bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term XMM–Newton view of magnetar CXOU J010043.1−721134: comprehensive spectral and temporal results
Authors: Chatterjee Rwitika , Agrawal Vivek K , Nandi Anuj
Published: June 2021

We present an in-depth analysis and results of eleven XMM–Newton data sets, spanning 2000–2016, of the anomalous X-ray Pulsar CXOU J010043.1−721134 that has been classified as a magnetar. We find a spin period of 8.0275(1) s as of December 2016 and calculate the period derivative to be (1.76 ± 0.02) × 10−11 s s−1, which translate to a dipolar magnetic field strength of 3.8 × 1014 G and characteristic age of ∼7200 yr for the magnetar. It has a double-peaked pulse profile, with one broad and one narrow peak, in both soft (0.3–1.3 keV) and hard (1.3–8 keV) energy bands. The pulse fractions in the two energy bands are found to be consistent with constant values. These results are in agreement with previously published results for this source. Although two-component models produce acceptable fits to its energy spectra, single component models are much simpler and are able to explain the similarity of the pulse profiles in the low- and high-energy bands. We attempt fitting with four different single-component models and find that the best fit to the spectra is obtained by fitting a thermal Comptonization model with the photon index (Γ) between 2.0 and 2.7, and the electron temperature ( kTe) between 0.5 and 0.9 keV, for a seed blackbody photon distribution of 0.2 keV. Finally, we conclude by discussing our results briefly.
XMM-Newton campaign on the ultraluminous X-ray source NGC 247 ULX-1: outflows
Authors: Pinto C , Soria R , Walton D J , D’Aì A , Pintore F , Kosec P , Alston W N , Fuerst F , Middleton M J , Roberts T P , Del Santo M , Barret D , Ambrosi E , Robba A , Earnshaw H , Fabian A C
Published: June 2021

Most ultraluminous X-ray sources (ULXs) are believed to be powered by super-Eddington accreting neutron stars and, perhaps, black holes. Above the Eddington rate the disc is expected to thicken and to launch powerful winds through radiation pressure. Winds have been recently discovered in several ULXs. However, it is yet unclear whether the thickening of the disc or the wind variability causes the switch between the classical soft and supersoft states observed in some ULXs. In order to understand such phenomenology and the overall super-Eddington mechanism, we undertook a large (800 ks) observing campaign with XMM-Newton to study NGC 247 ULX-1, which shifts between a supersoft and classical soft ULX state. The new observations show unambiguous evidence of a wind in the form of emission and absorption lines from highly ionized ionic species, with the latter indicating a mildly relativistic outflow (−0.17c) in line with the detections in other ULXs. Strong dipping activity is observed in the light curve and primarily during the brightest observations, which is typical among soft ULXs, and indicates a close relationship between the accretion rate and the appearance of the dips. The latter is likely due to a thickening of the disc scale height and the wind as shown by a progressively increasing blueshift in the spectral lines.
Rotational variation in the chemically peculiar B0 star θ Car as seen by TESS
Authors: Koen Chris , Johnston Cole
Published: June 2021

θ Car is a bright well studied B0 type star in a close binary (Porb = 2.2 d) with an unseen companion. The system has enjoyed extensive spectroscopic characterization at multiple wavelengths, revealing narrow X-ray lines, a soft X-ray tail, and chemical peculiarities. The star was recently observed in high-cadence photometric time-series by the NASA TESS satellite. In this paper, we investigate the photometric variability and demonstrate that it is likely associated with surface brightness inhomogeneities rather than orbital modulation. We investigate the potential distribution of surface features required to produce the observed variability, and report a new rotational period of Prot = 2.2034 d to be commensurate with the orbital period.
Fundamental differences in the radio properties of red and blue quasars: kiloparsec-scale structures revealed by e-MERLIN
Authors: Rosario D J , Alexander D M , Moldon J , Klindt L , Thomson A P , Morabito L , Fawcett V A , Harrison C M
Published: June 2021

Red quasi-stellar objects (QSOs) are a subset of the quasar population with colours consistent with reddening due to intervening dust. Recent work has demonstrated that red QSOs show special radio properties that fundamentally distinguish them from normal blue QSOs, specifically a higher incidence of low-power radio emission (1.4 GHz luminosities L1.4 ≈ 1025–1027 W Hz−1) that is physically compact when imaged by arcsecond-resolution radio surveys such as FIRST. In this work, we present e-MERLIN imaging of a set of intermediate-redshift (1.0 < z < 1.55), luminous (bolometric luminosities Lbol ≈ 1046–1047 erg s−1) red and normal QSOs carefully selected to have radio properties that span the range over which red QSOs show the most divergence from the general population. With an angular resolution 25× better than FIRST, we resolve structures within the host galaxies of these QSOs (>2 kpc). We report a statistically significant difference in the incidence of extended kpc-scale emission in red QSOs. From an analysis of the radio size distributions of the sample, we find that the excess radio emission in red QSOs can be attributed to structures that are confined to galaxy scales (<10 kpc), while we confirm previous results that red and normal QSOs have similar incidences of radio jets and lobes on circumgalactic or larger scales (>10 kpc). Our results indicate that the primary mechanism that generates the enhanced radio emission in red QSOs is not directly connected with the nuclear engine or accretion disc, but is likely to arise from extended components such as AGN-driven jets or winds.
The Cosmic Ultraviolet Baryon Survey (CUBS) – III. Physical properties and elemental abundances of Lyman-limit systems at z < 1
Authors: Zahedy Fakhri S , Chen Hsiao-Wen , Cooper Thomas M , Boettcher Erin , Johnson Sean D , Rudie Gwen C , Chen Mandy C , Cantalupo Sebastiano , Cooksey Kathy L , Faucher-Giguère Claude-André , Greene Jenny E , Lopez Sebastian , Mulchaey John S , Penton Steven V , Petitjean Patrick , Putman Mary E , Rafelski Marc , Rauch Michael , Schaye Joop , Simcoe Robert A , Walth Gregory L
Published: June 2021

We present a systematic investigation of physical conditions and elemental abundances in four optically thick Lyman-limit systems (LLSs) at z = 0.36–0.6 discovered within the Cosmic Ultraviolet Baryon Survey (CUBS). Because intervening LLSs at z < 1 suppress far-UV (ultraviolet) light from background QSOs, an unbiased search of these absorbers requires a near-UV-selected QSO sample, as achieved by CUBS. CUBS LLSs exhibit multicomponent kinematic structure and a complex mix of multiphase gas, with associated metal transitions from multiple ionization states such as C ii, C iii, N iii, Mg ii, Si ii, Si iii, O ii, O iii, O vi, and Fe ii absorption that span several hundred km s−1 in line-of-sight velocity. Specifically, higher column density components (log N(H i)/cm−2≳ 16) in all four absorbers comprise dynamically cool gas with $\langle T \rangle =(2\pm 1) \times 10^4\,$K and modest non-thermal broadening of $\langle b_\mathrm{nt} \rangle =5\pm 3\,$km s−1. The high quality of the QSO absorption spectra allows us to infer the physical conditions of the gas, using a detailed ionization modelling that takes into account the resolved component structures of H i and metal transitions. The range of inferred gas densities indicates that these absorbers consist of spatially compact clouds with a median line-of-sight thickness of $160^{+140}_{-50}$ pc. While obtaining robust metallicity constraints for the low density, highly ionized phase remains challenging due to the uncertain $N\mathrm{(H\, {\small I})}$, we demonstrate that the cool-phase gas in LLSs has a median metallicity of $\mathrm{[\alpha /H]_{1/2}}=-0.7^{+0.1}_{-0.2}$, with a 16–84 percentile range of [α/H] = (−1.3, −0.1). Furthermore, the wide range of inferred elemental abundance ratios ([C/α], [N/α], and [Fe/α]) indicate a diversity of chemical enrichment histories. Combining the absorption data with deep galaxy survey data characterizing the galaxy environment of these absorbers, we discuss the physical connection between star-forming regions in galaxies and diffuse gas associated with optically thick absorption systems in the z < 1 circumgalactic medium.
Comparison Between Flow-Regulated and Gravitational Shunt Valves in the Treatment of Normal Pressure Hydrocephalus: Flow-Grav Study
Authors: Scheffler Pierre , Oertel Markus Florian , Stieglitz Lennart Henning
Published: June 2021

BACKGROUND

Normal pressure hydrocephalus (NPH) is frequently treated with ventriculoperitoneal shunt (VPS) surgery. However, VPS implantation can lead to overdrainage and complications such as headaches, hygroma, and subdural hematoma due to a siphon effect in an upright position. Gravitational valves prevent overdrainage through position-dependent adjustment of valve resistance. Flow-regulated valves that increase resistance in presence of high cerebrospinal fluid flow may provide similar protection against overdrainage and present an alternative to gravitational valves.

OBJECTIVE

To compare gravitational and flow-regulated shunt valves in patients with symptomatic NPH.

METHODS

We performed a retrospective analysis of 97 patients suffering from NPH who underwent VPS implantation with a gravitational or a flow-regulated valve. The primary endpoint was the occurrence of hygroma or subdural hematoma. Secondary endpoints were neurological outcome (Kiefer score, Stein and Langfitt score, and NPH recovery rate), frequency of valve adjustments, and reoperations.

RESULTS

No significant differences in the occurrence of hygroma and subdural hematoma (11.4% for flow-regulated valves vs 5.7% for gravitational valves, P = .462) or response to treatment (77.3% vs 81.1%, P = .802) were found. Patients with flow-regulated valves required fewer valve adjustments (1.12 vs 2.02, P < .001) to reach their optimal neurological outcome and underwent fewer surgical revisions (11.4% vs 28.3%, P = .047).

CONCLUSION

Our data suggest that shunt therapy in NPH patients with a flow-regulated instead of a gravitational valve is safe and effective with a comparable clinical outcome and risk of overdrainage complications. Moreover, patients with flow-regulated valves may need fewer valve adjustments and reoperations.
Fully accounting for nest age reduces bias when quantifying nest survival
Authors: Weiser Emily L
Published: June 2021

Accurately measuring nest survival is challenging because nests must be discovered to be monitored, but nests are typically not found on the first day of the nesting interval. Studies of nest survival therefore often monitor a sample that overrepresents older nests. To account for this sampling bias, a daily survival rate (DSR) is estimated and then used to calculate nest survival to the end of the interval. However, estimates of DSR (and thus nest survival) can still be biased if DSR changes with nest age and nests are not found at age 0. Including nest age as a covariate of DSR and carefully considering the method of estimating nest survival can prevent such biases, but many published studies have not fully accounted for changes in DSR with nest age. I used a simulation study to quantify biases in estimates of nest survival resulting from changes in DSR with nest age under a variety of scenarios. I tested four methods of estimating nest survival from the simulated datasets and evaluated the bias and variance of each estimate. Nest survival estimates were often strongly biased when DSR varied with age but DSR was assumed to be constant, as well as when the model included age as a covariate but calculated nest survival from DSR at the mean monitored nest age (the method typically used in previous studies). In contrast, biases were usually avoided when nest survival was calculated as the product of age-specific estimates of DSR across the full nesting interval. However, the unbiased estimates often showed large variance, especially when few nests were found at young ages. Future field studies can maximize the accuracy and precision of nest survival estimates by aiming to find nests at young ages, including age as a covariate in the DSR model, and calculating nest survival as the product of age-specific estimates of DSR when DSR changes with nest age.
The assessment: artificial intelligence and financial services
Authors: Bholat David , Susskind Daniel
Published: June 2021

This special issue of the Oxford Review of Economic Policy, based on papers presented at a Bank of England conference, explores the impact of artificial intelligence (AI) on financial services. This opening article provides an overview of AI and its increased use in the financial sector; considers the implications for consumers and competition in the sector; looks at the consequences for central bankers and regulators; and reflects on a more distant world where AI is far more advanced than today. In short, the effect of AI on financial services is likely to be transformative, but that impact remains complex and uncertain.
Associations Between Negative Symptoms and Effort Discounting in Patients With Schizophrenia and Major Depressive Disorder
Authors: Cathomas Flurin , Klaus Federica , Guetter Karoline , Seifritz Erich , Hartmann-Riemer Matthias N , Tobler Philippe N , Kaiser Stefan , Kaliuzhna Mariia
Published: June 2021

Deficits in goal-directed decision making and motivation are hallmark characteristics of several neuropsychiatric disorders, including schizophrenia (SZ) and major depressive disorder (MDD). Studies using effort-based decision-making tasks have shown that both patients with SZ and MDD invest less physical effort in order to obtain rewards. However, how these motivational deficits relate to clinically assessed symptom dimensions such as apathy remains controversial. Using a grip-strength-based effort discounting task we assessed effort-based decision-making behavior in healthy controls (HC) (N = 18), patients with SZ (N = 42), and MDD (N = 44). We then investigated how effort discounting relates to different symptom dimensions. There were no differences in effort discounting between HC participants and patients with SZ or MDD. In addition, we did not observe a correlation between effort discounting and negative symptoms (NS) in patients with SZ or MDD. In conclusion, the current study does not support an association between effort discounting and NS in SZ or MDD. Further studies are needed to investigate effort discounting and its relation to psychopathological dimensions across different neuropsychiatric disorders.
Complete Genome Sequence of Ralstonia syzygii subsp. indonesiensis Strain LLRS-1, Isolated from Wilted Tobacco in China
Authors: Lu Can-Hua , Li Jun-Ying , Mi Meng-Ge , Lin Zhong-Long , Jiang Ning , Gai Xiao-Tong , Jun-Hong Ma , Lei Li-Ping , Xia Zhen-Yuan
Published: June 2021

Here, we present the complete genome sequence and annotation of Ralstonia syzygii subsp. indonesiensis strain LLRS-1, which caused bacterial wilt on flue-cured tobacco in Yunnan Province, southwest China. Strain LLRS-1 is the first R. syzygii strain identified to be pathogenic to tobacco in China. The completely assembled genome of strain LLRS-1 consists of a 3,648,314-bp circular chromosome and a 2,046,405-bp megaplasmid with 5,190 protein-coding genes, 55 transfer RNAs, 28 small RNAs, 3 structural RNAs (5S, 16S, and 23S), and a G+C content of 67.05%.
Risky Food Handling Practices among Community‐Residing Older Adults
Authors: Yap LeLee , FRANCIS SARAH L , SHELLEY MACK , LILLEHOJ CATHERINE , MONTGOMERY DORIS , WINHAM DONNA M
Published: June 2021

Older adults are at greater risk for foodborne illness due to age and weakened immune function. Despite higher susceptibility to foodborne illness, older adults have low knowledge of food safety risk. It is essential to identify unsafe food handling behaviors among older adults so that interventions can be developed to decrease the likelihood of foodborne illness. Targeted, needs‐driven education materials and programs are the best methods to increase risk awareness among older adults and to provide the necessary prevention steps. The study purpose was to assess food handling behaviors that are increasing community‐residing older adults’ risk for foodborne illness. A convenience sample of 720 older adults from 67 congregate meal sites in a Midwest state completed a 10‐item food safety knowledge questionnaire that asked about the frequency of performing food safety behaviors. Participants were primarily widowed (54.3%), white (95.9%), females (75.4%), with a mean age of 78.6 years, who had a high school education (46.6%), and reported being in “average” health (31.9%). Review of descriptive statistics identified safety practices; chi‐square tests evaluated the associations between frequency of food safety practices, age, and gender. The majority of participants reported regularly practicing these specific safe food handling practices: refrigerating cold food immediately (97.6%), washing cutting boards after contact with meats (93.6%), discarding suspicious leftovers (93.6%), keeping sponges and towels clean (92.3%), and washing hands before food prep (91.4%). Conversely, a number of safety behaviors were not observed including: (1) thaw meat in refrigerator (50.0%), (2) pick up refrigerated/ frozen food just before checking out (38.5%), (3) check “sell‐by” and “use by” dates on packages (35.8%), or (4) use separate cutting boards for meat (21.0%). Age category was associated with picking up refrigerated / frozen food just before checking out (χ2[3] = 8.45, p = .038) and refrigerating leftovers immediately (χ2 [3] = 8.18, p = .043); participants aged 71–80 years reported a higher frequency of responding “no” than other age groups. Gender was associated with washing cutting boards after contact with meat (χ2 [1] = 12.25, p < .001) and keeping towels and sponges clean (χ2 [1] = 9.86, p = .002); a higher percentage of males reported “no” to these behaviors. Future food safety education for older adults should target these aforementioned food safety practices to reduce the risk of foodborne illness. Specific education should be targeted to older adults age 71–80 related to refrigeration safety and to older males regarding cleaning of food prep materials.

Support or Funding Information

Funded by USDA's SNAP, an equal opportunity provider and employer, in collaboration with the Iowa Department of Public Health
Dietary Strawberry Improves Cognition in Older adults: A Randomized, Double‐Blind, Placebo‐Controlled Trial
Authors: Miller Marshall G , Thangthaeng Nopporn , Scott Tammy M , Shukitt‐Hale Barbara
Published: June 2021

Older adults experience a variety of functional changes that decrease their quality of life with age‐related cognitive decline and reduced mobility being of particular concern. Pre‐clinical research indicates that berry fruit offer a promising dietary approach to preserving nervous system function, in part due to the antioxidant and anti‐inflammatory properties of their polyphenolic compounds. Based on the improvements in mobility and cognition observed among strawberry‐supplemented aged rats, we hypothesized that dietary supplementation with strawberry would also benefit older adults. The present study investigated the effects of strawberry supplementation (24g/day, ≈2 cups/day fresh strawberry) or placebo powder on healthy older men and women (60–75 years old). Motor and cognitive ability were assessed at days 0, 45, and 90 of supplementation. Improvements in hippocampally‐mediated word recognition and spatial memory were observed among participants that consumed strawberry, relative to placebo; however, no effects on mobility were observed. These findings suggest that the inclusion of strawberry in the diet may aid in preserving aspects of cognitive function during aging.

Support or Funding Information

USDA Intramural, California Strawberry Commission
Double Up Food Bucks Farmers’ Market Incentive Program: Food Insecurity and Fruit and Vegetable Consumption
Authors: Zimmerman Grant , Roskos Mateja Savoie , Feller Chelsea , Durward Carrie
Published: June 2021

Objective

To determine the impact of a farmers’ market incentive program on fruit and vegetable (F&V) intake and food security status of program participants.

Methods

Adults enrolled in the Supplemental Nutrition Assistance Program in the state of Utah were eligible to receive a dollar‐per‐dollar match up to $10/farmers market visit in tokens which could be used to purchase fruits and vegetables. F&V intake and food security status were measured in of 138 adult participants at the market and four weeks later using validated surveys. Changes in food security status and F&V consumption were tested using the Wilcoxon signed‐rank test.

Results

Participants were mostly non‐Hispanic white (87%) females (79.7%), with a mean age of 40 ± 12.5 (mean ± standard deviation) years. Although significant changes in food security were found when comparing baseline to endpoint (p= 0.001), the median change was 0.00 because some participants increased and others decreased. After the incentive program, reported F&V consumption increased by a median of 0.63 times/day (p=0.002), total fruit decreased by −0.02 times/day (p=0.008) and vegetable increase of 0.43 times/day (p=0.001).

Conclusions

Participation in the farmers’ market incentive program was associated with increased consumption of F&V for participants in the Supplemental Nutrition Assistance Program.

Support or Funding Information

USDA; Food Security and Nutritional Incentive Grants Program
Nutritional Changes During Biofortified Maize Fermentation (Steeping) for Ogi Production
Authors: Ortiz Darwin , Nkhata Smith , Buechler Aimee , Rocheford Torbert , Ferruzzi Mario G.
Published: June 2021

Maize is a staple food crop with an important role in the household food security in sub‐Saharan Africa where a significant number of people suffer vitamin A deficiency. Efforts are underway to develop new maize cultivars with improved levels of pro‐vitamin A carotenoids (pVACs). To enhance the bioavailability of nutrients from maize, various processes are used including soaking, fermentation, germination, malting, as well as thermal and mechanical processing. Fermentation is widely used in West Africa in the production of fermented cereal flours and in preparation of porridges and weaning foods. Recovery and bioavailability of pVACs from such foods is not well established for biofortified maize varieties. The purpose of this study was to assess nutritional and physical changes to five promising biofortified maize genotypes during processing of maize to a common fermented food product consumed in West Africa. Composition, stability, carotenoid bioaccessibility and carbohydrate digestibility were evaluated in experimental porridges prepared from each biofortified maize genotype processed with different degrees of fermentation (24, 72, 120h) as traditionally used for “ogi” production. Genotypes evaluated contained 3.0–8.5 μg/g β‐carotene equivalents on a dry weight basis (DW). pVAC retention after 24 h and 72 h fermentation ranged from 60–100% among genotypes. However, after 120 h fermentation recovery was reduced 27–48%. These results suggest some variation in stability of pVACs between genotypes. Bioaccessibility of pVACs determined by in vitro digestion of porridges ranged from 1.3–2.3% with significant differences observed among genotypes (p < 0.05) but not fermentation time. Rapid Visco Analyser (RVA) was used to assess functional properties of the fermented flours. RVA data showed that in general fermentation increased final viscosity of the fermented flours from an initial viscosity (403.4 ± 14.3 cP) to a maximum level (722.1 ± 12.2 cP) achieved after 72 h. However, a close relation between genotypes and final viscosity was observed that could potentially impact product sensory characteristics and bioaccessibility of pVACs. Biofortified genotypes did not have differences in their starch digestibility (p > 0.05). However, fermentation time did alter starch digestibility as assessed by glucose release (18.1–19.4 g/100g FW).

Support or Funding Information

Funding provided by NSF, HarvestPlus, USAID Food Processing Innovation Lab, Colciencias and Fulbright‐Colombia.
Effect of Allosteric Changes in MERS 3CL protease Enzymatic Activity and Dimerization
Authors: Gonzalez Leticia Sofia , Anson Brandon , Mesecar Andrew
Published: June 2021

MERS‐CoV, the Middle Eastern Respiratory Syndrome Coranavirus, was first identified in late 2012 causing public health havoc as more research tried to identity its virulence and relationship to SARS‐CoV. Currently, MERS‐CoV appears to have a 35% fatality rate for those infected. The catalytic dyad in its 3CLprotease (cysteine and histidine) is conserved within other beta coronaviruses. Overall there is ~98% conservation of the MERS‐CoV, HKU4, HKU5 proteome, yet the three viruses vary significantly in their dimerization binding affinity of their 3Clproteases. HKU4, HKU5 appear to have much stronger binding of their 3CLproteases, while MERS's 3CLprotease binding affinity constant is significantly lower. With a large percent of conserved proteomics it is crucial to further understand why the small percent of non‐conserved protein regions within the 3CLproteases contribute to great differences in affinity constant for MERS 3CLpro. It was the goal of the project is to identify allosteric interactions that would make a stronger dimer within the MERS‐CoV 3CLprotease using and mutating non‐conserved regions in the 3CLproteases family. Through site directed mutagenesis a A15N mutant was cloned, purified and its kinetic and binding affinity was tested. FRET‐based kinetic assays for A15N show that A15N 3CLpro binding affinity was weaker as compared to 3CL protease wild‐type. This results leaves further opportunities to explore other important sites (amino acids/bonds) within the dimer interface that influence more heavily to its dimerization.

Support or Funding Information

National Science Foundation
Metabolic Fate of Blueberry Anthocyanins after Chronic Supplementation in Healthy Older Adults
Authors: Sandhu Amandeep , Miller Marshall G. , Shukitt‐Hale Barbara , Edirisinghe Indika , Burton‐Freeman Britt
Published: June 2021

Plant derived anthocyanin rich foods play a protective role against chronic diseases such as diabetes, obesity, cardiovascular, cancer and neurodegenerative diseases. Anthocyanins are absorbed in their intact form and can be metabolized to a wide array of phenolic metabolites/conjugates. Blueberries are considered to be one of the richest source of anthocyanins and in the present study, we explored the metabolic fate of blueberry anthocyanins after chronic (90 days) supplementation of freeze‐dried blueberry (24 g/d, equivalent to 1 cup of fresh blueberries) in 19 healthy older adults (67.8 ± 4.6 y). Blood samples were collected at baseline (t=0 h) and 2 h post consumption on day 1 (no treatment), day 45 and day 90. A total of 28 anthocyanin metabolites were identified in plasma using ultra high‐performance liquid chromatography coupled with electrospray ionization triple quadrupole mass spectrometer. Peonidin glucuronide, a conjugated metabolite of peonidin, reached 204.5 ± 87.5 nmol/L at 2 h on day 45, which was the highest concentration among all phase II metabolites maintaining the parent structure. Among the parent untransformed anthocyanins, the content of malvidin galactoside was highest (37.4 ± 10.4 nmol/L) while the content of cyanidin glucoside was lowest (10.0 ± 2.9 nmol/L) in 2 h plasma sample on day 45. Out of 14 phenolic acid metabolites, the concentration of 7 metabolites were increased in baseline plasma at day 45 and 90 when compared to baseline plasma at day 1. The concentration of twelve phenolic acid metabolites increased at 2 h when compared to 0 h on day 45 and 90. Ferulic acid, vanillic acid, syringic acid and ferulic acid glucuronide were detected only in 2 h plasma samples. Our results suggest that blueberry anthocyanins are absorbed and extensively metabolized/catabolized resulting in the production of various phenolic acid derivatives and their conjugates, all together contributing to the bioavailability and beneficial effects associated with blueberry consumption.

Support or Funding Information

U.S. Department of Agriculture, U.S. Highbush Blueberry Council, Tufts University and Investigator (Burton‐Freeman/Edirisinghe) various donor funds.
Drug allergy management in the elderly
Authors: Wong Jane C.Y. , Li Philip H.
Published: June 2021

Purpose of review

Drug allergy management has previously not been emphasized in the elderly. However, the geriatric population poses several unique characteristics, challenges for drug allergy testing and considerations in the management. Especially in the era of COVID-19, the elderly population is a vulnerable cohort and reviewing the management during this unprecedented time is both timely and relevant.

Recent findings

In recent years, larger scale studies focusing on the epidemiology and prevalence trends of drug allergies among older adults has been summarized in this review. Emphasis on anaphylaxis in the older adults has been studied.

There are many implications of these findings. Epidemiological studies are useful in realizing the burden and spectrum of drug allergies on our healthcare system. It has allowed us to identify certain barriers in drug allergy management and develop ways to overcome these challenges through. Lastly, we have proposed an approach to drug allergy management based on previous studies as well as from our perspective and local experience.
Golf cart injuries in children: the experience of trauma centers in a single state in the USA
Authors: Garay Mariano , Silver Jeremy , Reynolds Alan W. , Hess Joseph , Armstrong Douglas , Hennrikus William
Published: June 2021

Golf carts remain a source of morbidity in children. We aimed to establish the incidence and injury characteristics of pediatric patients injured due to golf cart usage over an 11-year period. This is a retrospective study using a single state trauma database of patients ages 0–17 years admitted to a trauma center and who sustained injures while a golf cart was in use. Thirteen Pediatric and Adult Trauma Centers within the state of Pennsylvania were evaluated from 1 January 2004 to 31 December 2014. The inclusion criteria were met by 108 patients. The mean annual incidence of injuries was 0.35/100 000. The median age of patients was 11 years. The median hospital length of stay and injury severity score were 2 days and 9.5, respectively. The majority of the patients (75.9%) sustained at least one bone fracture. Skull fractures were more prevalent (43.5%), whereas extremity fractures were sustained by 26.9% of patients. Intracranial hemorrhages were sustained by 29.6% of patients. Ejections and rollovers accounted for 58.3% and 31.4% of patient injuries, respectively. The concussion rate was 26.9%. Neither age group nor sex was associated with a difference in fractures, intracranial hemorrhage or concussions. Golf cart injuries in pediatric patients commonly stem from ejections and rollover mechanisms resulting in skull fractures, extremity fractures, intracranial hemorrhages and concussions. The overall incidence of injury was 0.35 cases per 100 000. Further efforts are needed to increase awareness of these injuries and modify regulations regarding the use of golf carts in the pediatric population.
Long-term follow-up of children treated with the Repiphysis expandable prosthesis for lower extremity bone sarcoma
Authors: Masrouha Karim , Abboud Miguel , Saab Raya , Muwakkit Samar A. , Khoury Nabil , Haidar Rachid , Saghieh Said
Published: June 2021

Expandable endoprostheses provide a limb salvage option for skeletally immature patients with bone sarcoma of the lower extremities. Initial reports of the Repiphysis prosthesis were encouraging; however, medium-term follow-up revealed high complication rates. We report on the long-term follow-up of a cohort of patients treated with the Repiphysis prosthesis. Eleven patients were included in the study. Data collected included sex, age at surgery, duration of follow-up, site of disease, histologic diagnosis, number of lengthening sessions, amount lengthened, postoperative complications, endoprosthetic failure, mode of endoprosthetic failure, duration from index surgery to failure and to revision, type of revision surgery and final limb-length discrepancy. The average duration of follow-up from the time of surgery was 180 months (range, 144–215 months). Fifteen Repiphysis implants were used in 11 patients. All implants failed with an average time from surgery to failure of 36 months (range, 3–72 months). Twenty-four complications were observed: one wound dehiscence, two deep infections, 18 mechanical failures, implant collapse with destruction of proximal tibia epiphysis in two and one periprosthetic proximal femur fracture with dislodgement of the stem. Despite being an option for limb salvage, the Repiphysis prosthesis has a high rate of mechanical failure and need for revision, similar to other expandable implants. The authors, therefore, recommend full disclosure of the potential short- and long-term complications and need for revision, as well as alternative treatment options if their use is considered. Level of evidence: IV (Therapeutic).
Dysnatremia and 6-Month Functional Outcomes in Critically Ill Patients With Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study
Authors: Cohen Jeremy , Delaney Anthony , Anstey James , Anstey Matthew , Barge Deborah , Bellomo Rinaldo , Bhardwa Vishnu , Brinkerhoff Gail , Board Jasmin , Campain Anna , Cooper D. James , Di Tanna Gian Luca , Finnis Mark , Fitzgerald Emily , Flower Oliver , Healey Paul , Hunt Anna , Lawrence Cassie , Merthens Jan , Newby Lynette , Pearson David , Raith Eamon , Robertson Yvonne , Schweikert Sacha , Starr Therese , Tallott Mandy , van der Poll Andrew , Young Paul , Udy Andrew
Published: June 2021

OBJECTIVES:

To investigate the association between plasma sodium concentrations and 6-month neurologic outcome in critically ill patients with aneurysmal subarachnoid hemorrhage.

DESIGN:

Prospective cohort study.

SETTING:

Eleven ICUs in Australia and New Zealand.

PARTICIPANTS:

Three-hundred fifty-six aneurysmal subarachnoid hemorrhage patients admitted to ICU between March 2016 and June 2018. The exposure variable was daily measured plasma sodium.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Six-month neurologic outcome as measured by the modified Rankin Scale. A poor outcome was defined as a modified Rankin Scale greater than or equal to 4. The mean age was 57 years (± 12.6 yr), 68% were female, and 32% (n = 113) had a poor outcome. In multivariable analysis, including age, illness severity, and process of care measures as covariates, higher mean sodium concentrations (odds ratio, 1.17; 95% CI, 1.05–1.29), and greater overall variability—as measured by the sd (odds ratio, 1.53; 95% CI, 1.17–1.99)—were associated with a greater likelihood of a poor outcome. Multivariable generalized additive modeling demonstrated, specifically, that a high initial sodium concentration, followed by a gradual decline from day 3 onwards, was also associated with a poor outcome. Finally, greater variability in sodium concentrations was associated with a longer ICU and hospital length of stay: mean ICU length of stay ratio (1.13; 95% CI, 1.07–1.20) and mean hospital length of stay ratio (1.08; 95% CI, 1.01–1.15).

CONCLUSIONS:

In critically ill aneurysmal subarachnoid hemorrhage patients, higher mean sodium concentrations and greater variability were associated with worse neurologic outcomes at 6 months, despite adjustment for known confounders. Interventional studies would be required to demonstrate a causal relationship.
Scarce Resource Allocation in a Pandemic: A Protocol to Promote Equity, Timeliness, and Transparency
Authors: Lynch Julia F. , Perera Isabel M. , Iwashyna Theodore J.
Published: June 2021

Shortages of equipment, medication, and staff under coronavirus disease 2019 may force hospitals to make wrenching decisions. Although bioethical guidance is available, published procedures for decision-making processes to resolve the time-sensitive conflicts are rare. Failure to establish decision-making procedures before scarcities arise exposes clinicians to moral distress and potential legal liability, entrenches existing systemic biases, and leaves hospitals without processes to guarantee transparency and consistency in the application of ethical guidelines. Formal institutional processes can reduce the panic, inequity, and irresolution that arise from confronting ethical conflicts under duress. Drawing on expertise in critical care medicine, bioethics, and political science, we propose a decision-making protocol to ensure fairness in the resolution of conflict, timely decision-making, and accountability to improve system response.
Clinical information and management status of de novo stage IV breast cancer patients: a Chinese multicenter investigation (CSBrS-002)
Authors: Zheng Ang , Guo Bao-Liang , Zhang Jian-Guo , Jin Feng
Published: June 2021

Background:

Although de novo stage IV breast cancer is so far incurable, it has entered an era of individualized treatment and chronic disease management. Based on systemic treatment, whether the surgical resection of primary or metastatic foci of de novo stage IV breast cancer can bring survival benefits is currently controversial. We aimed to explore the clinicopathological factors and current status of the management of de novo stage IV breast cancer in China to provide a reference for clinical decisions.

Methods:

Based on the assistance of Chinese Society of Breast Surgery, a retrospective study was conducted to analyze the clinical data of patients with de novo stage IV breast cancer in 33 centers from January 2017 to December 2018. The relationship between basic characteristic (age, menstrual status, family history, reproductive history, pathological type, estrogen receptor [ER] status, progesterone receptor [PR] status, human epidermal growth factor receptor 2 [HER2] status, Ki-67 percentage, and molecular subtype), and metastasis sites (lung metastasis, liver metastasis, and bone metastasis) was examined by Pearson Chi-square tests.

Results:

A total of 468 patients with de novo stage IV breast cancer were enrolled. The median age of the enrolled patients was 51.5 years. The most common pathological type of primary lesion was invasive carcinoma (97.1%). Luminal A, luminal B, HER2 overexpressing, and triple-negative subtypes accounted for 14.3%, 51.8%, 22.1%, and 11.8% of all cases, respectively. Age, PR status, and HER2 status were correlated with lung metastasis (χ
2 = 6.576, 4.117, and 8.643 and P = 0.037, 0.043, and 0.003, respectively). Pathological type, ER status, PR status, and molecular subtype were correlated with bone metastasis (χ
2 = 5.117, 37.511, 5.224, and 11.603 and P = 0.024, <0.001, 0.022, and 0.009, respectively). Age, PR status, HER2 status, Ki-67 percentage, and molecular subtype were correlated with liver metastasis (χ
2 = 11.153, 13.378, 10.692, 21.206, and 17.684 and P = 0.004, <0.001, 0.001, <0.001, and 0.001, respectively). Combined treatment with paclitaxel and anthracycline was the most common first-line chemotherapy regimen for patients with de novo stage IV breast cancer (51.7%). Overall, 91.5% of patients used paclitaxel-containing regimens. Moreover, 59.3% of hormone receptor-positive patients underwent endocrine therapy.

Conclusions:

In 2018, 1.07% of patients from all studied centers were diagnosed with de novo stage IV breast cancer. This study indicated that 95.1% of patients received systemic therapy and 54.2% of patients underwent surgical removal of the primary lesion in China.
Heart rate variability and haemodynamic factors associated with hypotension during spinal anaesthesia for caesarean delivery
Authors: Du Emma Wei , Tan Hon Sen , Tan Chin Wen , Sultana Rehena , Sng Ban Leong
Published: June 2021

BACKGROUND

Hypotension frequently occurs during spinal anaesthesia for caesarean delivery, with potential adverse effects.

OBJECTIVE

To investigate heart rate variability and haemodynamic factors associated with spinal anaesthesia-induced hypotension.

DESIGN

Secondary case–control analysis of a randomised study.

SETTING

Single obstetric centre.

PATIENTS

Data were obtained from 230 healthy term singleton parturients who underwent elective caesarean delivery under spinal anaesthesia.

INTERVENTION

With parturients at rest, continuous haemodynamic measurements were recorded using a Nexfin cardiac monitor. Baseline pre-operative values were defined as the average of five minutes of continuous measurements. After initiation of standardised spinal anaesthesia, vasopressors were administered to maintain SBP within 10% of pre-operative values. Hypotension was defined as any 10 seconds average SBP less than 80% of pre-operative values from initiation of spinal anaesthesia to foetal delivery. Parturients were classified into cases (hypotensive) or controls (normotensive), and both univariate and multivariable logistic regression models were used to identify independent factors associated with hypotension.

MAIN OUTCOME MEASURES

Pre-operative standard deviation of the interbeat interval (SDNN), root mean square of successive interbeat difference, low-frequency to high-frequency ratio, SD1, SD2, approximate entropy, sample entropy, mean arterial pressure, SBP, stroke volume variation and systemic vascular resistance index were recorded, as were sensory block height, intravenous fluid volume and vasopressor use between spinal anaesthesia and foetal delivery.

RESULTS

Of 230 parturients, 113 (49.1%) experienced hypotension. Pre-operative lower SDNN [odds ratio (OR) 0.87, 95% confidence interval (CI) 0.78 to 0.97], higher SD2 (OR 25.06, 95% CI 2.41 to 261.06), and lower SBP (OR 0.98, 95% CI 0.97 to 1.00) were independently associated with hypotension. Between spinal anaesthesia to foetal delivery, lower sensory block height (OR 0.76, 95% CI 0.65 to 0.90) and higher intravenous fluid volume (OR 0.98, 95% CI 0.96 to 0.99 per 15 ml change) were associated with a lower incidence of hypotension. Area under the receiver operating characteristic curve was 0.701.

CONCLUSION

Pre-operative higher SD2, lower SDNN and lower SBP were associated with hypotension during spinal anaesthesia for caesarean delivery.

TRIAL REGISTRATION

NCT02277730.
GEOGRAPHIC ATROPHY INCIDENCE AND PROGRESSION AFTER INTRAVITREAL INJECTIONS OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR AGENTS FOR AGE-RELATED MACULAR DEGENERATION
Authors: Eshtiaghi Arshia , Issa Mariam , Popovic Marko M. , Muni Rajeev H. , Kertes Peter J.
Published: June 2021

Purpose:

Geographic atrophy (GA) is a complication of advanced neovascular age-related macular degeneration that can lead to permanent vision loss. We sought to estimate the incidence and progression of GA after intravitreal injections of antivascular endothelial growth factor agents in eyes with neovascular age-related macular degeneration.

Methods:

Ovid MEDLINE, EMBASE, and Cochrane CENTRAL were searched from inception to May 2020. Included studies reported on the progression or development of GA in eyes with neovascular age-related macular degeneration after antivascular endothelial growth factor therapy.

Results:

Thirty-one articles and 4,609 study eyes (4,501 patients) were included. Eyes received a mean of 17.7 injections over 35.2 months. The prevalence of GA at baseline was 9.7%. The pooled incidence of GA was 30.5% at the end of follow-up. There was a positive, moderate linear correlation between the mean total number of injections and GA incidence at the final follow-up (R2 = 0.30; P = 0.01). Monthly treatment was associated with a significantly higher risk for GA development relative to pro re nata (relative risk = 1.40, 95% confidence interval = [1.21–1.61], P < 0.001). Risk factors for GA development included GA in the fellow eye, retinal angiomatous proliferation, drusen, and reticular pseudodrusen.

Conclusion:

We found an association between the frequency and number of treatments with antivascular endothelial growth factor agents and the development of GA in neovascular age-related macular degeneration. Future studies should clarify risk factors, population characteristics, and relative contributions of treatment and disease progression on GA development in this context.
Domestic Mass Shooters
Authors: Glick Ira D. , Cerfolio Nina E. , Kamis Danielle , Laurence Michael
Published: June 2021

Background

Given the relative lack of psychiatric information and data on the perpetrators of US mass shootings, the aim of our study was to understand who these “mass shooters” were and whether they had a psychiatric illness. If so, were they competently diagnosed, and if so, were they treated with appropriate medication for their diagnoses before the violence?

Methods

Because a prospective study of diagnosis and treatment could not, for obvious reasons, be carried out, we designed a retrospective, observational study of mass shooters, defined as those who killed 4 or more people with firearms between 1982 and 2012 or who killed 3 or more people with firearms between 2013 and 2019 in the United States. We used the Mother Jones database—a database of 115 persons identified as committing a mass shooting in the United States between January 1982 and September 2019. In the vast majority of the incidents identified in the database, the perpetrator died either during or shortly after the crime, leaving little reliable information about their history—especially psychiatric history. We focused on the 35 mass shooters who survived and for which legal proceedings were instituted because these cases presented the most reliable psychiatric information. For each of these 35 mass shootings, we interviewed forensic psychiatrists and forensic psychologists who examined the perpetrator after the crime and/or collected the testimony and reports by psychiatrist(s) at trial or in the postconviction proceedings contained in the court record. In addition, we reviewed available information from the court proceedings, public records, a videotaped interview of assailant by law enforcement, social media postings of the assailant, and writings of the assailant. After collecting the clinical information from multiple sources on each case to make a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosis, we also completed a Sheehan Diagnostic Scale. After this, 20 additional cases where the assailant died at the crime were randomly selected form the remaining 80, to determine whether there were differences in psychiatric diagnoses and treatment between such assailants and those who survived.

Results

Twenty-eight of 35 cases in which the assailant survived had a psychiatric diagnosis—18 with schizophrenia, 3 with bipolar I disorders, 2 with delusional disorders, persecutory type, 2 with personality disorders (1 paranoid and 1 borderline), 2 with substance-related disorders without other psychiatric diagnoses, and 1 with posttraumatic stress disorder. Four had no psychiatric diagnosis, and in 3, we did not have enough information to make a diagnosis.

Of 15 of 20 cases in which the assailant died, 8 had schizophrenia. None of those diagnosed with psychiatric illnesses were treated with medication.

Conclusions

A significant proportion of mass shooters experienced unmedicated and untreated psychiatric disorder.