bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of empiric cardioprotective therapy in patients receiving cardiotoxic chemotherapies: systematic review & bayesian network meta-analysis
Authors: Abdelfattah OM , Sayed AS , Munir M , Shazly O , Awad AK , Ghaith HS , Gerew M , Guha A , Barac A , Fradley MG , Abela GS , Addison D
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Cardioprotective therapies represent an important avenue to reduce these limiting toxicities, including serious heart failure (HF) events. However, due to conflicting isolated reports, the true efficacy and optimal cardioprotective therapy at the time of anticancer treatment initiation is unclear. Therefore, we undertook a network meta-analysis to elucidate the most effective therapies at cardiotoxic HF prevention.

Purpose

To determine the efficacy, and optimal cardioprotective strategy in patients receiving cardiotoxic chemotherapies.

Methods

Leveraging the MEDLINE/Pubmed, CENTRAL, and clinicaltrials.gov databases, we identified all randomized controlled trials (RCTs) investigating cardioprotective therapies from inception to November 2021. Eligible cardioprotective classes included ACEIs, ARBs, Beta-blockers, dexrazoxane (DEX), statins, and mineralocorticoid receptor antagonists (MRA). The primary endpoint was the prevention of new-onset HF. The secondary outcomes were the mean difference in left ventricular ejection fraction (LVEF) change, the incidence of hypotension, and all-cause mortality. Network meta-analyses were used to assess the cardioprotective effects of each therapy to deduce the most effective therapies. Both analyses were undertaken using a Bayesian random-effects model to estimate risk ratios (RR) and 95% credible intervals (95% CrI).

Results

Overall, from 726 articles, 39 studies evaluating 5,931 participants (38.0±19.1 years, 72.0% females) were identified. Over a median follow-up of 6 months, use of any cardioprotective strategy was associated with a significant reduction in new-onset HF (RR:0.32; 95% CrI:0.19-0.55), improved LVEF (mean difference: 3.92%; 95% CrI:2.81-5.07), and increased hypotension (RR:3.27; 95% CrI:1.38-9.87); there was no difference in mortality (RR:1.03; 95% CrI:0.84-1.22). Based on the median risk of incident HF in the control groups being 3.28%, the number need to treat (NNT) for "any" cardioprotective therapy to prevent one incident HF event was 45 patients. For dexrazoxane and neurohormonal agents, the median NNT was 36 and 53 patients, respectively. In this network analysis, dexrazoxane was most effective at HF prevention [Surface Under the Cumulative Ranking curve (SUCRA): 81.47%] and MRA most effective at preserving LVEF (SUCRA: 99.22%). ARBs most greatly increased hypotension (RR:7.20; 95% CrI:2.46-26.94).

Conclusion

Cardiotoxicity remains a challenge for cancer patients requiring life-saving cancer therapies. The initiation of a cardioprotective strategy reduces incident HF. Additional head-to-head trials are needed to confirm the optimal preventative strategy.
An artificial intelligence model to predict 12-month mortality among patients with myocardial infarction
Authors: Hovornyan AV , Ilashchuk TO
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Ischemic heart disease and acute myocardial infarction (AMI) are the number one causes of death and disability, affecting around 126 million individuals worldwide [1]. About 30% of all cases of AMI lead to death. According to different sources, 8-20% of people with AMI die within 1 year of the event, and every second patient is rehospitalized [1-2]. Thus, it is necessary to assess the risk and to predict the outcomes during the first admission to the hospital, in order to guide the management and treatment after AMI [2]. Conventional risk rating scales and methods have a lot of drawbacks, so novel approaches such as artificial intelligence (AI) and deep learning (DL) methods have the potential to provide an accurate risk assessment and share decision-making in patients who experienced AMI [3-4].

Purpose

To develop and validate a deep-learning-based risk stratification model to predict the 12-months mortality in patients with AMI.

Methods

A cohort of 250 AMI patients with Killip class I-IV was enrolled in the study. The data was collected on the admission day and a year after the event and included anamnesis as well as the results of the physical and laboratory-instrumental examination (72 values). All patients were randomly divided into 2 groups: the derivation cohort, which consisted of 215 individuals, and the validation cohort consisted of 35 patients. Our model was created using the Python programming language in GoogleColab and it is a convolutional neural network (CNN) with 1 input layer, 4 hidden layers, and 1 output layer consisting of neurons with a sigmoid activation function (Fig. 1). We used MaxAbsScaler for data normalization and Adam for optimization. Also, we calculated the GRACE risk score and compared the performance of the models only for the validation cohort that was not used for the model development.

Results

We developed our DL-based model using the derivation data during the 30 cycles of work, receiving the maximum value of training accuracy of 96.7%. The mortality risk, calculated by our model for the validation group was compared with real 12-months mortality, and the CNN "lied" only 2 times (Table 1). The test of the validation cohort showed such results of our DL-based model: 94% - accuracy, 71% - sensitivity, 100% - specificity, 100% - positive, and 93% - negative prognostic value. These results significantly outperformed the GRACE scale, which showed 63%, 71%, 54%, 26%, and 94% respectively.

Conclusions

In summary, we develop and validate a DL-based risk stratification model to predict the 12-months mortality in patients with AMI. The accuracy of the created model is significantly higher than conventional risk scales (GRACE score). Thus, it is proved that algorithms based on deep learning may be more effective to predict mortality and guide the management of cardiac patients.
Cardiovascular risk factor insights into the Tesco 1.0 Dataset
Authors: Pimenta D , Taubel J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Tesco published an open-source dataset containing area-aggregated product purchase information from 420m transactions across 16m individual Clubcard users in the Great London area, at a borough level. This dataset is presented as a ‘typical product’ purchase for each borough, divided into 220 individual datapoints.

Purpose

We wanted to explore dietary correlates with cardiovascular outcomes including age-standardised mortality rates for myocardial infarct, stroke, cardiac arrhythmia and COVID-19.

Methods

The Tesco 1.0 dataset was accessed on 1/11/21 and a sample of traditional dietary clinical risk and protective factor datapoints for each London borough were selected. Data for age-standardised mortality rates (ASMR) in each London borough were downloaded from the Office of National Statistics for 2019 for myocardial infarction, stroke, cardiac arrhythmia and 2020 COVID-19 deaths (March-July 2020). To explore for relevant associated factors, the average deprivation index (IMD) for each borough was accessed from Public Health England, and demographic data accessed from the Greater London Authority database.

Statistics using Spearman’s Rho calculator were derived in Excel and calculated using a web-based statistics calculator.

Results

Myocardial infarction (MI) ASMR closely correlated with increased levels of salt (g), fat and oils (% of total product), and weight of purchase (g). Increased fibre (g) was correlated with lower MI mortality. An important associated risk factor was the deprivation index, a important co-variable to consider when assessing diet-health relationships.

Stroke ASMR was more closely correlated with typical product constituents, significant risk factors were weight (g) of fat, carbohydrate, sugar and ready meals (%) and sweets (%), while % of fish and both % and total weight (g) of fruit and veg were protective factors. Importantly salt content was NOT a statistically significant factor.

Cardiac arrhythmia ASMR did not correlate with any dietary constituents reviewed.

COVID ASMR was closely correlated with myocardial infarction ASMR risk factors (salt, % of fat and oils and total weight of purchase) and total fibre (g) was again a protective factor. Interestingly, the % of ready meals was a protective factor for COVID ASMR, possibly associated with cultural and ethnicity-related behaviours, with higher BAME communities less likely to purchase ready meals.

Conclusions

This unique dataset offers a Big Data insight into the relationship between diet and health but is limited by a lack of individual granularity and heterogenous intra-borough populations. This research offers a starting point to further exploring in-depth food purchasing habits with healthcare outcomes, and further partnership in the future may unlock this.
Israel's first national remote cardiac rehabilitation program - patient response and potential factors affecting successful completion
Authors: Nabutovsky I , Heller A , Breitner D , Klemphner Y , Nachshon A , Yeshayahu S , Gang N , Klempfner R
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Sheba Medical Center

Introduction

Cardiac rehabilitation is an essential program for the reduction of future cardiac events and improve quality of life. However, many vulnerable individuals do not achieve this desired outcome due to the restrictive nature of institution-based rehabilitation. With this in mind was developed the Remote Cardiac Rehabilitation Program (RCRP). Our aim was to create the optimal conditions so that our patients are guided and stimulated in order to successfully complete the program.

Material and method

This study involved 306 patients with established CHD who underwent a six-month RCRP, three months of which were subsidized by health insurance. RCRP involves regular exercise, monitored by a smart sports watch and transferred to both the medical operations center as well as the mobile application on the patient’s smartphone. We built models to get predictors for the best patient performance in the last (third) month. Predictions were made based on their performance in the first month and some demographical data. Age and gender were taken as base features to all the models.

Results and discussion

The study involved patients, 81.5% men, aged 57.59 (±10.62), who were admitted to the RCRP mainly after myocardial infarction or coronary interventions (49%). The median minutes per week that patients performed aerobic exercise was 164, a median of 92 minutes at target HR (established by exercise physiologist), and the median percent of heart rate reserve was 76 % across exercise training. The median number aerobic sessions per week was 4, while the median daily steps was 8,370. Values had no significant differences across the 24 weeks. Following the 24-weeks of intervention, there was a significant improvement in exercise capacity, assessed by estimated METS using pre and post exercise stress tests from 9.95±2.57 to 11.71±3.43 (p<0.001). The most significant predictors of program adherence were older age and the number of weekly aerobic minutes and sessions in the first weeks of training (p<0.005). There is a direct relationship between the patient's age and the program compliance - the older the patient, the higher the compliance.

Conclusion

Adherence and the performance achieved by patients in the RCRP is well within guideline recommendations, leading to a significant improvement in exercise capacity. Older age, as well as early program adherence were significant factors which led to better program completion.
Rehabilitation of the unmotivated: remote cardiac rehabilitation among patients of all risk levels who reported unwillingness to participate in hospital-based rehabilitation
Authors: Nabutovsky I , Levin C , Yeshayahu S , Gang N , Nachshon A , Heller A , Breitner D , Klempfner R
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Cardiac Prevention and Rehabilitation Institute, Leviev Heart Center, Sheba medical center

Introduction

Remote cardiac rehabilitation (RCR) is recognized as a viable alternative to conventional, center-based rehabilitation. However, to achieve meaningful functional improvement, a high level of adherence and motivation to collaborate with the healthcare team, is necessary. The feasibility of RCR among patients who actively avoid hospital rehabilitation has not been adequately investigated by randomized studies.

Method

This year-long prospective study enrolled 60 cardiac patients at various risk levels, including those with heart transplants and heart failure, who refused to participate in conventional rehabilitation. Accordingly, 40 participants were randomized to a 6-month RCR program, while the remaining 20 received usual care in the community. Both groups were monitored for activity and self-reported outcomes. RCR is based on behavioral theories, includes multidisciplinary support, motivational and educational content, regular exercise, controlled by a smart sports watch, and transmitted to both the medical operations center and the patients mobile phone application. The main outcome was the change in Peak VO2, measured by the Cardiopulmonary Exercise Testing, after 4 months of intervention compared to baseline.

Results

The study included 60 patients, 82% men, aged 55 (±12), who were admitted to the 6-month RCR program mainly after myocardial infarction or coronary interventions (44%), heart failure (29%), cardiomyopathy (13.5%) and heart transplantation (10.5%). After RCR, there was a significant increase in Peak VO2 in the intervention group (+2.46±7.1 mL/(kg·min) compared to the control group (-0.72±7.9 mL/(kg·min) (p<0.001). High-density lipoprotein (HDL) levels also improved significantly.

The average minutes per week of aerobic exercise was 221 (±124.74), which was 147% of the goal. The average minutes at the recommended target heart rate was 117.38 (±78.36), and the percentage of intensity of training was 69.39% (±15.11) of the maximum capacity. The average aerobic sessions per week was 5 (±3), while the resistance sessions was 0.8 (±0.74). The average daily step count in the intervention group was 9145 (±3860) versus 4445 (±3005; p<0.001). The surveys showed a significant improvement in patients’ mental and physical perception of health in the intervention vs. control group.

Conclusion

The adherence and results achieved by patients in RCR who avoided conventional rehabilitation were well within guideline recommendations, resulting in a significant improvement in physical capacity. Risk level, age, and lack of motivation at the beginning of the program were not barriers to achieving goals and cooperation.
The role of cardiac nuclear imaging of women with suspected coronary artery disease: data from Latvian cardiac SPECT registry
Authors: Vitola B , Mintale I , Kedrova J , Kalnina M , Erglis A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac imaging is a leading method in the diagnosis and treatment of ischemic heart disease. As the prognostic value of exercise stress tests for women is relatively low, ESC Guidelines suggest more accurate imaging method. Myocardial perfusion imaging with SPECT is one of the most commonly performed non-invasive cardiac imaging tests evaluating myocardial viability, assessing prognosis and estimating the efficacy of therapy.

Purpose

To determine the role for cardiac nuclear imaging for women with suspected coronary artery disease (CAD) in Latvia and to analyze prescribed further diagnostic approaches to establish the diagnosis and appropriate treatment.

Methods

For women included in Latvian cardiac SPECT registry the cardiac SPECT was performed in single University Hospital from 2018 till 2021. The patients were divided into 2 groups: normal myocardial perfusion and true myocardial perfusion defect, defined as area of ischemia ≥ 10% of the left ventricle myocardium. Patients with perfusion defect were analyzed according to prescribed further diagnostic test or treatment option.

Results

700 women with suspected CAD were analyzed. True myocardial perfusion defect was detected in 120 patients (17.1%). As further diagnostic approach in 29 (24.2%) cases cardiac computed tomography angiography (CTA) was performed; the invasive coronary angiography (ICA) - in 76 (63.3%) cases and percutaneous coronary intervention (PCI) in 15 (12.5%) cases was suggested.

Analyzing results of all performed CTAs’, stenosis in main coronary arteries were not found (100%) and CAD was excluded. Of all performed ICA, in 41 (53.9%) women atherosclerosis in main coronary arteries was not observed and microvascular angina as a primary diagnosis was assessed. In 17 (22.3%) patients the significant stenosis in main coronary arteries was present and PCI was performed, of whom 10 (58.5%) women were primarily diagnosed. 1 patient (1.3%) underwent coronary artery bypass surgery (CBP). In 9 (11.8%) patients significant stenosis was not detected and they were discharged on optimal medical treatment (OMT). In all these 9 patients the CAD was already known before the SPECT. From all suggested PCIs’: 8 women underwent PCI (53.3 %), 1 – CBP (6.6%) and 6 (40%) patients continued OMT.

Conclusion

Based on Latvian cardiac SPECT registry data, myocardial perfusion imaging with cardiac SPECT is valuable and is highly recommended for the diagnostics of women with known or suspected CAD. Despite the low availability of cardiac SPECT in Latvia, the registry shows the importance of nuclear diagnostics for such a difficult to diagnose group as women.
Left ventricle myocardial deformation in olympic athletes assessed by cardiac magnetic resonance: does the sex and discipline matter?
Authors: Monosilio S , Filomena D , Birtolo L I , Penza M , Lemme E , Squeo M R , Mango R , Tonti G , Pedrizzetti G , Fedele F , Gualdi G , Spataro A , Pelliccia A , Di Giacinto B , Maestrini V
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Sport induces structural and functional cardiac adaptation with different entity related to several factors including type of training and gender. Cardiovascular Magnetic Resonance (CMR) is the gold standard for morpho-functional evaluation of athletes’ heart and commonly relies on ventricular volume, wall thickness and ejection fraction (EF) assessment. Data on myocardial deformation (MD) are limited to echocardiography and are scarce.

Purpose

To assess MD in Olympic athletes and to evaluate the possible influence of sport categories and gender.

Methods

A group of Olympic athletes evaluated prior the Olympic games with unremarkable cardiovascular pre-participation screening tests underwent CMR without contrast administration. A group of sedentary subjects was enrolled as a control group. Cine-images were post-processed for volume and function evaluation and to assess global longitudinal strain (GLS) and global circumferential strain (GCS) by feature-tracking software. Athletes were divided in subgroups according to ESC sport classification. Male and female athletes were compared. Athletes were also divided based on EF (≤53% or >53%).

Results

93 elite athletes (33% power, 33% mixed, 33% endurance) and 18 controls were enrolled. No differences in terms of EF were observed, while endurance athletes showed the greater LV remodeling (Table). GLS and GCS values of the entire population were -22.5±2.7% and -30.7±3.4%, respectively. No significant differences were found comparing athletes of different sport categories and sedentary controls for GLS (p= 0.940) and GCS (p=0.072). Female athletes showed higher GLS compared to male (-23.5±2.8% vs-21.9±2.8%, p=0.002) but not differences in terms of GCS (-31.5±3.1% vs-30.2±3.5%, p=0.076). Athletes with EF≤53% had lower GLS values compared with those with >53% but within normal limits (Figure).

Conclusion

No differences were observed in MD assessed by CMR between different sport categories and controls. Female athletes showed higher longitudinal but not circumferential strain compared with male. Athletes with lower EF presented lower values of strain but within normal range with the potentiality to be used as a tool for differential diagnosis between normal adaptation and disease.
Assessing COVID-19 Health Literacy (CoHL) and its relationships with sociodemographic features, locus of control and compliance with social distancing rules during the first lockdown in France
Authors: Rodon Carole , Chin Jessie , Chevalier Aline
Published: May 2022

Health literacy (HL) is critical to find, understand and use health information for adopting appropriate health behavior, especially during a pandemic crisis in which people can be exposed to an overwhelming amount of information from different media. To this end, we conducted an online study to first validate the measure of COronaVIrus Disease appeared in 2019 (COVID-19) health literacy (CoHL) and then investigated its relationships with locus of control (LoC), news information search and the adoption of protective behaviors (PBs) during the first lockdown in France. We first showed the good structural and psychometric qualities of the CoHL scale on a 3-dimensional structure: the Critical dimension, the Extraction/Communicative and the Application/Communicative dimension. We then found that CoHL was associated with the adoption of PBs suggesting that people with higher CoHL tended to adopt more PBs during the first lockdown, regardless of their LoC. However, people with low CoHL would be more likely to adopt PBs if they believe that they may get COVID-19 due to the behavior and health conditions of others (high external LoC). The study has implications for the design of public health campaigns for people with inadequate HL and with a different LoC.
Blind inverse problems with isolated spikes
Authors: Debarnot Valentin , Weiss Pierre
Published: May 2022

Assume that an unknown integral operator living in some known subspace is observed indirectly, by evaluating its action on a discrete measure containing a few isolated Dirac masses at an unknown location. Is this information enough to recover the impulse response location and the operator with a sub-pixel accuracy? We study this question and bring to light key geometrical quantities for exact and stable recovery. We also propose an in-depth study of the presence of additive white Gaussian noise. We illustrate the well-foundedness of this theory on the challenging optical imaging problem of blind deconvolution and blind deblurring with non-stationary operators.
Decision support system for evidence-based precautionary ecological planning
Authors: Min Deedee , Lee Ji-Hyun
Published: May 2022

While using precedent knowledge is critical especially for ecological planning to minimize permanent adverse effect on the natural environment, there have been only few cases that apply case-based design or decision support system to ecological designs. A possible reason might be because the design context varies dramatically for different sites with diverse variables to consider. Despite the difficulties, ecological wisdom – a relatively newly suggested ecological planning and design strategy – suggests using evidence-based precedents for new ecological designs to avoid ecologically harmful designs. For the past 5 years, there has been ongoing research on ecological wisdom by notable scholars; however, there remains a gap between the concept and its applicability as a planning or design methodology even though one of the goals of ecological wisdom is to be made practical. In this research, we propose a computational framework for the implementation of evidence-based Precautionary Ecological Planning Assistant and apply to a design case. To accomplish this goal, we found design patterns from vernacular garden designs in relation to environmental factors. By identifying statistically significant ecological design patterns, we generated a list of rules that were then incorporated into a decision support system alerting the users that the performed space planning strategy has never been observed before in previous ecological designs. From this research process, we were able to confirm that the proposed computational framework supports ecological design process to be more data-driven and precautionary providing second thoughts to planners when planning for unconfirmed ecological design.
United States Military Fatalities During Operation Inherent Resolve and Operation Freedom’s Sentinel
Authors: Kotwal Russ S , Janak Jud C , Howard Jeffrey T , Rohrer Andrew J , Harcke Howard T , Holcomb John B , Eastridge Brian J , Gurney Jennifer M , Shackelford Stacy A , Mazuchowski Edward L
Published: May 2022

Background

Military operations provide a unified action and strategic approach to achieve national goals and objectives. Mortality reviews from military operations can guide injury prevention and casualty care efforts.

Methods

A retrospective study was conducted on all U.S. military fatalities from Operation Inherent Resolve (OIR) in Iraq (2014-2021) and Operation Freedom’s Sentinel (OFS) in Afghanistan (2015-2021). Data were obtained from autopsy reports and other existing records. Fatalities were evaluated for population characteristics; manner, cause, and location of death; and underlying atherosclerosis. Non-suicide trauma fatalities were also evaluated for injury severity, mechanism of death, injury survivability, death preventability, and opportunities for improvement.

Results

Of 213 U.S. military fatalities (median age, 29 years; male, 93.0%; prehospital, 89.2%), 49.8% were from OIR, and 50.2% were from OFS. More OIR fatalities were Reserve and National Guard forces (OIR 22.6%; OFS 5.6%), conventional forces (OIR 82.1%; OFS 65.4%), and support personnel (OIR 61.3%; OFS 33.6%). More OIR fatalities also resulted from disease and non-battle injury (OIR 83.0%; OFS 28.0%). The leading cause of death was injury (OIR 81.1%; OFS 98.1%). Manner of death differed as more homicides (OIR 18.9%; OFS 72.9%) were seen in OFS, and more deaths from natural causes (OIR 18.9%; OFS 1.9%) and suicides (OIR 29.2%; OFS 6.5%) were seen in OIR. The prevalence of underlying atherosclerosis was 14.2% in OIR and 18.7% in OFS. Of 146 non-suicide trauma fatalities, most multiple/blunt force injury deaths (62.2%) occurred in OIR, and most blast injury deaths (77.8%) and gunshot wound deaths (76.6%) occurred in OFS. The leading mechanism of death was catastrophic tissue destruction (80.8%). Most fatalities had non-survivable injuries (80.8%) and non-preventable deaths (97.3%).

Conclusions

Comprehensive mortality reviews should routinely be conducted for all military operation deaths. Understanding death from both injury and disease can guide preemptive and responsive efforts to reduce death among military forces.
Modeling Balmer line signatures of stellar CMEs
Authors: Leitzinger M , Odert P , Heinzel P
Published: May 2022

From the Sun we know that coronal mass ejections (CMEs) are a transient phenomenon, often correlated with flares. They have an impact on solar mass- and angular momentum loss, and therefore solar evolution, and make a significant part of space weather. The same is true for stars, but stellar CMEs are still not well constrained, although new methodologies have been established, and new detections presented in the recent past. So far, probable detections of stellar CMEs have been presented, but their physical parameters which are not directly accessible from observations, such as electron density, optical thickness, temperature, etc., have been so far not determined for the majority of known events. We apply cloud modeling, as commonly used on the Sun, to a known event from the literature, detected on the young dMe star V374 Peg. This event manifests itself in extra emission on the blue side of the Balmer lines. By determining the line source function from 1D NLTE modeling together with the cloud model formulation we present distributions of physical parameters of this event. We find that except for temperature and area all parameters are at the upper range of typical solar prominence parameters. The temperature and the area of the event were found to be higher than for typical solar prominences observed in Balmer lines. We find more solutions for the filament than for the prominence geometry. Moreover we show that filaments can appear in emission on dMe stars contrary to the solar case.
Photoionized Herbig–Haro objects in the Orion Nebula through deep high-spectral resolution spectroscopy – III. HH 514
Authors: Méndez-Delgado J E , Esteban C , García-Rojas J , Henney W J
Published: May 2022

We analyse the physical conditions and chemical composition of the photoionized Herbig–Haro object HH 514, which emerges from the protoplanetary disc (proplyd) 170-337 in the core of the Orion Nebula. We use high-spectral resolution spectroscopy from Ultraviolet and Visual Echelle Spectrograph at the Very Large Telescope and IFU-spectra from MEGARA at the Gran Telescopio de Canarias. We observe two components of HH 514, the jet base and a knot, with $n_{\rm e}= (2.3 \pm 0.1) \times 10^5 \rm{cm}^{-3}$ and $n_{\rm e}= (7 \pm 1) \times 10^4 \rm{ cm}^{-3}$, respectively, both with Te ≈ 9000 K. We show that the chemical composition of HH 514 is consistent with that of the Orion Nebula, except for Fe, Ni, and S, which show higher abundances. The enhanced abundances of Fe and Ni observed in HH objects compared with the general interstellar medium are usually interpreted as destruction of dust grains. The observed sulphur overabundance (more than two times solar) is challenging to explain since the proplyd photoevaporation flow from the same disc shows normal sulphur abundance. If the aforementioned S-overabundance is due to dust destruction, the formation of sulfides and/or other S-bearing dust reservoirs may be linked to planet formation processes in proplyds, which filter large sulfide dust grains during the accretion of matter from the disc to the central star. We also show that published kinematics of molecular emission close to the central star are not consistent with either a disc perpendicular to the optical jet, or with an outflow that is aligned with it.
On the stability of 2D modulated electrostatic wavepackets in non-Maxwellian dusty plasma – application in Saturn’s magnetosphere
Authors: Singh Kuldeep , McKerr Michael , Kourakis Ioannis
Published: May 2022

Motivated by observations of localized electrostatic wavepackets by the Voyager 1 and 2 and Cassini missions in Saturn’s magnetosphere, we have investigated the evolution of modulated electrostatic wavepackets in a dusty plasma environment. The well-known dust-ion acoustic (DIA) mode was selected to explore the dynamics of multidimensional structures, by means of a Davey–Stewartson (DS) model, by taking into account the presence of a highly energetic (suprathermal, kappa-distributed) electron population in combination with heavy (immobile) dust in the background. The modulational (in)stability profile of DIA wavepackets for both negative as well as positive dust charge is investigated. A set of explicit criteria for modulational instability (MI) to occur is obtained. Wavepacket modulation properties in 3D dusty plasmas are shown to differ from e.g. Maxwellian plasmas in 1D. Stronger negative dust concentration results in a narrower instability window in the K (perturbation wavenumber) domain and to a suppressed growth rate. In the opposite manner, the instability growth rate increases for higher positive dust concentration and the instability window gets larger. In a nutshell, negative dust seems to suppress instability while positive dust appears to favour the amplitude modulation instability mechanism. Finally, stronger deviation from the Maxwell–Boltzmann equilibrium, i.e. smaller κe values, lead(s) to stronger instability growth in a wider wavenumber window – hence suprathermal electrons favour MI regardless of the dust charge sign (i.e. for either positive or negative dust). The wavepacket modulation properties in 2D dusty plasmas thus differ from e.g. Maxwellian plasmas in 1D, both quantitatively and qualitatively, as indicated by a generalized dispersion relation explicitly derived in this paper (for the amplitude perturbation). Our results can be compared against existing experimental data in space, especially in Saturn’s magnetosphere.
Reflection symmetry in the folded light curve of the Crab pulsar from NICER
Authors: Vivekanand M
Published: May 2022

The rotation powered pulsars Crab, Vela, and Geminga have double peaked folded light curves (FLC) at gamma-ray energies that have an approximate reflection symmetry. Here, this aspect is studied at soft X-ray energy by analysing a high-resolution FLC of the Crab pulsar obtained at 1–10 keV, using the Neutron star Interior Composition Explorer observatory. The rising edge of the first peak of the FLC and the reflected version of the falling edge of the second peak are compared in several ways, and phase ranges are identified where the two curves are statistically similar. The best matching occurs when the two peaks are aligned, but only in a small phase range of ≈0.0244 just below their peaks; their mean difference is −0.78 ± 1.8 photons s−1 with a reduced χ2 of 0.93. If the first curve is convolved by a Laplace function, the corresponding numbers are phase range of ≈0.0274, mean difference of −1.23 ± 1.30 and χ2 of 0.76. These phase ranges are much smaller than those over which the reflection symmetry has been perceived. Therefore, the only way the two edges can have a mirror relation over a substantial phase range is if one invokes a broad and faint emission component of amplitude ≈100 photons s−1 and width ≈0.1 in phase, centred at phase ≈0.1 beyond the second peak.
Investigating the contribution of extended radio sources to the Epoch of Reionization power spectrum
Authors: Cook J H , Trott C M , Line J L B
Published: May 2022

We investigate the contribution of extended radio sources such as Centaurus A, and Galactic supernova remnants (SNRs) to our ability to detect the statistical 21-cm signal from the Epoch of Reionisation (EoR) with the Murchison Widefield Array (MWA). These sources are typically ignored because they are in highly attenuated parts of the MWA primary beam, however, in aggregate, these sources have apparent flux densities of $10\, \rm {Jy}$ on angular scales we expect to detect the 21-cm signal. We create bespoke multicomponent 2D Gaussian models for Galactic SNRs and for Centaurus A, and simulate the visibilities for two MWA snapshot observations. We grid those visibilities and then Fourier transform them with respect to frequency, averaging them both spherically and cylindrically to produce the 1D and 2D power spectra. We compare the simulated 1D power spectra to the expected 21-$\rm {cm}$ power spectrum. We find that although these extended sources are in highly attenuated parts of the MWA primary beam pattern, collectively they have enough power (∼104−105 $\rm {mK^2}\, {\it h^{-3}} \, \rm {Mpc^{3}}$) on EoR significant modes $(|{\boldsymbol k}| \lesssim 0.1\, h\, \rm {Mpc^{-1}})$ to prohibit detection of the 21-$\rm {cm}$ signal (∼104 $\rm {mK^2}\, {\it h^{-3}} \, \rm {Mpc^{3}}$). We find that $50{-}90{{\ \rm per\ cent}}$ of sources must be removed in order to reduce leakage to a level of $\sim 10{-}20{{\ \rm per\ cent}}$ of the 21-$\rm {cm}$ power spectrum on EoR significant modes. The effects of wide-field extended sources will have implications on the detectability of the 21-$\rm {cm}$ signal for the MWA and with the future Square Kilometre Array (SKA).
A case of central nervous system vasculitis secondary to rheumatoid arthritis treated successfully with mycophenolate
Authors: Das Shyamashis , Sinha Debanjali , Ghosal Anirban , Purkayastha Sukalyan
Published: May 2022

Here, we report a case of central nervous system vasculitis in rheumatoid arthritis (RA) treated successfully with corticosteroid and mycophenolate. A 53-year-old female with poorly controlled RA presented with unilateral lower motor neurone type seventh cranial nerve palsy. Magnetic resonance imaging (MRI) of the brain revealed bilateral signal intensity changes in posterior fossa, basal ganglia, and periventricular white matter with contrast enhancement. Rheumatoid factor, anti-cyclic citrullinated peptides, and C-reactive protein were high. Cerebrospinal fluid analysis showed pleocytosis with elevated protein. Digital subtraction angiography of the brain revealed a beading pattern in distal branches of anterior, middle, and posterior cerebral arteries bilaterally suggestive of central nervous system vasculitis. We treated the patient with intravenous methylprednisolone followed by oral prednisolone tapered off in 6 months. Mycophenolate mofetil was started at the dose of 2 g per day, along with prednisolone. Sulfasalazine and hydroxychloroquine were also started to treat her arthritis. The patient showed complete neurological improvement, along with a significant resolution of the lesions in MRI.
MutL binds to 3′ resected DNA ends and blocks DNA polymerase access
Authors: Borsellini Alessandro , Lebbink Joyce H G , Lamers Meindert H
Published: May 2022

DNA mismatch repair removes mis-incorporated bases after DNA replication and reduces the error rate a 100–1000-fold. After recognition of a mismatch, a large section of up to a thousand nucleotides is removed from the daughter strand followed by re-synthesis. How these opposite activities are coordinated is poorly understood. Here we show that the Escherichia coli MutL protein binds to the 3′ end of the resected strand and blocks access of Pol I and Pol III. The cryo-EM structure of an 85-kDa MutL-DNA complex, determined to 3.7 Å resolution, reveals a unique DNA binding mode that positions MutL at the 3′ end of a primer-template, but not at a 5′ resected DNA end or a blunt DNA end. Hence, our work reveals a novel role for MutL in the final stages of mismatch repair by preventing premature DNA synthesis during removal of the mismatched strand.
Is Long-acting Cabotegravir a Pre-exposure Prophylaxis Option for Women of Childbearing Potential?
Authors: Sahloff Eric G , Hamons Nikki , Baumgartner Kevin , Duggan Joan M
Published: May 2022

Long-acting cabotegravir (CAB-LA) provides an exciting new option for pre-exposure prophylaxis (PrEP) in multiple populations. In this Perspective, we consider the unique pharmacokinetics of CAB-LA and the potential impact on the prescribing of CAB-LA, specifically in cis-women of reproductive potential.
Cybersecurity Risk
Authors: Florackis Chris , Louca Christodoulos , Michaely Roni , Weber Michael
Published: May 2022

Based on textual analysis and a comparison of cybersecurity risk disclosures of firms that were hacked to others that were not, we propose a novel firm-level measure of cybersecurity risk for all U.S.-listed firms. We then examine whether cybersecurity risk is priced in the cross-section of stock returns. Portfolios of firms with high exposure to cybersecurity risk outperform other firms, on average, by up to 8.3$\%$ per year. Yet, high-exposure firms perform poorly in periods of high cybersecurity risk. Reassuringly, the measure is higher in information-technology industries, correlates with characteristics linked to firms hit by cyberattacks, and predicts future cyberattacks.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online
NUMERICAL EVALUATION OF SPECIFIC ABSORPTION RATE IN HUMAN HEAD AND TORSO FOR WEARABLE WIRELESS DEVICES IN UNDERGROUND MINE SCENARIOS
Authors: Ashraf Muhammad Ahsan , Mahmood Asad , Mahboob Muhammad Ahsan
Published: May 2022

The radiofrequency field levels may increase in confined environments, such as underground mines, due to reflections from inner boundaries (walls and arches). This study investigated the specific absorption rate (SAR) in the head and torso of a miner wearing a wireless device in underground mine scenarios. Two high-resolution voxel models were used to analyse the effects of a tunnel structure, a metal arch and a safety helmet at 2.4 GHz and 868 MHz. The results indicated that the SAR increase is modest for all simulated underground mine scenarios and was maximum in the presence of a metal arch. At 868 MHz, some observed that the SAR was greater in deep tissues of the head and torso as compared to SAR at 2.4 GHz. Also, the torso is a better site for mounting wearable devices on the body to mitigate exposure.
Publicly Available and Validated DNA Reference Sequences Are Critical to Fungal Identification and Global Plant Protection Efforts: A Use-Case inColletotrichum
Authors: Kennedy Aaron H. , Schoch Conrad L. , Marrero Glorimar , Brover Vyacheslav , Robbertse Barbara
Published: May 2022

Publicly available and validated DNA reference sequences useful for phylogeny estimation and identification of fungal pathogens are an increasingly important resource in the efforts of plant protection organizations to facilitate safe international trade of agricultural commodities. Colletotrichum species are among the most frequently encountered and regulated plant pathogens at U.S. ports-of-entry. The RefSeq Targeted Loci (RTL) project at NCBI (BioProject no. PRJNA177353) contains a database of curated fungal internal transcribed spacer (ITS) sequences that interact extensively with NCBI Taxonomy, resulting in verified name−strain−sequence type associations for >12,000 species. We present a publicly available dataset of verified and curated name−type strain−sequence associations for all available Colletotrichum species. This includes an updated GenBank Taxonomy for 238 species associated with up to 11 protein coding loci and an updated RTL ITS dataset for 226 species. We demonstrate that several marker loci are well suited for phylogenetic inference and identification. We improve understanding of phylogenetic relationships among verified species, verify or improve phylogenetic circumscriptions of 14 species complexes, and reveal that determining relationships among these major clades will require additional data. We present detailed comparisons between phylogenetic and similarity-based approaches to species identification, revealing complex patterns among single marker loci that often lead to misidentification when based on single-locus similarity approaches. We also demonstrate that species-level identification is elusive for a subset of samples regardless of analytical approach, which may be explained by novel species diversity in our dataset and incomplete lineage sorting and lack of accumulated synapomorphies at these loci.
The PA profession in the 1990s
Authors: Cawley James F. , Hooker Roderick S.
Published: May 2022

History is rarely linear, and nowhere is this more evident than the US physician assistant/associate (PA) movement (1965-2021). The 1990s stand out as pivotal years for the PA profession, marked by advances that shaped the profession, experiments in primary care delivery, sex equity, the Balanced Budget Act, and national policy errors in predicting a physician surplus. Rapid growth followed program expansion, doubling from 57 in 1993 to 120 by 1999. By the end of the decade, all states had advanced PA-enabling legislation with broad-based prescribing. During this era, PA-focused research moved from descriptive to predictive, an official journal emerged in 1988, the Accreditation Review Commission on Education for the Physician Assistant became independent, and the American Academy of Physician Associates helped shape federal health policy. Also during this period, the profile of PAs shifted from older males to younger females with important sociological implications in leadership and career development. Notable milestones included national recognition of PAs as Medicare-eligible providers, direct commissioning in the military, and employment surges in the Veterans Health Administration and US Public Health Service. Not least of all this was a time of role shifts toward specialized medicine and surgery.
Ethical Management of COVID-19 Pandemic at a Neurological Hospital: The Ethicovid Report
Authors: Engrand Nicolas , Sene Thomas , Caputo Georges , Sabben Candice , Gregoire Charles , Blanc Raphael , Aldea Sorin , Chauvet Dorian , Vo-Thanh Sophie , Teissier Séverine , Versace Nathalie , Rohou Léa , Piotin Michel , Gueguen Antoine
Published: May 2022

Background:

During the first wave of the coronavirus disease-2019 (COVID-19) pandemic, it was necessary to prepare for the possibility of triaging patients who could benefit from access to an intensive care unit (ICU). In our neuroscience institution, the challenge was to continue to manage usual neurological emergencies as well as the influx of COVID-19 patients.

Methods:

We report the experience of an ethical consulting unit to support care clinical decisions during the first wave of the pandemic (March 16 to April 30, 2020). Three objective evaluation criteria were defined: 2 of these criteria, patient’s factors and general disease severity (Simplified Acute Physiology Score II), were common to all patients, and the third was the specific severity of the disease (neurological for brain injury, respiratory for COVID-19). Given our scarce resources, we used a high probability of a 3-month modified Rankin Scale ≤3 as the criterion for further resuscitation and management.

Results:

A total of 295 patients were admitted during the first pandemic wave; 111 with COVID-19 and 184 with neurological emergencies. The ethical unit’s expertise was sought for 75 clinical situations in 56 patients (35 COVID-19 and 21 neurological). Decisions were as follows: 11% no limitation on care, 5% expectant care with reassessment (maximum therapy to assess possible progress pending decision), 67% partial limitation (no intensification of care or no transfer to ICU), and 17% limitation of curative care. At no time did a lack of availability of ICU beds require the ethical unit to advise against admission to the ICU.

Conclusions:

Our ethical consulting unit allowed for collegial ethical decision-making in line with international recommendations. This model could be easily transferred to other triage situations, provided it is adapted to the local context.