bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the stellarator through advances in plasma theory
Authors: Hegna C.C. , Anderson D.T. , Bader A. , Bechtel T.A. , Bhattacharjee A. , Cole M. , Drevlak M. , Duff J.M. , Faber B.J. , Hudson S.R. , Kotschenreuther M. , Kruger T.G. , Landreman M. , McKinney I.J. , Paul E. , Pueschel M.J. , Schmitt J.S. , Terry P.W. , Ware A.S. , Zarnstorff M. , Zhu C.
Published: September 2021

Improvements to the stellarator concept can be realized through advancements in theoretical and computational plasma physics. Herein, recent advances are reported in the topical areas of: (1) improved energetic ion confinement, (2) the impact of three-dimensional (3D) shaping on turbulent transport, (3) reducing coil complexity, (4) novel optimization and design methods, and (5) computational magnetohydrodynamic tools. These advances enable the development of new stellarator configurations with improved confinement properties.
Two- and three-terminal HfO2-based multilevel resistive memories for neuromorphic analog synaptic elements
Authors: Kang Heebum , Park Jinah , Lee Dokyung , Kim Hyun Wook , Jin Sol , Ahn Minjoon , Woo Jiyong
Published: September 2021

Synaptic elements based on memory devices play an important role in boosting neuromorphic system performance. Here, we show two types of fab-friendly HfO2 material-based resistive memories categorized by configuration and an operating principle for a suitable analog synaptic device aimed at inference and training of neural networks. Since the inference task is mainly related to the number of states from a recognition accuracy perspective, we first demonstrate multilevel cell (MLC) properties of compact two-terminal resistive random-access memory (RRAM). The resistance state can be finely subdivided into an MLC by precisely controlling the evolution of conductive filament constructed by the local movement of oxygen vacancies. Specifically, we investigate how the thickness of the HfO2-switching layer is related to an MLC, which is understood by performing physics-based modeling in MATLAB from a microscopic view. Meanwhile, synaptic devices driven by an interfacial switching mechanism instead of local filamentary dynamics are preferred for training accelerated neuromorphic systems, where the analogous transition of each state ensures high accuracy. Thus, we introduce three-terminal electrochemical random-access memory that facilitates mobile ions across the entire HfO2 switching area uniformly, resulting in highly controllable and gradually tuned current proportional to the amount of migrated ions.
Decoupling on the Wiener Space, Related Besov Spaces, and Applications to BSDEs
Authors: Geiss Stefan , Ylinen Juha
Published: September 2021

We introduce a decoupling method on the Wiener space to define a wide class of anisotropic Besov spaces. The decoupling method is based on a general distributional approach and not restricted to the Wiener space.

The class of Besov spaces we introduce contains the traditional isotropic Besov spaces obtained by the real interpolation method, but also new spaces that are designed to investigate backwards stochastic differential equations (BSDEs). As examples we discuss the Besov regularity (in the sense of our spaces) of forward diffusions and local times. It is shown that among our newly introduced Besov spaces there are spaces that characterize quantitative properties of directional derivatives in the Malliavin sense without computing or accessing these Malliavin derivatives explicitly.

Regarding BSDEs, we deduce regularity properties of the solution processes from the Besov regularity of the initial data, in particular upper bounds for their

L
p

L_p

-variation, where the generator might be of quadratic type and where no structural assumptions, for example in terms of a forward diffusion, are assumed. As an example we treat sub-quadratic BSDEs with unbounded terminal conditions.

Among other tools, we use methods from harmonic analysis. As a by-product, we improve the asymptotic behaviour of the multiplicative constant in a generalized Fefferman inequality and verify the optimality of the bound we established.
Ischaemic Heart Disease and Occupational Exposures: A Longitudinal Linkage Study in the General and Māori Populations of New Zealand
Authors: Barnes Lucy A , Eng Amanda , Corbin Marine , Denison Hayley J , ‘t Mannetje Andrea , Haslett Stephen , McLean Dave , Ellison-Loschmann Lis , Jackson Rod , Douwes Jeroen
Published: September 2021

Objectives

This study assessed associations between occupational exposures and ischaemic heart disease (IHD) for males and females in the general and Māori populations (indigenous people of New Zealand).

Methods

Two surveys of the general adult [New Zealand Workforce Survey (NZWS); 2004–2006; n = 3003] and Māori population (Māori NZWS; 2009–2010; n = 2107), with information on occupational exposures, were linked with administrative health data and followed-up until December 2018. Cox proportional hazards regression (adjusted for age, deprivation, and smoking) was used to assess associations between organizational factors, stress, and dust, chemical and physical exposures, and IHD.

Results

Dust [hazard ratio (HR) 1.6, 95%CI 1.1–2.4], smoke or fumes (HR 1.5, 1.0–2.3), and oils and solvents (HR 1.5, 1.0–2.3) were associated with IHD in NZWS males. A high frequency of awkward or tiring hand positions was associated with IHD in both males and females of the NZWS (HRs 1.8, 1.1–2.8 and 2.4, 1.1–5.0, respectively). Repetitive tasks and working at very high speed were associated with IHD among NZWS females (HRs 3.4, 1.1–10.4 and 2.6, 1.2–5.5, respectively). Māori NZWS females working with vibrating tools and those exposed to a high frequency of loud noise were more likely to experience IHD (HRs 2.3, 1.1–4.8 and 2.1, 1.0–4.4, respectively). Exposure to multiple dust and chemical factors was associated with IHD in the NZWS males, as was exposure to multiple physical factors in males and females of the NZWS.

Conclusions

Exposures associated with an elevated IHD risk included dust, smoke or fumes, oils and solvents, awkward grip or hand movements, carrying out repetitive tasks, working at very high speed, loud noise, and working with tools that vibrate. Results were not consistently observed for males and females and between the general and Māori populations.
Suppression of Low-Frequency Gamma Oscillations by Activation of 40-Hz Oscillation
Authors: Sugiyama Shunsuke , Taniguchi Tomoya , Kinukawa Tomoaki , Takeuchi Nobuyuki , Ohi Kazutaka , Shioiri Toshiki , Nishihara Makoto , Inui Koji
Published: September 2021

Gamma oscillations have received considerable attention owing to their association with cognitive function and various neuropsychiatric disorders. However, interactions of gamma oscillations at different frequency bands in humans remain unclear. In the present magnetoencephalographic study, brain oscillations in a wide frequency range were examined using a time-frequency analysis during the 20-, 30-, 40-, and 50-Hz auditory stimuli in 21 healthy subjects. First, dipoles for auditory steady-state response (ASSR) were estimated and interaction among oscillations at 10–60 Hz was examined using the source strength waveforms. Results showed the suppression of ongoing low-gamma oscillations at approximately 30 Hz during stimulation at 40 Hz. Second, multi-dipole analyses suggested that the main dipole for ASSR and dipoles for suppressed low-frequency gamma oscillations were distinct. Third, an all-sensor analysis was performed to clarify the distribution of the 40-Hz ASSR and suppression of low-frequency gamma oscillations. Notably, the area of suppression surrounded the center of the 40-Hz ASSR and showed a trend of extending to the vertex, indicating that different groups of neurons were responsible for these two gamma oscillations and that the 40-Hz oscillation circuit have specific inhibitory innervation to the low-gamma circuit.
Big mitral annular calcification: a case report of a dynamic liquefaction necrosis as a potential source of embolism
Authors: Frey Simon M , Hofmann Verena , Zellweger Michael J , Haaf Philip
Published: September 2021

Background 

Mitral annular calcification (MAC) is a degenerative, mostly asymptomatic abnormality usually in elderly patients. Caseous MAC (cMAC) is a rare form with central liquefaction necrosis, which typically involves the posterior annulus of the mitral valve and can cause serious sequelae. However, optimal management of patients with cMAC is not clearly defined.

Case summary 

In a 71-year-old female patient, MAC was incidentally detected. Tissue characterization with cardiac magnetic resonance (CMR) revealed a cMAC and a conservative approach was chosen. Six months after cMAC diagnosis, the patient developed an acute hemi-occlusion of a retinal artery with cholesterol embolism. At this time, CMR showed a liquefied cavity of the cMAC. Except for atherosclerotic plaques in the aorta and carotid arteries, further stroke work-up was negative. Therefore, the conservative approach was continued. During follow-up, the liquefied cavity regressed completely after another 6 months and the patient was free from further events (total follow-up 3 years since diagnosis of cMAC).

Discussion 

A clear diagnosis and quantitative assessment of dynamic processes, such as cMAC, are made possible by performing CMR with multi-parametric tissue characterization. Dynamic changes in cMAC may have serious clinical implications, such as mitral regurgitation or systemic embolization. Among cardiac tumours, thrombus and abscess, cMAC should be included in the differential diagnosis of an intracardiac mass of the posterior mitral annulus in order to avoid further inappropriate diagnostic interventions.
Reassessing the development of cori spezzati: new discoveries in Bologna
Authors: Morucci Valerio
Published: September 2021

For a long time, musicology viewed early polychoral music (cori spezzati) as a Venetian tradition invented by the famous composer and noted teacher Adrian Willaert. Scholars later suggested that this technique was first used by native Italian composers of the Veneto and Lombardy regions between the second and third decades of the 16th century. This idea contributed to the shaping of our perception that the embryonic stage of cori spezzati was confined to northern Italy. Meanwhile, new sources have come to light. Recent research has demonstrated that early polychoral music also flourished in central Italy, and that this development should therefore be placed in a wider geographical context. Nevertheless, music historians have not yet fully investigated the emergence of polychoral music in Europe. In spite of valuable studies, the phenomenon of 16th- and 17th-century polychorality is still largely under-studied, and underestimated both in its extent and in its cultural significance. Based on a group of newly discovered manuscripts preserved in the Basilica of San Petronio, this article illuminates the genesis of cori spezzati in Bologna. I argue that its origins can be traced back to the first half of the 16th century, thus enlarging the northern Italian area normally considered as the epicentre of the phenomenon. I show that San Petronio (although not the first) was an important centre in the initial stages of this musical tradition. In so doing, this study contributes to a rebalancing of the Venice-centric view that still dominates the perception of polychorality among scholars, performers and audiences.
Towards Equitable Surgical Management of Inflammatory Bowel Disease: A Systematic Review of Disparities in Surgery for Inflammatory Bowel Disease
Authors: Booth Alexander , Ford Wilson , Brennan Emily , Magwood Gayenell , Forster Erin , Curran Thomas
Published: September 2021

Background

Existing evidence for disparities in inflammatory bowel disease is fragmented and heterogenous. Underlying mechanisms for differences in outcomes based on race and socioeconomic status remain undefined. We performed a systematic review of the literature to examine disparities in surgery for inflammatory bowel disease in the United States.

Methods

Electronic databases were searched from 2000 through June 11, 2021, to identify studies addressing disparities in surgical treatment for adults with inflammatory bowel disease. Eligible English-language publications comparing the use or outcomes of surgery by racial/ethnic, socioeconomic, geographic, and/or institutional factors were included. Studies were grouped according to whether outcomes of surgery were reported or surgery itself was the relevant end point (utilization). Quality was assessed using the Newcastle-Ottawa Scale for observational studies.

Results

Forty-five studies were included. Twenty-four reported surgical outcomes and 21

addressed utilization. Race/ethnicity was considered in 96% of studies, socioeconomic status in 44%, geographic factors in 27%, and hospital/surgeon factors in 22%. Although study populations and end points were heterogeneous, Black and Hispanic patients were less likely to undergo abdominal surgery when hospitalized; they were more likely to have a complication when they did have surgery. Differences based on race were correlated with socioeconomic factors but frequently remained significant after adjustments for insurance and baseline health.

Conclusions

Surgical disparities based on sociologic and structural factors reflect unidentified differences in multidisciplinary disease management. A broad, multidimensional approach to disparities research with more granular and diverse data sources is needed to improve health care quality and equity for inflammatory bowel disease.
Connected Algebraic Groups Acting on three-dimensional Mori Fibrations
Authors: Blanc Jérémy , Fanelli Andrea , Terpereau Ronan
Published: September 2021

We study the connected algebraic groups acting on Mori fibrations $X \to Y$ with $X$ a rational threefold and $\textrm{dim}(Y) \geq 1$. More precisely, for these fibre spaces, we consider the neutral component of their automorphism groups and study their equivariant birational geometry. This is done using, inter alia, minimal model program and Sarkisov program and allows us to determine the maximal connected algebraic subgroups of $\textrm{Bir}(\mathbb{P}^3)$, recovering most of the classification results of Hiroshi Umemura in the complex case.
Severe Acute Respiratory Syndrome Coronavirus 2 RNAemia and Clinical Outcomes in Children With Coronavirus Disease 2019
Authors: Mertz Cameron , Glowinski Rebecca , Cohen Shira H , Mertz Sara , Ye Fang , Hall Mark W , Peeples Mark E , King Tiffany , Wang Huanyu , Leber Amy L , Sanchez Pablo J , Ramilo Octavio , Mejias Asuncion
Published: September 2021

The burden of coronavirus disease 2019 (COVID-19) in children represents a fraction of cases worldwide, yet a subset of those infected are at risk for severe disease. We measured plasma severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in a cohort of 103 children hospitalized with COVID-19 with diverse clinical manifestations. SARS-CoV-2 RNAemia was detected in 27 (26%) of these children, lasted for a median of 6 (interquartile range, 2–9) days, and was associated with higher rates of oxygen administration, admission to the intensive care unit, and longer hospitalization.
Manifestation of lattice topology data model for indoor navigation path based on the 3D building environment
Authors: Rahman Syed Ahmad Fadhli Syed Abdul , Maulud Khairul Nizam Abdul , Pradhan Biswajeet , Mustorpha Sharifah Nurul Ain Syed
Published: September 2021

Navigation, also known as discovering one’s direction, is a complex human activity. To produce effective routes, it relies on knowledge of the surroundings’ precise geometry and semantic information. Complex geometrical data can be precisely delineated with the improvement of 3D geometric models. A precise 3D geometric model containing a specifically built-in Building Information Modelling (BIM) environment can be integrated into the Geographical Information System platform for indoor path generation to satisfy the requirements of indoor location-based services. Therefore, this paper proposes an approach to evaluate a 3D indoor topology network called a lattice topology data model (LTDM) for the floor-level paths in a 3D multipatch-based model. The LTDM requires the geometric information of the integrated BIM model to identify the indoor space and bounding lines for indoor network generation. The novelty of this study is in the application of the replacement of cell values into vector length for pathfinding through a combination of the Poincaré duality theorem and Dijkstra’s algorithm. The Campus Infrastructure Building model was chosen to validate the proposed method. Multiple space centroid pairs within the floor level were randomly selected to identify the shortest path using the LTDM principle. Paths drawn from the Medial Axis Transformation were compared with LTDM-generated paths for availability testing. The average floor-level path availability was 112% due to the generation of extra paths reflecting real-life situations. The LTDM paths were compared with on-site measurements for accuracy tests, and the average error rate was 3.18%. The results show that the implementation of the LTDM generates an excellent topology data network.
Metastases to the Pituitary Gland: Histological Patterns of Spread and Review of the Literature
Authors: Kleinschmidt-DeMasters B K
Published: September 2021

Few studies have focused on histological patterns of metastatic spread to the pituitary gland. We review our experience and that in the literature, 1970–present. Departmental cases, 1998–2021, were assessed for anterior versus posterior gland and/or capsular involvement and cohesive tumor obliterating underlying pituitary architecture versus metastatic cells filling pituitary acini with relative acinar preservation. Eleven autopsy/15 surgical cases, including 2 metastases to pituitary adenomas, were identified. Cohesive/obliterative patterns predominated histologically in both surgical and autopsy cases, but acinar filling by metastatic cells was extensive in 3/26 cases, focal in 5/26, and had resulted in initial erroneous impressions of atypical pituitary adenoma/pituitary carcinoma in 1 case and pituitary adenoma with apoplexy in another, likely due to focusing on necrotic areas in the specimen where the acinar pattern had been broken down and not appreciating nearby areas with acinar filling by metastatic cells. Although most pituitary metastases produce readily identifiable cohesive/obliterative patterns, diagnostic challenges remain with the less frequently seen “acinar filling” pattern. A dichotomy exists between patients with symptomatic pituitary metastases occurring early in the disease course and requiring surgical excision versus patients in whom asymptomatic small pituitary metastases are found incidentally at autopsy, the latter almost invariably in late disease stages, with widely disseminated metastatic disease.
Prediction of liver Dmean for proton beam therapy using deep learning and contour-based data augmentation
Authors: Jampa-ngern Sira , Kobashi Keiji , Shimizu Shinichi , Takao Seishin , Nakazato Keiji , Shirato Hiroki
Published: September 2021

The prediction of liver Dmean with 3-dimensional radiation treatment planning (3DRTP) is time consuming in the selection of proton beam therapy (PBT), and deep learning prediction generally requires large and tumor-specific databases. We developed a simple dose prediction tool (SDP) using deep learning and a novel contour-based data augmentation (CDA) approach and assessed its usability. We trained the SDP to predict the liver Dmean immediately. Five and two computed tomography (CT) data sets of actual patients with liver cancer were used for the training and validation. Data augmentation was performed by artificially embedding 199 contours of virtual clinical target volume (CTV) into CT images for each patient. The data sets of the CTVs and OARs are labeled with liver Dmean for six different treatment plans using two-dimensional calculations assuming all tissue densities as 1.0. The test of the validated model was performed using 10 unlabeled CT data sets of actual patients. Contouring only of the liver and CTV was required as input. The mean relative error (MRE), the mean percentage error (MPE) and regression coefficient between the planned and predicted Dmean was 0.1637, 6.6%, and 0.9455, respectively. The mean time required for the inference of liver Dmean of the six different treatment plans for a patient was 4.47±0.13 seconds. We conclude that the SDP is cost-effective and usable for gross estimation of liver Dmean in the clinic although the accuracy should be improved further if we need the accuracy of liver Dmean to be compatible with 3DRTP.
Optimizing Performance and Mental Skills With Mindfulness-Based Attention Training: Two Field Studies With Operational Units
Authors: Nassif Thomas H , Adrian Amanda L , Gutierrez Ian A , Dixon Alexis C , Rogers Scott L , Jha Amishi P , Adler Amy B
Published: September 2021

Introduction

Mental skills such as focusing attention and managing emotions are essential for optimal performance in high-stress occupations. Studies with military samples have demonstrated that mindfulness training (MT) led to improved computer-based cognitive performance.

Materials and Methods

To examine the impact of MT on operational performance, mental skills, and psychological health, a short-form program, Mindfulness-Based Attention Training (MBAT), was delivered to active duty soldiers as part of two randomized trials. Participants in study 1 (n = 121) and study 2 (n = 77) were randomized to one of three conditions: MT with proctored practice, MT with unproctored practice, or a waitlist control. Weekly 2-hour MBAT sessions were offered to participants in both MT conditions for 4 weeks. Beyond these sessions, participants also engaged in mindfulness practice that was proctored (within the occupational context) or unproctored (left up to the individual) for four subsequent weeks.

Results

Overall, the frequency of mindfulness practice was generally associated with better performance and improvements in mental skills. In study 1, those who practiced 3 or more days per week performed better on marksmanship under physical stress and reported fewer attentional lapses, less emotion regulation difficulties, greater mental toughness, and higher self-reported mindfulness compared to those who did not practice. In study 2, the frequency of mindfulness practice was associated with fewer attentional lapses and emotion regulation difficulties.

Conclusions

Consistent with prior findings, results suggest that regular engagement in MT practice may help to optimize operational performance and improve mental skills in military cohorts.
Oral Health Status of New Zealand Defence Force Recruits
Authors: Naysmith k E , Foster Page L A , Tong D C , Thomson W M
Published: September 2021

Introduction

The demands of operational deployment mean that defense force personnel must be dentally fit. Although medical evacuation for dental causes should be avoided, dental emergencies are a major non-combat-related contributor to withdrawal from deployment. Information on the oral health status of recruits and officer cadets entering the New Zealand Defence Force (NZDF) is scarce, yet it is useful for service and workforce planning. We investigated oral health status and its associations in new recruits and officer cadets entering the NZDF over a 13-month period.

Materials and Methods

This study used data from recruits’ initial dental examination (including baseline forensic charting), posterior bitewing radiographs, orthopantomograph radiograph, and a socio-dental questionnaire. The impaction status of third molar teeth was evaluated. Ethical approval was obtained from the University of Otago Ethics Committee (reference number D18/200) and the NZDF Organisational Research Committee.

Results

Of the 874 (83%) of the 1,053 recruits (age range 17-59 years) who participated, one in five were Māori. Nearly two-thirds were Army recruits. Caries prevalence was almost 70%. Mean Decayed, Missing, and Filled Teeth (DMFT) (3.0 overall) was higher among females and Māori. Few teeth were missing due to caries. Third molars were common, seen in 745 (88.3%). One in four maxillary third molars (but only one in six mandibular ones) had fully erupted. The most common type of impaction among mandibular third molars was the mesioangular type, followed by vertical, horizontal, and distoangular. Almost 60% of recruits had one or more potentially problematic third molars. The prevalence was highest in the youngest age groups, those of medium or low socioeconomic status and in Army or Navy recruits.

Conclusions

Recruits’ oral health was acceptable, but potentially problematic third molars were common, indicating a need for careful assessment (and their possible removal) before operational deployment.
DecoPath: a web application for decoding pathway enrichment analysis
Authors: Mubeen Sarah , Bharadhwaj Vinay S , Gadiya Yojana , Hofmann-Apitius Martin , Kodamullil Alpha T , Domingo-Fernández Daniel
Published: September 2021

The past decades have brought a steady growth of pathway databases and enrichment methods. However, the advent of pathway data has not been accompanied by an improvement in interoperability across databases, hampering the use of pathway knowledge from multiple databases for enrichment analysis. While integrative databases have attempted to address this issue, they often do not account for redundant information across resources. Furthermore, the majority of studies that employ pathway enrichment analysis still rely upon a single database or enrichment method, though the use of another could yield differing results. These shortcomings call for approaches that investigate the differences and agreements across databases and methods as their selection in the design of a pathway analysis can be a crucial step in ensuring the results of such an analysis are meaningful. Here we present DecoPath, a web application to assist in the interpretation of the results of pathway enrichment analysis. DecoPath provides an ecosystem to run enrichment analysis or directly upload results and facilitate the interpretation of results with custom visualizations that highlight the consensus and/or discrepancies at the pathway- and gene-levels. DecoPath is available at https://decopath.scai.fraunhofer.de, and its source code and documentation can be found on GitHub at https://github.com/DecoPath/DecoPath.
RapGreen, an interactive software and web package to explore and analyze phylogenetic trees
Authors: Dufayard Jean-François , Bocs Stéphanie , Guignon Valentin , Larivière Delphine , Louis Alexandra , Oubda Nicolas , Rouard Mathieu , Ruiz Manuel , de Lamotte Frédéric
Published: September 2021

RapGreen is a modular software package targeted at scientists handling large datasets for phylogenetic analysis. Its primary function is the graphical visualization and exploration of large trees. In addition, RapGreen offers a tree pattern search function to seek evolutionary scenarios among large collections of phylogenetic trees. Other functionalities include tree reconciliation with a given species tree: the detection of duplication or loss events during evolution and tree rooting. Last but not least, RapGreen features the ability to integrate heterogeneous data while visualizing and otherwise analyzing phylogenetic trees.
Toward a unified information framework for cell atlas assembly
Authors: Chen Sijie , Luo Yanting , Gao Haoxiang , Li Fanhong , Li Jiaqi , Chen Yixin , You Renke , Lv Hairong , Hua Kui , Jiang Rui , Zhang Xuegong
Published: September 2021

This perspective discusses the need and directions for the development of a unified information framework to enable the assembly of cell atlases and a revolution in medical research on the virtual body of assembled cell systems.
Safeguard measures and fresh produce trade: The case of US blueberry imports
Authors: Muhammad Andrew , Countryman Amanda M
Published: September 2021

Safeguard measures are used to limit excessive import growth and protect domestic producers from unfair import competition. The global safeguard investigation for blueberries highlights these concerns and raises questions about the relationship between imports, prices, and the well-being of US producers. Although the US International Trade Commission (USITC) ruled that imports have not caused serious injury to US blueberry producers, it was important to further examine this issue. In this study, we employ an inverse demand model and dynamic vector autoregressive procedure linking source-specific fresh blueberry imports from countries like Mexico and Chile to US blueberry prices. Our results mostly support the USITC ruling. Results indicate that declines in US prices are small when compared to the level of import growth. Impulse response functions indicate that import price shocks are not long-lasting.
Validity of the Alarm Point in Intraoperative Neurophysiological Monitoring of the Spinal Cord by the Monitoring Working Group of the Japanese Society for Spine Surgery and Related Research
Authors: Takahashi Masahito , Imagama Shiro , Kobayashi Kazuyoshi , Yamada Kei , Yoshida Go , Yamamoto Naoya , Ando Muneharu , Kawabata Shigenori , Kanchiku Tsukasa , Fujiwara Yasushi , Taniguchi Shinichirou , Iwasaki Hiroshi , Wada Kanichiro , Shigematsu Hideki , Tadokoro Nobuaki , Ushirozako Hiroki , Funaba Masahiro , Yasuda Akimasa , Ando Kei , Hashimoto Jun , Morito Shinji , Takatani Tsunenori , Tani Toshikazu , Matsuyama Yukihiro
Published: September 2021

Study Design.

Prospective multicenter cohort study.

Objective.

The aim of this study was to validate an alarm point of intraoperative neurophysiological monitoring () formulated by the Monitoring Working Group (WG) of the Japanese Society for Spine Surgery and Related Research (JSSR).

Summary of Background Data.

The Monitoring WG of the JSSR formulated an alarm point of IONM using transcranial electrical stimulation-muscle motor evoked potentials (Tc(E)-MEPs) and has conducted a prospective multicenter study. The validity of the JSSR alarm point of ≥ 70% decreased in Tc(E)-MEPs for each high-risk surgery and any other spine surgeries has not been verified.

Methods.

Patients who underwent spine and spinal cord surgery with IONM in 16 Japanese spine centers in the Monitoring WG of the JSSR from 2017 to 2018 were enrolled. The patients were divided into the high-risk surgery group (Group HR) and the common surgery group (Group C). Group HR was defined by ossification of the posterior longitudinal ligament (OPLL), spinal deformity, and spinal cord tumor. Group C was classified as other spine surgeries. The alarm point was defined as a ≥70% decrease in the Tc(E)-MEPs.

Results.

In Group HR, the sensitivity and specificity were 94.4% and 87.0%, respectively. In Group C, the sensitivity and specificity were 63.6% and 91.9%. The sensitivity in Group C was statistically lower than that in Group HR (P < 0.05). In Group HR, the sensitivity and specificity in OPLL were 100% and 86.9%, respectively. The sensitivity and specificity in spinal deformity were 87.5% and 84.8%, respectively, and the sensitivity and specificity in spinal cord tumors were 92.9% and 89.9%, respectively. The sensitivity and specificity in each high-risk surgery showed no significant difference.

Conclusion.

The alarm point of IONM by the Monitoring WG of the JSSR appeared to be valid for each disease in Group HR. Meanwhile, applying the JSSR alarm point for Group C potentially needed attention.

Level of Evidence: 3
Videolaryngoscopy vs. Direct Laryngoscopy for Elective Airway Management in Paediatric Anaesthesia
Authors: Klabusayová Eva , Klučka Jozef , Kosinová Martina , Ťoukálková Michaela , Štoudek Roman , Kratochvíl Milan , Mareček Lukáš , Svoboda Michal , Jabandžiev Petr , Urík Milan , Štourač Petr
Published: September 2021

BACKGROUND

The indirect visualisation of the glottic area with a videolaryngoscope could improve intubation conditions which may possibly lead to a higher success rate of the first intubation attempt.

OBJECTIVE

Comparison of videolaryngoscopy and direct laryngoscopy for elective airway management in paediatric patients.

DESIGN

Prospective randomised controlled trial.

SETTINGS

Operating room.

PARTICIPANTS

535 paediatric patients undergoing elective anaesthesia with tracheal intubation. 501 patients were included in the final analysis.

INTERVENTIONS

Patients were randomly allocated to the videolaryngoscopy group (n 
= 265) and to the direct laryngoscopy group (n 
= 269) for the primary airway management.

MAIN OUTCOME MEASURES

The first attempt intubation success rate was assessed as the primary outcome. The secondary outcomes were defined as: the time to successful intubation (time to the first EtCO2 wave), the overall intubation success rate, the number of intubation attempts, the incidence of complications, and the impact of the length of the operator's clinical practice.

RESULTS

The study was terminated after the planned interim analysis for futility. There were no significant demographic differences between the two groups. The first attempt intubation success rate was lower in the videolaryngoscopy group; 86.8% (n 
= 211) vs. 92.6% (n 
= 239), P = 0.046. The mean time to the first EtCO2 wave was longer in the videolaryngoscopy group at 39.0 s ± 36.7 compared to the direct laryngoscopy group, 23.6 s ± 24.7 (P < 0.001). There was no difference in the overall intubation success rate, in the incidence of complications nor significant difference based on the length of the clinical practice of the operator.

CONCLUSIONS

The first attempt intubation success rate was lower in the videolaryngoscopy group in comparison to the direct laryngoscopy group. The time needed for successful intubation with videolaryngoscopy was longer compared with direct laryngoscopy.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT03747250
Agreement Analysis on Angle Characteristics With Automated Gonioscopy
Authors: Correia Barão Rafael , Cutolo Carlo , Tanito Masaki , Hommer Anton , Faschinger Christoph , Abegão Pinto Luís , Traverso Carlo
Published: September 2021

Précis:

Automated gonioscopy is a recent method of recording angle pictures. Our study shows that agreement between observers is moderate in most categories used in clinical practice, underlying its clinical usefulness but also room for improvement.

Introduction:

Iridocorneal angle (ICA) imaging methods have been recently developed to record gonioscopic images. The purpose of this study was to perform an interrater agreement analysis of ICA photographs.

Methods:

Multicentric cross-sectional observational study. Consecutive patients in 2 ophthalmology departments underwent automated gonioscopy. One picture per quadrant from each eye was selected for randomization. Pictures were graded and analyzed by 4 masked glaucoma specialists regarding angle opening, width, Shaffer and Spaeth gradings and other findings. Fleiss’ κ statistics was performed to assess interrater agreement.

Results:

A total of 50 patients were recruited, with the sample containing a variety of diagnosis including pseudoexfoliation (22%), angle-closure suspect (12%), and pigmentary glaucoma (4%). The sample included phakic (68%) and pseudophakic patients, as well as cases with gonio-implanted surgical devices (10%). There was moderate agreement on angle opening, angle width, presence of angle vessels, and peripheral anterior synechiae (κ=0.435, 0.511, 0.558, 0.488, respectively; P<0.01). Fair agreement was observed regarding Shaffer grading, site of iris root insertion, angle pigmentation features, and the presence of iris processes. Expectedly from a 2-dimensional picture, the configuration of peripheral iris was found to have a poor agreement. Subset analysis on higher quality pictures seemed to improve agreement on pigment but did not further improve on the overall good agreement on angle opening status.

Conclusions:

Our study shows that automated gonioscopy provides moderate agreement on most clinically relevant features. Binary characteristics such as angle opening or PAS seem to be more robust than more complex angle classification parameters.
Olanzapine Reduction From High Dose to Standard Dose
Authors: Okeya Komugi , Misawa Fuminari , Fujii Yasuo , Takeuchi Hiroyoshi
Published: September 2021

Purpose/Background

Although high-dose olanzapine might be a treatment option in patients with treatment-resistant schizophrenia, it can be reduced to the standard dose after symptoms are stabilized. We examined the rate of olanzapine reduction from high to standard dose and whether this change was successful.

Methods/Procedures

We included patients who received high-dose olanzapine (>20 mg/d) for 4 weeks or longer at our hospital. First, we retrospectively followed the patients for 6 years and estimated the percentage of those whose olanzapine was reduced from high to standard dose. Second, we followed patients who received olanzapine reduction for 1 year and estimated the rate of success based on the study-defined criteria for unsuccessful reduction. We also explored factors associated with the dose reduction and successful results.

Findings/Results

Among 110 patients who received high-dose olanzapine treatment, 72 had their olanzapine dose reduced to the standard dose for 6 years; the duration of high-dose olanzapine treatment was significantly and negatively associated with a reduction in olanzapine (hazard ratio, 0.98; 95% confidence interval, 0.98–0.99). Among the patients whose olanzapine was reduced, 50 achieved successful reduction for 1 year. Among the reasons for the reduction, an unknown reason was significantly associated with successful reduction (hazard ratio, 4.93; 95% confidence interval, 1.55–22.8).

Implications/Conclusions

The findings suggest that high-dose olanzapine can be reduced to the standard dose after stabilization of symptoms in most patients with schizophrenia.
The survival time of end-of-life home care patients in Fukui prefecture, Japan
Authors: Kosaka Makoto , Miyatake Hirotomo , Kotera Yasuhiro , Masunaga Hidehisa , Arita Satoshi , Tsunetoshi Chie , Nishikawa Yoshitaka , Ozaki Akihiko , Beniya Hiroyuki
Published: September 2021

End-of-life advance care planning (ACP) has become increasingly important in home care setting. In facilitating ACP discussion in home care setting, accurate understanding of patients’ survival would be beneficial because it would facilitate healthcare professionals to individualize ACP discussion. However, little is known about survival outcome of home care patients. This study aimed to clarify the outcome of patients and identify factors to better predict the survival outcome of home care patients with the focus on patients’ primary diseases.

We conducted a retrospective analysis using data from 277 patients managed at a home care clinic in Japan and first treated in 2017 or 2018. Data regarding sociodemographic and clinical characteristics, and clinical outcome on December 31, 2019 were extracted. Using Kaplan–Meier product-limit method, we estimated the overall 30 days, 90 days, 1 year, and 3 year survival probabilities among the entire patients and their differences according to their primary disease. We also evaluated whether outcomes differed based on the primary disease or other factors using the hazard ratio and Cox proportional hazards regression.

The overall survival probability was 82.5% at 30 days, 67.8% at 90 days, 52.7% at 1 year, and 39.1% at 3 years. The survival rates at 30 days, 90 days, 1 year, and 3 years were 64.6%, 33.4%, 9.5%, and 4.1% among cancer patients; 91.9%, 86.4%, 78.1%, and 47.0% among dementia patients; and 91.9%, 86.4%, 78.1%, and 47.0% among patients with other nervous and cerebrovascular diseases, respectively. Cox proportional hazard regression clarified that cancer patients (hazard ratio 6.53 [95% CI 4.16–10.28]) and older adults (hazard ratio 1.01 [95% CI 1.00–1.02]) were significantly more likely to die than dementia patients and young patients, respectively.

Primary disease had a significant influence on the prediction of survival time and could be a useful indicator to individualize ACP in home care setting.
Effects of marijuana on reproductive health: preconception and gestational effects
Authors: Ryan Kimberly S. , Bash Jasper C. , Hanna Carol B. , Hedges Jason C. , Lo Jamie O.
Published: September 2021

Purpose of review

Recent widespread legalization changes have promoted the availability of marijuana and its increased potency and perceived safety. The limited evidence on reproductive and perinatal outcomes from marijuana exposure is enough to warrant concern and action. The objective of this review is to provide a current and relevant summary of the recent literature surrounding this topic.

Recent findings

The available published studies on the effect of marijuana exposure on reproductive health and pregnancy outcomes are conflicting. Human studies are often observational or retrospective and confounded by self-report and polysubstance use. However, the current, limited evidence suggests that marijuana use adversely affects male and female reproductive health. Additionally, prenatal marijuana exposure has been reported to be associated with an increased risk of preterm birth and small for gestational age infants.

With the increasing prevalence of marijuana use, there is an urgent need for evidence-driven recommendations and guidelines for couples interested in conception, affected by infertility or who are expecting. At this time, no amount of marijuana use during conception or pregnancy is known to be well tolerated and the limited available evidence suggests that the safest choice is to abstain.
Healthy People 2030 Leading Health Indicators and Overall Health and Well-being Measures: Opportunities to Assess and Improve the Health and Well-being of the Nation
Authors: Ochiai Emmeline , Kigenyi Tiffani , Sondik Edward , Pronk Nico , Kleinman Dushanka V. , Blakey Carter , Fromknecht Catharine Q. , Heffernan Megan , Brewer Karen H.
Published: September 2021

Context:

Released by the US Department of Health and Human Services (HHS) every decade since 1980, Healthy People identifies science-based objectives with targets to monitor progress and motivate and focus action. Healthy People 2030 is the current iteration of the Healthy People initiative.

Program:

Healthy People 2030 includes 3 sets of measures—Healthy People 2030 objectives, Leading Health Indicators (LHIs), and Overall Health and Well-being Measures (OHMs). Collectively, these components of Healthy People 2030 drive progress toward the initiative's vision of “a society in which all people can achieve their full potential for health and well-being across the life span.”

Implementation:

The Healthy People 2030 LHIs and OHMs were developed with input from multiple subject matter experts and launched in December 2020. Designed as an entry point for users interested in improving the health of their communities and selected for their ability to improve health and well-being, the LHIs will be assessed annually. As broad, global outcome measures of overall health and well-being, the OHMs will be assessed at least 3 times before 2030.

Evaluation:

The 23 LHIs are a subset of Healthy People 2030 core objectives that have been selected to drive action toward improved health and well-being. LHIs are intended to help organizations, communities, and states across the nation focus resources and efforts to improve the health and well-being of all people. The OHMs include 8 broad, global outcome measures of overall health and well-being that help assess progress toward the Healthy People 2030 vision. The Healthy People 2030 OHMs include the addition of a measure of overall well-being.

Discussion:

Together with the Healthy People 2030 objectives, the LHIs and OHMs provide a plan of action to improve the health and well-being of the nation through a framework for assessing progress, addressing health disparities and social determinants of health, and advancing health equity.
Improving Lead Screening Rates in a Large Pediatric Primary Care Network
Authors: Davidson Joel R. , Karas David R. , Bigham Michael T.
Published: September 2021

Introduction:

Exposure to environmental lead continues to be a significant public health concern. Elevated blood lead levels can lead to neurocognitive delays and other adverse health outcomes. Unfortunately, screening rates in most communities remain low. This quality improvement project aimed to improve universal screening at 12 months of age and increase screening rates from 71% to 95%. The project team also aimed to improve risk-based screening at 24 months of age to increase screening rates from 41% to 70%.

Methods:

This project utilized the Model for Improvement. After identifying key drivers, the team designed, tested, and adopted a series of interventions to improve lead screening. Dynamic order sets were developed that pre-checked the lead order, if appropriate, based on the patient’s age, previous results, and risk factors. Sites received regular feedback on their screening rates.

Results:

The percentage of patients receiving universal lead screening at their 12-month well visit increased from 71% to 96%. 70% of 2-year-olds were at risk for lead exposure based on ZIP code and insurance provider. Development of dynamic orders for patients at risk increased screening rates from 41% to 74% at the 24-month well visit.

Conclusions:

Utilization of clinical decision support tools within an electronic health record can significantly increase the percentage of children screened for lead toxicity. Similar tools could identify patients due for other screens or interventions, resulting in improved care and patient outcomes.
SARS-CoV-2 incidence, testing rates, and severe COVID-19 outcomes among people with and without HIV
Authors: Spinelli Matthew A. , Brown Lillian B. , Glidden David V. , Hunter Kyle , Martin-Tuite Patrick , Zheng James , Sera Curtis , Havlir Diane , Buchbinder Susan P. , Gandhi Monica
Published: September 2021

To assess SARS-CoV-2 outcomes, we matched a municipal COVID-19 registry and clinic rosters from a municipal primary care network containing a large HIV clinic and assessed clinical outcomes by HIV status. The risk of severe COVID-19 was higher among people with HIV (PWH, adjusted relative risk = 1.84, 95% confidence interval = 1.05–3.25), while SARS-CoV-2 incidence was lower despite higher testing rates. SARS-CoV-2 vaccination campaigns should prioritize PWH to prevent severe COVID-19 disease given potentially higher risk.