bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-effectiveness ofCYP2C19-guided P2Y12 inhibitors in Veterans undergoing percutaneous coronary intervention for acute coronary syndromes
Authors: Dong Olivia M , Friede Kevin A , Chanfreau-Coffinier Catherine , Voora Deepak
Published: June 2022

Aims

CYP2C19-guided P2Y12 inhibitor selection can reduce cardiovascular (CV) events and bleeding in patients with acute coronary syndromes (ACSs) post-percutaneous coronary intervention (PCI). The 12-month cost-effectiveness of CYP2C19-guided P2Y12 inhibitor selection for Veterans post-ACS/PCI was evaluated from the Veterans Health Administration's (VHA) perspective.

Methods and results

Using average annualized PCI volumes and P2Y12 inhibitor use from VA data, a decision-analytic model simulated CYP2C19 testing vs. no testing outcomes in 2800 hypothetical Veterans receiving PY212 inhibitor for 12 months post-ACS/PCI (74% clopidogrel, 5% prasugrel, and 21% ticagrelor use at baseline without testing). CYP2C19 loss-of-function (LOF) carrier prevalence was 28%. Model inputs were from studies (bleeding/ischaemic events, CYP2C19-guided therapy effect, health state utilities, CYP2C19 LOF carrier prevalence) and VHA administrative data (costs of events, drugs, CYP2C19 testing; PCI volumes, and P2Y12 inhibitor prescriptions). The primary outcome was cost (2020 US${\$}$) per quality-adjusted life year (QALY) gained. Base-case scenarios, probabilistic sensitivity analyses, and scenario analyses were completed. CYP2C19-guided therapy resulted in 496 (24%) escalations (clopidogrel to prasugrel/ticagrelor) and 465 (65%) de-escalations (prasugrel/ticagrelor to clopidogrel). CYP2C19 testing averted 1 stroke, 27 myocardial infarctions, 8 CV-related deaths, and caused 3 bleeds. CYP2C19 testing (vs. no testing) was dominant in the base-case scenario (0.0027 QALYs gained, ${\$}$527 saved/person) and in 97.1% of simulations, making it cost-effective and high-value. In scenario analyses, de-escalation in conjunction with escalation is required for CYP2C19 testing to be cost-effective and high-value.

Conclusion

In Veterans post-ACS/PCI, CYP2C19-guided P2Y12 inhibitor selection can improve CV outcomes and lower costs for the VHA within 12 months of implementation.
Best methods for urine sample collection for diagnostic accuracy in women with urinary tract infection symptoms: a systematic review
Authors: Llor Carl , Moragas Ana , Aguilar-Sánchez Mercedes , García-Sangenís Ana , Monfà Ramon , Morros Rosa
Published: June 2022

Background

Most guidelines recommend a midstream urine (MSU) or a midstream clean-catch (MSCC) sample for urinalysis. However, whether this sample is better than others is still controversial.

Objectives

To assess the most adequate non-invasive method to collect a urine specimen for diagnosing urinary tract infections (UTI) in symptomatic non-pregnant women.

Methods

This review was conducted according to the Systematic Reviews of Diagnostic Test Accuracy guidelines (PROSPERO CRD42021241758). PubMed was searched paired sample studies and controlled trials. Studies comparing MSCC, MSU without cleaning, first-void urine, and random voiding samples were considered. Studies evaluating invasive methods were excluded. The main outcome was diagnostic accuracy of urine cultures. Contamination rates were evaluated. The risk of bias tool for systematic reviews on diagnostic accuracy (QUADAS-2) was assessed.

Results

Six studies including 1,010 patients were evaluated. Only two studies used paired samples. No study was considered as having low risk of bias. There was no difference in contamination for MSU specimens collected with or without cleansing and between random void urine collection and MSCC. In one study comparing first-void urine with MSU samples, the contamination rate was lower in the latter, but the gold standard of urine culture was only used for one sampling collection.

Conclusions

To the best of our knowledge, this systematic review is the first to assess the evidence available from different exclusively non-invasive urine sampling. Despite being widely recommended, our review did not find consistent evidence that asking women to provide midstream samples with or without cleansing is better.
Three-dimensional time-lapse inversion of transient electromagnetic data, with application at an Icelandic geothermal site
Authors: Xiao Longying , Fiandaca Gianluca , Maurya Pradip K , Christiansen Anders Vest , Lévy Léa
Published: June 2022

Transient electromagnetic (TEM) is an efficient non-invasive method to map electrical conductivity distribution in the subsurface. This paper presents an inversion scheme for 3-D TEM time-lapse (TL) data using a generalized minimum support (MS) norm and its application to monitoring conductivity changes over time. In particular, two challenges for TL TEM applications are addressed: (i) the survey repetition with slightly different acquisition position, that is, because systems are not installed and (ii) non-optimal data coverage above the TL anomalies, for instance, due to the presence of infrastructure that limits the acquisition layout because of coupling. To address these issues, we developed a new TEM TL inversion scheme with the following features: (1) a multimesh approach for model definition and forward computations, which allows for seamless integration of data sets with different acquisition layouts; (2) 3-D sensitivity calculation during the inversion, which allows retrieving conductivity changes in-between TEM soundings and (3) simultaneous inversion of two data sets at once, imposing TL constraints defined in terms of a generalized MS norm, which ensures compact TL changes. We assess the relevance of our implementations through a synthetic example and a field example. In the synthetic example, we study the capability of the inversion scheme to retrieve compact time-lapse changes despite slight changes in the acquisition layout and the effect of data coverage on the retrieval of TL changes. Results from the synthetic tests are used for interpreting field data, which consists of two TEM data sets collected in 2019 and 2020 at the Nesjavellir high-temperature geothermal site (Iceland) within a monitoring project of H2S sequestration. Furthermore, the field example illustrates the effect of the trade-off between data misfit and TL constraints in the inversion objective function, using the tuning settings of the generalized MS norm. Based on the results from both the synthetic and field cases, we show that our implementation of 3-D TL inversion has a robust performance for TEM monitoring.
RABENOSYN separation-of-function mutations uncouple endosomal recycling from lysosomal degradation, causing a distinct Mendelian disorder
Authors: Paul Franziska , Ng Calista , Mohamad Sahari Umar Bin , Nafissi Shahriar , Nilipoor Yalda , Tavasoli Ali Reza , Bonnard Carine , Wong Pui-Mun , Nabavizadeh Nasrinsadat , Altunoğlu Umut , Estiar Mehrdad A , Majoie Charles B , Lee Hane , Nelson Stanley F , Gan-Or Ziv , Rouleau Guy A , Van Veldhoven Paul P , Massie Rami , Hennekam Raoul C , Kariminejad Ariana , Reversade Bruno
Published: June 2022

Rabenosyn (RBSN) is a conserved endosomal protein necessary for regulating internalized cargo. Here, we present clinical, genetic, cellular and biochemical evidence that two distinct RBSN missense variants are responsible for a novel Mendelian disorder consisting of progressive muscle weakness, facial dysmorphisms, ophthalmoplegia and intellectual disability. Using exome sequencing, we identified recessively acting germline alleles p.Arg180Gly and p.Gly183Arg, which are both situated in the FYVE domain of RBSN. We find that these variants abrogate binding to its cognate substrate phosphatidylinositol 3-phosphate (PI3P) and thus prevent its translocation to early endosomes. Although the endosomal recycling pathway was unaltered, mutant p.Gly183Arg patient fibroblasts show accumulation of cargo tagged for lysosomal degradation. Our results suggest that these variants are separation-of-function alleles, which cause a delay in endosomal maturation without affecting cargo recycling. We conclude that distinct germline mutations in RBSN cause non-overlapping phenotypes with specific and discrete endolysosomal cellular defects.
Nosocomial COVID: the moral and clinical imperative for worldwide data collection and action
Authors: Junaid Fatima , Badrinath Padmanabhan
Published: June 2022

There is a wide disparity worldwide in data collection and sharing of rates of hospital-acquired coronavirus disease (COVID). There is an ethical imperative that such information is systematically gathered, distributed and acted on to reduce rates of this form of preventable and devastating transmission during a pandemic.
Spinal myxomas: review of a rare entity
Authors: Patel Sabina , Suji Trisha , Pang Graeme , Alg Varinder S , Visagan Ravindran , Reisz Zita , Lavrador Jose P , Kailaya-Vasan Ahilan , Grahovac Gordan
Published: June 2022

Intramuscular myxomas are rare, benign mesenchymal tumours, occurring predominantly in large skeletal muscles as large, slow-growing and painless masses. Spinal occurrence is rare, and may present incidentally, or diagnosed via localized symptoms secondary to local infiltration of surrounding structures. Differential diagnosis based on imaging includes sarcomas, meningiomas and lipomas. We discuss two contrasting cases presenting with well-circumscribed cystic paraspinal lesions indicative of an infiltrative tumour and discuss the radiological and histological differences that distinguish myxomas from similar tumours. Surgical resection of the tumour was performed in both cases, however one patient required surgical fixation due to bony erosion secondary to tumour infiltration. Immuno-histopathological analysis confirmed the diagnosis of a cellular myxoma. Follow up imaging at 6 months confirmed no symptomatic or tumour recurrence in both cases. Histological analysis is the definitive means for diagnosis to differentiate myxomas from other tumours. Recurrence is rare if full resection is achieved.
PyNAPLE: Lunar Surface Impact Crater Detection
Authors: Sheward D , Avdellidou C , Cook A , Sefton-Nash E , Delbo M , Cantarella B , Zanatta L
Published: June 2022

In the last 20 yr, over 600 impact flashes have been documented on the lunar surface. This wealth of data presents a unique opportunity to study the meteoroid flux of the Earth–Moon environment, and in recent years the physical properties of the impactors. However, other than through serendipitous events, there has not been yet a systematic search and discovery of the craters associated to these events. Such a meteoroid-crater link would allow us to get insight into the crater formation via these live observations of collisions. Here, we present the pynaple (python NAC Automated Pair Lunar Evaluator) software pipeline for locating newly formed craters using the location and epoch of an observed impact flash. We present the first results from pynaple, having been implemented on the 2017-09-27 impact flash. A rudimentary analysis on the impact flash and linked impact crater is also performed, finding that the crater’s ejecta pattern indicates an impact angle between 10–30°, and although the rim-to-rim diameter of the crater is not resolvable in current LRO NAC images, using crater scaling laws we predict this diameter to be 24.1–55.3 m, and using ejecta scaling predict a diameter of 27.3–37.7 m. We discuss how pynaple will enable large scale analyses of sub-kilometer scale cratering rates and refinement of both scaling laws, and the luminous efficiency.
SIRIUS Project – IV. The formation history of the Orion Nebula Cluster driven by clump mergers
Authors: Fujii Michiko S , Wang Long , Hirai Yutaka , Shimajiri Yoshito , Kumamoto Jun , Saitoh Takayuki
Published: June 2022

The Orion Nebula Cluster (ONC) is an excellent example for understanding the formation of star clusters. Recent studies have shown that ONC has three distinct age populations and anisotropy in velocity dispersions, which are key characteristics for understanding the formation history of the ONC. In this study, we perform a smoothed-particle hydrodynamics/N-body simulation of star cluster formation from a turbulent molecular cloud. In this simulation, stellar orbits are integrated using a high-order integrator without gravitational softening; therefore, we can follow the collisional evolution of star clusters. We find that hierarchical formation causes episodic star formation that is observed in the ONC. In our simulation, star clusters evolve due to mergers of subclumps. The mergers bring cold gas with the clumps into the forming cluster. This enhances the star formation in the cluster centre. The dense cold gas in the cluster centre continues to form stars until the latest time. This explains the compact distribution of the youngest stars observed in the ONC. Subclump mergers also contribute to the anisotropy in the velocity dispersions and the formation of runaway stars. However, the anisotropy disappears within 0.5 Myr. The virial ratio of the cluster also increases after a merger due to the runaways. These results suggest that the ONC recently experienced a clump merger. We predict that most runaways originated from the ONC have already been found, but walkaways have not.
The diversity of spiral galaxies explained
Authors: Frosst Matthew , Courteau Stéphane , Arora Nikhil , Stone Connor , Macciò Andrea V , Blank Marvin
Published: June 2022

An extensive catalogue of spatially resolved galaxy rotation curves (RCs) and multiband optical light profiles for 1752 observed spiral galaxies is assembled to explore the drivers of diversity in galaxy structural parameters, RC shapes, and stellar mass profiles. Similar data were extracted from the ‘Numerical Investigation of a Hundred Astrophysical Objects’ galaxy simulations to identify any differences between observations and simulations. Several parameters, including the inner slope $\mathcal {S}$ of a RC, were tested for diversity. Two distinct populations are found in observed and simulated galaxies: (i) blue, low-mass spirals with stellar mass M⋆ ≲ 109.3 M⊙ and roughly constant $\mathcal {S}$; and (ii) redder, more massive and more diverse spirals with rapidly increasing $\mathcal {S}$. In all cases, the value of $\mathcal {S}$ seems equally contributed by the baryonic and non-baryonic (dark) matter. Diversity is shown to increase mildly with mass. Numerical simulations reproduce well most baryon-dominated galaxy parameter distributions, such as the inner stellar mass profile slope and baryonic scaling relations, but they struggle to match the full diversity of observed galaxy RCs (through $\mathcal {S}$) and most dark matter-dominated parameters. To reproduce observations, the error broadening of the simulation’s intrinsic spread of RC metrics would have to be tripled. The differences in various projections of observed and simulated scaling relations may reflect limitations of current subgrid physics models to fully capture the complex nature of galaxies. For instance, active galactic nuclei (AGNs) are shown to have a significant effect on the shapes of simulated RCs. The inclusion of AGN feedback brings simulated and observed inner RC shapes into closer agreement.
SDSS-IV MaNGA: Identification and multiwavelength properties of Type-1 AGN in the DR15 sample
Authors: Cortes-Suárez Edgar , Negrete C A , Hernández-Toledo H M , Ibarra-Medel H , Lacerna I
Published: June 2022

We present a method to identify type-1 active galactic nuclei (AGNs) in the central 3 arcsec integrated spectra of galaxies in the MaNGA DR15 sample. It is based on flux ratios estimates in spectral bands flanking the expected h α broad component h αBC. The high signal-to-noise ratio obtained (mean S/N = 84) permits the identification of h αBC without prior subtraction of the host galaxy (HG) stellar component. A final sample of 47 type-1 AGN is reported out of 4700 galaxies at z < 0.15. The results were compared with those from other methods based on the SDSS DR7 and MaNGA data. Detection of type-1 AGN in those works compared to our method goes from 26 per cent to 81 per cent. Spectral indexes were used to classify the type-1 AGN spectra according to different levels of AGN-HG contribution, finding 9 AGN-dominated, 14 intermediate, and 24 HG-dominated objects. Complementary data in NIR-MIR allowed us to identify type I AGN-dominated objects as blue and HG-dominated as red in the WISE colours. From NVSS and FIRST radio continuum data, we identify 5 HERGs (high-excitation radio galaxies) and 4 LERGs (low-excitation radio galaxies), three showing evidence of radio-jets in the FIRST maps. Additional X-ray data from ROSAT allowed us to build [O iii] and h αBC versus X-ray, NIR-MIR, and radio continuum diagrams, showing that L(h αBC) and L([O iii]) provide good correlations. The range in h αBC luminosity is wide 38 < logL(h αBC) < 44, with log FWHM(h αBC) ∼ 3–4, covering a range of Eddington ratios of −5.15 < log Lbol/LEdd < 0.70. Finally, we also identify and report ten possible changing-look AGN candidates.
Galaxy pairs in the Sloan Digital Sky Survey – XV. Properties of ionized outflows
Authors: Matzko William , Satyapal Shobita , Ellison Sara L , Sexton Remington O , Secrest Nathan J , Canalizo Gabriela , Blecha Laura , Patton David R , Scudder Jillian M
Published: June 2022

Powerful outflows are thought to play a critical role in galaxy evolution and black hole growth. We present the first large-scale systematic study of ionized outflows in paired galaxies and post-mergers compared to a robust control sample of isolated galaxies. We isolate the impact of the merger environment to determine if outflow properties depend on merger stage. Our sample contains ∼4000 paired galaxies and ∼250 post-mergers in the local universe (0.02 ≤ z ≤ 0.2) from the Sloan Digital Sky Survey Data Release 7 (SDSS DR 7) matched in stellar mass, redshift, local density of galaxies, and [O iii] λ5007 luminosity to a control sample of isolated galaxies. By fitting the [O iii] λ5007 line, we find ionized outflows in ∼15 per cent of our entire sample. Outflows are much rarer in star-forming galaxies compared to active galactic nuclei (AGNs), and outflow incidence and velocity increase with [O iii] λ5007 luminosity. Outflow incidence is significantly elevated in the optical + mid-infrared selected AGN compared to purely optical AGN; over 60 per cent show outflows at the highest luminosities ($L_{\mathrm{[OIII]~\lambda 5007}}\, \gtrsim$ 1042 erg s−1), suggesting mid-infrared AGN selection favours galaxies with powerful outflows, at least for higher [O iii] λ5007 luminosities. However, we find no statistically significant difference in outflow incidence, velocity, and luminosity in mergers compared to isolated galaxies, and there is no dependence on merger stage. Therefore, while interactions are predicted to drive gas inflows and subsequently trigger nuclear star formation and accretion activity, when the power source of the outflow is controlled for, the merging environment has no further impact on the large-scale ionized outflows as traced by [O iii] λ5007.
Dark lenses through the dust: parallax microlensing events in the VVV
Authors: Kaczmarek Zofia , McGill Peter , Evans N Wyn , Smith Leigh C , Wyrzykowski Łukasz , Howil Kornel , Jabłońska Maja
Published: June 2022

We use near-infrared photometry and astrometry from the VISTA Variables in the Via Lactea (VVV) survey to analyse microlensing events containing annual microlensing parallax information. These events are located in highly extincted and low-latitude regions of the Galactic bulge typically off-limits to optical microlensing surveys. We fit a catalogue of 1959 events previously found in the VVV and extract 21 microlensing parallax candidates. The fitting is done using nested sampling to automatically characterize the multimodal and degenerate posterior distributions of the annual microlensing parallax signal. We compute the probability density in lens mass-distance using the source proper motion and a Galactic model of disc and bulge deflectors. By comparing the expected flux from a main sequence lens to the baseline magnitude and blending parameter, we identify four candidates which have probability >50 per cent that the lens is dark. The strongest candidate corresponds to a nearby (≈0.78 kpc), medium-mass ($1.46^{+1.13}_{-0.71} \ M_{\odot }$) dark remnant as lens. In the next strongest, the lens is located at heliocentric distance ≈5.3 kpc. It is a dark remnant with a mass of $1.63^{+1.15}_{-0.70} \ M_{\odot }$. Both of those candidates are most likely neutron stars, though possibly high-mass white dwarfs. The last two events may also be caused by dark remnants, though we are unable to rule out other possibilities because of limitations in the data. We are also demonstrating future possibilities of studying similar events with the Roman Space Telescopeby modelling a mock dataset of Roman photometry and astrometry for an event resembling our strongest candidate.
The Pristine survey – XVIII. C-19: tidal debris of a dark matter-dominated globular cluster?
Authors: Errani Raphaël , Navarro Julio F , Ibata Rodrigo , Martin Nicolas , Yuan Zhen , Aguado David S , Bonifacio Piercarlo , Caffau Elisabetta , González Hernández Jonay I , Malhan Khyati , Sánchez-Janssen Rubén , Sestito Federico , Starkenburg Else , Thomas Guillaume F , Venn Kim A
Published: June 2022

The recently discovered C-19 stellar stream is a collection of kinematically associated metal-poor stars in the halo of the Milky Way lacking an obvious progenitor. The stream spans across an arc of ∼15° in the sky, and orbit-fitting suggests an apocentric distance of ${\sim} 20\, \mathrm{kpc}$ and a pericentre of ${\sim} 10\, \mathrm{kpc}$. The narrow metallicity dispersion of stars with available spectra, together with light element abundance variations, suggests a globular cluster (GC) origin. The observed metallicity ([Fe/H] ≈ −3.4), however, is much lower than that of any known GC. In addition, the width and velocity dispersion of the stream are similar to those expected from disrupting dwarf galaxies, and substantially larger than the tidal debris of GCs able to disrupt on C-19’s orbit. We propose here an unconventional model where the C-19 progenitor is a dark matter-dominated stellar system with GC-like abundance patterns. We use N-body simulations to show that the tidal disruption of a ∼100 pc King-model stellar component embedded in a ∼20 km s−1 cuspy cold dark matter halo yields debris consistent with C-19’s observed width and velocity dispersion. The stellar component of the progenitor is fully disrupted, and is spread over two distinct streams, one corresponding to C-19 and another possibly hiding behind the Galactic plane. If such companion stream were found, it would suggest that dark matter-dominated dwarfs may also develop GC-like enrichment patterns, a finding that would inform our theoretical understanding of the formation of multiple populations in GCs and dwarf galaxies alike.
Observations of the very young Type Ia Supernova 2019np with early-excess emission
Authors: Sai Hanna , Wang Xiaofeng , Elias-Rosa Nancy , Yang(杨轶) Yi , Zhang Jujia , Lin Weili , Mo Jun , Piro Anthony L , Zeng Xiangyun , Andrea Reguitti , Brown Peter , Burns Christopher R , Cai Yongzhi , Fiore Achille , Hsiao Eric Y , Isern Jordi , Itagaki K , Li Wenxiong , Li Zhitong , Pessi Priscila J , Phillips M M , Schuldt Stefan , Shahbandeh Melissa , Stritzinger Maximilian D , Tomasella Lina , Vogl Christian , Wang Bo , Wang Lingzhi , Wu Chengyuan , Yang Sheng , Zhang Jicheng , Zhang Tianmeng , Zhang Xinghan
Published: June 2022

Early-time radiative signals from Type Ia supernovae (SNe Ia) can provide important constraints on the explosion mechanism and the progenitor system. We present observations and analysis of SN 2019np, a nearby SN Ia discovered within 1–2 days after the explosion. Follow-up observations were conducted in optical, ultraviolet, and near-infrared bands, covering the phases from ∼−16.7 d to ∼+ 367.8 d relative to its B-band peak luminosity. The photometric and spectral evolutions of SN 2019np resemble the average behaviour of normal SNe Ia. The absolute B-band peak magnitude and the post-peak decline rate are Mmax(B) = −19.52 ± 0.47 mag and Δm15(B) = 1.04 ± 0.04 mag, respectively. No Hydrogen line has been detected in the nebular-phase spectra of SN 2019np. Assuming that the 56Ni powering the light curve is centrally located, we find that the bolometric light curve of SN 2019np shows a flux excess up to 5.0 per cent in the early phase compared to the radiative diffusion model. Such an extra radiation perhaps suggests the presence of an additional energy source beyond the radioactive decay of central nickel. Comparing the observed colour evolution with that predicted by different models, such as interactions of SN ejecta with circumstellar matter (CSM)/companion star, a double-detonation explosion from a sub-Chandrasekhar mass white dwarf (WD) and surface 56Ni mixing, we propose that the nickel mixing is more favoured for SN 2019np.
Large-scale expansion of OB stars in Cygnus
Authors: Quintana Alexis L , Wright Nicholas J
Published: June 2022

The proper motions (PMs) of OB stars in Cygnus have recently been found to exhibit two large-scale kinematic patterns suggestive of expansion. We perform a 3D traceback on these OB stars, the newly identified OB associations and related open clusters in the region. We find that there are two groups of stars, associations and clusters and that they were each more compact in the past, reaching their closest approach $7.9^{+3.0}_{-1.8}$ and $8.5^{+0.8}_{-2.8}$ Myr ago. We consider two main scenarios for the driver of these large-scale expansion patterns: feedback-driven expansion from a previous generation of massive stars, and expansion as a result of the turbulent velocity field in the primordial molecular cloud. While it is tempting to attribute such large-scale expansion patterns to feedback processes, we find that the observed kinematics are fully consistent with the turbulent origin, and therefore that the injection of further energy or momentum from feedback is not required. Similar conclusions may be drawn for other star forming regions with large-scale expansion patterns.
Anthropogenic monoterpenes aggravating ozone pollution
Authors: Wang Haichao , Ma Xuefei , Tan Zhaofeng , Wang Hongli , Chen Xiaorui , Chen Shiyi , Gao Yaqin , Liu Ying , Liu Yuhan , Yang Xinping , Yuan Bin , Zeng Limin , Huang Cheng , Lu Keding , Zhang Yuanhang
Published: June 2022

Monoterpenes have been known to have a critical influence on air quality and climate change through their impact on the formation of fine particles. Here we present field evidence that monoterpene oxidations largely enhanced local ozone production in a regional site in eastern China. The observed monoterpene was most likely from biomass burning rather than biogenic emissions, as indicated by the high correlation with CO at night-time, and the observed ratio of these two species was consistent with previously determined values from biomass burning experiments. Fast monoterpene oxidations were determined experimentally based on direct radical measurements, leading to a daily ozone enhancement of 4–18 parts per billion by volume (ppb), which was 6%–16% of the total ozone production, depending on the speciation of monoterpenes. It demonstrates that the previously overlooked anthropogenic monoterpenes make an important contribution to O3 production in eastern China. The role could possibly be important at similar locations across China and other parts of the world that are characterized by massive emissions, especially where there are high NOx levels. Our results highlight that anthropogenic monoterpenes should be taken into account when proceeding with the coordinated mitigation of O3 and particulate matter pollution.
Benefits and Concerns regarding Use of Cannabis for Therapeutic Purposes Among People Living with Chronic Pain: A Qualitative Research Study
Authors: AminiLari Mahmood , Kithulegoda Natasha , Strachan Patricia , MacKillop James , Wang Li , Pallapothu Sushmitha , Neumark Samuel , Sharma Sangita , Sethi Jagmeet , Zacharias Ramesh , Blain Allison , Patterson Lisa , Busse Jason W
Published: June 2022

Objective

Although there is growing interest in medically authorized cannabis for chronic pain, little is known about patients’ perspectives. We explored perceptions of people living with chronic pain regarding benefits and concerns surrounding their use of cannabis for therapeutic purposes.

Setting

A hospital-based clinic in Hamilton and two community-based interdisciplinary pain clinics in Burlington, Ontario, Canada.

Methods

In this qualitative descriptive study, we conducted semi-structured interviews with 13 people living with chronic pain who used cannabis therapeutically, living in Ontario, Canada. We used thematic analysis, with data collection, coding, and analysis occurring concurrently.

Results

People living with chronic pain reported important benefits associated with use of cannabis for therapeutic purposes, including reduced pain, improved functionality, and less risk of harms compared to prescription opioids. Most patients also acknowledged harms, such as grogginess and coughing, and there was considerable variability in patient experiences. Financial costs and stigma were identified as important barriers to use of cannabis.

Conclusion

Evidence-based guidance that incorporates patients’ values and preferences may be helpful to inform the role of cannabis in the management of chronic pain.
Timing of Adjunctive Azithromycin for Unscheduled Cesarean Delivery and Postdelivery Infection
Authors: Sanusi Ayodeji , Ye Yuanfan , Boggess Kim , Saade George , Longo Sherri , Clark Erin , Esplin Sean , Cleary Kirsten , Wapner Ron , Owens Michelle , Blackwell Sean , Szychowski Jeff M. , Tita Alan T. N. , Subramaniam Akila
Published: June 2022

OBJECTIVE:

To estimate the association between timing of administration of adjunctive azithromycin for prophylaxis at unscheduled cesarean delivery and maternal infection and neonatal morbidity.

METHODS:

We conducted a secondary analysis of a randomized trial of adjunctive azithromycin prophylaxis in patients with singleton gestations who were undergoing unscheduled cesarean delivery. The primary exposure was the timing of initiation of the study drug (after skin incision or 0–30 minutes, more than 30–60 minutes, or more than 60 minutes before skin incision). The primary outcome was a composite of endometritis, wound infection, and other maternal infections occurring up to 6 weeks after cesarean delivery. Secondary outcomes included composite neonatal morbidity, neonatal intensive care unit admission for longer than 72 hours, and neonatal sepsis. The association of azithromycin with outcomes was compared within each antibiotic timing group and presented as risk ratios (RRs) with 95% CIs. A Breslow-Day homogeneity test was applied to assess differences in association by antibiotic timing.

RESULTS:

Of 2,013 participants, antibiotics were initiated after skin incision (median 3 minutes, range 0–229 minutes) in 269 (13.4%), 0–30 minutes before skin incision in 1,378 (68.5%), more than 30–60 minutes before skin incision in 270 (13.4%), and more than 60 minutes before skin incision (median 85 minutes, range 61–218 minutes) in 96 (4.8%). The RRs (95% CIs) of the infectious composite outcome for azithromycin compared with placebo were significantly lower for groups that initiated azithromycin after skin incision or within 1 hour before skin incision (after skin incision: RR 0.31, 95% CI 0.13–0.76; 0–30 minutes before: RR 0.62, 95% CI 0.44–0.89; more than 30–60 minutes before: 0.31, 95% CI 0.13–0.66). Risks were not significantly different in patients who received azithromycin more than 60 minutes before skin incision (RR 0.59, 95% CI 0.10–3.36). Results were similar when endometritis and wound infections were analyzed separately. Neonatal outcomes were not significantly different for azithromycin compared with placebo across all timing groups.

CONCLUSION:

Adjunctive azithromycin administration up to 60 minutes before or at a median of 3 minutes after skin incision was associated with reduced risks of maternal composite postoperative infection in unscheduled cesarean deliveries.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01235546.
Postlingually Deafened Adult Cochlear Implant Users With Prolonged Recovery From Neural Adaptation at the Level of the Auditory Nerve Tend to Have Poorer Speech Perception Performance
Authors: He Shuman , Skidmore Jeffrey , Carter Brittney L. , Lemeshow Stanley , Sun Shuai
Published: June 2022

Objective:

This study investigated the effects of two temporal response properties of the auditory nerve (i.e., neural adaptation and recovery from neural adaptation) on speech perception performance in postlingually deafened adult cochlear implant (CI) users.

Design:

Study participants included 18 postlingually deafened adults who were Cochlear Nucleus device users with a full electrode array insertion in the test ear(s). Neural adaptation and adaptation recovery of the auditory nerve (AN) were evaluated using electrophysiological measures of the electrically evoked compound action potential (eCAP). The amount of neural adaptation was quantified by the adaptation index within three time windows: 0 to 8.89 (window 1), 44.44 to 50.00 (window 2), and 94.44 to 100.00 ms (window 3). The speed of neural adaptation was estimated using a two-parameter power law function. To evaluate adaptation recovery of the AN, eCAPs to the last pulse of the 100-ms pulse train were recorded at masker-probe-intervals ranging from 1.054 to 256 ms in logarithmic steps. The amount of adaptation recovery was quantified by the adaptation recovery ratio. The time-constant of adaptation recovery was estimated using an exponential function with up to three components. Speech perception performance was evaluated by measuring consonant-nucleus-consonant (CNC) word scores presented in quiet and in speech-shaped noise at a signal-to-noise ratio (SNR) of +10 dB. One-tailed Pearson Product Moment correlation tests were used (1) to assess the associations among parameters of neural adaptation and adaptation recovery and (2) to evaluate the strength of association between these parameters and CNC word scores measured in quiet and in noise. The contributions of different parameters quantifying neural adaptation and adaptation recovery on speech perception scores were evaluated using multivariable linear regression analyses.

Results:

The Pearson Product Moment correlation coefficient demonstrated a moderate, negative correlation between the speed of adaptation recovery and CNC word scores measured in quiet and in noise. The speed of adaptation recovery accounted for 14.1% of variability in CNC word scores measured in quiet and 16.7% of variability in CNC word scores measured in noise. The correlation strengths between CNC word scores and the adaptation index, the adaptation recovery ratio and the speed of neural adaptation ranged from negligible to weak.

Conclusions:

The speed of adaptation recovery plays a more important role than other features of neural adaptation and adaptation recovery of the AN in speech perception in postlingually deafened adult CI users. Patients with prolonged adaptation recovery tend to show poorer speech perception performance.
Primary Cutaneous Malignant Perivascular Epithelioid Cell Tumor Mimicking Undifferentiated Pleomorphic Sarcoma: A Report of a Rare Entity
Authors: Neumann Neil M. , Cornelia Ding Chien-Kuang , Borgen Amanda , Corvera Carlos U. , North Jeffrey P. , Qorbani Amir , Horvai Andrew E.
Published: June 2022

Primary cutaneous malignant perivascular epithelioid cell tumor (PEComa) is a rare and potentially aggressive neoplasm. In this article, we report the case of a 34-year-old man who initially presented with a 3-cm mass involving the skin and soft tissue of the right shoulder that, over 3 months, enlarged to 12 cm. Histologic examination of the mass revealed an infiltrative neoplasm with features resembling an undifferentiated pleomorphic sarcoma, including sheets of pleomorphic cells with abundant atypical mitoses and necrosis. Immunohistochemical evaluation showed features suggestive of PEComa. Next-generation sequencing revealed pathogenic homozygous deletions of TSC2 and TP53 genes and numerous large-scale copy number changes. Taken together, the findings supported malignant PEComa. This case demonstrates only the seventh example of malignant cutaneous PEComa. Although cutaneous PEComa is chiefly a benign mesenchymal neoplasm, in rare cases, it can rapidly transform into a malignant and infiltrative sarcoma, requiring prompt surgical management.
Comparison of Outcomes from Delayed Onset Bleb-related Endophthalmitis Treated with Pars Plana Vitrectomy versus Vitreous Biopsy
Authors: Islam Yasmin Florence Khodeja , Vanner Elizabeth A. , Khurshid Syed Gibran , Flynn Harry W. , Greenfield David S.
Published: June 2022

Précis:

Bleb-related endophthalmitis is a serious complication of glaucoma filtration surgery. The current study reports similar visual and intraocular pressure outcomes in eyes treated with pars plana vitrectomy compared to vitreous biopsy and intravitreal antibiotics.

Purpose:

To investigate the isolated organisms, visual acuity (VA) and intraocular pressure (IOP) outcomes associated with delayed-onset bleb-related endophthalmitis (BRE) in eyes treated with pars plana vitrectomy (PPV) versus vitreous biopsy and injection of intravitreal antibiotics (TI).

Methods:

A retrospective chart review was conducted at the Bascom Palmer Eye Institute (Miami, Florida) and University of Florida (Gainesville, Florida) identifying patients treated for BRE with at least one month of follow-up from the inception of an electronic health record (2011 and 2014, respectively) through 2021. All patients had undergone bleb-forming glaucoma surgery at least 1 month prior to endophthalmitis diagnosis.

Results:

Thirty-nine eyes from 39 patients (33 from Bascom Palmer, 6 from University of Florida) were included. Trabeculectomy was performed in 34 of 39 eyes (87.2%). Streptococcus species (9 eyes, 23.1%) and Staphylococcus species (8 eyes, 20.5%) were the most common isolated organisms and were similar in both treatment groups (P=0.49). Baseline VA was worse in the PPV group (logMAR 2.51 vs. 2.16, P=0.04), but VA at last follow up was similar (P=0.48) in both groups. After recovery from BRE, the average intraocular pressure in the PPV group was 15.1▒mmHg on 0.9 IOP-lowering medications compared to 12.6▒mmHg on 1.2 medications in the TI group (IOP: P=0.56; medications: P=0.80). Additional glaucoma surgery was performed in 44.4% of the PPV eyes and 16.7% of the TI eyes (P=0.09).

Conclusions:

In eyes with delayed-onset BRE, isolated organisms, visual outcomes and IOP control were similar after initial PPV compared to TI.
Long-term Outcomes of Modified 360-degree Suture Trabeculotomy for Uveitic Glaucoma Compared with Primary Open Angle Glaucoma
Authors: Kijima Riki , Shinmei Yasuhiro , Chin Shinki , Kanaya Rina , Shinkai Akihiro , Ohguchi Takeshi , Namba Kenichi , Ishida Susumu
Published: June 2022

Précis:

A Kaplan-Meier survival curve analysis showed no significant differences in success rates between UG and POAG 120 months after modified 360-degree suture trabeculotomy, which was effective for both groups in the long term.

Purpose:

To examine the outcomes of modified 360-degree suture trabeculotomy in patients with uveitic glaucoma (UG) as compared to those with primary open angle glaucoma (POAG).

Methods:

This was a retrospective, non-randomized, and comparative case series study. Modified 360-degree trabeculotomy using a 5-0 nylon suture (S-LOT) was performed on 51 eyes of 51 patients (54.4±13.4 y) with UG between October 2005 and January 2012 at Hokkaido University Hospital. Age-matched patients with POAG who underwent S-LOT during the same period were enrolled as controls. Written informed consent was obtained from all patients enrolled in the present study. Surgical success was defined as an intraocular pressure (IOP) <18 mmHg with similar or lower doses of antiglaucoma medications. Kaplan-Meier survival curves of surgical failure were analyzed and compared between UG and POAG.

Results:

The mean follow-up periods (±SD) for UG and POAG were 104.8±44.0 and 98.1±36.3 months (P=0.23), respectively. Mean pre-operative IOP in UG and POAG were 34.9±11.0 and 25.3±9.4 mmHg (P<0.001), respectively. After surgery, mean IOP in UG and POAG decreased to 12.0±4.1 and 13.8±3.2 mmHg, respectively, at 60 months, and 12.1±5.6 and 12.4±1.8 mmHg (P=0.86), respectively, at 120 months. The Kaplan-Meier survival curve analysis showed no significant differences in success rates between UG and POAG at the end of the follow-up (Log-rank test, P=0.13). Success rates in UG and POAG were 70.0 and 62.5% at 60 months, and 67.5 and 41.2% at 120 months, respectively.

Conclusion:

These results suggest that S-LOT is effective for UG and POAG alike.
Preliminary demonstration of a novel intraocular lens power calculation: the O formula
Authors: Goto So , Maeda Naoyuki , Ohnuma Kazuhiko , Lawu Tjundewo , Kawasaki Ryo , Koh Shizuka , Nishida Kohji , Noda Toru
Published: June 2022

Purpose:

To evaluate the performance of a new formula of intraocular lens (IOL) power calculation (the O formula) based on ray tracing without commonly used parameters, including ultrasound-compatible axial length, keratometry readings, and A-constant.

Setting:

Tokyo Medical Center, Tokyo, Japan.

Design:

Retrospective consecutive case series.

Methods:

423 eyes (423 patients) implanted with a single-piece, L-loop, acrylic IOL were enrolled. All biometric data for the O formula were obtained by anterior segment swept-source optical coherence tomography (SS-OCT) and SS-OCT–based biometer. The performance of the O formula was compared with those of the Barrett Universal II (BUII) and Kane formulas at 1 month postoperatively. Statistical analysis was applied according to a heteroscedastic test with SD of prediction errors as the main parameter for formula performance.

Results:

The SD of the O formula (0.426) was statistically significantly lower than that of the BUII formula (0.464, P = .034) but not statistically significantly different from that of the Kane formula (0.433, P = .601). The percentages of patients with refractive prediction errors within ±0.50 diopter (D) and ±1.00 D of the O, BUII, and Kane formulas were 75.4% and 98.6%, 77.1% and 97.9%, and 76.6% and 98.1%, respectively.

Conclusions:

The O formula, based on ray tracing using SS-OCT–based devices, is one of the promising approaches for IOL power calculation, although additional larger scale studies are needed. It may be used as an alternative in IOL power calculation because of its independence from commonly used parameters.
Development of an Interprofessional Handoff Assessment for Doctor of Physical Therapy Students
Authors: Ronnebaum Julie , Jie Chunfa , Salazar Kristina
Published: June 2022

Background and Purpose:

Handoff communication, especially interprofessional (IPE) handoff communication, has been shown to make up a large portion of communication errors in health care. There is variability in the way professionals are trained and deliver the pertinent patient information in handoffs, which, causes confusion, makes recall difficult, and increases the incidence of medical errors. Thus, this study aimed at assessing IPE handoffs for individuals who are trained in SBAR (Situation, Background, Assessment, and Recommendation) method of IPE communication developed by TEAM STEPPS®.

Method:

To assess IPE handoffs for those who are trained with the SBAR method, an existing tool was modified to make it more explicit to IPE handoff communication using descriptors from SBAR. Reliability and internal consistency were evaluated using videos of IPE handoffs of doctor of physical therapy (DPT) students.

Results:

Spearman rank coefficients for the revised assessment domains ranged from 0.56 to 0.86, indicating a strong correlation. The communication and content domains had the highest level of correlation. The interrater reliability of the 5 raters was 0.85, indicating high reliability.

Discussion and Conclusion:

This assessment proved to be simple and reliable to measure IPE handoff communication skills during emergent situations between DPT students and standardized nurses. Thus, this assessment can be used to assess interprofessional handoffs, develop competencies improved teamwork, and reduce medical errors.
Concurrent Validity Between the AM-PAC “6-Clicks” Basic Mobility Short Form and the WeeFIM in the Pediatric Acute Care Population
Authors: Gates Erin , Eilerman Sarah , Bican Rachel
Published: June 2022

Purpose:

To evaluate concurrent validity between the Activity Measure for Post-Acute Care (AM-PAC) “6-clicks” basic mobility short form (BMSF) and the Functional Independence Measure for Children (WeeFIM) and the interrater reliability for the AM-PAC BMSF for pediatric patients in the acute care setting.

Methods:

In this prospective, cross-sectional study, study participants completed the AM-PAC BMSF and the mobility domains of the WeeFIM. One therapist recorded scores for each of the outcome measures, while a second blinded therapist recorded scores for the AM-PAC BMSF. Spearman correlation coefficients (r
s) were used to describe the relationships between measures, and the intraclass correlation coefficient (ICC) was used to assess interrater reliability.

Results:

n = 30 children (4-17 years of age) participated in this study. A significant, strong, and positive correlation was found between the AM-PAC BMSF and WeeFIM total scores (r
s = 0.95, P < .001) as well as between the transfer scores (r
s = 0.93, P < .001). Excellent agreement was found between raters for the AM-PAC BMSF (ICC = 0.97).

Conclusions:

The AM-PAC BMSF demonstrates strong concurrent validity compared with the WeeFIM and has an excellent interrater agreement, suggesting that it may be a valid and reliable measure to objectively quantify functional mobility for pediatric patients in the acute care setting.
Epidemiology and Natural History of Childhood-Acquired Chronic Hepatitis C: A Single-Center Long-Term Prospective Study
Authors: Stinco Mariangela , Bartolini Elisa , Veronese Piero , Rubino Chiara , Moriondo Maria , Ricci Silvia , Trapani Sandra , Azzari Chiara , Resti Massimo , Indolfi Giuseppe
Published: June 2022

Objectives:

To prospectively describe the epidemiology and long-term outcome of childhood-acquired hepatitis C virus (HCV) infection in a large cohort of children followed at a single center.

Methods:

All children with chronic HCV infection followed at the Liver Unit of our tertiary Hospital in Florence (Italy) from January 1, 1988, to September 30, 2021, were included in the analysis.

Results:

The final sample consisted of 163 children (median age at enrollment 4 years, interquartile range (IQR): 10; median age at last follow-up 14 years, IQR: 7). The median duration of follow-up was 86 months (IQR: 112). One hundred twenty-five children were vertically infected and 26 acquired the infection horizontally. Twenty-six of the 125 children who were vertically infected (20.8%) underwent spontaneous clearance of HCV RNA at a median age of 4 years (IQR: 2), whereas all the others remained persistently viremic. One patient was diagnosed with cirrhosis; 2 presented clinically detectable extrahepatic manifestations (chronic urticaria). Thirty-two children (19.6%) received antiviral therapy: 8 out of 32 (25%) were treated with pegylated-interferon alfa-2b [sustained virological response (SVR) 24 weeks after the end of treatment in 7/8]; 24 out of 32 (75%) were treated with direct-acting antivirals (SVR 12 weeks after the end of treatment in 23/24).

Conclusions:

The present study describes the largest cohort of children with chronic HCV infection prospectively evaluated with a long follow-up at a single center. HCV infection in children is often a chronic infection that can be cured with modern antiviral therapy. Early treatment could prevent the development of advanced liver disease.