bluuebunny/crossref_metadata_2025 huggingface dataset:
Higher-order superintegrable momentum-dependent Hamiltonians on curved spaces from the classical Zernike system
Authors: Blasco Alfonso , Gutierrez-Sagredo Ivan , Herranz Francisco J
Published: January 2023

We consider the classical momentum- or velocity-dependent two-dimensional Hamiltonian given by

where q

i
and p

i
are generic canonical variables, γ

n
are arbitrary coefficients, and

N
∈

N

. For N = 2, being both

γ
1

,

γ
2

different from zero, this reduces to the classical Zernike system. We prove that

always provides a superintegrable system (for any value of γ

n
and N) by obtaining the corresponding constants of the motion explicitly, which turn out to be of higher-order in the momenta. Such generic results are not only applied to the Euclidean plane, but also to the sphere and the hyperbolic plane. In the latter curved spaces,

is expressed in geodesic polar coordinates showing that such a new superintegrable Hamiltonian can be regarded as a superposition of the isotropic 1 : 1 curved (Higgs) oscillator with even-order anharmonic curved oscillators plus another superposition of higher-order momentum-dependent potentials. Furthermore, the symmetry algebra determined by the constants of the motion is also studied, giving rise to a

(
2
N
−
1
)

th-order polynomial algebra. As a byproduct, the Hamiltonian

is interpreted as a family of superintegrable perturbations of the classical Zernike system. Finally, it is shown that

(and so the Zernike system as well) is endowed with a Poisson

s
l

(
2
,

R

)

-coalgebra symmetry which would allow for further possible generalizations that are also discussed.
Artificial intelligence can use physiological parameters to optimize treatment strategies and predict clinical deterioration of sepsis in ICU
Authors: Zhang Quan , Wang Jianqi , Liu Guohua , Zhang Wenjia
Published: January 2023

Objective. Sepsis seriously threatens human life. Early identification of a patient’s risk status and appropriate treatment can reduce septic shock risk and mortality. Our purpose is to design and validate an adjunctive therapy system based on deep reinforcement learning (DRL), which can provide treatment recommendations with providence and assess the patient’s risk status and treatment options in the early stages. Approach. Data is from the Beth Israel Deaconess Medical Center. The raw data included 53 423 patients from MIMIC-III. Of these, 19 620 eligible samples were screened to form the final cohort. First, the patient’s physiological parameters were fed into the DRL therapy strategy recommendation module (TSRM), which provides a forward-looking recommendation for treatment strategy. The recommended strategies were then fed into the reinforcement learning risk assessment module (RAM), which predicts the patient’s risk status and treatment strategy from a long-term perspective. The DRL model designed in this paper assists in formulating treatment plans and evaluating treatment risks and patient status through continuous interaction with patient trajectory; this model therefore has the foresight that a supervising deep learning model does not. Main results. The experiment shows that, in the test set for the TSRM, mortality is the lowest when the treatment strategy that is actually implemented is the same as the AI-recommended strategy. Regarding the RAM, it can accurately grasp a patient’s deterioration trend, and can reasonably assess a patient’s risk status and treatment plans at an early stage. The assessment results of the model were matched with the actual clinical records. Significance. A DRL-based sepsis adjunctive therapy model is proposed. It can prospectively assist physicians in proposing treatment strategies, assess the patient’s risk status and treatment methods early on, and detect deterioration trends in advance.
Drift kinetic effects on plasma response to resonant magnetic perturbation for EU DEMO design
Authors: Zhou Lina , Liu Yueqiang , Hu Hanqing , Siccinio Mattia , Francesco Maviglia , Zohm Hartmut , Pigatto Leonardo , Wang Yong , Li Li , Hao Guangzhou , Yang Xu , Zhang Hanyu , Duan Ping , Chen Long
Published: January 2023

A systematic investigation of the plasma response to an externally applied resonant magnetic perturbation (RMP) field, for the purpose of controlling edge localized modes, is carried out for an EU DEMO reference plasma. Particular emphasis is placed on the role of kinetic effects associated with both thermal particles and fusion-born alphas. The single fluid, resistive model predicts a large peak amplification of the n= 1 (n is the toroidal mode number) plasma response to the target equilibrium, which is found to be close to the Troyon no-wall limit. A more advanced response model, including kinetic resonances between the RMP perturbation and drift motions of thermal and energetic particles, on the other hand, finds a strong suppression of the n= 1 field amplification. A major role is played by the precessional drift resonance of fusion-born alphas. A strong parallel sound wave damping model is found to well reproduce the full kinetic response results for the DEMO plasma, in terms of both the resonant field response amplitude and the plasma displacement. Finally, both fluid and kinetic models produce similar responses for the n = 2 and 3 RMP fields for the considered DEMO plasma, whilst kinetic effects again become important for the n = 4 RMP due to proximity of the reference plasma to the no-wall limit for the n = 4 ideal kink instability.
Accuracy of using metastable state measurements in laser-induced fluorescence diagnostics of xenon ion velocity in Hall thrusters
Authors: Konopliv Mary F , Chaplin Vernon H , Johnson Lee K , Wirz Richard E
Published: January 2023

Laser-induced fluorescence measurements of singly-charged xenon ion velocities in Hall thrusters typically target metastable states due to lack of available laser technology for exciting the ground state. The measured velocity distribution of these metastable ions are assumed to reflect the ground state ion behavior. However, this assumption has not been experimentally verified. To investigate the accuracy of this assumption, a recently developed xenon ion (Xe II) collisional-radiative model is combined with a 1D fluid model for ions, using plasma parameters from higher fidelity simulations of each thruster, to calculate the metastable and ground state ion velocities as a function of position along the channel centerline. For the HERMeS and SPT-100 thruster channel centerlines, differences up to 0.5 km s−1 were observed between the metastable and ground state ion velocities. For the HERMeS thruster, the difference between the metastable and ground state velocities is less than 150 m s−1 within one channel length of the channel exit, but increases thereafter due to charge exchange (CEX) that reduces the mean velocity of the ground state ions. While both the ground state ions and metastable state ions experience the same acceleration by the electric field, these small velocity differences arise because ionization and CEX directly into these states from the slower neutral ground state can reduce their mean velocities by different amounts. Therefore, the velocity discrepancy may be larger for thrusters with lower propellant utilization efficiency and higher neutral density. For example, differences up to 1.7 km s−1 were calculated on the HET-P70 thruster channel centerline. Note that although the creation of slow ions can influence the mean velocity, the most probable velocity should be unaffected by these processes.
Design and analysis of a hybrid magnetic shielding system: application for the magnetic non-destructive testing of circuits
Authors: Wang S Y , Wang S S , Yu X , Xu H , Li Y Y , Jiang H Y , Sun K Y
Published: January 2023

A magnetic shielding system combining three-axis active magnetic shielding and a high-Tc superconducting ring (TASR) was developed. The active shield mainly responds to DC field while the ring operates for shielding AC fields below 1 kHz. In this study, the system’s shielding effects were evaluated experimentally, and the results suggest that this system can effectively shield the interference of static and low-frequency magnetic fields to ensure the operation of high-precision magnetic sensors. The shielding factor reached 99.9% for geomagnetic field (DC, 38 500 nT), which exceeded 98% for about 10 000 nT AC magnetic field at 30–1000 Hz. Then, magnetic non-destructive testing of the circuit was performed in this TASR shielding system. The images clearly showed the magnetic field distribution in different kinds of circuits that could be inverted to current density information, indicating that the shielding system can detect circuit defects and has great application potential in integrated circuit diagnosis.
Adding a single pulse into high-frequency pulse stimulations can substantially alter the following episode of neuronal firing in rat hippocampus
Authors: Hu Yifan , Feng Zhouyan , Zheng Lvpiao , Xu Yipeng , Wang Zhaoxiang
Published: January 2023

Background. High-frequency stimulation (HFS) sequences of electrical pulses are commonly utilized in many types of neuromodulation therapies. The temporal pattern of pulse sequences characterized by varying inter-pulse intervals (IPI) has emerged as an adjustable dimension to generate diverse effects of stimulations to meet the needs for developing the therapies. Objective: To explore the hypothesis that a simple manipulation of IPI by inserting a pulse in HFS with a constant IPI can substantially change the neuronal responses. Approach. Antidromic HFS (A-HFS) and orthodromic HFS (O-HFS) sequences were respectively applied at the alveus (the efferent axons) and the Schaffer collaterals (the afferent axons) of hippocampal CA1 region in anesthetized rats in-vivo. The HFS sequences lasted 120 s with a pulse frequency of 100 Hz and an IPI of 10 ms. In the late steady period (60–120 s) of the HFS, additional pulses were inserted into the original pulse sequences to investigate the alterations of neuronal responses to the changes in IPI. The amplitudes and latencies of antidromic/orthodromic population spikes (APS/OPS) evoked by pulses were measured to evaluate the alterations of the evoked firing of CA1 pyramidal neurons caused by the pulse insertions. Main Results. During the steady period of A-HFS at efferent axons, the evoked APSs were suppressed due to intermittent axonal block. Under this situation, inserting a pulse to shorten an IPI was able to redistribute the following neuronal firing thereby generating an episode of oscillation in the evoked APS sequence including APSs with significantly increased and decreased amplitudes. Also, during the steady period of O-HFS without obvious OPS, a pulse insertion was able to generate a large OPS, indicating a synchronized firing of a large population of post-synaptic neurons induced by a putative redistribution of activations at the afferent axons under O-HFS. Significance. This study firstly showed that under the situation of HFS-induced axonal block, changing an IPI by a single-pulse insertion can substantially redistribute the evoked neuronal responses to increase synchronized firing of neuronal populations during both antidromic and O-HFS with a constant IPI originally. The finding provides a potential way to enhance the HFS action on neuronal networks without losing some other functions of HFS such as generating axonal block.
The drivers and predictability of wildfire re-burns in the western United States (US)
Authors: Solander K C , Talsma C J , Vesselinov V V
Published: January 2023

Evidence is mounting that the effectiveness of using prescribed burns as a management tactic may be diminishing due to the higher incidence of wildfire re-burns. The development of predictive models of re-burns is thus essential to better understand their primary drivers so that forest management practices can be updated to account for these events. First, we assess the potential for human activity as a driver of re-burns by evaluating re-burn trends both within and outside of the wildland–urban interface (WUI) of the western US. Next, we investigate the predictability of re-burns through the application of both random forest and the explanatory machine learning non-negative matrix factorization using k-means clustering (NMFk) algorithms to predict re-burn occurrence over California based on a number of climate factors. Our findings indicate that while most states showed increasing trends within the WUI when trends were conducted over longer moving windows (e.g. 20 years), California was the only state where the rate of increase was consistently higher in the WUI, indicating a stronger potential for human activity as a driver in that location. Furthermore, we find model performance was found to be robust over most of California (Testing F1 scores = 0.688), although results were highly variable based on EPA level III Ecoregion (F1 scores = 0.0–0.778). Insights provided from this study will lead to a better understanding of climate and human activity drivers of re-burns and how these vary at broad spatial scales so that improvements in forest management practices can be tuned according to the level of change that is expected for a given region.
The scaffold RhoGAP protein ARHGAP8/BPGAP1 synchronizes Rac and Rho signaling to facilitate cell migration
Authors: Wong Darren Chen Pei , Pan Catherine Qiurong , Er Shi Yin , Thivakar T. , Rachel Tan Zi Yi , Seah Sock Hong , Chua Pei Jou , Jiang Tingting , Chew Ti Weng , Chaudhuri Parthiv Kant , Mukherjee Somsubhro , Salim Agus , Aye Thike Aye , Koh Cheng Gee , Lim Chwee Teck , Tan Puay Hoon , Bay Boon Huat , Ridley Anne J. , Low Boon Chuan
Published: January 2023

How the activities of Rho and Rac are coordinated through their GEF and GAP remains unclear. The prometastatic RhoGAP, BPGAP1, recruits the RacGEF Vav1 to activate Rac1 while it down-regulates the local RhoA activity that in turns influences Rac1 activation by Vav1. BPGAP1 acts as a scaffold to synchronize Rho and Rac signaling in cell motility.
Integrated care in cardiovascular disease: a statement of the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology
Authors: Ski Chantal F , Cartledge Susie , Foldager Dan , Thompson David R , Fredericks Suzanne , Ekman Inger , Hendriks Jeroen M
Published: January 2023

In a rapidly changing health and care landscape, there is acknowledgement that the organization of care should be integrated with the patient placed at the centre. In reality, care systems are often fragmented, disjointed, and focused on the condition rather than the patient. The Science Committee of the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology recognizes the need for a statement on integrated care to guide health professionals caring for people with cardiovascular disease. This statement outlines the evidence for integrated cardiovascular care, identifies challenges, and offers advice for practice, education, and research.
A new test of dynamical dark energy models and cosmic tensions in Hořava gravity
Authors: Di Valentino Eleonora , Nilsson Nils A , Park Mu-In
Published: January 2023

Hořava gravity has been proposed as a renormalizable, higher derivative, Lorentz-violating quantum gravity model without ghost problems. A Hořava gravity-based dark energy (HDE) model for dynamical dark energy has also been proposed earlier by identifying all the extra (gravitational) contributions from the Lorentz-violating terms as an effective energy–momentum tensor in Einstein equation. We consider a complete cosmic microwave background, baryon acoustic oscillation (BAO), and supernova Ia data test of the HDE model by considering general perturbations over the background perfect HDE fluid. Except from BAO, we obtain the preference of non-flat universes for all other data set combinations. We obtain a positive result on the cosmic tensions between the Hubble constant H0 and the cosmic shear S8, because we have a shift of H0 towards a higher value, though not enough for resolving the H0 tension, but the value of S8 is unaltered. This is in contrast to a rather decreasing H0 but increasing S8 in a non-flat Lambda cold dark matter (LCDM). For all other parameters, like Ωm and $\Omega _\Lambda$, we obtain quite comparable results with those of LCDM for all data sets, especially with BAO, so that our results are close to a cosmic concordance between the data sets, contrary to the standard non-flat LCDM. We also obtain some undesirable features, like an almost null result on Ωk, which gives back the flat LCDM, if we do not predetermine the sign of Ωk, but we propose several promising ways for improvements by generalizing our analysis.
Effect of Second-Stage Pushing Timing on Postpartum Pelvic Floor Morbidity
Authors: Tuuli Methodius G. , Gregory W. Thomas , Arya Lily A. , Lowder Jerry L. , Woolfolk Candice , Caughey Aaron B. , Srinivas Sindhu K. , Tita Alan T. N. , Macones George A. , Cahill Alison G. , Richter Holly E.
Published: January 2023

OBJECTIVE:

To assess whether immediate or delayed pushing in the second-stage results in higher risk of pelvic floor morbidity.

METHODS:

This study was a planned secondary aim of a multicenter randomized clinical trial that included nulliparous patients at 37 weeks of gestation or greater in labor with neuraxial analgesia. Participants were randomized in the second stage to initiate pushing immediately or wait 60 minutes before pushing. Participants had pelvic floor assessments at 1–5 days postpartum, 6 weeks postpartum, and 6 months postpartum. Rates of perineal lacerations, pelvic organ prolapse quantification (POP-Q) measures, and scores on validated symptom-specific distress and quality-of-life questionnaires (PFDI-20 [Pelvic Floor Distress Inventory], PFIQ [Pelvic Floor Impact Questionnaire], FISI [Fecal Incontinence Severity Index], and MMHQ [Modified Manchester Health Questionnaire]) were compared. It was estimated that 630 participants would provide more than 80% power to detect a 40% difference in second-degree or greater perineal lacerations and approximately 80% power to detect a 40% difference in stage 2 or greater pelvic organ prolapse (POP).

RESULTS:

Among 2,414 participants in the primary trial conducted between May 19, 2014, and December 16, 2017, 941 (39%) had pelvic floor assessments: 452 immediate pushing and 489 delayed pushing. The mean age was 24.8 years, and 93.4% had vaginal delivery. There were no significant differences in perineal lacerations at delivery and POP at 6 weeks and 6 months postpartum. Changes from baseline in total and subscale scores for the PFDI-20, the PFIQ, and the MMHQ were not significantly different at 6 weeks postpartum and 6 months postpartum. The change in FISI score was higher in the immediate pushing group at 6 months (2.9±5.7 vs 2.0±4.5, difference 0.9, P=.01), but less than the minimum important difference of 4.

CONCLUSION:

Among nulliparous patients in the second stage with neuraxial analgesia, immediate pushing, compared with delayed pushing, did not increase perineal lacerations, POP-Q measures, or patient-reported pelvic floor symptoms at 6 weeks and 6 months postpartum.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02137200.
A Population-Based Analysis of the Impact of the COVID-19 Pandemic on Solid Organ Transplantation in Ontario, Canada
Authors: Gomez David , Stukel Therese A. , Baxter Nancy N. , Acuna Sergio A. , Wilton Andrew S. , Treleaven Darin , Ordon Michael , Kim S. Joseph
Published: January 2023

Objectives:

To evaluate the impact of the COVID-19 pandemic on solid organ transplantation.

Background:

COVID-19 caused unprecedented disruption to solid organ transplantation (kidney, liver, heart, lung). Concerns about safety and decreases in deceased donors due to pandemic lockdowns have been described as potential causes.

Methods:

We report population-based rates of transplantation during the first 3 waves of COVID-19 in Ontario, Canada (March 1, 2020–July 3, 2021) versus a pre-COVID-19 baseline period (January 1, 2017–February 29, 2020). Poisson models were used to predict transplantation rates during COVID-19, based on pre-COVID-19 rates, and generate observed to expected rate ratios (RRs). Ninety-day transplant outcomes (mortality, retransplantation, transplant nephrectomy) were captured.

Results:

A 34.4% decrease (RR, 0.656; 95% confidence interval [CI], 0.586–0.734) in transplant rates was observed, coinciding with wave 1 and the deployment of a provincial transplant triaging system. Transplants decreased by 14.6% in wave 2 (RR, 0.854; 95% CI, 0.770–0.947) and 23.1% in wave 3 (RR, 0.769; 95% CI, 0.690–0.857) despite the triaging system not being activated. Overall, there was a 24.3% decrease (RR, 0.757; 95% CI, 0.679–0.844) in transplant rates, equivalent to 409 fewer transplants. No sustained changes were observed in heart or liver but sustained and large decreases were seen for lung (RR, 0.664; 95% CI, 0.482–0.915) and kidney (RR, 0.721; 95% CI, 0.602–0.863) transplantation. A low prevalence (1.7%) of COVID-19 infection within 90 days of transplantation was seen. No differences were observed in other 90-day outcomes.

Conclusions:

Early safety concerns limited transplantation to immediate life-saving procedures; however, the reductions in kidney and lung transplants continued for the rest of the pandemic, where no restrictions were in place.
Complications affecting the functional outcome after 1 year in older adults with severe head injury
Authors: Lin Ming-Hsiu , Lu Chih-Cheng , Chang Chia-Hao , Tsai Tsung-Chih
Published: January 2023

Background

This study explored possible significant complications, which affected the functional outcome after 1-year follow-up in older adults with severe head injury.

Methods

Retrospective secondary data were collected from the hospital medical information system. The patients who suffered from severe head injury (Injury Severity Score [ISS] ≧16) with the disease classification system were collected in the study. The survived patients were followed by telephone 1 year after discharge. Documented complications, Glasgow Outcome Scale, and Functional Independence Measure were used for comparisons. This study protocol was approved by the institutional review board of the hospital.

Results

Between January 2009 and September 2015, patients who were 65 years and older, diagnosed with ISS ≧16, were enrolled. There were 142 patients collected, and 60 patients survived reachable for more than 1 year for follow-up and analysis. The mean age of collected survival was 75.2 ± 6.1 years. Both complications of pneumonia and urinary tract infection had worsened the outcome of the older patients after 1-year follow-up (P < 0.001). After 1 year, those who had complications with urinary tract infection but not pneumonia had a worse prognosis in the aspects of functional outcome in 1-year follow-up.

Conclusions

Older adults with severe head injuries often have high mortality. When they survived, independent life activities are critical for their quality of life. Urinary tract infections during admission have detrimental effects on the functional outcome in the older patients. Prevention of urinary tract infection is encouraged for better outcome in older patients with severe head injury.
Epidemiology of Injuries in Wheelchair Basketball: Trauma Versus Overuse Mechanism and Prevention Rehabilitative Strategies
Authors: Farì Giacomo , Macchiarola Dario , Quarta Francesco , Bianchi Francesco Paolo , Caforio Laura , Cutti Andrea Giovanni , Megna Marisa , Ranieri Maurizio
Published: January 2023

Introduction

Wheelchair basketball (WB) is one of the most practiced sports among people with disabilities worldwide. There is a lack of data in scientific literature about injuries in sports for disabled people compared with able-bodied sports. The aim of this study is to investigate the epidemiology of injuries in professional WB athletes in an Italian cohort, distinguishing between trauma and overuse lesions and discussing the role of rehabilitation to prevent them.

Materials and Methods

The design is that of a cross-sectional study. An online survey was distributed to a group of Italian WB athletes competing in the first and second division of FIPIC (Wheelchair Basketball Italian Federation). The survey included demographic data, medical diagnoses, and athletes’ injuries history. The sample size consisted of 104 players.

Results

Forty-six injuries were reported. Of these, 32/46 (69.6%) were traumatic injuries and 14/46 (30.4%) were overuse injuries. The incidence of tendinopathies and fractures was significantly higher than for other injuries (P < 0.0001). Right shoulder (P < 0.0001), right hand (P = 0.002), and left hand (P = 0.041) injuries incidence was higher than any other injury in a statistically significant manner. The traumatic injuries group had a statistically significant difference in terms of days of suspension from sport activities compared with overuse injuries group (traumatic: median, 30; interquartile range [IQR], 14.5–40.0; range, 1–730 vs. overuse: median, 20.5; IQR, 10–21; range, 1–30; P = 0.006).

Conclusions

Trauma injuries are more common than overuse injuries. Injury prevention strategies should be based on rethinking protection devices technologies and integrating sport activities into a tailored rehabilitation global project that considers each athlete’s functional impairment and needs.

Clinical Relevance

Implementing the knowledge on WB injuries can really help to reinterpret rehabilitation in a new way, aimed at both the treatment and the prevention of these injuries. This will make this sport safer and more effective in improving the physical skills of people with disabilities.
Test–Retest Reliability and Efficacy of Individual Symptoms in Concussion Management
Authors: Caccese Jaclyn B. , Garcia Gian-Gabriel P. , Kontos Anthony P. , Port Nicholas , Valerio Kate , Broglio Steven P. , McCrea Michael , McAllister Thomas W. , Pasquina Paul F. , Buckley Thomas A. ,   CARE Consortium Investigators
Published: January 2023

Objective:

(1) To determine test–retest reliability of individual Sport Concussion Assessment Tool—Third Edition (SCAT-3) symptom scores and symptom severity scores, (2) to examine the specificity/sensitivity of individual SCAT-3 symptom severity scores acutely (24-48 hours) postconcussion, and (3) to develop a model of symptoms best able to differentiate concussed from nonconcussed student athletes and cadets.

Design:

Prospective, longitudinal, and cross-sectional.

Setting:

Twenty-six civilian schools and 3 US service academies.

Participants:

Collegiate student athletes (n = 5519) and cadets (n = 5359) from the National Collegiate Athletic Association–Department of Defense Grand Alliance: Concussion Assessment, Research and Education Consortium, including 290 student athletes and 205 cadets, assessed 24 to 48 hours postconcussion.

Independent Variables:

Concussed and nonconcussed student athlete and cadet groups.

Main Outcome Measures:

Sport Concussion Assessment Tool—Third Edition individual symptom severity scores, total symptom scores, and symptom severity scores.

Results:

Results indicated poor test–retest reliability across all symptom scores (intraclass correlation coefficient = 0.029-0.331), but several individual symptoms had excellent predictive capability in discriminating concussed from nonconcussed participants (eg, headache, pressure in the head, and don't feel right had area under the curve >0.8, sensitivity >70%, and specificity >85%) regardless of baseline testing. These symptoms were consistent with Chi-square Automatic Interaction Detector classification trees with the highest mean probability.

Conclusions:

Findings support the excellent diagnostic accuracy of honest symptom reporting, notwithstanding the known limitations in symptom underreporting, and suggest that there may be added value in examining individual symptoms rather than total symptom scores and symptom severity scores alone. Finally, findings suggest that baseline testing is not necessary for interpreting postconcussion symptom scores.
Factors associated with bleeding after ultrasound-assisted catheter-directed thrombolysis for the treatment of pulmonary embolism
Authors: Shald Elizabeth A. , Ohman Kelsey , Kelley Denise , Busey Kirsten , Erdman Michael J. , Smotherman Carmen , Ferreira Jason A.
Published: January 2023

Ultrasound-assisted catheter directed thrombolysis (US-CDT) is frequently used for the treatment of pulmonary embolism. Due to the variety of thrombolytic and anticoagulant dosing utilized in practice, patients with pulmonary embolism who undergo US-CDT may be at an increased risk of bleeding.

The primary objective of this study was to determine factors associated with major bleeding occurring with US-CDT. Secondary outcomes included in-hospital mortality and ventilator-free days.

This multicentre retrospective cohort study evaluated inpatients diagnosed with pulmonary embolism and treated with US-CDT and systemic anticoagulation.

A total of 173 patients were included. Most patients receiving US-CDT had a submassive pulmonary embolism with a median Pulmonary Embolism Severity Index (PESI) score of 85. Major bleeding events occurred in 37 of the 173 patients (21%). In-hospital mortality occurred in four (11%) of the patients who experienced major bleeding and three (2%) patients who did not experience major bleeding (P = 0.04). Factors associated with a higher risk of major bleeding included female sex and anticoagulation strategy. The odds of major bleeding were 3.3 times higher for women than for men (odds ratio = 3.32, 95% confidence interval 1.29–8.54). In addition, for each second increase in goal aPTT the odds of major bleeding increased by 5% (odds ratio = 1.05, 95% confidence interval 1.02–1.09).

In patients with pulmonary embolism treated with US-CDT, major bleeding may be underestimated. In this analysis, major bleeding was associated with female sex and higher goal aPTT levels. In addition, bleeding with US-CDT was associated with a higher risk of in-hospital mortality.
Military deployment-related respiratory problems: an update
Authors: Garshick Eric , Blanc Paul D.
Published: January 2023

Purpose of review

Military personnel deployed to Southwest Asia and Afghanistan were potentially exposed to high levels of fine particulate matter and other pollutants from multiple sources, including dust storms, burn pit emissions from open-air waste burning, local ambient air pollution, and a range of military service-related activities that can generate airborne exposures. These exposures, individually or in combination, can have adverse respiratory health effects. We review exposures and potential health impacts, providing a framework for evaluation.

Recent findings

Particulate matter exposures during deployment exceeded U.S. National Ambient Air Quality Standards. Epidemiologic studies and case series suggest that in postdeployment Veterans with respiratory symptoms, asthma is the most commonly diagnosed illness. Small airway abnormalities, most notably particularly constrictive bronchiolitis, have been reported in a small number of deployers, but many are left without an established diagnosis for their respiratory symptoms. The Promise to Address Comprehensive Toxics Act was enacted to provide care for conditions presumed to be related to deployment exposures. Rigorous study of long-term postdeployment health has been limited.

Veterans postdeployment to Southwest Asia and Afghanistan with respiratory symptoms should undergo an exposure assessment and comprehensive medical evaluation. If required, more advanced diagnostic considerations should be utilized in a setting that can provide multidisciplinary expertise and long-term follow-up.
Biomarkers for acute kidney injury in children – where are we now?
Authors: Sandokji Ibrahim , Greenberg Jason H.
Published: January 2023

Purpose of review

Review the literature over the last 2 years on commonly evaluated biomarkers of acute kidney injury (AKI) and highlight the findings of these biomarkers.

Recent findings

Among several studied AKI biomarkers, urine neutrophil gelatinase-associated lipocalin (NGAL) and the combination of urine tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) have been recently studied most frequently as diagnostic biomarkers of AKI and for AKI risk stratification. Urine NGAL has continued to show good discriminative value to predict and diagnose AKI in childhood. Urine TIMP-2∗IGFBP7 can provide modest improvement to clinical models of AKI.

Prior research supports that AKI biomarkers may identify AKI at an earlier time point and indicate clinically meaningful tubular injury. More effort should be made to understand if AKI biomarkers can guide treatments and improve outcomes
Simultaneous thoracic and abdominal donation after circulatory death organ recovery: the abdominal surgeon's perspective
Authors: Thiessen Carrie , Wisel Steven A. , Roll Garrett R.
Published: January 2023

Purpose of the review

To summarize the international experience with heart-liver (joint) donation after circulatory death (DCD) procurements and to explore the technical challenges in joint abdominal and thoracic DCD procurement.

Recent findings

Following completion of the Donors After Circulatory Death Heart Trial in the US, combined thoracic and abdominal DCD is poised to become the standard of care, expanding access to life-saving heart and lung allografts. DCD heart procurement relies on collection of donor blood for priming of the normothermic perfusion pump, which delays cooling of abdominal organs and increases risk of ischemic injury. We review the effect of donor ischemia time on abdominal organs, with several proposed technical solutions to optimize transplant outcomes for all organs.

The strategies reviewed in this manuscript may inform clinical decision-making, preoperative coordination between thoracic and abdominal procurement teams, and surgical technique for joint DCD procurements. Several approaches to organ procurement organization (OPO) and national policy, as well as future areas of focus for research are proposed.
Sensitivity and Specificity of Whole-body MRI for the Detection of Pediatric Malignancy
Authors: Cochran Thomas , Patel Sachit , Kruse Travis , Lyden Elizabeth , Comer Susan , Ford James
Published: January 2023

Children with cancer often present with general and nonspecific symptoms leading to initial diagnostic workup inclusive of clinical imaging. Various sequences of magnetic resonance imaging (MRI) are becoming more available for diagnostic imaging. However, there is currently a dearth of literature quantifying the sensitivity and specificity of whole-body MRI in identifying pediatric malignancy. In this study, a retrospective analysis was performed of pediatric whole-body MRI inclusive of short tau inversion recovery sequence conducted at an academic pediatric medical center from 2013 to 2018. Kappa statistics were used to evaluate the diagnostic agreement between MRI results and the gold standard diagnostic study of the respective final diagnosis. Sensitivity, specificity, false-positive, and false-negative estimates were provided with joint 90% confidence regions. One hundred forty-two patients received a whole-body MRI during the study period. The sensitivity of whole-body MRI in detecting malignancy was found to be 93.8% with a specificity of 93.4%. The positive and negative predictive values were determined to be 65.2% and 99.1%, respectively. Our findings suggest that whole-body MRI may be of value as an initial diagnostic tool for pediatric malignancy. Larger multicenter collaboration will be needed to further support these data.
The Impact of Religion and Spirituality on Suicide Risk in Veterans and Refugees With Posttraumatic Stress Disorder
Authors: Brandt Mathilde K. , Sandahl Hinuga , Carlsson Jessica
Published: January 2023

It has been suggested that religion and spirituality have a protective impact on suicide risk in populations living with posttraumatic stress disorder (PTSD). This review sought to examine the association between suicide risk among veterans and refugees with PTSD and religion or spirituality as a modifying factor. Two databases, PubMed and Embase, were searched and 10 publications were identified and included. Seven publications found that religion or spirituality was associated with lower suicide risk. The findings in this study suggest that religion and spirituality contain social as well as psychological domains, which should be considered in future interventions and in strategies of prevention of suicide in populations with PTSD. Further high-quality research with well-defined terms of religion and spirituality that investigates the connection to suicide risk of veterans and refugees with PTSD is recommended.
Paper Charts
Authors: Frost Emma D. , Donlon Jack , Mitwally Aimin , Magnani Gretchen , Tomlin Shay , Berk Michael , Koola Maju Mathew
Published: January 2023

The use of electronic medical records (EMRs) has increased dramatically over the last 15 years. However, psychiatry has lagged. EMRs are not being used by many mental health professionals. There are many reasons, including financial burden, lack of technological support, stigma, disaggregation of upfront costs, indirect benefits, and concerns about privacy and Health Insurance Portability and Accountability Act compliance. Obtaining paper records is a lengthy process, making continuity of care and emergency care challenging. Even when records are made available, it is common for information to be incomplete. The objective of this article is to highlight how the continued use of paper charts may decrease the quality and timeliness of psychiatric care provided and to discuss the psychiatry-specific issues created by EMRs. A case illustrating the disruption of care by continued use of paper charts in psychiatric facilities is presented. The growing use of EMR creates new challenges that affect psychiatry in ways other fields are not affected. These challenges include confidentiality issues, the frequent change/spectrum of diagnoses, determining how much information should be recorded in a note, and what the implications are of the information recorded. This article will discuss the use of EMRs in psychiatry, as well as encourage medical students and residents to take a deeper dive into psychiatry-specific issues regarding the use of EMR. EMR use may have a profound impact on our patient outcomes, health care delivery system, shorter inpatient stay, as well as reduce health care costs.
Opioid Use in Pregnancy: A Review
Authors: Ryan Kimberly S. , Prewitt Kristin C. , Hayer Sarena , Hedges Madeline A. , Benson Ashley E. , Lo Jamie O.
Published: January 2023

Importance

The use and misuse of opioids in pregnancy have been increasing and are a major public health issue. Opioid use in pregnancy and during lactation has been associated with increased maternal and neonatal morbidity and mortality.

Objective

This review aims to summarize the existing literature and current recommendations for opioid use while pregnant or lactating.

Evidence Acquisition

A PubMed, Cochrane Library, and Google Scholar literature search using the following terms was performed to gather relevant data: “opioids,” “opioid maintenance therapy,” “opioid use disorder,” “suboxone,” “buprenorphine,” “methadone,” “medication for opioid use disorder,” “fetal outcomes,” “perinatal outcomes,” “pregnancy,” “lactation,” and “neonatal abstinence syndrome.”

Results

Available studies on opioid use in pregnancy and during lactation were reviewed and support association with increased odds of maternal death, placental insufficiency, cardiac arrest, preterm birth, neonatal intensive care unit admission, low birth weight, and small for gestational age infants. Studies were also reviewed on pharmacotherapy options in pregnancy and promising prenatal care models.

Conclusion and Relevance

There is a critical need for research on the effects of opioid use and related pharmacotherapy options in pregnancy. Once the adverse perinatal effects of opioid exposure are identified and well-characterized, patient education, intervention, and antenatal surveillance can be developed to predict and mitigate its impact on maternal and fetal health.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After participating in this activity, the learner should be better able to propose patient counseling strategies regarding prenatal opioid use; explain patient assessment measures for opioid use during pregnancy; and discuss recommendations regarding opioid use while breastfeeding.
Estimated Incidence and Prevalence of Gonorrhea in the United States, 2006–2019
Authors: Pollock Emily D. , Clay Patrick A. , Kreisel Kristen M. , Spicknall Ian H.
Published: January 2023

Background

We extend recent work estimating incidence and prevalence of gonococcal infections among men and women aged 15 to 39 years in the United States in 2018 by applying the same modeling framework to estimate gonococcal incidence and prevalence during 2006 to 2019.

Methods

The model is informed by cases from the Nationally Notifiable Disease Surveillance System, data from the National Survey of Family Growth, and data on other factors known to impact gonococcal incidence and prevalence. We use Monte Carlo simulation to account for uncertainty in input parameters. Results are reported as median annual per-capita incidence and prevalence; uncertainty intervals are characterized by the 25th and 75th simulated percentiles.

Results

There were 1,603,473 (1,467,801-1,767,779) incident cases of gonorrhea estimated in 2019. Per-capita incidence increased 32%, from 1101 (1002–1221) to 1456 (1333–1605) infections per 100,000 persons. This trend in per-capita incidence had 3 phrases: an initial decline during 2006 to 2009, a plateau through 2013, and a rapid increase of 66% through 2019. Men aged 25 to 39 years experienced the greatest increase in incidence (125%, 541 [467–651] to 1212 infections [1046–1458] per 100,000 men). Women aged 25 to 39 years had the lowest incidence in 2019, with 1040 infections (882–1241) per 100,000 women. Prevalence increased more slowly among those aged 25 to 39 years versus 15 to 24 years. The incidence ratio comparing men with women aged 25 to 39 years increased from 0.76 to 1.18.

Conclusions

The burden of gonorrhea has increased among men and women aged 15 to 39 years since 2013. An increasing proportion of incident infections are among men. Additional biomedical and behavioral interventions are needed to control gonococcal transmission.
Retrospective Analysis of Imaging Characteristics of Tectal Gliomas
Authors: Pokhylevych Halyna , Khose Swapnil , Amer Ahmad , Alhasan Hamza , Kaya Diana , Johnson Rashad , Fuller Greg , Gruschkus Stephen K. , Zaky Wafik , Weinberg Jeffrey S. , Johnson Jason M.
Published: January 2023

Background and Purpose

Tectal gliomas (TGs) are rare tumors that involve critical locations in the brainstem, including the superior and inferior colliculi and the Sylvian aqueduct. The rarity of these tumors and the lack of large clinical studies have hindered adequate understanding of this disease. We sought to determine the association between imaging characteristics of TG and progression-free survival (PFS).

Materials and Methods

In this retrospective cohort study, impact of imaging characteristics (contrast enhancement, calcifications, cystic changes, presence of hydrocephalus) on survival was analyzed for 39 patients with TG. We used the Kaplan-Meier survival analysis method for determining the association between imaging characteristics and PFS. Progression-free survival was measured from time of diagnosis to radiographic or pathological disease progression during observation period. Progression was defined as more than 25% increase of the lesion in size, per response assessment in neuro-oncology, together with clinical deterioration and/or a need for intervention. Progression-free survival differences by various imaging characteristics were assessed using the log-rank test and univariable Cox proportional hazard regression. Because most of the studies in the current literature tend to overrepresent pediatric patients, we aimed to determine the association between TG tumors' imaging characteristics and PFS in both adult and pediatric patients. All statistical analyses were performed using STATA version 16.1 (Stata Corp, College Station, Tex).

Results

Of the 39 patients, radiographic tumor progression was observed in 15 cases (38.5%). Median PFS for 39 patients during observation was 21.8 years. Tectal gliomas that showed contrast enhancement initially or developed contrast enhancement during surveillance on magnetic resonance imaging had significantly lower PFS than those without (hazard ratio, 3.55; 95% confidence interval, 1.09–11.58; log-rank P value, 0.02).

Conclusions

Analysis of this patient population showed that contrast-enhancing TGs should not be categorically defined as benign lesions. This subgroup of patients should be followed closely for signs of progression.
DEVELOPMENT OF A MACHINE LEARNING MODEL FOR PREDICTING 28-DAY MORTALITY OF SEPTIC PATIENTS WITH ATRIAL FIBRILLATION
Authors: Wang Ziwen , Zhang Linna , Chao Yali , Xu Meng , Geng Xiaojuan , Hu Xiaoyi
Published: January 2023

Introduction: Septic patients with atrial fibrillation (AF) are common in the intensive care unit accompanied by high mortality. The early prediction of prognosis of these patients is critical for clinical intervention. This study aimed to develop a model by using machine learning (ML) algorithms to predict the risk of 28-day mortality in septic patients with AF. Methods: In this retrospective cohort study, we extracted septic patients with AF from the Medical Information Mart for Intensive Care III (MIMIC-III) and IV database. Afterward, only MIMIC-IV cohort was randomly divided into training or internal validation set. External validation set was mainly extracted from MIMIC-III database. Propensity score matching was used to reduce the imbalance between the external validation and internal validation data sets. The predictive factors for 28-day mortality were determined by using multivariate logistic regression. Then, we constructed models by using ML algorithms. Multiple metrics were used for evaluation of performance of the models, including the area under the receiver operating characteristic curve, sensitivity, specificity, recall, and accuracy. Results: A total of 5,317 septic patients with AF were enrolled, with 3,845 in the training set, 960 in the internal testing set, and 512 in the external testing set, respectively. Then, we established four prediction models by using ML algorithms. AdaBoost showed moderate performance and had a higher accuracy than the other three models. Compared with other severity scores, the AdaBoost obtained more net benefit. Conclusion: We established the first ML model for predicting the 28-day mortality of septic patients with AF. Compared with conventional scoring systems, the AdaBoost model performed moderately. The model established will have the potential to improve the level of clinical practice.