bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of prolonged exposure therapy for a patient with late-onset PTSD affected by evacuation due to the Fukushima nuclear power plant accident
Authors: Hori Arinobu , Takebayashi Yoshitake , Tsubokura Masaharu , Kim Yoshiharu
Published: December 2019

Trauma-focused cognitive–behavioural therapy (TF-CBT), such as prolonged exposure therapy, is a first-line treatment for post-traumatic stress disorder (PTSD). However, adapting TF-CBT as an intervention in situations with limited resources, such as in disaster settings, is problematic. This case report concerns a Japanese man in his 30s who was diagnosed with late-onset PTSD 5 years after the 2011 Great East Japan Earthquake. The onset and progression of his symptoms were heavily affected by changes in his life after evacuation due to the postearthquake nuclear power plant accident. We were able to successfully implement structured CBT and help the patient better cope with his symptoms in a disaster-stricken location. CBT for PTSD includes exposure to traumatic memories, which may lead to worsening of PTSD symptoms, but we were able to administer the therapy successfully with clinical support through the use of modern information and communication technology.
Small cell carcinoma of the bladder presenting with paraneoplastic syndrome of inappropriate antidiuretic hormone
Authors: Stoll Kristin , Tomkovich Ashleigh , Howells Joseph
Published: December 2019

Small cell carcinoma (SCC) of the bladder is a rare malignancy, representing less than 1% of bladder cancers diagnosed annually in the USA. In contrast to SCC of the lung, paraneoplastic syndromes are rarely documented in cases of extrapulmonary SCCs, particularly those of genitourinary origin. We present a case of SCC of the bladder presenting with paraneoplastic syndrome of inappropriate antidiuretic hormone, which resolved after treatment with sequential chemoradiation.
Diagnostic delay in a case of T-cell neurolymphomatosis
Authors: Li Vivien , Jaunmuktane Zane , Cwynarski Kate , Carr Aisling
Published: December 2019

A 69-year-old woman presented with severe subacute painful meningoradiculoneuritis. Neurophysiology showed a patchy, proximal axonal process with widespread denervation. Cerebrospinal fluid (CSF) was lymphocytic (normal T-cell predominant) with negative cytology. MRI revealed multiple sites of enhancement, but fluorodeoxyglucose positron emission tomography was negative. Bone marrow aspirate and trephine (BMAT) showed no evidence of a lymphoproliferative condition. Right brachial plexus biopsy demonstrated mixed T-cell/B-cell endoneurial inflammation not fulfilling criteria for vasculitis. She was stabilised with high-dose steroids and cyclophosphamide, followed by mycophenolate for inflammatory myeloradiculoneuritis. However, symptoms recurred when prednisolone was weaned. Although T-cell receptor gene analysis from the initial CSF demonstrated clonal rearrangements, it was only when the same clones were identified on two repeat BMATs and CSF that T-cell neurolymphomatosis, an exceedingly rare condition, was diagnosed. This case highlights the diagnostic challenge in peripheral neurolymphomatosis related to patchy disease, variable sensitivity and specificity of investigative tools, and the influence of therapies on traditional cytological definitions of lymphoma. The clinical picture, exhaustive exclusion of alternative causes and the persistence of an abnormal T-cell clone ultimately lead to a diagnostic consensus between specialist neurology and haematology clinicians.
Lyme neuroborreliosis presenting as spinal myoclonus
Authors: Li Xena , Kirschner Aaron , Metrie Mary , Loeb Mark
Published: December 2019

Early neurological Lyme disease (neuroborreliosis) typically presents with well-recognised neurological syndromes. Spinal myoclonus is however a rare manifestation of neuroborreliosis. We present the case of a man who developed spinal myoclonus 3 weeks after returning from the Czech Republic where he developed erythema migrans on his arm following multiple tick exposures. Spinal fluid analysis showed a pleocytosis and MRI showed enhancement at C5-C6. His serology was positive for IgM antibodies toBorrelia afzelli. He was successfully treated with ceftriaxone and doxycycline with improvement of his spinal myoclonus and radiculitis. We conclude that early Lyme neuroborreliosis may present with uncommon neurological manifestations and so a high degree of suspicion is needed.
Ascending aortic dissection in a pregnant patient with neonatally repaired coarctation of aorta and bicuspid aortic valve
Authors: Cassar Mark Philip , Shabbir Asad , Orchard Elizabeth , Stirrup James
Published: December 2019

Aortic dissection is characterised by a tear in the intimal and medial layers of the endovascular aortic wall which propagates distally. Here, we discuss the case of a 35-year-old woman who was 37 weeks pregnant and presented with dizziness and blurred vision. She had a history of a neonatal end-to-end repair of a coarctation of aorta, a known bicuspid aortic valve and a dilated ascending aorta under surveillance. A transthoracic echocardiogram revealed an ascending aortic dissection. An emergency CT aortogram was performed which confirmed the diagnosis. The patient underwent emergency caesarean section and aortic surgery, with a good outcome for mother and baby. The case highlights the atypical nature of presentation and the absence of haemodynamic instability. Atypical and unexplained symptoms on a background of congenital heart disease should trigger a referral to cardiology with thorough investigation, often with echocardiography, to exclude rare and life-threatening complications.
Sleep problems of healthcare workers in tertiary hospital and influencing factors identified through a multilevel analysis: a cross-sectional study in China
Authors: Liu Huan , Liu Jingjing , Chen Mingxi , Tan Xiao , Zheng Tong , Kang Zheng , Gao Lijun , Jiao Mingli , Ning Ning , Liang Libo , Wu Qunhong , Hao Yanhua
Published: December 2019

Objectives

Sleep problems are common among healthcare workers, especially among those who work in tertiary hospitals; however, studies focusing on healthcare workers in tertiary hospitals in China are limited. Therefore, we aimed to examine the prevalence of sleep problems among tertiary hospital employees in China and identify associated factors.

Design

Cross-sectional questionnaire survey study.

Setting

The study was conducted in 317 departments at 33 tertiary hospitals in the Heilongjiang Province, China.

Participants

The study included a representative sample of 4007 healthcare workers, including clinicians, medical technicians and office workers, who were selected using a multistage cluster sampling method. Ultimately, 3810 participants completed valid questionnaires, yielding a response rate of 95%.

Primary and secondary outcome measures

Participants completed a structured questionnaire which collected data regarding demographics, sleep problems, employment, chronic pain and health-related behaviours. A two-level logistic regression model was constructed to examine determinants of sleep problems.

Results

We found that nearly half of the respondents reported experiencing sleep problems. The two-level logistic model suggested a positive association of sleep problems with headache (OR=2.64, 95% CI=2.27 to 3.07), working hours (OR=1.41, 95% CI=1.20 to 1.66) and night shifts (OR=1.43, 95% CI=1.21 to 1.69). In contrast, regular diet (OR=0.44, 95% CI=0.36 to 0.53) and exercise (OR=0.65, 95% CI=0.53 to 0.80) protected the study population against sleep problems.

Conclusions

We found that sleep problems are prominent among tertiary hospital employees in China. The risk factor most strongly associated with sleep problems was headaches. To alleviate sleep problems in this population, medical institutions and health policy makers should establish reasonable working schedules and night-shift work systems, while the healthcare workers themselves should pay attention to their chronic pain problems and engage in regular diet and exercise.
Improving chronic pain management with eHealth and mHealth: study protocol for a randomised controlled trial
Authors: Jaén Irene , Suso-Ribera Carlos , Castilla Diana , Zaragoza Irene , García-Palacios Azucena , Gómez Palones Jose Luis
Published: December 2019

Introduction

Chronic pain has become a matter of public health concern due to its high prevalence and because public costs associated with treatment and disability increase each year. Research suggests that limitations in the traditional assessment of chronic pain patients limit the effectiveness of current medical treatments. The use of technology might serve change patient traditional monitoring into ecological momentary assessments, which might be visualised by physicians live. This study describes a randomised control trial designed to test the utility of a technology-based solution for pain telemonitoring consisting of a smartphone app for patients and a web application for physicians. The goal of this study will be to explore whether this combination of eHealth and mHealth improves the effectiveness of existing pain treatments.

Methods and analysis

Participants will be 250 patients randomly assigned to one of these two conditions: treatment-as-usual (TAU) and TAU +app+ web. All participants will receive the usual treatment for their pain. Only the TAU +app+ web group use Pain Monitor app, which generates alarms that are sent to the physicians in the face of previously established undesired events. Physicians will be able to monitor app reports using a web application, which might result in an adjustment of treatment. We anticipate that the use of Pain Monitor plus the therapist web will result in a reduction of pain intensity and side effects of the medication. Improvements on secondary outcomes, namely fatigue, mood, pain interference, rescue medication use and quality of life, are also expected. Mixed repeated-measure multivariate analyses of variances will be conducted to investigate whether there are differences between preassessment and postassessment scores as a function of the experimental condition.

Ethics and dissemination

Ethical approval from the Hospital General Universitari de Castellon was obtained. The findings will be published in peer-reviewed journals.

Trial registration number

NCT03606265
Family-building decision aid and planning tool for young adult women after cancer treatment: protocol for preliminary testing of a web-based decision support intervention in a single-arm pilot study
Authors: Benedict Catherine , Ford Jennifer S , Schapira Lidia , Simon Pamela , Spiegel David , Diefenbach Michael
Published: December 2019

Introduction

Many young adult female (YA-F) cancer survivors who received gonadotoxic therapy will experience fertility problems. After cancer, having a child will often require assisted reproductive technology (ART), surrogacy or adoption. However, there are significant informational, psychosocial, financial and logistical barriers to pursuing these options. Survivors report high rates of decision uncertainty and distress related to family-building decisions. The aim of this study is to pilot test a web-based decision aid and planning tool for family-building after cancer.

Methods and analysis

The pilot study will use a single-arm trial design to test the feasibility and acceptability (aim 1) and obtain effect size estimates of the decision support intervention (aim 2). The target sample size is 100. Participants will include YA-F survivors (aged 18–45 years) who are post-treatment and have not completed desired family-building. A longitudinal prepost design will be conducted. Participants will complete three psychosocial assessment surveys over a 3-month time period to track decisional conflict (primary outcome) and cognitive, emotional, and behavioural functioning (secondary outcomes). After completing the baseline survey (T1; pre-intervention), participants will have access to the decision aid website. Postintervention surveys will be administered at 1-month (T2) and 3-month (T3) follow-up time points. Feasibility and acceptability metrics will be analysed. Pairwise t-tests will test mean scores of outcome variables from T1 to T2. Effect size estimates (Cohen’s d) will be calculated. Google analytics will evaluate user engagement with the website over the study period. Baseline and follow-up data will examine measures of feasibility, acceptability and intervention effect size.

Ethics and dissemination

This will be the first test of a supportive intervention to guide YA-F cancer survivors in family-building decisions and early planning. Study findings will inform intervention development. Future directions will include a randomised controlled trial to test intervention efficacy over a longer time period.

Trial registration number

NCT04059237; Pre-results.
Resilience and associative stigma among mental health professionals in a tertiary psychiatric hospital: a cross-sectional study in Singapore
Authors: Chang Sherilyn , Picco Louisa , Abdin Edimansyah , Yuan Qi , Chong Siow Ann , Subramaniam Mythily
Published: December 2019

Objectives

The mental health profession exposes healthcare workers to unique stressors such as associative stigma (stigmatisation that is extended from the stigmatised patients to psychiatric professionals and is based on affiliation with an individual with mental illness). Enhancing resilience, or the ability to ‘bounce back’ from adversity, is found to be useful in reducing occupational stress and its negative effects. In view of the high burnout rates reported among mental health professionals, this study aimed to examine resilience in this group of professionals and to explore the association between resilience and associative stigma.

Design

Observational study—cross-sectional design.

Setting

Tertiary psychiatry hospital in Singapore.

Participants

The study was conducted among 470 mental health professionals (doctors, nurses and allied health professionals) working in the hospital.

Measures

Resilience was assessed using the Brief Resilience Scale (BRS) and participants completed questionnaires that examined associative stigma. Participants provided their sociodemographic information, length of service, and information on whether they knew of a close friend or family member who had a mental illness.

Results

Mean resilience score for the overall sample was 3.59 (SD=0.64). Older age (β=0.012, 95% CI 0.004 to 0.019, p=0.003) and having known a family member or close friend with a mental illness (β=0.155, 95% CI 0.019 to 0.290, p=0.025) predicted higher BRS score. Associative stigma remained significantly associated with resilience score after controlling for sociodemographic factors whereby higher associative stigma predicted lower resilience scores.

Conclusion

The present finding suggests that resilience building programmes among mental health workers should target those of the younger age group, and that addressing the issue of associative stigma is essential.
Does ‘online confidence’ predict application success and later academic performance in medical school? A UK-based national cohort study
Authors: Tiffin Paul A , Paton Lewis W
Published: December 2019

Objectives

The UK Clinical Aptitude Test (UKCAT) previously piloted an assessment of ‘online confidence’, where candidates were asked to indicate how confident they were with their answers. This study examines the relationship between these ratings, the odds of receiving an offer to study medicine and subsequent undergraduate academic performance.

Design

National cohort study.

Setting

UK undergraduate medical selection.

Participants

56 785 UKCAT candidates who sat the test between 2013 and 2016 and provided valid responses to the online confidence pilot study.

Primary outcome measures

Two measures of ‘online confidence’ were derived: the well-established ‘confidence bias’, and; a novel ‘confidence judgement’ measure, developed using Item Response Theory in order to derive a more sophisticated metric of the ability to evaluate one’s own performance on a task. Regression models investigated the relationships between these confidence measures, application success and academic performance.

Results

Online confidence was inversely related to cognitive performance. Relative underconfidence was associated with increased odds of receiving an offer to study medicine. For ‘confidence bias’ this effect was independent of potential confounders (OR 1.48, 1.15 to 1.91, p=0.002). While ‘confidence judgement’ was also a univariable predictor of application success (OR 1.22, 1.01 to 1.47, p=0.04), it was not an independent predictor. ‘Confidence bias’, but not ‘confidence judgement’, predicted the odds of passing the first year of university at the first attempt, independently of cognitive performance, with relative underconfidence positively related to academic success (OR 3.24, 1.08 to 9.72, p=0.04). No non-linear effects were observed, suggesting no ‘sweet spot’ exists in relation to online confidence and the outcomes studied.

Conclusions

Applicants who either appear underconfident, or are better at judging their own performance on a task, are more likely to receive an offer to study medicine. However, online confidence estimates had limited ability to predict subsequent academic achievement. Moreover, there are practical challenges to evaluating online confidence in high-stakes selection.
Feasibility study of early outpatient review and early cardiac rehabilitation after cardiac surgery: mixed-methods research design—a study protocol
Authors: Ngaage Dumbor , Mitchell Natasha , Dean Alexandra , Hirst Claire , Akowuah Enoch , Doherty Patrick Joseph , Fairhurst Caroline , Flemming Kate , Hewitt Catherine , Hinde Sebastian , Mitchell Alex , Nichols Simon , Watson Judith
Published: December 2019

Introduction

Following cardiac surgery, patients currently attend an outpatient review 6 weeks after hospital discharge, where recovery is assessed and suitability to commence cardiac rehabilitation (CR) is determined. CR is then started from 8 weeks. Following a median sternotomy, cardiac surgery patients are required to refrain from upper body exercises, lifting of heavy objects and other strenuous activities for 12 weeks. A delay in starting CR can prolong the recovery process, increase dependence on family/carers and can cause frustration. However, current guidelines for activity and exercise after median sternotomy have been described as restrictive, anecdotal and increasingly at odds with modern clinical guidance for CR. This study aims to examine the feasibility of bringing forward outpatient review and starting CR earlier.

Methods and analyses

This is a multicentre, randomised controlled, open feasibility trial comparing postoperative outpatient review 6 weeks after hospital discharge, followed by CR commencement from 8 weeks (control arm) versus, postoperative outpatient review 3 weeks after hospital discharge, followed by commencement of CR from 4 weeks (intervention arm). The study aims to recruit 100 eligible patients, aged 18–80 years who have undergone elective or urgent cardiac surgery involving a full median sternotomy, over a 7-month period across two centres. Feasibility will be measured by consent, recruitment, retention rates and attendance at appointments and CR sessions. Qualitative interviews with trial participants and staff will explore issues around study processes and acceptability of the intervention and the findings integrated with the feasibility trial outcomes to inform the design of a future full-scale randomised controlled trial.

Ethics and dissemination

Ethics approval was granted by East Midlands—Derby Research Ethics Committee on 10 January 2019. The findings will be presented at relevant conferences disseminated via peer-reviewed research publications, and to relevant stakeholders.

Trial registration number

ISRCTN80441309
Rehabilitation in palliative care: a qualitative study of team professionals
Authors: Harding Zoe , Hall Charlie , Lloyd Anna
Published: December 2019

Objectives

There has been a recent drive to embed rehabilitation within palliative care. The concept of rehabilitative palliative care has been advocated to help patients preserve function and independence, through greater patient enablement and self-management. Such an approach requires engagement from all members of the palliative care team. There is a lack of understanding of such viewpoints. The objective of this research was to explore hospice-based palliative care professionals’ understanding and perceptions of rehabilitation.

Methods

Qualitative semi-structured interviews were conducted. Eighteen hospice-based healthcare professionals were recruited from a hospice in central Scotland. Interviews were audio-recorded, transcribed and thematically analysed.

Results

Overall, participants clearly articulated the underlying values and benefits of rehabilitative palliative care. Emphasis was placed on ensuring that rehabilitation was appropriately tailored to each individual patient. There was more ambiguity regarding the pragmatic implementation of rehabilitative palliative care, with a number of barriers and facilitators identified.

Conclusions

The findings suggest that hospice-based palliative care professionals would be receptive to further implementation of rehabilitative palliative care. A lack of conceptual clarity among palliative care professionals may be a barrier to the effective implementation of rehabilitative palliative care. At an organisational level, this would require clarification of the approach, and additional training involving all members of the multidisciplinary team.
Cranial burr holes in the emergency department: to drill or not to drill?
Authors: Howard Alan , Krishnan Vinaithan , Lane Gerard , Caird John
Published: December 2019

The practice oftrepanning(referred to today as a craniotomy) dates back to the Neolithic period. Reasons for drilling a hole through the skull evolved from releasing evil spirits and curing insanity to practical management of head injuries in ancient Greece and Rome. Today, craniotomy or drilling a burr hole through the skull is very much the purview of the neurosurgeon. Yet one could argue that the procedure itself is more ‘bone surgery’ than ‘brain surgery’. Nevertheless, despite the fact that head injury is a common presentation at district general hospitals and traumatic extra-axial haemorrhages are encountered often, the straightforward skillset required to drill a burr hole as a pretransfer, temporising, life-saving measure is seldom taught and has never gained traction. What we advocate in this article is the adaptation and novel application of an old, tried and tested technique in new hands. The critical pathophysiological turning point of any expanding extra-axial haemorrhage is the inflection point on the volume/Intracranial pressure (ICP) curve beyond which compensation is impossible. The subsequent rising ICP initiates a predictable continuum of clinical signs signalling progressive herniation. There are few emergencies as time-critical as a patient with an isolated, expanding extradural haemorrhage embarking on a trajectory of rostrocaudal deterioration and inevitable death. In many cases, the tragedy is compounded by the knowledge that such a patient probably has a healthy underlying brain, often evidenced by a lucid period after trauma. Our emergency department is attached to a small 300-bed District General Hospital (DGH) on the rural North West coast of Ireland. We are 262 km distant by road from a national neurosciences department that can, at best, be reached in 2 hours and 30 min. Quality improvement review of years of dismal outcomes in patients such as those described earlier with potentially remediable pathology prompted research and development of the skillset we are now able to offer, an old technique in new hands.
Refeeding syndrome : physiological background and practical management
Authors: De Silva Aminda , Nightingale Jeremy M D
Published: December 2019

Refeeding problems have been recognised since the the liberation of starved communities under siege. The main clinical problems may relate to hypophosphataemia, hypomagnesaemia and hypokalaemia with a risk of sudden death; thiamine deficiency with the risk of Wernike’s encephalopathy/Korsakoff psychosis and sodium/water retention. The problems are greatest with oral/enteral feeding and especially with carbohydrate due to it increasing plasma insulin and thus glucose entry into cells. It is difficult to predict patients at risk of refeeding problems so there must be a high clinical suspicion on refeeding any malnourished patient (including any who have had no or very little nutrition for over5days). Generous vitamin and electrolyte supplementation may be given while monitoring closely and increasing the calorie intake reasonably rapidly from 10 to 20 kcal/kg/24 hours. Often patients in this category are not hungry, but over the course of a few days, the restoration of their appetite is an indication that the risks of refeeding have been managed and it is now safe to increase the feed aiming for repletion. If problems do occur, the feed should be slowed to the previous day’s amount,reduced further or rarely stopped while fluid and electrolyte issues are corrected.
Using Bluetooth beacon technology to reduce distracted pedestrian behaviour: a cross-over trial study protocol
Authors: Schwebel David C , Hasan Ragib , Griffin Russell
Published: December 2019

Objective

Over 6400 American pedestrians die annually, a figure that is currently increasing. One hypothesised reason for the increasing trend is the role of mobile technology in distracting both pedestrians and drivers. Scientists and policy-makers have attended somewhat to distracted driving, but attention to distracted pedestrian behaviour has lagged. We will evaluate Bluetooth beacon technology as a means to alert and warn pedestrians when they approach intersections, reminding them to attend to the traffic environment and cross streets safely.

Methods

Bluetooth beacons are small devices that broadcast information unidirectionally within a closed proximal network. We will place beacons at an intersection frequently trafficked by urban college students. From there, the beacons will transmit to an app installed on users’ smartphones, signalling users to attend to their environment and cross the street safely. A cross-over trial will evaluate the app with 411 adults who frequently cross the target intersection on an urban university campus. We will monitor those participants’ behaviour over three distinct time periods: (1) 3 weeks without the app being activated, (2) 3 weeks with the app activated and (3) 4 weeks without the app activated to assess retention of behaviour. Throughout the 10-week period, we will gather information to evaluate whether the intervention changes distracted pedestrian behaviour using a logistic regression to estimate the likelihood of key behavioural outcome measures and adjusting for any residual confounding. We also will test for changes in perceived risk. The trial will follow CONSORT (Consolidated Standards of Reporting Trials) statement guidelines, as modified for cross-over design studies.

Conclusion

If this program proves successful, it offers exciting implications for future testing and ultimately for broad distribution to reduce distracted pedestrian behavior. We discuss issues of feasibility, acceptability and scalability.
Lessons learned in conducting youth suicide prevention research in emergency departments
Authors: Runyan Carol W , Brandspigel Sara , Barber Catherine W , Betz Marian , Azrael Deborah , Miller Matthew
Published: December 2019

Introduction

To address youth suicide, we recruited seven emergency departments (EDs) for what we believe is the first controlled trial of an intervention to promote safer firearm and medication storage after a child was seen in an ED by a behavioural health clinician. We provided training and a common protocol that required behavioural health clinicians to counsel about reducing access to household firearms and medication and provide locking devices. This paper examines how we addressed implementation challenges and considers how lessons learnt might inform future studies and interventions.

Methods

We tracked enrolment numbers and documented, through project records, the challenges in recruiting and developing partnerships with hospitals, as well as implementing the intervention and carrying out data collection.

Results

We encountered challenges identifying hospitals with sufficient patient volumes to meet our analytic requirements, obtaining contact information from families in the ED and providing supplies to the sites. These challenges were compounded by lack of uniformity in data systems, making it difficult to estimate total ED encounters meeting our eligibility criteria, and by differences in patterns of behavioural healthcare delivery across sites. The strategies we devised to address these challenges included creating visual materials that appealed to parents’ altruistic desire to help other families, laminated ‘cheat sheets’ and hang tags for clinician badges reminding them of the key points of the intervention and contracting with a distribution centre to coordinate shipping.

Discussion

Despite the challenges noted, we found that the behavioural health clinicians in the EDs followed the protocol and found it useful in engaging families in discussions about both firearm and medication storage. Several hospitals intend to continue the intervention on their own as the new usual care, suggesting that the challenges encountered can be and are worth tackling.
IncreasedTBX6gene dosages induce congenital cervical vertebral malformations in humans and mice
Authors: Ren Xiaojun , Yang Nan , Wu Nan , Xu Ximing , Chen Weisheng , Zhang Ling , Li Yingping , Du Ren-Qian , Dong Shuangshuang , Zhao Sen , Chen Shuxia , Jiang Li-Ping , Wang Lianlei , Zhang Jianguo , Wu Zhihong , Jin Li , Qiu Guixing , Lupski James R , Shi Jiangang , Zhang Feng , Liu Pengfei
Published: December 2019

Background

Congenital vertebral malformations (CVMs) manifest with abnormal vertebral morphology. Genetic factors have been implicated in CVM pathogenesis, but the underlying pathogenic mechanisms remain unclear in most subjects. We previously reported that the human 16p11.2 BP4-BP5 deletion and its associatedTBX6dosage reduction caused CVMs. We aim to investigate the reciprocal 16p11.2 BP4-BP5 duplication and its potential genetic contributions to CVMs.

Methods and results

Patients who were found to carry the 16p11.2 BP4-BP5 duplication by chromosomal microarray analysis were retrospectively analysed for their vertebral phenotypes. The spinal assessments in seven duplication carriers showed that four (57%) presented characteristics of CVMs, supporting the contention that increasedTBX6dosage could induce CVMs. For further in vivo functional investigation in a model organism, we conducted genome editing of the upstream regulatory region of mouseTbx6using CRISPR-Cas9 and obtained three mouse mutant alleles (Tbx6up1toTbx6up3) with elevated expression levels ofTbx6. Luciferase reporter assays showed that theTbx6up3allele presented with the 160% expression level of that observed in the reference (+) allele. Therefore, the homozygousTbx6up3/up3mice could functionally mimic theTBX6dosage of heterozygous carriers of 16p11.2 BP4-BP5 duplication (approximately 150%, ie, 3/2 gene dosage of the normal level). Remarkably, 60% of theTbx6up3/up3mice manifested with CVMs. Consistent with our observations in humans, the CVMs induced by increasedTbx6dosage in mice mainly affected the cervical vertebrae.

Conclusion

Our findings in humans and mice consistently support that an increasedTBX6dosage contributes to the risk of developing cervical CVMs.
Association of mechanism of injury with overtriage of injured youth patients as trauma alerts
Authors: Ryan Jessica Lynn , Pracht Etienne , Langland-Orban Barbara , Crandall Marie
Published: December 2019

Background

Trauma alert criteria include physiologic and anatomic criteria, although field triage based on injury mechanism is common. This analysis evaluates injury mechanisms associated with pediatric trauma alert overtriage and estimates the effect of overtriage on patient care costs.

Methods

Florida’s Agency for Health Care Administration inpatient and financial data for 2012–2014 were used. The study population included mildly and moderately injured patients aged 5–15 years brought to a trauma center and had an International Classification of Diseases-based Injury Severity Score survival probability ≥0.90, a recorded mechanism of injury, no surgery, a hospital stay less than 24 hours, and discharged to home. Overtriaged patients were those who had a trauma alert. Logistic regression was used to analyze the odds of overtriage relative to mechanism of injury and multivariable linear regression was used to analyze cost of overtriage.

Results

Twenty percent of patients were overtriaged; yet these patients accounted for 37.2% of total costs. The mechanisms of injury related to firearms (OR 11.99) and motor vehicle traffic (2.25) were positively associated with overtriage as a trauma alert. Inpatient costs were 131.8% higher for overtriaged patients.

Discussion

Firearm injuries and motor vehicle injuries can be associated with severe injuries. However, in this sample, a proportion of patients with this mechanism suffered minimal injuries. It is possible that further identifying relevant anatomic and physiologic criteria in youth may help decrease overtriage without compromising outcomes.

Level of evidence

Economic, level IV.
Translational research: turning research into advocacy
Authors: Dechert Tracey
Published: December 2019

The social determinants of health are increasingly being recognized within the trauma community. These determinants are major drivers of health and have a huge impact on access to surgery and surgical disparities. As trauma surgeons, we continue to struggle with optimizing care for our patients with many social needs and struggle with trauma as a chronic disease. As we are now using public health approaches to combat complex issues such as gun violence, it is ideal to view our work in a wider context which includes addressing the root causes of trauma and advocating for our patients and our communities. In addition, we need to teach and mentor this broader approach for our students and residents.
Framework for generalized polytropes with complexity factor
Authors: Khan Shiraz , Mardan S. A. , Rehman M. A.
Published: December 2019

A framework is developed for generalized polytropes with the help of complexity factor introduced by Herrera (Phy Rev D 97:044010, 2018), by using the spherical symmetry with anisotropic inner fluid distribution. For this purpose generalized polytropic equation of state will be used, having two cases (i) for mass density $$(\mu _{o})$$(μo), (ii) for energy density $$(\mu )$$(μ), each case leads to a system of differential equations. These systems of differential equations involve two equations with three unknowns and they will be made consistent by using the complexity factor. The analysis of the solutions of these systems will be carried out graphically by using different parametric values involved in the systems.
Constraining chameleon field driven warm inflation with Planck 2018 data
Authors: Sheikhahmadi Haidar , Mohammadi Abolhassan , Aghamohammadi Ali , Harko Tiberiu , Herrera Ramón , Corda Christian , Abebe Amare , Saaidi Khaled
Published: December 2019

We investigate warm inflationary scenario in which the accelerated expansion of the early Universe is driven by chameleon-like scalar fields. Due to the non-minimal coupling between the scalar field and the matter sector, the energy-momentum tensor of each fluid component is not conserved anymore, and the generalized balance equation is obtained. The new source term in the energy equation can be used to model warm inflation. On the other hand, if the coupling function varies slowly, the model reduces to the standard model used for the description of cold inflation. To test the validity of the warm chameleon inflation model, the results for warm inflationary scenarios are compared with the observational Planck2018 Cosmic Microwave Background data. In this regard, the perturbation parameters such as the amplitude of scalar perturbations, the scalar spectral index and the tensor-to-scalar ratio are derived at the horizon crossing in two approximations, corresponding to the weak and strong dissipative regimes. As a general result it turns out that the theoretical predictions of the chameleon warm inflationary scenario are consistent with the Planck 2018 observations.
Time-of-flight mass spectrographs of high mass resolving power
Authors: Wollnik H. , Wada M. , Schury P. , Rosenbusch M. , Ito Y. , Miyatake H.
Published: December 2019

The masses of charged atoms and molecules were first investigated by laterally dispersive sector field mass analyzers, which early on already achieved high mass resolving powers. Equally, high mass resolving powers were achieved by time-of-flight mass analyzers during the last decades. These measurements became possible when fast and precise electronic circuitries became available. Such techniques have been developed and used extensively for the mass analysis of short-lived nuclei, whose mass values reveal insight in processes that describe the formation of elements in star explosions. Precise mass determinations of short-lived ions have been performed for energetic ions in large accelerator storage rings as well as for low-energy ions in time-of-flight mass spectrographs with long flight paths. Similarly, precise mass measurements can also be performed for molecular ions that help to reveal the structure of molecules. In case of very high mass resolving powers, the mass determination of molecular ions can be so high that the measured ion mass directly reveals the molecule’s sum formula.
Mitigation of intensity limitation in the CERN SPS using a double RF system
Authors: Repond J. , Schwarz M. , Shaposhnikova E.
Published: December 2019

The Super Proton Synchrotron (SPS) at CERN is the injector of the Large Hadron Collider (LHC). Multi-bunch instabilities limit the intensity of the beam that can be accelerated to 450 GeV in the SPS and transferred to the LHC. Without mitigation measures, the threshold of bunch intensity of the longitudinal instability is three times below the nominal bunch intensity of the LHC beam. The High Luminosity LHC project (HL-LHC), which requires a doubling of the nominal bunch intensity, relies on improvement of beam stability in the SPS. A fourth harmonic RF system allows, presently, to stabilize the beam up to nominal LHC intensity. It increases the synchrotron frequency spread inside the bunch, providing more efficient Landau damping of beam instability. However, nonlinearities of the synchrotron frequency distribution inside the bunch pose a limitation on bunch length. This paper explores possible intensity increase in the SPS by studying the effect on beam stability of the voltage ratio between two RF systems. The results are substantiated by beam measurements and particle-tracking simulations. An optimized voltage program of the second RF system during the cycle has been tested in operation and beam stability and the quality have been successfully improved.
Quantum corrections to AdS black hole in massive gravity
Authors: Nadeem-ul-islam  , Ganai Prince A.
Published: December 2019

In this paper, we investigate the effect of quantum corrections on the thermodynamics of AdS black hole in massive gravity. We compute the leading order corrections to the entropy of AdS black hole and then plot the entropy as a function of event horizon radius so as to have a comparative analysis between the corrected and the uncorrected entropy densities. Furthermore, we also evaluate the first-order leading corrections to other thermodynamic quantities like free energy, internal energy, pressure, enthalpy, and Gibbs free energy and later plot these quantities against event horizon radius for different values of correction parameter in order to have a qualitative picture of the effect that quantum corrections lead to the thermodynamics of massive AdS black hole.
Solar neutrinos as indicators of the Sun’s activity
Authors: Boyarkin O. M. , Boyarkina I. O.
Published: December 2019

Opportunity of the solar flares (SFs) prediction observing the solar neutrino fluxes is investigated. In three neutrino generations, the evolution of the neutrino flux traveling the coupled sunspots (CSs) which are the SF source is considered. It is assumed that the neutrinos possess both the dipole magnetic moment and the anapole moment while the magnetic field above the CSs may reach the values [Formula: see text] Gs, display the twisting nature and posses the nonpotential character. The possible resonance conversions of the solar neutrino flux are examined. Since the [Formula: see text] resonance takes place before the convective zone, its existence can in no way be connected with the SF. However, when the solar neutrino flux moves through the CSs in the preflare period, then it may undergo the additional resonance conversions and, as a result, depleting the electron neutrinos flux may be observed.
Quasi-uniform gravitational field of a disk revisited
Authors: Silenko Alexander J. , Tsalkou Yury A.
Published: December 2019

We calculate the quasi-uniform gravitational field of a disk in the weak-field approximation and demonstrate an inappropriateness of preceding results. The Riemann tensor of this field is determined. The nonexistence of the uniform gravitational field is proven without the use of the weak-field approximation. The previously found difference between equations of motion for the momentum and spin in the accelerated frame and in the quasi-uniform gravitational field also takes place for the disk. However, it does not violate the Einstein equivalence principle because of the nonexistence of the uniform gravitational field.
Microstructures and mechanical properties of TiAl alloy fabricated by spark plasma sintering
Authors: Su Yongjun , Lin Yunfeng , Zhang Na , Zhang Deliang
Published: December 2019

This work deals with the consolidation of a TiAl alloy powder by spark plasma sintering (SPS). Pre-alloyed powder with a composition of Ti–48Al–2Cr–2Nb (at.%) was consolidated in a SPS furnace at temperatures between 1200[Formula: see text]C and 1325[Formula: see text]C and with a pressure of 50 MPa. The microstructures obtained after SPS depend on the sintering temperature. Tensile tests at room temperature were performed. The alloy SPSed at temperatures not less than 1250[Formula: see text]C exhibits good properties at room temperature.
Study on the phase structure and mechanical properties of (Ti,Al,Si)N coatings deposited by multiarc ion plating
Authors: Wang Mengchao , Wang Lijun , Chen Hui , Cheng Yinfen
Published: December 2019

Different structural [Formula: see text] coatings were designed and deposited on WC-Co cemented carbide by the technology of multiarc ion plating. Monolayered [Formula: see text] coating was deposited using cathode of [Formula: see text]. Multilayered (Ti,Al)N/[Formula: see text] coating and [Formula: see text] coating with gradual silicon content were deposited using two cathodes of [Formula: see text] and [Formula: see text] simultaneously. The surface and cross-section morphology, compositions, and phase structure were characterized by scanning electron microscopy (SEM) and X-ray diffraction (XRD). The dense [Formula: see text] coatings with droplets on the surface and without obvious columnar structure on the cross-sections were obtained. All coatings had the strong peaks of (200) orientation. The different angular shift occurred with different combination of cathodes and processes. The introduction of multilayered and gradient structure effectively reduced the lattice distortion of coatings. Meanwhile, the coating-substrate adhesion strength increased from 38.57 N to 60.17 N with a coating thickness of approximately 3.5 [Formula: see text]m by scratch tests. The highest hardness of [Formula: see text] coating obtained in this paper were [Formula: see text] GPa by nanoindentation. The multilayered coating showed better toughness.
Effect of Mg plate pretreatment on microstructure and mechanical properties of Al/Mg/Al laminated composites fabricated by hot roll bonding
Authors: Yu Yang , Xue Xinzhe , Lu Zhehao , Li Tingyu , Ma Cong , Yan Pengfei , Yan Biao
Published: December 2019

The AA7075/AZ31/AA7075 laminated composites were fabricated by hot roll bonding. The effects of pretreatment of Mg plate by severe plastic deformation (SPD) and heat treatment on its interface, microstructure and mechanical properties were studied. The diffusion layer is formed at the interface between Al and Mg layers, which is composed of the hard and brittle intermetallic phases [Formula: see text] and [Formula: see text], and become the weak zone of the laminated composites where the crack is first-generated and propagated to cause the delamination at the interface of the laminated composites. The hardness of laminated composites at the interface reaches 300–400 HV. Meanwhile, Mg plate pretreatment can increase the plastic matching and the deformation compatibility of the Al and Mg layers, and can effectively improve the mechanical properties of the laminated composites to a certain extent. The bending strength of the laminated composites with pretreated Mg plates are 1080 MPa.
Effect of heat treatment on structure and properties of GTAW and laser beam welded super-duplex stainless steel joints
Authors: Qi Kai , Wang Guangjin , Jin Yunxue , Gu Jiayang , Zhang Zhongyu , Tao Yanwu
Published: December 2019

Duplex stainless steel, consisting of ferrite and austenite, has good corrosion resistance and is often used in harsh marine environments. In this paper, welding on SAF2507 duplex stainless steel with 5 mm thickness was finished by laser beam welding (LBW) and gas tungsten arc welding (GTAW). The post-weld solid solution treatment was also conducted at temperature of [Formula: see text]C followed with cooling by water after 1 h. The results showed that both LBW and GTAW could produce well-produced welds. The microstructures of the welds were composed of ferrite and austenite phases. After solid solution treatment at [Formula: see text]C, the two-phase structure of LBW joint became uniform, while [Formula: see text] phase was produced in GTAW joint. The impact test of welded joints at room-temperature was carried out. After solid solution treatment at [Formula: see text]C, the impact toughness of LBW joints obviously increased, but the impact toughness of GTAW joint decreased with the fracture morphology of brittle mode. The electrochemical experiments on the welded joints showed that the pitting corrosion resistance of LBW joints improved after solid solution treatment, while the pitting corrosion resistance of GTAW joints decreased.
Haze removal with automatic recovery of atmospheric light
Authors: Xiang Ruxi , Zhu Xifang , Wu Feng
Published: December 2019

Most haze removal methods are based on the classical haze imaging model, which can effectively describe the image from the haze, where one of the key factors is the atmospheric light. Existing methods either depend on the user input or keep to the color constancy. In this paper, we present a new and effective method for computing the atmospheric light based on the salient region of the input haze image. The method computes the salient map and the darkness channel map of the input image and adaptively selects the region of the atmospheric light according to the assumption that the atmospheric light does not belong to the salient region of the input image. Then, the atmospheric light is estimated by combining the statistical characteristics between the darkness channel and the region of the atmospheric light. Finally, the transmission map is computed and refined by the weight-guided filter and the clear image without the haze is produced. Compared with some existing methods, a number of experimental results show that the proposed method can not only accurately recover the atmospheric light, but also effectively remove the haze from bad weather condition and improve the image quality such as the contrast, sharpness and color.