bluuebunny/crossref_metadata_2025 huggingface dataset:
Hydro-generators fault diagnosis with short-time-wavelet-entropy and variational auto-encoder
Authors: Zemouri Ryad , Bernier Simon , Kokoko Olivier , Merkhouf Arezki
Published: December 2021

The prognosis and health management (PHM) of hydroelectric plants are full of difficulties caused by the complexity of the hydro-generators where each machine is different and almost unique. At industrial level, several tools are used to monitor the generator condition. Among these tools, the measurement of magnetic stray flux is one which is gaining interest. This measurement is generally based on an inductive sensor and mainly mounted near the stator. The main advantages of the magnetic stray flux are the non-invasive nature and the simplicity of its implementation. In this work, the discrete wavelet transform (DWT) is used to decompose the stray flux signal. Short-Time-Wavelet-Entropy (STWE) is then applied to extract the features from the sub-bands. Finally, a variational auto-encoder (VAE) is used in an unsupervised learning process to structure the STWE signatures of more than 400 stray flux measurement collected on real hydroelectric plants. The obtained results show that the VAE has well captured the features from the wavelet entropy (WE) signatures. An analysis of the resulting latent space shows a strong correlation between a given trajectory in the reduced space and an increase of the WE.
A hybrid approach for modelling multidimensional degradation processes
Authors: Jiang Renyan , Xiong Binbin
Published: December 2021

Degradation processes are often multidimensional. Modeling such degradation processes needs to address two key issues: indicator fusion and degradation model selection; and they have been separately addressed in the literature. This paper proposes a hybrid approach to jointly address these two issues. The proposed approach first fuses multiple degradation indicators into a composite degradation indicator. This fusion step involves data normalization, aggregation model selection and determination of indicator weights. After the fusion step, the problem becomes one-dimensional, and the existing method to select the degradation model for a one-dimensional degradation process can be applied. The resulting model obtained from the proposed approach can be a two-phase model; and the model for the second phase has a closed-form expression. This considerably facilitates residual life prediction. A real-world example is included to illustrate the proposed approach and its appropriateness.
Classification of helicopter’s typical flight state based on threshold
Authors: Sheng-nan Li , Jing-lin Wang , Le Yang , ZhangShang-tian
Published: December 2021

Dividing the 37 flying state of a certain line number helicopter. Firstly, dividing the helicopter rotation and single-engine flight. Secondly, performing preliminary state division for the remaining samlpes, the specific division of yaw angle, helicopter flight altitude and indicated air speed are different states, the least squares polynomial method is used for smoothing respectively. Calculating the extreme value of each parameter data, with the difference value of the extreme value of the parameter data being less than 10 as the limiting condition, dividing the original data segment into non-turning, level flight and steady speed state. The remaining sampling points are in the state of unsteady turning and non-level flight. Taking the difference value 0 as the limiting condition, further divide the non-steady speed and non-level flight state. Dividing the state of turning and non-turning, level flight, ascent and descent, steady speed, increase speed and deceleration state, which is the preliminary division state. Finally, dividing the near-ground and non-near-ground, classifying the helicopter status according to the height threshold, and analyze the accuracy of the classification results. The results show that this method is versatile, can quickly divide helicopters with different flight complexity, and has high accuracy.
Instrumental variable estimation of the marginal structural Cox model for time-varying treatments
Authors: Cui Y , Michael H , Tanser F , Tchetgen Tchetgen E
Published: December 2021

Robins (1998) introduced marginal structural models, a general class of counterfactual models for the joint effects of time-varying treatments in complex longitudinal studies subject to time-varying confounding. Robins (1998) established the identification of marginal structural model parameters under a sequential randomization assumption, which rules out unmeasured confounding of treatment assignment over time. The marginal structural Cox model is one of the most popular marginal structural models for evaluating the causal effect of time-varying treatments on a censored failure time outcome. In this paper, we establish sufficient conditions for identification of marginal structural Cox model parameters with the aid of a time-varying instrumental variable, in the case where sequential randomization fails to hold due to unmeasured confounding. Our instrumental variable identification condition rules out any interaction between an unmeasured confounder and the instrumental variable in its additive effects on the treatment process, the longitudinal generalization of the identifying condition of Wang & Tchetgen Tchetgen (2018). We describe a large class of weighted estimating equations that give rise to consistent and asymptotically normal estimators of the marginal structural Cox model, thereby extending the standard inverse probability of treatment weighted estimation of marginal structural models to the instrumental variable setting. Our approach is illustrated via extensive simulation studies and an application to estimating the effect of community antiretroviral therapy coverage on HIV incidence.
Repeatome-Based Phylogenetics in Pelargonium Section Ciconium (Sweet) Harvey
Authors: Breman Floris C , Chen Guangnan , Snijder Ronald C , Schranz M Eric , Bakker Freek T
Published: December 2021

The repetitive part of the genome (the repeatome) contains a wealth of often overlooked information that can be used to resolve phylogenetic relationships and test evolutionary hypotheses for clades of related plant species such as Pelargonium. We have generated genome skimming data for 18 accessions of Pelargonium section Ciconium and one outgroup. We analyzed repeat abundancy and repeat similarity in order to construct repeat profiles and then used these for phylogenetic analyses. We found that phylogenetic trees based on read similarity were largely congruent with previous work based on morphological and chloroplast sequence data. For example, results agreed in identifying a “Core Ciconium” group which evolved after the split with P. elongatum. We found that this group was characterized by a unique set of repeats, which confirmed currently accepted phylogenetic hypotheses. We also found four species groups within P. sect. Ciconium that reinforce previous plastome-based reconstructions. A second repeat expansion was identified in a subclade which contained species that are considered to have dispersed from Southern Africa into Eastern Africa and the Arabian Peninsula. We speculate that the Core Ciconium repeat set correlates with a possible WGD event leading to this branch.
Complex modulation of cytokine-induced α-synuclein aggregation by glypican-1-derived heparan sulfate in neural cells
Authors: Cheng Fang , Fransson Lars-Åke , Mani Katrin
Published: December 2021

In Parkinson’s disease (PD), there is accumulation of α-synuclein (SYN) aggregates in neurons, which is promoted by neuroinflammation. The cytokines TNF-α, IL-1β and IL-6 induce accumulation of degradation products of the amyloid precursor protein (APP) combined with heparan sulfate (HS) chains released from glypican-1 (Gpc-1) by NO-dependent cleavage. We have investigated the effects of the cytokines and HS on SYN aggregation and secretion in dividing human neuroblastoma (SH-SY5Y) and inducible neural progenitor cells (NPC) by using immunofluorescence microscopy, vesicle isolation and slot blotting with antibodies recognizing SYN monomers and aggregates, Gpc-1, the released HS, endosomes, and autophagosomes. In SH-SY5Y cells, the capacity to release HS was fully utilized, while NPC displayed dormant capacity. TNF-α induced increased formation of SYN aggregates and clustering of HS in SH-SY5Y cells. When the supply of NO was simultaneously increased, SYN and HS accumulation disappeared. When NO formation was inhibited, SYN and HS aggregation also disappeared, but there was now a 4-fold increase in SYN secretion. In NPC, IL-6 induced increased aggregation of SYN and stimulated HS release from Gpc-1. Both SYN and HS co-localized with autophagosome marker. When HS-deficient Gpc-1 was simultaneously generated, by using a cyanobacterial neurotoxin, accumulation diminished and there was massive secretion of SYN. We suggest that the cytokines increase APP processing, which initiates NO-dependent release of HS from Gpc-1. The APP degradation products also trigger SYN aggregation. As HS can inhibit APP processing, HS- or NO-deficiency may result in autophagosomal dysfunction and both APP degradation products and SYN are secreted.
Nationalism versus “identity pluralism”? Preserving and valorizing archeological heritage
Authors: Bernard Elisa
Published: December 2021

This article discusses how archeological objects’ “pluralistic identity”—defined as the archeological relic’s life in the ancient world and its afterlife, including its reuse and potential return to its original national context—complicates the protection of archeological heritage on the Italian territory in the shadow of the cultural property nationalism/internationalism dialectic. It begins by reconstructing and discussing the debate underscoring the first retentionist cultural property law in post-Unity Italy. The article then analyzes a series of case studies testifying to the (in)efficacy of such a law—for instance, vis-à-vis political interests—the impact of bilateral agreements for the repatriation of looted archeological property from “universal museums” to Italy as the Nation of origin, and the dilemma over the state’s functions of preservation and fruition. The paper asks whether archeological relics which are understood as state property are indeed the “national(ist)” heritage of one national past and whether and how the national identity that they are thought to epitomize can coexist with an inclusive valorization of their “pluralistic identity” in our contemporary society.
Fifty years of Protein Data Bank in the Journal of Biochemistry
Authors: Kurisu Genji
Published: December 2021

Protein Data Bank (PDB), jointly founded in 1971 by Brookhaven National Laboratory, USA, and the Cambridge Crystallographic Data Centre, UK, is the single global archive of experimentally determined biological macromolecular structures. PDB deposition is mandatory for publication in most scientific journals, which means ‘no PDB deposition, no structural publication’. The current PDB archive contains more than 180,000 entries and includes many structures from Asian institutions. The first protein structure from Japan was that of cytochrome c determined by Prof Masao Kakudo’s group at the Institute for Protein Research, Osaka University, in 1971 at a resolution of 4 Å, and a subsequent atomic structure at 2.3 Å resolution was deposited to PDB in 1976 as the 1st Asian and 21st entry of the entire PDB archive. Since then, 317 protein structures whose primary citation was the Journal of Biochemistry (J. Biochem.) have been deposited to PDB. Based on this long history between PDB and J. Biochem., a statistical analysis of all structural reports in J. Biochem. has been carried out using the relational database system at PDBj (https://pdbj.org) and reviewed the yearly distribution, resolution, quality of structure, type of target protein, number of citations and comparison against other major journals.
Doing Good and Feeling Good: A Critical Analysis of Human Rights Research
Authors: Klassen-Molyneaux Riley
Published: December 2021

The question guiding this article is: ‘when is nongovernmental organization (NGO) research useful?’. The first section after the introduction addresses this question directly. It does so by drawing on the author’s personal experience and by considering what scholars say about research done by NGOs on human rights. It then considers Bent Flyvbjerg’s grounded conception of the social sciences as well as what good a checklist could do to curb human rights violations in the maritime sector. The second section of the paper asks a more difficult question: when is NGO research not useful? Drawing on Thomas Sowell’s critique of intellectuals in Intellectuals and Society, this section aims to show that, although people tend to think that working at an NGO is an unassailable good, hidden motivations can—and maybe should—sometimes cast doubt on this assumption. The third section of the paper synthesizes the first two and draws some additional conclusions about other—perhaps better—ways to improve the human condition. The section then concludes that while NGO research might be useful for some specific purposes, well-meaning scholars should not assume that their research into human rights is always useful.
Digital Transnational Repression and Host States’ Obligation to Protect Against Human Rights Abuses
Authors: Anstis Siena , Barnett Sophie
Published: December 2021

In October 2018, public research by the Citizen Lab, a research laboratory at the Munk School of Global Affairs and Public Policy at the University of Toronto, documented how a Saudi dissident living in Montreal, Canada, was likely targeted with spyware operated by the Saudi authorities. The target, Omar Abdulaziz, was a close friend of murdered journalist Jamal Khashoggi. Both individuals were the object of the increasingly ‘long-arm’ of repressive regimes. These were not isolated incidents, but part of a broader pattern of state repression. This article considers the digital dynamics of the phenomenon of transnational repression in more detail. Specifically, it looks at how states that host targeted dissidents and activists (‘host states’) are responding (or not) to the use of digital technologies to silence transnational political and social debate and dissent. It argues that host states which are parties to international human rights instruments such as the International Covenant on Civil and Political Rights must act in conformity with their positive obligations under international human rights law and suggests a baseline of ‘good practices’ that should be considered by host states in addressing digital transnational repression.
Music As Extended Agency: On Notation And Entextualization IN Improvised Music
Authors: Schuiling Floris
Published: December 2021

This article presents results from fieldwork with two groups of improvisers using different forms of notation in their creative practice. Such practices raise fundamental questions about the relation of notation to performance. Drawing on theories of entextualization in linguistic anthropology, I argue that, contrary to many arguments for a performative understanding of music, performance is partly about creating something that has an identifiable existence, transcending space and time. The notations and compositional systems used by improvisers are a means of achieving this entextualization of their musical utterances. One of the main findings of my fieldwork was that improvisers frequently speak of acting ‘in service of the music’, a phrase commonly associated with composition-centred musical discourse. Drawing on the work of Karin Barber and Alfred Gell, I argue that this idea represents a process of entextualization that is not a negation of performers’ creative agency, but an extension of it.
What does lie at the Milky Way centre? Insights from the S2-star orbit precession
Authors: Argüelles C R , Mestre M F , Becerra-Vergara E A , Crespi V , Krut A , Rueda J A , Ruffini R
Published: December 2021

It has been recently demonstrated that both, a classical Schwarzschild black hole (BH), and a dense concentration of self-gravitating fermionic dark matter (DM) placed at the Galaxy centre, can explain the precise astrometric data (positions and radial velocities) of the S-stars orbiting Sgr A*. This result encompasses the 17 best resolved S-stars, and includes the test of general relativistic effects such as the gravitational redshift in the S2-star. In addition, the DM model features another remarkable result: The dense core of fermions is the central region of a continuous density distribution of DM whose diluted halo explains the Galactic rotation curve. In this Letter, we complement the above findings by analysing in both models the relativistic periapsis precession of the S2-star orbit. While the Schwarzschild BH scenario predicts a unique prograde precession for S2, in the DM scenario, it can be either retrograde or prograde, depending on the amount of DM mass enclosed within the S2 orbit, which, in turn, is a function of the DM fermion mass. We show that all the current and publicly available data of S2 cannot discriminate between the two models, but upcoming S2 astrometry close to next apocentre passage could potentially establish if Sgr A* is governed by a classical BH or by a quantum DM system.
Loss of Timeless Underlies an Evolutionary Transition within the Circadian Clock
Authors: Kotwica-Rolinska Joanna , Chodáková Lenka , Smýkal Vlastimil , Damulewicz Milena , Provazník Jan , Wu Bulah Chia-Hsiang , Hejníková Markéta , Chvalová Daniela , Doležel David
Published: December 2021

Most organisms possess time-keeping devices called circadian clocks. At the molecular level, circadian clocks consist of transcription–translation feedback loops (TTFLs). Although some components of the negative TTFL are conserved across the animals, important differences exist between typical models, such as mouse and the fruit fly. In Drosophila, the key components are PERIOD (PER) and TIMELESS (TIM-d) proteins, whereas the mammalian clock relies on PER and CRYPTOCHROME (CRY-m). Importantly, how the clock has maintained functionality during evolutionary transitions between different states remains elusive. Therefore, we systematically described the circadian clock gene setup in major bilaterian lineages and identified marked lineage-specific differences in their clock constitution. Then we performed a thorough functional analysis of the linden bug Pyrrhocoris apterus, an insect species comprising features characteristic of both the Drosophila and the mammalian clocks. Unexpectedly, the knockout of timeless-d, a gene essential for the clock ticking in Drosophila, did not compromise rhythmicity in P. apterus, it only accelerated its pace. Furthermore, silencing timeless-m, the ancestral timeless type ubiquitously present across animals, resulted in a mild gradual loss of rhythmicity, supporting its possible participation in the linden bug clock, which is consistent with timeless-m role suggested by research on mammalian models. The dispensability of timeless-d in P. apterus allows drawing a scenario in which the clock has remained functional at each step of transition from an ancestral state to the TIM-d-independent PER + CRY-m system operating in extant vertebrates, including humans.
Locus-specific chromatin profiling of evolutionarily young transposable elements
Authors: Taylor Darren , Lowe Robert , Philippe Claude , Cheng Kevin C L , Grant Olivia A , Zabet Nicolae Radu , Cristofari Gael , Branco Miguel R
Published: December 2021

Despite a vast expansion in the availability of epigenomic data, our knowledge of the chromatin landscape at interspersed repeats remains highly limited by difficulties in mapping short-read sequencing data to these regions. In particular, little is known about the locus-specific regulation of evolutionarily young transposable elements (TEs), which have been implicated in genome stability, gene regulation and innate immunity in a variety of developmental and disease contexts. Here we propose an approach for generating locus-specific protein–DNA binding profiles at interspersed repeats, which leverages information on the spatial proximity between repetitive and non-repetitive genomic regions. We demonstrate that the combination of HiChIP and a newly developed mapping tool (PAtChER) yields accurate protein enrichment profiles at individual repetitive loci. Using this approach, we reveal previously unappreciated variation in the epigenetic profiles of young TE loci in mouse and human cells. Insights gained using our method will be invaluable for dissecting the molecular determinants of TE regulation and their impact on the genome.
Precise phase structure in a four-fermion interaction model on a torus
Authors: Inagaki Tomohiro , Matsuo Yamato , Shimoji Hiromu
Published: December 2021

We investigate finite-size effects on chiral symmetry breaking in a four-fermion interaction model at finite temperature and chemical potential. Applying the imaginary-time formalism, the thermal quantum field theory is constructed on an S1 in the imaginary-time direction. In this paper, the finite-size effect is introduced by a compact S1 spatial direction with a U(1)-valued boundary condition. Thus, we study the model on an $\mathbb {R}^{D-2} \times S^{1} \times S^{1}$ torus. Phase diagrams are obtained by evaluating the local minima of the effective potential in the leading order of the 1/N expansion. From the grand potential, we calculate the particle number density and the pressure; then we illustrate the correspondence with the phase structure. We obtain a stable size for which the sign of the pressure flips from negative to positive as the size decreases. Furthermore, the finite chemical potential expands the parameter range over which the stable size exists.
Are Increasing Earnings Associations between Partners of Concern for Inequality? A Comparative Study of 21 Countries
Authors: Boertien Diederik , Bouchet-Valat Milan
Published: December 2021

Partners increasingly resemble each other in terms of earnings across Western countries. These increases in earnings similarity are often considered to be drivers behind growing income inequality between households. We argue that increases in earnings similarity do not necessarily lead to augmented inequality between households. Their overall effect depends on whether and how the processes that increase earnings similarity affect inequality through other pathways. Using data from the Luxembourg Income Study on 21 countries, we decompose changes over time in earnings inequality. We show that even though the correlation in earnings between partners increased in most countries, this only amplified inequality on some occasions. In several countries, increases in the earnings correlation are driven by general changes in employment rates. Given that these increases in employment equalized earnings across households through other pathways, the inherently connected increases in the earnings correlation are of less concern from an inequality perspective. In other countries, where increases in earnings similarity are produced by augmented similarity in earnings among dual-breadwinner couples or by selective changes in employment, increases in earnings similarity are of more concern for inequality between households.
Molecular pathways dysregulated by Pb2+ exposure prompts pancreatic beta-cell dysfunction
Authors: Daniel P Vineeth , Kamthan Mohan , Thakur Shilpa , Mondal Prosenjit
Published: December 2021

Type 2 diabetes mellitus (T2DM) is a metabolic disease characterized by reduced insulin sensitivity and dysfunction of β-cells. Although the increasing prevalence of diabetes worldwide is largely attributed to genetic predisposition or lifestyle factors (insufficient physical activity), and caloric intake. Environmental factors, exposure to xenobiotics and heavy metals have also been reported to be causative factors of T2DM. At this juncture, we, through our work unveil a plausible link between Pb2+ exposure and diabetes mellitus, and delineated a comprehensive understanding of the potential mechanisms of Pb2+-induced β-cells dysfunction. In our in vivo observations, we found that Pb2+ exposure strongly reduced glucose-stimulated insulin secretion and diminished functional pancreatic β-cell mass. Mechanistically, we found that Pb2+ downregulates intracellular cAMP level via hyper-activating Ca2+/calmodulin-dependent 3′,5′-cyclic nucleotide phosphodiesterase 1C and thereby reduces glucose-stimulated insulin secretion. Further, we report that Pb2+ inhibited mitochondrial adenosine triphosphate production and also identified Pb2+ as a negative regulator of β-cell proliferation via Ca2+/calmodulin-dependent protein kinase kinases-pAMPK-pRaptor axis. Together, our findings strongly reinforce Pb2+ to hijack the physiological role of calcium ions, by mimicking Ca2+ within pancreatic β-cell and thereby stands as a diabetogenic xenobiotic.
Trends in and Maternal Outcomes of Delivery Hospitalizations of Patients With an Asthma Diagnosis
Authors: Friedman Alexander M. , DiMango Emily A. , Guglielminotti Jean R. , Huang Yongmei , Wright Jason D. , D'Alton Mary E. , Wen Timothy
Published: December 2021

OBJECTIVE:

To characterize asthma prevalence and outcomes during U.S. delivery hospitalizations.

METHODS:

For this repeated cross-sectional analysis, deliveries to women aged 15–54 years with asthma were identified in the 2000–2018 National Inpatient Sample, which approximates a 20% stratified sample of all hospitalizations nationally. Temporal trends in asthma were analyzed using joinpoint regression to estimate the average annual percent change with 95% CIs. The association of asthma with other comorbid conditions was analyzed. The relationship between asthma and several adverse maternal outcomes was analyzed with unadjusted and adjusted logistic regression models, with unadjusted odds ratios and adjusted odds ratios (aORs) as measures of effect. Risk for and trends in a composite of rare, but severe, respiratory complications also were analyzed.

RESULTS:

An estimated 73,109,790 delivery hospitalizations from 2000 to 2018 were included in the analysis, of which 2,221,644 (3.0%) had a diagnosis of asthma. (Unweighted, the study sample included 15,213,024 deliveries, of which 462,276 [3.0%] had a diagnosis of asthma.) Asthma diagnoses rose from 1.2% in 2000 to 5.3% in 2018, representing an average annual percent change of 8.3% (95% CI 7.4–9.2%). Asthma was more common among women with obesity and chronic hypertension. In adjusted analyses, asthma was associated with severe maternal morbidity (aOR 1.50, 95% CI 1.45–1.55), preeclampsia and gestational hypertension (aOR 1.29, 95% CI 1.26–1.30), postpartum hemorrhage (aOR 1.21, 95% CI 1.19–1.24), cesarean delivery (aOR 1.16, 95% CI 1.15–1.18), gestational diabetes (aOR 1.20, 95% CI 1.18–1.21), venous thromboembolism (aOR 1.79, 95% CI 1.65–1.95), and preterm delivery (aOR 1.27, 95% CI 1.25–1.29). From 2000 to 2018, severe respiratory complications decreased from 72 per 10,000 deliveries with asthma to 14 per 10,000 deliveries with asthma (average annual percent change −9.4%, 95% CI −13.3% to −5.3%). This decreasing risk was offset on a population level by an increase in the risk of asthma.

CONCLUSION:

Asthma is increasing during deliveries, is associated with adverse maternal outcomes, and is associated with comorbid conditions. Severe respiratory complications are decreasing proportionately among deliveries with asthma, but are stable on a population basis.
Blood Pressure in Critically Ill Children: Exploratory Analyses of Concurrent Invasive and Noninvasive Measurements
Authors: Goodwin Andrew , Mazwi Mjaye L. , Somer Jonathan , Schwartz Steven M. , McEwan Alistair , Eytan Danny
Published: December 2021

OBJECTIVES:

Differences and biases between directly measured intra-arterial blood pressure and intermittingly measured noninvasive blood pressure using an oscillometric cuff method have been reported in adults and children. At the bedside, clinicians are required to assign a confidence to a specific blood pressure measurement before acting upon it, and this is challenging when there is discordance between measurement techniques. We hypothesized that big data could define and quantify the relationship between noninvasive blood pressure and intra-arterial blood pressure measurements and how they can be influenced by patient characteristics, thereby aiding bedside decision-making.

DESIGN:

A retrospective analysis of cuff blood pressure readings with associated concurrent invasive arterial blood pressure measurements (452,195 noninvasive blood pressure measurements).

SETTING:

Critical care unit at The Hospital for Sick Children, Toronto.

PATIENTS:

Six-thousand two-hundred ninety-seven patients less than or equal to 18 years old, hospitalized in a critical care unit with an indwelling arterial line.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Two-dimensional distributions of intra-arterial blood pressure and noninvasive blood pressure were generated and the conditional distributions of intra-arterial blood pressure examined as a function of the noninvasive systolic, diastolic, or mean blood pressure. Modification of these distributions according to age and gender were examined using a multilevel mixed-effects model. For any given combination of patient age and noninvasive blood pressure, the expected distribution of intra-arterial blood pressure readings exhibited marked variability at the population level and a bias that significantly depended on the noninvasive blood pressure value and age. We developed an online tool that allows exploration of the relationship between noninvasive blood pressure and intra-arterial blood pressure and the conditional probability distributions according to age.

CONCLUSIONS:

A large physiologic dataset provides clinically applicable insights into the relationship between noninvasive blood pressure and intra-arterial blood pressure measurements that can help guide decision-making at the patient bedside.
Society for Developmental & Behavioral Pediatrics Position Statement on Telehealth
Authors: Keder Robert D. , Mittal Shruti , Stringer Kimberlly , Wallis Kate E. , Wallace Jenna E. , Soares Neelkamal S.
Published: December 2021

Telehealth has long held promise as a way to increase access to subspecialty care for children and families, including in developmental and behavioral pediatrics (DBP). The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid uptake of telehealth to continue care delivery that was facilitated by “temporary” policy changes related to the pandemic. As a result, the field of DBP has recognized telehealth as a potential model of care for performing home-based diagnostic assessments, providing medication management follow-up, and delivering therapeutic interventions for children with neurodevelopmental disorders. Telehealth has been helpful in mitigating barriers families often face when attending in-person visits (lack of transportation and child care, missed work hours, etc) but has also highlighted additional determinants of health that need to be addressed to provide equitable access to care (broadband connectivity, device access, digital literacy, access to interpretation and sign language services, etc). Anticipating the lifting of pandemic-related emergency declaration and expiration of temporary policies around telehealth, the ability to continue to deliver DBP care by telehealth is uncertain. The purpose of this policy statement is to advocate for legislation and policies that support ongoing, equitable, home-based telehealth care for patients seen by DBP providers while ensuring equitable access to DBP in general. In addition, there is a need to recognize the benefits and challenges of telehealth versus in-person care and to identify clinical scenarios that favor 1 model of care versus the other.
A Pregnant Mother Infected With Severe Acute Respiratory Syndrome Coronavirus 2 With Substance Dependence
Authors: Nagdi Dorabati Peymaneh , Khoshnam rad Mahsa , Hedayat Yaghoobi Mojtaba , Mahmoodi Zohreh
Published: December 2021

Background

In December 2019, the novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China, and now, it has spread all over the world. Pregnant women are a susceptible population, but there is scant information about COVID-19 in this population. Here, we report a case of a mother with substance use disorders who was infected with COVID-19 in her pregnancy.

Case

The patient was a 29-year-old, primigravida mother at the 37th gestational week who was referred to our center because of vaginal bleeding and severe uterine contractions. The patient was abusing opioids. With the suspicion of placental abruption, she was admitted for cesarean section. One day after delivery, she developed dyspnea, rhinorrhea, and vomiting. These were thought of as withdrawal signs. Despite methadone administration, these signs persisted. After ruling out deprivation syndrome and possible obstetric causes, a SARS-CoV-2 Polymerase chain reaction (PCR) test was ordered; the result was positive.

Conclusion

In this case, because of the flu-like symptoms of substance withdrawal and postpartum causes of shortness of breath, the medical team's attention was drawn to these causes. SARS-CoV-2 infection should be considered as a differential diagnosis for these patients.
It's Not Denial, It's Stigma
Authors: Harding Shari
Published: December 2021

Addictions nurses often encounter barriers to care for clients such as stigma, especially in settings outside addictions specialty care. This article utilizes a case-study format to show and discuss concepts related to client engagement in recovery and overcoming stigma. Laura, a 65-year-old woman, presents with a worsening of her alcohol use disorder in the setting of a recent retirement, worsening symptoms of major depressive disorder, and the stressors associated with the COVID-19 pandemic. She presents with her depression and is reluctant to discuss her alcohol use, after a past experience in a program that utilized a confrontational approach. Her primary care provider describes her as “in denial,” but this case study will discuss elements including stigma, self-stigma, and the culture of addictions treatment and their impact on recovery. Finally, this presentation will describe how the addictions nurse can leverage a person-centered and recovery-oriented approach to promote engagement and positive problem solving with the client and the care team.
A Constellation of Rare Gynecological Malignancies and Familial Adenomatous Polyposis Gastrointestinal Adenocarcinoma: A Case Report
Authors: Gill Stephanie J. , Pirzada Amrah , Power Patti , Neveu Joannie
Published: December 2021

Ovarian microcystic stromal tumors (MST) are a rare subtype of sex-cord stromal tumors. We are presenting a case of a MST arising in a patient with familial adenomatous polyposis (FAP) and concurrent colonic adenocarcinoma. During the patient’s workup of an ampullary adenoma associated with her FAP, she was found to have an enlarged uterus with a thickened endometrium and an incidental pelvic mass on the fundus of the uterus. Subsequent imaging identified heterogenous bulky ovaries. This patient underwent surgical resection including a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, bilateral pelvic sentinel lymph node biopsy during her planned total proctocolectomy and transduodenal ampullectomy. Extensive histologic and immunohistochemical investigations were completed and the final pathology report revealed a unique compilation of International Federation of Gynecology and Obstetrics Stage II, grade 1 endometrioid endometrial adenocarcinoma, bilateral ovarian MST, a sperate pedunculated mass favoring a diagnosis of uterine tumor resembling ovarian sex cord tumor (UTROSCT), 2 distinct adenocarcinomas of the colon (T2N0 and T1N0) and a tubular adenoma of the ampulla. The pathology showed the endometroid adenocarcinoma was β-catenin negative while the MST and UTROSCT both showed nuclear positivity with β-catenin. To our knowledge this is the first reported case of a UTROSCT with concurrent endometrial adenocarcinoma presenting with bilateral ovarian MST’s and adenomatous polyposis coli gene positive FAP colon adenocarcinoma.
Reproducibility of Morphologic Parameters of the International Endocervical Adenocarcinoma Criteria and Classification System and Correlation With Clinicopathologic Parameters: A Multi-Institutional Study
Authors: Bulutay Pinar , Haberal Nihan , Özen Özlem , Erdem Özlem , Zeren Emine H. , Kulac İbrahim , Taskiran Çagatay , Vatansever Dogan , Ayhan Ali , Kapucuoğlu Nilgün
Published: December 2021

Endocervical adenocarcinomas (ECAs) have been recently reclassified according to their morphologic features linked to etiology by the International Endocervical Adenocarcinoma Criteria and Classification (IECC) and this system is adopted by WHO 2020. This classification separates the ECAs as human papillomavirus (HPV)-associated (HPVA) and HPV-independent (HPVI) subtypes. According to WHO 2020, high risk (HR)-HPV association can be histologically recognized by the presence of luminal mitoses and apoptosis. Therefore, investigating the reproducibility of the morphologic criteria of this new classification will be important in observing the recognizability of tumor types. Full slide sets of 94 ECAs were collected from 4 institutions in Turkey and reclassified on the basis of IECC/WHO 2020 criteria and the presence or absence of HR-HPV. HR-HPV presence was confirmed by HPV DNA in situ hybridization, p16 immunohistochemistry and in conflicted cases with real time-polymerase chain reaction. The final diagnoses were given based on the combination of the histologic evaluation and ancillary test results. Our cohort consisted of 73.4% HPVA and 26.6% HPVI cases. According to the WHO 2020 criteria 92.7% of HPVAs and 88% of HPVIs were easily classified. HPV DNA in situ hybridization was positive in 91.3% of the HPVAs and p16 was positive in all HPVAs, and also positive in 8% of the HPVIs. In conclusion, most of the ECAs can be diagnosed by their characteristic morphologic features by the WHO 2020 criteria. However, we want to emphasize that mitosis/apoptosis criteria may not be helpful especially in mucinous ECAs and ancillary tests for HR-HPV should be used in challenging cases.
The Potential Prognostic and Therapeutic Implications of Prolactin Receptor and Growth Hormone-releasing Hormone Receptor Expression in Uterine Leiomyosarcomas
Authors: Jones Terri E. , La Hae-Sun , Upadhyay-Baskota Swikrity , Bhargava Rohit , Jones Mirka W.
Published: December 2021

The management of uterine leiomyosarcomas (uLMS) remains challenging. The rate of recurrence and metastasis is high, with 5-yr survival reaching only 40% to 50% in patients with tumor confined to the uterus (FIGO stage I or II). Prolactin receptor (PRLR) and growth hormone-releasing hormone receptor (GHRHR) have been implicated in the carcinogenesis of malignant tumors of the breast, endometrium, ovary, liver, and prostate. GHRHR antagonists inhibit in vitro growth of many human tumors and the expression of PRLR is associated with resistance to chemotherapy. The immunohistochemical expression of PRLR and GHRH in 24 primary and 2 recurrent uLMS was evaluated. Representative sections were stained with PRLR and GHRHR antibodies and immunoreactivity was calculated using H-score. The results were correlated with clinicopathologic data using Kaplan-Meier survival and multivariable Cox proportion hazard regression analyses. All tumors were positive for both markers with predominantly moderate to strong expression of PRLR (89%) and GHRHR (82%). Patients with tumors showing moderate to strong expression of PRLR were significantly less likely to achieve disease-free survival (P=0.004) and significantly more likely to have a poor overall survival (P=0.049). No significant difference in mean PRLR expression was found between tumors with higher mitotic counts (>20/10 hpf) and lower mitotic counts (20 or less/10 hpf). Furthermore, in 2 patients where the primary and recurrent tumors were tested, there was stronger expression of PRLR in the recurrence compared with the primary. This correlation was not found with GHRHR. Both PRLR and GHRHR may play a role in carcinogenesis in uLMS, as they do in other malignant neoplasms. To our knowledge, this study is the first evaluating the expression of these receptors in uLMS. Moderate or high expression of PRLR may serve as a prognostic marker associated with recurrences and increased mortality in uLMS patients.
Uterine Sarcoma With FGFR1-TACC1 Gene Fusion: A Case Report and Review of the Literature
Authors: Zyla Roman E. , Goebel Emily A. , Jang Ji-Hyun , Turashvili Gulisa
Published: December 2021

With the growing availability of RNA sequencing technology in the pathology laboratory, new gene fusion-associated malignancies are increasingly being characterized. In this article, we describe the second ever reported case of a uterine sarcoma harboring a FGFR1-TACC1 gene fusion. The patient, a 53-yr-old perimenopausal woman, was found to have a 6 cm mass spanning the lower uterine segment and endocervix. Histologically, this was a spindle cell neoplasm with coagulative necrosis, moderate cytologic atypia, and increased mitotic activity. By immunohistochemistry, the neoplastic cells coexpressed CD34 and S100, and lacked smooth muscle marker expression. RNA sequencing revealed the presence of a FGFR1-TACC1 gene fusion. This report provides further evidence to suggest that FGFR1-TACC1 may be a recurrent fusion in a subset of uterine sarcomas. RNA sequencing using a panel that includes FGFR-TACC family fusions should be considered for uterine sarcomas that do not fit conventional diagnostic criteria, particularly as tumors with these fusions may be amenable to targeted therapy.
Sebaceous Carcinoma Arising in Ovarian Teratoma: First Report Associated With Germline Mismatch Repair Gene Mutation
Authors: Murray Jacinta , McIlwaine Patrick , Morrison Patrick J. , McCluggage W. Glenn
Published: December 2021

Sebaceous carcinoma is an uncommon primary cutaneous neoplasm which may be associated with mismatch repair (MMR) abnormalities and sometimes with Muir-Torré syndrome. These neoplasms rarely arise in the ovary within a teratoma/ dermoid cyst. We report a sebaceous carcinoma arising in an ovarian teratoma in a 49-yr old (the 14th case reported in the literature) which exhibited loss of expression of MMR proteins MSH2 and MSH6. A germline mutation c.1102C>T was present in exon 7 of the MSH2 gene, the first report of a germline mutation associated with this tumor type. In reporting this case, we review prior reports of primary ovarian sebaceous carcinoma. We recommend that all sebaceous carcinomas of the ovary undergo immunohistochemistry for MMR proteins for investigation of possible Lynch syndrome.
Clinical Utility of the Signal-to-Cutoff Ratio of Reactive HIV Antigen/Antibody Screening Tests in Guiding Emergency Physician Management
Authors: White Douglas A. E. , Anderson Erik S. , Basham Kellie , Ng Valerie L. , Russell Carly , Lyons Michael S. , Powers-Fletcher Margaret V. , Giordano Thomas P. , Muldrew Kenneth L. , Siatecka Hanna , Hsieh Yu-Hsiang , Dashler Gaby , Carroll Karen C. , Mostafa Heba H. , Rothman Richard E.
Published: December 2021

Background:

The signal-to-cutoff (S/CO) ratio of the HIV antigen/antibody test may help immediately to differentiate true-positive results from false-positive results, which may be particularly useful in time-sensitive circumstances, such as when providing emergency department (ED) care.

Setting:

Seven US EDs with HIV screening programs using HIV antigen/antibody assays.

Methods:

This cross-sectional study of existing data correlated S/CO ratios with confirmed HIV status. Test characteristics at predetermined S/CO ratios and the S/CO ratio with the best performance by receiver operator characteristic (ROC) curve were calculated.

Results:

Of 1035 patients with a reactive HIV antigen/antibody test, 232 (22.4%) were confirmed HIV-negative and 803 (77.6%) were confirmed HIV-positive. Of the 803 patients, 713 (88.8%) experienced chronic infections and 90 (11.2%) experienced acute infections. S/CO ratios were greater for HIV-positive (median 539.2) than for HIV-negative patients (median 1.93) (P < 0.001) and lower for acute infection (median 22.8) than for chronic infection (median 605.7) (P < 0.001). All patients with an S/CO ratio < 1.58 (n = 93) were HIV-negative (NPV 100%), and nearly all with an S/CO ≥ 20.7 (n = 760) (optimal level by ROC analysis) were HIV-positive (PPV 98.6%). Of patients with S/CO values between 1.58 and 20.7 (n = 182), 29.7% were HIV-positive.

Conclusions:

The S/CO ratio may be used in real time to classify most ED patients as almost certain to be either HIV-positive or HIV-negative long before nucleic acid confirmatory testing is available. When combined with clinical judgment, this could guide preliminary result disclosure and management.
Use of Indocyanine Green Angiography to Identify the Superficial Temporal Artery and Vein in Forehead Flaps for Facial Reconstruction
Authors: Zang Mengqing , Zhu Shan , Chen Bo , Li Shanshan , Han Tinglu , Liu Yuanbo
Published: December 2021

The superficial temporal artery (STA) frontal branch flap is susceptible to venous congestion because of its unpredictable and variable outflow. The authors applied indocyanine green angiogra-phy in identifying the superficial temporal vessels to help surgeons with proper flap designs to avoid severe complications. A retrospective review from 2015 to 2020 was conducted. All the patients who underwent indocyanine green angiography before forehead flap transfer for facial defect reconstruction were reviewed. The STA and vein were observed using indocyanine green angiography preoperatively. The relationship between the artery and vein was investigated. The venous anatomy was analyzed to guide the pedicle design. The survival of the flap and complications were assessed. A total of 12 patients were identified and included in this study. Indocyanine green angiography allows clear visualization of the detailed anatomy of the STA and vein. The frontal branch of the vein had great variations and generally diverged from the arterial branch. The tiny venae comitantes provided sufficient drainage for 2 small forehead flaps. The frontal branch of the vein entered the forehead and was used as the outflow channel in 4 patients. The parietal branch of the vein, which consistently gave off secondary tributaries to the superior forehead, was included in the pedicle in 6 patients. All flaps survived without complications. indocyanine green angiography provided accurate localization of the superficial temporal vessels. This technique may be helpful in the precise planning forehead flap surgeries and in avoiding the risk of venous congestion.
Inexpensive and colorimetric RNA detection by E. coli cell-free protein synthesis platform at room temperature
Authors: Notarangelo Michela , Quattrone Alessandro , Pizzato Massimo , Mansy Sheref S. , Toparlak Ö. Duhan
Published: December 2021

We report colorimetric detection of SARS-CoV-2 viral RNA by an in vitro transcription/translation assay with crude E. coli extracts at room temperature, with the aid of body heat. Clinically-relevant concentrations of viral RNA (ca. 600 copies/test) were detected from synthetic RNA samples. The activation of cell-free gene expression was achieved by toehold-switch-mediated riboregulatory elements that are specific to viral RNA sequences. The colorimetric output was generated by the α-complementation of β-galactosidase ω-fragment (LacZω) with cell-free expressed LacZα, using an X-gal analogue as a substrate. The estimated cost of single reaction is <€1/test, which may facilitate diagnostic kit accessibility in developing countries.