bluuebunny/crossref_metadata_2025 huggingface dataset:
Asser and the Writing of West Saxon Charters
Authors: Gallagher Robert
Published: September 2021

This article uses the evidence of vocabulary to explore the connections between the two most substantial bodies of Latin literature to survive from late ninth-century and early tenth-century Britain, namely Asser’s famed Life of King Alfred and the corpus of Anglo-Saxon charters. By doing so, several hitherto unidentified connections are made that offer important new evidence in two regards. First, they add significant weight to the view that Asser’s Life is an authentic text of the late ninth century. Secondly, they provide rare insights into the reception of Asser’s Latinity in early medieval England. Throughout, particular attention is given to a single royal diploma of Edward the Elder that purports to have been issued at a meeting at Bicanleag in 904. External evidence tells us that Asser was present at this meeting, and, given the concentration of phrasal echoes of the Life within this document, it is suggested that it was composed by Asser himself. If this suggestion is correct, this charter therefore not only extends and expands Asser’s activity as a Latin author within the West Saxon royal milieu, but it also enhances our view of the episcopal and international contribution to the production of royal diplomatic in early medieval England.
Grandchild Care and Well-Being: Gender Differences in Mental Health Effects of Caregiving Grandparents
Authors: Notter Isabelle R
Published: September 2021

Objectives

The literature on the gendered differences of mental health as a result of grandchild care has shown mixed results. Research on grandchild care further suggests that nonresidential grandchild care improves mental health outcomes, while residential grandchild care arrangements decrease mental health outcomes in grandparents. The moderating or buffering role of social engagement remains understudied in the grandchild care–mental health relationship. This study examines mental health effect differences between caregiving grandmothers and grandfathers and the moderating effects of social engagement.

Methods

Using 2002–2012 data from the Health and Retirement Study, a nationally representative sample of U.S. adults aged 50 and older, I examine the mental health effects of grandchild care and the moderating effect of social engagement in fixed effects models.

Results

Grandfathers experience particularly worsened mental health outcomes when providing grandchild care in a skipped-generation household. Both grandmothers and grandfathers experience mental health improvements from increased social engagement. Social engagement, particularly for grandmothers, serves as a buffer or produces role enhancement for grandmothers in skipped-generation care arrangements.

Discussion

Nonresidential and residential grandchild care affects mental health outcomes differently for grandmothers and grandfathers. However, social engagement consistently serves as a buffer or mental health improvement for all grandparents. Findings further encourage the continued study of social engagement and gender differences in older adults more broadly.
Thermal stress reduces carbonate production of benthic foraminifera and changes the material properties of their shells
Authors: Titelboim Danna , Lord Oliver T , Schmidt Daniela N
Published: September 2021

In shallow marine environments, benthic foraminifera are important foundation species and carbonate producers. Understanding their response to future climate is often drawn from their acclimation potential in short laboratory experiments, thereby limiting our understanding of migration, species replacement, and adaptive potential. To overcome this challenge, we examine two species of benthic foraminifera from a thermally polluted field site mimicking future warming. This site and a control station cover 13–36°C causing both warm and cold stress to the local species. Computer Tomography reveals that under heat stress, even with acclimation, Lachlanella significantly reduced its shell volume. In contrast, Pararotalia calcariformata did not reduce its shell volume but reduced the relative amount of calcite with respect to shell volume and changed its reproduction cycle from twice to once per year. Raman spectroscopy indicates that thermal conditions alter the chemical composition of the calcite shells of both species. Calcification during thermal stress creates alterations in the crystal structure that are unexpectedly more prominent under cold stress than warm stress indicating warming might positively affect the shell's protective function. Supported by previous laboratory experiments and observations from the geological record, our results provide new perspective to the effect of warming on benthic foraminifera.
Jensen’s Inequality for Separately Convex Noncommutative Functions
Authors: Humeniuk Adam
Published: September 2021

Classically, Jensen’s Inequality asserts that if $X$ is a compact convex set, and $f:K\to {\mathbb {R}}$ is a convex function, then for any probability measure $\mu $ on $K$, that $f(\text {bar}(\mu ))\le \int f\; \text {d}\mu $, where $\text {bar}(\mu )$ is the barycenter of $\mu $. Recently, Davidson and Kennedy proved a noncommutative (“nc”) version of Jensen’s inequality that applies to nc convex functions, which take matrix values, with probability measures replaced by ucp maps. In the classical case, if $f$ is only a separately convex function, then $f$ still satisfies the Jensen inequality for any probability measure that is a product measure. We prove a noncommutative Jensen inequality for functions that are separately nc convex in each variable. The inequality holds for a large class of ucp maps that satisfy a noncommutative analogue of Fubini’s theorem. This class of ucp maps includes any free product of ucp maps built from Boca’s theorem, or any ucp map that is conditionally free in the free-probabilistic sense of Młotkowski. As an application to free probability, we obtain some operator inequalities for conditionally free ucp maps applied to free semicircular families.
Amalgamation and Injectivity in Banach Lattices
Authors: Avilés Antonio , Tradacete Pedro
Published: September 2021

We study distinguished objects in the category $\mathcal{B}\mathcal{L}$ of Banach lattices and lattice homomorphisms. The free Banach lattice construction introduced by de Pagter and Wickstead [ 8] generates push-outs, and combining this with an old result of Kellerer [ 17] on marginal measures, the amalgamation property of Banach lattices is established. This will be the key tool to prove that $L_1([0,1]^{\mathfrak{c}})$ is separably $\mathcal{B}\mathcal{L}$-injective, as well as to give more abstract examples of Banach lattices of universal disposition for separable sublattices. Finally, an analysis of the ideals on $C(\Delta ,L_1)$, which is a separably universal Banach lattice as shown by Leung et al. [ 21], allows us to conclude that separably $\mathcal{B}\mathcal{L}$-injective Banach lattices are necessarily non-separable.
Dynamics of the Cellular and Humoral Immune Response After BNT162b2 Messenger Ribonucleic Acid Coronavirus Disease 2019 (COVID-19) Vaccination in COVID-19-Naive Nursing Home Residents
Authors: Van Praet Jens T , Vandecasteele Stefaan , De Roo Anneleen , Vynck Matthijs , De Vriese An S , Reynders Marijke
Published: September 2021

Short-term humoral and cellular immune responses are diminished after BNT162b2 messenger ribonucleic acid coronavirus disease 2019 (COVID-19) vaccination in COVID-19-naive nursing home residents, a population particularly vulnerable to the disease. We found both responses to decline after 4 weeks and remain lower than those of healthcare workers after 24 weeks, with an estimated half-life of the antibody response of 47 days. At 4 weeks, older age was significantly associated with a decreased humoral response, and diabetes mellitus and active malignancy were associated with a decreased cellular response. Our results imply that COVID-19-naive nursing home residents are a target group for booster vaccination trials.
Update on the epidemiology of healthcare-acquired bacterial infections: focus on complicated skin and skin structure infections
Authors: Wilcox Mark H , Dryden Matthew
Published: September 2021

Healthcare-associated infections (HCAIs) are a threat to patient safety and cause substantial medical and economic burden in acute care and long-term care facilities. Risk factors for HCAIs include patient characteristics, the type of care and the setting. Local surveillance data and microbiological characterization are crucial tools for guiding antimicrobial treatment and informing efforts to reduce the incidence of HCAI. Skin and soft tissue infections, including superficial and deep incisional surgical site infections, are among the most frequent HCAIs. Other skin and soft tissue infections associated with healthcare settings include vascular access site infections, infected burns and traumas, and decubitus ulcer infections.
A Framework of Brand Contestation: Toward Brand Antifragility
Authors: Dietrich Daniel , Russell Cristel Antonia
Published: September 2021

The consumer literature on branding to date coalesces around the notion that brands are constantly contested. Brand contestation arises where the actions of consumer brand actors meet, and sometimes confront, those of the brands’ legal owners. This article integrates the extant branding research, a qualitative prestudy, and two complementary empirical studies to advance a theoretical process model of brand contestation. First, an in-depth analysis of thirty historical cases reveals its dynamics and how both the magnitude of contestation and the momentum of mobilization affect brand contestations’ scope and evolution. Second, interviews with upper-level marketing and branding executives add an emerging perspective that brand managers can use the energy generated by consumers’ contestation to develop antifragility—a brand’s ability to grow and thrive as a result of contestation.
Effects of non-vanishing dark matter pressure in the Milky Way Galaxy
Authors: Boshkayev K , Konysbayev T , Kurmanov E , Luongo O , Malafarina D , Mutalipova K , Zhumakhanova G
Published: September 2021

We consider the possibility that the Milky Way’s dark matter halo possesses a non-vanishing equation of state. Consequently, we evaluate the contribution due to the speed of sound, assuming that the dark matter content of the galaxy behaves like a fluid with pressure. In particular, we model the dark matter distribution via an exponential sphere profile in the galactic core, and inner parts of the galaxy whereas we compare the exponential sphere with three widely used profiles for the halo, i.e. the Einasto, Burkert and Isothermal profile. For the galactic core, we also compare the effects due to a dark matter distribution without black hole with the case of a supermassive black hole in vacuum and show that present observations are unable to distinguish them. Finally we investigate the expected experimental signature provided by gravitational lensing due to the presence of dark matter in the core.
Gamma-ray blazar variability: new statistical methods of time-flux distributions
Authors: Duda Jarosław , Bhatta Gopal
Published: September 2021

Variable γ-ray emission from blazars, one of the most powerful classes of astronomical sources featuring relativistic jets, is a widely discussed topic. In this work, we present the results of a variability study of a sample of 20 blazars using γ-ray (0.1–300 GeV) observations from Fermi/LAT telescope. Using maximum likelihood estimation (MLE) methods, we find that the probability density functions that best describe the γ-ray blazar flux distributions use the stable distribution family, which generalizes the Gaussian distribution. The results suggest that the average behaviour of the γ-ray flux variability over this period can be characterized by log-stable distributions. For most of the sample sources, this estimate leads to standard lognormal distribution (α = 2). However, a few sources clearly display heavy tail distributions (MLE leads to α < 2), suggesting underlying multiplicative processes of infinite variance. Furthermore, the light curves were analysed by employing novel non-stationarity and autocorrelation analyses. The former analysis allowed us to quantitatively evaluate non-stationarity in each source – finding the forgetting rate (corresponding to decay time) maximizing the log-likelihood for the modelled evolution of the probability density functions. Additionally, evaluation of local variability allows us to detect local anomalies, suggesting a transient nature of some of the statistical properties of the light curves. With the autocorrelation analysis, we examined the lag dependence of the statistical behaviour of all the {(yt, yt + l)} points, described by various mixed moments, allowing us to quantitatively evaluate multiple characteristic time scales and implying possible hidden periodic processes.
Anomaly detection in Hyper Suprime-Cam galaxy images with generative adversarial networks
Authors: Storey-Fisher Kate , Huertas-Company Marc , Ramachandra Nesar , Lanusse Francois , Leauthaud Alexie , Luo Yifei , Huang Song , Prochaska J Xavier
Published: September 2021

The problem of anomaly detection in astronomical surveys is becoming increasingly important as data sets grow in size. We present the results of an unsupervised anomaly detection method using a Wasserstein generative adversarial network (WGAN) on nearly one million optical galaxy images in the Hyper Suprime-Cam (HSC) survey. The WGAN learns to generate realistic HSC-like galaxies that follow the distribution of the data set; anomalous images are defined based on a poor reconstruction by the generator and outlying features learned by the discriminator. We find that the discriminator is more attuned to potentially interesting anomalies compared to the generator, and compared to a simpler autoencoder-based anomaly detection approach, so we use the discriminator-selected images to construct a high-anomaly sample of ∼13 000 objects. We propose a new approach to further characterize these anomalous images: we use a convolutional autoencoder to reduce the dimensionality of the residual differences between the real and WGAN-reconstructed images and perform UMAP clustering on these. We report detected anomalies of interest including galaxy mergers, tidal features, and extreme star-forming galaxies. A follow-up spectroscopic analysis of one of these anomalies is detailed in the Appendix; we find that it is an unusual system most likely to be a metal-poor dwarf galaxy with an extremely blue, higher-metallicity H ii region. We have released a catalogue with the WGAN anomaly scores; the code and catalogue are available at https://github.com/kstoreyf/anomalies-GAN-HSC; and our interactive visualization tool for exploring the clustered data is at https://weirdgalaxi.es.
Optical turbulence and wind speed distributions above the Tibetan Plateau from balloon-borne microthermal measurements
Authors: Qing Chun , Luo Tao , Bi Cuicui , Li Xuebin , Cui Shengcheng , Yang Qike , Su Changdong , Wu Su , Qian Xianmei , Wu Xiaoqing , Zhu Wenyue
Published: September 2021

The vertical profiles of wind speed and the optical turbulence are critical to the design and operation of a new generation of highly sophisticated astronomical telescopes and adaptive optics instrumentation. We present the first study of the temporal evolution behaviours and probability distributions of wind speed [V(h) profiles, as well as the 200 hPa pressure level wind speed, V200] and optical turbulence [$C_n^2(h)$ profiles, and the most relevant integrated astronomical parameters derived from $C_n^2(h)$ profiles, i.e. the seeing ε, the isoplanatic angle θAO, the wavefront coherence time τAO, the average velocity of turbulence VAO, and the seeing layer height hAO] above the Dachaidan site of the Tibetan Plateau. The field campaigns of wind speed and optical turbulence were collected using the balloon-borne microthermal measurement system. From the whole field campaigns, the results are remarkable: The median VAO is 21.1 m s−1, the median V200 is 32.5 m s−1, the median hAO is 7566 m, the median ε is 1.04 arcsec (below 1.00 arcsec 52 per cent of the time), the median θAO is 0.74 arcsec, and the median τAO is 1.33 ms; these conditions are comparable to some of the best astronomical observatories in the world. In particular, the linear relationship of average velocity and 200 hPa level wind at this site is VAO = 0.627V200. In this study, we flag the temporal evolution and probability distribution feature of wind speed, optical turbulence profile, and the relevant integrated astronomical parameters for astronomical applications.
Racial and ethnic differences in COVID-19 hospitalizations by metropolitan status among Medicare beneficiaries, 1 January–31 December 2020
Authors: Chang Man-Huei , Moonesinghe Ramal , Truman Benedict I
Published: September 2021

Background

Risk for COVID-19 hospitalizations increases with increasing age and presence of underlying medical conditions. However, the burden has not been well-assessed in metropolitan and nonmetropolitan areas by race/ethnicity among Medicare population with chronic conditions.

Methods

We used the 2020 Medicare data to estimate COVID-19 hospitalization rates by race/ethnicity among Medicare beneficiaries for COVID-19 by metropolitan status and to assess the association of hospitalizations from COVID-19 with each of selected 29 chronic conditions for patients by metropolitan status and by race/ethnicity.

Results

The COVID-19 hospitalization rate was higher among beneficiaries residing in nonmetropolitan counties than those residing in metropolitan counties in 2020. Approximately 1 in 2 AI/AN, 1 in 3 NHB, Hispanic and A/PI, and 1 in 4 NHW beneficiaries with COVID-19 residing in nonmetropolitan counties were hospitalized. Beneficiaries with COVID-19 and chronic conditions were more likely to be hospitalized compared with those without chronic conditions.

Conclusions

Hospitalization rates among beneficiaries with COVID-19 and chronic conditions were not distributed equally by race/ethnicity and by metropolitan status. Researchers, policymakers and practitioners can use these findings to explore more effective ways of reducing racial/ethnic and geographic disparities among minorities disproportionately affected by COVID-19 and are at highest risk of hospitalization.
Mapping the current psychology provision for children and young people with juvenile dermatomyositis
Authors: Livermore Polly , Gibson Faith , Mulligan Kathleen , Wedderburn Lucy R , McCann Liza J , Gray Suzanne
Published: September 2021

Objectives

Juvenile Dermatomyositis (JDM) is a rare, chronic autoimmune condition of childhood, with known psychosocial implications. In this study, we sought to establish current psychological support for children and young people across the UK with rheumatic conditions, with a specific focus on those with JDM.

Methods

Electronic surveys were distributed to the 15 centres that belong to the JDM Research Group in the UK, collecting responses from health-care professionals in the fields of medicine, nursing and psychology.

Results

One hundred per cent of professionals from medicine and nursing replied from all 15 centres. Of these, 7 (47%) did not have a named psychologist as part of their rheumatology team, despite the majority [13 (87%)] having >200 paediatric rheumatology patients. Of the remaining centres, hospital psychology provision varied considerably. When rating their service, only 3 (8%) of 40 professionals scored their service as five (where one is poor and five is excellent); there were wide discrepancies in these scores. Many challenges were discussed, including limited psychology provision, lack of time and difficulties in offering support across large geographical areas.

Conclusion

Many of the challenges discussed are applicable to other centres worldwide. Suggestions have been proposed that might help to improve the situation for children and young people with rheumatic conditions, including JDM. Based on these findings, we suggest that rheumatology teams maximize use of these data to advocate and work toward more comprehensive psychology provision and support in their individual centres.
Consumer-based activity trackers in evaluation of physical activity in myositis patients
Authors: Saygin Didem , Rockette-Wagner Bonny , Oddis Chester , Neiman Nicole , Koontz Diane , Moghadam-Kia Siamak , Aggarwal Rohit
Published: September 2021

Objectives

Inflammatory myopathies are characterized by muscle weakness that limits the activities of daily living. Daily step count is an accepted metric of physical activity. Wearable technologies such as Fitbit® enable tracking of daily step counts. We assessed the psychometric properties of Fitbit® and compared the accuracy of Fitbit® step counts to ActiGraph®.

Methods

This was a pilot, proof of concept, prospective observational study with four visits at 0, 1, 3 and 6 months in PM, DM, necrotizing myopathy (NM) or anti-synthetase syndrome (AS) subjects. Six core set measures (manual muscle testing, physician global disease activity, patient global disease activity, and extra-muscular disease activity, HAQ-Disability Index and creatine kinase), three functional tests (six-min walk, timed up-and-go, sit-to-stand tests) and SF-36 physical function-10 (PF10) were collected at each visit. Patients wore waist-worn Fitbit® One and ActiGraph® T3X-BT concurrently for 7 days/month for 6 months.

Results

Twenty-four (10 DM, 8 PM/NM, 6 AS) patients (17 females/7 males; 91% Caucasian) were enrolled. Test-retest reliability of daily steps was strong in 1-month follow-up (ICC 0.89). Daily steps and peak 1-min cadence showed moderate-strong correlations with physician global disease activity, patient global disease activity, HAQ-Disability Index, SF-36 PF10 and all three functional tests. Fitbit® and ActiGraph® step counts demonstrated good agreement and strong correlation (ICC 0.96).

Conclusion

Fitbit® daily steps and peak 1-min cadence are reliable and valid measures of physical activity in a cohort of myositis patients. This pilot data suggests that Fitbit® has a potential for use in clinical practice and trials to monitor physical activity in myositis patients, but larger studies are needed for further validation.
The early impact of the COVID-19 pandemic on mathematical competencies on entry into a UK university
Authors: Hodds Mark
Published: September 2021

Students from England and Wales had their A-level results in 2020 decided by a ‘triple lock’ system as traditional examinations were cancelled due to the pandemic. Therefore, there was a fear that students were either being unfairly judged ( Arden University 2020) or would enter university with a reduced understanding of concepts leading to an increase in drop-out rates ( Staton, 2020). To measure mathematical ability, diagnostic testing is used at universities. This is now a well-established practice that supports students and their lecturers in discovering areas of mathematical strength and weakness upon entry to a course ( Lawson, 2003; Hodds, Shao, and Lawson, 2020). This article compares the entry competencies of students arriving at one UK university in October 2020 with those who entered in previous years, using the same diagnostic test taken by all students as the method for comparison. Students who received their A levels in the year of entry are also compared to those who entered with A levels from years prior, allowing for a fair comparison of students in 2020 in particular. Furthermore, the abilities of students at different A-level grades are also compared. The results showed that students in 2020 appear not to be disadvantaged by the issues caused by the pandemic. On the contrary, many students outperformed colleagues who had summative assessment prior to 2020.
Dermal Exposure to the Immunomodulatory Antimicrobial Chemical Triclosan Alters the Skin Barrier Integrity and Microbiome in Mice
Authors: Baur Rachel , Gandhi Jasleen , Marshall Nikki B , Lukomska Ewa , Weatherly Lisa M , Shane Hillary L , Hu Gangqing , Anderson Stacey E
Published: September 2021

Triclosan is an antimicrobial chemical used in healthcare settings that can be absorbed through the skin. Exposure to triclosan has been positively associated with food and aeroallergy and asthma exacerbation in humans and, although not directly sensitizing, has been demonstrated to augment the allergic response in a mouse model of asthma. The skin barrier and microbiome are thought to play important roles in regulating inflammation and allergy and disruptions may contribute to development of allergic disease. To investigate potential connections of the skin barrier and microbiome with immune responses to triclosan, SKH1 mice were exposed dermally to triclosan (0.5–2%) or vehicle for up to 7 consecutive days. Exposure to 2% triclosan for 5–7 days on the skin was shown to increase transepidermal water loss levels. Seven days of dermal exposure to triclosan decreased filaggrin 2 and keratin 10 expression, but increased filaggrin and keratin 14 protein along with the danger signal S100a8 and interleukin-4. Dermal exposure to triclosan for 7 days also altered the alpha and beta diversity of the skin and gut microbiome. Specifically, dermal triclosan exposure increased the relative abundance of the Firmicutes family, Lachnospiraceae on the skin but decreased the abundance of Firmicutes family, Ruminococcaceae in the gut. Collectively, these results demonstrate that repeated dermal exposure to the antimicrobial chemical triclosan alters the skin barrier integrity and microbiome in mice, suggesting that these changes may contribute to the increase in allergic immune responses following dermal exposure to triclosan.
Stepwise Approach to the Management of Endometriosis-Related Dysmenorrhea
Authors: Bohn Jacqueline A. , Bullard Kimberley A. , Rodriguez Maria I. , Ecker Amanda M.
Published: September 2021

OBJECTIVE:

To evaluate the cost effectiveness of sequential medical and surgical therapy for the treatment of endometriosis-related dysmenorrhea.

METHODS:

A cost-effectiveness model was created to compare three stepwise medical and surgical treatment strategies compared with immediate surgical management for dysmenorrhea using a health care payor perspective. A theoretical study cohort was derived from the estimated number of reproductive age (18–45) women in the United States with endometriosis-related dysmenorrhea. The treatment strategies modeled were: strategy 1) nonsteroidal antiinflammatory drugs (NSAIDs) followed by surgery; strategy 2) NSAIDs, then short-acting reversible contraceptives or long-acting reversible contraceptives (LARCs) followed by surgery; strategy 3) NSAIDs, then a short-acting reversible contraceptive or LARC, then a LARC or gonadotropin-releasing hormone modulator followed by surgery; strategy 4) proceeding directly to surgery. Probabilities, utilities, and costs were derived from the literature. Outcomes included cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Univariate, bivariate, and multivariate sensitivity analyses were performed.

RESULTS:

In this theoretical cohort of 4,817,894 women with endometriosis-related dysmenorrhea, all medical and surgical treatment strategies were cost effective at a standard willingness-to-pay threshold of $100,000 per QALY gained when compared with surgery alone. Strategy 2 was associated with the lowest cost per QALY gained ($1,155). Requiring a trial of a third medication before surgery would cost an additional $257 million, compared with proceeding to surgery after failing two medical treatments. The probability of improvement with surgery would need to exceed 83% for this to be the preferred first-line approach.

CONCLUSION:

All sequential medical and surgical management strategies for endometriosis-related dysmenorrhea were cost effective when compared with surgery alone. A trial of hormonal management after NSAIDs, before proceeding to surgery, may provide cost savings. Delaying surgical management in an individual with pain refractory to more than three medications may decrease quality of life and increase cost.
Insights into origins and specificities of autoantibodies in systemic sclerosis
Authors: Tiniakou Eleni , Crawford Jonathan , Darrah Erika
Published: September 2021

Purpose of review

Autoantibodies are hallmark findings in systemic sclerosis (SSc), often present prior to disease onset. Clinical diagnosis and prognosis of SSc have long relied on the antitopoisomerase – anticentromere – anti-RNA polymerase antibody trichotomy. However, many more autoantibodies found in SSc are being actively investigated for insights into triggering events, mechanisms of tolerance break, and connections to tissue damage. This review examines recent studies on SSc autoantibodies and the early events that lead to their development.

Recent findings

Recent work has elucidated potential connections between human cytomegalovirus infection, silicone breast implants, and malignancy to SSc autoantibody development. At the level of the dendritic cell:T cell interaction, where tolerance is broken, new studies identified shared motifs in the peptide-binding domains of SSc-associated human leukocyte antigen alleles. Immunological analysis of SSc patient B cells has uncovered several anomalies in the regulatory capacities of SSc naïve and memory B cell populations. Expanding efforts to uncover new SSc autoantibodies revealed anti-CXCL4, anticollagen V, and other autoantibodies as potential players in disease pathogenesis.

Further research into the role of autoantibodies in SSc development may uncover new mechanism-guided therapeutic targets. In addition, a better understanding of autoantibody associations with SSc disease outcomes will improve clinical care.
Contribution of monocytes and macrophages to the pathogenesis of systemic sclerosis: recent insights and therapeutic implications
Authors: Lescoat Alain , Lecureur Valérie , Varga John
Published: September 2021

Purpose of review

To discuss recent studies addressing the role of monocytes and macrophages in the pathogenesis of systemic sclerosis (SSc) based on human and mouse models.

Recent findings

Studies indicate that monocyte adhesion could be increased in SSc secondary to an interferon-dependent loss of CD52, and chemotaxis up-regulated through the CCR3/CCL24 pathway. Beyond the conventional M1/M2 paradigm of macrophage subpopulations, new subpopulations of macrophages have been recently described in skin and lung biopsies from SSc patients. Notably, single-cell ribonucleic acid sequencing has provided evidence for SPP1+ lung macrophages or FCGR3A+ skin macrophages in SSc. Impaired pro-resolving capacities of macrophages such as efferocytosis, i.e. the ability to phagocyte apoptotic cells, could also participate in the inflammatory and autoimmune features in SSc.

Through their potential pro-fibrotic and pro-inflammatory properties, macrophages are at the cross-road of key SSc pathogenic processes and associated manifestations. Investigative drugs targeting macrophage polarization, such as pan-janus kinase inhibitors (tofacitinib or ruxolitinib) impacting both M1 and M2 activations, or Romilkimab inhibiting IL-4 and IL-13, have shown promising results in preclinical models or phase I/II clinical trials in SSc and other fibro-inflammatory disorders. Macrophage-based cellular therapy may also represent an innovative approach for the treatment of SSc, as initial training of macrophages may modulate the severity of fibrotic and autoimmune manifestations of the disease.
A review of ophthalmic manifestations of inflammatory bowel disease and associated treatments
Authors: Janardhana Priya , Al-Kadhi Saad
Published: September 2021

Purpose of review

To review the ocular manifestations of inflammatory bowel disease (IBD) and the treatments for each of these, including novel therapies and their effects on uveitis. With the advent of newer treatments for ulcerative colitis and Crohn's disease, it is important to investigate whether these therapies have beneficial effects for extraintestinal manifestations (EIM) of IBD, in particular, ocular manifestations.

Recent findings

The newer treatments for IBD, including biologics, such as golimumab (Simponi), certolizumab (Cimzia), vedolizumab (Entyvio), and interleukin (IL) receptor inhibitors, such as ustekinimab (Stelara), could potentially have treatment benefits for patients with uveitis and IBD.

Ocular manifestations of IBD are important to detect early and treat appropriately. With novel treatments for IBD, it is important to further study whether these therapies have benefits for ocular manifestations of IBD, such as uveitis. Future clinical trials need to be conducted to investigate this.
Congenital Rubella Syndrome Surveillance After Measles Rubella Vaccination Introduction in Yogyakarta, Indonesia
Authors: Herini Elisabeth Siti , Triono Agung , Iskandar Kristy , Prasetyo Ashadi , Nugrahanto Andika Priamas , Gunadi
Published: September 2021

Background:

Congenital rubella syndrome (CRS) is a fatal disease causing severe congenital defects. Indonesia had the highest CRS cases in the world in 2016 with a commitment to achieve elimination of rubella disease by 2020, through the campaign and introduction of measles rubella (MR) national vaccination program in 2017 and 2018. This study aimed to describe the impact of the national vaccination campaign by conducting surveillance of CRS cases and comparing the incidence of new CRS cases before and after the MR vaccination campaign.

Methods:

From July 2015 to July 2020, we conducted surveillance of CRS in Yogyakarta. Suspected patients underwent complete clinical examinations. Serology was tested for the presence of IgM and IgG antibodies against rubella. Descriptive analysis was used to characterize the demographic and clinical characteristics of the cases before and after the MR vaccination campaign.

Results:

The study involved 229 infants who were suspected for CRS. Laboratory-confirmed cases were found in 47 of them (20.86%). Most of the laboratory-confirmed cases (55.3%) were reported among 1–5 months old infants. Common clinical features among laboratory-confirmed cases included structural heart defects in 43 (91.4%). There was a significant decrease (60.9%) of CRS incidence from 0.39 per 1000 live births in the precampaign era to 0.08 in the postcampaign era (P = 0.00).

Conclusion:

There has been a significant declining number of CRS cases based on pre- and post-MR vaccination campaign in Yogyakarta, Indonesia. An effective surveillance system will help monitor the number of CRS cases.
Finding Children Living With HIV in Low-prevalence Countries
Authors: Hrapcak Susan , Bekele Alemayehu , Ahmed Jelaludin , Ayalew Jemal , Gutreuter Steve , Kumssa Hanna , Antefe Tenagnework , Mengistu Semegnew , Mirkovic Kelsey , Dziuban Eric J. , Ross Christine , Belay Zena , Tilahun Tsegaye , Kassa Desta , Teferi Wondimu
Published: September 2021

Background:

Limited data in low HIV prevalence settings such as Ethiopia limit policy development and implementation of optimized pediatric testing approaches to close the treatment gap. This study aimed to determine HIV prevalence, testing yield and factors associated with HIV among children at 5 entry points.

Methods:

We conducted a cross-sectional study from May 2017 to March 2018 in 29 public health facilities in Amhara and Addis Ababa regions in Ethiopia. Children 2–14 years were enrolled through 5 entry points. Data were obtained from registers, medical records and interviews with caregivers. HIV prevalence and testing yields were calculated for each entry point. Mixed-effects logistic regression analysis identified factors associated with undiagnosed HIV.

Results:

The study enrolled 2166 children, of whom 94 were HIV positive (40 newly diagnosed). HIV prevalence and testing yield were the highest among children of HIV-positive adults (index testing; 8.2% and 8.2%, respectively) and children presenting to tuberculosis clinics (7.9% and 1.8%) or with severe malnutrition (6.5% and 1.4%). Factors associated with undiagnosed HIV included tuberculosis or index entry point [adjusted odds ratio (aOR), 11.97; 95% CI 5.06–28.36], deceased mother (aOR 4.55; 95% CI 1.30–15.92), recurrent skin problems (aOR 17.71; 95% CI 7.75–40.43), severe malnutrition (aOR 4.56; 95% CI 2.04–10.19) and urban residence (aOR 3.47; 95% CI 1.03–11.66).

Conclusions:

Index testing is a critical strategy for pediatric case finding in Ethiopia. Strategies and resources can prioritize minimizing missed opportunities in implementing universal testing for very sick children (tuberculosis, severe malnutrition) and implementing targeted testing in other entry points through use of factors associated with HIV.
Initiative to Improve Postintubation Sedation in a Pediatric Emergency Department
Authors: Irwin Whitney W. , Berg Kathleen T. , Ruttan Timothy K. , Wilkinson Matthew H. , Iyer Sujit S.
Published: September 2021

Background:

Previous research has shown that appropriate pediatric postintubation sedation (PIS) after rapid sequence intubation only occurs 28% of the time. Factors such as high provider variability, cognitive overload, and errors of omission can delay time to PIS in a paralyzed patient.

Purpose:

To increase the proportion of children receiving timely PIS by 20% within 6 months.

Methods:

A multidisciplinary team identified key drivers and targeted interventions to improve timeliness of PIS. The primary outcome of “sedation in an adequate time frame” was defined as a time to post-Rapid Sequence Intubation sedative administration less than the duration of action of the RSI sedative agent. Secondary outcomes included the proportion of patients receiving any sedation and time to PIS administration.

Results:

Pediatric postintubation sedation in an adequate time was improved from 27.9% of intubated patients to 55.6% after intervention (p = .001). The number of patients receiving any PIS improved from 74% to 94% (p = .006). The median time from RSI to PIS was reduced from 13 to 9 minutes (p < .001). Process control charts showed a reduction in PIS variability and a centerline reduction from 19 to 10 minutes.

Conclusions:

Implementation of an intubation checklist and a multidisciplinary approach improved the rate of adequate pediatric PIS.
Binge Drinking Among Public Sector Food Service Workers in Brazil
Authors: Costa Bruna Vieira de Lima , Assunção Ada Ávila , Santos Jennifer Elaine , da Silva Larissa Andreza França , Ramos Sabrina Alves , Lima Eduardo de Paula
Published: September 2021

Objective:

To investigate occupational risk factors associated with binge drinking (BD) among public sector food service workers in a Brazilian capital.

Methods:

All workers from the Government-backed Economy Restaurant Program (GbERP) in Belo Horizonte city were evaluated. BD was defined as consumption of five or more doses (male) or four or more doses (female) of alcoholic beverages on a single occasion within 30 days. Occupational psychosocial and physical stressors were the main exposure variables; sociodemographic, health, and lifestyle variables were inserted as potential confounding factors. We performed logistic regression.

Results:

A total of 214 people participated in the study and 30.7% reported BD. Psychosocial (violence and high demands) and ergonomic aspects were associated with the outcome.

Conclusion:

There was a high prevalence of BD among GbERP workers. Actions are necessary to reduce violence and high strain and consequently BD.
Seroprevalence of SARS-CoV-2 Among Firefighters/Paramedics in San Francisco, CA
Authors: Grant Megan , Harrison Robert , Nuñez Arlene , Kurtz Theodore , Phelps Stephanie , Brokaw Jennifer , Shusterman Dennis
Published: September 2021

Objectives:

Despite having close contact with the general public, members of the San Francisco Fire Department (SFFD) reported relatively few cases of COVID-19 during the first half of 2020. Our objective was to explore evidence for prior undetected infections by conducting a seroprevalence survey, and to document both risk and protective factors for prior COVID-19 infection.

Methods:

This cross-sectional study assessed workplace practices and exposures of SFFD personnel during the first 6 months of 2020 via questionnaire and documented prior COVID-19 infections by serologic antibody testing using an orthogonal testing protocol.

Results:

Of 1231 participating emergency responders, three (0.25%) had confirmed positive COVID-19 antibody results.

Conclusions:

Safe workplace practices, community public health intervention, and low community infection rates appear to have been protective factors for emergency responders in San Francisco during our study period.
The Future of Military Occupational and Environmental Medicine in the Department of Defense
Authors: Krahl Pamela L. , Thomas Richard J. , Gaydos Joel C. , Mallon Timothy M.
Published: September 2021

Objective:

Transfer of military medical facilities to the Defense Health Agency is transforming the Military Health System. Our objective is to inform this transformation with respect to optimum application of occupational and environmental medicine (OEM) expertise.

Methods:

We defined and analyzed the external influences on military OEM practice using a structured framework to identify key drivers.

Results:

Key drivers are political and economic factors. These may change the size or military/civilian ratio of the specialty. Limited career development pathways should prompt consideration of making OEM a second or combined residency, and military-funded training of civilian physicians may be required. OEM specialist utilization should be reassessed.

Conclusions:

OEM is a highly adaptable specialty defined by the needs of its stakeholders. Comprehensive analysis of external influences can ensure that OEM practice remains in step with changing needs.
Double Major for Slashing: Management of Blunt Popliteal Fossa Trauma in Ice Hockey in the Setting of Popliteal Artery Entrapment Syndrome
Authors: Singh Brij M. , Galimova Irina , Singh Tej M.
Published: September 2021

Popliteal artery entrapment syndrome (PAES) is a rare condition that produces calf claudication in young patients. It is most commonly a result of aberrant anatomy of the popliteal fossa. If undiagnosed, PAES can lead to acute ischemia and a threatened limb as a result of complete arterial occlusion or embolism. Ice hockey is a contact sport, and slashing on the covered legs is well described as a strategy and contact point. We present a unique case that highlights a blunt popliteal artery injury in a young player with an underlying type 2 PAES. We discuss the initial diagnosis and endovascular/vascular surgical treatment, followed by the delayed management of the popliteal artery injury. We also provide considerations for popliteal fossa blunt trauma and need for future protection of the popliteal fossa for athletes.
A Direct Comparative Study of Bronchoscopic Navigation Planning Platforms for Peripheral Lung Navigation
Authors: Akulian Jason A. , Molena Daniela , Wahidi Momen M. , Chen Alex , Yu Diana , Maldonado Fabien , Lee Hans , Vachani Anil , Yarmus Lonny ,   on behalf of the Interventional Pulmonary Outcomes Group (IPOG)
Published: September 2021

Background:

The use of mapping to guide peripheral lung navigation (PLN) represents an advance in the management of peripheral pulmonary lesions (PPL). Software has been developed to virtually reconstruct computed tomography images into 3-dimensional airway maps and generate navigation pathways to target PPL. Despite this there remain significant gaps in understanding the factors associated with navigation success and failure including the cartographic performance characteristics of these software algorithms. This study was designed to determine whether differences exist when comparing PLN mapping platforms.

Methods:

An observational direct comparison was performed to evaluate navigation planning software packages for the lung. The primary endpoint was distance from the terminal end of the virtual navigation pathway to the target PPL. Secondary endpoints included distal virtual and segmental airway generations built to the target and/or in each lung.

Results:

Twenty-five patient chest computed tomography scans with 41 PPL were evaluated. Virtual airway and navigation pathway maps were generated for each scan/nodule across all platforms. Virtual navigation pathway comparison revealed differences in the distance from the terminal end of the navigation pathway to the target PPL (robotic bronchoscopy 9.4 mm vs. tip-tracked electromagnetic navigation 14.2 mm vs. catheter based electromagnetic navigation 17.2 mm, P=0.0005) and in the generation of complete distal airway maps.

Conclusion:

Comparing PLN planning software revealed significant differences in the generation of virtual airway and navigation maps. These differences may play an unrecognized role in the accurate PLN and biopsy of PPL. Further prospective trials are needed to quantify the effect of the differences reported.
Therapeutic Rigid Bronchoscopy Intervention for Malignant Central Airway Obstruction Improves Performance Status to Allow Systemic Treatment
Authors: Lee Edward Y.C. , McWilliams Annette M. , Salamonsen Matthew R.
Published: September 2021

Background:

Malignant central airway obstruction may result in an Eastern Cooperative Oncology Group Performance Status (ECOG PS) that precludes treatment with systemic therapies. We sought to evaluate outcomes of patients undergoing rigid bronchoscopy for malignant central airways obstruction (MCAO) and its effect on access to systemic therapies including immunotherapy.

Patients and Methods:

We conducted a retrospective observational single-center study evaluating 77 consecutive patients who underwent rigid bronchoscopy from March 2015 to November 2019. Procedural details, preprocedural and postprocedural ECOG PS, complications, and proportions of patients receiving systemic therapy postprocedure were recorded.

Results:

The majority of patients were ECOG PS 2 to 3 at diagnosis (62%). The most common indication was MCAO due to squamous cell carcinoma (35.1%). MCAO was managed with a debulking/dilatation procedure alone (51.9%) or in combination with stenting (48.1%). The laser was unavailable, electrocautery was used for hemostasis only not tumor ablation. Significant improvement in ECOG PS postprocedure in the group with baseline ECOG PS 3 to 4 (P<0.0001) and in those with baseline ECOG PS 0 to 4 (P<0.00001) was observed. The main complication was bleeding, controlled bronchoscopically with mechanical compression with a rigid bronchoscope and/or electrocautery (68.8% of patients). No deaths occurred. Overall, 70% of those presenting with ECOG 3 to 4 went onto receive systemic therapies that would have been contraindicated due to poor baseline ECOG PS.

Conclusion:

Therapeutic rigid bronchoscopy is safe and efficacious in the management of MCAO, improving ECOG PS allowing for the administration of systemic therapies. This is especially important in the era of immunotherapy and directed therapies, which have been shown to provide significant survival benefit over conventional therapies alone.