bluuebunny/crossref_metadata_2025 huggingface dataset:
Power-to-heat on the reserve capacity market—Policy implications considering economic constraints and competing heat production
Authors: Monie Svante W. , Hesamzadeh Mohammad Reza , Åberg Magnus
Published: August 2022

Studies have shown that surplus power from variable renewable electricity generation can be consumed in electric boilers or compressor heat pumps, i.e., Power-to-Heat (P2H), for heat production. This potentially provides power balancing for the electric grid and can also decarbonize and/or reduce biofuel demand in the district heating (DH) sector. This sector-coupling of thermal and electrical systems is, however, limited by production planning complexity, grid fees, tariffs, and risk-averse actors. The conditions for P2H production vary between DH-systems due to non-homogeneity in the configuration of production units in different systems. This study investigates the economic feasibility of placing bids for P2H electricity consumption on the reserve capacity market in three different DH systems. It is assumed that P2H electricity consumption is controlled by a hypothetical balance operator. To increase production flexibility, the DH systems are equipped with heat storage where P2H-produced heat is stored. The results show that P2H on the reserve capacity market can increase revenue for DH operators, but DH systems with co-generation of heat and electricity risk reducing income from power production. Furthermore, stored heat needs to compete with cost-efficient base-load production to avoid the large storage required. The power balancing potential of P2H in DH systems is generally limited by the installed P2H capacity as well as the rest of the constituents and the production strategy of the DH system. To overcome these limitations, policies are needed that reward power balancing services and provide investment support for P2H capacity and heat storage.
Global patterns of antigen receptor repertoire disruption across adaptive immune compartments in COVID-19
Authors: Joseph Magdalene , Wu Yin , Dannebaum Richard , Rubelt Florian , Zlatareva Iva , Lorenc Anna , Du Zhipei Gracie , Davies Daniel , Kyle-Cezar Fernanda , Das Abhishek , Gee Sarah , Seow Jeffrey , Graham Carl , Telman Dilduz , Bermejo Clara , Lin Hai , Asgharian Hosseinali , Laing Adam G. , del Molino del Barrio Irene , Monin Leticia , Muñoz-Ruiz Miguel , McKenzie Duncan R. , Hayday Thomas S. , Francos-Quijorna Isaac , Kamdar Shraddha , Davis Richard , Sofra Vasiliki , Cano Florencia , Theodoridis Efstathios , Martinez Lauren , Merrick Blair , Bisnauthsing Karen , Brooks Kate , Edgeworth Jonathan , Cason John , Mant Christine , Doores Katie J. , Vantourout Pierre , Luong Khai , Berka Jan , Hayday Adrian C.
Published: August 2022

Whereas pathogen-specific T and B cells are a primary focus of interest during infectious disease, we have used COVID-19 to ask whether their emergence comes at a cost of broader B cell and T cell repertoire disruption. We applied a genomic DNA-based approach to concurrently study the immunoglobulin-heavy (IGH) and T cell receptor (TCR) β and δ chain loci of 95 individuals. Our approach detected anticipated repertoire focusing for the IGH repertoire, including expansions of clusters of related sequences temporally aligned with SARS-CoV-2–specific seroconversion, and enrichment of some shared SARS-CoV-2–associated sequences. No significant age-related or disease severity–related deficiencies were noted for the IGH repertoire. By contrast, whereas focusing occurred at the TCRβ and TCRδ loci, including some TCRβ sequence–sharing, disruptive repertoire narrowing was almost entirely limited to many patients aged older than 50 y. By temporarily reducing T cell diversity and by risking expansions of nonbeneficial T cells, these traits may constitute an age-related risk factor for COVID-19, including a vulnerability to new variants for which T cells may provide key protection.
The CMS Inner Tracker electronics system development
Authors: Orfanelli S.
Published: August 2022

A new Silicon Tracker will be built for the phase-2 upgrade of the CMS experiment. The innermost part, called the Inner Tracker, will be featuring high-granularity pixelated silicon sensors of 2500 µm2 and will need to cope with the unprecedented radiation levels of 1.9 Grad and 3.5 × 1016 neq/cm2 fluence and particle hit rates of 3.2 GHz/cm2. The pixel electronics system is based on innovative solutions such as a radiation hard pixel ASIC, the novel serial powering scheme used to power up to 12 detector modules in series and advanced technologies for the high bandwidth readout system based on electrical light-weight readout links of 1.28 Gbps, electrical to optical conversion as close as possible to the detector modules and back-end boards each one capable of receiving an aggregated data bandwidth of 190 Gbps. The recently optimised design of the CMS Inner Tracker electronics system will be presented in this contribution.
Development of an underwater networking system using bio-inspired electrocommunication
Authors: Zhang Han , Wang Wei , Wang Qinghao , Wang Chen , Xie Guangming
Published: August 2022

Current underwater communication typically includes acoustic, optical, radio frequency, and magneto-inductive channels. Wireless sensor networks are usually built on these four channels. However, these underwater networks are vulnerable to complex aquatic environments. In nature, weakly electric fish are able to communicate electrically (called electrocommunication), which is ‘invisible’ to most other animals, to convey information such as species, courtship, and environmental conditions. Inspired by the electrocommunication of weakly electric fish, an artificial electrocommunication system that uses an electric induction (EI) channel has been developed recently. This paper further develops an underwater networking system using the EI channel, which addresses the solutions to collision avoidance and routing problems during electrocommunication networking. In particular, a CSMA/CA-based electrocommunication mechanism was used to solve the collision problem. Then, a single-hop underwater electrocommunication network (UEN) was established. Furthermore, a complex multi-hop UEN was implemented on the basis of the ad hoc on-demand distance vector routing protocol. Theoretical analysis, simulations, and experiments were conducted to demonstrate the effectiveness of the developed UEN. Extensive results show that the UEN holds the potential to serve as a complement to future underwater wireless sensor networks.
Hybrid fibroin/polyurethane small-diameter vascular grafts: from fabrication to in vivo preliminary assessment
Authors: Caldiroli Alice , Pederzani Elia , Pezzotta Marco , Azzollini Nadia , Fiori Sonia , Tironi Matteo , Rizzo Paola , Sangalli Fabio , Figliuzzi Marina , Fiore Gianfranco Beniamino , Remuzzi Andrea , Riboldi Stefania Adele , Soncini Monica , Redaelli Alberto
Published: August 2022

To address the need of alternatives to autologous vessels for small-calibre vascular applications (e.g. cardiac surgery), a bio-hybrid semi-degradable material composed of silk fibroin (SF) and polyurethane (Silkothane®) was herein used to fabricate very small-calibre grafts (Øin = 1.5 mm) via electrospinning. Bio-hybrid grafts were in vitro characterized in terms of morphology and mechanical behaviour, and compared to similar grafts of pure SF. Similarly, two native vessels from a rodent model (abdominal aorta and vena cava) were harvested and characterized. Preliminary implants were performed on Lewis rats to confirm the suitability of Silkothane® grafts for small-calibre applications, specifically as aortic insertion and femoral shunt. The manufacturing process generated pliable grafts consisting of a randomized fibrous mesh and exhibiting similar geometrical features to rat aortas. Both Silkothane® and pure SF grafts showed radial compliances in the range from 1.37 ± 0.86 to 1.88 ± 1.01% 10−2 mmHg−1, lower than that of native vessels. The Silkothane® small-calibre devices were also implanted in rats demonstrating to be adequate for vascular applications; all the treated rats survived the surgery for three months after implantation, and 16 rats out of 17 (94%) still showed blood flow inside the graft at sacrifice. The obtained results lay the basis for a deeper investigation of the interaction between the Silkothane® graft and the implant site, which may deal with further analysis on the potentialities in terms of degradability and tissue formation, on longer time-points.
On the L∞ structure of Poisson gauge theory
Authors: Abla O , Kupriyanov V G , Kurkov M A
Published: August 2022

The Poisson gauge theory is a semi-classical limit of full non-commutative gauge theory. In this work we construct an

L

∞

full

algebra which governs both the action of gauge symmetries and the dynamics of the Poisson gauge theory. We derive the minimal set of non-vanishing ℓ-brackets and prove that they satisfy the corresponding homotopy relations. On the one hand, it provides new explicit non-trivial examples of L∞ algebras. On the other hand, it can be used as a starting point for bootstrapping the full non-commutative gauge theory. The first few brackets of such a theory are constructed explicitly in the text. In addition we show that the derivation properties of ℓ-brackets on

L

∞

full

with respect to the truncated product on the exterior algebra are satisfied only for the canonical non-commutativity. In general,

L

∞

full

does not have a structure of P∞ algebra.
Integrable fractional modified Korteweg–deVries, sine-Gordon, and sinh-Gordon equations
Authors: Ablowitz Mark J , Been Joel B , Carr Lincoln D
Published: August 2022

The inverse scattering transform allows explicit construction of solutions to many physically significant nonlinear wave equations. Notably, this method can be extended to fractional nonlinear evolution equations characterized by anomalous dispersion using completeness of suitable eigenfunctions of the associated linear scattering problem. In anomalous diffusion, the mean squared displacement is proportional to t

α
, α > 0, while in anomalous dispersion, the speed of localized waves is proportional to A

α
, where A is the amplitude of the wave. Fractional extensions of the modified Korteweg–deVries (mKdV), sine-Gordon (sineG) and sinh-Gordon (sinhG) and associated hierarchies are obtained. Using symmetries present in the linear scattering problem, these equations can be connected with a scalar family of nonlinear evolution equations of which fractional mKdV (fmKdV), fractional sineG (fsineG), and fractional sinhG (fsinhG) are special cases. Completeness of solutions to the scalar problem is obtained and, from this, the nonlinear evolution equation is characterized in terms of a spectral expansion. In particular, fmKdV, fsineG, and fsinhG are explicitly written. One-soliton solutions are derived for fmKdV and fsineG using the inverse scattering transform and these solitons are shown to exhibit anomalous dispersion.
Interfacial charge transfer and Schottky barriers at c-Si/a-In heterojunctions
Authors: Fang Piet Xiaowen , Nihtianov Stoyan , Sberna Paolo , de Wijs Gilles A , Fang Changming
Published: August 2022

Metal-Semiconductor (M/S) heterojunctions, better known as Schottky junctions play a crucial role in modern electronics. At present, the mechanisms behind the M/S junctions are still a subject of discussion. In this work, we investigate the interfaces between semiconducting crystalline Si and amorphous metallic indium, Si{0 0 1}/a-In and Si{1 1 1}/a-In using both ab initio molecular dynamics simulations and a Schottky-Mott approach. The simulations reveal the formation of a distinct border between the Si substrates and amorphous In at the interfaces. The In atoms adjacent to the interfaces exhibit atomic ordering. Charge transfer occurs from In to Si, forming c-Si−q/a-In+q charge barriers at the interfaces. This indicates that a crystalline p-Si/a-In heterojunction will have rectifying properties, which agrees with an analysis using the Schottky-Mott model which predicts a Schottky barrier height of 1.3 eV for crystalline p-Si/a-In using the calculated work function for a-In (3.82 eV). We further discuss the interfacial charge transfer, related hole-depletion regions in Si adjacent to the interfaces and the Schottky-Mott approximations.
Path integrals as analysis on path space by time slicing approximation
Authors: Kumano-go Naoto
Published: August 2022

We explain the Lagrangian (configuration space) path integrals in Section 1 and the Hamiltonian (phase space) path integrals in Section 2. The two sections are independent of each other. Readers can read from either section.
Applications of Laplace’s method in Bayesian analysis and related topics
Authors: Miyata Yoichi
Published: August 2022

This article reviews some second-order approximations to the posterior mean, and the marginal distribution of observations called a marginal likelihood, where “second-order” means that the approximation has asymptotic errors of order

O
(

n

−
2

)

O(n^{-2})

as the sample size

n
n

goes to infinity. In addition, the Laplace approximations using asymptotic modes instead of the exact mode of integrand, and higher-order asymptotic expansions are presented.
Severe acute ischaemic stroke early after wedge resection in middle-aged patients: analysis and endovascular treatment
Authors: Zhang Chong , Meng Di , Xu Jinming , Cao Jinlin , Hu Jian
Published: August 2022

Severe acute ischaemic stroke early after wedge resection is very rare in healthy middle-aged patients. Here, we reviewed the data and characteristics of 9 cases. The infarction resulted from embolism in intracranial arteries, severely impacting the quality of life. In the first 2 patients, the onset symptom was confused with residual anaesthetic effects early after surgery. Drawing from the initial 2 cases, the following 7 patients received accurate diagnosis and emergent endovascular thrombus aspiration with good outcome due to immediate reperfusion. Furthermore, we discuss the principal causes of severe acute stroke in healthy middle-aged patients and the efficacy of endovascular thrombus aspiration.
Characterizing the interfacial fracture energy of stiff islands on stretchable films
Authors: Lin Jui-Chi , Tsai Jia-Lin
Published: August 2022

This study characterized the interfacial fracture energy of stiff islands deposited on a thermoplastic polyurethane (TPU) film. The film can deform by >200%. The film was stretched using a designed fixture, and the fracture behaviors of the islands were observed using a microscope. The island–substrate interface debonding lengths associated with different levels of substrate strain were determined in the stretching tests. Because the stretchable film was a nonlinear material, the Ogden model was employed to characterize the nonlinear constitutive relation. Through the tensile tests, the material parameters in the Ogden model were determined using the reduced-gradient optimization method. On the basis of the measured debonding lengths, a finite element model was generated for the nonlinear properties of the film, and the energy release rates at the crack tip were calculated using the J-integral method. The energy release rates, representing the interfacial fracture energy, were calculated on the basis of the arrested crack associated with different crack lengths. Results reveal that the interfacial fracture energy increased from 0.14 to 0.91 kJ/m2 as the debonding length increased. The behavior is related to the rising resistance curve in TPU materials. In addition, the shearing-dominated mode slightly decreased as the debonded length increased in the stretching tests.
Stylometric similarity in literary corpora: Non-authorship clustering andDeutscher Novellenschatz
Authors: Päpcke Simon , Weitin Thomas , Herget Katharina , Glawion Anastasia , Brandes Ulrik
Published: August 2022

A distant-reading task in literary corpus analysis is to group stylometrically similar texts. Since there are many ways to define writing style, the result not only depends on the clustering method but even more so on the measure of similarity. With authorship attribution, the predominant application of stylometry, as its benchmark much research has addressed the utility of methods for measuring similarity. We use a corpus of German-language novellas to demonstrate that one may be interested in very different meaningful groups of texts simultaneously, and that these can be recovered from stylometric clustering if the measure is chosen accordingly. As can be expected, different measures do better at recovering groups associated with, for instance, subgenre, author gender, or narrative perspective. As a consequence, it is suggested that corpus analyses should not be based on what is currently considered the most refined measure of stylometric similarity, but rather break down the decisions that yield a specific measure and provide substantively justified arguments for them.
Development and transdifferentiation into inner hair cells require Tbx2
Authors: Bi Zhenghong , Li Xiang , Ren Minhui , Gu Yunpeng , Zhu Tong , Li Shuting , Wang Guangqin , Sun Suhong , Sun Yuwei , Liu Zhiyong
Published: August 2022

Atoh1 is essential for the development of both outer hair cells (OHCs) and inner hair cells (IHCs) in the mammalian cochlea. Whereas Ikzf2 is necessary for OHC development, the key gene required for IHC development remains unknown. We found that deletion of Tbx2 in neonatal IHCs led to their transdifferentiation into OHCs by repressing 26.7% of IHC genes and inducing 56.3% of OHC genes, including Ikzf2. More importantly, persistent expression of Tbx2 coupled with transient Atoh1 expression effectively reprogrammed non-sensory supporting cells into new IHCs expressing the functional IHC marker vGlut3. The differentiation status of these new IHCs was considerably more advanced than that previously reported. Thus, Tbx2 is essential for IHC development and co-upregulation of Tbx2 with Atoh1 in supporting cells represents a new approach for treating deafness related to IHC degeneration.
Case Report: Erroneous Human Immunodeficiency Virus-1 Diagnosis in a Pregnant Woman Using Centers for Disease Control and Prevention Diagnostic Algorithm
Authors: Hastie Elizabeth , Stangl Lisa , Deutsch Karen , Yin Jeffrey , Hull Andrew , Spector Stephen A , Blumenthal Jill
Published: August 2022

We describe a case of a pregnant cisgender woman diagnosed with human immunodeficiency virus (HIV)-1 using the current Centers for Disease Control and Prevention diagnostic algorithm who subsequently had her diagnosis overturned after additional testing outside of the algorithm, including an HIV-1 proviral deoxyribonucleic acid test that was negative.
The impact of transformational leadership on risk management and Dubai police performance
Authors: Zaher Omair Juma Abdulla Ahmed , Batool Mewish , Ali Salsabeel , Perumal Puvanasvaran A
Published: August 2022

Effective leadership is essential to manage potential risks facing the mission of law enforcement and improve the performance of police departments. While risk management by itself does not provide an adequate guarantee for an effective police operation, transformational leaders motivate, and inspire police officers to display high performance. Hence, the absence of effective risk management and transformational leadership may weaken police performance and potentially increase the risk to the work of police officers. Accordingly, this research aims to inspect the direct relationships between transformational leadership on risk management and police performance. Quantitative methods have been used to measure the strength of associations between these variables, simple random sampling has been adopted for the survey on a sample consisting of 307 police officers in the Dubai police department. The outcomes of the study showed that transformational leadership has a substantial effect on risk management and police performance, while age (moderator) has a significant impact on the choice of transformational leadership by the leader. These outcomes show the significance of the transformational leadership approach in the work of policing and explain why many law enforcement organizations increasingly rely on transformational leaders to reduce crime rates and improve the performance of the police.
Anaphylaxis across Europe: are pollen food syndrome and lipid transfer protein allergy so far apart?
Authors: Olivieri Bianca , Stoenchev Kostadin V. , Skypala Isabel J.
Published: August 2022

Purpose of review

Traditionally pollen-food syndrome (PFS) is considered to be a mild cross-reacting food allergy affecting only Northern Europe, with lipid transfer protein (LTP) allergy being more severe and mainly occurring in Southern Europe. This review seeks to update the reader on both types of plant food allergy and to determine whether the stereotypical presentations of these plant food allergies remain the same, with a particular focus on reaction severity.

Recent findings

Recent findings suggest that both these types of plant food allergy occur in children and adults. Although it is true that PFS allergy is more prevalent in Northern Europe and LTP allergy is more well known in Southern Europe, these conditions are not hidebound by geography, and the increasing spread and allergenicity of pollen due to global warming continues to change their presentation. Both conditions have a spectrum of symptom severity, with PFS sometimes presenting with more severe symptoms, including anaphylaxis and LTP allergy with milder reactions.

It is important to consider that in many parts of Europe, reactions to plant foods, especially fruits or vegetables, could be mediated either by pollen cross-reactivity or primary sensitization to LTP allergens. All those presenting with symptoms to plant foods will benefit from a detailed clinical history and appropriate tests so that an accurate diagnosis can be made, and correct management implemented.
Highlights mild traumatic brain injury 2021
Authors: van der Naalt Joukje , Jacobs Bram
Published: August 2022

Purpose

Mild traumatic brain injury (TBI) is one of the most common causes of morbidity worldwide. Patients at risk of unfavourable outcome may benefit from additional attention and help but identification of these patients necessitates the development of diagnostic methods to assess indices of brain injury at an early stage. The aim of this overview is to highlight studies that reflect the growing scientific attention to the early diagnosis and prognostication of mild TBI.

Recent findings

The value of serum biomarkers for the diagnosis of TBI severity has been acknowledged in recent studies. The diagnostic and prognostic utility of several biomarkers of brain injury, such as glial fibrillary acidic protein, and of inflammation, such as interleukin (IL)-6 and IL-10, holds promise for application in daily clinical practice in a point-of-care platform. Besides head CT imaging, early advanced MRI brain imaging has been reported as a tool for assessment of injury severity and prognostication. The introduction of direct oral anticoagulants (DOACs) has raised new challenges for the treatment of intracranial traumatic haemorrhage at the Emergency Department.

Promising findings of new diagnostic markers of brain injury severity highlight the potential prognostic value of serum biomarkers and early MRI imaging. The accurate assessment of patients at risk of incomplete recovery after mTBI will enhance more timely and individualized treatment.
The Utility of Transcranial Stimulated Motor-Evoked Potential Alerts in Cervical Spine Surgery Varies Based on Preoperative Motor Status
Authors: Funaba Masahiro , Kanchiku Tsukasa , Kobayashi Kazuyoshi , Yoshida Go , Machino Masaaki , Yamada Kei , Shigematsu Hideki , Tadokoro Nobuaki , Ushirozako Hiroki , Takahashi Masahito , Yamamoto Naoya , Morito Shinji , Kawabata Shigenori , Fujiwara Yasushi , Ando Muneharu , Taniguchi Shinichirou , Iwasaki Hiroshi , Wada Kanichiro , Yasuda Akimasa , Hashimoto Jun , Takatani Tsunenori , Ando Kei , Matsuyama Yukihiro , Imagama Shiro
Published: August 2022

Study Design.

A prospective multicenter observational study.

Objective.

The aim was to investigate the validity of transcranial motor-evoked potentials (Tc-MEP) in cervical spine surgery and identify factors associated with positive predictive value when Tc-MEP alerts are occurred.

Summary of Background Data.

The sensitivity and specificity of Tc-MEP for detecting motor paralysis are high; however, false-positives sometimes occur.

Materials and Methods.

The authors examined Tc-MEP in 2476 cases of cervical spine surgeries and compared patient backgrounds, type of spinal disorders, preoperative motor status, surgical factors, and the types of Tc-MEP alerts. Tc-MEP alerts were defined as an amplitude reduction of more than 70% from the control waveform. Tc-MEP results were classified into two groups: false-positive and true-positive, and items that showed significant differences were extracted by univariate analysis and detected by multivariate analysis.

Results.

Overall sensitivity was 66% (segmental paralysis: 33% and lower limb paralysis: 95.8%) and specificity was 91.5%. Tc-MEP outcomes were 33 true-positives and 233 false-positives. Positive predictive value of general spine surgery was significantly higher in cases with a severe motor status than in a nonsevere motor status (19.5% vs. 6.7%, P=0.02), but not different in high-risk spine surgery (20.8% vs. 19.4%). However, rescue rates did not significantly differ regardless of motor status (48% vs. 50%). In a multivariate logistic analysis, a preoperative severe motor status [P=0.041, odds ratio (OR): 2.46, 95% confidence interval (95% CI): 1.03–5.86] and Tc-MEP alerts during intradural tumor resection (P<0.001, OR: 7.44, 95% CI: 2.64–20.96) associated with true-positives, while Tc-MEP alerts that could not be identified with surgical maneuvers (P=0.011, OR: 0.23, 95% CI: 0.073–0.71) were associated with false-positives.

Conclusion.

The utility of Tc-MEP in patients with a preoperative severe motor status was enhanced, even in those without high-risk spine surgery. Regardless of the motor status, appropriate interventions following Tc-MEP alerts may prevent postoperative paralysis.
Neoadjuvant chemotherapy for patients with locally advanced vulvar cancer
Authors: Nooij Linda , Schaake Eva , Reyners Anna , Zijlmans Henry , Amant Frédéric
Published: August 2022

Purpose of review

Studies on treatment options for patients with locally advanced vulvar cancer (LAVC) are scarce, and high-level evidence for a primary treatment choice is lacking. Furthermore, current treatment options are associated with extensive morbidity and high complication rates. More effective treatment options are urgently needed. This review describes current treatment possibilities, focusing on literature regarding neoadjuvant chemotherapy (NACT) followed by surgery.

Recent findings

Although data are heterogeneous and limited, NACT followed by surgery might be an effective and well tolerated treatment alternative associated with lower morbidity compared with current treatment options, such as excenterative surgery or definitive chemoradiation.

Up until now, several studies describe an overall response rate of 40–86%. Surgery turned out to be possible in 40–90% of the LAVC patients who received NACT. Prospective studies on the efficacy and safety of NACT followed by surgery with a homogeneous chemotherapy regimen are urgently awaited. NACT should, at this point, still be considered investigational.
Evidence-Based Clinical Decision Support to Improve Care for Patients Hospitalized With Acute Myocardial Infarction
Authors: Fry Corey , Engel Jill , Granger Bradi , Komada Michael , Lovins Jon
Published: August 2022

Clinical decision support in the EHR is an innovation that can support guideline adherence in acute myocardial infarction. Cardiac rehabilitation referral and left ventricular systolic function assessment are part of evidence-based clinical practice guidelines associated with reduced morbidity and mortality following acute myocardial infarction. Effective clinical decision support is sustained by evidence-based principles for design and implementation. This quality improvement project evaluated the impact of practice advisories designed using principles of effective clinical decision support design to improve performance of left ventricular systolic function assessment and ambulatory referral to cardiac rehabilitation for patients hospitalized with acute myocardial infarction. Performance in cardiac rehabilitation referral and left ventricular systolic function assessment was measured for a 3-month interval pre- and post-intervention. Pre-implementation, cardiac rehabilitation referral or valid documented reason for non-referral was 80.3%. Rehabilitation referral or documented valid reason for non-referral increased to 98.4% post-implementation (P < .001). Left ventricular systolic function assessment increased from 94.2% to 100% following clinical decision support implementation (P = .120). This quality improvement project supports the positive impact of effective clinical decision support design and implementation to improve outcomes for patients hospitalized with acute myocardial infarction.
Immune Checkpoint Inhibitors Have Clinical Activity in Patients With Recurrent Chordoma
Authors: Bishop Andrew J. , Amini Behrang , Lin Heather , Raza Shaan M. , Patel Shreyaskumar , Grosshans David R. , Ghia Amol , Farooqi Ahsan , Guadagnolo B. Ashleigh , Mitra Devarati , Akdemir Kadir C. , Lazar Alexander J. , Wang Wei-Lien , Alvarez-Breckenridge Christopher , Bird Justin , Rhines Laurence D. , Somaiah Neeta , Conley Anthony P.
Published: August 2022

The aim of this study is to evaluate the outcomes and tolerance of immune checkpoint inhibitors (ICIs) for patients with recurrent chordoma. We reviewed the records of 17 patients with recurrent chordomas who received ICIs for progressing disease as part of their treatment between 2016 and 2020. Response was assessed using response evaluation criteria in solid tumors 1.1 criteria. The Kaplan-Meier method was used to estimate the duration of response, progression-free survival (PFS), and overall survival (OS). Clinical benefit was defined as having stable disease (SD), a partial response, or a complete response. The median follow-up from the start of ICIs was 29 months [interquartile range (IQR): 13–35 m]. The majority received pembrolizumab (n=9, 53%), and the median number of cycles delivered was 8 (IQR: 7–12). The 1-year OS was 87%, and the 1-year PFS was 56% with a median PFS of 14 months (95% CI, 5–17 mo). After ICI initiation, most patients (n=15, 88%) had clinical benefit consisting of a complete response (n=1, 6%), partial response (n=3, 18%), and stable disease (n=11, 65%). Among all responders (n=15), the median duration of response was 12 months. Toxicities were limited: 2 (12%) patients having grade 3/4 immune-related toxicities (colitis, grade 3; myocarditis, grade 4). We observed a high rate of clinical benefit and favorable durability from ICI use for patients with recurrent chordoma. These data provide support for the integration of ICIs as a standard first-line systemic therapy option for patients with recurrent chordoma. Prospective studies are warranted to further evaluate efficacy and enhance response rates.
Essential tremor-Parkinson's disease syndrome: clinical characteristics and subtypes using cluster analysis
Authors: Hou Yanbing , Han Qin , Ou Ruwei , Liu Kuncheng , Lin Junyu , Yang Tianmi , Shang Huifang
Published: August 2022

Background:

Essential tremor (ET) and Parkinson's disease (PD) are common movement disorders. ET-PD syndrome is characterized by the occurrence of PD in patients with a previous history of ET, which may be an independent phenotype distinct from PD. This study aims to identify clinical characteristics and subtypes in ET-PD.

Methods:

A total of 93 newly diagnosed ET-PD patients and 93 newly diagnosed PD patients matched for age, sex, education, and disease duration of PD were selected using propensity score matching analysis. The K-means cluster analysis was performed for 11 variables derived from the ET-PD group, and cluster profiles were established through statistical analysis of demographic and clinical variables.

Results:

The ET-PD group consisted of a high number of patients with a family history of ET exhibiting evident tremor with milder hypokinesia and postural instability symptoms, as compared to the PD group. Through the cluster analysis, two clusters of ET-PD patients were identified. The ET-PD cluster 1 (n = 34) had a shorter ET duration before PD onset, lower number of patients with a family history of ET, higher unified PD rating scale instability scores, higher non-motor symptoms scores (non-motor symptoms scale D1 scores, Hamilton depression scale scores, Hamilton anxiety scale scores, and PD sleep scale-2 scores), and higher Chinese version of the PD questionnaire-39 scores relative to the ET-PD cluster 2 (n = 59).

Conclusion:

ET-PD patients had significantly different characteristics for motor symptoms as compared to PD patients, and may be distinctly divided into two clinical subtypes, namely, the ET-PD complex type and the ET-PD simple type.
Clinical impact and mechanisms in hepatitis B virus infection concurrent with non-alcoholic fatty liver disease
Authors: Tong Xin , Song Yu , Yin Shengxia , Wang Jian , Huang Rui , Wu Chao , Shi Junping , Li Jie
Published: August 2022

Chronic hepatitis B (CHB) virus infection is an important threat to global health despite the administration of vaccines and the use of antiviral treatments. In recent years, as the prevalence of obesity and metabolic syndrome has increased, non-alcoholic fatty liver disease (NAFLD) in patients with CHB has become more common. Both diseases can lead to liver fibrosis and even hepatocellular carcinoma, but the risk of dual etiology, outcome, and CHB combined with NAFLD is not fully clear. In this review, we assess the overlapping prevalence of NAFLD and CHB, summarize recent studies of clinical and basic research related to potential interactions, and evaluate the progressive changes and treatments for CHB patients with NAFLD. This study increases the understanding of the relationship and mechanisms of interaction between steatosis and hepatitis B virus infection, and it provides new strategies for the future clinical management and treatment of CHB combined with NAFLD.
SARS-CoV-2 Outbreak Dynamics in an Isolated US Military Recruit Training Center With Rigorous Prevention Measures
Authors: Lizewski Rhonda A. , Sealfon Rachel S. G. , Park Sang Woo , Smith Gregory R. , Porter Chad K. , Gonzalez-Reiche Ana S. , Ge Yongchao , Miller Clare M. , Goforth Carl W. , Pincas Hanna , Termini Michael S. , Ramos Irene , Nair Venugopalan D. , Lizewski Stephen E. , Alshammary Hala , Cer Regina Z. , Chen Hua Wei , George Mary-Catherine , Arnold Catherine E. , Glang Lindsay A. , Long Kyle A. , Malagon Francisco , Marayag Jan J. , Nunez Edgar , Rice Gregory K. , Santa Ana Ernesto , Schilling Megan A. , Smith Darci R. , Sugiharto Victor A. , Sun Peifang , van de Guchte Adriana , Khan Zenab , Dutta Jayeeta , Vangeti Sindhu , Voegtly Logan J. , Weir Dawn L. , Metcalf C. Jessica E. , Troyanskaya Olga G. , Bishop-Lilly Kimberly A. , Grenfell Bryan T. , van Bakel Harm , Letizia Andrew G. , Sealfon Stuart C.
Published: August 2022

Background:

Marine recruits training at Parris Island experienced an unexpectedly high rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, despite preventive measures including a supervised, 2-week, pre-entry quarantine. We characterize SARS-CoV-2 transmission in this cohort.

Methods:

Between May and November 2020, we monitored 2,469 unvaccinated, mostly male, Marine recruits prospectively during basic training. If participants tested negative for SARS-CoV-2 by quantitative polymerase chain reaction (qPCR) at the end of quarantine, they were transferred to the training site in segregated companies and underwent biweekly testing for 6 weeks. We assessed the effects of coronavirus disease 2019 (COVID-19) prevention measures on other respiratory infections with passive surveillance data, performed phylogenetic analysis, and modeled transmission dynamics and testing regimens.

Results:

Preventive measures were associated with drastically lower rates of other respiratory illnesses. However, among the trainees, 1,107 (44.8%) tested SARS-CoV-2-positive, with either mild or no symptoms. Phylogenetic analysis of viral genomes from 580 participants revealed that all cases but one were linked to five independent introductions, each characterized by accumulation of mutations across and within companies, and similar viral isolates in individuals from the same company. Variation in company transmission rates (mean reproduction number R0; 5.5 [95% confidence interval [CI], 5.0, 6.1]) could be accounted for by multiple initial cases within a company and superspreader events. Simulations indicate that frequent rapid-report testing with case isolation may minimize outbreaks.

Conclusions:

Transmission of wild-type SARS-CoV-2 among Marine recruits was approximately twice that seen in the community. Insights from SARS-CoV-2 outbreak dynamics and mutations spread in a remote, congregate setting may inform effective mitigation strategies.
Differences in Health Care Access, Utilization, and Experiences Among LGBTQ+ Subgroups in the Southern United States
Authors: Holt Natalie R. , Eldridge-Smith Elizabeth D. , Griffin James A. , Stepleman Lara M. , Drescher Christopher F. , Casanova Tracy
Published: August 2022

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals experience health inequities and barriers to accessing appropriate, affirming care. Little is known about differing health care experiences within the LGBTQ+ population, particularly among individuals living in underserved areas. This study explored health care experiences and utilization among LGBTQ+ subgroups: lesbian and gay cisgender individuals (n = 258), bisexual+ cisgender individuals (n = 71), and transgender and gender-diverse individuals (n = 80). Participants were recruited from a geographic region in South Carolina and Georgia and completed an online survey regarding negative health care experiences, barriers to care, and utilization of different health care venues and services. Results revealed significant differences between LGBTQ+ subgroups, with transgender and gender-diverse participants reporting more discriminatory experiences and greater barriers to care. Bisexual+ cisgender individuals also experienced some disparities compared with lesbian and gay cisgender individuals. Most participants endorsed a need for more competent providers. Findings and recommendations are considered within the context of the Southeastern United States for addressing access and utilization disparities among LGBTQ+ communities.
Time course of beat-to-beat blood pressure variability and outcome in patients with spontaneous intracerebral haemorrhage
Authors: Qu Yang , Guo Zhen-Ni , Zhang Peng , Ma Hong-Yin , Sun Ying-Ying , Ren Jia-Xin , Liu Jia , Zhang Pan-Deng , Yang Yi
Published: August 2022

Objectives:

Increased blood pressure variability (BPV) over 24 h or longer was associated with poor clinical outcomes in patients with intracerebral haemorrhage (ICH). However, the characteristics of beat-to-beat BPV, a rapid assessment of BPV and its association with outcome in ICH patients remain unknown.

Methods:

We consecutively and prospectively recruited patients with ICH between June 2014 and December 2020. Five-minute noninvasive beat-to-beat recordings were measured serially at three time points, 1–2, 4–6 and 10–12 days after ICH onset. BPV was calculated using standard deviation (SD) and variation independent of mean (VIM). Favourable outcome was defined as modified Rankin Scale score of less than 2 at 90 days.

Results:

The analysis included 66 participants (54.12 ± 10.79 years; 71.2% men) and 66 age and sex-matched healthy controls. Compared with that in healthy adults, beat-to-beat BPV was significantly increased 1–2 days after ICH and was completely recovered 10–12 days later. BPV recorded 1–2 days after ICH onset was higher among patients with unfavourable outcomes than among those with favourable outcomes (all P < 0.05) and higher BPV on days 1–2 was independently associated with a 3-month unfavourable outcome after adjustment for major covariates.

Conclusion:

Beat-to-beat BPV was significantly increased among patients with ICH and could be completely recovered 10–12 days later. In addition, beat-to-beat BPV 1–2 days after ICH was independently associated with prognosis and could be regarded as a potential prognostic predictor and effective therapeutic target in the future.
Mineralocorticoid receptor antagonism improves transient receptor potential vanilloid 4-dependent dilation of cerebral parenchymal arterioles and cognition in a genetic model of hypertension
Authors: Chambers Laura C. , Diaz-Otero Janice M. , Fisher Courtney L. , Jackson William F. , Dorrance Anne M.
Published: August 2022

Objective:

In a model of secondary hypertension, mineralocorticoid receptor (MR) antagonism during the development of hypertension prevents the impairment of transient receptor potential vanilloid 4 (TRPV4) activation in parenchymal arterioles (PAs) and cognitive impairment. However, it is unknown whether MR antagonism can improve these impairments when treatment begins after the onset of essential hypertension. We tested the hypothesis that MR activation in stroke-prone spontaneously hypertensive rats (SHRSP) leads to impaired TRPV4-mediated dilation in PAs that is associated with cognitive dysfunction and neuroinflammation.

Methods:

20–22-week-old male SHRSP ± eplerenone (EPL; 100 mg/kg daily for 4 weeks) were compared to normotensive Sprague−Dawley (SD) rats. Pressure myography was used to assess PA function. Cognition was tested using Y-maze. Neuroinflammation was assessed using immunofluorescence and qRT-PCR.

Results:

Carbachol-mediated endothelium-dependent dilation was impaired in SHRSP, and MR antagonism improved this without affecting myogenic tone. Dilation to TRPV4 agonist GSK1016790A was impaired in SHRSP, and ELP treatment restored this. Intermediate conductance potassium channel (IKCa)/small conductance potassium channel (SKCa)-mediated dilation was impaired by hypertension and unaffected by EPL treatment. TRPV4 and IKCa/SKCa channel mRNA expression were reduced in PAs from hypertensive rats, and EPL did not improve this. Impairments in PA dilation in SHRSP were associated with cognitive decline, microglial activation, reactive astrogliosis, and neuroinflammation; cognitive and inflammatory changes were improved with MR blockade.

Conclusions:

These data advance our understanding of the effects of hypertension on cerebral arterioles using a clinically relevant model and treatment paradigm. Our studies suggest TRPV4 and the MR are potential therapeutic targets to improve cerebrovascular function and cognition during hypertension.
Presbyopic Corneal Inlay Extrusion Consequent to Sterile Keratolysis: Surgical Revision and Long-Term Management
Authors: Kanellopoulos Anastasios John
Published: August 2022

Purpose:

The purpose of this study was to report a serious complication of early sterile keratolysis associated with a presbyopia inlay implantation combined with hyperopic laser in situ keratomileusis (LASIK).

Methods:

A 55-year-old hyperopic man underwent uneventful topography-guided bilateral femtosecond laser-assisted hyperopic LASIK, combined with same-day polymer refractive inlay implantation in the nondominant eye for additional presbyopia correction. Within 2 months, anterior sterile keratolysis and partial extrusion required surgical explantation of the inlay, and long-term medical management over 9 years achieved effective visual rehabilitation documented also with corneal imaging.

Results:

Immediate postoperative results were binocular 20/20 uncorrected distance visual acuity and J1 uncorrected near visual acuity. The early progressive anterior sterile keratolysis and partial extrusion necessitated surgical explantation at 2 months, severe anterior scarring of the perforated flap area and severe focal flattening of the cornea of over 10 diopters, developed despite aggressive topical corticosteroid use. The uncorrected distance visual acuity in the OS dropped from 20/25 to 20/400. The LASIK flap portion that underwent keratolysis and perforated, remodeled long-term from a scarred, epithelial plug with early significant surface concavity to evidently a mild subepithelial localized hazy area with regularized curvature over a period of 9 years.

Conclusions:

Some refractive synthetic corneal inlays have been recalled because they may result in significant corneal haze. We present herein a case of severe keratolysis that necessitated surgical explantation and further document long-term care for eventual visual rehabilitation.
Unintentional Descemet Cleft Introduces Novel Mechanism of Maintenance of Corneal Clarity
Authors: Sherif Noha A. , Fleischman David , Knight O'Rese J.
Published: August 2022

Purpose:

The purpose of this study was to report a case of corneal transparency for 7 months after the formation and persistence of a Descemet fluid cleft.

Methods:

We report the case of a 64-year-old woman undergoing anterior chamber reformation 2 months after Baerveldt implantation of the right eye. During the procedure, the ophthalmic viscoelastic was inadvertently injected into the posterior stroma, nearly isolating the corneal endothelial cell layer, and creating a Descemet fluid cleft filled with viscoelastic. The patient was managed conservatively and monitored near monthly for corneal decompensation.

Results:

The cornea remained centrally clear for 207 days after the initial anterior chamber reformation until the collapse of the viscoelastic cleft. When the cleft completely collapsed, the cornea became diffusely edematous, and the patient underwent cataract removal and intraocular lens placement without need for Descemet stripping endothelial keratoplasty to maintain vision. During these 7 months, the patient's best-corrected visual acuity remained stable at 20/25+2 or better. Intraocular pressure was also stable, averaging 18.2 mm Hg.

Conclusions:

We hypothesize that corneal transparency can be maintained in the absence of endothelial cell function provided that aqueous humor cannot reach the cornea and disrupt the arrangement of the interfibrillar space.
Analysis of Changes in High-order Aberration and Contrast Sensitivity After Epiblepharon Surgery
Authors: Na Jeong Ho , Lee Soo Jung
Published: August 2022

Purpose:

To investigate changes in corneal anterior high-order aberration (HOA) and contrast sensitivity (CS) before and after epiblepharon surgery.

Methods:

A retrospective observational analysis of the degree of corneal erosion, HOAs and CS was conducted in the OD and OS, respectively, before and after epiblepharon surgery. The correlations between corneal erosion, HOAs, and CS were analyzed.

Results:

Forty-nine patients were included in the study. Among the anterior HOAs, total HOA, coma, and trefoil showed significant improvement after surgery (P = 0.003, P = 0.009, and P = 0.018, respectively). In the CS test, there was a significant improvement in CS after surgery at 1.1 cycles per degree (cpd) under photopic conditions, regardless of glare. Preoperative correlation analysis between HOAs and corneal erosion showed a significant positive correlation with total HOA (P = 0.001) and coma (P = 0.001). Preoperative correlation analysis between CS and corneal erosion showed a significant negative correlation at 1.1 cpd with glare under photopic conditions (P = 0.049). A negative correlation was also observed between CS under mesopic and photopic conditions and total HOA both before and after surgery.

Conclusion:

Significant improvement in corneal anterior HOAs and CS at 1.1 cpd under photopic conditions was observed after epiblepharon surgery. Total HOA of anterior cornea showed a negative correlation with CS. A decrease in HOAs and recovery of corneal erosion after epiblepharon surgery will help improve CS.