bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of phased recurrent units in the classification of multiple catalogues of astronomical light curves
Authors: Donoso-Oliva C , Cabrera-Vives G , Protopapas P , Carrasco-Davis R , Estevez P A
Published: June 2021

In the new era of very large telescopes, where data are crucial to expand scientific knowledge, we have witnessed many deep learning applications for the automatic classification of light curves. Recurrent neural networks (RNNs) are one of the models used for these applications, and the Long Short-Term Memory (LSTM) unit stands out for being an excellent choice for the representation of long time series. In general, RNNs assume observations at discrete times, which may not suit the irregular sampling of light curves. A traditional technique to address irregular sequences consists of adding the sampling time to the network’s input, but this is not guaranteed to capture sampling irregularities during training. Alternatively, the Phased LSTM (PLSTM) unit has been created to address this problem by updating its state using the sampling times explicitly. In this work, we study the effectiveness of the LSTM- and PLSTM-based architectures for the classification of astronomical light curves. We use seven catalogues containing periodic and non-periodic astronomical objects. Our findings show that LSTM outperformed PLSTM on six of seven data sets. However, the combination of both units enhances the results in all data sets.
Electron energy distributions in the extended gas nebulae associated with high-z AGN: Maxwell–Boltzmann versus κ distributions
Authors: Morais S G , Humphrey A , Villar Martín M , Binette L , Silva M
Published: June 2021

Emission line observations together with photoionization models provide important information about the ionization mechanisms, densities, temperatures, and metallicities in active galactic nuclei (AGN)-ionized gas. Photoionization models usually assume Maxwell–Boltzmann (M–B) electron energy distributions (EED), but it has been suggested that using κ distributions may be more appropriate and could potentially solve the discrepancies in temperatures and abundances found in HII regions and planetary nebulae. We consider the impact of the presence of κ distributions in photoionized nebulae associated with AGN and study how this might affect spectral modelling and abundance analyses for such regions. Using the photoionization code MAPPINGS 1e, we compute models adopting M–B and κ distributions of electron energies and compare the behaviour of emission line ratios for different values of κ, gas metallicity, density, ionization parameter, and SED slope. We find that the choice of EED can have a large impact on some UV and optical emission lines emitted by photoionized nebulae associated with AGN, and that the impact of adopting a κ distribution is strongly dependent on gas metallicity and ionization parameter. We compile a sample of line ratios for 143 type 2 AGN and compare our models against the observed line ratios. We find that for 98 objects, κ distributions provide a better fit to the observed line ratios than M–B distributions. In addition, we find that adopting κ-distributed electron energies results in significant changes in the inferred gas metallicity and ionization parameter in a significant fraction of objects.
Patient and caregiver perspectives on blood pressure in children with chronic kidney disease
Authors: Wu Justin Guang-Ao , Tong Allison , Evangelidis Nicole , Manera Karine E , Hanson Camilla S , Baumgart Amanda , Amir Noa , Sinha Aditi , Dart Allison , Eddy Allison A , Guha Chandana , Gipson Debbie S , Bockenhauer Detlef , Yap Hui-Kim , Groothoff Jaap , Zappitelli Michael , Alexander Stephen I , Furth Susan L , Samuel Susan , Carter Simon A , Walker Amanda , Kausman Joshua , Martinez-Martin David , Gutman Talia , Craig Jonathan C
Published: June 2021

Background

More than 50% of children with chronic kidney disease (CKD) have uncontrolled hypertension, increasing their long-term risk of cardiovascular disease and progression to kidney failure. Children receiving medications or dialysis may also experience acute blood pressure fluctuations accompanied by debilitating symptoms. We aimed to describe the perspectives of children with CKD and their parental caregivers on blood pressure to inform patient-centered care.

Methods

Secondary thematic analysis was conducted on qualitative data from the Standardized Outcomes in Nephrology—Children and Adolescents initiative, encompassing 16 focus groups, an international Delphi survey and two consensus workshops. We analyzed responses from children with CKD (ages 8–21 years) and caregivers (of children ages 0–21 years) pertaining to blood pressure.

Results

Overall, 120 patients and 250 caregivers from 22 countries participated. We identified five themes: invisibility and normalization (reassured by apparent normotension, absence of symptoms and expected links with CKD), confused by ambiguity (hypertension indistinguishable from cardiovascular disease, questioning the need for prophylactic intervention, frustrated by inconsistent messages and struggling with technical skills in measurement), enabling monitoring and maintaining health (gaging well-being and preventing vascular complications), debilitating and constraining daily living (provoking anxiety and agitation, helpless and powerless and limiting life activities) and burden of medications (overwhelmed by the quantity of tablets and distress from unexpected side effects).

Conclusions

For children with CKD and their caregivers, blood pressure was an important heath indicator, but uncertainty around its implications and treatment hampered management. Providing educational resources to track blood pressure and minimizing symptoms and treatment burden may improve outcomes in children with CKD.
Smokers’ Use of E-Cigarettes in Situations Where Smoking Is not Permitted in England: Quarterly Trends 2011–2020 and Associations With Sociodemographic and Smoking Characteristics
Authors: Jackson Sarah E , Beard Emma , Brown Jamie
Published: June 2021

Introduction

This study aimed to examine how the proportion of dual users of cigarettes and e-cigarettes who use e-cigarettes in situations where smoking is not permitted has changed since e-cigarettes became popular in England, and to characterize those who do so.

Methods

Data were from 5081 adults in England who reported current smoking and current use of e-cigarettes (‘dual users’) participating in a nationally-representative monthly survey between April 2011 and February 2020. We modeled quarterly changes in prevalence of e-cigarette use in situations where smoking is not permitted and assessed multivariable associations with sociodemographic and smoking characteristics.

Results

Between 2011 and 2020, prevalence of e-cigarette use in situations where smoking is not permitted followed a positive cubic trend, with a decelerating increase from an estimated 52.5% of dual users in Q2-2011 to 72.7% in Q3-2014, followed by a small decline to 67.5% in 2018, and subsequent increase to 74.0% in 2020. Odds were higher among those who were from more disadvantaged social grades, reported stronger smoking urges, or had made a past-year quit attempt, and lower among those who were aged at least 65 years (vs. 16–24 years), from the south (vs. north) of England, reported currently cutting down on their cigarette consumption or currently using nicotine replacement therapy.

Conclusions

In England, use of e-cigarettes in situations where smoking is not permitted is common among dual cigarette and e-cigarette users, has increased nonlinearly since 2011, and is particularly prevalent among those who are younger, disadvantaged, more addicted, have recently failed to quit, and are not attempting to cut down.

Implications

The ability to use nicotine in smoke-free settings appears to be an important part of the appeal of e-cigarettes. It is possible that if e-cigarette use was prohibited in public places, smokers may be deterred from using e-cigarettes alongside combustible tobacco, which could undermine quitting. Our results suggest disadvantaged and more addicted smokers would be disproportionately affected, suggesting such restrictions may contribute to inequalities in smoking and associated health outcomes.
Differences in Cognitive Task Performance, Reinforcement Enhancement, and Nicotine Dependence Between Menthol and Nonmenthol Cigarette Smokers
Authors: Jao Nancy C , Levin Edward D , Simon Melissa A , Hitsman Brian
Published: June 2021

Introduction

Menthol has been shown to target similar brain regions and neural receptors as nicotine, yet the association between menthol cigarette use and cognitive performance remains unknown.

Aims and Methods

This study examined differences in cognitive task performance between menthol (MS) and nonmenthol (NMS) cigarette smokers after acute cigarette consumption. Sixty white and black and/or African American, nonabstinent, MS (n = 30) and NMS (n = 30) were assessed presmoking and postsmoking their preferred cigarette on four computerized tasks: Continuous Performance Task (CPT; alerting attention), N-Back Task (working memory), Finger Tapping Task (motor control), and Apple Picker Task (reinforcement enhancement). Self-reported nicotine dependence and objective smoking topography measures were also compared between groups.

Results

Initial unadjusted analyses showed a significant effect of cigarette type × time on CPT speed (p = .042), where MS improved while NMS group worsened in CPT speed after smoking. After controlling for baseline cigarette craving and cigarette nicotine levels, the effect of cigarette type × time for all cognitive outcomes was statistically nonsignificant (ps > .05). However, there remained a significant effect of cigarette type, where MS versus NMS had poorer CPT (p = .046) and N-Back Task accuracy (p = .006) but faster N-Back speed (p = .039). There were no statistically significant differences between groups on reinforcement enhancement, nicotine dependence, or smoking behavior outcomes (ps > .05).

Conclusions

Contrary to our hypotheses, results did not find a significant effect of cigarette type on the change in cognitive performance after acute smoking in nonabstinent smokers. Further studies are needed to clarify the specific pharmacological effects of nicotine and menthol on cognitive functioning.

Implications

The current study is the first to compare the potential enhancement of cognitive task performance after acute cigarette smoking between satiated menthol and nonmenthol cigarette smokers. Study results suggest that acute menthol cigarette use may not enhance cognitive function above and beyond nonmenthol cigarettes to increase dependence among menthol smokers. However, the contribution of other psychological factors (eg, craving, mood) and cigarette characteristics (eg, nicotine content) may be involved in cognitive function enhancement to perpetuate dependence and smoking persistence for menthol smokers.
A light curve model of V2491 Cyg: Classical nova outburst on a cool and massive white dwarf
Authors: Kato Mariko , Saio Hideyuki , Hachisu Izumi
Published: June 2021

The classical nova V2491 Cyg was once suggested to be a recurrent nova. We have broadly reproduced the light curve of V2491 Cyg by a nova outburst model on a cold 1.36 M⊙ white dwarf (WD), which strongly suggests that V2491 Cyg is a classical nova outbursting on a cold very massive WD rather than a recurrent nova outbursting on a warmer WD like the recurrent nova RS Oph. In the long-term evolution of a cataclysmic binary, an accreting WD has settled to a thermal equilibrium state with the balance of gravitational energy release and neutrino loss. The central temperature of the WD is uniquely determined by the energy balance. The WD is hot (cold) for a high (low) mass accretion rate. We present the central temperatures, ignition masses, ignition radii, and recurrence periods for various WD masses and mass accretion rates. In a classical nova, which corresponds to a low mass accretion rate, the WD is cool and strongly degenerated and the ignition mass is large, which result in a strong nova outburst. In a recurrent nova, the WD is relatively warmer because of a high mass accretion rate and the outburst is relatively weaker. The gravitational energy release substantially contributes to the luminosity during the recurrent nova outbursts. We compare physical properties between classical novae and recurrent novae and discuss the essential differences between them.
Arabidopsis thaliana Ubiquitin-Associated Protein 1 (AtUAP1) Interacts with redundant RING Zinc Finger 1 (AtRZF1) to Negatively Regulate Dehydration Response
Authors: Min Ji-Hee , Park Cho-Rong , Chung Jung-Sung , Kim Cheol Soo
Published: June 2021

Ubiquitination, one of the most frequently occurring post-translational modifications, is essential for regulating diverse cellular processes in plants during abiotic stress. The E3 ubiquitin (Ub) ligase Arabidopsis thaliana really interesting new gene (RING) zinc finger 1 (AtRZF1) mutation is known to enhance drought tolerance in A. thaliana seedlings. To further investigate the function of AtRZF1 in osmotic stress, we isolated Ub-associated protein 1 (AtUAP1) which interacts with AtRZF1 using a yeast two-hybrid system. AtUAP1, a Ub-associated motif containing protein, increased the amount of Ub-conjugated AtRZF1. Moreover, AtUAP1 RNA interference lines were more tolerant to osmotic stress than wild type, whereas AtUAP1-overexpressing (OX) transgenic lines showed sensitive responses, including cotyledon greening, water loss, proline accumulation and changes in stress-related genes expression, indicating that AtUAP1 could negatively regulate dehydration-mediated signaling. In addition, AtUAP1-green fluorescent protein fusion protein was observed in the nuclei of root cells of transgenic seedlings. Genetic studies showed that the AtRZF1 mutation could rescue the sensitive phenotype of AtUAP1-OX lines in response to osmotic stress, suggesting that AtRZF1 was epistatic to AtUAP1 in dehydration signaling. Taken together, our findings describe a new component in the AtRZF1 ubiquitination pathway which controls the dehydration response in A. thaliana.
Intravenous Ketamine for Cancer Pain Management, Including Flares During the COVID-19 Pandemic: A Retrospective Study
Authors: Oh Daniel , Haffey Paul , Patel Ankur , Gulati Amitabh
Published: June 2021

Objectives

Cancer-related neuropathic pain (CNP) affects an increasing proportion of cancer patients, given improved survival, but it remains difficult to treat. There are no studies on an extended intravenous ketamine protocol and its synergies with common neuropathy treatments to treat CNP. This study aims to 1) evaluate the safety and effectiveness of an intravenous ketamine protocol to treat refractory CNP and 2) uncover synergies between ketamine and common neuropathy treatments.

Methods

This is a single-center, retrospective review of 57 patients and 192 infusions, with prospective follow-up on 14 enrolled patients during the coronavirus disease 2019 (COVID-19) pandemic.

Results

The etiologies of CNP were as follows: 13 from tumor compression, 25 with chemotherapy-induced peripheral neuropathy, 13 from surgery, and 6 from radiation therapy. Overall, 42 of 57 patients (73.7%) were responders, and 71.8% of responders received >3 weeks of pain relief on their last infusion. Analysis of adjuvant treatments revealed that the combination of serotonin-norepinephrine reuptake inhibitors and ketamine resulted in an increase in responders compared with nonresponders (P < 0.01). Adverse events occurred in 32 of 192 infusions (16.7%). All side effects self-resolved or resolved with intervention per the adverse events protocol. During the pandemic, all 14 currently enrolled patients did not receive ketamine infusions. Thirteen of the 14 patients returned to baseline pain, with 61.5% increasing medications. All experienced worsened function, mobility, mood, or anorexia.

Conclusion

Intravenous ketamine may be a safe and effective adjuvant treatment for CNP, especially with serotonin-norepinephrine reuptake inhibitors. Larger, prospective studies are warranted and should explore parameters to help prognosticate response to ketamine infusions.
The impact of signposting and group support pathways on a community-based physical activity intervention grounded in motivational interviewing
Authors: Wade M , Brown N , Steele J , Mann S , Dancy B , Winter S , Majumdar A
Published: June 2021

Background

Brief advice is recommended to increase physical activity (PA) within primary care. This study assessed change in PA levels and mental well-being after a motivational interviewing (MI) community-based PA intervention and the impact of signposting (SP) and social action (SA) (i.e. weekly group support) pathways.

Methods

Participants (n = 2084) took part in a community-based, primary care PA programme using MI techniques. Self-reported PA and mental well-being data were collected at baseline (following an initial 30-min MI appointment), 12 weeks, 6 months and 12 months. Participants were assigned based upon the surgery they attended to the SP or SA pathway. Multilevel models derived point estimates and 95% confidence intervals for outcomes at each time point and change scores.

Results

Participants increased PA and mental well-being at each follow-up time point through both participant pathways and with little difference between pathways. Retention was similar between pathways at 12 weeks, but the SP pathway retained more participants at 6 and 12 months.

Conclusions

Both pathways produced similar improvements in PA and mental well-being; however, the addition of a control would have provided further insight as to the effectiveness. Due to lower resources yet similar effects, the SP pathway could be incorporated to support PA in primary care settings.
ASSESSMENT OF THE OUTDOOR GAMMA RADIATION LEVELS IN ALGIERS PROVINCE, ALGERIA
Authors: Dehimi F Z , Seghour A , Taieb-Errahmani D , Hammadi A
Published: June 2021

The outdoor gamma radiation dose rates due to natural radioactivity and due to the artificial radionuclides released from the Chernobyl and Fukushima accidents and Algeciras incident were assessed in the Algiers province (capital of Algeria). Furthermore, the dose rates induced by the cosmic rays were analytically calculated in the province concerned. The recorded dose rates due to terrestrial outdoor gamma radiation were found to range from 14.3 ± 0.7 to 114.3 ± 5.7 nGy h −1, those due to cosmic rays ranged from 32.021 ± 0.013 to 34.029 ± 0.367 nGy h −1, while the contribution of the dose rate due to external exposure induced by 137Cs deposits, from major accidents, was estimated to be less than 0.3 nGy h−1. The spatial distributions of terrestrial and cosmic rays dose rates were mapped using QGIS software. The obtained radiological baseline maps can be used as reference information to assess any changes in the radiation exposure levels having an impact on the population health.
Taxation of trusts in Singapore
Authors: Banfield Stephen
Published: June 2021

Trusts are commonly used in the design of wealth planning structures in Asia. It is generally necessary for a trustee to consider the Singapore taxation of a trust if it is administered in Singapore, or otherwise has a nexus due to the functions performed by other parties. Few specific legislative provisions apply and the administrative practise of the Inland Revenue Authority of Singapore is concisely stated. This gives rise to a number of potentially complex issues which should be considered by trustees. These issues are ripe for future administrative or judicial clarification.
Uncovering Russian trust management agreements: not an alternative to Russian private foundations
Authors: Alimirzoev Sergei , Aleshchev Ilya
Published: June 2021

A Russian trust management arrangement is a contract for managing third party assets and cannot be mirrored with common law trusts since Russian law is not familiar with the concept of beneficial ownership. Russian trust management agreements are mainly used for managing portfolios of securities by regulated Russian asset managers, for managing Russian real estate and for the short-term management of assets falling into the estate of a deceased person during the probation period. Not suitable for exclusive succession planning purposes, trust management thus cannot be an alternative to Russian hereditary foundations which were specifically launched in Russian law in 2018 as post-mortem local foundations, and whose use remains to be seen in practice.
Behavioral and social science in support of SARS-CoV-2 vaccination: National Institutes of Health initiatives
Authors: Hunter Christine M , Chou Wen-Ying Sylvia , Webb Hooper Monica
Published: June 2021

Control of the COVID-19 pandemic relies heavily on behavioral mitigation strategies such as physical distancing, hand washing and mask wearing. Even with the availability of SARS-CoV-2 vaccines, the extraordinary effort to distribute the vaccines must be paired with continued adherence to behavioral recommendations as well as vaccine confidence. To facilitate rapid and equitable uptake of the vaccines, there is a need for responsive, trustworthy, and evidence-informed communication about vaccination, enhanced trust in science, and engaging populations disproportionately affected by the pandemic. Efforts to address vaccine hesitancy and increase vaccine confidence will address the emerging gaps between vaccine availability and actual vaccination. Although these gaps are attributable, in part, to challenges with logistics and access, social and behavioral drivers of vaccination decision making also have a significant role in vaccination uptake. As federal, state, and local health and public health agencies coordinate vaccine dissemination, there will be a continuous need to adapt to an evolving landscape of SARS-CoV-2 vaccines, new scientific information, and the spread of COVID-19- and vaccine-related misinformation. Facilitating widespread vaccination and maintaining a focus on equity requires thoughtful and compassionate approaches to reach and address the needs of those who are disproportionately affected by the pandemic such as underserved, vulnerable, and racial/ethnic minority populations. This commentary focuses on several National Institutes of Health initiatives that are supporting behavioral and social science research to address SARS-CoV-2 vaccine communication and increase the uptake of vaccination. We conclude with implications for future research.
Evaluations of Continuing Health Provider Education Focused on Opioid Prescribing: A Scoping Review
Authors: Sud Abhimanyu , Molska Graziella R. , Salamanca-Buentello Fabio
Published: June 2021

Purpose

Continuing health provider education (HPE) is an important intervention supported by health policy to counter the opioid epidemic; knowledge regarding appropriate program design and evaluation is lacking. The authors aim to provide a comprehensive understanding of evaluations of opioid-related continuing HPE programs and their appropriateness as interventions to improve population health.

Method

In January 2020, the authors conducted a systematic search of 7 databases, seeking studies of HPE programs on opioid analgesic prescribing and overdose prevention. Reviewers independently screened the titles and abstracts of all studies and then assessed the full texts of all studies potentially eligible for inclusion. The authors extracted a range of data using categories for evaluating complex programs: the use of theory, program purpose, inputs, activities, outputs, outcomes, and industry involvement. Results were reported in a narrative synthesis.

Results

Thirty-nine reports on 32 distinct HPE programs met inclusion criteria. Of these 32, 31 (97%) were U.S./Canadian programs and 28 (88%) were reported after 2010. Measurements of changes in knowledge and confidence were common. Performance outcomes were less common and typically self-reported. Most studies (n = 27 [84%]) used concerns of opioid-related harms at the population health level to justify the educational intervention, but only 5 (16%) measured patient- or population-level outcomes directly related to the educational programs. Six programs (19%) had direct or indirect opioid manufacturer involvement.

Conclusions

Continuing HPE has been promoted as an important means of addressing population-level opioid-related harms by policymakers and educators, yet published evaluations of HPE programs focusing on opioid analgesics inadequately evaluate patient- or population-level outcomes. Instead, they primarily focus on self-reported performance outcomes. Conceptual models are needed to guide the development and evaluation of continuing HPE programs intended to have population health benefits.
Postoperative Outcomes Following Posterior Lumbar Fusion in Patients With Multiple Sclerosis
Authors: Kamalapathy Pramod N. , Bell Joshua , Puvanesarajah Varun , Hassanzadeh Hamid
Published: June 2021

Summary of Background:

Multiple sclerosis (MS) is a chronic inflammatory disease that can cause physical and neurological dysfunction. Patients with MS are living longer and undergoing more orthopedic procedures, but the risk of patients with MS undergoing posterior lumbar fusion (PLF) has not been studied in literature before.

Objective:

This study aims to (1) analyze the rates of postoperative complications of MS patients undergoing primary PLF and (2) analyze the economic burden associated with these surgeries in the MS population compared with patients without MS.

Methods:

A retrospective review of the Medicare database was conducted on all patients who underwent PLF and/or posterior lumbar interbody fusion between the years of 2006 and 2013. Cases involving same-day anterior or revision procedures and patients with a history of spine, infection, and trauma, or neoplasm were excluded from the study. Demographics, comorbidities, 90-day postoperative complications, cost, and length of stay were calculated. All outcomes of interest were analyzed using multivariate logistic regression, adjusting for age, sex, and comorbidity burden. Significance was defined as P-value <0.05.

Results:

There were 2363 patients with MS and 23,569 matched controlled patients. We found a significant increase in the risk of sepsis [odds ratio (OR)=1.85, P=0.034], urinary tract infection (OR=1.89, P<0.001), deep vein thrombosis (OR=1.4, P=0.044), 90-day emergency room visit (OR=1.14, P=0.027), and 90-day readmissions (OR=1.20, P=0.011) compared with patients without a history of MS. Patients with MS also incurred $4379 extra in total hospital charge, a $1679 increase in the cost of hospitalization, and an increase in length of stay (4.05 vs. 3.61, P<0.001).

Conclusions:

A diagnosis of MS is associated with a significant increase in postoperative complications and higher costs after hospitalization. It is imperative for physicians to understand the risk factors of patients undergoing PLF and/or posterior lumbar interbody fusion with MS to better counsel them about postoperative complications before surgery.

Level of Evidence:

Level III.
Development and Validation of ARC, a Model for Anticipating Acute Respiratory Failure in Coronavirus Disease 2019 Patients
Authors: Saria Suchi , Schulam Peter , Yeh Brian J. , Burke Daniel , Mooney Sean D. , Fong Christine T. , Sunshine Jacob E. , Long Dustin R. , O’Reilly-Shah Vikas N.
Published: June 2021

OBJECTIVES:

To evaluate factors predictive of clinical progression among coronavirus disease 2019 patients following admission, and whether continuous, automated assessments of patient status may contribute to optimal monitoring and management.

DESIGN:

Retrospective cohort for algorithm training, testing, and validation.

SETTING:

Eight hospitals across two geographically distinct regions.

PATIENTS:

Two-thousand fifteen hospitalized coronavirus disease 2019–positive patients.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Anticipating Respiratory failure in Coronavirus disease (ARC), a clinically interpretable, continuously monitoring prognostic model of acute respiratory failure in hospitalized coronavirus disease 2019 patients, was developed and validated. An analysis of the most important clinical predictors aligns with key risk factors identified by other investigators but contributes new insights regarding the time at which key factors first begin to exhibit aberrency and distinguishes features predictive of acute respiratory failure in coronavirus disease 2019 versus pneumonia caused by other types of infection. Departing from prior work, ARC was designed to update continuously over time as new observations (vitals and laboratory test results) are recorded in the electronic health record. Validation against data from two geographically distinct health systems showed that the proposed model achieved 75% specificity and 77% sensitivity and predicted acute respiratory failure at a median time of 32 hours prior to onset. Over 80% of true-positive alerts occurred in non-ICU settings.

CONCLUSIONS:

Patients admitted to non-ICU environments with coronavirus disease 2019 are at ongoing risk of clinical progression to severe disease, yet it is challenging to anticipate which patients will develop acute respiratory failure. A continuously monitoring prognostic model has potential to facilitate anticipatory rather than reactive approaches to escalation of care (e.g., earlier initiation of treatments for severe disease or structured monitoring and therapeutic interventions for high-risk patients).
Awake Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019 Patients Without Invasive Mechanical Ventilation
Authors: Azzam Mohamed H. , Mufti Hani N. , Bahaudden Husam , Ragab Ahmed Z. , Othman Mahdi M. , Tashkandi Wail A.
Published: June 2021

OBJECTIVES/BACKGROUND:

Extracorporeal membrane oxygenation is used as rescue therapy for patients with acute respiratory distress syndrome in whom conventional therapy has failed prior to an Extra Corporeal Membrane Oxygenator to rescue Lung Injury in Severe Acute Respiratory Distress Syndrome trial. Since then, extracorporeal membrane oxygenation has been incorporated as part of the standard treatment algorithm in many centers for patients with severe acute respiratory distress syndrome. Since the emergence of coronavirus disease 2019 in early 2020, extracorporeal membrane oxygenation has been used effectively as rescue therapy and as a bridge to recovery in some patients with refractory respiratory failure.

DESIGN, SUBJECT, AND INTERVENTION:

We present a 38-year-old male healthcare worker diagnosed with coronavirus disease 2019 and progressed to critical condition with severe surgical emphysema on a high-flow nasal cannula with Fio2 100%, a flow of 40 L/min, and a maximum oxygen saturation of 88%. He was successfully treated by applying awake extracorporeal membrane oxygenation, without a need for invasive mechanical ventilation, to avoid worsening barotrauma and hemodynamic compromise potentially induced by positive pressure ventilation.

MAIN RESULTS AND CONCLUSIONS:

To our knowledge, this is one of the first cases to be reported in the literature on the use of awake extracorporeal membrane oxygenation as a “treatment” for barotrauma due to severe acute respiratory distress syndrome in a coronavirus disease 2019 patient, without the need for invasive mechanical ventilation. In selected patients with severe respiratory failure, awake extracorporeal membrane oxygenation can be used as a salvage treatment and obviate the need for invasive mechanical ventilation.
Effect of Hyperbaric Oxygen Therapy Initiation Time in Acute Carbon Monoxide Poisoning
Authors: Lee Yoonsuk , Cha Yong Sung , Kim Sung Hwa , Kim Hyun
Published: June 2021

OBJECTIVES:

Hyperbaric oxygen therapy (HBO2) is recommended for symptomatic patients within 24-hour postcarbon monoxide poisoning. Previous studies have reported significantly better outcomes with treatment administered within 6 hours after carbon monoxide poisoning. Thus, we aimed to compare the neurocognitive outcomes according to HBO2 delay intervals.

DESIGN:

Retrospective analysis of data from our prospectively collected carbon monoxide poisoning registry.

SETTING:

A single academic medical center in Wonju, Republic of Korea.

PATIENTS:

We analyzed the data of 706 patients older than 16 years treated with HBO2 with propensity score matching. Based on carbon monoxide exposure-to-HBO2 delay intervals, we classified patients into the early (control, less than or equal to 6 hr) and late (case, 6–24 hr) groups. The late group was further divided into Case-1 (6–12 hr) and Case-2 (12–24 hr) groups. We also compared mild (nonintubated) and severe (intubated) groups.

INTERVENTIONS:

HBO2.

MEASUREMENTS AND MAIN RESULTS:

After propensity score matching, Global Deterioration Scale scores at 6 months postcarbon monoxide exposure showed significantly fewer poor outcome patients in the early than in the late group (p = 0.027). The early group had significantly fewer patients with poor outcomes than the Case-2 group (p = 0.035) at 1 month and than the Case-1 (p = 0.033) and Case-2 (p = 0.004) groups at 6 months. There were significantly more patients with poor prognoses at 6 months as treatment interval increased (p = 0.008). In the mild cohort, the early group had significantly fewer patients with poor 6-month outcomes than the late group (p = 0.033).

CONCLUSIONS:

Patients who received HBO2 within 6 hours of carbon monoxide exposure had a better 6-month neurocognitive prognosis than those treated within 6–24 hours. An increase in the interval to treatment led to an increase in poor outcomes.
Assessing taxane-associated adverse events using the FDA adverse event reporting system database
Authors: Lao Dong-Hui , Chen Ye , Fan Jun , Zhang Jian-Zhong
Published: June 2021

Background:

Taxanes are an essential class of antineoplastic agents used to treat various cancers and are a fundamental cause of hypersensitivity reactions. In addition, other adverse events, such as bone marrow toxicity and peripheral neuropathy, can lead to chemotherapy discontinuation. This study aimed to evaluate the safety of taxanes in the real world.

Methods:

Taxane-associated adverse events were identified by the Medical Dictionary for Regulatory Activities Preferred Terms and analyzed and compared by mining the US Food and Drug Administration Adverse Event Reporting System pharmacovigilance database from January 2004 to December 2019. Reported adverse events, such as hypersensitivity reaction, bone marrow toxicity, and peripheral neuropathy, were analyzed with the following signal detection algorithms: reporting odds ratio (ROR), proportional reporting ratio (PRR), multi-item gamma Poisson shrinker (MGPS), Bayesian confidence propagation neural network (BCPNN), and logistic regression methods. Adverse outcome events and death outcome rates were compared between different taxane groups using Pearson's χ2 test, whereas significance was determined at P < 0.05 with a 95% confidence interval (CI).

Results:

A total of 966 reports of hypersensitivity reactions, 1109 reports of bone marrow toxicity, and 1374 reports of peripheral neuropathy were analyzed. Compared with paclitaxel and docetaxel, bone marrow toxicity following the use of nab-paclitaxel had the highest ROR of 6.45 (95% two-sided CI, 6.05–6.88), PRR of 5.66, (χ
2 = 4342.98), information component of 2.50 (95% one-sided CI = 2.34), and empirical Bayes geometric mean of 5.64 (95% one-sided CI = 5.34). Peripheral neuropathy following the use of nab-paclitaxel showed a higher ROR of 12.78 (95% two-sided CI, 11.55–14.14), PRR of 12.16 (χ
2 = 4060.88), information component of 3.59 (95% one-sided CI = 3.25), and empirical Bayes geometric mean of 12.07 (95% one-sided CI = 11.09).

Conclusions:

The results showed that bone marrow toxicity and peripheral neuropathy were the major adverse events induced by taxanes. Nab-paclitaxel exhibited the highest potential for taxane-associated adverse events. Further research in the future is warranted to explain taxane-associated adverse effects in real-world circumstances.
Diagnosis and Treatment of Intracardiac Thrombus
Authors: Patel Murti , Wei Xin , Weigel Kylie , Gertz Zachary M. , Kron Jordana , Robinson Austin A. , Trankle Cory R.
Published: June 2021

Intracardiac thrombi can occur in a variety of locations and are frequently encountered in clinical practice. Yet evidence-based guidance for clinicians managing patients with intracardiac thrombi is often limited. This review summarizes what is known regarding the prevalence of intracardiac thrombus, diagnostic strategies, clinical relevance, and treatment options, focusing on four specific types of thrombus for which recent research has shifted clinical understanding and treatment decisions: (1) left atrial appendage thrombus, (2) cardiac implantable electronic device lead thrombus, (3) bioprosthetic aortic valve thrombus, and (4) left ventricular thrombus. Additional studies, ideally prospective, randomized, and head-to-head in design, are needed to better inform best practices in patients with intracardiac thrombi.
Anxiety symptom remission is associated with genetic variation of PTPRZ1 among patients with major depressive disorder treated with escitalopram
Authors: Su Yun-Ai , Bousman Chad A. , Liu Qi , Lv Xiao-Zhen , Li Ji-Tao , Lin Jing-Yu , Yu Xin , Tian Li , Si Tian-Mei
Published: June 2021

Objectives

Genome-wide analyses of antidepressant response have suggested that genes initially associated with risk for schizophrenia may also serve as promising candidates for selective serotonin reuptake inhibitor (SSRI) efficacy. Protein tyrosine phosphatase, receptor-type, zeta-1 (PTPRZ1) has previously been shown to be associated with schizophrenia, but it has not been investigated as a predictor of antidepressant efficacy. The main objective of the study was to assess whether SSRI-mediated depressive and anxiety symptom remission in Chinese patients with major depressive disorder (MDD) are associated with specific PTPRZ1 variants.

Methods

Two independent cohorts were investigated, the first sample (N = 344) received an SSRI (i.e. fluoxetine, sertraline, citalopram, escitalopram, fluvoxamine, or paroxetine) for 8 weeks. The second sample (N = 160) only received escitalopram for 8 weeks. Hamilton Depression and Hamilton Anxiety Rating Scale scores at 8-weeks post-baseline in both cohorts were used to determine remission status. Five PTPRZ1 variants (rs12154537, rs6466810, rs6466808, rs6955395, and rs1918031) were genotyped in both cohorts.

Results

Anxiety symptom remission was robustly associated with PTPRZ1 rs12154537 (P = 0.004) and the G–G–G–G haplotype (rs12154537–rs6466810–rs6466808–rs6955395; P = 0.005) in cohort 2 but not cohort 1 (mixed SSRI use). Associations with depressive symptom remission did not survive correction for multiple testing.

Conclusions

These findings suggest that PTPRZ1 variants may serve as a marker of escitalopram-mediated anxiety symptom remission in MDD.
Analysis of Popular Social Media Addressing Breast Augmentation, Implants, and Anaplastic Large Cell Lymphoma
Authors: Ben-Naftali Yeela , Eremenko Ron , Pikkel Yoav Yechezkel , Duek Ori Samuel , Bar Meir Eran D.
Published: June 2021

Background:

Social media is part of modern life, for better or worse. Patients seek counsel on treatments, their side-effects, and the surgeon performing the surgery. Previous study has found several “dos” and “don’ts” regarding social media. The aim of this study was to specifically look for social media posts addressing breast augmentation, breast implants, and breast implant associated anaplastic large cell lymphoma (BIA-ALCL).

The aims of this study were to examine social media posting regarding BIA-ALCL and to analyze the ways general public receive information regarding this disease.

Methods:

A prospective analysis of 3 popular, global social media networks was performed, using the key phrase in English “anaplastic large cell lymphoma” or “ALCL” or “#ALCL.” Three hundred posts related to breast cancer published on Instagram, YouTube, and Facebook in June 2018 were assessed by the following parameters: author identity, subject, “social media currency” (likes, shares, comments), presence of special effects (videos, photographs, research, etc.).

Results:

Most posts were posted by professional entity (ie, plastic surgeon, company, or general practitioner), with YouTube being the social media least used by patients (P < 0.001). Facebook was the only social network that had more posts authored by non-professional authors (P < 0.001). Social currency did not change between the professional and non-professional authors. The highest return for investment was seen on Instagram (P < 0.001, “likes” only). YouTube, having the most posts published by professionals, was more positive toward breast augmentation and the use of implants (P < 0.001).

Conclusions:

Social media is here to stay and not a trend. It is a tool for the patient when searching for treatment and surgeon. It would be wise to invest and understand these communication platforms, since this is where our patients are, and the way they are researching.
Risk factors for posterior capsule rupture in cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery
Authors: Segers Maartje H.M. , Behndig Anders , van den Biggelaar Frank J.H.M. , Brocato Lucia , Henry Ype P. , Nuijts Rudy M.M.A. , Rosen Paul , Tassignon Marie-José , Young David , Stenevi Ulf , Lundström Mats , Dickman Mor M.
Published: June 2021

Purpose:

To analyze the incidence and risk factors for posterior capsule rupture (PCR) in cataract surgery.

Setting:

European clinics affiliated with the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO).

Design:

Retrospective cross-sectional register-based study.

Methods:

Data were obtained from the EUREQUO. The database contains data on demographics, comorbidities, and intraoperative complications, including PCR for the study period from January 1, 2008, to December 31, 2018. Univariate and multivariate logistic regression analyses were performed to estimate the (adjusted) odds ratio (OR) and 95% confidence intervals (CIs).

Results:

We analyzed EUREQUO registry data of 2,853,376 patients, and 31,749 (1.1%) cataract surgeries were complicated by a PCR. Data were available of 2 853 376 patients, and 31 749 (1.1%) cataract surgeries were complicated by a PCR. The PCR rate ranged from 0.60% to 1.65% throughout the years, with a decreasing trend (P < .001). The mean age of the PCR cohort was 74.8 ± 10.5 years, and 17 29 (55.5%) patients were female. Risk factors most significantly associated with PCR were corneal opacities (OR 3.21, 95% CI, 3.02-3.41, P < .001), diabetic retinopathy (OR 2.74, 95% CI, 2.59-2.90, P < .001), poor preoperative visual acuity (OR 1.98, 95% CI, 1.88-2.07, P < .001), and white cataract (OR 1.87, 95% CI, 1.72-2.03, P < .001).

Conclusions:

Risk factors for PCR were identified based on the EUREQUO, and the incidence of this complication is decreasing over time.
Blood Pumps for Extracorporeal Membrane Oxygenation: Platelet Activation During Different Operating Conditions
Authors: Fiusco Francesco , Broman Lars Mikael , Prahl Wittberg Lisa
Published: June 2021

Extracorporeal membrane oxygenation (ECMO) is a therapy used in severe cardiopulmonary failure. Blood is pumped through an artificial circuit exposing it to nonphysiologic conditions, which promote platelet activation and coagulation. Centrifugal pumps used at lower flow rates than their design point may lose pump efficiency and increase the risk of hemolysis. In this study, thrombogenic properties of two ECMO pumps designed for adult and neonatal use were evaluated using simulations in different flow scenarios. Three scenarios, adult pump in adult mode (4 L/min), adult pump in baby mode (300 ml/min), and neonatal pump used in its design point (300 ml/min), were simulated using computational fluid dynamics. The flow was numerically seeded with platelets, whose activation state was computed considering the stress history that acted along their respective path lines. Statistical distributions of activation state and residence time were drawn. The results showed that using the adult pump in baby mode increased the fraction of platelets with higher activation state confirming that low-pump flow rate impacts thrombogenicity. The neonatal pump showed a backflow at the inlet, which carried platelets in a retrograde motion contributing to an increased thrombogenic potential compared with the adult mode scenario.
Management of Circuit Air in Extracorporeal Membrane Oxygenation: A Single Center Experience
Authors: Chan Kai Man , Wan Winnie Tsz Pan , Ling Lowell , So Jack Mei Chun , Wong Constance Hau Ling , Tam Sandy Bik Shan
Published: June 2021

Air in circuit in patients receiving extracorporeal membrane oxygenation (ECMO) is an emergency. Different protocols have been suggested to deal with this rare but fatal complication, but their efficacies are rarely reported. We report our institutions’ experience in the management of circuit air in Cardiohelp HLS ECMO system. Between October 2009 and July 2020, 4 out of 116 patients developed gas bubbles in ECMO circuit or systemic gas embolism. The clinical characteristics of these patients, source of air, presence of arterial air or pump airlock, cardiorespiratory status during the event, techniques employed to re-establish flow, ECMO downtime, neurologic, and other clinical outcomes were reported. In all cases, the source of air was located, with three of them being on the venous side of the circuit. Centrifugal pump airlock with cessation of ECMO flow was reported in two patients. Strategies used to re-establish ECMO flow included circuit change or deairing using backflush technique. All patients were weaned from ECMO, and three of them were discharged from hospital alive. With effective management, systemic gas embolism could be avoided during air in circuit emergencies. Backflush technique is a safe and effective deairing method to overcome centrifugal pump airlock in Cardiohelp HLS system.
Mechanical Circulatory Support as a Bridge-to-Transplant Candidacy: When Does It Work?
Authors: Zaliznyak Michael , Stern Lily , Cole Robert , Shen Adriana , Nishihara Keith , Runyan Carmelita , Fishman Alisa , Olanisa Linda , Olman Megan , Singer-Englar Tahli , Luong Eric , Cheng Susan , Moriguchi Jaime , Kobashigawa Jon , Esmailian Fardad , Kittleson Michelle M.
Published: June 2021

Durable mechanical circulatory support (dMCS) devices can be offered as a bridge-to-transplant (BTT) or as a bridge-to-candidacy (BTC) strategy for candidates with contraindications to transplant listing, including pulmonary hypertension (BTC-PH), morbid obesity (BTC-Obes), social issues (BTC-Soc), or chronic illness (BTC-Illness). An understanding of the trajectory of BTC patients could guide future triage of advanced heart failure patients who are not candidates for transplantation. We performed a retrospective review all patients who underwent dMCS implantation as either BTT (206 patients) or BTC (114 patients) at our center from January 1, 2010, to March 31, 2020. There was no significant difference in mortality between BTC patients and BTT patients. Compared with the BTT group, significantly more patients in the BTC-PH group were transplanted (81% vs. 63%; p < 0.05) and significantly fewer patients in the BTC-Obes group (44%; p < 0.05) and BTC-Soc group (39%; p < 0.05) were transplanted. Additionally, the readmission rate was higher for those in the BTC-Obes (6.2 vs. 2.1; p < 0.05) and BTC-Soc (3.9 vs. 2.1; p < 0.05) groups. Bridge-to-candidacy patients generally had poorer post-dMCS trajectories than BTT patients. Centers should not be dissuaded from pursuing a BTC strategy for qualified patients; however, careful consideration of potential adverse outcomes is necessary.