bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of the Cirrhotic Ascites Severity model—A patient‐reported outcome‐based model to predict 1‐year mortality
Authors: Gantzel Rasmus Hvidbjerg , Aagaard Niels Kristian , Vilstrup Hendrik , Watson Hugh , Grønbæk Henning , Jepsen Peter
Published: August 2022

Ascites formation is a sign of decompensation of cirrhosis and heralds a poor prognosis. The widely used standard binary classification of ascites as diuretic‐responsive or refractory does not cover the spectrum of ascites and has limited prognostic information. We developed the Cirrhotic Ascites Severity (CIRAS) model to predict 1‐year mortality among 465 patients randomized to placebo in the satavaptan trials investigating treatment of cirrhotic ascites. We used multivariable logistic regression to derive the CIRAS model based on these variables: ascites discomfort score (≤50 or >50), plasma sodium (≥140, 133–139, 125–132, or <125 mmoL/L), and a composite of ascites accumulation and diuretic treatment. We validated the prediction model in 697 trial participants randomized to satavaptan treatment. The 1‐year all‐cause mortality was 19.6%. The area under the receiver operator curve was higher for the CIRAS model than for the standard ascites classification into refractory and diuretic‐responsive in both the development cohort (0.68 [95% confidence interval (CI): 0.62–0.75] vs. 0.62 [0.57–0.68]), and the validation cohort (0.68 [0.64–0.72] vs. 0.55 [0.51–0.60]). The CIRAS model had similar discrimination to the Child‐Pugh score and nearly as good as the Model for End‐Stage Liver Disease (MELD), MELD‐Na, and MELD 3.0. Conclusions: The CIRAS model based on simple ascites‐relevant data is an easily applicable and patient‐centered way to describe the severity and prognosis of all ascites grades. It carries more prognostic information than today's label of “refractory ascites” and forms the basis for earlier and better clinical decisions related to ascites management.
Comparison of some biochemical markers between early‐onset and late‐onset colorectal precancerous lesions: A single‐center retrospective study
Authors: Tang Chao‐Tao , Li Jun , Yang Zhenzhen , Zeng Chunyan , Chen Youxiang
Published: August 2022

Objective

Given that the onset of diseases including colorectal cancer precursors is affecting younger individuals and that obesity is an important risk factor for early‐onset, we conducted a study to explore the biochemical profile of differences in serum between early‐onset patients and late‐onset colorectal precancerous lesions.

Methods

A total of 1447 patients, including 469 early‐onset patients and 978 late‐onset patients, were enrolled from the First Affiliated Hospital of Nanchang University (FAHNU), of which there were 311 sessile serrated adenoma/polyps (SSA/P) and 1136 normal adenomas. The distribution of the included categorical variables was compared via Pearson's chi‐squared test, whereas continuous variables were compared by using the nonparametric Kruskal–Wallis test and ANOVA.

Results

Compared with late‐onset patients, the levels of total bilirubin and HDL‐C were lower (p < 0.05), whereas triglyceride and uric acid levels were higher, in early‐onset patients. Interestingly, in the subgroup analysis, triglyceride and uric acid levels remained at higher levels, whereas HDL‐C remained at lower levels, in early‐onset patients than in late‐onset patients. Other characteristics, such as LDL‐C, drinking, γ‐GT, and the N/L ratio, were similar between the two groups. An additional analysis of the association of tumor size with markers showed that lower levels of HDL‐C and higher levels of uric acid were associated with increased tumor size (p < 0.05).

Conclusions

Early‐onset CRC precursor cases exhibit higher levels of triglycerides and lower levels of HDL‐C than late‐onset cases. Additionally, levels of HDL‐C are negatively associated with tumor size, whereas uric acid was positively correlated with tumor size.
Hospital practices and clinical outcomes associated with behavioral symptoms in persons with dementia
Authors: Tannenbaum Rachel , Boltz Marie , Ilyas Anum , Gromova Valeria , Ardito Suzanne , Bhatti Mutahira , Mercep Gwenyth , Qiu Michael , Wolf‐Klein Gisele , Tan Zaldy S. , Wang Jason , Sinvani Liron
Published: August 2022

Background

Hospitalized persons living with dementia (PLWD) often experience behavioral symptoms that challenge medical care.

Objective

This study aimed to identify clinical practices and outcomes associated with behavioral symptoms in hospitalized PLWD.

Design

A retrospective cross‐sectional study.

Settings and Participants

The study included PLWD (65+) admitted to one of severe health system hospitals in 2019.

Intervention

Behavioral symptoms were defined as the presence of (1) a psychoactive medication for behavioral symptoms; (2) an order for physical restraints or constant observation; and/or (3) physician documentation of delirium, encephalopathy, or behavioral symptoms.

Main Outcome and Measures

Associations between behavioral symptoms and patient characteristics and hospital practices (e.g., bladder catheter) were examined. Multivariable logistic/linear regression was used to evaluate the association between behavioral symptoms and clinical outcomes (e.g., mortality).

Results

Of hospitalized PLWD (N = 8637), the average age was 84.5 years (IQR = 79−90), 61.7% were female, 60.1% were white, and 9.4% (n = 833) were Hispanic. Behavioral symptoms were identified in 40.6% (N = 3606) of individuals. Behavioral symptoms were significantly associated with male gender (40.3% vs. 36.9%, p = .001), white race (62.7% vs. 58.3%, p < .001), and residence in a facility prior to admission (26.6% vs. 23.7%, p < .001). Regarding hospital practices, indwelling bladder catheters (11.2% vs. 6.0%, p < .001) and dietary restriction (41.9% vs. 33.8%, p < .001) were associated with behavioral symptoms. In multivariable models, behavioral symptoms were associated with increased hospital mortality (odds ratio [OR]: 1.90, CI95%: 1.57−2.29), length of stay (parameter estimate: 2.10, p < .001), 30‐day readmissions (OR: 1.14, CI95%: 1.014–1.289), and decreased discharge home (OR: 0.59, CI95%: 0.53−0.65, p < .001).

Conclusions

Given the association between behavioral symptoms and poor clinical outcomes, there is an urgent need to improve the provision of care for hospitalized PLWD.
Three‐dimensional fine structure of fibroblasts and other mesodermally derived tissues in the dermis of adults of the Bahamas lancelet (Chordata, Cephalohordata), as seen by serial block‐face scanning electron microscopy
Authors: Holland Nicholas D. , Holland Linda Z. , Somorjai Ildiko M. L.
Published: August 2022

Tissues of adult cephalochordates include sparsely distributed fibroblasts. Previous work on these cells has left unsettled such questions as their developmental origin, range of functions, and even their overall shape. Here, we describe fibroblasts of a cephalochordate, the Bahamas lancelet,Asymmetron lucayanum, by serial block‐face scanning electron microscopy to demonstrate their three‐dimensional (3D) distribution and fine structure in a 0.56‐mm length of the tail. The technique reveals in detail their position, abundance, and morphology. In the region studied, we found only 20 fibroblasts, well separated from one another. Each was strikingly stellate with long cytoplasmic processes rather similar to those of a vertebrate telocyte, a possibly fortuitous resemblance that is considered in the discussion section. In the cephalochordate dermis, the fibroblasts were never linked with one another, although they occasionally formed close associations of unknown significance with other cell types. The fibroblasts, in spite of their name, showed no signs of directly synthesizing fibrillar collagen. Instead, they appeared to be involved in the production of nonfibrous components of the extracellular matrix—both by the release of coarsely granular dense material and by secretion of more finely granular material by the local breakdown of their cytoplasmic processes. For context, the 3D structures of two other mesoderm‐derived tissues (the midline mesoderm and the posteriormost somite) are also described for the region studied.
How the VA is training the Next‐Generation workforce for learning health systems
Authors: Kilbourne Amy M. , Schmidt Joel , Edmunds Margo , Vega Ryan , Bowersox Nicholas , Atkins David
Published: August 2022

Objectives

The U.S. Department of Veterans Affairs (VA) has been a national leader in Learning Health System (LHS) implementation due to its combined mission of research, education, clinical care, and emergency preparedness. We describe the current VA LHS training ecosystem within the Veterans Health Administration's Office of Academic Affiliations (OAA), Office of Research and Development (ORD), ORD's Health Services Research and Development (HSR&D) program, and Innovation Ecosystem (IE), including lessons learned regarding their sustainment.

Methods

The VA LHS training ecosystem is based on the Learning Loop and HSR&D Quality Enhancement Research Initiative (QUERI) Roadmap, which describes VA learning opportunities, underlying infrastructures, and core competencies.

Results

VA‐focused LHS educational programs include data‐to‐knowledge initiatives in health sciences and analytics, for example, OAA/HSR&D health services and informatics research fellowships; knowledge‐to‐performance opportunities in implementation and quality improvement, for example, QUERI Learning Hubs and IEs' Diffusion of Excellence Initiative; and performance‐to‐data embedded opportunities, for example, IE's entrepreneur fellowship programs and QUERI's Advancing Diversity in Implementation Leadership. These training programs are supported by combined VA research and clinical operations investments in funding, informatics, governance, and processes. Lessons learned include ongoing alignment of research funding with operational priorities and capacity, relentless recruitment and retention of implementation, system, and information scientists especially from under‐represented groups, sustainment of data infrastructures suitable for research and quality improvement, and ensuring sustainable funding opportunities for researchers to work on system‐wide health care problems.

Conclusions

There is an urgent need to expand training opportunities in LHSs, especially as health care is increasingly driven by multiple interested parties, impacted by persistent health disparities exacerbated by emerging public health threats, and rapid technology growth. With ongoing alignment of research and clinical goals, foundational support through research funding, underlying clinical operations infrastructures, and active engagement interested parties, VA's LHS training ecosystem promotes a more LHS‐savvy, 21st century workforce.
Tailor‐Made Vinylogous Urethane Vitrimers Based on Binary and Ternary Block and Random Copolymers: An Approach toward Reprocessable Materials
Authors: Weerathaworn Siraphat , Abetz Volker
Published: August 2022

Vitrimers are promising reprocessable materials. To tune their properties, microphase separated block copolymers as backbones play an essential role in the thermal and mechanical properties of the resulting nanostructured networks. In this study, various narrow disperse di‐ and triblock copolymers containing a hydroxyethyl methacrylate block and, for comparison, random copolymers of the same comonomers are synthesized in a controlled manner by photoiniferter reversible addition‐fragmentation chain transfer polymerization. Subsequently, the copolymers are modified by acetoacetate groups and cross‐linked with diamines. After curing, the di‐ and triblock copolymer‐based vitrimers exhibit excellent thermal and mechanical properties compared to random ones; moreover, their characteristic properties can be adjusted by different types and amounts of diamines. As the transamination reaction is a thermoreversible exchange reaction, the resulting vitrimers are reprocessable and therefore are recyclable materials. The combining of two of these classes of soft materials, namely vitrimers and block copolymers, leads to materials with a broad spectrum of adjustable mechanical properties for various applications with an improved end‐of‐life management, when compared to permanently crosslinked thermosets.
Construction of traveling wave solutions of the (2 + 1)‐dimensional modified KdV‐KP equation
Authors: Khan Kamruzzaman , Salam Md. Abdus , Mondal Manik , Akbar M. Ali
Published: August 2022

Traveling wave solutions have played a vital role in demonstrating the wave character of nonlinear problems emerging in the field of mathematical sciences and engineering. To depict the nature of propagation of the nonlinear waves in nature, a range of nonlinear evolution equations has been proposed and investigated in the existing literature. In this article, solitary and traveling periodic wave solutions for the (2 + 1)‐dimensional modified KdV‐KP equation are derived by employing an ansatz method, named the enhanced (G′/G)‐expansion method. For this continued equation, abundant solitary wave solutions and nonlinear periodic wave solutions, along with some free parameters, are obtained. We have derived the exact expressions for the solitary waves that arise in the continuum‐modified KdV‐KP model. We study the significance of parameters numerically that arise in the obtained solutions. These parameters play an important role in the physical structure and propagation directions of the wave that characterizes the wave pattern. We discuss the relation between velocity and parameters and illustrate them graphically. Our numerical analysis suggests that the taller solitons are narrower than shorter waves and can travel faster. In addition, graphical representations of some obtained solutions along with their contour plot and wave train profiles are presented. The speed, as well as the profile of these solitary waves, is highly sensitive to the free parameters. Our results establish that the continuum‐modified KdV‐KP system supports solitary waves having different shapes and speeds for different values of the parameters.
Incorporating Time-Lapse Digital Cameras into Creel Surveys at Three Alabama Reservoirs
Authors: Eckelbecker Robert W. , Coleman Tyler Steven , Catalano Matthew J.
Published: August 2022

We compared different creel survey methods at three Alabama reservoirs (Harris, Jordan, and Mitchell) to identify approaches that could improve precision. We were particularly interested in whether boat trailer counts from time-lapse photos taken at boat ramp parking lots could be used as an index of fishing effort to improve the temporal coverage of sampling. Angler effort was estimated independently using roving creels, access point creels, and aerial census counts and compared with fixed-location digital camera images of trailers at boat ramps. Digital camera counts of trailers correlated with angler effort from aerial census, access point creel surveys, and roving creel surveys. This finding suggests that time-lapse digital cameras as a sampling method to obtain angler effort may provide a feasible method once calibrated to a system. Best-fitting models for relationships between time-lapse trailer counts and the other creel methods included covariates for season and day type (weekend versus weekday) effects, but not reservoir and time-of-day effects. The inclusion of effort predicted from time-lapse digital cameras incorporated with roving creel surveys did not statistically affect the magnitude of effort estimates but substantially increased the precision of effort estimates.
Functional capacity and quality of life in patients with vascular ring
Authors: Nir Vered , Bentur Lea , Zucker‐Toledano Merav , Gur Michal , Adler Zvi , Hanna Moneera , Toukan Yazeed , Masarweh Kamal , Hakim Fahed , Bar‐Yoseph Ronen
Published: August 2022

Background

Vascular rings are congenital anomalies of the aortic arch that compress the trachea and esophagus and may require corrective surgery. Data about the long‐term effects of vascular rings are scarce. We aimed to evaluate the long‐term cardiorespiratory, exercise capacity, and quality of life of vascular ring patients.

Methods

A single center prospective study evaluating spirometry, echocardiography, six‐minute walk test (6MWT), cardiopulmonary exercise testing (CPET), and quality of life questionnaire (SF36) in patients with a diagnosis of vascular ring, with or without corrective surgery.

Results

Twenty‐seven patients participated (11.9 ± 6 years, 52% males). The most common diagnosis was double aortic arch (16 patients, 59%). Nineteen patients had corrective surgery (O) and 8 did not (NO). Pulmonary function tests were within normal range in both groups (FEV1% predicted O = 87.6 ± 16.5, NO = 83 ± 10.8%). However, 11/27 had abnormal FEV1, 5 had abnormal FVC, and 13 (48%) had flattening of the expiratory curve. 6MWD and oxygen uptake were similarly mildly reduced in both groups; (6MWD O = 80.1 ± 10.7% predicted, NO = 74.1 ± 10.9% and oxygen uptake O = 78.5 ± 23.2% predicted, NO = 73.4 ± 14.3%). Peak O2 pulse (V̇O2/HR% predicted) was mildly reduced in the NO group (O = 88.4 ± 17.3%, NO = 75.8 ± 16.2%). Echocardiogram and SF36 scores were normal in all patients.

Conclusions

Long‐term evaluation of patients born with vascular rings revealed mild pulmonary impairment, reduction in 6MWD, and oxygen uptake. The NO group had also mild reduced peak O2 pulse. Larger, long‐term studies assessing functional parameters in operated and non‐operated patients are needed to assess disease/surgery limitation in patients with vascular rings. Clinical trial registration number: NCT04781738.
Localization of macrophage subtypes and neutrophils in the prostate tumor microenvironment and their association with prostate cancer racial disparities
Authors: Maynard Janielle P. , Godwin Taylor N. , Lu Jiayun , Vidal Igor , Lotan Tamara L. , De Marzo Angelo M. , Joshu Corinne E. , Sfanos Karen S.
Published: August 2022

Background

Black men are two to three times more likely to die from prostate cancer (PCa) than White men. This disparity is due in part to discrepancies in socioeconomic status and access to quality care. Studies also suggest that differences in the prevalence of innate immune cells and heightened function in the tumor microenvironment of Black men may promote PCa aggressiveness.

Methods

We evaluated the spatial localization of and quantified CD66ce+ neutrophils by immunohistochemistry and CD68+ (pan), CD80+ (M1), and CD163+ (M2) macrophages by RNA in situ hybridization on formalin‐fixed paraffin‐embedded tissues from organ donor “normal” prostate (n = 9) and radical prostatectomy (n = 38) tissues from Black and White men. Neutrophils were quantified in PCa and matched benign tissues in tissue microarray (TMA) sets comprised of 560 White and 371 Black men. Likewise, macrophages were quantified in TMA sets comprised of tissues from 60 White and 120 Black men. The phosphatase and tensin homolog (PTEN) and ETS transcription factor ERG (ERG) expression status of each TMA PCa case was assessed via immunohistochemistry. Finally, neutrophils and macrophage subsets were assessed in a TMA set comprised of distant metastatic PCa tissues collected at autopsy (n = 6) sampled across multiple sites.

Results

CD66ce+ neutrophils were minimal in normal prostates, but were increased in PCa compared to benign tissues, in low grade compared to higher grade PCa, in PCa tissues from White compared to Black men, and in PCa with PTEN loss or ERG positivity. CD163+ macrophages were the predominant macrophage subset in normal organ donor prostate tissues from both Black and White men and were significantly more abundant in organ donor compared to prostatectomy PCa tissues. CD68,+ CD80,+ and CD163+ macrophages were significantly increased in cancer compared to benign tissues and in cancers with ERG positivity. CD68+ and CD163+ macrophages were increased in higher grade cancers compared to low grade cancer and CD80 expression was significantly higher in benign prostatectomy tissues from Black compared to White men.

Conclusions

Innate immune cell infiltration is increased in the prostate tumor microenvironment of both Black and White men, however the composition of innate immune cell infiltration may vary between races.
A Geodetic Determination of the Gravitational Potential Difference Toward a 100-km-Scale Clock Frequency Comparison in a Plate Subduction Zone
Authors: Tanaka Yoshiyuki , Aoki Yosuke
Published: August 2022

Recent advances in the developments of optical atomic clocks have enabled 10−18-level frequency comparisons between fibre-linked clocks. Therefore, chronometric leveling with an uncertainty on the order of 1 cm has become possible, based on the general theory of relativity. Since measurement uncertainty does not deteriorate with increasing fibre length, applications of chronometric leveling in geodesy, particularly unification of height reference systems, have been actively studied. In Japan, a frequency comparison is under experimentation using a fibre link connecting two optical lattice clocks approximately 100 km apart. This study estimates both the potential difference between these two clock sites with a geodetic method and its uncertainty to verify the results of chronometric leveling, which will be obtained in the near future. We use orthometric heights derived from leveling surveys repeated for monitoring crustal deformation. When discussing an uncertainty at the 1-cm level in height, the effects of temporal variations in the gravitational potential on the height measurement need to be considered due to various geophysical phenomena, including tides. Our results show that the uncertainty in the height measurements by geodetic leveling is the largest and that tidal potential changes during the height measurements can cause systematic errors of a few mm. The effects due to variations in the nontidal ocean bottom pressure and atmospheric pressure are more than an order of magnitude smaller than the tidal effects at this spatial scale. An upper limit of groundwater effects is also estimated. In a future comparison with clocks with an uncertainty on the order of 10−19, tidal potential changes and groundwater effects must be more rigorously evaluated.
Discrete Fault Models
Authors: Dragoni Michele
Published: August 2022

Fault surfaces are characterized by an inhomogeneous friction distribution, that can be represented with asperity models. Fault mechanics is dominated by asperities, so that a fruitful approach is to use discrete models, where asperities are the basic elements and the state of the fault is described by the average values of stress, friction and slip on each asperity. Under reasonable assumptions, the equations of motion can be solved analytically, with a deeper understanding of the behavior of the system. Fault dynamics has a sticking mode, where asperities are stationary, and a number of slipping modes, corresponding to the separate or simultaneous motion of asperities. Any seismic event is a sequence of slipping modes and a large variety of source functions is possible. Many large earthquakes are observed to be the consequence of the failure of two asperities: a discrete two-asperity model shows a rich dynamics and allows a detailed study of interaction between asperities. In this framework, fault evolution during coseismic and interseismic intervals can be calculated in terms of fault slip, stress state, energy release and seismic spectrum, including viscoelastic relaxation, fault creep and stress perturbations from other faults. Discrete models may include interaction between neighboring faults, allowing to assess conditions for the occurrence of seismic sequences in a fault system. A review of recent work on this subject is presented with applications to real earthquakes.
Medial patellofemoral ligament reconstruction using nonresorbable sutures yields comparable outcomes to reconstruction with a pedicled quadriceps tendon autograft when performed in addition to bony risk factor correction
Authors: Milinkovic Danko Dan , Zimmermann Felix , Balcarek Peter
Published: August 2022

Purpose

To evaluate the results for reconstruction of the medial patellofemoral ligament using synthetic nonresorbable sutures (S-MPFL-R) in comparison to MPFL-R using quadriceps tendon autograft (QT-MPFL-R) in patients undergoing simultaneous correction of anatomic risk factors for lateral patellar instability (LPI) at a minimum of 2 years of follow-up.

Methods

Between November 2018 and June 2019, 19 patients (male/female 8/11; mean age 26 ± 7 years) underwent S-MPFL-R (FiberTape®) in combination with the correction of predisposing risk factors for LPI. The control group of 38 patients (male/female 16/22, mean age 26 ± 6 years) who underwent QT-MPFL-R was matched 1:2 by sex, age, anatomic risk factors, and concomitant surgical correction of bony risk factors. The Banff Patella Instability Instrument 2.0 (BPII 2.0) and a numerical analog scale (NAS 0–10) for patellofemoral pain and subjective knee joint function were used to assess patients’ reported quality of life before and after surgery.

Results

The BPII 2.0 score increased from 35.0 ± 21.7 points to 79.7 ± 13.3 points (p < 0.0001) in the S-MPRL-R group and from 44.3 ± 19.6 points to 80.9 ± 15 points (p < 0.0001) in the QT-MPFL-R group from preoperatively to postoperatively, respectively, without any significant difference between the groups. In the S-MPFL-R group and QT-MPFL-R group, 95% (18/19) and 92% (35/38) of patients, respectively, crossed the minimally clinically important difference reported for the BPII 2.0. NAS values for pain and subjective knee joint function improved significantly in both groups (p < 0.0001,p < 0.0001) without any significant difference between the groups at the final follow-up.

Conclusions

This study demonstrates that nonresorbable sutures can serve as a viable option for MPFL-R, yielding comparable outcomes compared to quadriceps tendon autograft reconstruction when performed concomitantly with the correction of anatomic risk factors for LPI. This option reduces the need for autologous tendon harvesting or the use of allografts for MPFL-R.

Level of evidence

Level III.
Patterns and trends of firework-related adult burns in New South Wales, Australia
Authors: Diab Jason , Hopkins Zachias , Diab Vanessa , Maitz Peter K. M. , Issler-Fisher Andrea C.
Published: August 2022

Background

Fireworks are often used to celebrate holidays and events. With novel designs and availability, there is potential for blast and burn injuries that can impact livelihood and function. This study aims to describe and analyse firework-related burns in adults across New South Wales and the Australian Capital Territory.

Methods

A retrospective statewide review was performed from January 2010 to December 2020 at the adult burns units. All firework-related burn injuries older than 18 years that attended or were referred to the burns unit were included.

Results

There were 203 patients with a firework-related burn injury. The male to female ratio was 4:1 with an average age of 32.2 years. Men were 5.2 years younger than women (31.2 vs 36.4, p = 0.010). Men were more likely to have firework-related injuries on non-holidays, whereas women were more likely on holidays (p = 0.050). Men were more likely to operate fireworks after consuming alcohol resulting in burns than women (34.4% vs 12.5%, p = 0.007). Sparklers were more common amongst women, whereas fireworks had higher proportions amongst men (p = 0.009). The most common site of injury was the hands. The most frequent type of injury was a mid-dermal burn (61.6%), followed by superficial (25.2%), and full thickness (13.2%) respectively. The operative rate was 17.7% with a mean total length of stay of 2.2 days (range: 1–12).

Conclusions

Firework-related burns have distinct patterns of use and injuries amongst men and women. Alongside legislation, awareness of the potential hazards for shopgood fireworks such as sparklers is critical for future prevention campaigns.

Level of evidence: Level III, Risk/Prognostic.
Linking the North Atlantic Oscillation to winter precipitation over the Western Himalaya through disturbances of the subtropical jet
Authors: Hunt Kieran M. R. , Zaz Sumira Nazir
Published: August 2022

Winter (December to March) precipitation is vital to the agriculture and water security of the Western Himalaya. This precipitation is largely brought to the region by extratropical systems, known as western disturbances (WDs), which are embedded in the subtropical jet. In this study, using seventy years of data, it is shown that during positive phases of the North Atlantic Oscillation (NAO+) the subtropical jet is significantly more intense than during negative phases (NAO−). Accordingly, it is shown that the NAO significantly affects WD behaviour on interannual timescales: during NAO+ periods, WDs are on average 20% more common and 7% more intense than during NAO− periods. This results in 40% more moisture flux entering the region and impinging on the Western Himalaya and an average increase in winter precipitation of 45% in NAO+ compared to NAO−. Using empirical orthogonal function (EOF) analysis, North Atlantic variability is causally linked to precipitation over North India—latitudinal variation in the jet over the North Atlantic is linked to waviness downstream, whereas variation in its tilt over the North Atlantic is linked to its strength and shear downstream. These results are used to construct a simple linear model that can skilfully predict winter precipitation over north India at a lead time of one month.
Serum neutrophil gelatinase-associated lipocalin (NGAL) as a diagnostic tool in pediatric acute appendicitis: a prospective validation study
Authors: Arredondo Montero Javier , Antona Giuseppa , Bardají Pascual Carlos , Bronte Anaut Mónica , Ros Briones Raquel , Fernández-Celis Amaya , Rivero Marcotegui Adriana , López-Andrés Natalia , Martín-Calvo Nerea
Published: August 2022

Introduction

NGAL has recently been studied as a biomarker in the diagnostic context of pediatric acute appendicitis (PAA), although existing series are scarce and have limited sample sizes.

Materials and methods

A prospective observational study was designed to validate serum NGAL as a diagnostic tool in PAA. This study included 215 patients, divided into 3 groups: (1) patients undergoing major outpatient surgery (n = 63), (2) patients with non-surgical abdominal pain in whom a diagnosis of PAA was excluded (n = 53) and (3) patients with a confirmed diagnosis of PAA (n = 99). Patients in group 3 were divided into complicated or uncomplicated appendicitis. In 201 patients, a serum sample was obtained at the time of diagnosis and NGAL concentration was determined by ELISA. The Kolmogorov–Smirnov test was used to assess normality. Comparative statistical analyses were performed using the Mann–Whitney U test, the Kruskal-Wallis test and the Fisher’s exact test. To calculate the discriminative ability of the molecule, the area under the receiver-operating characteristic curves (AUC) was calculated. A p value < 0.05 established statistical significance.

Results

Median (interquartile range) of serum NGAL values were 38.88 (27.15–48.04) ng/mL (group 1), 51.84 (37.33–69.80) ng/mL (group 2) and 65.06 (50.50–86.60) ng/mL (group 3). The AUC (group 2 vs 3) was 0.642 (95% CI 0.542–0.741) (p < 0.001) and the best cutoff point was found to be at 40.97 ng/mL, with a sensitivity of 89% and a specificity of 34.6%. No statistically significant differences in serum NGAL values were found between patients with uncomplicated PAA and those with complicated PAA.

Conclusions

This prospective validation study with a large sample size confirms that the diagnostic yield of NGAL in the context of PAA is only moderate, and therefore, it should not be used as a unique diagnostic tool. Furthermore, NGAL is not a valid biomarker to discern between uncomplicated and complicated PAA.
Single-center study for robotic-assisted laparoscopic sacropexies: a one-fits-all strategy for pelvic organ prolapse?
Authors: Mach Pawel , Kaufold Cara , Rusch Peter , Kimmig Rainer , Buderath Paul
Published: August 2022

Purpose

Sarcopenia has been established as the “gold standard” for the treatment of pelvic organ prolapse (POP). Minimal invasive laparoscopy can help to reduce the risks of open access surgery. We compare the surgical results and outcomes of robotic-assisted sacropexies.

Methods

In this monocentric retrospective study we enrolled 49 patients operated on symptomatic POP. Patients were divided into two groups according to the type of robotic-assisted sacropexy: patients with a history of hysterectomy received robotic-assisted sacrocolpopexy (RSCP; n = 19), while patients with subtotal hysterectomy received robotic-assisted cervicosacropexy (RCSP; n = 30). Failure was defined as recurrence of the disease with a need for reoperation. Validated questionnaires (the Pelvic Floor Distress Inventory—20 (PFDI-20) and Pelvic Floor Impact Questionnaire—7 (PFIQ-7)), were used for evaluation of patients quality of life postoperatively.

Results

The comparison between RCSP versus RSCP showed that the latter is related to slightly but not significantly increased recurrence rates and a higher impact of POP symptoms on quality of life in long-term follow-up (p = 0.04). Perioperative data showed similar complication rates in both RSP types but shorter postoperative time of bladder catheterization in the case of RCSP (p = 0.008).

Conclusions

The monocentric long-term data confirm that RSP is a safe and effective method of surgical POP treatment, regardless of the site of the anatomical compartment. In comparison to RSCP, RCSP is associated with a lower impact of POP symptoms on patients’ quality of life with a tendency to slightly lower rates of POP recurrence.
Perioperative fluid management and associated complications in children receiving kidney transplants in the UK
Authors: Wyatt Natalie , Norman Karen , Ryan Kate , Shenoy Mohan , Malina Michal , Weerassoriya Lasanthi , Merritt Jack , Balasubramanian Ramnath , Hayes Wesley
Published: August 2022

Background

Intravenous fluid administration is an essential part of perioperative care for children receiving a kidney transplant. There is a paucity of evidence to guide optimal perioperative fluid management. This study aimed to identify the volume of perioperative fluids administered across 5 UK paediatric kidney transplant centres and explore associations between fluid volume administered, graft function, and fluid-related adverse events.

Methods

Data were collected from five UK paediatric kidney transplant centres on perioperative fluid volumes administered, and incidence of pulmonary oedema, systemic hypertension, and requirement for intensive care support. Children < 18 years of age who received a kidney-only transplant between 1st January 2020 and 31st December 2021 were included.

Results

Complete data from 102 children were analysed. The median total volume of fluid administered in 72 h was 377 ml/kg (IQR 149 ml/kg) with a high degree of variability. A negative relationship between total fluid volume administered and day 7 eGFR was noted (p < 0.001). Association between urine volume post-transplant and day 7 eGFR was also negative (p < 0.001). Adverse events were frequent but no significant difference was found in the fluid volume administered to those who developed an adverse event, vs those who did not.

Conclusions

This study describes a high degree of variability in perioperative fluid volumes administered to children receiving kidney transplants. Both fluid volume and urine output were negatively associated with short-term graft function. These data contrast traditional interpretation of high urine output as a marker of graft health, and highlight the need for prospective clinical trials to optimise perioperative fluid administration for this group.

Graphical Abstract

A higher resolution version of the Graphical abstract is available as Supplementary information
The effect of antithrombotic therapy on the recurrence and outcome of chronic subdural hematoma after burr-hole craniostomy in a population-based cohort
Authors: Kerttula Santtu , Huttunen Jukka , Leinonen Ville , Kämäräinen Olli-Pekka , Danner Nils
Published: August 2022

Purpose

To study the effect of antithrombotic therapy (ATT) on the outcome of operatively treated chronic subdural hematomas (CSDH).

Methods

A retrospective population-based cohort study from Eastern Finland including all adult patients who underwent a burr-hole craniostomy (BHC) for CSDH during 2016 and 2017. The follow-up time for recurrence was 6 months and for mortality 3 years.

Results

A total of 301 CSDH patients were included in the study. ATT (antithrombotic therapy; antiplatelet or anticoagulant medication) was used by 164 patients (54.5%) at the time of diagnosis. The hematoma was bilateral in 102 patients (33.9%). Forty-seven patients (15.8%) encountered hematoma recurrence. Bilateral CSDHs required reoperations more often than unilateral hematomas (12.6% vs. 22.0%; p = 0.036) regardless of the primary operation (uni- or bilateral). A bivariate logistic regression analysis showed that bilateral hematoma (OR 1.918; 95% CI 1.013–3.630; p = 0.045) and male gender (OR 2.363; 95% CI 1.089–5.128; p = 0.030) independently predicted hematoma recurrence. The overall three-year mortality was 27.9%. The use of ATT was not associated with CSDH recurrence, and the length of the temporary postoperative ATT discontinuation did not correlate with the rate of thromboembolic events.

Conclusions

ATT did not affect CSDH recurrence in our study population, and the duration of the temporary postoperative ATT discontinuation was not associated with the rate of thromboembolic complications. Male gender and bilateral hematomas were more frequently associated with recurrences.
Polynomial-time algorithms for multimarginal optimal transport problems with structure
Authors: Altschuler Jason M. , Boix-Adserà Enric
Published: August 2022

Multimarginal Optimal Transport (MOT) has attracted significant interest due to applications in machine learning, statistics, and the sciences. However, in most applications, the success of MOT is severely limited by a lack of efficient algorithms. Indeed, MOT in general requires exponential time in the number of marginals k and their support sizes n. This paper develops a general theory about what “structure” makes MOT solvable in $$\mathrm {poly}(n,k)$$

poly
(
n
,
k
)

time. We develop a unified algorithmic framework for solving MOT in $$\mathrm {poly}(n,k)$$

poly
(
n
,
k
)

time by characterizing the structure that different algorithms require in terms of simple variants of the dual feasibility oracle. This framework has several benefits. First, it enables us to show that the Sinkhorn algorithm, which is currently the most popular MOT algorithm, requires strictly more structure than other algorithms do to solve MOT in $$\mathrm {poly}(n,k)$$

poly
(
n
,
k
)

time. Second, our framework makes it much simpler to develop $$\mathrm {poly}(n,k)$$

poly
(
n
,
k
)

time algorithms for a given MOT problem. In particular, it is necessary and sufficient to (approximately) solve the dual feasibility oracle—which is much more amenable to standard algorithmic techniques. We illustrate this ease-of-use by developing $$\mathrm {poly}(n,k)$$

poly
(
n
,
k
)

-time algorithms for three general classes of MOT cost structures: (1) graphical structure; (2) set-optimization structure; and (3) low-rank plus sparse structure. For structure (1), we recover the known result that Sinkhorn has $$\mathrm {poly}(n,k)$$

poly
(
n
,
k
)

runtime; moreover, we provide the first $$\mathrm {poly}(n,k)$$

poly
(
n
,
k
)

time algorithms for computing solutions that are exact and sparse. For structures (2)-(3), we give the first $$\mathrm {poly}(n,k)$$

poly
(
n
,
k
)

time algorithms, even for approximate computation. Together, these three structures encompass many—if not most—current applications of MOT.
Get up, stand up: a randomized controlled trial to assess the effectiveness of a messenger-based intervention to reduce sedentary behavior in university students
Authors: Kellner Mona , Faas Franziska
Published: August 2022

Aim

Sedentary behavior is a severe and independent risk factor for health. According to current research, sitting time is at a dangerously high level. Especially young adults show a high prevalence compared to others. The study aimed to assess the effectiveness of a 6-week messenger-based intervention to reduce sedentary behavior in university students.

Subject and methods

The 345 university students that enrolled were randomly assigned to the intervention group (n = 173) and control group (n = 172). Randomization and allocation to the trial group were computer assisted. The trial was conducted remotely, without any personal contact. A drop out of 276 participants led to a primary analysis of 71 (IG n = 41; CG n = 31) participants. Sedentary behavior was assessed online using the Heidelberg Questionnaire for the Assessment of Sitting Behavior, at 5 time points: baseline (T0), 2 weeks (Z1), 4 weeks (Z2) 6 weeks (end of the intervention, T1), and follow-up 4 weeks after intervention (T2).

Results

Mixed ANOVA was carried out for T0 and T1 to reveal interaction effects between time and group. Mean differences show a highly practically and statistically relevant reduction in sitting time in the intervention group of 60 min between baseline and T1. No sustained effect of the intervention could be detected by analyzing sitting times at follow-up, 4 weeks after the end of the intervention.

Conclusions

Reduction in sedentary behavior in the intervention group after 6 weeks shows that the intervention is practically and statistically relevant. Limitations concerning the assessment method (questionnaire) as well as the sample size should be considered. The trial serves as a pilot study. However, the positive outcome of sitting time reduction paves the way for further research in this field.
Embracing policy paradoxes: EU’s Just Transition Fund and the aim “to leave no one behind”
Authors: Sarkki Simo , Ludvig Alice , Nijnik Maria , Kopiy Serhiy
Published: August 2022

With the adoption of the 2030 Agenda, UN Member States pledge “to leave no one behind” and “endeavour to reach the furthest behind first”. The EU Just Transition Fund (JTF) was designed to meet these policy objectives. It is one of three pillars of the Just Transition Mechanism, aiming at fair delivery of the European Green Deal and reducing adverse social and economic impacts of the transition towards a climate-neutral Europe. We examine the formulation of the JTF Regulation, from January 2020 until July 2021 and analyse seven topics of importance during the JTF formulation. Based on the results, we identify and discuss four paradoxes related to governance scales, offsetting exclusion, equity illusion, and eligibility criteria. The paradoxes arise from tension between the all-inclusive objective to leave no one behind, and selective affirmative actions, seeking to reach the furthest behind first. Results of the analysis enabled us to put forward plausible strategies to embrace these policy paradoxes to offer important lessons learned for the JTF and also to future policies that seek to leave no one behind.
A note on the cost of capital with fixed payout ratios
Authors: Diedrich Ralf , Dierkes Stefan , Gröger Hans-Christian
Published: August 2022

The insights of Modigliani and Miller (Am Econ Rev 53:433–443, 1963) and Miles and Ezzell (15:719–730, https://doi.org/10.2307/2330405, 1980) on the cost of capital of firms rank among the most important results in financial theory. The underlying assumptions regarding the financial policy, however, can hardly be reconciled with empirical findings. We investigate the implications of an alternative approach that is characterized by a fixed payout ratio. By introducing additional assumptions about investment opportunities, we find relationships between the cost of equity of levered and unlevered firms. The results contribute to explaining empirical findings and open the possibility to base valuation techniques on realistic and yet practicable assumptions.
Determinanten und Verläufe musikalischer Begabung im Jugendalter
Authors: Labonde Philippe , Müllensiefen Daniel
Published: August 2022

Nur wenige Langzeitstudien beschreiben bislang musikalische Entwicklungsverläufe mit einem Fokus auf Begabungsforschung (Müllensiefen 2017). Diese Lücke will der vorliegende Beitrag schließen und anhand der Daten aus einer internationalen Langzeitstudie die Frage beantworten, wie hilfreich unterschiedliche Begabungsansätze für die Modellierung musikalischer Entwicklung sind. Dabei soll untersucht werden, wie sich verschiedene Definitionen musikalischer Begabung und deren statistische Umsetzung auf die Identifikation musikalisch Begabter auswirken. Hierfür werden klassische Begabungskriterien nach Gagné (1998) und der TAD-Ansatz (Preckel et al. 2020) zur Klassifizierung der Studienteilnehmer/innen verwendet und die Ergebnisse miteinander verglichen. In beiden Ansätzen erweisen sich fluide Intelligenz, Arbeitsgedächtniskapazität, die Persönlichkeitsdimension Offenheit und der Glaube an die Veränderbarkeit von Musikalität durch Training als robuste Prädiktoren. Als zentraler Unterschied zeigt sich, dass die perzeptuellen musikalische Fähigkeiten der Begabten, die nach traditionellen Kriterien ausgewählt wurden, ab dem ersten Messzeitpunkt sinkt. Die Ergebnisse werden mit Referenz auf das Phänomen der Regression zur Mitte diskutiert und legen nahe, dass die Analyse von Langzeitdaten unter Berücksichtigung des TAD-Ansatzes einen geeigneteren Ansatz für Entscheidungen über die musikalische Begabung von Jugendlichen darstellen.
Prereduction Behavior of Manganese Ores With Solid Carbon and in CO/CO2 Gas Atmosphere
Authors: Mukono Tichaona , Reiersen Henrik Stensdal , Schanche Trygve Lindahl , Wallin Maria , Tangstad Merete
Published: August 2022

The prereduction reactions in the submerged arc furnace (SAF) are highly decisive of the total carbon, and energy consumption of the ferromanganese process. Therefore, understanding the dependency of prereduction behavior on ore characteristics and furnace conditions is of paramount importance. Prereduction behavior of Comilog, Nchwaning and UMK ores with solid carbon was studied in an open 75 kVA induction furnace set up simulating the conditions of an industrial SAF. In addition, the ores were thermogravimetrically studied with non-isothermal heating to 1000 °C in a flowing 70/30 CO/CO2 atmosphere. Gasification of carbon according to Boudouard reaction was considered significant for carbonate ores in induction furnace setup. UMK had a greater extent of prereduction compared to Nchwaning which is low in carbonates and Comilog which is known to have a higher CO reactivity at similar CO contents. TGA rate curves shows that prereduction of UMK ore occurred with two major distinctive steps. The first one was a combination of prereduction reactions and decomposition of carbonates with a peak temperature of 700 °C, and the second peak was the decomposition of calcite at 900 °C. The O/Mn ratio for UMK shows that prereduction is already completed prior to the second decomposition peak at 900 °C. In addition to prereduction reactions, Nchwaning is also characterized by an endothermic step which is decomposition of carbonates at 900 °C. Comilog ore produced the most fines followed by Nchwaning and lastly UMK on decrepitation.