bluuebunny/crossref_metadata_2025 huggingface dataset:
Irradiation‐free RIC HSCT has a tolerable safety profile and is effective therapy for pediatric bone marrow failure syndromes
Authors: Wang YunZu M. , Anderson Eric , Gloude Nicholas , Marion Ayesha , King Catherine , Leung Wing , Schiff Deborah
Published: October 2020

For patients with bone marrow failure syndromes (BMFS) who may tolerate gradual donor engraftment and achieve adequate disease control with stable mixed chimerism, RIC regimens may be preferable to myeloablative regimens. We performed a retrospective analysis of outcomes for patients who underwent HSCT at our institution between 2009 and 2017 for BMFS using an irradiation‐free RIC regimen. Fourteen pediatric patients with BMFS received fludarabine (30 mg/m2 IV daily × 3), thiotepa (5 mg/kg IV every 12 hours × 2), and melphalan (70 mg/m2 IV daily × 2) prior to HSCT. Our cohort included the following diagnoses: SAA (n = 7), CAMT (n = 4), SCN (n = 1), DBA (n = 1), and non‐Fanconi congenital BMF (n = 1). Seven patients underwent a MSD transplant; seven underwent an unrelated donor transplant. All patients are alive with median follow‐up of 1112 days (range 455‐2549 days). The median time to neutrophil engraftment was 16 days (range 10‐26 days). All were transfusion independent by day + 100. The highest grade of aGVHD was grade 2; 8 (57%) did not develop aGVHD. Four (28.5%) developed extensive cGVHD, 4 (28.5%) developed limited cGVHD, and 6 (43%) did not develop cGVHD. No patients developed SOS. None died from GVHD or infectious complications. HSCT with RIC with fludarabine, thiotepa, and melphalan for BMFS was effective with a tolerable safety profile. Probability of OS at 100 days and 1 year was 100%.
The German Employment Agency's measures for integrating the long‐term unemployed with multiple constraints into the labour market: Some individual experiences
Authors: Kerschbaumer Lukas , Boost Marie
Published: October 2020

Nearly a decade after the Lisbon Strategy's formulation, long‐term unemployed individuals in Germany seem to lack opportunities on the labour market that their short‐term unemployed counterparts enjoy. Despite Germany's robust economic development and declining unemployment rates in the past, the German Federal Employment Agency (Bundesagentur für Arbeit) has nevertheless identified the ‘hardening of the long‐term unemployment situation’. This article illuminates the institutional measures taken by the BA, along with their promotional and inhibitory effects, as analysed in narrative interviews with long‐term unemployed individuals who transitioned into Germany's primary labour market despite multiple constraints. Although the BA provides a range of measures to promote integration into the labour market, the people affected have no binding claim to those services and measures, and many of the long‐term unemployed individuals that we interviewed revealed problematic consequences of institutional support received and described strategies for securing employment apart from the BA's institutional means.
Job search, transition to employment and discouragement among older unemployed welfare recipients in Germany
Authors: Nivorozhkin Anton , Nivorozhkin Eugene
Published: October 2020

This paper quantifies the importance of active job search for the probability of re‐employment, estimates the share of older job seekers that become discouraged and explore factors that may lead to discouragement. We use the sample of older unemployed welfare benefit recipients in Germany covered by the Panel Study “Labour Market and Social Security” (PASS). We find that employment transition rates are low for older job seekers: only around 11% found a job within a year. Participation in job search is an important but not a decisive factor for the transition to employment, other variables such education levels and health status are as important for the probability to transit to employment. Furthermore, more than 29.4% of individuals that did not find employment gave up the job search. We argue that a large share of these group of unemployed could be classified as discouraged. The job centre caseworkers' strategies specifically aimed at helping older job seekers to develop a new perspective in the labour market are likely to increase their probability of continuing to search for work.
3d phase‐contrast nanotomography of unstained human skin biopsies may identify morphological differences in the dermis and epidermis between subjects
Authors: Eckermann Marina , Peruzzi Niccolò , Frohn Jasper , Bech Martin , Englund Elisabet , Veress Béla , Salditt Tim , Dahlin Lars B. , Ohlsson Bodil
Published: October 2020

Background

Enteric neuropathy is described in most patients with gastrointestinal dysmotility and may be found together with reduced intraepidermal nerve fiber density (IENFD). The aim of this pilot study was to assess whether three‐dimensional (3d) imaging of skin biopsies could be used to examine various tissue components in patients with gastrointestinal dysmotility.

Material and methods

Four dysmotility patients of different etiology and two healthy volunteers were included. From each subject, two 3‐mm punch skin biopsies were stained with antibodies against protein gene product 9.5 or evaluated as a whole with two X‐ray phase‐contrast computed tomography (CT) setups, a laboratory µCT setup and a dedicated synchrotron radiation nanoCT end‐station.

Results

Two patients had reduced IENFD, and two normal IENFD, compared with controls. µCT and X‐ray phase‐contrast holographic nanotomography scanned whole tissue specimens, with optional high‐resolution scans revealing delicate structures, without differentiation of various fibers and cells. Irregular architecture of dermal fibers was observed in the patient with Ehlers‐Danlos syndrome and the patient with idiopathic dysmotility showed an abundance of mesenchymal ground substance.

Conclusions

3d phase‐contrast tomographic imaging may be useful to illustrate traits of connective tissue dysfunction in various organs and to demonstrate whether disorganized dermal fibers could explain organ dysfunction.
Investigation of the 2D assumption in the image‐based inertial impact test
Authors: Van Blitterswyk Jared , Fletcher Lloyd , Pierron Fabrice
Published: October 2020

The image‐based inertial impact (IBII) test has shown promise for measuring properties of composites at strain rates where existing test methods become unreliable due to inertial effects (> 102 s−1). Typically, the IBII tests are performed with a single camera, and therefore, to use surface measurements for material property identification, it is necessary to assume that the test is two‐dimensional. In this work, synchronised ultra‐high‐speed cameras are used to quantify the relevance of this assumption when nonuniform, through‐the‐thickness loading is applied to interlaminar samples. Initial experiments revealed that an angular misalignment of approximately 1° between the impact faces of the waveguide and projectile created a bending wave that propagated along the sample behind the axial pulse. Even under these conditions, consistent measurements of stiffness were made by assuming a linear distribution of the behaviour through‐the‐thickness. When the misalignment was reduced to 0.2°, the effects on single‐sided measurements were significantly reduced. The two alignment cases were compared to show that three‐dimensional loading had a small effect on stiffness identification (approximately 5% bias) relative to failure stress (approximately 30% bias). This study highlights the importance of impact alignment for reliable characterisation of the interlaminar failure stress and was used to establish guidelines for diagnosing loading issues from single‐sided measurements.
Two novel HLA‐DPA1*01:03:01 variants identified in Brazilian individuals: DPA1*01:03:01:38 and DPA1*01:03:01:39
Authors: Vianna Romulo , Lopes Giovanna , Porto Luís Cristóvão
Published: October 2020

Characterization of two novel HLA‐DPA1*01:03:01 variants, HLA‐DPA1*01:03:01:38 and ‐DPA1*01:03:01:39.
“BURSTING THE BUBBLE”: Service learning in schools
Authors: Pilling Rachel , Mollaney Jenna , Chandauka Rumbidzai , Barai Ishani , Parekh Ravi
Published: October 2020

Background

At Imperial College, we developed a novel teaching programme for medical students based within a local primary school, with the aim of developing students’ teaching skills and centring social accountability in our curriculum. Similar service‐learning programmes have shown significant benefit for student participants, including: improving communication skills, developing an understanding of the social determinants of health, and increased empathy. In partnership with a local primary school, the programme involved a group of medical students designing, developing and delivering a teaching session to primary school children.

Methods

Medical students completed written reflections on the programme and semi‐structured interviews were conducted with teachers who had participated in the programme. These were then thematically analysed.

Results

Themes from student reflections included: improvement in teaching and communication skills; and an increased awareness of social accountability. Themes from teacher interviews included: benefits of an aspirational figure in the school; engagement of the children; and the ongoing inspirational benefit for the pupils.

Discussion

Our analysis suggested students and the school community benefitted. Students reported the experience was an effective way to learn teaching skills and to improve their communication with children. The programme delivered skills transferrable to other clinical contexts including leadership and behavioural management, adaptability and creative thinking. Teacher interviews suggested the programme was mutually beneficial. The framing of medical students as role models raised the possibility that such programmes may help tackle the challenge of widening participation in medicine. We would recommend medical educators to consider developing other mutually beneficial service‐learning programmes.
Does globalisation alleviate polarisation?
Authors: Fang Jianchun , Gozgor Giray , Yan Cheng
Published: October 2020

In this study, we investigate the effects of globalisation on polarisation in a panel data set of 149 countries between 2000 and 2017. We consider the Revisited KOF Globalisation indices and two measures of polarisation: polarisation of society and political polarisation. The findings show that globalisation decreases polarisation. We also separate de jure and de facto measures of globalisation and observe significant suppressing effects of the de facto and de jure indices of globalisation on both indicators of polarisation. In addition, we find that economic and political globalisation measures are negatively related to polarisation indicators. The baseline findings are robust to estimate different models and to use different econometric procedures. Finally, we address potential issues with endogeneity, omitted variable bias, outliers and reverse causality.
Differences Between Magnet and Non‐Magnet‐Designated Hospitals in Nurses’ Evidence‐Based Practice Knowledge, Competencies, Mentoring, and Culture
Authors: Melnyk Bernadette Mazurek , Zellefrow Cindy , Tan Alai , Hsieh Andreanna Pavan
Published: October 2020

Background

Obtaining Magnet recognition is important to hospitals as it has been linked to positive nursing and patient outcomes. Evidence‐based practice (EBP) also has been shown to positively impact these same outcomes. However, the effect that Magnet designation has on different facets of EBP when compared to non‐designated institutions is less understood.

Aims

To determine the differences between Magnet‐designated versus non‐Magnet‐designated hospitals on nurses’ EBP knowledge, competency, mentoring, and culture.

Methods

A secondary analysis was performed on data obtained from the Melnyk et al. (2018) national study of U.S. nurses’ EBP competencies.

Results

2,344 nurses completed the survey (n = 1,622 Magnet and n = 638 non‐Magnet). Magnet‐designated hospital nurses had higher scores in EBP knowledge (mean ± SD: 19.9 ± 6.8 vs. 19.1 ± 7.0, Cohen’s d = 0.12), mentoring (22.6 ± 11.1 vs. 18.6 ± 10.1, d = 0.38), and culture (82.9 ± 21.8 vs. 74.1 ± 21.3, d = 0.41). There was no difference between the two groups in EBP competency scores (53.8 ± 16.2 vs. 53.0 ± 15.9, d = 0.05), and average scores for the 24 EBP competency items were less than competent in both groups.

Linking Evidence to Practice

Despite having higher knowledge, stronger perceived EBP cultures, and greater EBP mentoring than non‐Magnet‐designated nurses, Magnet nurses did not meet the EBP competencies. A tremendous need exists to provide nurses with the knowledge and skills to achieve the EBP competencies in both Magnet and non‐Magnet‐designated hospitals. A critical mass of EBP mentors who also meet the EBP competencies is needed to work with point‐of‐care nurses to ensure that EBP competency is achieved in order to ultimately ensure healthcare quality and safety. Rigorous studies are needed to determine which interventions at the academic and clinical education level result in improved EBP competency.
Forced Vibration Tests for In-Line Vortex-Induced Vibration to Assess Partially Strake-Covered Pipeline Spans
Authors: Wu Jie , Yin Decao , Passano Elizabeth , Lie Halvor , Peek Ralf , Sequeiros Octavio E. , Ang Sze Yu , Bernardo Chiara , Atienza Meliza
Published: October 2020

Helical strakes can suppress vortex-induced vibrations (VIVs) in pipelines spans and risers. Pure in-line (IL) VIV is more of a concern for pipelines than for risers. To make it possible to assess the effectiveness of partial strake coverage for this case, an important gap in the hydrodynamic data for strakes is filled by the reported IL forced-vibration tests. Therein, a strake-covered rigid cylinder undergoes harmonic purely IL motion while subject to a uniform “flow” created by towing the test rig along SINTEF Ocean's towing tank. These tests cover a range of frequencies, and amplitudes of the harmonic motion to generate added-mass and excitation functions are derived from the in-phase and 90 deg out-of-phase components of the hydrodynamic force on the pipe, respectively. Using these excitation- and added-mass functions in VIVANA together with those from experiments on bare pipe by Aronsen (2007 “An Experimental Investigation of In-Line and Combined In-Line and Cross-Flow Vortex Induced Vibrations,” Ph.D. thesis, Norwegian University of Science and Technology, Trondheim, Norway.), the IL VIV response of partially strake-covered pipeline spans is calculated. It is found that as little as 10% strake coverage at the optimal location effectively suppresses pure IL VIV.
Strength Against Fracture of End Hemispherical Cavity Roller Under Static Loading: Experimental and Simulation Investigation
Authors: Chhotani Paresh C. , Vakharia Dipak P.
Published: October 2020

Enhancement in fatigue life of the rolling-element bearing has been captivating since years. The hollow concept had been triggered years back; however, it could not catch widespread applications due to catastrophic failure. Thus, any novel concept of the rolling element must be assessed for its strength against catastrophic failure before competing for better fatigue life on field with other alternatives. This paper commences with the outcomes of the comparative assessment of the experimental evaluation of strength against fracture under static loads for layered and hollow rollers with solid rollers, which devise the requirements for new concepts. The end hemispherical cavity (EHC) roller concept, being a proper geometrical blending of solidity and hollowness, prospects to overcome the strength concern along with a considerable reduction in contact stresses. Thus, experimental investigation was conducted with full-bearing fracture tests and individual roller specimens fracture tests for five variants: EHC, solid, layered, 61H, and 37H (hollow rollers with 61% and 37% hollowness, respectively). The simulations were carried out to support the outcomes of experimental trials. The experimental results with full-bearing samples and individual roller specimens demonstrated ranking as follows: EHC, 37H, layered, and 61H. The EHC roller concept was substantiated to be stronger than hollow and layered rollers besides prompting appreciable reduction in contact stresses compared with the solid roller. The simulation results agreed well with experimental results of fracture tests, and the recommendations from findings of failure theories (maximum normal stress, distortion energy, and maximum shear stress) adopted for estimating fracture load for rollers have been discussed.
Influence of Equation-of-States on Supercritical CO2 Combustion Mixtures
Authors: (Raghu) Manikantachari K.R.V. , Rahman Ramees K. , Martin Scott M. , Velez Carlos , Vasu Subith S.
Published: October 2020

Fossil fuel based direct-fired supercritical CO2 (sCO2) cycles are gaining the attention of industry, academia, and government due to their remarkable efficiency and carbon capture at high-source temperatures. Modeling plays an important role in the development of sCO2 combustors because experiments are very expensive at the designed operating conditions of these direct-fired cycles. Inaccurate density estimates are detrimental to the simulation output. Hence, this work focuses on comprehensive evaluation of the influence and applicability of various equation-of-states (EOS) which are being used in the supercritical combustion modeling literature. A state-of-the-art supercritical combustion modeling methodology is used to simulate counter-flow supercritical CO2 flames by using various equation-of-states. The results show that using the corresponding state principle to evaluate compressibility factor is not accurate. Also, van der Waal type EOSs predictions can be as accurate as complex Benedict–Webb–Rubin EOSs; hence van der Waal EOSs are more suitable to simulate sCO2 combustor simulations. Non-ideal effects are significant under the operating conditions considered in this work. The choice of EOS significantly influences the flame structure and heat release rate. Also, assuming the binary interaction parameter as zero is reasonable in sCO2 combustion simulations.
Development of a Polyacrylamide-Based Mud Formulation for Loss Circulation Treatments
Authors: Magzoub Musaab I. , Salehi Saeed , Hussein Ibnelwaleed , Nasser Mustafa
Published: October 2020

Loss circulation materials in the last two decades have witnessed a lot of developments and implementations. New technologies and materials are introduced to treat various types of loss zones. However, the success rate is still very low due to many uncertainties in the selection of types and particle size of the bridging materials. In addition, there are many operational restrictions such as the risk of plugging and pumping difficulties when large size of particle is needed, especially in deep-water drilling. In this study, polyacrylamide (PAM) crosslinked with polyethylenimine (PEI) is introduced as polymer-based mud for loss circulation treatment. The PAM/PEI systems have wide applications in water shutoff for high water production zones and are known for their strong gel and exceptional rheological properties. This study provides a rheological method for screening of PAM/PEI-based drilling formulation with optimized molecular weight and concentrations. Comparative analysis of rheology of non-crosslinked and crosslinked polyacrylamide with other drilling fluids additives as well as proper mixing procedures are provided. The results achieved in this study are used as a strong tool to design a polymer-based mud with competitive rheological properties which achieved an 80% reduction in fluid loss when compared with other conventional loss circulation materials.
Effect of evaporation behavior of zinc tin phosphide alloys on the composition, structure, and photoconductive properties of their thin films
Authors: Sivakumar P. , Peranantham P. , Siva Kumar V. V. , Asokan K. , Jeyachandran Y. L.
Published: October 2020

The evaporation behavior of zinc tin phosphide (ZTP) alloys and its effect on the composition, structure, and photoconductive properties of the deposited films were investigated. ZTP alloys were prepared, and they were found to be of ZnSn-phosphide composition and chalcopyrite structure as obtained by thermogravimetric and x-ray diffraction analysis. The evaporation of the alloys produced random and inhomogeneous deposition with unevaporated residues due to the large difference in vapor pressure, particularly, between Zn and Sn. A closed spaced vapor deposition type setup favored uniform deposition of the films, however, with a dramatic deviation of composition and structure from that of the alloys. Rutherford backscattering, x-ray photoelectron, and energy dispersive spectroscopic studies revealed that the composition of the films is close to ZnP2 stoichiometry with less than 2% of Sn content. Raman spectroscopy and transmission electron microscopy studies showed that the films are of polycrystalline tetragonal ZnP2 structure and evolve to monocrystalline on electron irradiation. The films exhibited a broad band photoresponse in the visible wavelength region with high responsivity to the red light. The study establishes the effect of evaporation behavior of materials with large difference in vapor pressure on the properties and activity of the deposited films thereof.
Introduction to the Special Issue: Global Perspectives in Sport Management Education
Authors: LeCrom Carrie , Naylor Michael
Published: October 2020

There is no doubt that sport has become a global industry. Therefore, it is crucial that global perspectives be integrated into sport management education, which is no doubt occurring. However, little has been published to date on the impact and effectiveness of curricular strategies aimed at internationalizing sport management education. This special issue provides sport management faculty with thoughtful dialogue on how they can educate their students for what has become an ever-changing global landscape. The articles in this issue capture global perspectives representing the breadth of activity across a burgeoning dimension of sport management education. The authors have used a variety of research designs that, taken together, provide a wide-angle lens on the nature of global sport management education and how effective it can be.
Escherichia coli Sequence Type 457 Is an Emerging Extended-Spectrum-β-Lactam-Resistant Lineage with Reservoirs in Wildlife and Food-Producing Animals
Authors: Nesporova Kristina , Wyrsch Ethan R. , Valcek Adam , Bitar Ibrahim , Chaw Khin , Harris Patrick , Hrabak Jaroslav , Literak Ivan , Djordjevic Steven P. , Dolejska Monika
Published: October 2020

Silver gulls carry phylogenetically diverse
Escherichia coli
, including globally dominant extraintestinal pathogenic
E. coli
(ExPEC) sequence types and pandemic ExPEC-ST131 clades; however, our large-scale study (504 samples) on silver gulls nesting off the coast of New South Wales identified
E. coli
ST457 as the most prevalent. A phylogenetic analysis of whole-genome sequences (WGS) of 138 ST457 samples comprising 42 from gulls, 2 from humans (Australia), and 14 from poultry farmed in Paraguay were compared with 80 WGS deposited in public databases from diverse sources and countries.
Evaluation of Three Commercial SARS-CoV-2 Serologic Assays and Their Performance in Two-Test Algorithms
Authors: Turbett Sarah E. , Anahtar Melis , Dighe Anand S. , Garcia Beltran Wilfredo , Miller Tyler , Scott Hannah , Durbin Sienna Marie , Bharadwaj Maheetha , Thomas Jason , Gogakos Tasos S. , Astudillo Michael , Lennerz Jochen , Rosenberg Eric S. , Branda John A.
Published: October 2020

Sensitive and specific severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serologic assays are needed to inform diagnostic, therapeutic, and public health decision-making. We evaluated three commercial serologic assays as stand-alone tests and as components of two-test algorithms. Two nucleocapsid antibody tests (Abbott IgG and Roche total antibody) and one spike protein antibody test (DiaSorin IgG) were included. We assessed sensitivity using 128 serum samples from symptomatic PCR-confirmed coronavirus disease 2019 (COVID-19)-infected patients and specificity using 1,204 samples submitted for routine serology prior to COVID-19’s emergence, plus 64 pandemic-era samples from SARS-CoV-2 PCR-negative patients with respiratory symptoms.
The Evolutionary Success of the Marine Bacterium SAR11 Analyzed through a Metagenomic Perspective
Authors: López-Pérez Mario , Haro-Moreno Jose M. , Coutinho Felipe Hernandes , Martinez-Garcia Manuel , Rodriguez-Valera Francisco
Published: October 2020

As the most abundant bacteria in oceans, the
Pelagibacterales
order (here SAR11) plays an important role in the global carbon cycle, but the study of the evolutionary forces driving its evolution has lagged considerably due to the inherent difficulty of obtaining pure cultures. Multiple evolutionary models have been proposed to explain the diversification of distinct lineages within a population; however, the identification of many of these patterns in natural populations remains mostly enigmatic. We have used a metagenomic approach to explore microdiversity patterns in their natural habitats. Comparison with a collection of bacterial and archaeal groups from the same environments shows that SAR11 populations have a different evolutionary regime, where multiple genotypes coexist within the same population and remain stable over time. Widespread homologous recombination could be one of the main driving factors of this homogenization.
Climate of the Last Glacial Maximum on the western Olympic Peninsula based on insect paleoecology, palynology, and glacial geology
Authors: Ashworth* Allan C. , Thackray* Glenn D. , Gavin* Daniel G.
Published: October 2020

Climate during the Last Glacial Maximum (LGM) varied substantially across North America, strongly influencing changes in plant and animal distributions and causing variations in the timing and relative magnitude of ice expansion and recession. The Olympic Peninsula is a mountainous maritime terrain in northwestern Washington, where the climate today is most strongly influenced by Pacific weather systems. However, what about during the LGM, when ice sheets covered most of northern North America? Fossil beetle assemblages of LGM age contain species that currently inhabit riparian and lacustrine habitats in the boreal zone of Canada and Alaska, and in higher elevations in the Cascades and Rocky Mountains. They include three Olophrum species that today are unknown from the Olympic Peninsula. Olophrum consimile is especially well represented, and its occurrence today above 1000 m elevation in the Cascades of northern Washington State indicates summers during the LGM would have been at least 4 °C cooler than today. The absence of wood-boring beetles, in contrast to assemblages from deposits correlating with marine isotope stage (MIS) 3, supports an open rather than a forested landscape. The insect fossils also include an undescribed species of a blind trechine ground beetle, likely endemic to the Pacific Northwest with biogeographic affinities to Asia. Pollen and plant macrofossil evidence for a Sitka spruce and mountain hemlock parkland with similarities to the vegetation of modern southeast Alaska also supports an interpretation of a climate with summer temperatures ~4 °C cooler than today. Both the vegetation and the insects provide evidence that the climate was wet with persistent snow cover and not as dry as has been reported from the Puget Lowland to the east. Glacial geology provides evidence that during the colder climate of the LGM, mountain glaciers advanced down the western valleys of the Olympic Peninsula to the lowlands but not as far as they had extended during MIS 3. The amount of climatic cooling on the Olympic Peninsula during the LGM was less than at similar latitudes in midcontinental or eastern North America, indicating a strong modulation of climate by the Pacific Ocean.
The eruptive history, magmatic evolution, and influence of glacial ice at long-lived Akutan volcano, eastern Aleutian Islands, Alaska, USA
Authors: Coombs Michelle L. , Jicha Brian R.
Published: October 2020

New 40Ar/39Ar and whole-rock geochemical data are used to develop a detailed eruptive chronology for Akutan volcano, Akutan Island, Alaska, USA, in the eastern Aleutian island arc. Akutan Island (166°W, 54.1°N) is the site of long-lived volcanism and the entire island comprises volcanic rocks as old as 3.3 Ma. Our current study is on the 225 km2 western half of the island, where our results show that the focus of volcanism has shifted over the last ∼700 k.y., and that on occasion, multiple volcanic centers have been active over the same period, including within the Holocene. Incremental heating experiments resulted in 56 40Ar/39Ar plateau ages and span 2.3 Ma to 9.2 ka.

Eruptive products of all units are primarily tholeiitic and medium-K, and range from basalt to dacite. Rare calc-alkaline lavas show evidence suggesting their formation via mixing of mafic and evolved magmas, not via crystallization-derived differentiation through the calc-alkaline trend. Earliest lavas are broadly dispersed and are almost exclusively mafic with high and variable La/Yb ratios that are likely the result of low degrees of partial mantle melting. Holocene lavas all fall along a single tholeiitic, basalt-to-dacite evolutionary trend and have among the lowest La/Yb ratios, which favors higher degrees of mantle melting and is consistent with the increased magma flux during this time. A suite of xenoliths, spanning a wide range of compositions, are found in the deposits of the 1.6 ka caldera-forming eruption. They are interpreted to represent completely crystallized liquids or the crystal residuum from tholeiitic fractional crystallization of the active Akutan magma system.

The new geochronologic and geochemical data are used along with existing geodetic and seismic interpretations from the island to develop a conceptual model of the active Akutan magma system. Collectively, these data are consistent with hot, dry magmas that are likely stored at 5–10 km depth prior to eruption. The prolonged eruptive activity at Akutan has also allowed us to evaluate patterns in lava-ice interactions through time as our new data and observations suggest that the influence of glaciation on eruptive activity, and possible magma composition, is more pronounced at Akutan than has been observed for other well-studied Aleutian volcanoes to the west.
Vitamin B12and risk of diabetes: new insight from cross-sectional and longitudinal analyses of the China Stroke Primary Prevention Trial (CSPPT)
Authors: Liu Lishun , Huang Xiao , Wang Binyan , Song Yun , Lin Tengfei , Zhou Ziyi , Wang Zhuo , Wei Yaping , Guo Huiyuan , Chen Ping , Yang Yan , Ling Wenhua , Li Youbao , Qin Xianhui , Tang Genfu , Liu Chengzhang , Li Jianping , Zhang Yan , Zalloua Pierre A , Wang Xiaobin , Huo Yong , Zhang Hao , Xu Xiping
Published: October 2020

Introduction

Previous studies in mostly Western populations have yielded conflicting findings on the association of vitamin B12with diabetes risk, in part due to differences in study design and population characteristics. This study sought to examine the vitamin B12–diabetes association in Chinese adults with hypertension by both cross-sectional and longitudinal analyses.

Research design and methods

This report included a total of 16 699 participants from the China Stroke Primary Prevention Trial, with pertinent baseline and follow-up data. Diabetes mellitus was defined as either physician-diagnosed diabetes, use of glucose-lowering drugs, or fasting blood glucose (FBG) ≥7.0 mmol/L. New-onset diabetes was defined as any new case of onset diabetes during the follow-up period or FBG ≥7.0 mmol/L at the exit visit.

Results

At baseline, there were 1872 (11.2%) patients with diabetes; less than 1.5% had clinical vitamin B12deficiency (<148.0 pmol/L). Over a median follow-up period of 4.5 years, there were 1589 (10.7%) cases of new-onset diabetes. Cross-sectional analyses showed a positive association between baseline vitamin B12levels and FBG levels (β=0.18, 95% CI 0.15 to 0.21) and diabetes (OR=1.16, 95% CI 1.10 to 1.21). However, longitudinal analyses showed no association between baseline vitamin B12and new-onset diabetes or changes in FBG levels. Among a subset of the sample (n=4366) with both baseline and exit vitamin B12measurements, we found a positive association between an increase in vitamin B12and an increase in FBG.

Conclusions

In this large Chinese population of patients with hypertension mostly sufficient with vitamin B12, parallel cross-sectional and longitudinal analyses provided new insight into the conflicting findings of previous studies, and these results underscore the need for future studies to consider both baseline vitamin B12and its longitudinal trajectory in order to better elucidate the role of vitamin B12in the development of diabetes. Such findings would have important clinical and public health implications.
Examining the impact of an asynchronous communication platform versus existing communication methods: an observational study
Authors: Jhala Meenakshi , Menon Rahul
Published: October 2020

Background

Healthcare systems revolve around intricate relations between humans and technology. System efficiency depends on information exchange that occur on synchronous and asynchronous platforms. Traditional synchronous methods of communication may pose risks to workflow integrity and contribute to inefficient service delivery and medical care.

Aim

To compare synchronous methods of communication to Medic Bleep, an instant messaging asynchronous platform, and observe its impact on clinical workflow, quality of work life and associations with patient safety outcomes and hospital core operations.

Methods

Cohorts of healthcare professionals were followed using the Time Motion Study methodology over a 2-week period, using both the asynchronous platform and the synchronous methods like the non-cardiac pager. Questionnaires and interviews were conducted to identify staff attitudes towards both platforms.

Results

A statistically significant figure (p<0.01) of 20.1 minutes’ reduction in average task completion was seen with asynchronous communication, saving 58.8% of time when compared with traditional synchronous methods. In subcategory analysis for staff: doctors, nurses and midwifery categories, a p value of <0.0495 and <0.01 were observed; a mean time reduction with statistical significance was also seen in specific task efficiencies of ‘To-Take-Out (TTO), patient review, discharge & patient transfer and escalation of care & procedure’. The platform was favoured with an average Likert value of 8.7; 67% found it easy to implement.

Conclusion

The asynchronous platform improved clinical communication compared with synchronous methods, contributing to efficiencies in workflow and may positively affect patient care.
Effect of a real-time feedback smartphone application (TCPRLink) on the quality of telephone-assisted CPR performed by trained laypeople in China: a manikin-based randomised controlled study
Authors: Dong Xuejie , Zhang Lin , Myklebust Helge , Birkenes Tonje Soraas , Zheng Zhi-Jie
Published: October 2020

Objectives

To determine the effect of a free smartphone application (TCPRLink) that provides real-time monitoring and audiovisual feedback on chest compressions (CC) on trained layperson telephone-assisted cardiopulmonary resuscitation (T-CPR) performance.

Design

A manikin-based randomised controlled study.

Setting

This study was conducted at a multidisciplinary university and a community centre in China.

Participants

One hundred and eighty-six adult participants (age 18–65 years) with T-CPR training experience were randomly assigned to the TCPRLink (n=94) and T-CPR (n=92) groups with age stratification.

Interventions

We compared the participants’ performance for 6 min of CC in a simulated T-CPR scenario both at the baseline and after 3 months.

Primary and secondary outcome measures

The primary outcomes were the CC rate and proportion of adequate CC rate (100–120 min−1). The secondary outcomes included the proportion of participants counting the CC rhythm, time to first CC, CC depth, hands-off time and CC full-release ratio.

Results

Participants in the TCPRLink feedback group more consistently performed CC with higher rate, both initially and 3 months later (median 111 (IQR 109–113) vs 108 (103–112) min−1, p=0.002 and 111 (109–113) vs 108 (105–112) min−1, p<0.001, respectively), with less need to count the rhythm (21.3% vs 41.3%, p=0.003% and 7% vs 22.6%, p=0.004, respectively) compared with the T-CPR group. There were no significant differences in time to the first CC, hands-off time or CC full-release ratio. Among 55–65 year group, the CC depth was deeper in the TCPRLink group than in the TCPR group (47.1±9.6 vs 38.5±8.7 mm, p=0.001 and 44.7±10.1 vs 39.3±10.8 mm, p=0.07, respectively).

Conclusions

The TCPRLink application improved T-CPR quality in trained laypersons to provide more effective CCs and lighten the load of counting out the CC with the dispatcher in a simulated T-CPR scenario. Further investigations are required to confirm this effectiveness in real-life resuscitation attempts.
Linking the Mini-Mental State Examination, the Alzheimer’s Disease Assessment Scale–Cognitive Subscale and the Severe Impairment Battery: evidence from individual participant data from five randomised clinical trials of donepezil
Authors: Levine Stephen Z , Yoshida Kazufumi , Goldberg Yair , Samara Myrto , Cipriani Andrea , Efthimiou Orestis , Iwatsubo Takeshi , Leucht Stefan , Furukawa Toshi A
Published: October 2020

Background

The Mini-Mental State Examination (MMSE), the Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog) and the Severe Impairment Battery (SIB) are widely used rating scales to assess cognition in Alzheimer’s disease.

Objective

To understand the correspondence between these rating scales, we aimed to examine the linkage of MMSE with the ADAS-Cog and SIB total and change scores.

Methods

We used individual-level data on participants with Alzheimer’s disease (n=2925) from five pivotal clinical trials of donepezil. Data were collected at baseline and scheduled visits for up to 6 months. We used equipercentile linking to identify the correspondence between simultaneous measurements of MMSE with ADAS-Cog, and SIB total and change ratings.

Findings

Spearman’s correlation coefficients were of strong magnitude between the MMSE total score and the ADAS-Cog (rs from −0.82 to −0.87; p<0.05) and SIB total scores (rs from 0.70 to 0.75; p<0.05). Weaker correlations between the change scores were observed between the MMSE change score and the ADAS-Cog (week 1: r=−0.11, p=0.18; rs thereafter: −0.28 to −0.45; p<0.05) and SIB change scores (rs from 0.31 to 0.44; p<0.05). Linking suggested that the MMSE total scores were sensitive to moderate and severe cognitive impairment levels. Despite weak to moderate correlations for the change scores, moderate change levels linked well, indicating ceiling and floor effects.

Conclusions

The current results can be used in meta-analyses, data harmonisation and may contribute to increasing statistical power when pooling data from multiple sources.

Clinical implications

The current study results help clinicians to understand these cognitive rating scale scores.
qSOFA as a new community-acquired pneumonia severity score in the emergency setting
Authors: Spagnolello Ornella , Ceccarelli Giancarlo , Borrazzo Cristian , Macrì Angela , Suppa Marianna , Baldini Enrico , Garramone Alessia , Alessandri Francesco , Celani Luigi , Vullo Francesco , Angeletti Silvia , Ciccozzi Massimo , Mastroianni Claudio , Bertazzoni Giuliano , D'Ettorre Gabriella
Published: October 2020

Background

Quick Sequential Organ Failure Assessment (qSOFA) score is a bedside prognostic tool for patients with suspected infection outside the intensive care unit (ICU), which is particularly useful when laboratory analyses are not readily available. However, its performance in potentially septic patients with community-acquired pneumonia (CAP) needs to be examined further, especially in relation to early outcomes affecting acute management.

Objective

First, to compare the performance of qSOFA and CURB-65 in the prediction of mortality in the emergency department in patients presenting with CAP. Second, to study patients who required critical care support (CCS) and ICU admission.

Methods

Between January and December 2017, a 1-year retrospective observational study was carried out of adult (≥18 years old) patients presenting to the emergency department (ED) of our hospital (Rome, Italy) with CAP. The accuracy of qSOFA, qSOFA-65 and CURB-65 was compared in predicting mortality in the ED, CCS requirement and ICU admission. The concordance among scores ≥2 was then assessed for 30-day estimated mortality prediction.

Results

505 patients with CAP were enrolled. Median age was 71.0 years and mortality rate in the ED was 4.7%. The areas under the curve (AUCs) of qSOFA-65, CURB-65 and qSOFA in predicting mortality rate in the ED were 0.949 (95% CI 0.873 to 0.976), 0.923 (0.867 to 0.980) and 0.909 (0.847 to 0.971), respectively. The likelihood ratio of a patient having a qSOFA score ≥2 points was higher than for qSOFA-65 or CURB-65 (11 vs 7 vs 6.7). The AUCs of qSOFA, qSOFA-65 and CURB-65 in predicting CCS requirement were 0.862 (95% CI 0.802 to 0.923), 0.824 (0.758 to 0.890) and 0.821 (0.754 to 0.888), respectively. The AUCs of qSOFA-65, qSOFA and CURB-65 in predicting ICU admission were 0.593 (95% CI 0.511 to 0.676), 0.585 (0.503 to 0.667) and 0.570 (0.488 to 0.653), respectively. The concordance between qSOFA-65 and CURB-65 in 30-day estimated mortality prediction was 93%.

Conclusion

qSOFA is a valuable score for predicting mortality in the ED and for the prompt identification of patients with CAP requiring CCS. qSOFA-65 may further improve the performance of this useful score, showing also good concordance with CURB-65 in 30-day estimated mortality prediction.
Interval cancer after colonoscopy in the Austrian National Screening Programme: influence of physician and patient factors
Authors: Waldmann Elisabeth , Penz Daniela , Šinkovec Hana , Heinze Georg , Rinner Christoph , Jiricka Lena , Majcher Barbara , Hinterberger Anna , Trauner Michael , Ferlitsch Monika
Published: October 2020

Objective

Postscreening colorectal cancer (PSCRC) after screening colonoscopy is associated with endoscopists’ performance and characteristics of resected lesions. Prior studies have shown that adenoma detection rate (ADR) is a decisive factor for PSCRC, but correlations with other parameters need further analysis and ADR may change over time.

Design

Cohort study including individuals undergoing screening colonoscopy between 1/2008 and 12/2019 performed by physicians participating in a quality assurance programme in Austria. Data were linked with hospitalisation data for the diagnosis of PSCRC (defined as CRC diagnosis >6 months after colonoscopy). ADR was defined dynamically in relation to the time point of subsequent colonoscopies; high-risk groups of patients were those with an adenoma ≥10 mm, or with high-grade dysplasia, or villous or tubulovillous histology, or a serrated lesion ≥10 mm or with dysplasia, or colonoscopies with ≥3 lesions. Main outcome was PSCRC for each risk group (negative colonoscopy, hyperplastic polyps, low-risk and high-risk group of patients) after colonoscopy by endoscopists with an ADR <20% compared with endoscopists with an ADR ≥20%.

Results

352 685 individuals were included in the study (51.0% women, median age 60 years) of which 10.5% were classified as high-risk group. During a median follow-up of 55.4 months, 241 (0.06%) PSCRC were identified; of 387 participating physicians, 19.6% had at least one PSCRC (8.4% two or more). While higher endoscopist ADR decreased PSCRC incidence (HR per 1% increase 0.97, 95% CI 0.95 to 0.98), affiliation to the high-risk group of patients was also associated with higher PSCRC incidence (HR 3.27, 95% CI 2.36 to 4.00). Similar correlations were seen with regards to high-risk, and advanced adenomas. The risk for PSCRC was significantly higher after colonoscopy by an endoscopist with an ADR <20% as compared with an endoscopist with an ADR ≥20% in patients after negative colonoscopy (HR 2.01, 95% CI 1.35 to 3.0, p<0.001) and for the high-risk group of patients (HR 2.51, 95% CI 1.49 to 4.22, p<0.001).

Conclusion

A dynamic calculation of the ADR takes into account changes over time but confirms the correlation of ADR and interval cancer. Both lesion characteristics and endoscopists ADR may play a similar role for the risk of PSCRC. This should be considered in deciding about appropriate surveillance intervals in the future.
High burden of acute kidney injury in COVID-19 pandemic: systematic review and meta-analysis
Authors: Oliveira Camila Barbosa , Lima Camilla Albertina Dantas , Vajgel Gisele , Campos Coelho Antonio Victor , Sandrin-Garcia Paula
Published: October 2020

Aims

Hospitalised patients with COVID-19 have a variable incidence of acute kidney injury (AKI) according to studies from different nationalities. The present systematic review and meta-analysis describes the incidence of AKI, need for renal replacement therapy (RRT) and mortality among patients with COVID-19-associated AKI.

Methods

We systematically searched electronic database PubMed, SCOPUS and Web of Science to identify English articles published until 25 May 2020. In case of significant heterogeneity, the meta-analyses were conducted assuming a random-effects model.

Results

From 746 screened publications, we selected 21 observational studies with 15 536 patients with COVID-19 for random-effects model meta-analyses. The overall incidence of AKI was 12.3% (95% CI 7.3% to 20.0%) and 77% of patients with AKI were critically ill (95% CI 58.9% to 89.0%). The mortality among patients with AKI was 67% (95% CI 39.8% to 86.2%) and the risk of death was 13 times higher compared with patients without AKI (OR=13.3; 95% CI 6.1 to 29.2). Patients with COVID-19-associated AKI needed for RRT in 23.4% of cases (95% CI 12.6% to 39.4%) and those cases had high mortality (89%–100%).

Conclusion

The present study evidenced an incidence of COVID-19-associated AKI higher than previous meta-analysis. The majority of patients affected by AKI were critically ill and mortality rate among AKI cases was high. Thus, it is extremely important for health systems to be aware about the impact of AKI on patients’ outcomes in order to establish proper screening, prevention of additional damage to the kidneys and adequate renal support when needed.
Frauds in scientific research and how to possibly overcome them
Authors: Boetto Erik , Golinelli Davide , Carullo Gherardo , Fantini Maria Pia
Published: October 2020

Frauds and misconduct have been common in the history of science. Recent events connected to the COVID-19 pandemic have highlighted how the risks and consequences of this are no longer acceptable. Two papers, addressing the treatment of COVID-19, have been published in two of the most prestigious medical journals; the authors declared to have analysed electronic health records from a private corporation, which apparently collected data of tens of thousands of patients, coming from hundreds of hospitals. Both papers have been retracted a few weeks later. When such events happen, the confidence of the population in scientific research is likely to be weakened. This paper highlights how the current system endangers the reliability of scientific research, and the very foundations of the trust system on which modern healthcare is based. Having shed light on the dangers of a system without appropriate monitoring, the proposed analysis suggests to strengthen the existing journal policies and improve the research process using new technologies supporting control activities by public authorities. Among these solutions, we mention the promising aspects of the blockchain technology which seems a promising solution to avoid the repetition of the mistakes linked to the recent and past history of research.