10yrs, 59% males, HbA1c:8.98±1.38%) with T2DM was recruited from primary health care centers in Beirut. Participants received culturally tailored, multidisciplinary education. Scales assessing self-care, social support, fatalism, and diabetes knowledge, as well as anthropometric measures, and blood samples were collected at baseline, 3-months and 6-months post- intervention. Results: Diabetes self-care (Diet, Self-Monitoring Blood Glucose and foot care) improved after 6 months, which was reflected in a significant drop in glycemic level (HbA1c:-0.5%; FPG: -38 mg/dl), and cholesterol/HDL ratio (4.45±1.39 vs. 4.06±1.29). Waist circumference decreased at 6 months compared to 3 months (p<0.05). Conclusions: This is the first effective culturally-tailored intervention that improved self-care, glycemic control, body adiposity and blood lipids of Lebanese with T2DM. Larger scale implementation with representative sample is warranted.
The Interplay Between Infection Risk Factors of SARS-CoV-2 and Prognosis: A Cross-Sectional Study from a Cohort of Long-Term Care Nursing Home Residents
Authors: Soldevila Laura , Prat Núria , Mas Miquel À. , Massot Mireia , Miralles Ramon , Bonet-Simó Josep Maria , Isnard Mar , Expósito-Izquierdo Marta , García-Sánchez Irene , Rodoreda-Noguerola Sara , Moreno Nemesio , Badia Esther , López Genís , Sevilla Javier , Estrada Oriol , Vallès Xavier
Published: September 2021

Background: Covid-19 pandemic has particularly affected older people living in Long-term Care settings. Methods: We carried out a cross-sectional analysis of a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at last one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered.Results: A total of 8021 participants were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = 0.03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < .001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). Conclusions: Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.
Identification of Risk Factors for Delirium, Cognitive Decline, And Dementia After Cardiac Surgery (FINDERI - Find Delirium Risk Factors): A Study Protocol of A Prospective Monocentric Observational Pilot Trial
Authors: Sadlonova Monika , Vogelgsang Jonathan , Lange Claudia , Günther Irina , Wiesent Adriana , Eberhard Charlotte , Ehrentraut Julia , Kirsch Mareike , Hansen Niels , Esselmann Hermann , Timäus Charles , Asendorf Thomas , Breitling Benedict , Chebbok Mohammed , Kutschka Ingo , Wiltfang Jens , Baraki Hassina , von Arnim Christine A.F.
Published: September 2021

BACKGROUND: Postoperative delirium is a common complication of cardiac surgery associated with higher morbidity, longer hospital stay, risk of cognitive decline, dementia, and mortality. Geriatric patients, patients undergoing cardiac surgery, and intensive care patients are at a high risk of developing a postoperative delirium. A gold standard assessment or biomarkers to predict risk factors for delirium, cognitive decline, and dementia in patients undergoing cardiac surgery are not yet available. METHODS: The FINDERI trial (FINd DElirium RIsk factors) is a prospective, single-center, observational pilot study. In total, 500 patients aged ≥ 50 years undergoing cardiac surgery at the Department of Cardiovascular and Thoracic Surgery of the University of Göttingen Medical Center will be recruited. Our primary aims are to validate a delirium screening questionnaire and to identify specific preoperative risk factors and perioperative exposition factors for postoperative delirium, cognitive decline, and accelerated dementia after cardiac surgery. Our secondary aim is to identify blood-based biomarkers that predict the incidence of postoperative delirium, cognitive decline, or dementia in the context of cardiac surgery. CONCLUSION: This prospective, observational pilot trial might help to identify pre- and perioperative risk factors and biomarkers for postoperative delirium, cognitive decline, and dementia. The predictive value of a delirium screening questionnaire in cardiac surgery might also be revealed.TRIAL REGISTRATION: Ethics approval for this study was obtained from the IRB of the University of Göttingen Medical Center. The investigators registered this study in German Clinical Trials Register (DRKS) (DRKS00025095) on April, 19th 2021 https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00025095.
Clinical Phenotyping In Sarcoidosis Using Cluster Analysis
Authors: Lin Nancy W , Arbet Jaron , Mroz Margaret M , Liao Shu-Yi , Restrepo Clara I , Mayer Annyce S , Li Li , Barkes Briana Q , Schrock Sarah , Hamzeh Nabeel , Fingerlin Tasha E. , Carlson Nichole E , Maier Lisa
Published: September 2021

Background Most phenotyping paradigms in sarcoidosis are based on expert opinion; however, no paradigm has been widely adopted because of the subjectivity in classification. We hypothesized that cluster analysis could be performed on common clinical variables to define more objective sarcoidosis phenotypes. MethodsModel-based clustering was performed using the VarSelLCM R package to identify distinct phenotypes of sarcoidosis based on 29 clinical features. The Integrated Completed Likelihood (ICL) criteria were used to estimate number of clusters. To identify features associated with cluster membership, features were ranked based on variable importance scores from the VarSelLCM model, and additional univariate tests (Fisher’s exact test and one-way ANOVA) were performed using q-values correcting for multiple testing. The Wasfi severity score was also compared between clusters. ResultsCluster analysis resulted in 6 sarcoidosis phenotypes. Salient characteristics for each cluster are as follows: Phenotype 1) supranormal lung function and majority Scadding stage 2/3; phenotype 2) supranormal lung function and majority Scadding stage 0/1; phenotype 3) normal lung function and split Scadding stages between 0/1 and 2/3; phenotype 4) obstructive lung function and majority Scadding stage 2/3; phenotype 5) restrictive lung function and majority Scadding stage 2/3; phenotype 6) mixed obstructive and restrictive lung function and mostly Scadding stage 4. Clusters 4,5,6 were significantly more likely to have ever been on immunosuppressive treatment and had higher Wasfi disease severity scores. ConclusionsCluster analysis produced 6 sarcoidosis phenotypes that demonstrated non-severe and severe phenotypes. Phenotypes 1,2,3 have less lung function abnormalities, a lower percentage on immunosuppressive treatment and lower Wasfi severity scores. Phenotypes 4,5,6 were characterized by lung function abnormalities, more parenchymal abnormalities, an increased percentage on immunosuppressive treatment and higher Wasfi severity scores. These data support using cluster analysis as an objective and clinically useful way to phenotype sarcoidosis subjects.
Symmetry resolved atomic photoionization phase shift by attosecond coincidence metrology
Authors: Jiang Wenyu , Armstrong Gregory S. J. , Tong Jihong , Xu Yidan , Zuo Zitan , Qiang Junjie , Lu Peifen , Clarke Daniel D. A. , Benda Jakub , Fleischer Avner , Ni Hongcheng , Ueda Kiyoshi , Hart Hugo van der , Brown Andrew C. , Gong Xiaochun , Wu Jian
Published: September 2021

Attosecond chronoscopy is central to the understanding of ultrafast electron dynamics from gas to condensed phase with attosecond temporal resolution. It has, however, not yet been able to determine the timing of individual partial waves, and steering their contribution has been a substantial challenge. Here, we develop a polarization-skewed attosecond chronoscopy to reveal their roles from the angle-resolved photoionization phase shifts in rare gas atoms. By scanning the relative polarization angle between an extreme-ultraviolet attosecond pulse train and a phase-locked near-infrared laser field serving as a partial wave meter, we break the cylindrical symmetry and observe an emission direction dependent phase shift in the photoionized electron momenta. The experimental observations are well supported by numerical simulations using the R-matrix with time-dependence method, and by analytical analysis using the soft-photon approximation. Our symmetry-resolved, partial-wave analysis identifies the transition rate and phase shifts of each individual ionization pathway in the attosecond photoelectron emission dynamics. Our findings provide critical insights into the ubiquitous attosecond optical timer and the underlying attosecond photoionization dynamics, thereby offer new perspectives for the control, manipulation, and exploration of ultrafast electron dynamics in complex systems.
Quantifying Intra- and Interlimb Coordination in Persons With Hemiparesis Post-stroke
Authors: Duff Susan V , Miller Aaron J , Quinn Lori , Youdan Gregory A , Bishop Lauri , Ruthrauff Heather , Wade Eric R
Published: September 2021

BackgroundIndividuals with hemiparesis post-stroke often have difficulty with tasks requiring upper extremity (UE) intra- and interlimb coordination, yet methods to quantify both are limited. Objective: To develop a quantitative yet sensitive method to identify distinct features of UE intra- and interlimb coordination. MethodsTwenty adults post-stroke and 20 controls wore five inertial sensors (wrists, upper arms, sternum) during 12 seated UE tasks. Three sensor modalities (acceleration, angular rate of change, orientation) were examined for three metrics (peak to peak amplitude, time, and frequency). To allow for comparison between sensor data, the resultant values were combined into one motion parameter, per sensor pair, using a novel algorithm. This motion parameter was compared in a group-by-task analysis of variance as a similarity score (0-1) between key sensor pairs: sternum to wrist, wrist to wrist, and wrist to upper arm. A use ratio (paretic/non-paretic arm) was calculated in persons post-stroke from wrist sensor data for each modality and compared to scores from the Adult Assisting Hand Assessment (Ad-AHA Stroke) and UE Fugl-Meyer (UEFM). ResultsA significant group x task interaction in the similarity score was found for all key sensor pairs. Post-hoc tests between task type revealed significant differences in similarity for sensor pairs in 8/9 comparisons for controls and 3/9 comparisons for persons post stroke. The use ratio was significantly predictive of the Ad-AHA Stroke and UEFM scores for each modality. ConclusionsOur algorithm and sensor data analyses distinguished task type within and between groups and were predictive of clinical scores. Future work will assess reliability and validity of this novel metric to allow development of an easy-to-use app for clinicians.
What Do We Know About the Health Status of Asylum Seekers in the United States? Identifying Research Gaps Following a Bibliometric Scoping Review of Existing Literature
Authors: Beer Jessica , Dorris C. Scott , Fateen Dahlia , Mishori Ranit
Published: September 2021

Background: Asylum Seekers are a high-risk group from a health perspective. The US is the largest recipient of asylum applications in the world. Multiple articles exist on asylum seekers’ health, but, anecdotally, the majority originate from Europe and elsewhere. We sought to assess the current health and medical literature on asylum seekers in the US, where asylum seekers are a distinct population from refugees. This limited representation in the scientific literature can impact the care they receive. We analyzed the existing literature on asylum seekers in the US via a Scoping Review of the literature from 1946 to 2020 that discussed the health of asylum seekers in the US. Refugees were excluded given their legal status which distinguishes the protections they receive. Results: A total of 114 articles were identified; 48 (42.1%) of which were empirical studies; (66 (57.9%) were editorials or commentaries. Analysis of empirical studies revealed enhanced focus on mental health (60.42%), on African asylees (45.83%). The majority of the editorials and commentaries focused on detention and the medico-legal process (31.82% and 30.3% respectively). Conclusion: Empirical data on the health of asylum seekers in the US context is very limited. Research gaps include domains that span the medical, social, and legal fields. Research expansion requires increased dedication from the research community, funding, and the ethical engagement of these vulnerable populations. This is especially important given the unprecedented migration and displacement of populations in the 21st century.
Efficacy of Combination Therapy With The JAK Inhibitor Baricitinib In The Treatment of COVID-19
Authors: Thoms Brendan Lawless , Gosselin Jeanne , Libman Bonita , Littenberg Benjamin , Budd Ralph
Published: September 2021

BACKGROUND:
Coronavirus disease-19 (COVID-19), resulting from infection with SARS-CoV-2, spans a wide spectrum of illness. In severely ill patients, highly elevated serum levels of certain cytokines and considerable cytolytic T cell infiltrates in the lungs have been observed. These same patients may bear low to negligible viral burdens suggesting that an overactive immune response, often termed cytokine storm, contributes to the severity of COVID-19. We report the safety and efficacy of baricitinib combined with remdesivir and dexamethasone in 45 hospitalized patients with COVID-19 pneumonia at a tertiary academic medical center.
METHODS:
Retrospective review of 45 patients hospitalized with COVID-19 pneumonia. Patients received 7-day course of baricitinib, 5-day course of remdesivir and 10-day course of dexamethasone. Clinical status and biomarkers were obtained daily. Outcomes assessed include mortality, duration of hospitalization, presence of shock, need for supplemental oxygen, need for non-invasive ventilation, need for mechanical ventilation and development of thrombosis.
RESULTS:
Obesity and multiple medical comorbidities were associated with hospitalization in the setting of COVID-19. Treated patients demonstrated rapid declines of C-reactive protein (CRP), ferritin and D-dimer with gradual improvement in hemoglobin, platelet counts and clinical status. Only 2 of 45 (4.4%) treated patients required mechanical ventilation after initiating treatment and there were six deaths (13.3%).Only 2 of 45 (4.4%) treated patients required mechanical ventilation after initiating treatment. There were six deaths (13.3%) and these were associated with lower BMI.
CONCLUSIONS:
These findings support the utility of immunosuppression via JAK inhibition in moderate to severe COVID-19 pneumonia.
A QoS-aware Scheduling with Node Grouping for IEEE 802.11ah
Authors: Ahmed Nurzaman , Hussain Iftekhar
Published: September 2021

The recent IEEE 802.11ah amendment has proven to be suitable for supporting large-scale devices in Internet of Things (IoT). It is essential to provide a minimum level of Quality of Service (QoS) for critical applications such as industrial automaton and healthcare. In this paper, we propose a QoSaware Medium Access Control (MAC) layer solution to enhance network reliability and reduce critical traffic latency by an adaptive station grouping and a priority traffic scheduling scheme. The proposed grouping scheme calculates the current traffic load and distributes among different RAW groups considering different requirements of the stations. The RAW scheduling scheme further provides priority slot access using a novel backoff scheme. Markov-chain model is developed to study the throughput and latency behaviours for the traffic generated from the critical application. The proposed protocol shows significant delay improvement for priority traffic. The overall throughput performance improves up to 12.7% over the existing RAW grouping scheme.
Long-Term Exposure of Binary Mixture of Cadmium And Mercury Through Alteration of Nrf2 Signalling Pathway Damages The Developed Ovary of Zebrafish
Authors: Patel Utsav N , Patel Urvesh D , Kadayata Aniket V , Vaja Rahul K , Modi Chirag M , Patel Harshad B
Published: September 2021

The toxicity of the binary mixture of cadmium (Cd) and mercury (Hg) on the ovary of adult zebrafish was evaluated in the present study. Adult female zebrafish were exposed to cadmium chloride (1 mg/L), mercury chloride (30 µg/L) and a binary mixture of both metals for 21 days. The toxic effects of both metals on the ovary were investigated by evaluating the oxidative stress markers and related gene expression in ovarian tissue along with the histopathological examination. The significantly decreased level of GSH and increased level of MDA in ovarian tissue of adult female zebrafish exposed to Cd + Hg indicated that the exposure of binary mixture of Cd and Hg caused more lipid peroxidation in the ovary. The decreased expression of mRNA of catalase (CAT) and Nuclear factor erythroid 2 (NF-E2)-related factor 2 (Nrf2) were observed in the ovary of zebrafish exposed to binary mixture. The down regulation of Nrf2 might be responsible for suppression of the antioxidant system which resulted in cellular alterations in the ovary. Upon histological evaluation, a decreased number of full-growth (mature) oocytes along with degenerative changes due to Cd exposure were noticed. While, ovary of zebrafish of Hg-exposed group had shown decreased number of pre- and early-vitellogenic oocytes along with atretic pre-vitellogenic oocytes compared to the control group. The ovary of zebrafish of Cd + Hg-exposed group had shown decreased number of pre-vitellogenic oocytes with marked pathological changes in mature oocytes. Present findings elucidate that simultaneous long-term exposure of Cd and Hg may significantly affect the ovary through alteration of Nrf2 mediated cascade in adult zebrafish.
Antagonizing the metabolic hormone cholecystokinin (CCK) and its receptor CCKAR in the lung abolishes obesity-induced airway hyperresponsiveness
Authors: Pangniban Ronald , Sun Maoyun , Park Chan Young , Koh Alvin , Kasahara David , Israel Elliot , Hershenson Marc , Weiss Scott , Himes Blanca , Fredberg Jeffrey , Tantisira Kelan , Shore Stephanie , Lu Quan
Published: September 2021

Obesity is a significant co-morbidity that associates with increased prevalence and severity of asthma. The mechanism underlying the obesity-asthma association remains poorly understood, and for obese asthmatics there is no effective therapy for obese asthmatics. Here we show that cholecystokinin (CCK)—a metabolic hormone best known for its roles in satiety regulation and fat metabolism–is increased in the lungs of obese mice and that pharmacological blockade of CCK and its receptor (CCKAR) signaling in the lung abolishes obesity-associated airway hyperresponsiveness (AHR)—a hallmark of asthma. By mining existing RNA-seq transcriptomic data, we first discovered CCKAR as a highly expressed G-protein-coupled receptor in primary human airway smooth muscle (ASM) cells. Interestingly, CCK is also expressed in ASM cells and is induced by free fatty acids. Activation of CCKAR by CCK induces ASM stiffening and contraction, which is abolished by either CRISPR-mediated CCKAR inactivation or CCKAR antagonists. In vivo, CCK levels are elevated in the lung of both genetically obese (db/db) and diet-induced obese mice. Importantly, intranasal administration of highly potent CCKAR antagonists (proglumide and devazepide) abolishes AHR in both genetically obese and diet-induced obese mice. Together, our results reveal an unexpected role for the metabolic hormone CCK and its receptor CCKAR in airway smooth muscle cells and in obesity-associated asthma. Our study provides critical pre-clinical data that support the repurposing of CCKAR antagonists as a novel therapy for obese asthmatics.
Capacity of Community Advisory Boards for Effective Engagement in Clinical Research; a Mixed Methods Study
Authors: Mugenyi Levicatus , Mijumbi Andrew , Nanfuka Mastula , Agaba Collins , Kaliba Fedress , Semakula Irene Seryazi , Nazziwa Winfred Badanga , Ochieng Joseph
Published: September 2021

Background: Community engagement is a key component in health research. One of the ways health researchers ensure community engagement is through Community Advisory Boards (CABs). The capacity of CABs to properly perform their role in clinical research has not been well described in many resource limited settings. In this study, we assessed the capacity of CABs for effective community engagement in Uganda.Methods: We conducted a cross sectional study with mixed methods. We used structured questionnaires and key informant interviews (KII) to collect data from CAB members, trial investigators, and community liaison officers. For quantitative data, we used descriptive statistics while for qualitative data we used content analysis. Results: Seventy three CAB members were interviewed using structured questionnaires; 58.9% males, median age 49 years (IQR: 24-70), 71.2% had attained tertiary education, 42.5% never attended any research ethics training, only 26% had a training in human subject protection, 30.1% had training in health research, 50.7% never attended any training about the role of CABs, and 72.6% had no guidelines for their operation. On the qualitative aspect, 24 KIIs cited CAB members to have some skills and ability to understand and review study documents, offer guidance on community norms and expectations and give valuable feedback to the investigators. However, challenges like limited resources, lack of independence and guidelines, and knowledge gaps about research ethics were cited as hindrances of CABs capacity.Conclusion: Though CABs have some capacity to perform their role in the Ugandan setting, their functionality is limited by lack of resources to facilitate their work, independence, guidelines for their operations and limited knowledge.
Predictors of Peri-Ophthalmic Aneurysm Incomplete Occlusion and Visual Symptoms After Treatment with a Pipeline Embolization Device: A Multi-Center Cohort Study
Authors: XU CHAO , WU PEI , SUN BOWEN , XU SHANCAI , LUO BIN , YANG XINJIAN , SHI HUAIZHANG
Published: September 2021

Objective: Peri-ophthalmic aneurysm is a special type of aneurysm. We assessed the relationship between ophthalmic artery (OA) origin and aneurysm and examined the effect of a pipeline embolization device (PED, Covidien/Medtronic) with or without coils on aneurysm occlusion rate and visual outcomes.Methods: We retrospectively analyzed 194 peri-ophthalmic aneurysms in 189 patients among 1,171 patients treated with a PED in a Chinese post-market multi-center registry study from November 2014 to October 2019. Peri-ophthalmic aneurysms were defined as carotid–ophthalmic segment aneurysms arising from the internal carotid artery dorsal wall at, or distal to, the OA origin, with a superior or superomedial projection. The relationship between OA origin and the aneurysm was classified as follows: Type A, OA originating separate from the aneurysm; Type B, OA originating from the aneurysm neck or dome. Patients with aneurysm were divided into the PED-only group and the PED + coils group according to treatment. Results: The median follow-up time was 6.8 months (range, 5.3–20.2 months). There were 163 occluded aneurysms (84%) and 31 aneurysms with incomplete occlusion (16%). A multivariate analysis showed that Type B aneurysm was a risk factor for incomplete occlusion in the PED-only group (odds ratio [OR] 4.951, 95% confidence interval [CI] 1.904-12.875, p = 0.001). Visual symptoms at final follow up correlated with preoperative visual symptoms (OR 16.005, 95% CI 2.505-102.273, p = 0.003).Conclusions: Type B aneurysm is associated with a lower occlusion rate after PED-only treatment. Patients with preoperative visual symptoms should be treated promptly to avoid permanent visual symptoms.
Patients’ Perspectives of Telemedicine Appointments for Psoriatic Arthritis During The COVID-19 Pandemic: Results of a Patient-Driven Pilot Survey
Authors: Jethwa Hannah , Brooke Melanie , Parkinson Andrew , Dures Emma , Gullick Nicola J
Published: September 2021

BackgroundOver recent years the lack of patient involvement in the design, set-up and implementation of clinical research studies has been well recognised; as such there has been a drive within research communities to increase patient participation. Anecdotally, patient perspectives on telemedicine differ widely, with variation in whether patients feel remote consultations are beneficial. By means of a patient-driven survey, we aimed to formally evaluate patient perspectives on its benefits and pitfalls, focusing on patients with psoriatic arthritis (PsA).MethodsAn e-survey was developed by two patient representatives on the BritPACT steering committee, with a view to determining unmet needs and the perceived impact on clinical care of virtual consultations amongst patients with PsA. Results128 patients responded to the e-survey. 109 patients rated the effectiveness of their telemedicine appointment and, of these, 18% felt their virtual consultation was very/extremely effective compared to a face-to-face consultation and 49% felt it was somewhat/equally as effective; furthermore, 48% (51/107) felt that such virtual consultations would be of benefit to them after the pandemic. 36% of respondents felt their virtual consultation was not as effective as a face-to-face review. Themes identified from open-ended questions included the lack of visual cues, lack of physical examination and effect on rapport and ease of open communication as the main pitfalls of virtual consultations. Patients with well-controlled symptoms appeared more satisfied with remote reviews compared to those with active disease, though on the whole respondents recognised the benefits, such as saving travel time and costs. Those who had an established relationship with their health professional appeared less concerned regarding virtual consultations though a recurring view was that newly diagnosed patients should have face-to-face appointments to build rapport and improve symptom control at an early stage.ConclusionsOverall patients’ perspectives on virtual consultations varied widely though patients with well-controlled symptoms and those who had a previously established relationship with their healthcare professionals and well-controlled disease appeared more satisfied with remote reviews. Patient-driven surveys may improve our true understanding of patients’ perspectives by improving engagement and honesty compared to surveys constructed by healthcare providers.
CD8 T cells and antibodies drive SARS-CoV-2 evolution in chronic infection
Authors: Khatamzas Elham , Muenchhoff Maximilian , Rehn Alexandra , Graf Alexander , Hellmuth Johannes , Hollaus Alexandra , Mohr Anne-Wiebe , Gaitzsch Erik , Weiglein Tobias , Georgi Enrico , Scherer Clemens , Stecher Stephanie-Susanne , Gruetzner Stephanie , Blum Helmut , Krebs Stefan , Reischer Anna , Leutbecher Alexandra , Subklewe Marion , Dick Andrea , Zange Sabine , Girl Philipp , Mueller Katharina , Weigert Oliver , Hopfner Karl-Peter , Stemmler Hans-Joachim , von Bergwelt-Baildon Michael , Keppler Oliver , Wölfel Roman , Moosmann Andreas , Antwerpen Markus
Published: September 2021

​​Since its recent zoonotic spill-over severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is constantly adapting to the human host as illustrated by the emergence of variants of concern with increased transmissibility and immune evasion. Prolonged replication in immunosuppressed individuals and evasion from spike-specific antibodies is known to drive intra-host SARS-CoV-2 evolution. Here we show for the first time the major role of CD8 T cells in SARS-CoV-2 evolution. In a patient with chronic, ultimately fatal infection, we observed three spike mutations that prevented neutralisation by convalescent plasma therapy. Moreover, at least four mutations in non-spike proteins emerged that hampered CD8 T-cell recognition of mutant epitopes, two of these occurred before spike mutations. A comparison with worldwide sequencing data showed that several of these T-cell escape mutations had emerged independently as homoplasies in multiple circulating lineages. We propose that human leukocyte antigen class I contributes to shaping the evolutionary landscape of SARS-CoV-2.