bluuebunny/crossref_metadata_2025 huggingface dataset:
Rare case of congenital coronary artery fistula coexistent and coalesced with aortopulmonary fistula
Authors: Osawa Takumi , Ito Yuta , Koizumi Tomomi
Published: July 2021

Coronary artery fistula (CAF) is an uncommon congenital heart disease. Furthermore, aortopulmonary fistula is a rare congenital heart disease of adult onset. We report the case of a 79-year-old man who presented with chest pain. ECG-gated cardiac CT and coronary artery angiography revealed an anomalous vessel arising from the right coronary cusp and a CAF from the left coronary descending artery. These fistulas coalesced and drained into the same portion of the pulmonary artery. Haemodynamic studies revealed that the estimated systemic-to-pulmonary flow ratio was 1.18. The mean pulmonary pressure was 14 mm Hg. We decided against surgical intervention due to his advanced age and lack of heart failure symptoms. The patient did not have any worsening heart failure and chest pain on follow-up. This was a rare case of CAF coexistent and coalesced with an aortopulmonary fistula.
Developing a pulse oximetry home monitoring protocol for patients suspected with COVID-19 after emergency department discharge
Authors: Gootenberg David B , Kurtzman Nicholas , O’Mara Thomas , Ge Jennifer Y , Chiu David , Shapiro Nathan I , Mechanic Oren J , Dagan Alon
Published: July 2021

Objectives

Patients with COVID-19 can present to the emergency department (ED) without immediate indication for admission, but with concern for decompensation. Clinical experience has demonstrated that critical illness may present later in the disease course and hypoxia is often the first indication of disease progression. The objectives of this study are to (a) assess feasibility and describe a protocol for ED-based outpatient pulse-oximetry monitoring with structured follow-up and (b) determine rates of ED return, hospitalisation and hypoxia among participants.

Methods

Prospective observational study of patients presenting to a single academic ED in Boston with suspected COVID-19. Eligible patients were adults being discharged from the ED with presumed COVID-19. Exclusion criteria included resting oxygen saturation <92%, ambulatory oxygen saturation <90%, heart rate >110 beats per minute or inability to use the device. Study personnel made scripted phone calls on postdischarge days 1, 3 and 7 to review the pulse-oximetry readings and to evaluate for decompensation. Return visit and admission information were collected via medical record and 28-day follow-up calls.

Results

81 patients were enrolled of which 10 (12%) developed hypoxia after their initial discharge from the ED. Overall, 23 (28%) of the 81 patients returned to the ED at least once and 10 of those who returned (43%) were admitted. We successfully contacted 76/81 (94%) of subjects via phone at least once for follow-up assessment.

Discussion

Patients are eager and willing to participate in home monitoring systems and are comfortable with using technology, which will allow providers and health systems to extend our hospitals capabilities for tracking patient populations in times of crisis.

Conclusions

It is feasible to implement an outpatient pulse-oximetry monitoring protocol to monitor patients discharged from the ED with confirmed or suspected COVID-19.
2 Perioperative medicines management for trauma inpatients – a quality improvement project
Authors: Adams Megan
Published: July 2021

Introduction

It was observed anecdotally that several trauma patients were not receiving routine oral meds due to being ‘Nil-by-mouth’. Our aim was to improve perioperative administration of regular medication for patients admitted with fractured neck of femur (NOF #) on the day of surgery.

Methods

Data was collected from drug charts of those admitted to the Queen Alexandra Hospital, Portsmouth with NOF # in 2019. Good practice was mostly observed, however areas for improvement were identified in anticoagulation, cardiac and diabetic medication. In addition, the pre-op guidelines and drug trolley posters were not always available and were out of date. Change was implemented by updating the NOF # guidelines using up-to-date guidance.

The ‘Nil by Mouth’ drug trolley posters were re-designed and were re-distributed to every drug trolley on the orthopaedic wards and the nursing teams were informed of the changes.

Results

Following re-audit, improvement was made in the following areas. Anticoagulation administration now had a 100% compliance. Rate-limiters administration had improved, as had the administration of antihypertensives (CCB). Parkinson’s medication, inhalers and alcohol withdrawal medication had continued to be consistently given. The reasons for omitting medication was documented. No improvement was made in the following areas: Gastric protection, oral analgesia, anti-anginals and more data was required to assess glycaemic management.

Conclusions

Optimisation of these high-risk patients requires a multi-faceted approach but by improving basic aspects of care such as peri-operative medication, it is hoped that overall mortality and morbidity are reduced. Further education on this topic may be required to continue improvement.

References

UKCPA. 2019. The Handbook of Perioperative Medicines. [online] Available at: https://www.ukcpa-periophandbook.co.uk/[Accessed 10 February 2020].

Escardio.org. 2014. ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. [online] Available at: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/ESC-ESA-Guidelines-on-non-cardiac-surgery-cardiovascular-assessment-and-management [Accessed 8 February 2020].
4 Optimisation of shared learning between critical care teams during the early stages of the COVID-19 pandemic
Authors: O’Brien Mark
Published: July 2021

Introduction

In anticipation of an uplift in critical care acuity due to COVID-19, staffing at JHG (SE) ICU was reconfigured into six discreet teams. At that time, there was no dedicated mechanism for shared learning and development of SOPs to occur in a horizontal fashion across teams. The aim of this project was to develop a tool that would enable the expanding knowledge base of each individual team to be captured, refined and rapidly disseminated to the rest of the department.

Methods

A ‘Virtual Whiteboard’ was created consisting of an electronic feedback form accessible via smartphone. Individual team feedback was collated and then reviewed by a designated consultant. Subsequent modification of SOPs was disseminated across all teams via group email.

Results

The Virtual White Board proved of particular use in the first few weeks of the new COVID-19 rota. Specific changes which occurred as a consequence of the project included improved efficiency in the use of personal protective equipment, increased clinical support to nursing staff from trainees and the development of new SOPs relating to more timely completion of death certificates.

Conclusions

The Virtual Whiteboard contributed to the ability of JHG (SE) Critical Care Unit to adapt rapidly and cohesively in the context of a fast-changing clinical environment.
Variation in COVID-19 characteristics, treatment and outcomes in Michigan: an observational study in 32 hospitals
Authors: Chopra Vineet , Flanders Scott A , Vaughn Valerie , Petty Lindsay , Gandhi Tejal , McSparron Jakob Israel , Malani Anurag , O'Malley Megan , Kim Tae , McLaughlin Elizabeth , Prescott Hallie
Published: July 2021

Objective

To describe patient characteristics, symptoms, patterns of care and outcomes for patients hospitalised with COVID-19 in Michigan.

Design

Multicentre retrospective cohort study.

Setting

32 acute care hospitals in the state of Michigan.

Participants

Patients discharged (16 March–11 May 2020) with suspected or confirmed COVID-19 were identified. Trained abstractors collected demographic information on all patients and detailed clinical data on a subset of COVID-19-positive patients.

Primary outcome measurements

Patient characteristics, treatment and outcomes including cardiopulmonary resuscitation, mortality and venous thromboembolism within and across hospitals.

Results

Demographic-only data from 1593 COVID-19-positive and 1259 persons under investigation discharges were collected. Among 1024 cases with detailed data, the median age was 63 years; median body mass index was 30.6; and 51.4% were black. Cough, fever and shortness of breath were the top symptoms. 37.2% reported a known COVID-19 contact; 7.0% were healthcare workers; and 16.1% presented from congregated living facilities.

During hospitalisation, 232 (22.7%) patients were treated in an intensive care unit (ICU); 558 (54.9%) in a ‘cohorted’ unit; 161 (15.7%) received mechanical ventilation; and 90 (8.8%) received high-flow nasal cannula. ICU patients more often received hydroxychloroquine (66% vs 46%), corticosteroids (34% vs 18%) and antibiotic therapy (92% vs 71%) than general ward patients (p<0.05 for all). Overall, 219 (21.4%) patients died, with in-hospital mortality ranging from 7.9% to 45.7% across hospitals. 73% received at least one COVID-19-specific treatment, ranging from 32% to 96% across sites.

Across 14 hospitals, the proportion of patients admitted directly to an ICU ranged from 0% to 43.8%; mechanical ventilation on admission from 0% to 12.8%; mortality from 7.9% to 45.7%. Use of at least one COVID-19-specific therapy varied from 32% to 96.3% across sites.

Conclusions

During the early days of the Michigan outbreak of COVID-19, patient characteristics, treatment and outcomes varied widely within and across hospitals.
Effect of faecal calprotectin testing on referrals for children with chronic gastrointestinal symptoms in primary care: study protocol for a cluster randomised controlled trial
Authors: Ansems Sophie , Berger Marjolein , van Rheenen Patrick Ferry , Vermeulen Karin , Beugel Gina , Couwenberg Maria , Holtman Gea
Published: July 2021

Introduction

Children with chronic gastrointestinal symptoms are frequently seen in primary care, yet general practitioners (GPs) often experience challenges distinguishing functional gastrointestinal disorders (FGID) from organic disorders. We, therefore, aim to evaluate whether a test strategy that includes point-of-care testing (POCT) for faecal calprotectin (FCal) can reduce the referral rate to paediatric specialist care among children with chronic gastrointestinal symptoms. The study findings will contribute to improving the recommendations on FCal use among children in primary care.

Methods and analysis

In this pragmatic cluster randomised controlled trial, we will randomise general practices into intervention and control groups. The intervention group will use FCal-POCT when indicated, after completing online training about its indication, interpretation and follow-up as well as communicating an FGID diagnosis. The control group will test and treat according to Dutch GP guidelines, which advise against FCal testing in children. GPs will include children aged 4–18 years presenting to primary care with chronic diarrhoea and/or recurrent abdominal pain. The primary outcome will be the referral rate for children with chronic gastrointestinal symptoms within 6 months after the initial assessment. Secondary outcomes will be evaluated by questionnaires completed at baseline and at 3- and 6-month follow-up. These outcomes will include parental satisfaction and concerns, gastrointestinal symptoms, impact of symptoms on daily function, quality of life, proportion of children with paediatrician-diagnosed FGID referred to secondary care, health service use and healthcare costs. A sample size calculation indicates that we need to recruit 158 GP practices to recruit 406 children.

Ethics and dissemination

The Medical Research Ethics Committee (MREC) of the University Medical Center Groningen (The Netherlands) approved this study (MREC number: 201900309). The study results will be made available to patients, GPs, paediatricians and laboratories via peer-reviewed publications and in presentations at (inter)national conferences.

Trial registration number

The Netherlands Trial Register: NL7690 (Pre-results)
Illness severity and risk of mental morbidities among patients recovering from COVID-19: a cross-sectional study in the Icelandic population
Authors: Saevarsdóttir Karen Sól , Hilmarsdóttir Hildur Ýr , Magnúsdóttir Ingibjörg , Hauksdóttir Arna , Thordardottir Edda Bjork , Gudjónsdóttir Ásdís Braga , Tomasson Gunnar , Rúnarsdóttir Harpa , Jónsdóttir Harpa Lind , Gudmundsdóttir Berglind , Pétursdóttir Gudrún , Petersen Pétur Henry , Kristinsson Sigurdur Yngvi , Love Thorvardur Jon , Hansdóttir Sif , Hardardóttir Hrönn , Gudmundsson Gunnar , Eythorsson Elias , Gudmundsdóttir Dóra Gudrún , Sigbjörnsdóttir Hildur , Haraldsdóttir Sigrídur , Möller Alma Dagbjört , Palsson Runolfur , Jakobsdóttir Jóhanna , Aspelund Thor , Valdimarsdottir Unnur
Published: July 2021

Objective

To test if patients recovering from COVID-19 are at increased risk of mental morbidities and to what extent such risk is exacerbated by illness severity.

Design

Population-based cross-sectional study.

Setting

Iceland.

Participants

A total of 22 861 individuals were recruited through invitations to existing nationwide cohorts and a social media campaign from 24 April to 22 July 2020, of which 373 were patients recovering from COVID-19.

Main outcome measures

Symptoms of depression (Patient Health Questionnaire), anxiety (General Anxiety Disorder Scale) and posttraumatic stress disorder (PTSD; modified Primary Care PTSD Screen for DSM-5) above screening thresholds. Adjusting for multiple covariates and comorbidities, multivariable Poisson regression was used to assess the association between COVID-19 severity and mental morbidities.

Results

Compared with individuals without a diagnosis of COVID-19, patients recovering from COVID-19 had increased risk of depression (22.1% vs 16.2%; adjusted relative risk (aRR) 1.48, 95% CI 1.20 to 1.82) and PTSD (19.5% vs 15.6%; aRR 1.38, 95% CI 1.09 to 1.75) but not anxiety (13.1% vs 11.3%; aRR 1.24, 95% CI 0.93 to 1.64). Elevated relative risks were limited to patients recovering from COVID-19 that were 40 years or older and were particularly high among individuals with university education. Among patients recovering from COVID-19, symptoms of depression were particularly common among those in the highest, compared with the lowest tertile of influenza-like symptom burden (47.1% vs 5.8%; aRR 6.42, 95% CI 2.77 to 14.87), among patients confined to bed for 7 days or longer compared with those never confined to bed (33.3% vs 10.9%; aRR 3.67, 95% CI 1.97 to 6.86) and among patients hospitalised for COVID-19 compared with those never admitted to hospital (48.1% vs 19.9%; aRR 2.72, 95% CI 1.67 to 4.44).

Conclusions

Severe disease course is associated with increased risk of depression and PTSD among patients recovering from COVID-19.
Experiences of supported isolation in returning travellers during the early COVID-19 response: a qualitative interview study
Authors: Carter Holly , Weston Dale , Greenberg Neil , Oliver Isabel , Robin Charlotte , Rubin G James , Wessely Simon , Gauntlett Louis , Amlot Richard
Published: July 2021

Objectives

(1) To understand the experiences and perceptions of those who underwent supported isolation, particularly in relation to factors that were associated with improved compliance and well-being; (2) to inform recommendations for the management of similar supported isolation procedures.

Design

We carried out a qualitative study using semistructured interviews to capture participants’ experiences and perceptions of supported isolation. Data were analysed using the framework approach, a type of thematic analysis that is commonly used in research that has implications for policy.

Setting

Telephone interviews carried out within approximately 1 month of an individual leaving supported isolation.

Participants

26 people who underwent supported isolation at either Arrowe Park Hospital (n=18) or Kents Hill Park Conference Centre (n=8) after being repatriated from Wuhan in January to February 2020.

Results

Six key themes were identified: factors affecting compliance with supported isolation; risk perceptions around catching COVID-19; management of supported isolation; communication with those outside supported isolation; relationship with others in supported isolation; and feelings on leaving supported isolation. Participants were willing to undergo supported isolation because they understood that it would protect themselves and others. Positive treatment by staff was fundamental to participants’ willingness to comply with isolation procedures. Despite the high level of compliance, participants expressed some uncertainty about what the process would involve.

Conclusions

As hotel quarantine is introduced across the UK for international arrivals, our findings suggest that those in charge should: communicate effectively before, during and after quarantine, emphasising why quarantine is important and how it will protect others; avoid coercion if possible and focus on supporting and promoting voluntary compliance; facilitate shared social experiences for those in quarantine; and ensure all necessary supplies are provided. Doing so is likely to increase adherence and reduce any negative effects on well-being.
Multimorbidity in Latin America and the Caribbean: a systematic review and meta-analysis
Authors: Huaquía-Díaz Alessandra M , Chalán-Dávila Tarick S , Carrillo-Larco Rodrigo M , Bernabe-Ortiz Antonio
Published: July 2021

Objective

To estimate the pooled prevalence of multimorbidity (≥2 non-communicable diseases in the same individual) among adults of the general population of Latin American and the Caribbean (LAC).

Design

Systematic review and meta-analysis.

Data sources

MEDLINE, Embase, Global Health, Scopus and LILACS up to 1 July 2020.

Eligibility criteria for selecting studies

The outcome was the prevalence of multimorbidity. Reports were selected whether they enrolled adult individuals (age ≥18 years) from the general population.

Data extraction and synthesis

Reviewers extracted relevant data and assessed risk of bias independently. A random-effects meta-analysis was conducted to report pooled prevalence estimates of multimorbidity; pooled estimates by pre-specified subgroups (eg, national studies) were also pursued.

Results

From 5830 results, we selected 28 reports, mostly from Brazil and 16 were based on a nationally representative sample. From the 28 selected reports, 26 were further included in the meta-analysis revealing a pooled multimorbidity prevalence of 43% (95% CI: 35% to 51%; I2: 99.9%). When only reports with a nationally representative sample were combined, the pooled prevalence was 37% (95% CI: 27% to 47%; I2: 99.9%). When the ascertainment of multimorbidity was based on self-reports alone, the pooled prevalence was 40% (95% CI: 31% to 48%; I2: 99.9%); this raised to 52% (95% CI: 33% to 70%; I2: 99.9%) for reports including self-reported and objective diagnosis.

Conclusions

Our results complement and advance those from global efforts by incorporating much more reports from LAC. We revealed a larger presence of multimorbidity in LAC than previously reported.

PROSPERO registration number

CRD42020196177.
Sociodemographic inequality in COVID-19 vaccination coverage among elderly adults in England: a national linked data study
Authors: Nafilyan Vahe , Dolby Ted , Razieh Cameron , Gaughan Charlotte Hannah , Morgan Jasper , Ayoubkhani Daniel , Walker Sarah , Khunti Kamlesh , Glickman Myer , Yates Thomas
Published: July 2021

Objective

To examine inequalities in COVID-19 vaccination rates among elderly adults in England.

Design

Cohort study.

Setting

People living in private households and communal establishments in England.

Participants

6 655 672 adults aged ≥70 years (mean 78.8 years, 55.2% women) who were alive on 15 March 2021.

Main outcome measures

Having received the first dose of a vaccine against COVID-19 by 15 March 2021. We calculated vaccination rates and estimated unadjusted and adjusted ORs using logistic regression models.

Results

By 15 March 2021, 93.2% of people living in England aged 70 years and over had received at least one dose of a COVID-19 vaccine. While vaccination rates differed across all factors considered apart from sex, the greatest disparities were seen between ethnic and religious groups. The lowest rates were in people of black African and black Caribbean ethnic backgrounds, where only 67.2% and 73.8% had received a vaccine, with adjusted odds of not being vaccinated at 5.01 (95% CI 4.86 to 5.16) and 4.85 (4.75 to 4.96) times greater than the white British group. The proportion of individuals self-identifying as Muslim and Buddhist who had received a vaccine was 79.1% and 84.1%, respectively. Older age, greater area deprivation, less advantaged socioeconomic position (proxied by living in a rented home), being disabled and living either alone or in a multigenerational household were also associated with higher odds of not having received the vaccine.

Conclusion

Research is now urgently needed to understand why disparities exist in these groups and how they can best be addressed through public health policy and community engagement.
Constructing high-quality rest facilities to maximise performance and ensure patient safety
Authors: Silva Geeth , Yam Aiken , Court Jessica , Imtiaz Rabia , Chisholm Cath
Published: July 2021

Introduction

Junior doctors are working in an increasingly overstretched National Health Service. In 2018, Kettering General Hospital (KGH) was awarded £60 800 of government funds to create high-quality rest facilities and improve junior doctor well-being.

Methods

An audit and survey in KGH identified the structural and functional improvements needed. From November 2019 to June 2020, £47 841.24 was spent on creating new rest facilities. On completion, a postaction review assessed how the changes impacted morale, well-being and quality of patient care.

Results

The majority of doctors were happy with the new rest areas (60%), a majority felt that they would use the on-call room area (63%) and the renovation improved morale and well-being. There was an increased ability to take breaks. However, the majority of doctors are not exception-reporting missing breaks: 79% (2019), 74% (2020).

Conclusions and Implications

This report recommends the maintenance of increased staffing levels and rest facilities during the recovery phase of COVID-19. The remaining £12 958.76 should be directed at sustaining the quality of KGH rest facilities. Lastly, the rate of exception-reporting must be increased through improving awareness, exploring alternative methods and supporting the action when necessary. The continual investment into rest facilities ensures workforce well-being and translates into patient safety.
Lupus clinical trial eligibility in a real-world setting: results from the British Isles Lupus Assessment Group-Biologics Register (BILAG-BR)
Authors: Dyball Sarah , Collinson Sophie , Sutton Emily , McCarthy Eoghan M , Bruce Ian N , Parker Ben
Published: July 2021

Objective

To quantify how well phase III randomised clinical trials in both SLE and lupus nephritis (LN) represents a real-world SLE cohort.

Methods

Literature reviews were performed of major published phase III SLE (n=12) and LN (n=6) clinical trials (ClinicalTrials.gov). Inclusion and exclusion criteria common across these trials were collated for non-renal SLE or LN trials, and applied to patients recruited to the British Isles Lupus Assessment Group-Biologics Register (BILAG-BR) starting either biological or standard-of-care (SOC) therapies.

Results

We recruited 837 patients to the BILAG-BR from September 2010 to June 2018, starting either SOC (n=125, 15%) or a biological medication (n=712, 85%). Active LN, defined as a BILAG A in the renal domain occurred in 20% (n=166). Overall, 530 (63%) patients were ineligible to participate in non-renal SLE clinical trials and 72 (43%) patients with active LN would be ineligible for LN trials. The most common reasons for ineligibility from the non-renal lupus trials included active renal involvement (n=166, 20%) and low disease activity (n=114, 15%). For LN trials, the most common exclusion met was pre-existing renal impairment (n=15, 9%). Patients with fewer comorbidities were more likely to be eligible to participate in non-renal SLE trials.

Conclusions

In this national register of patients with moderate-to-severe SLE, nearly two-thirds would not be eligible for recruitment to key SLE clinical trials nor would almost half of those with active LN. Eligibility criteria may excessively constrain enrolment and thus, how we can generalise trial results in a real-world setting.
A customized fragment for seepage beneath a dam with a vertical wall
Authors: Zhang Yijiang , Griffiths D.V.
Published: July 2021

Based on the method of fragments for the analysis of steady confined seepage, a customized type E fragment is developed, with results presented in the form of charts for the estimation of seepage quantities and exit gradients under embedded water-retaining structures with a vertical cut-off wall. The type E fragment is shown to be an extension of previously derived type A and type D fragments, allowing for both embedment and a cut-off wall. The charts are generated using finite element analysis and cover both isotropic and anisotropic permeability cases. Validation of the fragment is confirmed by comparison with existing method of fragments and full finite element analysis. The charts are shown to predict the flow rate and exit gradient more precisely than existing methods of fragments. The design charts presented in this paper cover a wide range of confined flow problems of practical interest.
$$\pi ^-p\rightarrow \eta ^{(\prime )}\, \pi ^- p$$ in the double-Regge region
Authors: Bibrzycki Ł. , Fernández-Ramírez C. , Mathieu V. , Mikhasenko M. , Albaladejo M. , Hiller Blin A. N. , Pilloni A. , Szczepaniak A. P.
Published: July 2021

The production of $$\eta ^{(\prime )}\pi $$

η

(
′
)

π

pairs constitutes one of the golden channels to search for hybrid exotics, with explicit gluonic degrees of freedom. Understanding the dynamics and backgrounds associated to $$\eta ^{(\prime )}\pi $$

η

(
′
)

π

production above the resonance region is required to impose additional constraints to the resonance extraction. We consider the reaction $$\pi ^-p\rightarrow \eta ^{(\prime )} \pi ^- \,p$$

π
-

p
→

η

(
′
)

π
-

p

measured by COMPASS. We show that the data in $$2.4< m_{\eta ^{(\prime )}\pi } < 3.0{\mathrm {\,GeV}} $$

2.4
<

m

η

(
′
)

π

<
3.0

GeV

can be described by amplitudes based on double-Regge exchanges. The angular distribution of the meson pairs, in particular in the $$\eta ' \pi $$

η
′

π

channel, can be attributed to flavor singlet exchanges, suggesting the presence of a large gluon content that couples strongly to the produced mesons.
Contribution of inter- and intraband transitions into electron–phonon coupling in metals
Authors: Medvedev Nikita , Milov Igor
Published: July 2021

We recently developed an approach for calculation of the electron–phonon (electron–ion in a more general case) coupling in materials based on tight-binding molecular dynamics simulations. In the present work, we utilize this approach to study partial contributions of inter- and intraband electron scattering events into total electron–phonon coupling in Al, Au, and Cu elemental metals and in AlCu alloy. We demonstrate that the interband scattering plays an important role in the electron–ion energy exchange process in Al and AlCu, whereas intraband d–d transitions are dominant in Au and Cu. Moreover, inter- and intraband transitions exhibit qualitatively different dependencies on the electron temperature. Our findings should be taken into account for the interpretation of experimental results on the electron–phonon coupling parameter.

Graphic abstract
Main mechanics issues of CEPC MDI in TDR
Authors: Wang Haijing , Wang Jianli , Qu Huamin , Liu Zhihua , Liu Baorui
Published: July 2021

CEPC has two MDI locations. It is very complex in the mechanics design owing to extremely high precision and stability requirement as well as the limited space. This paper will describe two most complex mechanics issues and the progress. For the vacuum connection between detector and accelerator, two schemes including RVC and inflatable seal have been designed in detail. For the cryostat support system, the preliminary structure design and FEA have been done, and the alignment method is under study.
Photographic image processing to predict radiation dermatitis in breast cancer patients using machine learning algorithms
Authors: Lee Chou-Hsien , Kang Chen-Lin , Tseng Chin-Dar , Chou Chi-Ming , Shieh Chin-Shiuh , Lin Chih-Hsueh , Tsai I-Hsing , Li Bo-Sheng , Ren Jia-Hong , Chao Pei-Ju , Lee Tsair-Fwu
Published: July 2021

Radiation therapy is an essential part of the comprehensive breast cancer treatment strategy, and radiation dermatitis is the inevitable side-effect. According to either patient-related or treatment-related factors, patients will experience different degrees of acute radiation dermatitis. This study proposes a machine learning architecture based on image and time series features. Using the skin image of the irradiated part during radiotherapy, the image feature is extracted with a gray-level co-occurrence matrix (GLCM) and color space, combined with the time series feature with gradient boosting decision trees (GBDT) to predict the severity of dermatitis after seven days of treatment. The results show that, through the combination of image and time series features, the predicted accuracy (ACC) and area under the curve (AUC) can be effectively improved to 0.8 and 0.85 respectively. The results of GBDT show higher prediction accuracy and robustness than AdaBoost algorithm. This framework can be used as an auxiliary diagnostic tool to assist doctors in making appropriate treatments before severe dermatitis occurs, in order to reduce the radiotoxicity caused by radiotherapy of patients.
Multi-layer thin-film deposition for high-performance X-ray field-emission characteristics
Authors: Jang Tae Hwan , Kim Tae Gyu , Bae Mun Ki , Kim Kyuseok , Choi Jaegu
Published: July 2021

In this study, we developed a nanoscale emitter having a multi-layer thin-film nanostructure in an effort to maximize the field-emission effect with a low voltage difference. The emitter was a sapphire board on which tungsten–DLC multi-player thin film was deposited using PVD and CVD processes. This multi-layer thin-film emitter was examined in a high-vacuum X-ray tube system. Its field-emission efficiency according to the applied voltage was then analyzed.
Proportional method for evaluating intensity of singular stress field for butt joint with adhesive spew
Authors: Miyazaki Tatsujiro , Naka Kaito , Takasuka Daiki
Published: July 2021

In this paper, a proportional method for evaluating an intensity of singular stress field (ISSF) at an interface corner in a butt joint (BJ) with an adhesive spew is proposed. Square-shaped inclusion models under bi-axial tensile stress and under shear stress are used as reference models. The ISSFs for the BJ are calculated by superposing those for the reference models. The reference and BJ models are analyzed by FEM under the same mesh division and the same material combination, and the stresses applied to the reference models are determined by the FEM stresses at the interface corner. The validity of the present method is examined by applying to the BJ composed of the steel and the epoxy resin. The asymptotic solution obtained by the method is in agreement with the FEM stress distributions. Then, the ISSFs for the BJ are calculated by changing adhesive spew similarly. It is shown that the ISSF normalized by the adhesive thickness is constant independent of the thickness.
Voltage tunable current MODE KHN filter based on current differencing transconductance amplifier (CDTA)
Authors: Thakur Rohit , Singh Sangeeta
Published: July 2021

The era of SoC design has great dependency on CMOS circuits owing to its low power and high reliability which could contribute in the effective circuit designing. Here, a unique approach for the designing of voltage tunable current differencing transconductance amplifier (CDTA) is reported for the realization of Kerwin–Huelsman–Newcomb (KHN) filter. The proposed design has been simulated by using Cadence Virtuoso simulation tool with 0.18 [Formula: see text]m technology parameters. This design is based on input voltage-based gain and frequency of operation tuning approach. In this reported design of filter, cutoff frequency can be tailored by input voltage instead of input current. This relaxes the need for the iterative circuit modifications to work in a particular frequency range. Thus, the reported CDTA design is expected to be robust and offers higher design flexibility as there is now no need of iterative designing and calibration in this approach. This also exhibits retained area requirement as per the current state of the art for the KHN filters. Further, the performance of designed CDTA-based KHN filter has also been verified with the existing KHN filters.
COMPARING THE SMALL-SAMPLE ESTIMATION ERROR OF CONCEPTUALLY DIFFERENT RISK MEASURES
Authors: AUER BENJAMIN R. , SCHUHMACHER FRANK
Published: July 2021

Motivated by the need to correctly rank risky alternatives in many investment, insurance and operations research applications, this paper uses a generalized location and scale framework from utility theory to propose a simple but powerful metric for comparing the estimation error of conceptually different risk measures. In an illustrative application, we obtain this metric — the probability that a risk measure ranks two assets falsely in finite samples — via Monte Carlo simulation for fourteen popular measures of risk and different distributional settings. Its results allow us to highlight interesting risk measure properties such as their relative quality under varying degrees of skewness and kurtosis. Because of the generality of our approach, the error probabilities derived for classic risk measures can serve as a benchmark for newly proposed measures seeking to replace the classic ones in decision making. It also supports the identification of the most suitable risk measures for a given distributional environment.
A Note on Connectivity of a Cubic Graph
Authors: Zhou Jinqiu , Li Qunfang , Liu Sufang
Published: July 2021

Connectedness of a graph has a longstanding interest in combinatorial mathematics. For example, it plays an essential role in applications of graph theory and also plays a basic role in theoretical considerations. In this note, we show that the connectivity, edge connectivity, cyclically edge connectivity and essentially edge connectivity of a cubic graph are equivalent.
Nonlinearly charged black holes surrounded by cloud of strings and quintessence in Einstein-Massive gravity
Authors: Ali Askar
Published: July 2021

In this work, a new model of double-Logarithmic electrodynamics has been minimally coupled to Einstein-massive gravity and the nonlinearly charged black holes in the presence of quintessential cosmic dark energy and string cloud background are investigated. In this set up, new magnetically charged black hole solution has been derived. Thermodynamics of these black holes are also analyzed and different thermodynamic quantities are computed. Basic thermodynamic quantities such as heat capacity and Hawking temperature have been plotted and the regions corresponding to thermodynamic stability and instability are pointed out. The generalized first law of thermodynamics and the associated Smarr’s relation have also been written down in this context of massive gravity and matter sources. At last, the nonlinearly electrically charged black holes are also briefly studied.
Loss of Integrin-Linked Kinase Leads to Dysplasia of the Colon in Mice
Authors: Gao Yujie , Xie Siyi , Fang Chushan , Sun Yunfu , Liang Xingqun
Published: July 2021

Normal development of the colon is essential for well-being during the life span. Integrin linked kinase (ILK), which is a key part of the integrin signaling pathway, connects intracellular and extracellular signaling pathways and is evolutionally conserved. It has been shown that ILK knockouts can lead to abnormal formation of various organs. In our study, we found that deletion of ILK by platelet-derived growth factor receptor B (PDGFR[Formula: see text]-Cre leads to the abnormal migration of neural crest cells (NCCs) and the shortening of the gastrointestinal tract, along with the expansion of the colon cavity and dysplasia of the intestinal nerve fibers. In conclusion, ILK is required for normal colon development.
An Empirical Study of the Impact of Data Splitting Decisions on the Performance of AIOps Solutions
Authors: Lyu Yingzhe , Li Heng , Sayagh Mohammed , Jiang Zhen Ming (Jack) , Hassan Ahmed E.
Published: July 2021

AIOps (Artificial Intelligence for IT Operations) leverages machine learning models to help practitioners handle the massive data produced during the operations of large-scale systems. However, due to the nature of the operation data, AIOps modeling faces several data splitting-related challenges, such as imbalanced data, data leakage, and concept drift. In this work, we study the data leakage and concept drift challenges in the context of AIOps and evaluate the impact of different modeling decisions on such challenges. Specifically, we perform a case study on two commonly studied AIOps applications: (1) predicting job failures based on trace data from a large-scale cluster environment and (2) predicting disk failures based on disk monitoring data from a large-scale cloud storage environment. First, we observe that the data leakage issue exists in AIOps solutions. Using a time-based splitting of training and validation datasets can significantly reduce such data leakage, making it more appropriate than using a random splitting in the AIOps context. Second, we show that AIOps solutions suffer from concept drift. Periodically updating AIOps models can help mitigate the impact of such concept drift, while the performance benefit and the modeling cost of increasing the update frequency depend largely on the application data and the used models. Our findings encourage future studies and practices on developing AIOps solutions to pay attention to their data-splitting decisions to handle the data leakage and concept drift challenges.
Understanding Software-2.0
Authors: Dilhara Malinda , Ketkar Ameya , Dig Danny
Published: July 2021

Enabled by a rich ecosystem of Machine Learning (ML) libraries, programming using
learned models
, i.e.,
Software-2.0
, has gained substantial adoption. However, we do not know what challenges developers encounter when they use ML libraries. With this knowledge gap, researchers miss opportunities to contribute to new research directions, tool builders do not invest resources where automation is most needed, library designers cannot make informed decisions when releasing ML library versions, and developers fail to use common practices when using ML libraries.

We present the first large-scale quantitative and qualitative empirical study to shed light on how developers in
Software-2.0
use ML libraries, and how this evolution affects their code. Particularly, using static analysis we perform a longitudinal study of 3,340 top-rated open-source projects with 46,110 contributors. To further understand the challenges of ML library evolution, we survey 109 developers who introduce and evolve ML libraries. Using this rich dataset we reveal several novel findings.

Among others, we found an increasing trend of using ML libraries: The ratio of new Python projects that use ML libraries increased from 2% in 2013 to 50% in 2018. We identify several usage patterns including the following: (i) 36% of the projects use multiple ML libraries to implement various stages of the ML workflows, (ii) developers update ML libraries more often than the
traditional libraries
, (iii) strict upgrades are the most popular for ML libraries among other update kinds, (iv) ML library updates often result in cascading library updates, and (v) ML libraries are often downgraded (22.04% of cases). We also observed unique challenges when evolving and maintaining
Software-2.0
such as (i) binary incompatibility of trained ML models and (ii) benchmarking ML models. Finally, we present actionable implications of our findings for researchers, tool builders, developers, educators, library vendors, and hardware vendors.
Influence of Systemic Administration of Coq10 Nanoparticles on Ischemia-Reperfusion Injury on Ovaries in Rat
Authors: Honardoust Pouria , Najafpour Alireza , Mohammadi Rahim
Published: July 2021

Using a rat ovary model, effects of COQ10 nanoparticles (NCOQ10) were studied on ischemia-reperfusion injury. In the present experimental study, following randomization of thirty healthy female Wistar rats ∼250 g, the animals were subjected to five experimental groups (n = 6): group SHAM : only laparotomy was performed, group IS: only a 3-hour ischemia was performed, group IS/REP: the procedure included a 3-hour ischemia followed by a 3-hour reperfusion, and 50 µL soybean oil (solvent of NCOQ10) was administered 30 min before cessation of reperfusion, group IS/NCOQ10: the procedure included a 3-hour ischemia only and 50 µL (0.3 mmol/lit/IP) of NCOQ10 30 min before cessation of ischemia, and group IS/REP/NCOQ10: the procedure included a 3-hour ischemia, a 3-hour reperfusion, and 20 µL (0.3 mmol/lit) of NCOQ10 30 min before cessation of ischemia. Significantly amended development of ischemia/reperfusion tissue injury was observed in animals treated with NCOQ10 compared to those of other groups (

P
=
0.001

). Mean values of biochemical indices were significantly higher than those observed for other groups (

P
=
0.001

). Significantly lower values of MDA were observed in IS/REP/NCOQ10 animals compared to those of other groups (

P
=
0.001

).Where ovarian tissue is exposed to ischemia, intraperitoneal administration of NCOQ10 could bear clinical benefits in diminishing ischemia-reperfusion injury.
Cranial Cruciate Ligament Desmotomies in Sheep Resulting in Peroneus Tertius Injury
Authors: Welsh Peter J. , Collier Crystal G. , Clement Holly M. , Vakula Michael N. , Mason Jeffrey B.
Published: July 2021

Surgical destabilization of the stifle joint via cranial cruciate ligament desmotomy (CCLD) is a routine procedure for the study of osteoarthritis (OA). Traditionally performed in rats, rabbits, cats, and dogs, CCLD in sheep provides an opportunity to study the pathology and treatment of joint instability in a species whose stifle better represents the equivalent human femorotibial joint. The surgical approaches for CCLD in sheep are variable and can result in inconsistent outcomes. Eight sheep underwent CCLD for use in a gene therapy study. We report this case in which six of the eight sheep were clinically diagnosed by pathognomonic signs and later confirmed by postmortem dissection, with injury of the peroneus tertius (PT) muscle. The PT plays a crucial role in the normal gait of large animals, including sheep. Injury to the PT results in failure of the reciprocal apparatus of the hind limb in which the hock can be extended during stifle flexion creating a varied gait and an indiscriminate increase in instability of the stifle and hock joints. Restricted movement postoperatively may provide decreased variability in surgical outcomes. Alternatively, increased stifle instability via CCLD coupled with PT transection or PT transection alone could potentially provide a superior model of stifle instability and OA development in sheep.
A Damage Constitutive Model for a Rock under Compression after Freeze-Thaw Cycles Based on the Micromechanics
Authors: Liu Hongyan , Zhang Xiaochen , Yan Xidong
Published: July 2021

The freeze-thaw cycles will cause continuous damage to the rock, which is much related to the microcrack length, rock permeability, and frost heaving pressure. However, the failure mechanism of the rock under compression after freeze-thaw cycles is not very clear; therefore, it is studied with the damage theory here. First of all, according to the hydraulic pressure theory, the relationship between the frost heaving pressure and the microcrack propagation length in one single microcrack is established based on the elastoplastic mechanics and fracture theory. Second, by assuming the total strain of the rock under compression is comprised of the initial damage strain, elastic strain, additional damage strain, and plastic damage strain, a constitutive model for a rock based on the deformation and propagation of the microcrack under compression after freeze-thaw cycles is established. Finally, the proposed model is verified with the test result. In all, the proposed model can perfectly reflect the deterioration of the rock mechanical behavior under compression after the freeze-thaw cycles.
Antihyperuricemic Effect of Dendropanax morbifera Leaf Extract in Rodent Models
Authors: Lee Dongho , Kim Jin-Kyoung , Han Yongjae , Park Kwang Il
Published: July 2021

Dendropanax morbifera is a well-known traditional medicine used in China and Korea to treat intestinal disorders, urosis, diuresis, and chronic glomerulonephritis. Hyperuricemia is a metabolic disorder characterized by a high uric acid level in serum due to an imbalance between uric acid production and excretion and causes gout. Recently, the prevalence of hyperuricemia worldwide has been continuously increasing. Xanthine oxidase (XOD) inhibitors (allopurinol (ALP) and febuxostat) and uricosuric agents (benzbromarone and probenecid) are used to treat hyperuricemia clinically. However, because these drugs are poorly tolerated and cause side effects, such as kidney diseases, hepatotoxicity, gastrointestinal symptoms, and hypersensitivity syndrome, only a limited number of drugs are available. We investigated the antihyperuricemic effects of Dendropanax morbifera leaf ethanol extract (DMLE) and its underlying mechanisms of action through in vitro and in vivo studies. We evaluated uric acid levels in serum and urine, and xanthine oxidase (XOD) inhibition activity in the serum and liver tissue of a hyperuricemic rat model of potassium oxonate (PO)-induced hyperuricemic rats. In vitro study, XOD-inhibitory activity was the lowest among the test substances at the IC50 of ALP. However, the IC50 of DMLE-70 was significantly low compared with that of other DMLEs (

p
<
0.05

). In PO-induced hyperuricemic rats, uric acid (UA) levels in serum and urine were significantly reduced in all DMLE-70 and allopurinol-treated (ALT) groups than in the PC group (

p
<
0.05

). UA levels in urine were lower than those in serum in all DME groups. In PO-induced hyperuricemic rats, DMEE-200 reduced UA concentration in serum and increased UA excretion in the urine. These findings suggest that DMLE exerts antihyperuricemic and uricosuric effects on promoting UA excretion by enhanced secretion and inhibition of UA reabsorption in the kidneys. Thus, DMLE may be a potential treatment for hyperuricemia and gout.