bluuebunny/crossref_metadata_2025 huggingface dataset:
P624 A higher prevalence of human papillomavirus in patients with perianal fistulizing Crohn’s disease compared to patients with anorectal fistula without Crohn’s disease
Authors: Rodrigues Boarini L , Sobrado Jr C W , Facanali C B G , Queiroz N S F , Albuquerque I C , Boarini P , Boarini M R , Borba M R , Nahas S C , Cecconello I
Published: May 2021

Background

Perianal fistulizing Crohn’s disease (PFCD) is the main risk factor for anal cancer in patients with inflammatory bowel disease. It is not known whether this occurs due to a higher frequency of human papillomavirus (HPV) in this population or due to the chronic inflammatory condition resulting from perianal fistulas. We aimed to evaluate whether there is a higher prevalence of HPV and high-risk HPV in patients with PFCD compared to the control group, estimate the prevalence of HPV and the subtypes most frequently associated with PFCD.

Methods

We performed a bicentric cross sectional study in which participants were matched by age and sex. A total of 108 patients with surgical indication for perianal fistula, were recruited, 54 patients in PFCD group and 54 patients with anorectal fistula without Crohn’s disease, from December 2018 through November 2020. These patients were subject to histological material collection during exam under anesthesia with biopsy of the fistulous pathway. The sample was sent for HPV detection and genotyping by INNO-LiPA HPV Genotyping Extra II.

Results

The PFCD group showed a statistically higher frequency of HPV in the fistulous path compared to control group (33.3% vs 16.7%, p = 0.046). The isolated analysis of the high-risk subtypes numerically demonstrated double the frequency in PFCD group, however, not statistically significant (18.5% vs 9.3%, p = 0.164). After multiple logistic regressions, patients with PFCD had a chance of HPV 3.42 times higher than patients without Crohn’s disease (OR = 3.42, 95% CI, 1.25–9.40), regardless of other variables. The subtypes most frequently identified in PFCD group were HPV11 (12.72%) and HPV16 (9.09%).

Conclusion

Perianal fistulizing Crohn’s disease is associated with a higher prevalence of HPV compared to patients with anorectal fistula without Crohn’s disease.
P652 Treatment patterns in patients receiving outpatient care for inflammatory bowel disease in Russian Federation
Authors: Uspenskiy Y , Galagudza M , Ivanov S , Fominikh Y , Dreval R , Mayorova O
Published: May 2021

Background

There is a global trend of increasing prevalence of inflammatory bowel disease (IBD) worldwide, Russian Federation including. Meanwhile, treatment options for patients with IBD have expanded significantly in recent years with the advent of novel biotherapeutics. However, insufficient information is available on the treatment patterns of Crohn’s disease (CD) and ulcerative colitis (UC) in large cities. We aimed to study the levels of usage of different therapeutic agents in the patients with IBD receiving outpatient care in St-Petersburg, Russian Federation.

Methods

In a cross-sectional study lasting from January 1, 2019 to December 31, 2019, the data on drug therapy of adult (> 18 years old) patients with IBD were obtained from 42 outpatient clinics of St. Petersburg. The Wilson’s method of 95% confidence interval (CI) determination was used to determine the statistical differences in the levels of usage of different therapeutics. р values ≤ 0.05 were considered significant. The data on continuous variables are presented as “median (25 quartile; 75 quartile)”.

Results

In total, 535 patients were included. Among them, there were 241 and 294 patients with CD and UC, respectively. Mean age of the patients with CD and UC was 40 (29; 59) and 43 (32; 59) years, respectively (p > 0.05). Among the patients with CD, the ileal, colonic, ileocolonic, and other locations were found in 23.4, 37.6, 34.4, and 4.6 %, respectively. In UC patients, we observed proctitis, left-sided colitis and pancolitis in 24.4, 55.2, and 20.4%, respectively. Oral 5-aminosalicylic acid (5-ASA) drugs, topical 5-ASA drugs, oral (both systemic and topical) glucocorticoids, immunosuppressants, and biologicals were used in 89.3 (84.4–92.8), 32.6 (26.7–39.1), 17.5 (13.0–23.1), 16.5 (12.2–22.0), and 7.3% (0.4–11.7) of patients with CD, accordingly. In UC patients, oral 5-ASA, topical 5-ASA, oral (both systemic and topical) glucocorticoids, immunosuppressants, and biologicals were used in 86.2 (81.4–90.0), 63.1 (56.9–68.8), 12.1 (8.6–16.8), 4.4 (2.5–7.7), and 0.8% (0.02–2.7) of cases, accordingly.

Conclusion

Oral 5-ASA is the most commonly used class of drugs in Russian patients with both CD and UC. The use of topical 5-ASA formulations was more common in patients with UC as compared to CD patients, while immunosuppressive drugs were more commonly prescribed to CD vs. UC patients. We found relatively rare use of systemic and topical oral glucocorticoids in the patients with IBD receiving outpatient care. In our cohort, the use of biological agents was minimal, which probably reflects the trend of prescribing biologicals mostly at the specialized clinics.
Pulsed field ablation prevents chronic atrial fibrotic changes and restrictive mechanics after catheter ablation for atrial fibrillation
Authors: Nakatani Yosuke , Sridi-Cheniti Soumaya , Cheniti Ghassen , Ramirez F Daniel , Goujeau Cyril , André Clementine , Nakashima Takashi , Eggert Charles , Schneider Christopher , Viswanathan Raju , Krisai Philipp , Takagi Takamitsu , Kamakura Tsukasa , Vlachos Konstantinos , Derval Nicolas , Duchateau Josselin , Pambrun Thomas , Chauvel Remi , Reddy Vivek Y , Montaudon Michel , Laurent François , Sacher Frederic , Hocini Mélèze , Haïssaguerre Michel , Jaïs Pierre , Cochet Hubert
Published: May 2021

Aims

Pulsed field ablation (PFA), a non-thermal ablative modality, may show different effects on the myocardial tissue compared to thermal ablation. Thus, this study aimed to compare the left atrial (LA) structural and mechanical characteristics after PFA vs. thermal ablation.

Methods and results

Cardiac magnetic resonance was performed pre-ablation, acutely (<3 h), and 3 months post-ablation in 41 patients with paroxysmal atrial fibrillation (AF) undergoing pulmonary vein (PV) isolation with PFA (n = 18) or thermal ablation (n = 23, 16 radiofrequency ablations, 7 cryoablations). Late gadolinium enhancement (LGE), T2-weighted, and cine images were analysed. In the acute stage, LGE volume was 60% larger after PFA vs. thermal ablation (P < 0.001), and oedema on T2 imaging was 20% smaller (P = 0.002). Tissue changes were more homogeneous after PFA than after thermal ablation, with no sign of microvascular damage or intramural haemorrhage. In the chronic stage, the majority of acute LGE had disappeared after PFA, whereas most LGE persisted after thermal ablation. The maximum strain on PV antra, the LA expansion index, and LA active emptying fraction declined acutely after both PFA and thermal ablation but recovered at the chronic stage only with PFA.

Conclusion

Pulsed field ablation induces large acute LGE without microvascular damage or intramural haemorrhage. Most LGE lesions disappear in the chronic stage, suggesting a specific reparative process involving less chronic fibrosis. This process may contribute to a preserved tissue compliance and LA reservoir and booster pump functions.
A programme for early diagnosis of atrial fibrillation: a multi-centre study in primary care
Authors: Cabrera Javier D , Fluxà Guillem , Fuentes Carmen , Hoyo Jordi , Navarro Marta , Sant Elisenda , de la Poza María Amparo , Altés Andrés , Duch Núria , Caubet Montserrat , Vieytes Gerardo , Pérez Ana M , Herrero María Alba , Gracia Pablo , Domínguez Veronica , Mont Lluís , Coll-Vinent Blanca
Published: May 2021

Background

Atrial fibrillation (AF) is a morbid disease whose complications can be prevented if prompt and correctly treated.

Objective

To assess the usefulness of an early AF diagnosis programme in at-risk individuals in primary care centres.

Methods

In an open-label, multi-centre, controlled interventional study, individuals with one or more risk factors for AF but without known AF were enrolled. They were allocated to intervention and control groups in a 1:2 ratio. Participants in the intervention group had three clinical and educational visits (0, 6 and 12 months). In intervention subgroup A, an electrocardiogram (ECG) was performed at each visit and in subgroup B, only if arrhythmia was detected on auscultation. After 2 years, the medical records of all participants were reviewed. Participants diagnosed with AF were followed for two additional years.

Results

Of the total 2231 participants enrolled, 1503 (67.36%) were allocated to the control group and 728 (32.63%) to the intervention groups (355 in subgroup A, 373 subgroup B). The groups showed similar clinical characteristics. New-onset AF was diagnosed in 38 patients. Early detection in subgroup B was similar to subgroup A and superior to control group (3.2% versus 1.2%, hazard ratio 3.149, 95% confidence interval 1.503–6.597, P = 0.002). AF patients in subgroups A and B had similar long-term complications and a tendency for fewer complications than AF patients in the control group.

Conclusions

An intervention programme consisting of health education, systematic auscultation and opportunistic ECG by a primary care provider is a useful method for the early diagnosis of AF.
Patient portal engagement and diabetes management among new portal users in the Veterans Health Administration
Authors: Zocchi Mark S , Robinson Stephanie A , Ash Arlene S , Vimalananda Varsha G , Wolfe Hill L , Hogan Timothy P , Connolly Samantha L , Stewart Maureen T , Am Linda , Netherton Dane , Shimada Stephanie L
Published: May 2021

Objective

The study sought to investigate whether consistent use of the Veterans Health Administration’s My HealtheVet (MHV) online patient portal is associated with improvement in diabetes-related physiological measures among new portal users.

Materials and Methods

We conducted a retrospective cohort study of new portal users with type 2 diabetes that registered for MHV between 2012 and 2016. We used random-effect linear regression models to examine associations between months of portal use in a year (consistency) and annual means of the physiological measures (hemoglobin A1c [HbA1c], low-density lipoproteins [LDLs], and blood pressure [BP]) in the first 3 years of portal use.

Results

For patients with uncontrolled HbA1c, LDL, or BP at baseline, more months of portal use in a year was associated with greater improvement. Compared with 1 month of use, using the portal 12 months in a year was associated with annual declines in HbA1c of -0.41% (95% confidence interval [CI], -0.46% to -0.36%) and in LDL of -6.25 (95% CI, -7.15 to -5.36) mg/dL. Twelve months of portal use was associated with minimal improvements in BP: systolic BP of -1.01 (95% CI, -1.33 to -0.68) mm Hg and diastolic BP of -0.67 (95% CI, -0.85 to -0.49) mm Hg. All associations were smaller or not present for patients in control of these measures at baseline.

Conclusions

We found consistent use of the patient portal among new portal users to be associated with modest improvements in mean HbA1c and LDL for patients at increased risk at baseline. For patients with type 2 diabetes, self-management supported by online patient portals may help control HbA1c, LDL, and BP.
Automated detection of substance use information from electronic health records for a pediatric population
Authors: Ni Yizhao , Bachtel Alycia , Nause Katie , Beal Sarah
Published: May 2021

Objective

Substance use screening in adolescence is unstandardized and often documented in clinical notes, rather than in structured electronic health records (EHRs). The objective of this study was to integrate logic rules with state-of-the-art natural language processing (NLP) and machine learning technologies to detect substance use information from both structured and unstructured EHR data.

Materials and Methods

Pediatric patients (10-20 years of age) with any encounter between July 1, 2012, and October 31, 2017, were included (n = 3890 patients; 19 478 encounters). EHR data were extracted at each encounter, manually reviewed for substance use (alcohol, tobacco, marijuana, opiate, any use), and coded as lifetime use, current use, or family use. Logic rules mapped structured EHR indicators to screening results. A knowledge-based NLP system and a deep learning model detected substance use information from unstructured clinical narratives. System performance was evaluated using positive predictive value, sensitivity, negative predictive value, specificity, and area under the receiver-operating characteristic curve (AUC).

Results

The dataset included 17 235 structured indicators and 27 141 clinical narratives. Manual review of clinical narratives captured 94.0% of positive screening results, while structured EHR data captured 22.0%. Logic rules detected screening results from structured data with 1.0 and 0.99 for sensitivity and specificity, respectively. The knowledge-based system detected substance use information from clinical narratives with 0.86, 0.79, and 0.88 for AUC, sensitivity, and specificity, respectively. The deep learning model further improved detection capacity, achieving 0.88, 0.81, and 0.85 for AUC, sensitivity, and specificity, respectively. Finally, integrating predictions from structured and unstructured data achieved high detection capacity across all cases (0.96, 0.85, and 0.87 for AUC, sensitivity, and specificity, respectively).

Conclusions

It is feasible to detect substance use screening and results among pediatric patients using logic rules, NLP, and machine learning technologies.
Growth performance and carcass quality are not different between pigs fed diets containing cold-fermented low-oil DDGS and pigs fed conventional DDGS, but pelleting improves gain to feed ratio regardless of source of DDGS
Authors: Rodriguez Diego A , Lee Su A , Stein Hans H
Published: May 2021

The objective of this study was to test the hypothesis that growth performance and carcass characteristics of pigs fed diets containing cold-fermented, low oil distillers dried grains with solubles (DDGS) is not different from that of pigs fed diets containing conventional DDGS regardless of the physical form of the diets. A total of 160 barrows and gilts were used. There were 4 diets, 10 pens per diet, and 4 pigs per pen. Pigs were weaned at 21 d of age and fed a common phase 1 diet that did not contain DDGS during the initial 7 d post-weaning. Pigs were then allotted to the four diets that were arranged in a 2 × 2 factorial design with two sources of DDGS (cold-fermented and conventional DDGS) and two diet forms (meal and pellets). Pigs were fed phase 2 diets from day 7 to 21 and phase 3 diets from day 21 to 43 post-weaning. All diets were based on corn and soybean meal, but phase 2 diets also contained 15% DDGS and phase 3 diets contained 30% DDGS. From day 43, pigs were fed grower diets for 38 d, early finisher diets for 38 d, and late finisher diets for 18 d and these diets also contained 30% DDGS. Feed was provided on an ad libitum basis and daily feed allotments were recorded. Pigs were weighed at the beginning of each phase and at the conclusion of the experiment. On the last day of the experiment, the pig in each pen with a body weight that was closest to the pen average was slaughtered and carcass measurements were determined. Combined results for the two nursery phases indicated that feeding meal diets instead of pelleted diets increased (P < 0.001) average daily feed intake and decreased (P < 0.05) gain to feed ratio (G:F). However, no differences between the two sources of DDGS were observed for the overall growth performance of weanling pigs. For the entire growing-finishing period, the source of DDGS did not affect growth performance, but pigs fed meal diets had reduced (P < 0.001) G:F compared with pigs fed the pelleted diets. There were no differences between the two sources of DDGS for carcass characteristics. Back fat was greater (P < 0.05) for pigs fed pelleted diets than for pigs fed meal diets. In conclusion, no differences in growth performance or carcass characteristics between pigs fed cold-fermented DDGS and pigs fed conventional DDGS were observed. However, pigs fed pelleted diets had greater G:F and greater back fat than pigs fed meal diets.
Evolution of splashback boundaries and gaseous outskirts: insights from mergers of self-similar galaxy clusters
Authors: Zhang Congyao , Zhuravleva Irina , Kravtsov Andrey , Churazov Eugene
Published: May 2021

A self-similar spherical collapse model predicts a dark matter (DM) splashback and accretion shock in the outskirts of galaxy clusters while missing a key ingredient of structure formation – processes associated with mergers. To fill this gap, we perform simulations of merging self-similar clusters and investigate their DM and gas evolution in an idealized cosmological context. Our simulations show that the cluster rapidly contracts during the major merger and the splashback radius rsp decreases, approaching the virial radius rvir. While in the self-similar model rsp depends on a smooth mass accretion rate parameter Γs, our simulations show that in the presence of mergers, rsp responds to the changes in the total mass accretion rate Γvir, which accounts for both mergers and smooth accretion. The scatter of the Γvir − rsp/rvir relation indicates a generally low Γs ∼ 1 in clusters in cosmological simulations. In contrast to the DM, the hot gaseous atmospheres significantly expand by the merger-accelerated (MA-) shocks formed when the runaway merger shocks overtake the outer accretion shock. After a major merger, the MA-shock radius is larger than rsp by a factor of up to ∼1.7 for Γs ≲ 1 and is ∼rsp for Γs ≳ 3. This implies that (1) mergers could easily generate the MA-shock-splashback offset measured in cosmological simulations, and (2) the smooth mass accretion rate is small in regions away from filaments where MA-shocks reside. We further discuss the shapes of the DM haloes, various shocks, and contact discontinuities formed at different epochs of the merger, and the ram-pressure stripping in cluster outskirts.
Non-linear dynamics of hydrodynamic tori as a model of oscillations and bending waves in astrophysical discs
Authors: Fairbairn Callum W , Ogilvie Gordon I
Published: May 2021

Understanding oscillations and waves in astrophysical fluid bodies helps to elucidate their observed variability and the underlying physical mechanisms. Indeed, global oscillations and bending modes of accretion discs or tori may be relevant to quasi-periodicity and warped structures around compact objects. While most studies rely on linear theory, observationally significant, non-linear dynamics is still poorly understood, especially in Keplerian discs for which resonances typically demand a separate treatment. In this work, we introduce a novel analytical model which exactly solves the ideal, compressible fluid equations for a non-self-gravitating elliptical cylinder within a local shearing sheet. The aspect ratio of the ring is an adjustable parameter, allowing a continuum of models ranging from a torus of circular cross-section to a thin ring. We restrict attention to flow fields which are a linear function of the coordinates, capturing the lowest order global motions and reducing the dynamics to a set of coupled ordinary differential equations (ODEs). This system acts as a framework for exploring a rich range of hydrodynamic phenomena in both the large amplitude and Keplerian regimes. We demonstrate the connection between tilting tori and warped discs within this model, showing that the linear modes of the ring correspond to oppositely precessing global bending modes. These are further confirmed within a numerical grid based simulation. Crucially, the ODE system developed here allows for a more tractable investigation of non-linear dynamics. This will be demonstrated in a subsequent paper which evidences mode coupling between warping and vertical motions in thin tilted rings.
Bridging the gap: spectral distortions meet gravitational waves
Authors: Kite Thomas , Ravenni Andrea , Patil Subodh P , Chluba Jens
Published: May 2021

Gravitational waves (GWs) have the potential to probe the entirety of cosmological history due to their nearly perfect decoupling from the thermal bath and any intervening matter after emission. In recent years, GW cosmology has evolved from merely being an exciting prospect to an actively pursued avenue for discovery, and the early results are very promising. As we highlight in this paper, spectral distortions (SDs) of the cosmic microwave background (CMB) uniquely probe GWs over six decades in frequency, bridging the gap between astrophysical high- and cosmological low-frequency measurements. This means SDs will not only complement other GW observations, but will be the sole probe of physical processes at certain scales. To illustrate this point, we explore the constraining power of various proposed SD missions on a number of phenomenological scenarios: early-universe phase transitions (PTs), GW production via the dynamics of SU(2) and ultralight U(1) axions, and cosmic string (CS) network collapse. We highlight how some regions of parameter space were already excluded with data from COBE/FIRAS , taken over two decades ago. To facilitate the implementation of SD constraints in arbitrary models, we provide GW2SD. This tool calculates the window function, which easily maps a GW spectrum to an SD amplitude, thus opening another portal for GW cosmology with SDs, with wide reaching implications for particle physics phenomenology.
Economic Loss from Rhizoctonia Bare Patch in Rainfed Winter Wheat and Spring Barley in Oregon
Authors: Smiley Richard W.
Published: May 2021

Economic loss from Rhizoctonia bare patch, caused by Rhizoctonia solani AG-8, was estimated in two 50-ha fields on a single farm. A winter wheat crop was managed as a conventionally cultivated 2-year wheat/fallow rotation and a spring barley crop was managed as a no-till annual crop. Aerial photographs revealed that the patch-affected area was nearly double in barley (17%) compared with wheat (9%). Yield inside patches was reduced by 73 and 68% for wheat and barley, respectively. Grain produced on each field was reduced more for winter wheat (21.6 metric tons [t], valued at US$5,080) than for spring barley (16.8 t, valued at US$2,784). More precise estimates of economic damage and more robust management practices for Rhizoctonia bare patch must be developed.
Moderate and deep procedural sedation-the role of proper monitoring and safe techniques in clinical practice
Authors: Manzi Joseph E. , Jones Mark R. , Cornett Elyse M. , Kaye Alan D.
Published: May 2021

Purpose of review

Interventional pain management procedures provide significant improvement to patient quality of life and functionality. In-office procedures are becoming an increasingly more common site of pain management intervention for patients with minimal risk of harm.

Recent findings

Moderate and deep sedation techniques can be used in patients with high anxiety, complex pharmacotherapy, or a low pain threshold. Proper guidance and oversight by an attending anesthesiologist, in addition to appropriate monitoring, are key. Epidural steroid injection complications rates have been cited at 2.4%, with the most common complications noted as persistent pain and flushing.

Serious complication errors can be avoided with proper supervision and monitoring. The adherence to published societal recommendations and guidelines for indications of when to use moderate to deep sedation techniques, and appropriate supervision and monitoring methods, can avoid errors in interventional pain management procedures.
An update on pediatric sedation techniques in nonoperating room locations
Authors: Sobey Jenna , Tsai Mitchell H. , Evans Rebecca E.
Published: May 2021

Purpose of review

To review advancements in care for pediatric patients in nonoperating room settings.

Recent findings

Advances in patient monitoring technology, utilization of Child Life specialists, and alternative staffing models are helping anesthesia providers meet the rising demand for coverage of pediatric nonoperating room anesthesia (NORA) cases. The Wake Up Safe and Pediatric Sedation Research Consortium registries are exploring outcome measures regarding the safety of pediatric anesthesia in off-site locations and have reported an increased risk for severe respiratory and cardiac adverse events when compared to OR anesthesia sites. Additionally, malpractice claims for NORA have a higher proportion of claims for death than claims in operating rooms.

Pediatric NORA requires thorough preparation, flexibility, and vigilance to provide safe anesthesia care to children in remote locations. Emerging techniques to reduce anesthetic exposure, improve monitoring, and alternative staffing models are expanding the boundaries of pediatric NORA to provide a safer, more satisfying experience for diagnostic and interventional procedures.
Severe bleeding in the ICU
Authors: Rauer Marcel J. , Neef Vanessa , Berra Lorenzo
Published: May 2021

Purpose of review

Severe bleeding events, which require blood transfusions, are a challenge faced by many critical care physicians on a daily basis. Current transfusion guidelines generally recommend rather strict transfusion thresholds and strategies, which can appear opposing to a patient in need for urgent transfusion at first sight. Moreover, applied guidelines are lacking evidence and specificity for the typical ICU patient population and its comorbidities. Transfusion decisions, which are pivotal for clinical outcome, are often unsatisfactorily based on hemoglobin levels only.

Recent findings

Recent publications generally support previous studies that a strict transfusion regimen is superior to a liberal one for the majority of cases. Newly developed and easily feasible techniques are currently in clinical trials and have the potential to become a valuable supplementation to hemoglobin-guided decision-making. In addition to the choice of the ideal transfusion strategy, physiological status and comorbidities were found to have a major impact on the outcome of severe bleedings in the ICU.

The body of evidence for ICU-specific transfusion guidelines is scarce. Critical care physicians should properly evaluate their patient's comorbidities and consider extended point-of-care testing for transfusion decisions in indistinct anemic situations. A strict transfusion strategy should, however, be applied whenever possible.
Sequential immunotherapy in melanoma: is it a realistic alternative to dual immunotherapy?
Authors: Wilson Thomas , Taylor Hannah , Winter Helen , Herbert Christopher
Published: May 2021

The treatment of metastatic melanoma has been revolutionised with the emergence of checkpoint inhibitors. The combination of Ipilimumab and Nivolumab offers the longest overall survival but is considerably more toxic than single-agent therapy. For patients who received single-agent immunotherapy it is unclear whether second-line immunotherapy is efficacious or tolerable. This study looked at outcomes for patients treated with sequential immunotherapy and compared them to patients who received dual immunotherapy. Fifty-eight patients received both Ipilimumab and an anti-PD-1 agent during the 5-year period, twenty-seven received dual immunotherapy, twenty received first-line Ipilimumab and eleven received an anti-PD-1 agent first line. The median overall survival (OS) was 24.8 months. The 5 year survival was greatest in patients treated with dual immunotherapy (42%) compared to first-line anti-PD-1 (33.3%) and first-line Ipilimumab (0%). As second-line treatments, anti-PD-1 agents had a median OS of 16.5 months compared to Ipilimumab at 3.4 months. 77.8% of patients had grade 3/4 toxicity with dual immunotherapy compared to 10% of patients treated with first-line Ipilimumab and 0% with anti-PD-1 agents. In the second line, 72.7% of patients treated with Ipilimumab experienced grade 3/4 toxicity, compared to 20% of patients treated with second-line anti-PD-1 agents. This study suggests Ipilimumab is not efficacious in patients who progress after anti-PD-1 agents, and this sequential approach does not avoid toxicity. The emergence of new checkpoint inhibitors will hopefully provide more efficacious treatment options for patients unable to tolerate Ipilimumab.
PET-CT for staging pT4b melanomas prior to sentinel lymph node biopsy: a 5-year review
Authors: Hardie Claire M. , Allouni Ammar , Edwards Sharon , Ahmed Najeeb , Maraveyas Anthony , Matteucci Paolo L.
Published: May 2021

In this centre, patients with pT4b cutaneous melanoma are staged using 18F-FDG PET–computed tomography (PET-CT) prior to considering sentinel lymph node biopsy (SLNB). The objective was to assess the utility of PET-CT in terms of rates of detection of metastases leading to changes in planned treatment and if performing PET-CT was associated with a delay in surgical management. In this single-centre retrospective cohort study, 88 consecutive patients with pT4b melanoma were identified from February 2014 to May 2019. Data were collected from clinical records. Of the 88 patients, 76 patients underwent PET-CT and 16/76 (21%) of these demonstrated metastatic/potentially metastatic disease. In total 16/76 (21%) patients had positive findings on PET-CT, and of these 14 (18%) had alterations to their clinical care. Performing PET-CT did not significantly delay time to wide local excision (PET-CT median 74 days (range 16–220) vs. no PET-CT median 55 days (range 36–143) P = 0.56) or SLNB (PET-CT median 67 days (range 16–206) vs. no PET-CT median 124 days (range 45–203) P = 0.66). Of the 29 patients undergoing SLNB who had negative PET-CT findings, 12/29 (41%) demonstrated microscopic metastatic disease. At the median follow-up of 1.75 years, 28 patients (34%) had died. Median survival was not reached. Performing staging PET-CT prior to SLNB in patients with pT4b melanoma can reveal metastases in over a fifth of patients, leading to alteration in management without treatment delay. Due to the low sensitivity of PET-CT for small metastases, SLNB remains important for definitive staging.
OculoMotor Assessment Tool Test Procedure and Normative Data
Authors: Yaramothu Chang , Morris Christopher J. , d'Antonio-Bertagnolli John Vito , Alvarez Tara L.
Published: May 2021

SIGNIFICANCE

This study establishes normative data and a testing procedure for the oculomotor assessment tool. The oculomotor assessment tool standardizes visual targets for the Vestibular/OculoMotor Screening assessment and provides additional metrics that may aid in the differentiation between those with normal and those with abnormal oculomotor function potentially caused by a concussion.

PURPOSE

This study aimed to assess the oculomotor endurance of healthy participants with no self-reported history of concussions using the oculomotor assessment tool.

METHODS

Healthy participants (n = 376, average age of 20.4 years, range of 11 to 34 years, with no self-reported history of concussions) were recruited to perform the following three tasks for 60 seconds each: (1) horizontal saccades, (2) vertical saccades, and (3) vergence jumps. The participants were instructed to alternate visual fixation between two targets for each of the tasks as fast as they could without overshooting or undershooting the visual target. The differences in the number of eye movements between the initial and latter 30 seconds of the 1-minute test were analyzed.

RESULTS

A statistical difference (P < .001) was observed in the number of eye movements for all three tasks (horizontal saccades [70 ± 15 for initial 30 seconds, 63 ± 13 for latter 30 seconds], vertical saccades [68 ± 14, 63 ± 13], and vergence jumps [43 ± 11, 39 ± 10]) between the initial and latter 30 seconds. No significant differences were identified in the number of eye movements or the change in eye movements between the initial and latter 30 seconds based on sex.

CONCLUSIONS

These results establish a normative database for various eye movements. These data could potentially be used to compare different patient populations who have binocular endurance dysfunctions potentially due to traumatic brain injury, such as patients with concussion(s).
Effect of Umbilical Cord Milking on Severity of Hypoxic Ischemic Encephalopathy in Asphyxiated Neonates A Pilot study
Authors: Kumar Roshith J , Varanattu Manoj
Published: May 2021

Background: The present study was aimed to evaluate the effect of umbilical cord milking technique on severity of Hypoxic Ischemic Encephalopathy (HIE) in asphyxiated neonates and assessed by Modified Sarnats staging as primary outcome, APGAR score at 5 minutes and Respiratory support requirement as secondary outcome.
Methods: This was a randomized, controlled pilot study conducted in neonatology department at a tertiary care centre, Thrissur, Kerala. The neonates were divided into two groups non milking group, control (n=38) and umbilical cord milking, case [UCM] (n=32) and their outcomes were compared. In the intervention group, the cord was cut at 30 cm from umbilical stump within 30 seconds of birth and euthermia was maintained. The umbilical cord was raised and milked from the cut end towards the infant 3 times with speed at 10 cm/sec and then clamped 2 to 3 cm from the umbilical stump. In the control group, the umbilical cord was clamped without doing cord milking.
Results: In this study moderate to severe HIE were less in case group 46.9 % than control group 55.1% and less neonates 44.7 % had Mild HIE in control group compared to case group 53.1% even though result was statistically not significant as primary outcome (p value not significant). Eight neonates (21.6%) in control group had Apgar at 5 min score 0 to 3, whereas only 4 (12.5%) neonates in cord milking group.
Conclusions: The insufficient knowledge of placental transfusion limits and benefits leads to a wide variation in the management of cord clamping. It would be useful to standardise the UCM procedure in order to offer protocols applicable to clinical practice, and to spread knowledge among professionals through educational programs.
Collation of indigenous and local knowledge as evidence base for herpetofauna conservation outside protected areas: Case study from an agricultural landscape in Eastern India
Authors: Ghosh Deyatima , Basu Parthiba
Published: May 2021

Systematic appraisal of community’s knowledge as evidence for biodiversity conservation has been widely recognized. For conserving the rich biodiversity in the rural landscape outside the protected areas, it is important to document the knowledge and perception of the farming community. Although such appraisal is available for different taxa, no such systematic study is available for herpetofauna-one of the most vulnerable faunal groups. Our study attempts to document the impact of agricultural intensification on herpetofauna in an agricultural landscape through knowledge and perception appraisal of the farming community. A semi-structured questionnaire survey and validation was conducted in areas of low, medium, and high agricultural intensification. In all areas, farmers indicated an overall decrease in herpetofauna abundance. Farmers at the mid and high agricultural intensification zones reported a more significant decrease in herpetofauna sightings specifically for amphibians and snakes compared to those under low intensification regions. Farmers at low intensification area recognized significantly more herpetofauna. Farmers attributed five major threats to herpetofauna and ranked pesticide as the most significant reason, especially those in higher intensification. The majority were aware of the importance of herpetofauna as a biological pest control agent. Level of education or farming experience did not seem to have any influence on the farmers’ knowledge. Our findings integrated with other quantitative studies will facilitate future community-driven conservation in the studied agricultural landscapes.
Simulation on an electro-hydrostatic actuator controlled by a high-pressure piezoelectric pump with a displacement amplifier
Authors: Wang Bin , Xu Nanyue , Wu Pengyuan , Yang Rongfei
Published: May 2021

Purpose

The purpose of this paper is to provide a new hydrostatic actuator controlled by a piezoelectric piston pump and to reveal its characteristics.

Design/methodology/approach

In this paper, a piezoelectric pump with passive poppet valves and hydraulic displacement amplifier is designed as a new control component in a hydrostatic actuator for high actuation capacity. A component-level mathematical model is established to describe the system characteristics. Simulation verification for cases under typical conditions is implemented to evaluate the delivery behavior of the pump and the carrying ability of the actuator.

Findings

By using the displacement amplifier and the passive distributing valves, simulation demonstrates that the pump can deliver flow rate up to 3 L/min, and the actuator controlled by this pump can push an object weighing approximately 50 kg. In addition, it is particularly important to decide a proper amplification ratio of the amplifier in the pump for better actuation performance.

Originality/value

The piezoelectric pump presented in this paper has its potential to light hydrostatic actuator. The model constructed in this paper is valid for characteristic analysis and performance evaluation of this pump and actuators.
Research on the influence of the discharge breakdown process on the crater formation during EDM
Authors: Zhang Wenchao
Published: May 2021

Purpose

This paper aims to study the breakdown, oscillation and vanishing of the discharge channel and its influence on crater formation with simulation and experimental methods. The experiment results verified the effect of the oscillating characteristics of the discharge channel on the shape of the crater.

Design/methodology/approach

A mathematical model that considers the magnetohydrodynamics (MHD) and the discharge channel oscillation was established. The micro process of discharging based on magnetic-fluid coupling during electrical discharge machining (EDM) was simulated. The breakdown, oscillation and vanishing stage of the discharge channel were analyzed, and the crater after machining was obtained. Finally, a single-pulse discharge experiment during EDM was conducted to verify the simulation model.

Findings

During the breakdown of the discharge channel, the electrons move towards the center of the discharge channel. The electrons at the end diverge due to the action of water resistance, making the discharge channel appear wide at both ends and narrow in the middle, showing the pinch effect. Due to the mutual attraction of electrons and positive ions in the channel, the transverse oscillation of the discharge channel is shown on the micro level. Therefore, the position of the discharge point on the workpiece changes. The longitudinal oscillation in the discharge channel causes the molten pool on the workpiece to be ejected due to the changing pressure. The experimental results show that the shape of the crater is similar to that in the simulation, which verifies the correctness of the simulation results and also proves that the crater generated by the single pulse discharge is essentially the result of the interaction between transverse wave and longitudinal wave.

Originality/value

In this paper, the simulation of the discharge breakdown process in EDM was carried out, and a new mathematical model that considers the MHD and the discharge channel oscillation was established. Based on the MHD module, the discharge breakdown, oscillation and vanishing stages were simulated, and the velocity field and pressure field in the discharge area were obtained.
Re-enterprising the unplanned urban areas of Greater Cairo- a social innovation perspective
Authors: Nicolopoulou Katerina , Salama Ashraf M. , Attia Sahar , Samy Christine , Horgan Donagh , Khalil Heba Allah Essam E. , Bakhaty Asser
Published: May 2021

Purpose

This study aims to develop an innovative and comprehensive framework to address water-related challenges faced by communities located in urban settlements in the area of Greater Cairo. It is commonly accepted that such global challenges that border issues of resilience, community development, social equity and inclusive growth, call for a collaboration of disciplines. Such collaboration allows for the identification of synergies in ways that can enlighten and enrich the space of potential solutions and create pathways towards robust solutions.

Design/methodology/approach

The research process has been participatory, and it involved, apart from site interviews, engagement via a photographic exhibition, during an outreach and engagement event, of the researched sites in one of the academic institutions of the authors. A total of 12 women were interviewed and the expert’s workshop was attended by 12 experts.

Findings

Social innovation can promote agile processes to prototyping services, involving multiple sectors and stakeholders through open ecosystems. For urban settlements undergoing rapid expansion, social innovation can help communities and governments to build resilience in the face of resource gaps – often making use of advancements in technology and improvements from other disciplines (Horgan and Dimitrijevic, 2019). For the unplanned urban areas around Greater Cairo, input from different knowledge areas can offer valuable contributions; in terms of the project and the study that we report on in this paper, the contributing areas included architecture and urban planning, as well as women-led entrepreneurship targeting economic growth, social and community impacts.

Originality/value

In this paper, we demonstrate the significance of a transdisciplinary framework based on social innovation, for the study of women-led entrepreneurship as a response to water-based challenges within an urban settlement. The creation of such a framework can be a significant contribution to conceptualise, examine and respond to “wicked challenges” of urban sustainability. This paper also believes that the readership of the journal will be subsequently benefitting from another way to conceptualise the interplay of theoretical perspectives at the level of organisations and the individual to support the inquiry into such challenges.
Precision agriculture technology adoption and technical efficiency
Authors: DeLay Nathan D. , Thompson Nathanael M. , Mintert James R.
Published: May 2021

We explore the relationship between precision agriculture (PA) technology adoption and technical efficiency using the 2016 USDA Agricultural Resource Management Survey (ARMS). Efficiency gains from PA are likely cumulative, that is, the true impact of precision farming depends on the integration of complementary tools. To examine the efficiency benefits of different PA bundles, we perform a two‐step analysis. First, we use cluster analysis to identify distinct producer groups based on patterns in PA technology adoption. These producer groups map naturally onto the classic technology adoption curve (laggards, late majority, early majority, innovators). Second, we use stochastic frontier analysis (SFA) and stochastic meta‐frontier analysis (SMFA) to estimate differences in technical efficiency between PA adoption groups. We find that farms with advanced PA technology bundles are significantly more technically efficient than non‐adopters. Differences in technical efficiency are not found to be driven by heterogeneous production technologies, but rather inefficiencies in input usage at the farm level. Our results have strong implications for farm consolidation in US agriculture.
Optimal financial contracting and the effects of firm's size
Authors: Brusco Sandro , Lopomo Giuseppe , Ropero Eva , Villa Alessandro T.
Published: May 2021

We consider the design of the optimal dynamic policy for a firm subject to moral hazard problems. With respect to the existing literature we enrich the model by introducing durable capital with partial irreversibility, which makes the size of the firm a state variable. This allows us to analyze the role of firm's size, separately from age and financial structure. We show that a higher level of capital decreases the probability of liquidation and increases the future size of the firm. Although analytical results are not available, we show through simulations that, conditional on size, the rate of growth of the firm, its variability, and the variability of the probability of liquidation decline with age.
From My Expression to Our Expressions: Multidirectionality of Learning in the Globalized Korea
Authors: Ahn Junehui
Published: May 2021

In this article, I examine how globally dominant socialization ideas and practices meet with local concerns in a preschool classroom in South Korea, focusing in particular on children's and teachers’ interactive participation in indigenizing processes. By analyzing classroom interactions surrounding the imported classroom activity called “message center,” the article shows that children, rather than passively adopt teachers’ interpretation of global imports, create their own meanings for them to address goals of their culture‐laden peer worlds. Furthermore, children's own interpretation leads to changes in their teachers’ understandings and enactment of imported practices and values. Findings of this article articulate the agentive role both children and teachers play in socialization landscapes and the dynamism of education in globalized contexts. [socialization, children's agency, globalization, Reggio Emilia, South Korea]

Abstract in Korean

본 논문은 전지구화의 맥락에서 변화하고 있는 한국 아동사회화 지형을 서구적 사회화 이데올로기의 유입과 토착화 과정을 중심으로 살펴본다. 서구적 유아교육법을 채택하여 실천하고 있는 유아원에 대한 민족지적 조사를 통해, 논문은 전지구적으로 우세한 사회화 이념과 관습이 한국적 가치와 조우하면서 나타나는 현상, 특히 토착화 과정에서 교사와 아동의 상호작용이 만들어내는 긴장과 역동성에 주목한다. ‘메시지 센터’라고 불리는 교실 활동을 둘러싼 상호작용 분석은 아동들이 글로벌한 이념과 관습을 교사들이 해석한대로 수동적으로 받아들이기보다는, 또래 문화의 사회적 목표에 맞게 창의적으로 재해석하고 있음을 보여준다. 더 나아가 아동들의 재해석은 교사들이 새로운 관습과 가치를 실행하고 이해하는 방식에 영향을 미치는 것으로 나타났다. 논문의 결과는 전지구화의 맥락에서 변화하는 사회화 지형에 아동과 교사의 행위성이 미치는 영향력과 사회화 과정의 역동성을 보여준다.
Insights into invasive species from whole‐genome resequencing
Authors: North Henry L. , McGaughran Angela , Jiggins Chris D.
Published: May 2021

Studies of invasive species can simultaneously inform management strategies and quantify rapid evolution in the wild. The role of genomics in invasion science is increasingly recognised, and the growing availability of reference genomes for invasive species is paving the way for whole‐genome resequencing studies in a wide range of systems. Here, we survey the literature to assess the application of whole‐genome resequencing data in invasion biology. For some applications, such as the reconstruction of invasion routes in time and space, sequencing the whole genome of many individuals can increase the accuracy of existing methods. In other cases, population genomic approaches such as haplotype analysis can permit entirely new questions to be addressed and new technologies applied. To date whole‐genome resequencing has only been used in a handful of invasive systems, but these studies have confirmed the importance of processes such as balancing selection and hybridization in allowing invasive species to reuse existing adaptations and rapidly overcome the challenges of a foreign ecosystem. The use of genomic data does not constitute a paradigm shift per se, but by leveraging new theory, tools, and technologies, population genomics can provide unprecedented insight into basic and applied aspects of invasion science.
Recognition and the perception–cognition divide
Authors: Abid Greyson
Published: May 2021

Recent discussions have fixated on the distinction between perception and cognition. How should recognition be understood in light of this distinction? The relevant sense of recognition involves a sensitivity to particulars from one's past. Recognizing the face of a familiar friend is one instance of this phenomenon, as is recognizing an object or place that one has viewed before. In this article, I argue that recognition is an interface capacity that straddles the border between perception and cognition.