bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment Goals and Alcohol Use Outcomes in Veterans With Comorbid Alcohol Dependence and Posttraumatic Stress Disorder
Authors: Lozano Brian E. , Allan Nicholas P. , Gros Daniel F. , Jones Jennifer , Back Sudie E.
Published: December 2020

Background and Objectives

Previous research demonstrates the utility of goals in attaining improved drinking outcomes. Considerably less is known about the association between substance use goals and outcomes among persons with comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD). This secondary analysis examined the association between alcohol use outcomes and participants’ treatment entry substance use goals to either abstain or reduce substance use in the context of treatment for comorbid SUD/PTSD.

Methods

Participants (N = 39) were treatment‐seeking veterans with current alcohol dependence and PTSD. Participants completed self‐report and clinician‐rated measures of substance use and PTSD as part of a larger randomized controlled trial.

Results

Participants in both goal groups (abstain; reduce) achieved significant reductions in the likelihood of drinking and the likelihood of exceeding low‐risk drinking levels. The primary analysis did not identify significant differences in outcome between goal groups; however, the exploratory analysis revealed that participants with reduced use goals were more likely to drink and more likely to exceed low‐risk drinking levels.

Conclusion and Scientific Significance

The findings suggest a moderately strong association between substance use goal and drinking outcome in the current study. Although the findings did not unequivocally support abstinence as a superior treatment goal, they offer a preliminary indication that abstinence may be an overall lower‐risk option. These findings expand consideration of the utility of substance use goals and suggest that clinicians should invite consideration of abstinence but may need not limit integrated treatment for SUD/PTSD based on strict adherence to abstinence, particularly if low‐risk use goals are targeted. (Am J Addict 2021;30:131–137)
Systematic Review and Meta‐Analysis: Treatment of Substance Use Disorder in Attention Deficit Hyperactivity Disorder
Authors: Fluyau Dimy , Revadigar Neelambika , Pierre Christopher G.
Published: December 2020

Background and Objectives

Treating substance use disorder (SUD) in patients with co‐occurring attention deficit hyperactivity disorder (ADHD) and SUD may lower medical, psychiatric, and social complications. We conducted a systematic review with meta‐analysis to investigate the clinical benefits of pharmacological interventions to treat SUD in patients with ADHD.

Methods

Articles were searched on Cochrane Central Register of Controlled Trials, PubMed, EBSCO, Google Scholar, Embase, Web of Science, and Ovid MEDLINE from 1971 to 2020. Data for SUD treatment as primary study endpoints and ADHD symptoms management as secondary outcomes were synthesized using random‐effects model meta‐analysis. Studies (N = 17) were included. The principal measure of effect size was the standardized mean difference (SMD). PROSPERO registration: CRD42020171646.

Results

The pooled effect of pharmacological interventions compared with placebo was small for the reduction in substance use (SMD = 0.405, 95% confidence interval [CI]: [0.252, 0.557], P < .001), abstinence (SMD = 0.328, 95% CI: [0.149, 0.507], P < .001), craving (SMD = 0.274, 95% CI: [0.103, 0.446], P = .002), and the reduction in the frequency of ADHD symptoms (SMD = 0.420, 95% CI: [0.259, 0.582], P < .001). The pooled effect was moderate for the management of withdrawal symptoms (SMD = 0.577, 95% CI: [0.389, 0.764], P = .001]) and the decrease in the severity of ADHD symptoms (SMD = 0.533, 95% CI: [0.393, 0.672], P < .001).

Conclusion and Scientific significance

The magnitude of benefits for pharmacological interventions varies. Despite some limitations, it was positive. This meta‐analysis is the first to appraise the benefits of medications to treat SUD in ADHD. It is the groundwork for treatment and risk mitigation. (Am J Addict 2020;00:00–00)
Innovative features and functionalities of an artificial pancreas system: What do youth and parents want?
Authors: Commissariat Persis V. , Volkening Lisa K. , Butler Deborah A. , Dassau Eyal , Weinzimer Stuart A. , Laffel Lori M.
Published: December 2020

Aims

Participant‐driven solutions may help youth and families better engage and maintain use of diabetes technologies. We explored innovative features and functionalities of an ideal artificial pancreas (AP) system suggested by youth with type 1 diabetes and parents.

Methods

Semi‐structured interviews were conducted with 39 youth, ages 10–25 years, and 44 parents. Interviews were recorded, transcribed and coded using thematic analysis.

Results

Youth (72% female, 82% non‐Hispanic white) were (M ± SD) ages 17.0 ± 4.7 years, with diabetes for 9.4 ± 4.9 years, and HbA1c of 68 ± 11 mmol/mol (8.4 ± 1.1%); 79% were pump‐treated and 82% were continuous glucose monitor users. Of parents, 91% were mothers and 86% were non‐Hispanic white, with a child 10.6 ± 4.5 years old. Youth and parents suggested a variety of innovative features and functionalities for an ideal AP system related to (1) enhancing the appeal of user interface, (2) increasing automation of new glucose management functionalities, and (3) innovative and commercial add‐ons for greater convenience. Youth and parents offered many similar suggestions, including integration of ketone testing, voice activation, and location‐tracking into the system. Youth seemed more driven by increasing convenience and normalcy while parents expressed more concerns with safety.

Conclusions

Youth and parents expressed creative solutions for an ideal AP system to increase ease of use, enhance normalcy, and reduce burden of management. Designers of AP systems will likely benefit from incorporating the desired preferences by end users to optimize acceptance and usability by young persons with diabetes.
Royal Geographical Society (with IBG) Medals and Awards 2020
Authors:   The Rt. Hon. the Baroness Chalker of Wallasey
Published: December 2020

The Royal Geographical Society (with IBG) annual Medals and Awards recognise achievements in researching, communicating, and teaching a wide range of geographical knowledge. The celebration of the 2020 Medal and Awards will take place in June 2021. This paper provides a list of the receipiants of medals and awards.
Wnt antagonist secreted frizzled‐related protein I (sFRP1) may be involved in the osteogenic differentiation of periodontal ligament cells in chronic apical periodontitis
Authors: Yang F. , Huang D. , Xu L. , Xu W. , Yi X. , Zhou X. , Ye L. , Zhang L.
Published: December 2020

Aim

To explore the mechanism of secreted frizzled‐related protein I (sFRP1) involvement in the osteogenic differentiation of human periodontal ligament cells (hPDLCs) under inflammatory conditions.

Methodology

hPDLCs were cultured in an osteogenic differentiation‐inducing medium (odi) and subjected to the stimulation of Porphyromonas gingivalis lipopolysaccharide (P. gingivalis LPS) with or without the inhibition of sFRP1. Quantitative real‐time polymerase chain reaction, Western blot and enzyme‐linked immunosorbent assay were carried out to evaluate the expression of osteogenic markers as well as the classic Wnt signalling pathway. Periapical periodontitis was induced in Wistar rats to further confirm the effect of sFRP1 inhibitor on bone loss in vivo. After the Shapiro–Wilk normality test, data were analysed by Student’s paired t‐test or one‐way Anova test with a P value less than 0.05 as the level of statistical significance.

Results

Significantly decreased mRNA and protein expression of osteogenic markers were detected in hPDLCs treated with P. gingivalis LPS during osteogenic induction (P < 0.001). Increased expression of sFRP1 was observed (P < 0.01), whilst Wnt/β‐catenin signalling pathway was inhibited by the addition of P. gingivalis LPS (P < 0.01). After the addition of the sFRP1 inhibitor, the decrease of osteogenic markers (P < 0.05) and the inhibition of Wnt/β‐catenin signalling pathway (P < 0.05) were reversed significantly. The animal experiment further confirmed that the sFRP1 inhibitor significantly reduced bone loss of periapical lesions in vivo (P < 0.0001).

Conclusions

Wnt antagonist sFRP1 was involved in the osteogenic differentiation of hPDLCs under inflammation. Modulation of the Wnt/β‐catenin signalling pathway through the inhibition of sFRP1 may offer a new perspective on the treatment of chronic apical periodontitis.
The risk of under‐insurance in the Finnish statutory pension scheme for self‐employed workers: A trajectory analysis
Authors: Salonen Janne , Koskinen Lasse , Nummi Tapio
Published: December 2020

Using unique data on the contribution base, we investigate under‐insurance within the statutory pension scheme for self‐employed workers in Finland. Under‐insurance is defined as the difference between pension‐declared income and tax‐declared income. The trajectory modelling technique applied has allowed us to estimate the levels of under‐insurance for different subgroups and to identify possible explanatory factors. Under‐insurance is found to be persistent and large. The analysis reveals six distinctive and homogenous sub‐groups of self‐employed workers. Close to 84 per cent of these workers pay too little in contributions, often leading to inadequate protection against personal risks. Especially for lower‐income self‐employed workers, this points to myopic behaviour as regards contributing to the self‐employed statutory pension scheme and calls for fine‐tuned economic incentives.
Bureaucrats as Lawmakers
Authors: Kroeger Mary A.
Published: December 2020

Bureaucratic influence in policymaking is often described as occurring subsequent to the legislative process and scholars argue that the legislative branch strategically constrains the bureaucracy via statutory language. A reality which complicates these claims and separation of powers research is that bureaucrats frequently play a role in creating the laws which ultimately govern their behavior. This project examines the extent to which bureaucrats attempt to and succeed in securing their preferred statutory language. I track bills introduced at bureaucrats’ request across 11 state legislatures. Legislatures extensively draw from agencies’ expertise in forming the agenda and crafting session law, with 9% of introduced bills and 21% of law coming from bureaucrats. A difference‐in‐differences analysis shows that committee chairs and legislators in the majority introduce more administration‐initiated bills. Bureaucrats’ extensive involvement in crafting statutory law and increased use in less professional legislatures imply that extant statutory control studies miss an important interaction.
Ethnographers and Collaborators in the Voluntourism Encounter
Authors: Taylor Sarah R.
Published: December 2020

Collaboration has been a hallmark of applied anthropology for as long as anthropologists have been putting anthropology to use. The very process of applying anthropological methods and theories to real‐world problems requires an understanding of the needs of the people experiencing the problem. Collaboration also has a long history in both archaeology and ethnography in Mesoamerica. This article explores the relationship between collaboration and applied anthropology in the context of a volunteer tourism program in rural Yucatan, Mexico. Tourism—and especially archaeological tourism—is a driving force in the region's economy. Increasingly, volunteer tourism initiatives provide visitors with the opportunity to contribute to the local community as part of their travel experience. I argue that the conceptual framework of what constitutes meaningful collaboration offers us a way to examine the interactions and power dynamics surrounding the encounter between volunteer, host, and even ethnographer. Specifically, the article questions whether contributions of various sorts are a requisite for achieving actual collaboration in these encounters.
Damped Vibration Response of An Axially Moving Wire Subject to An Oscillating Boundary Condition and the Application to Slurry Wiresaws
Authors: Li Liming , Kao Imin
Published: December 2020

This paper presents the analysis of a new class of differential continuum system with a solution of traveling waves containing coupled spatial and temporal variables. Herein, we derive the analytical solution of the damped vibration response of a longitudinally moving wire with damping, subject to an oscillating boundary condition. The vibration response is the outcome of combining four traveling waves, induced by a wave initiating from the oscillating boundary, and traveling between the two boundaries. The four different traveling waves are the independent bases of the vibration responses that span the solution space of vibration of such continuum system. The combination, or the interference, of these traveling waves in the undamped condition produces nodal points in the vibration response, which can be formulated through the analytical solution. The impacts of wire speed, oscillating frequency at the boundary and damping factors on the vibration response are investigated. Furthermore, the vibration induced by the oscillating motion of the boundary has a profound impact on the effectiveness of slicing ingots with rocking motion of oscillating wire guides in wiresaw manufacturing processes.
Energy and Exergy Analysis of a Subcritical Cascade Refrigeration System With Internal Heat Exchangers Using Environmentally Friendly Refrigerants
Authors: Aktemur Cenker , Ozturk Ilhan Tekin
Published: December 2020

This study focuses on a thermodynamic performance analysis of a subcritical cascade refrigeration system (CRS) with internal heat exchangers (IHXs) using R41/R601, R41/R602A, and R41/cyclopentane as refrigerant pairs. The effect of evaporator temperature (Tev), condenser temperature (Tcond), and temperature difference in the cascade heat exchanger (ΔTCHX) on examined performance parameters are investigated. Each performance parameter is scrutinized by an optimum low-temperature circuit (LTC) condenser temperature. The operating parameters have some implications on the overall thermodynamic performance of the system. A change of 10 °C in the Tev and Tcond affects the performance of the system by approximately +26% and −8%, respectively. Moreover, a variation of 1 °C in the ΔTCHX reduces the performance of the system by about 2%. The effect of IHXs on the system has some interesting results. The coefficient of performance (COP) and exergy efficiency values of the system using R41/cyclopentane tend to constantly decrease by nearly 4.05%. Although not as much as R41/cyclopentane, there is also a slight drop in the performance of other refrigerant pairs. The discharge temperature in LTC and high-temperature circuit (HTC) compressors exceeds 120 °C for low-temperature refrigeration requirements, which is highly undesirable. Furthermore, the top priority components for the system improvement are HTC condenser, HTC compressor, and CHX. The refrigerant pairs with the thermodynamic performance from best to worst are R41/R601, R41/cyclopentane, and R41/R602A, respectively. Finally, the COP and exergy efficiency values of the modeled system are 10.40% higher and 3.06% lower, respectively, compared with current models in the literature.
Modeling for Fluid Flow and Heat Transfer in Closed Loop Pulsating Heat Pipe
Authors: Sarangi R. K. , Kar S. P. , Rane M. V. , Swain A. , Pothal L. K.
Published: December 2020

Numerical modeling of multi-turn closed-loop pulsating heat pipe (CLPHP) is presented in this paper for ethanol as a working fluid. Modeling is carried out for 1-mm and 2-mm ID PHP for different numbers of turns, different orientations, and at constant wall temperature boundary conditions. Momentum and heat transfer variations with time are investigated numerically solving the one-dimensional governing equations for vapor bubble and liquid plugs. Evaporation and condensation take place by heat transfer through liquid film present around the vapor bubble. The code takes into account the realistic phenomena such as vapor bubble generation, liquid plug merging, and superheating of vapor bubbles above its saturation temperature. During the merging of liquid plugs, a time-step adaptive scheme is implemented and this minimum time-step was found to be 10−7 s. Nature of flow is investigated by momentum variation plot. Model results are compared with the experimental results from literature for nine different cases. Maximum variation in heat transfer for all these cases is found to be below ±34%.
A Techno-Economic Analysis of Solar-Driven Atmospheric Water Harvesting
Authors: Siegel Nathan P. , Conser Ben
Published: December 2020

Water may be produced from atmospheric humidity anywhere on Earth; however, current approaches are energy-intensive and costly, thus limiting the deployment of atmospheric water harvesting (AWH) technologies. A system-level thermodynamic model of several AWH pathways is presented to elucidate the important energy flows in these processes as a means of reducing the energy required to produce a unit of water. Model results show that freshwater may be produced from humid air via processes driven solely with solar electricity in an arid climate with an energy input between 116 kWhe/m3 and 1021 kWhe/m3, depending on atmospheric conditions and processing configuration. We describe a novel, desiccant-based AWH approach in which the latent heat of vaporization is internally recovered resulting in a significant reduction in energy requirements relative to the state of the art. Finally, a parametric model of a desiccant-based AWH system is used to estimate the minimum levelized cost of water (LCOW) via solar-driven AWH at 6.5 $/m3 when both latent and sensible energy are recovered internally.
Carbon Dioxide Bubbles Removal by Capillary Actuation in the Anode Channel of Direct Methanol Fuel Cells
Authors: Osman Sameer , Ookawara Shinichi , Ahmed Mahmoud
Published: December 2020

On the anode side of a direct-methanol fuel cell, carbon dioxide bubbles are generated as a result of the methanol oxidation reaction. The accumulation of such bubbles prevents methanol from reaching the diffusion layer (DL). Hence, a reduction in the reaction rate occurs, which limits the maximum current density of the cell. To keep carbon dioxide bubbles away from the diffusion layer surface, a new design of the anode flow channel besides wall surface treatment is developed. Such a design can introduce capillary actuation, which forces the carbon dioxide bubbles to move away from the diffusion layer due to capillary forces. This can be achieved by using a trapezoidal shape of the flow channel, as well as the combined effect of hydrophilic and hydrophobic surface treatments on the diffusion layer and top wall, respectively. To identify the optimal design of the anode flow channel, a three-dimensional, two-phase flow model is developed. The model is numerically simulated, and the results are validated with available measurements. Results indicated that treating the diffusion layer with a hydrophilic layer increases the area in direct contact with liquid methanol. Besides, the hydrophobic top channel wall makes it easier for the carbon dioxide bubbles to attach and spread out on the top surface. However, super-hydrophobic treatment of the top wall should be avoided, as it can cause difficulty in bubble extraction from the channel. The current findings create a promising opportunity to improve the performance of direct-methanol fuel cells.
Noninvasive characterization of Alzheimer’s disease by circulating, cell-free messenger RNA next-generation sequencing
Authors: Toden Shusuke , Zhuang Jiali , Acosta Alexander D. , Karns Amy P. , Salathia Neeraj S. , Brewer James B. , Wilcock Donna M. , Aballi Jonathan , Nerenberg Mike , Quake Stephen R. , Ibarra Arkaitz
Published: December 2020

Transcriptomic profiles of Alzheimer’s disease patients and healthy individuals were investigated using cell-free mRNA sequencing.
RNA polymerase II CTD S2P is dispensable for embryogenesis but mediates exit from developmental diapause in
C. elegans
Authors: Cassart C. , Yague-Sanz C. , Bauer F. , Ponsard P. , Stubbe F. X. , Migeot V. , Wery M. , Morillon A. , Palladino F. , Robert V. , Hermand D.
Published: December 2020

CTD S2P mediates nutrient-dependent development.
Neuroengineering challenges of fusing robotics and neuroscience
Authors: Cheng Gordon , Ehrlich Stefan K. , Lebedev Mikhail , Nicolelis Miguel A. L.
Published: December 2020

Advances in neuroscience are inspiring developments in robotics and vice versa.
Gene dosage manipulation alleviates manifestations of hereditary
PAX6
haploinsufficiency in mice
Authors: Rabiee Behnam , Anwar Khandaker N. , Shen Xiang , Putra Ilham , Liu Mingna , Jung Rebecca , Afsharkhamseh Neda , Rosenblatt Mark I. , Fishman Gerald A. , Liu Xiaorong , Ghassemi Mahmood , Djalilian Ali R.
Published: December 2020

Pharmacological induction of wild-type
PAX6
allele improved ocular abnormalities induced by
PAX6
haploinsufficiency in mice.
Agonist-antagonist myoneural interface amputation preserves proprioceptive sensorimotor neurophysiology in lower limbs
Authors: Srinivasan Shriya S. , Tuckute Greta , Zou Jasmine , Gutierrez-Arango Samantha , Song Hyungeun , Barry Robert L. , Herr Hugh M.
Published: December 2020

Agonist-antagonist myoneural interfaces in lower-limb amputation help preserve sensory feedback to the brain.
Preexisting immunity shapes distinct antibody landscapes after influenza virus infection and vaccination in humans
Authors: Dugan Haley L. , Guthmiller Jenna J. , Arevalo Philip , Huang Min , Chen Yao-Qing , Neu Karlynn E. , Henry Carole , Zheng Nai-Ying , Lan Linda Yu-Ling , Tepora Micah E. , Stovicek Olivia , Bitar Dalia , Palm Anna-Karin E. , Stamper Christopher T. , Changrob Siriruk , Utset Henry A. , Coughlan Lynda , Krammer Florian , Cobey Sarah , Wilson Patrick C.
Published: December 2020

Antibody immunodominance to conserved influenza virus epitopes is affected by both preexisting B cell memory and route of exposure.
A Short-Tandem-Repeat Assay (
Mmy
STR) for Studying Genetic Variation in
Madurella mycetomatis
Authors: Nyuykonge Bertrand , Eadie Kimberly , Zandijk Willemien H. A. , Ahmed Sarah A. , Desnos-Ollivier Marie , Fahal Ahmed H. , de Hoog Sybren , Verbon Annelies , van de Sande Wendy W. J. , Klaassen Corné H. W.
Published: December 2020

Madurella mycetomatis
is the major causative agent of eumycetoma, a neglected tropical infection characterized by painless subcutaneous lesions, inflammation, and grains draining from multiple sinuses. To study the epidemiology of mycetoma, a robust discriminatory typing technique is needed.
Draft Genome Sequence of the Multiple Antibiotic Producer Bacillus velezensis X-BIO-1
Authors: Kravchenko S. V. , Poshvina D. V. , Vasilchenko A. V. , Vasilchenko A. S.
Published: December 2020

Here, we describe the draft genome sequence of
Bacillus velezensis
strain X-BIO-1, which contains 16 contigs, comprising 3,861,135 bp with a G+C content of 46.54%. The annotated draft genome contains 3,710 protein-coding genes and 62 RNA genes. We identified genes responsible for the synthesis of various antibiotics.
Amylases in the Human Vagina
Authors: Nunn Kenetta L. , Clair Geremy C. , Adkins Joshua N. , Engbrecht Kristin , Fillmore Thomas , Forney Larry J.
Published: December 2020

In this study, we show that multiple bacteria in the vaginal community produce amylases that hydrolyze glycogen into simpler sugars (i.e., maltose and maltotriose). These sugars serve as “common goods” that sustain bacterial populations in vaginal communities.
Deglaciation of the Puget Lowland, Washington
Authors: Haugerud Ralph A.
Published: December 2020

Recently obtained radiocarbon ages from the southern Puget Lowland and reevaluation of limiting ages from the Olympic Peninsula in the light of new light detection and ranging (LiDAR) data suggest that the Juan de Fuca and Puget lobes of the Cordilleran ice sheet reached their maximum extents after 16,000 calibrated yr B.P. Source areas for both lobes fed through a common conduit, likely requiring that downstream responses to changes in either source area were similar. Dates for ice-sheet retreat are sparse and contradictory, but they suggest that retreat was rapid. Depositional and geomorphic evidence shows that retreat of the Juan de Fuca lobe predated retreat of the Puget lobe. No recessional end moraines have been identified in the Puget Lowland, in contrast to numerous recessional end moraines constructed by the Okanogan lobe east of the Cascade Range, and in contrast to later ice-sheet retreat in western Whatcom County north of the Puget Lowland. These observations lead to the hypothesis that collapse of the Juan de Fuca lobe, hastened by the instability of a marine-based ice sheet, steepened the ice-sheet surface over the eastern Strait of Juan de Fuca and diverted ice flow upstream of the Puget lobe to the west. Starved of ice, the Puget lobe retreated quickly.
Supplemental Material: New geodetic constraints on southern San Andreas fault-slip rates, San Gorgonio Pass, California
Authors: Guns K.A. , al. et
Published: December 2020

Includes tables of statistical details regarding estimation of GPS velocities (including the map position and names of all campaign and continuous station sites) and the full model assessments of fit. Also includes figures that present details of all strike-slip and dip-slip fault-slip rates calculated within models.
Supplemental Material: A tale of five enclaves: Mineral perspectives on origins of mafic enclaves in the Tuolumne Intrusive Complex
Authors: Barnes C.G. , al. et
Published: December 2020

Contains petrographic descriptions, mineral and rock compositions, illustrations of mineral spot analyses, and additional trace element diagrams.
Colonic inflammatory myofibroblastic tumour presenting as ‘pyrexia of unknown origin’: report of a rare disease and its unique presentation.
Authors: Coelho Victor Vijay , Surendran Suraj , Roopavathana Beulah , Chase Suchita
Published: December 2020

An intra-abdominal inflammatory myofibroblastic tumour (IMT) belongs to a rare group of diseases initially described as an inflammatory pseudotumour. Even though it is seen more often in children, its incidence in adults is even rarer. Clinical presentations can vary depending on its site and inherent tumour properties. The colon is an uncommon site for IMT and pyrexia of unknown origin (PUO) as its dominant clinical presentation is even rarer. A 27-year-old woman presented with PUO. She was evaluated under the department of internal medicine before undergoing an 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan. This showed an intensely enhancing descending colon mass. An image-guided biopsy of this lesion was reported as IMT. She underwent a left hemicolectomy and complete excision of the tumour, following which her symptoms resolved completely. The patient has been disease-free at a 6-month follow-up and is asymptomatic at 1 year.
Primary cardiac angiosarcoma masquerading as intracardiac thrombus
Authors: Villano Nicholas , Flavin William P , Tsing Pamela
Published: December 2020

A 49-year-old man with a recent history of atrial tachycardia and intracardiac thrombus presented to the emergency department with melena and cardiac tamponade. Physical examination was notable for a vascular mass at the right lower gingival sulcus and a right chest wall nodule. Enteroscopy revealed a target lesion with friable ulcer in the gastric body. Cardiac MRI revealed a large right atrial mass, previously thought to represent thrombus. The patient was ultimately diagnosed with primary cardiac angiosarcoma (PCAS) by histopathology of gingival, gastric and subcutaneous lesions. This case illustrates the significant morbidity and mortality resulting from aggressive local invasion and growth of PCAS, as well as the challenge of differentiating between primary thrombosis and vascular malignancy. Misdiagnosis of this elusive clinical entity may be costly, potentially resulting in delay of intervention and adverse effects of alternate therapies such as anticoagulation.
Intussusception as a rare clinical presentation of a child with type 1 diabetes and diabetic ketoacidosis
Authors: Shah Nikhil , Khadilkar Vaman , Khadilkar Anuradha , Jahagirdar Rahul
Published: December 2020

Intussusception in children is mainly idiopathic or due to a viral aetiology. Occasionally, pathological lead points like Meckel diverticulum or rarely metabolic causes like hyperglycaemia can result in formation of an intussusception. We describe the case of a boy with diabetic ketoacidosis presenting with abdominal pain. Despite correction of acidosis, the gastrointestinal symptoms persisted for which an ultrasonography of the abdomen was performed. It revealed an ileo-ileal intussusception, which was confirmed by a CT scan. He underwent an exploratory laparotomy. After reduction of the intussusception, a Meckel diverticulum was found as the lead point that was then resected. We present a case of a child with type 1 diabetes having an intussusception due to Meckel diverticulum, which was probably made worse by the decreased intestinal motility due to hyperglycaemia. Intussusception should thus be suspected in patients with diabetic ketoacidosis if the pain is persistent despite correction of acidosis.
Disseminated mycobacterial septicemia presented as acute abdomen: a surgeon’s perspective on Landouzy’s sepsis
Authors: Vellore Dasarathan Lokesh , Gaikwad Pranay , Telugu Ramesh Babu
Published: December 2020

A 20-year-old man presented in emergency with fever, abdominal pain and obstipation. On evaluation, he was found to have an acute abdomen with septic shock. The cross-sectional abdominal imaging revealed hepatosplenomegaly, pleural effusion and ascites with retroperitoneal lymphadenopathy. He was resuscitated and started on broad-spectrum antibiotics. There was no other source of infection identified elsewhere. While bacterial and fungal cultures were negative, the sputum, blood, bone marrow and ascitic fluid were positive forMycobacterium tuberculosisfollowing which he was started on antituberculosis therapy. Despite therapy, the patient’s clinical condition continued to deteriorate requiring critical care. In view of Landouzy’s sepsis, pulse steroid therapy was started. However, the patient’s clinical condition continued to deteriorate and developed systemic inflammatory response syndrome and multi-organ dysfunction syndrome. Despite the best efforts, the patient expired.
Tuberculous mastoiditis in a 2-month-old infant presenting with facial nerve palsy
Authors: McMaster David , Din Waqas BM , Ramalingaiah Babu , Agrawal Shailesh
Published: December 2020

We present a rare case of tuberculous mastoiditis in a 2-month-old infant. The patient presented with facial nerve palsy, fever and otorrhoea and was subsequently confirmed to have aMycobacterium tuberculosisinfection. Mastoiditis was confirmed with a CT scan of the head, and gastric aspirate analysis with the Xpert MTB/RIF assay (Cepheid, USA) rapidly confirmed tuberculosis (TB), allowing prompt initiation of anti-TB therapy. The patient is now recovering, with the initial facial nerve palsy resolved.
Cardiac arrest due to accidental overdose with norepinephrine dissolved in crystalloid
Authors: Hansel Jan , Ármannsson Gunnar Skúli
Published: December 2020

Vasoactive agents should be administered through a controlled well-marked infusor pump, ideally via a central venous catheter if given over longer periods of time. During transfer of haemodynamically unstable patients with limited staffing and resources on site, a peripheral vasopressor infusion is sometimes resorted to as a temporary measure of optimising haemodynamic parameters. We report a case of accidental norepinephrine overdose after such practice, resulting in cardiac arrest. It illustrates the importance of careful use and labelling of vasoactive agents during the transport and handover of critically ill patients. Finally, we explore human factor issues associated with transfer from the pre-hospital to the in-hospital environment when such preparations are used.
The impact of implementing the 2016 WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience on perinatal deaths: an interrupted time-series analysis in Mpumalanga province, South Africa
Authors: Lavin Tina , Pattinson Robert Clive , Kelty Erin , Pillay Yogan , Preen David Brian
Published: December 2020

Objectives

To investigate if the implementation of the 2016 WHO Recommendations for a Positive Pregnancy Experience reduced perinatal mortality in a South African province. The recommendations were implemented which included increasing the number of contacts and also the content of the contacts.

Methods

Retrospective interrupted time-series analysis was conducted for all women accessing a minimum of one antenatal care contact from April 2014 to September 2019 in Mpumalanga province, South Africa. Retrospective interrupted time-series analysis of province level perinatal mortality and birth data comparing the pre-implementation period (April 2014–March 2017) and post-implementation period (April 2018–September 2019). The main outcome measure was unadjusted prevalence ratio (PR) for perinatal deaths before and after implementation; interrupted time-series analyses for trends in perinatal mortality before and after implementation; stillbirth risk by gestational age; primary cause of deaths (and maternal condition) before and after implementation.

Results

Overall, there was a 5.8% absolute decrease in stillbirths after implementation of the recommendations, however this was not statistically significant (PR 0.95, 95% CI 0.90% to 1.05%; p=0.073). Fresh stillbirths decreased by 16.6% (PR 0.86, 95% CI 0.77% to 0.95%; p=0.003) while macerated stillbirths (p=0.899) and early neonatal deaths remained unchanged (p=0.499). When stratified by weight fresh stillbirths >2500 g decreased by 17.2% (PR 0.81, 95% CI 0.70% to 0.94%; p=0.007) and early neonatal deaths decreased by 12.8% (PR 0.88, 95% CI 0.77% to 0.99%; p=0.041). The interrupted time-series analysis confirmed a trend for decreasing stillbirths at 0.09/1000 births per month (−0.09, 95% CI −1.18 to 0.01; p=0.059), early neonatal deaths (−0.09, 95% CI −0.14 to 0.04; p=<0.001) and perinatal mortality (−1.18, 95% CI −0.27 to −0.09; p<0.001) in the post-implementation period. A decrease in stillbirths, early neonatal deaths or perinatal mortality was not observed in the pre-implementation period. During the period when additional antenatal care contacts were implemented (34–38 weeks), there was a decrease in stillbirths of 18.4% (risk ratio (RR) 0.82, 95% CI 0.73% to 0.91%, p=0.0003). In hypertensive disorders of pregnancy, the risk of stillbirth decreased in the post-period by 15.1% (RR 0.85; 95% CI 0.76% to 0.94%; p=0.002).

Conclusion

The implementation of the 2016 WHO Recommendations for a Positive Pregnancy Experience may be an effective public health strategy to reduce stillbirths in South African provinces.
Propofol Target-Controlled Infusion in Emergency Department Sedation (ProTEDS): a multicentre, single-arm feasibility study
Authors: Burton Fiona Marie , Lowe David John , Millar Jonathan , Corfield Alasdair R , Watson Malcolm J , Sim Malcolm A B
Published: December 2020

Background

Procedural sedation is a core skill of the emergency physician. Bolus administration of propofol is widely used in UK EDs. Titrated to an end point of sedation, it has a rapid effect but has been associated with adverse incidents. The use of a target-controlled infusion (TCI) of propofol is not routine but may reduce the incidence of adverse incidents.

The primary aims of this single-arm feasibility study were patient satisfaction and to establish recruitment rates for a randomised controlled trial comparing propofol TCI to bolus administration.

Methods

Four EDs in Scotland, UK, participated. Patients aged 18-65 years, with anterior shoulder dislocation, weight ≥ 50kg, fasted ≥ 90 min were screened. Patients underwent reduction of their dislocated shoulder using TCI propofol. The primary end point was patient satisfaction recorded on a Visual Analogue Scale.

Results

Between 3 April 2017 and 31 December 2018, 25 patients were recruited with a recruitment rate of 20% for the 16-month recruitment window, with a temporary pause to allow amendment of drug dosage.

Two patients were excluded. Twenty achieved adequate sedation, defined as a Modified Observer’s Assessment of Alertness/Sedation Scale (OAA/S) 3. Successful reduction was achieved in all adequately sedated. Patient satisfaction was documented in 14 patients, mean±SD of 97±9 and time to sedation was 25±8 min. No adverse events were recorded using the Society of Intravenous Anaesthesia adverse event reporting tool.

Conclusion

Propofol TCI was acceptable as a method of procedural sedation for patients. The lower than expected recruitment rates highlight the need for dedicated research support.

Trial registration number

NCT03442803.
Mobilization of pre-existing polyclonal T cells specific to neoantigens but not self-antigens during treatment of a patient with melanoma with bempegaldesleukin and nivolumab
Authors: Veatch Joshua R , Singhi Naina , Jesernig Brenda , Paulson Kelly G , Zalevsky Jonathan , Iacucci Ernesto , Tykodi Scott S , Riddell Stanley R
Published: December 2020

T cells that recognize self-antigens and mutated neoantigens are thought to mediate antitumor activity of immune checkpoint blockade (ICB) in melanoma. Few studies have analyzed self and neoantigen-specific T cell responses in patients responding to ICB. Here, we report a patient with metastatic melanoma who had a durable clinical response after treatment with the programmed cell death protein 1 inhibitor, nivolumab, combined with the first-in-class CD122-preferential interleukin-2 pathway agonist, bempegaldesleukin (BEMPEG, NKTR-214). We used a combination of antigen-specific T cell expansion and measurement of interferon-γ secretion to identify multiple CD4+and CD8+T cell clones specific for neoantigens, lineage-specific antigens and cancer testis antigens in blood and tumor from this patient prior to and after therapy. Polyclonal CD4+and CD8+T cells specific to multiple neoantigens but not self-antigens were highly enriched in pretreatment tumor compared with peripheral blood. Neoantigen, but not self-antigen-specific T cell clones expanded in frequency in the blood during successful treatment. There was evidence of dramatic immune infiltration into the tumor on treatment, and a modest increase in the relative frequency of intratumoral neoantigen-specific T cells. These observations suggest that diverse CD8+and CD4+T cell clones specific for neoantigens present in tumor before treatment had a greater role in immune tumor rejection as compared with self-antigen-specific T cells in this patient. Trial registration number:NCT02983045.
Role of endovascular embolisation for curative treatment of intracranial non-Galenic pial arteriovenous fistula
Authors: Jin Hengwei , Meng Xiangyu , Quan Jiale , Lu Yi , Li Youxiang
Published: December 2020

Background and purpose

The safety and effectiveness of endovascular treatment for non-Galenic pial arteriovenous fistula (NGPAVF) is inadequately known. The aim of this study is to explore the role of endovascular embolisation for curative treatment of NGPAVF.

Materials and methods

Patients with NGPAVF underwent endovascular treatment from January 2011 to November 2019 in our institution were retrospectively reviewed. Demographics, clinical information, treatment details and clinical outcomes were collected. Factors associated with clinical outcomes were statistically analysed.

Results

Twenty patients were included, with a total of 22 (2 patients have 2 fistulas) lesions. A total of 25 procedures were performed and 5 patients underwent 2 procedures. Follow-up ranged from 3 to 84 months (mean=34.5 months). Thirteen (59.1%) lesions in 12 (60.0%) patients acquired immediate occlusion after initial treatment (immediately occluded group) and follow-up confirmed the complete obliteration. A total of 17 (77.3%) lesions in 15 (75.0%) patients were cured at last follow-up. The maximal diameter of feeding arteries (p=0.04) and the maximal diameter of the varix (p=0.01) in immediately occluded group was smaller than non-immediately occluded group. The number of feeding artery (p=0.004) and the maximal diameter of the varix (p<0.001) were much smaller in curative group than non-curative group. Seven patients suffered procedure-related complications. No patients had an increased Modified Rankin Scale (mRS) and all patients had favourable clinical outcome (mRS ≥2) at last follow-up.

Conclusions

Endovascular therapy plays an important role in curative treatment of NGPAVF. Patients with less feeding arteries and small varix may be easier to be cured by endovascular embolisation.
Acoustic Emission Signal Classification Using Feature Analysis and Deep Learning Neural Network
Authors: Wu Jian-Da , Wong Yu-Han , Luo Wen-Jun , Yao Kai-Chao
Published: December 2020

With the development of artificial intelligence in recent years, deep learning has been widely used in mechanical system signal classification but the impact of different feature extractions on the efficiency and effectiveness of deep learning neural networks is more important. In this study, a vehicle classification based on engine acoustic emission signal in the time domain, the frequency domain and the wavelet transform domain for deep learning network techniques is presented and compared. In signal classification, different feature extractions will show in different decomposition levels and can be used to recognize the various acoustic conditions. In the experimental work, as engines from 10 different ground vehicles operate, the measured sound signal is converted into a digital signal, and the established data set is classified and identified by the deep learning method. The number of samples, identification rate and identification time in the various signal domains are compared and discussed in this study. Finally, the experimental results and data analysis show that by using the wavelet signal and the deep learning method, excellent identification time and identification rate can be achieved, compared with traditional time and frequency domain signals.
GetFEM
Authors: Renard Yves , Poulios Konstantinos
Published: December 2020

This article presents the major mathematical and implementation features of a weak form language (GWFL) for an automated finite-element (FE) solution of partial differential equation systems. The language is implemented in the GetFEM framework and strategic modeling and software architecture choices both for the language and the framework are presented in detail. Moreover, conceptual similarities and differences to existing high-level FE frameworks are discussed. Special attention is given to the concept of a generic transformation mechanism that contributes to the high expressive power of GWFL, allowing to interconnect multiple computational domains or parts of the same domain. Finally, the capabilities of the language for expressing strongly coupled multiphysics problems in a compact and readable form are shown by means of modeling examples.
Algorithm 1013
Authors: Arroyo Daisy , Emery Xavier
Published: December 2020

A continuous spectral algorithm and computer routines in the R programming environment that enable the simulation of second-order stationary and intrinsic (i.e., with second-order stationary increments or generalized increments) vector Gaussian random fields in Euclidean spaces are presented. The simulation is obtained by computing a weighted sum of cosine and sine waves, with weights that depend on the matrix-valued spectral density associated with the spatial correlation structure of the random field to simulate. The computational cost is proportional to the number of locations targeted for simulation, below that of sequential, matrix decomposition and discrete spectral algorithms. Also, the implementation is versatile, as there is no restriction on the number of vector components, workspace dimension, number and geometrical configuration of the target locations. The computer routines are illustrated with synthetic examples and statistical testing is proposed to check the normality of the distribution of the simulated random field or of its generalized increments. A by-product of this work is a spectral representation of spherical, cubic, penta, Askey, J-Bessel, Cauchy, Laguerre, hypergeometric, iterated exponential, gamma, and stable covariance models in the
d
-dimensional Euclidean space.
A Flexible, Parallel, Adaptive Geometric Multigrid Method for FEM
Authors: Clevenger Thomas C. , Heister Timo , Kanschat Guido , Kronbichler Martin
Published: December 2020

We present the design and implementation details of a geometric multigrid method on adaptively refined meshes for massively parallel computations. The method uses local smoothing on the refined part of the mesh. Partitioning is achieved by using a space filling curve for the leaf mesh and distributing ancestors in the hierarchy based on the leaves. We present a model of the efficiency of mesh hierarchy distribution and compare its predictions to runtime measurements. The algorithm is implemented as part of the
deal.II
finite-element library and as such available to the public.
Algorithm 1014
Authors: Borges Carlos F.
Published: December 2020

We develop fast and accurate algorithms for evaluating √x
2
+y
2
for two floating-point numbers
x
and
y
. Library functions that perform this computation are generally named hypot(x,y). We compare five approaches that we will develop in this article to the current resident library function that is delivered with Julia 1.1 and to the code that has been distributed with the C math library for decades. We will investigate the accuracy of our algorithms by simulation.
Long noncoding RNA Kcnq1ot1 promotes sC5b-9-induced podocyte pyroptosis by inhibiting miR-486a-3p and upregulating NLRP3
Authors: Zhang Chunjian , Gong Yimeng , Li Na , Liu Xiaoyan , Zhang Yunzhu , Ye Fangze , Guo Qiang , Zheng Jiaxin
Published: December 2020

Podocytes are epithelial cells adhering glomerular capillaries, which regulate the integrity of glomerular filtration barrier. Irreversible podocyte injury induces glomerular inflammation and causes chronic renal diseases. Kcnq1ot1, a long noncoding RNA, participates in the pathogenesis of diabetic retinopathy and cardiomyopathy. However, its function in podocyte injury is elusive. Pyroptosis of murine podocyte MPC5 was triggered by sublytic complement C5b-9 (sC5b-9) for subsequent in vitro functional and mechanistic investigation. Gain/loss-of-function analysis was conducted to examine the functional role of Kcnq1ot1 in podocyte pyroptosis. Meanwhile, the molecular mechanism of Kcnq1ot1’s effect on podocyte injury was explored by identifying downstream molecules and their intermediate interactions. Kcnq1ot1 was upregulated in sC5b-9-induced podocytes, and silencing Kcnq1ot1 could inhibit sC5b-9’s effect on podocyte pyroptosis. We also identified the interaction between Kcnq1ot1 and miR-486a-3p, through which Kcnq1ot1 mediated miR-486a-3p inhibition by sC5b-9. Furthermore, miR-486a-3p reduced the transcriptional activity of NLRP3, while the overexpression of NLRP3 enhanced sC5b-9’s effect on podocyte pyroptosis through activating NLRP3 inflammasome. sC5b-9 induces pyroptosis in podocytes through modulating the Kcnq1ot1/miR-486a-3p/NLRP3 regulatory axis, and these uncovered key molecules might facilitate podocyte-targeted treatment for renal inflammatory diseases.