bluuebunny/crossref_metadata_2025 huggingface dataset:
Corn ethanol in the Midwestern USA: Local competition, entry and agglomeration
Authors: Thome Karen E , Lin Lawell C -Y Cynthia
Published: September 2021

This article analyzes the entry of corn-ethanol plants in the Midwestern USA, where the majority of corn in the USA is grown, during the second US ethanol boom. In particular, we examine whether the presence of existing ethanol plants affects ethanol plant entry decisions at the county level using discrete response panel models. There are two main channels through which existing ethanol plants may affect ethanol plant entry decisions: a competition effect and an agglomeration effect. Our results show that existing ethanol plants have a negative effect on the probability of ethanol plant entry in a given county. The net negative competition effect dissipates with distance. We also find that existing conglomerates and large ethanol producing firms in neighboring counties have a positive effect on ethanol plant entry, while existing singlet plants in neighboring counties do not. These results provide evidence for both local competition among ethanol plants within counties, as well as possible agglomeration benefits from existing conglomerates and large ethanol producing firms in neighboring counties.
Fused deposition modelling 3D printing proof-of-concept study for personalised inner ear therapy
Authors: Haddow Oisin , Mathew Essyrose , Lamprou Dimitrios A
Published: September 2021

Objectives

There is a requirement within ear therapeutics for a delivery system capable of safely delivering controlled doses to the inner ear. However, the anatomy and sensitivity of the inner ear make current delivery systems problematic and often ineffective. Therefore, a new delivery system is required to overcome these issues and provide a more efficacious system in the treatment of inner ear disease. This study assesses the potential of 3D printing (3DP) as a fabrication method for an implantable drug delivery system (DDS) to the inner ear.

Key findings

Three implantable designs of varying geometry were produced with fused deposition modelling (FDM) 3DP, each loaded with 0.25%, 0.5% and 1% levofloxacin; filaments prepared by hot-melt extrusion. Each implant was effective in providing sustained, therapeutic release of levofloxacin for at least 4 days and as such would be effective in therapeutic treatment of many common inner ear diseases, such as otitis media or Ménière’s disease.

Conclusions

This proof-of-concept research was successful in utilising FDM as a fabrication method for a DDS capable of providing prolonged release directly to the inner ear and highlights the viability of 3DP in the fabrication of an inner ear DDS.
Item Count Technique with a Continuous or Count Control Variable for Analyzing Sensitive Questions in Surveys
Authors: Kowalczyk Barbara , Niemiro Wojciech , Wieczorkowski Robert
Published: September 2021

The paper introduces a new item count technique (ICT) for dealing with sensitive features. One of the aims of the proposed method is to eliminate both the “ceiling” and “floor” effects that can occur in the original ICT. In the new model, in contrast to the classical one and recently proposed models, the two groups into which the sample is split are treated similarly. Therefore, there is no traditional distinction between the control and treatment groups. The control variable can be either a qualitative count variable or a continuous variable. To our knowledge, ICT methods with continuous control have not been proposed before. Although our new model differs substantially in the approach, it requires only a slight modification of the questionnaire design, which in no way leaks respondents’ privacy. Substantial gain in statistical efficiency is achieved as compared to the earlier proposed Poisson and negative binomial ICTs. The new method also reduces the bias of maximum likelihood estimators and allows to obtain bootstrap confidence intervals with a substantially smaller width. The statistical properties of the method are investigated theoretically and by simulations.
The importance of mock observations in validating galaxy properties for cosmological simulations
Authors: Tang Lin , Lin Weipeng , Wang Yang , Napolitano N R
Published: September 2021

The galaxy luminosity function and galaxy stellar mass function are fundamental statistics in the testing of galaxy formation models. Theoretical predictions based on cosmological simulations can deviate from observations, especially at the bright and faint ends. In this case, the mismatch may come from missing physics, oversimplified or inaccurate model recipes, or inappropriate methods of extracting basic astrophysical quantities from simulations. The latter is a crucial aspect to consider to avoid misleading conclusions when comparing simulations with observations. In this paper, we apply a new method to produce ‘observed’ galaxies identified in mock imaging of hydrodynamical simulations. We generate low-redshift mock galaxies from the TNG100-1 simulation of IllustrisTNG and analyse them using standard ‘observational’ techniques to extract their main structural parameters. We show that our technique can produce realistic surface-brightness distributions of the simulated galaxies, including classical morphological substructures, such as spiral arms and bars. In particular, we find a very good agreement of the total luminosity and stellar mass versus halo mass relationships, and the galaxy stellar mass versus size relationship between mock observations and real galaxies. We also compare the luminosity function and the mass function of the mock galaxy sample with literature data and find a good agreement at all luminosity and mass scales. In particular, we find no significant tension at the bright end of the galaxy luminosity function, as reported in many analyses using simplified recipes to identify galaxy haloes, which in fact miscount the contribution of the extended galaxy haloes around large galaxies. This demonstrates the critical importance of using observation-driven approaches to simulation analyses to produce realistic predictions to compare with observations.
globalemu: a novel and robust approach for emulating the sky-averaged 21-cm signal from the cosmic dawn and epoch of reionization
Authors: Bevins H T J , Handley W J , Fialkov A , de Lera Acedo E , Javid K
Published: September 2021

Emulation of the Global (sky-averaged) 21-cm signal with neural networks has been shown to be an essential tool for physical signal modelling. In this paper, we present globalemu, a Global 21-cm signal emulator that uses redshift as a character-defining variable alongside a set of astrophysical parameters to estimate the signal brightness temperature. Combined with physically motivated data pre-processing, this makes for a reliable and fast emulator that is relatively insensitive to the network design. globalemu can emulate a high-resolution signal in 1.3 ms in comparison to 133 ms, a factor of 102 improvement, when using the existing public state-of-the-art 21cmGEM. We illustrate, with the standard astrophysical models used to train 21cmGEM, that globalemu is almost twice as accurate and for a test set of ≈1700 signals we achieve a mean root mean squared error of 2.52 mK across the band z = 7–28 [≈10 per cent the expected noise of the Radio Experiment for the Analysis of Cosmic Hydrogen (REACH)]. The models are parametrized by the star formation efficiency, f*, minimum virial circular velocity, Vc, X-ray efficiency, fX, cosmic microwave background optical depth, τ, the slope and low energy cut-off of the X-ray spectral energy density, α and νmin, respectively, and the mean free path of ionizing photons, Rmfp. globalemu provides a flexible framework for easily emulating updated simulations of the Global signal and in addition the neutral fraction history. The emulator is pip installable and available at https://github.com/htjb/globalemu. globalemu will be used extensively by the REACH collaboration.
Iron Rain: measuring the occurrence rate and origin of small iron meteoroids at Earth
Authors: Mills Tristan , Brown P G , Mazur M J , Vida D , Gural Peter S , Moorhead Althea V
Published: September 2021

We report results of a 4-yr survey using Electron Multiplied Charged Coupled Device cameras recording 34 761 two-station video meteor events complete to a limiting magnitude of +6. The survey goal was to characterize probable iron meteoroids. Using only physical properties of the meteor trajectories including early peaking light curves, short luminous trajectories, and high energies accumulated per area at beginning, we identified 1068 iron meteors. Our iron candidates are most abundant at slow speeds <15 km s−1, where they make up ≈20 per cent of the mm-sized meteoroid population. They are overwhelmingly on asteroidal orbits, and have particularly low orbital eccentricities and smaller semimajor axes when compared to non-irons between 10 and 20 km s−1. Our iron population appears to be more numerous at fainter magnitudes, comprising 15 per cent of slow (10–15 km s−1) meteors with peak brightness of +3 with the fraction rising to 25 per cent at +6 to +7, our survey limit. The iron orbits are most consistent with an asteroidal source and are in highly evolved orbits, suggesting long collisional lifetimes (107 yr). Metal-rich chondrules (nodules) found in abundance in EL chondrites are one possible source for this population. We also propose a possible technique using R-band colours to more robustly identify fainter iron meteors with very high confidence.
Temporal and spectral study of PKS B1222 + 216 flares in 2014
Authors: Chatterjee Anshu , Roy Abhradeep , Sarkar Arkadipta , Chitnis Varsha R
Published: September 2021

We report on a temporal and spectral study of a flat-spectrum radio quasar, PKS B1222 + 216, in a flare state to get insight into the acceleration and emission mechanisms inside the jet. It is one of the brightest and highly active blazars in the MeV–GeV regime. The long-term multiwaveband light curves of this object showed flaring activity in 2014, with two distinct flares. The work presented here includes the study of flux-index variation, flare fitting, and hardness ratio, and the spectral modelling of X-ray and γ-ray data. The flux-index correlation found in the MeV–GeV regime indicates a ‘softer when brighter’ feature. The modelling of γ-ray light curves suggests that low-energy particles initiate both the flares, followed by the injection of high-energy particles. The short rise time indicates the presence of Fermi first-order acceleration. A single-zone leptonic model is used to fit the multiwaveband spectral energy distributions generated for both flares. The spectral energy distribution modelling shows that inverse Compton scattering of the photon field reprocessed from the broad-line region primarily accounts for the GeV emission. In addition, we have reported a shift in the break energy in the soft X-ray regime during flares, which is due to a rapid change in the injection spectrum.
Subaru Hyper Suprime-Cam Survey of Cygnus OB2 Complex – I. Introduction, photometry, and source catalogue
Authors: Gupta Saumya , Jose Jessy , More Surhud , Das Swagat R , Herczeg Gregory J , Samal Manash R , Guo Zhen , Prakash Prem , Damian Belinda , Takami Michihiro , Takahashi Satoko , Ogura Katsuo , Terai Tsuyoshi , Pyo Tae-Soo
Published: September 2021

Low-mass star formation inside massive clusters is crucial to understand the effect of cluster environment on processes like circumstellar disc evolution, planet, and brown dwarf formation. The young massive association of Cygnus OB2, with a strong feedback from massive stars, is an ideal target to study the effect of extreme environmental conditions on its extensive low-mass population. We aim to perform deep multiwavelength studies to understand the role of stellar feedback on the IMF, brown dwarf fraction and circumstellar disc properties in the region. We introduce here, the deepest and widest optical photometry of 1.5○ diameter region centred at Cygnus OB2 in r2, i2, z, and Y-filters, using Subaru Hyper Suprime-Cam (HSC). This work presents the data reduction, source catalogue generation, data quality checks, and preliminary results about the pre-main sequence sources. We obtain 713 529 sources in total, with detection down to ∼28, 27, 25.5, and 24.5 mag in r2, i2, z, and Y-band, respectively, which is ∼3 – 5 mag deeper than the existing Pan-STARRS and GTC/OSIRIS photometry. We confirm the presence of a distinct pre-main sequence branch by statistical field subtraction of the central 18 arcmin region. We find the median age of the region as ∼5 ± 2 Myr with an average disc fraction of ∼9 per cent. At this age, combined with A $_V\, \sim$ 6 – 8 mag, we detect sources down to a mass range of ∼0.01–0.17 M⊙. The deep HSC catalogue will serve as the groundwork for further studies on this prominent active young cluster.
Search for gamma-ray bursts and gravitational wave electromagnetic counterparts with High Energy X-ray Telescope of Insight-HXMT
Authors: Cai C , Xiong S L , Li C K , Liu C Z , Zhang S N , Li X B , Song L M , Li B , Xiao S , Yi Q B , Zhu Y , Zheng Y G , Chen W , Luo Q , Huang Y , Song X Y , Zhao H S , Zhao Y , Zhang Z , Bu Q C , Cao X L , Chang Z , Chen L , Chen T X , Chen Y B , Chen Y , Chen Y P , Cui W W , Du Y Y , Gao G H , Gao H , Ge M Y , Gu Y D , Guan J , Guo C C , Han D W , Huo J , Jia S M , Jiang W C , Jin J , Kong L D , Li G , Li T P , Li W , Li X , Li X F , Li Z W , Liang X H , Liao J Y , Liu B S , Liu H W , Liu H X , Liu X J , Lu F J , Lu X F , Luo T , Ma R C , Ma X , Meng B , Nang Y , Nie J Y , Ou G , Qu J L , Ren X Q , Sai N , Sun L , Tan Y , Tao L , Tuo Y L , Wang C , Wang L J , Wang P J , Wang W S , Wang Y S , Wen X Y , Wu B B , Wu B Y , Wu M , Xiao G C , Xu Y P , Yang R J , Yang S , Yang Y J , Yang Y R , Yang X J , Yin Q Q , You Y , Zhang F , Zhang H M , Zhang J , Zhang P , Zhang S , Zhang W C , Zhang W , Zhang Y F , Zhang Y H , Zhao X F , Zheng S J , Zhou D K
Published: September 2021

The High Energy (HE) X-ray telescope on board the Hard X-ray Modulation Telescope (Insight-HXMT) can serve as a wide field of view (FOV) gamma-ray monitor with high time resolution (μs) and large effective area (up to thousands cm2). We developed a pipeline to search for gamma-ray bursts (GRBs), using the traditional signal-to-noise ratio (SNR) method for blind search and the coherent search method for targeted search. By taking into account the location and spectrum of the burst and the detector response, the targeted coherent search is more powerful to unveil weak and sub-threshold bursts, especially those in temporal coincidence with gravitational wave (GW) events. Based on the original method in literature, we further improved the coherent search to filter out false triggers caused by spikes in light curves, which are commonly seen in gamma-ray instruments (e.g. Fermi/GBM, POLAR). We show that our improved targeted coherent search method could eliminate almost all false triggers caused by spikes. Based on the first two years of Insight-HXMT/HE data, our targeted search recovered 40 GRBs, which were detected by either Swift/BAT or Fermi/GBM but too weak to be found in our blind search. With this coherent search pipeline, the GRB detection sensitivity of Insight-HXMT/HE is increased to about 1.5E-08 erg cm−2 (200 keV–3 MeV). We also used this targeted coherent method to search Insight-HXMT/HE data for electromagnetic counterparts of LIGO-Virgo GW events (including O2 and O3a runs). However, we did not find any significant burst associated with GW events.
Tidal migration of hot Jupiters: introducing the impact of gravity wave dissipation
Authors: Lazovik Yaroslav A
Published: September 2021

We study the migration of hot Jupiters orbiting solar-type pre-main sequence and main-sequence stars under the effect of tidal dissipation. The explored range of stellar mass extends from 0.6 to 1.3 M⊙. We apply recently developed prescriptions that allow us to explore the orbital evolution over the wide parameter space. Three types of tides are considered: equilibrium tide, inertial waves, and gravity waves. We combine the results of our simulations with the observed distribution of stellar and planetary parameters to evaluate the infall rate of hot Jupiters in the Milky Way Galaxy. In particular, we find that, for 11–21 per cent of the initial hot Jupiter population, coalescence occurs before the host star’s main sequence termination. If the planet is massive enough, such an event can potentially be accompanied by a powerful transient detectable with new facilities. Orbital decay by itself can be observed through transit-timing variation. However, the obtained coalescence rate in the Galaxy is too low (340–650 events per million years) to make positive predictions about the observational possibility. Potentially identifiable decaying systems formed by a star corresponding to a given mass interval might be too rare to be detected with the modern space telescopes, like TESS, within a 10-yr baseline. At the same time, the forthcoming missions, like PLATO, look more promising in this regard.
The coordinated replication of Vibrio cholerae’s two chromosomes required the acquisition of a unique domain by the RctB initiator
Authors: Fournes Florian , Niault Theophile , Czarnecki Jakub , Tissier-Visconti Alvise , Mazel Didier , Val Marie-Eve
Published: September 2021

Vibrio cholerae, the pathogenic bacterium that causes cholera, has two chromosomes (Chr1, Chr2) that replicate in a well-orchestrated sequence. Chr2 initiation is triggered only after the replication of the crtS site on Chr1. The initiator of Chr2 replication, RctB, displays activities corresponding with its different binding sites: initiator at the iteron sites, repressor at the 39m sites, and trigger at the crtS site. The mechanism by which RctB relays the signal to initiate Chr2 replication from crtS is not well-understood. In this study, we provide new insights into how Chr2 replication initiation is regulated by crtS via RctB. We show that crtS (on Chr1) acts as an anti-inhibitory site by preventing 39m sites (on Chr2) from repressing initiation. The competition between these two sites for RctB binding is explained by the fact that RctB interacts with crtS and 39m via the same DNA-binding surface. We further show that the extreme C-terminal tail of RctB, essential for RctB self-interaction, is crucial for the control exerted by crtS. This subregion of RctB is conserved in all Vibrio, but absent in other Rep-like initiators. Hence, the coordinated replication of both chromosomes likely results from the acquisition of this unique domain by RctB.
Structural basis of chromatin regulation by histone variant H2A.Z
Authors: Lewis Tyler S , Sokolova Vladyslava , Jung Harry , Ng Honkit , Tan Dongyan
Published: September 2021

The importance of histone variant H2A.Z in transcription regulation has been well established, yet its mechanism-of-action remains enigmatic. Conflicting evidence exists in support of both an activating and a repressive role of H2A.Z in transcription. Here we report cryo-electron microscopy (cryo-EM) structures of nucleosomes and chromatin fibers containing H2A.Z and those containing canonical H2A. The structures show that H2A.Z incorporation results in substantial structural changes in both nucleosome and chromatin fiber. While H2A.Z increases the mobility of DNA terminus in nucleosomes, it simultaneously enables nucleosome arrays to form a more regular and condensed chromatin fiber. We also demonstrated that H2A.Z’s ability to enhance nucleosomal DNA mobility is largely attributed to its characteristic shorter C-terminus. Our study provides the structural basis for H2A.Z-mediated chromatin regulation, showing that the increase flexibility of the DNA termini in H2A.Z nucleosomes is central to its dual-functions in chromatin regulation and in transcription.
Acute paediatric kidney replacement therapies in Europe: demographic results from the EurAKId Registry
Authors: Guzzo Isabella , de Galasso Lara , Bayazit Aysun Karabay , Yildizdas Dincer , Schmitt Claus Peter , Hayes Wesley , Shroff Rukshana , Jankauskiene Augustina , Virsilas Ernestas , Longo Germana , Vidal Enrico , Mir Sevgi , Bulut Ipek Kaplan , Tkaczyk Marcin , Mencarelli Francesca , Bertulli Cristina , Cvetkovic Mrjana , Kostic Mirjana , Paglialonga Fabio , Montini Giovanni , Yilmaz Ebru , Teixeira Ana , Atmis Bahriye , Schaefer Franz
Published: September 2021

Background

Acute kidney injury (AKI), particularly that requiring dialysis, is a severe complication in hospitalized children that is associated with high morbidity and mortality. A prospective European AKI registry (EurAKId registry, NCT02960867) was created to describe the epidemiology and outcomes of paediatric patients treated with acute dialysis.

Methods

Children were recruited who were between 0 and 18 years of age and were treated both in and outside the paediatric intensive care unit (PICU) with peritoneal dialysis (PD), haemodialysis (HD) or continuous kidney replacement therapy (CKRT) for AKI or metabolic derangement, fluid overload (FO), sepsis or respiratory distress. Five age groups and 12 categories of primary diseases were defined.

Results

Data on 340 patients were analysed, of whom 86% received dialysis for AKI and 14% for reasons other than AKI. Boys accounted for 60% of the patients. Illness severity was greater in children with cardiac and haematologic diseases than those with kidney diseases. Most patients received dialysis in the PICU (84%). The most frequently used dialysis modality was CKRT (64%), followed by PD (14%) and HD (14%). The overall survival rate was 65%. Survival was significantly lower in children with three comorbidities than in children with no comorbidities (41% and 83%; P < 0.001).

Conclusions

The EurAKId registry is the first prospective registry considering paediatric acute kidney replacement therapies (KRTs) in both critical and non-critical care settings, focusing on the three dialysis modalities in Europe. The clinical indications for KRT have expanded; our population was characterized by critically ill patients, primarily boys, who frequently received dialysis in the PICU with CKRT.
The impact of depression, anxiety and comorbidity on occupational outcomes
Authors: Deady M , Collins D A J , Johnston D A , Glozier N , Calvo R A , Christensen H , Harvey S B
Published: September 2021

Background

Anxiety and depression account for considerable cost to organizations, driven by both presenteeism (reduced performance due to attending work while ill) and absenteeism. Most research has focused on the impact of depression, with less attention given to anxiety and comorbid presentations.

Aims

To explore the cross-sectional relationship between depression and anxiety (individually and comorbidly) on workplace performance and sickness absence.

Methods

As part of a larger study to evaluate a mental health app, 4953 working Australians were recruited. Participants completed in-app assessment including demographic questions, the Patient Health Questionnaire-9, two-item Generalized Anxiety Disorder and questions from the World Health Organization Health and Work Performance Questionnaire. Cut-off scores were used to establish probable cases of depression alone, anxiety alone and comorbidity.

Results

Of the total sample, 7% met cut-off for depression only, 13% anxiety only, while 16% were comorbid. Those with comorbidity reported greater symptom severity, poorer work performance and more sickness absence compared to all other groups. Presenteeism and absenteeism were significantly worse in those with depression only and anxiety only compared to those with non-clinical symptom levels. Although those with depression alone tended to have poorer outcomes than the anxiety-only group, when sample prevalence rates were considered, the impact on presenteeism was comparable.

Conclusions

Workplace functioning is heavily impacted by depression and anxiety both independently and where they co-occur. While comorbidity and more severe depression presentations stand out as impairing, workplace interventions should also prioritize targeting of anxiety disorders (and associated presenteeism) given their high population prevalence.
A kinetics of the spinning gravitational field
Authors: Yamamoto Tokonatsu
Published: September 2021

According to the general theory of relativity, a spinning shell drags its gravitational field. Owing to this frame-dragging effect, the gravitational field rotates. The spinning field also drags particles in the field. Although this moment of force is negligibly small, its kinetics should be properly handled. In this study, we show that the spinning gravitational field generates a central force, which makes the spinning shells heavy. The observed galactic rotation is naturally described by this central force without dark matter. We describe the kinetics of the spinning field and central force.
Incidence and prevalence of juvenile idiopathic arthritis in the United Kingdom, 2000–2018: results from the Clinical Practice Research Datalink
Authors: Costello Ruth , McDonagh Janet , Hyrich Kimme L , Humphreys Jenny H
Published: September 2021

Objective

The incidence and prevalence of JIA was last estimated in the UK in 1994. Since then the disease has been reclassified, the specialty of paediatric rheumatology has evolved and there has been a significant shift in disease management with new advanced therapies. This study aimed to provide up-to-date national estimates of this disease.

Methods

Children and young people (CYP) with JIA were identified in the Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases, which source data from the two most commonly used primary care electronic health record systems in the UK. These databases were combined and the cohort was identified (2000–18) using predefined code lists. Validation was performed through linkage to the England Hospital Episode Statistics. Annual incidence and prevalence rates were calculated and stratified by gender, age group and nation of the UK. Direct standardization to the UK population was performed and 5 year incidence rates were calculated between 2003 and 2018.

Results

The age-standardized incidence rate was 5.61 per 100 000 population. The age-standardized prevalence rate in 2018 was 43.5 per 100 000. Rates were higher in Scotland compared with England: incidence rate ratio 1.27 (95% CI 1.11, 1.46). The 5 year incidence rates did not change significantly over time.

Conclusions

This study has provided the first contemporaneous estimates of occurrence of JIA in the UK in 25 years. These data provide important estimates to inform resource allocation and health service development for management of JIA.
The Strait of Gibraltar is an ineffective palaeogeographic barrier for some flightless darkling beetles (Coleoptera: Tenebrionidae:Pimelia)
Authors: Mas-Peinado Paloma , García-París Mario , Ruiz José L , Buckley David
Published: September 2021

The geographic distribution of a species is shaped by its biology and by environmental and palaeogeographic factors that interact at different spatial-temporal scales, which leads to distributions and diversification patterns observed between and within lineages. The darkling beetle genus Pimelia has been diversifying for more than 31.2 Mya showing different colonization patterns after the opening of the Gibraltar Strait 5 Mya. Three of the 14 subgenera of Pimelia have populations on both sides of the Strait. Through extensive sampling and the analysis of three molecular markers, we determine levels of intra- and interspecific genetic variation, identify evolutionary lineages in subgenera, estimate their temporal origin and distribution ranges and discuss the historical basis for the geographic and diversification patterns of Pimelia around the Strait. This single geographical feature acted both as a barrier and as a dispersal route for different Pimelia species. The Strait has represented a strong barrier for the subgenus Magrebmelia since the Middle Miocene. However, the subgenera Amblyptera and Amblypteraca share repetitive signatures of post-Messinian colonization across the Strait, possibly driven by stochastic or ‘catastrophic’ events such as tsunamis. Our demographic analyses support Wallace’s hypothesis on insect dispersal stochasticity. Some taxonomic changes, including the designation of a lectotype for Pimelia maura, are also proposed.
Preventing Medjacking
Authors: Cuningkin Veneine , Riley Elizabeth , Rainey Larronda
Published: September 2021

Advances in medical device technology have led to greater connectivity with other devices, networks, and systems, raising concerns about associated security risks. Many clinicians, as well as the patients who rely on these lifesaving devices, are unaware of these risks and how they can be mitigated. This article describes several types of cyberattacks, including medjacking, hacking, and ransomware, and what nurses can do to guard against security threats and educate patients.
Postpartum Nurse Home Visits Offer Long-Lasting Benefits
Authors: Rosenberg Karen
Published: September 2021

According to this study:

A high-quality, broad-reaching postpartum nurse home visitation program had long-lasting benefits on the well-being of children and families, including reduced rates of child maltreatment investigations and emergency medical care use.
On Its Own Terms: An ICU Nurse Considers Human Adaptability
Authors: Phipps Marcy
Published: September 2021

Updated several times a week with posts by a wide variety of authors, AJN's blog Off the Charts allows us to provide more timely—and often more personal—perspectives on professional, policy, and clinical issues. Best of the Blog is a regular column to draw the attention of AJN readers to posts we think deserve a wider audience. To read more, please visit: www.ajnoffthecharts.com.
Jackie Campbell: Creator of the Danger Assessment
Authors: Fauteux Nicole
Published: September 2021

As part of its Raise the Voice campaign to showcase nurses who are key players in transforming health care, the American Academy of Nursing has identified nurses they call edge runners—“practical innovators who have led the way in bringing new thinking and new methods to a wide range of health care challenges.” This is the eighth in AJN's series of profiles of these nursing innovators. Read and be proud of what nurses can accomplish.
A Mixed-Methods Study of Teaching Health Center Residents’ Experiences of Mentorship, Career Planning, and Postresidency Practice Environments
Authors: Strasser Julia H. , Jewers Mariellen M. , Kepley Hayden , Chen Candice , Erikson Clese , Regenstein Marsha
Published: September 2021

Purpose

The Teaching Health Center (THC) Graduate Medical Education program enables primary care physicians to train in community-based, underserved settings by shifting the payment structure and training environment for graduate medical education. To understand how THCs have successfully trained primary care physicians who practice in community-based settings, the authors conducted a mixed-methods exploratory study to examine THC residency graduates’ experiences of mentorship and career planning during their residencies, perceptions of preparation for postresidency practice, and how these experiences were related to postresidency practice environments.

Method

Surveys were conducted for all 804 graduating THC residents nationally, 2014–2017 (533 respondents, 66% response rate). Three quantitative outcomes were measured: graduates’ perceptions of preparation for practice after residency (Likert scale), satisfaction with mentorship and career planning (Likert scale), and characteristics of postresidency practice environment (open-ended). A qualitative analysis of open-text survey answers, using thematic content analysis, was also conducted.

Results

Most THC graduates (68%) were satisfied with their mentorship and career planning experience and generally felt prepared for postresidency practice in multiple settings (78%–93%). Of the 533 THC graduates who provided information about their practice environment, 445 (84%) were practicing in primary care; nationally, 64% of physicians who completed primary care residencies practiced in primary care. Of the 445 THC graduates practicing in primary care, 12% practiced in rural areas, compared with 7% of all physicians. Just over half of THC graduates (51%) practiced in medically underserved areas, compared with 39% of all physicians.

Conclusions

This study offers early evidence that the THC model produces and retains primary care physicians who are well prepared to practice in underserved areas. Given these promising findings, there appears to be a substantial benefit to growing the THC program. However, the program continues to face uncertainty around ongoing, stable funding.
Simulating for Quality: A Centralized Quality Improvement and Patient Safety Simulation Curriculum for Residents and Fellows
Authors: Luty Jacob T. , Oldham Hayden , Smeraglio Andrea , DiVeronica Matthew , Terndrup Christopher , Tibayan Frederick A. , Engle Joshua , Lepin Kimberly , Nonas Stephanie
Published: September 2021

Problem

Requirements for experiential education in quality improvement and patient safety (QI/PS) in graduate medical education (GME) have recently expanded. Major challenges to meeting these requirements include a lack of faculty with the needed expertise, paucity of standardized curricular models allowing for skill demonstration, and inconsistent access to data for iterative improvement.

Approach

In October 2017, the authors began development of a centralized QI/PS flipped-classroom simulation-based medical education (SBME) curriculum for GME trainees across multiple disciplines at Oregon Health & Science University (OHSU). The curriculum development team included OHSU and Veterans Affairs faculty with experience in QI/PS and SBME, as well as house officers. The curriculum consisted of a preassessment and prework readings and videos (sent 3 weeks before the simulation day) and an 8-hour simulation day, with introductory activities, 4 linked simulation sessions, and concluding activities. The 4 linked sessions followed the same medication error from disclosure and reporting to root cause analysis, iterative implementation of an action plan, and consolidation of lessons learned into routine operations with Lean huddles.

Outcomes

In academic year 2018–2019, 71 residents and fellows of various postgraduate years from 23 training programs enrolled in 2 pilot sessions. Learners reacted favorably to the simulation curriculum. Learner attitudes, confidence, knowledge, and skills significantly increased across all QI/PS domains studied.

Next Steps

This approach focuses a small cadre of educators toward the creation of a centralized resource that, owing to its experiential SBME foundation, can accommodate many learners with data-driven practice-based learning and improvement cycles in a shorter time frame than traditional QI initiatives. Next steps include the addition of a control group, assessment of the sustainability of learner outcomes, translation of learning to behavior change and improvements in patient and health system outcomes, and adapting the materials to include learners from different professions and levels.
Cerebral arterial fenestration associated with stroke and other cerebrovascular diseases
Authors: Ye Dan , Huang Jinzhong , Wang Sulei , Sheng Shiying , Liu Meng
Published: September 2021

Background

Cerebral arterial fenestration is a rare vascular malformation that has not been fully understood. Whether it is related to cerebrovascular diseases remains to be determined. In this study, we aimed to investigate the imaging characteristics of cerebral fenestrations, the clinical characteristics of fenestrations complicated with cerebrovascular diseases, and the correlation between fenestrations and cerebrovascular diseases.

Methods

We reviewed the magnetic resonance imaging and computed tomography (CT) imaging findings of patients with cerebrovascular fenestrations in the Third Affiliated Hospital of Soochow University from January 2016 to December 2020, mainly focused on the shape and location of fenestrations. According to the location of fenestrated arteries, patients were divided into the internal carotid arterial system (ICAS) group and the vertebrobasilar arterial system (VAS) group. For patients complicated with cerebrovascular diseases, detailed data about the demographics and clinical characteristics were recorded. Stroke patients with injured lesions located in the territories of fenestrated arteries were further screened out and analyzed. Moreover, the proportions of cerebrovascular diseases including stroke between the ICAS group and the VAS group were compared.

Results

A total of 280 cerebrovascular fenestrations were found in 274 patients (six patients had two fenestrations). The most frequently involved vessels were the anterior cerebral artery (123/280), the basilar artery (76/280) and the vertebral artery (35/280). As to the shape of fenestrations, slit-like fenestrations accounted for 63.2% (177/280), followed by convex-lens-like type 26.1% (73/280) and duplicated type 10.7% (30/280). A total of 70 patients were complicated with cerebrovascular diseases, including ischemic stroke 64.3% (45/70), hemorrhagic stroke 22.9% (16/70), aneurysm 10% (7/70), arteriovenous malformation 1.4% (1/70) and cavernous hemangioma 1.4% (1/70). There were no significant differences between the ICAS group and the VAS group in terms of the demographics and clinical characteristics. Furthermore, among the 61 patients complicated with stroke, 16 patients’ stroke lesions were located in the territories of fenestrated arteries, including 12.5% (2/16) in the ICAS and 87.5% (14/16) in the VAS. In addition, compared with the ICAS group, the proportions of cerebrovascular diseases including stroke in patients with fenestrations were higher in the VAS group (P < 0.05).

Conclusions

Cerebral arterial fenestrations are most commonly found in the anterior cerebral artery, the basilar artery and the vertebral artery. Vertebrobasilar fenestrations are more related to cerebrovascular diseases, especially stroke.
Ethanol and opioids do not act synergistically to depress excitation in carotid body type I cells
Authors: Rakoczy Ryan , Kamra Kajal , Yi Yoon-Jae , Wyatt Christopher
Published: September 2021

Objective

The combination of opioids and ethanol can synergistically depress breathing and the acute ventilatory response to hypoxia. Multiple studies have shown that the underlying mechanisms for this may involve calcium channel inhibition in central neurons. But we have previously identified opioid receptors in the carotid bodies and shown that their activation inhibits calcium influx into the chemosensitive cells. Given that the carotid bodies contribute to the drive to breathe and underpin the acute hypoxic ventilatory response, we hypothesized that ethanol and opioids may act synergistically in these peripheral sensory organs to further inhibit calcium influx and therefore inhibit ventilation.

Methods

Carotid bodies were removed from 56 Sprague–Dawley rats (1021 days old) and then enzymatically dissociated to allow calcium imaging of isolated chemosensitive type I cells. Cells were stimulated with high K+ in the presence and absence of the µ-opioid agonist [D-Ala2, N-MePhe4, Gly-ol]-enkephalin (DAMGO) (10 µM), a maximal sublethal concentration of ethanol (3 g L-1, 65.1 mM) or a combination of both.

Results

DAMGO alone significantly inhibited Ca2+ influx but this effect was not potentiated by the high concentration of ethanol.

Conclusion

These results indicate for the first time that while opioids may suppress breathing via an action at the level of the carotid bodies, ethanol is unlikely to potentiate inhibition via this pathway. Thus, the synergistic effects of ethanol and opioids on ventilatory parameters are likely mediated by central rather than peripheral actions.
Network rewiring promotes cooperation in an aspirational learning model
Authors: Pal Anuran , Sengupta Supratim
Published: September 2021

We analyze a cooperative decision-making model that is based on individual aspiration levels using the framework of a public goods game in static and dynamic networks. Sensitivity to differences in payoff and dynamic aspiration levels modulate individual satisfaction and affects subsequent behavior. The collective outcome of such strategy changes depends on the efficiency with which aspiration levels are updated. Below a threshold learning efficiency, cooperators dominate despite short-term fluctuations in strategy fractions. Categorizing players based on their satisfaction level and the resulting strategy reveal periodic cycling between the different categories. We explain the distinct dynamics in the two phases in terms of differences in the dominant cyclic transitions between different categories of cooperators and defectors. Allowing even a small fraction of nodes to restructure their connections can promote cooperation across almost the entire range of values of learning efficiency. Our work reinforces the usefulness of an internal criterion for strategy updates, together with network restructuring, in ensuring the dominance of altruistic strategies over long time-scales.

Maintaining a public resource requires sustained cooperation through contributions by community members who benefit from it. Yet, a selfish individual who refuses to contribute can enjoy the benefits without paying the cost of sustaining the public good. If however, too many members of the community act selfishly, the public resource collapses to the detriment of all. The public goods game highlights such a social dilemma and provides a framework for exploring different mechanisms of strategic decision-making that allow cooperation and consequently the public good to be sustained. Among many mechanisms, the reorganization of social ties has been shown to be effective in promoting cooperation in PGG. However, the efficacy of most mechanisms in sustaining cooperation rely on individuals updating their strategy on the basis of information about the contributions of other members of the community. Often such information is either not forthcoming or cannot be effectively utilized. An alternative low-information model of behavioral updating relies on a comparison between the actual benefit received and the benefit aspired for. Individuals tend to retain their strategy if they are satisfied with the benefit received and change their strategy if they are unsatisfied. We show that such a simple reinforcement learning model along with modest restructuring of social ties over time can allow cooperation to be sustained. Our work shows that a low-information strategy-update model can be very effective in ensuring dominance of cooperators in social dilemmas.
Body mass index and childhood symptoms of depression, anxiety, and attention-deficit hyperactivity disorder: a within-family Mendelian randomization study
Authors: Hughes Amanda M , Sanderson Eleanor , Morris Tim , Ayorech Ziada , Tesli Martin , Ask Helga , Reichborn-Kjennerud Ted , Andreassen Ole A. , Magnus Per , Helgeland Øyvind , Johansson Stefan , Njølstad Pål , Davey Smith George , Havdahl Alexandra , Howe Laura D , Davies Neil M
Published: September 2021

Background

Higher BMI in childhood is associated with emotional and behavioural problems, but these associations may not be causal. Results of previous genetic studies imply causal effects but may reflect influence of demography and the family environment.

Methods

This study used data on 40,949 8-year-old children and their parents from the Norwegian Mother, Father and Child Cohort Study (MoBa) and Medical Birth Registry of Norway (MBRN). We investigated the impact of BMI on symptoms of depression, anxiety, and attention-deficit hyperactivity disorder (ADHD) at age 8. We applied within-family Mendelian randomization, which accounts for familial effects by controlling for parental genotype.

Results

Within-family Mendelian randomization estimates using genetic variants associated with BMI in adults suggested that a child’s own BMI increased their depressive symptoms (per 5kg/m2increase in BMI, beta=0.26 S.D., CI=-0.01,0.52, p=0.06) and ADHD symptoms (beta= 0.38 S.D., CI=0.09,0.63, p=0.009). These estimates also suggested maternal BMI, or related factors, may independently affect a child’s depressive symptoms (per 5kg/m2increase in maternal BMI, beta=0.11 S.D., CI:0.02,0.09, p=0.01). However, within-family Mendelian randomization using genetic variants associated with retrospectively-reported childhood body size did not support an impact of BMI on these outcomes. There was little evidence from any estimate that the parents’ BMI affected the child’s ADHD symptoms, or that the child’s or parents’ BMI affected the child’s anxiety symptoms.

Conclusions

We found inconsistent evidence that a child’s BMI affected their depressive and ADHD symptoms, and little evidence that a child’s BMI affected their anxiety symptoms. There was limited evidence of an influence of parents’ BMI. Genetic studies in samples of unrelated individuals, or using genetic variants associated with adult BMI, may have overestimated the causal effects of a child’s own BMI.

Funding

This research was funded by the Health Foundation. It is part of the HARVEST collaboration, supported by the Research Council of Norway. Individual co-author funding: the European Research Council, the South-Eastern Norway Regional Health Authority, the Research Council of Norway, Helse Vest, the Novo Nordisk Foundation, the University of Bergen, the South-Eastern Norway Regional Health Authority, the Trond Mohn Foundation, the Western Norway Regional Health Authority, the Norwegian Diabetes Association, the UK Medical Research Council. The Medical Research Council (MRC) and the University of Bristol support the MRC Integrative Epidemiology Unit.
The proportion of seizure onset zone contacts resected is not associated with outcome following SEEG-guided resective epilepsy surgery in children
Authors: Khan Mehdi , Chari Aswin , Seunarine Kiran , Eltze Christin , Moeller Friederike , D’Arco Felice , Thornton Rachel , Das Krishna , Boyd Stewart , Cross J Helen , Tahir M Zubair , Tisdall Martin M
Published: September 2021

Purpose

Children undergoing stereoelectroencephalography (SEEG)-guided epilepsy surgery represent a complex cohort. We aimed to determine whether the proportion of putative seizure onset zone (SOZ) contacts resected associates with seizure outcome in a cohort of children undergoing SEEG-guided resective epilepsy surgery.

Methods

Patients who underwent SEEG-guided resective surgery over a six-year period were included. The proportion of SOZ contacts resected was determined by co-registration of pre- and post-operative imaging. Seizure outcomes were classified as seizure free (SF, Engel class I) or not seizure-free (NSF, Engel class II-IV) at last clinical follow-up.

Results

Of 94 patients undergoing SEEG, 29 underwent subsequent focal resection of whom 22 had sufficient imaging data to be included in the primary analysis (median age at surgery of 10 years, range 5-18). Fifteen (68.2%) were SF and 7 (31.8%) NSF at median follow-up of 19.5 months (range 12-46). On univariate analysis, histopathology, was the only significant factor associated with SF (p<0.05). The percentage of defined SOZ contacts resected ranged from 25-100% and was not associated with SF (p=0.89). In a binary logistic regression model, it was highly likely that histology was the only independent predictor of outcome, although the interpretation was limited by pseudo-complete separation of the data.

Conclusion

Histopathology is a significant predictor of surgical outcomes in children undergoing SEEG-guided resective epilepsy surgery. The percentage of SOZ contacts resected was not associated with SF. Factors such as spatial organisation of the epileptogenic zone, neurophysiological biomarkers and the prospective identification of pathological tissue may therefore play an important role.