bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of Professional Competencies of Teachers in the Slovak Republic through Update Training
Authors: Pisoňová Mária
Published: May 2020

Currently, in Slovakia, there appear many discussions about the benefits of individual kinds of continuous training for teacher’s work. The topic of the empirical study is, therefore, analysis of continuous training of primary and lower-secondary level teachers with the emphasis on update training. When creating the content, professional literature by authors who focus in their scientific activities on andragogy and pedeutology e.g. I. Pavlov, G. Porubská (Petrová), B. Kosová, J. Veteška, B. Lazarová, B. Kasáčová etc. was used. When preparing the study we also used Slovak legislative standards and regulations which define conditions and requirements for continuous training. For the purpose of comparison of certain terms, it was necessary to use also Czech source documents. In the article, we identified the motivational factors which incited primary and lower-secondary level teachers (further only on primary level) to participate in continuous training. The focus of the study was on the importance of update training for teaching practice. Based on this we were able to objectively evaluate the benefits of the presented type of training for the practice and therefore define barriers in the implementation of its content into educational programmes or the educational reality. The obtained data pointed out certain deficiencies of continuous training which are related mainly to the expectations of the respondents and with the overall mission of lifelong learning of the teachers. Based on the obtained data topics for discussion and practical suggestions were formulated with the aim to develop educational science.
Corrigendum: Around -independence
Authors: Chiarellotto Bruno , Lazda Christopher
Published: May 2020

We correct the proof of the main $\ell$-independence result of the above-mentioned paper by showing that for any smooth and proper variety over an equicharacteristic local field, there exists a globally defined such variety with the same ($p$-adic and $\ell$-adic) cohomology.
Overexpression of NDRG2 in skeletal muscle does not ameliorate the effects of stress in vivo
Authors: Mir Bilal A. , Mason Shaun A. , May Anthony K. , Russell Aaron P. , Foletta Victoria C.
Published: May 2020

New Findings

What is the central question of this study?

Do elevated levels of the stress‐response protein NDRG2 protect against fasting and chronic disease in mouse skeletal muscle?

What is the main finding and its importance?

NDRG2 levels increased in the tibialis anterior muscle in response to fasting and the effects of motor neurone disease. No alleviation of the stress‐related and proteasomal pathways, mitochondrial dysfunction or muscle mass loss was observed even with the addition of exogenous NDRG2 indicating that the increase in NDRG2 is a normal adaptive response.

Skeletal muscle mass loss and dysfunction can arise from stress, which leads to enhanced protein degradation and metabolic impairment. The expression of N‐myc downstream‐regulated gene 2 (NDRG2) is induced in response to different stressors and is protective against the effects of stress in some tissues and cell types. Here, we investigated the endogenous NDRG2 response to the stress of fasting and chronic disease in mice and whether exogenous NDRG2 overexpression through adeno‐associated viral (AAV) treatment ameliorated the response of skeletal muscle to these conditions. Endogenous levels of NDRG2 increased in the tibialis anterior muscle in response to 24 h fasting and with the development of the motor neurone disease, amyotrophic lateral sclerosis, in SOD1G93A transgenic mice. Despite AAV‐induced overexpression and increased expression with fasting, NDRG2 was unable to protect against the activation of proteasomal and stress pathways in response to fasting. Furthermore, NDRG2 was unable to reduce muscle mass loss, mitochondrial dysfunction and elevated oxidative and endoplasmic reticulum stress levels in SOD1G93A mice. Conversely, elevated NDRG2 levels did not exacerbate these stress responses. Overall, increasing NDRG2 levels might not be a useful therapeutic strategy to alleviate stress‐related disease pathologies in skeletal muscle.
Preliminary Design and Performance Assessment of an Underwater Compressed Air Energy Storage System for Wind Power Balancing
Authors: Astolfi Marco , Guandalini Giulio , Belloli Marco , Hirn Adriano , Silva Paolo , Campanari Stefano
Published: May 2020

A key approach to large renewable power management is based on implementing storage technologies, including batteries, power-to-gas, and compressed air energy storage (CAES). This work presents the preliminary design and performance assessment of an innovative type of CAES, based on underwater compressed air energy storage (UW-CAES) volumes and intended for installation in the proximity of deep-water seas or lakes. The UW-CAES works with constant hydrostatic pressure storage and variable volumes. The proposed system is adiabatic, not using any fuel to increase the air temperature before expansion; a sufficient turbine inlet temperature (TIT) is instead obtained through a thermal energy storage (TES) system which recovers the compression heat. The system includes (i) a set of turbomachines (modular multistage compressor, with partial intercooling; expansion turbine); (ii) a TES system with different temperature levels designed to recover a large fraction of the compression heat, allowing the subsequent heating of air prior to the expansion phase; (iii) an underwater modular compressed air storage, conceived as a network of rigid but open tanks lying on the seabed and allowing a variable-volume and constant pressure operation. The compressor operates at variable loads, following an oscillating renewable power input, according to strategies oriented to improve the overall system dispatchability; the expander can be designed to work either at full load, thanks to the stability of the air flowrate and of the TIT guaranteed by the thermal storage, or at variable load. This paper first discusses in detail the sizing and off-design characterization of the overall system; then it simulates a case study where the UW-CAES is coupled to a wind farm for peak shaving and dispatchability enhancement, evaluating the impact of a realistic power input on performances and plant flexibility. Although the assessment shall be considered preliminary, it is shown that round-trip efficiency (RTE) in the range of 75–80% can be obtained depending on the compressor section configuration, making the UW-CAES a promising technology compared to electrochemical and pumped-hydrostorage systems. The technology is also applied to perform peak-shaving of the electricity production from an off-shore wind farm; annual simulations, based on realistic wind data and considering part-load operation, result in global RTE around 75% with a 10–15% reduction in the average unplanned energy injection in the electric grid. The investigated case study provides an example of the potential of this system in providing power output peak shaving when coupled with an intermittent and nonpredictable energy source.
Spectral Element Approach for Flexural Waves Control in Smart Material Beam With Single and Multiple Resonant Impedance Shunt Circuit
Authors: Machado Marcela R. , Fabro Adriano T. , de Moura Braion B.
Published: May 2020

The accurate prediction of the dynamic characteristics of a structure is key to successful vibration control strategies. A typical vibration and wave propagation control is performed through periodic and shunted piezoelectric patches, also known as a smart material. Therefore, the smart metamaterial considers periodic arrangement of shunted piezoelectric patches providing a beam with attenuation properties which depend on the resonant behavior of the shunts. The vibration attenuation occurs due to an elastic-electrical system characterized by an internal resonance of the shunt circuit. The spectral element approach provides very accurate solutions for the structural dynamic response. In this paper, a beam-piezoelectric structure is introduced to focus on the control of flexural waves in beams with piezolayers connected to single and multiresonant shunt approaches. The smart structure is modeled using the spectral element method. It is shown that the effective wavenumber presents the locally resonant behavior at the same frequencies of the vibration attenuation for both single and multishunt approached, indicating that each shunt circuit is independently associated with a attenuation frequency. The spectral element approach presented in this paper shows to be an accurate and simple approach for the design smart metamaterial beams.
Aerodynamic Performance Improvement of a Wing Model Using an Array of Slotted Synthetic Jets
Authors: Salunkhe Pramod , Wu Yanhua , Tang Hui
Published: May 2020

This work deals with the improvement in aerodynamic performance of a NACA0025 wing model using an array of slotted synthetic jets (SJs). A novel SJ actuator was designed and located at 30% of the chord from the leading edge (LE). Time-resolved particle image velocimetry (TR-PIV), force balance, static pressure distribution, and hotwire measurements were carried out in a subsonic wind tunnel to assess the performance enhancement due to the slotted SJ array. Initially, the SJ velocity was measured in quiescent flow condition at different actuation frequencies and amplifier voltages. Actuation at 1000 Hz and 200 V resulted in the highest blowing velocity of 10.5 m/s. Experiments were performed at various actuation frequencies, namely, 200, 600, and 1000 Hz. It was observed that actuation at 1000 Hz led to the highest increase in lift coefficient by 35.6% and reduction in average drag coefficient by 33%. TR-PIV measurements showed flow separation with flow reversal in the baseline case. After switching on the SJ array at 1000 Hz, the flow separation was completely eliminated. The momentum transfer from the highenergy primary flow to the retarding boundarylayer flow and actuation of SJ in a particular frequency range was observed to be the mechanisms for the flow separation control. Subsequently, fast Fourier transform (FFT) power spectra of hotwire data were computed from 40% to 80% of the chord. The FFT power spectra showed the successful stabilization of the flow field at the actuation of 1000 Hz.
Expression profiles of glutathione S-transferases genes in semi-engorged Haemaphysalis longicornis (Acari: Ixodidae) exposed to Cymbopogon citratus essential oil

Authors: Agwunobi Desmond O. , Pei Tingwei , Yang Jia , Wang Xiaoshuang , Lv Lihong , Shen Ruowen , Yu Zhijun , Liu Jingze
Published: May 2020

Glutathione S-transferases (GSTs) are phase II detoxification enzymes, which function via combining with pesticidal molecules and catalyzing the conjugation of molecules by thiol of glutathione, so as to protect tissues from oxidative stress damage. In the tick Haemaphysalis longicornis, glutathione S-transferases (HlGST and HlGST2) have been previously identified. However, the relationship between the transcription of glutathione S-transferases and the essential oil treatment in ticks remains unexplored. Hence, in the present study, the transcription profiles of HlGST and HlGST2 mRNAs were evaluated in H. longicornis after exposure to Cymbopogon citratus essential oil. At 24 h post-exposure of H. longicornis to different sublethal concentrations of C. citratus essential oil, there was significant difference (P = 0.0001) in the transcription of HlGST. Tukey’s test showed that HlGST was significantly induced after treatment with 1% C. citratus essential oil (P = 0.0002); whereas no significant difference (P = 0.3551) was detected after treated by 2% C. citratus essential oil. No significant difference (P = 0.4555) in the transcription of HlGST2 between the treatment and the control group of 50% ethanol. Nevertheless, the down-regulation of HlGST2 in the treatment groups versus the untreated control group was not significant (P = 0.1208). The above results imply that the essential oil can modulate the expression of GST mRNA, therefore, further understanding of the underlying mechanisms of the GST at the molecular level could contribute to the development of effective control measures for ticks and tick-borne diseases.
In vacuo atomic layer deposition and electron tunneling characterization of ultrathin dielectric films for metal/insulator/metal tunnel junctions
Authors: Wu Judy Z. , Acharya Jagaran , Goul Ryan
Published: May 2020

Metal-insulator-metal tunnel junctions (MIMTJs) are an enabling technology for future electronics including advanced computing, data storage, sensors, etc. MIMTJs are formed by inserting an ultrathin insulating layer, known as the tunnel barrier (TB), between metal electrodes. Devices based on MIMTJs have advantages of enhanced quantum coherent transport, fast speed, small size, and energy efficiency. The performance of MIMTJs depends critically on the thickness and quality of the tunnel barrier. Specifically, the tunneling current, for example, the superconducting critical current in superconductor-insulator-superconductor Josephson junctions (JJs) or the spin tunneling current in ferromagnetic-insulator-ferromagnetic magnetic tunnel junctions (MTJs), decreases exponentially with the TB thickness. This means thinner TBs would enable stronger coherent tunneling in MIMTJs. In addition, the defects in the TBs can degrade the quantum coherence of electrons (spins) of JJs and MTJs, respectively, resulting in decoherence and degraded performance of the MIMTJs. This justifies the urgent need in research and development of ultrathin (subnanometers to 1 nm) pinhole-free and defect-free TBs beyond the current state-of-the-art TBs of larger thickness (>1–2 nm) and high defect concentration made using thermal diffusion of oxygen or physical vapor deposition (PVD) including magnetron sputtering and molecular beam epitaxy. Atomic layer deposition (ALD) can provide a unique resolution to achieving ultrathin and defect-free dielectric TBs for high-performance MIMTJs for future electronics. In this article, a review on their recent effort in the development of in vacuo ALD for the fabrication of ultrathin TBs for JJs and MTJs is presented. A custom-designed system that integrates high-vacuum/ultrahigh-vacuum PVD, ALD, and scanning probe microscopy was established for in vacuo fabrication of MIMTJs and characterization of the electronic properties of ALD TBs including Al2O3, MgO, and Al2MgO4 on both superconductor metals (Al) and ferromagnetic metals (Fe and FeCoB). Capacitors with ALD dielectric of thickness in the range of 1–5 nm were also constructed for the characterization of the dielectric properties of the ALD TBs. The authors have found that the metal-insulator interface plays a critical role in controlling the quality of the ALD TBs including the tunnel barrier height, dielectric constant, electric breakdown, and uniformity. They have shown that JJs and MTJs with 0.1–1.0 nm thick ALD Al2O3 TBs can be obtained with highly promising performance. The result obtained suggests that the in vacuo ALD may provide a unique approach toward MIMTJs with an atomic-scale control of the device structure required for high-performance future electronics.
Auditory and auditory-visual frequency-band importance functions for consonant recognition
Authors: Bernstein Joshua G. W. , Venezia Jonathan H. , Grant Ken W.
Published: May 2020

The relative importance of individual frequency regions for speech intelligibility has been firmly established for broadband auditory-only (AO) conditions. Yet, speech communication often takes place face-to-face. This study tested the hypothesis that under auditory-visual (AV) conditions, where visual information is redundant with high-frequency auditory cues, lower frequency regions will increase in relative importance compared to AO conditions. Frequency band-importance functions for consonants were measured for eight hearing-impaired and four normal-hearing listeners. Speech was filtered into four 1/3-octave bands each separated by an octave to minimize energetic masking. On each trial, the signal-to-noise ratio (SNR) in each band was selected randomly from a 10-dB range. AO and AV band-importance functions were estimated using three logistic-regression analyses: a primary model relating performance to the four independent SNRs; a control model that also included band-interaction terms; and a different set of four control models, each examining one band at a time. For both listener groups, the relative importance of the low-frequency bands increased under AV conditions, consistent with earlier studies using isolated speech bands. All three analyses showed similar results, indicating the absence of cross-band interactions. These results suggest that accurate prediction of AV speech intelligibility may require different frequency-importance functions than for AO conditions.
Introductions and early spread of SARS-CoV-2 in the New York City area
Authors: Gonzalez-Reiche Ana S. , Hernandez Matthew M. , Sullivan Mitchell J. , Ciferri Brianne , Alshammary Hala , Obla Ajay , Fabre Shelcie , Kleiner Giulio , Polanco Jose , Khan Zenab , Alburquerque Bremy , van de Guchte Adriana , Dutta Jayeeta , Francoeur Nancy , Melo Betsaida Salom , Oussenko Irina , Deikus Gintaras , Soto Juan , Sridhar Shwetha Hara , Wang Ying-Chih , Twyman Kathryn , Kasarskis Andrew , Altman Deena R. , Smith Melissa , Sebra Robert , Aberg Judith , Krammer Florian , García-Sastre Adolfo , Luksza Marta , Patel Gopi , Paniz-Mondolfi Alberto , Gitman Melissa , Sordillo Emilia Mia , Simon Viviana , van Bakel Harm
Published: May 2020

Blighted Gotham

Deaths caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in New York City (NYC) during the spring of 2020 have vastly exceeded those reported in China and many other countries. What were the early events that led to such a severe outbreak? Gonzalez-Reiche
et al.
sampled some of the early patients seeking assistance in February and March of 2020 at the Mount Sinai Health System. Phylogenetic analysis of virus sequences in these people, who were drawn from across NYC, showed that the virus had been independently introduced many times from Europe and elsewhere in the United States. Subsequent clusters of community transmission occurred. The focus of infection in NYC is a marker of the role this city plays as a two-way hub for human movement.

Science
this issue p.
297
CheY1 and CheY2 of Azorhizobium caulinodans ORS571 Regulate Chemotaxis and Competitive Colonization with the Host Plant
Authors: Liu Wei , Bai Xue , Li Yan , Min Jun , Kong Yachao , Hu Xiaoke
Published: May 2020

Azorhizobium caulinodans
ORS571 is a motile soil bacterium that has the dual capacity to fix nitrogen both under free-living conditions and in symbiosis with
Sesbania rostrata
, forming nitrogen-fixing root and stem nodules. Bacterial chemotaxis to chemoattractants derived from host roots promotes infection and subsequent nodule formation by directing rhizobia to appropriate sites of infection. In this work, we identified and demonstrated that CheY2, a chemotactic response regulator encoded by a gene outside the chemotaxis cluster, is required for chemotaxis and multiple other cell phenotypes. CheY1, encoded by a gene in the chemotaxis cluster, also plays a role in chemotaxis. Two response regulators mediate bacterial chemotaxis and motility in different ways. This work extends the understanding of the role of multiple response regulators in Gram-negative bacteria.
Biennial Upsurge and Molecular Epidemiology of Enterovirus D68 Infection in New York, USA, 2014 to 2018
Authors: Gilrane Victoria L. , Zhuge Jian , Huang Weihua , Nolan Sheila M. , Dhand Abhay , Yin Changhong , Salib Christian , Shakil Faariah , Engel Helen , Fallon John T. , Wang Guiqing
Published: May 2020

Enterovirus D68 (EV-D68) infection has been associated with outbreaks of severe respiratory illness and increased cases of nonpolio acute flaccid myelitis. The patterns of EV-D68 circulation and molecular epidemiology are not fully understood. In this study, nasopharyngeal (NP) specimens collected from patients in the Lower Hudson Valley, New York, from 2014 to 2018 were examined for rhinovirus/enterovirus (RhV/EV) by the FilmArray respiratory panel. Selected RhV/EV-positive NP specimens were analyzed using two EV-D68-specific real-time RT-PCR assays, Sanger sequencing and metatranscriptomic next-generation sequencing.
Accuracy of Xpert Ultra in Diagnosis of Pulmonary Tuberculosis among Children in Uganda: a Substudy from the SHINE Trial
Authors: Ssengooba Willy , Iragena Jean de Dieu , Nakiyingi Lydia , Mujumbi Serestine , Wobudeya Eric , Mboizi Robert , Boulware David , Meya David B. , Choo Louise , Crook Angela M. , Lebeau Kristen , Joloba Moses , Demers Anne-Marie , Cresswell Fiona V. , Gibb Diana M.
Published: May 2020

Childhood tuberculosis (TB) presents significant diagnostic challenges associated with paucibacillary disease and requires a more sensitive test. We evaluated the diagnostic accuracy of Xpert MTB/RIF Ultra (Ultra) compared to other microbiological tests using respiratory samples from Ugandan children in the SHINE trial. SHINE is a randomized trial evaluating shorter treatment in 1,204 children with minimal TB disease in Africa and India. Among 352 samples and one cervical lymph node fine needle aspirate, one sample was randomly selected per patient and tested with the Xpert MTB/RIF assay (Xpert) and with Lowenstein-Jensen medium (LJ) and liquid mycobacterial growth indicator tube (MGIT) cultures.
Multiple branching and attachment structures in cloudinomorphs, Nama Group, Namibia
Authors: Shore Amy , Wood Rachel , Curtis Andrew , Bowyer Frederick
Published: May 2020

The Ediacaran-Cambrian cloudinomorphs, which include Cloudina, are the first putative skeletal metazoans. They have a benthic ecology and tubular, organic, or biomineralized stacked funnel morphologies but an unresolved phylogenetic affinity. Rare dichotomous branching has been described in Cloudina, but here we demonstrate the presence of multiple (polytomous), dichotomous branching in cloudinomorphs from a microbial mat community from the Nama Group, Namibia, as revealed by three-dimensional models created from serial sections. Branches share an open, central cavity, and branching is achieved via external budding. These cloudinomorphs show attachment and mutual cementation to each other, and also to Namacalathus, via extratubular skeletal structures to potentially form a horizontal framework. Polytomous branching excludes a bilaterian affinity as proposed for other cloudinomorphs. This raises the possibility that the Ediacaran tubular, funnel morphology is convergent, and that cloudinomorphs may, in fact, represent taxa of diverse affinity.
Long-term natural history of visual acuity in eyes with choroideremia: a systematic review and meta-analysis of data from 1004 individual eyes
Authors: Shen Liangbo L , Ahluwalia Aneesha , Sun Mengyuan , Young Benjamin K , Grossetta Nardini Holly K , Del Priore Lucian V
Published: May 2020

Background/aims

Best-corrected visual acuity (BCVA) is the most common primary endpoint in treatment trials for choroideremia (CHM) but the long-term natural history of BCVA is unclear.

Methods

We searched in seven databases to identify studies that reported BCVA of untreated eyes with CHM. We sought individual-level data and performed segmented regression between BCVA and age. For eyes followed longitudinally, we introduced a horizontal translation factor to each dataset to account for different ages at onset of a rapid BCVA decline.

Results

We included 1004 eyes from 23 studies. BCVA of the right and left eyes was moderately correlated (r=0.60). BCVA as a function of age followed a 2-phase decline (slow followed by rapid decline), with an estimated transition age of 39.1 years (95% CI 33.5 to 44.7). After the introduction of horizontal translation factors to longitudinal datasets, BCVA followed a 2-phase decline until it reached 0 letters (r2=0.90). The BCVA decline rate was 0.33 letters/year (95% CI −0.38 to 1.05) before 39 years, and 1.23 letters/year (95% CI 0.55 to 1.92) after 39 years (p=0.004).

Conclusion

BCVA in eyes with CHM follows a 2-phase linear decline with a transition age of approximately 39 years. Future trials enrolling young patients may not be able to use BCVA as a primary or sole endpoint, but rather, may need to employ additional disease biomarkers that change before age 39. BCVA may still have utility as a primary endpoint for patients older than 39 years who have measurable BCVA decline rates.
Physical activity and health in Chinese children and adolescents: expert consensus statement (2020)
Authors: Chen Peijie , Wang Dengfeng , Shen Hongbing , Yu Lijuan , Gao Qian , Mao Lijuan , Jiang Fan , Luo Yaojia , Xie Minhao , Zhang Yong , Feng Lianshi , Gao Feng , Wang Yuling , Liu Yu , Luo Chunyan , Nassis George P , Krustrup Peter , Ainsworth Barbara E , Harmer Peter A , Li Fuzhong
Published: May 2020

China is experiencing significant public health challenges related to social and demographic transitions and lifestyle transformations following unprecedented economic reforms four decades ago. Of particular public health concern is the fourfold increase in overweight and obesity rates in the nation’s youth population, coupled with the low prevalence of adolescents meeting recommended levels of physical activity. Improving the overall health of China’s more than 170 million children and adolescents has become a national priority. However, advancing nationwide health initiatives and physical activity promotion in this population has been hampered by the lack of a population-specific and culturally relevant consensus on recommendations for achieving these ends. To address this deficiency and inform policies to achieveHealthy China 2030goals, a panel of Chinese experts, complemented by international professionals, developed this consensus statement. The consensus was achieved through an iterative process that began with a literature search from electronic databases; in-depth reviews, conducted by a steering committee, of the resulting articles; and panel group evaluations and discussions in the form of email correspondence, conference calls and written communications. Ultimately, the panel agreed on 10 major themes with strong scientific evidence that, in children and adolescents aged 6–17, participating in moderate to vigorous physical activities led to multiple positive health outcomes. Our consensus statement also (1) highlights major challenges in promoting physical activity, (2) identifies future research that addresses current knowledge gaps, and (3) provides recommendations for teachers, education experts, parents and policymakers for promoting physical activity among Chinese school-aged children and adolescents. This consensus statement aligns with international efforts to develop global physical activity guidelines to promote physical activity and health and prevent lifestyle-related diseases in children and adolescents. More importantly, it provides a foundation for developing culturally appropriate and effective physical activity interventions, health promotion strategies and policy initiatives to improve the health of Chinese children and adolescents.
Association between self-reported moderate to vigorous physical activity and the rate of outpatient treated COPD exacerbations: retrospective cohort study
Authors: Nguyen Huong Q , Mularski Richard A , Moy Marilyn L , Lee Janet S , Shen Ernest
Published: May 2020

Introduction

Little has been published regarding the relationship between physical activity (PA) and outpatient treated, mild to moderate acute exacerbation of chronic obstructive pulmonary disease exacerbations (AECOPD). The purpose of this study was to determine the association between self-reported PA and outpatient treated AECOPD over 2 years using real-world data obtained from existing electronic medical records (EMRs).

Methods

We included 44 896 patients with a chronic obstructive pulmonary disease diagnosis from the EMR in this retrospective cohort study. Moderate to vigorous PA was measured via patient self-report, obtained during routine clinical care; patients were classified as inactive (0 min/week), insufficiently active (1–149 min/week) or active (≥150 min/week). AECOPDs were measured using both encounter and prescription fill (antibiotics and/or oral steroids) data. We used Poisson regression models to compare the unadjusted and adjusted rates of outpatient treated AECOPD over 2 years across the PA categories.

Results

In adjusted models, the 2-year AECOPD incidence rate ratio (IRR) was not different between the inactive and insufficiently inactive groups (IRR 0.98, 95% CI 0.96 to 1.01) and only marginally meaningful lower for the active group (IRR 0.97, 95% CI 0.95 to 0.98). Sensitivity analyses of patients meeting or not meeting obstructive criteria produced similar results with generally weak or non-significant associations.

Conclusion

The lack of an association between PA and AECOPD contrasts with previous published findings of a strong relationship between moderate to vigorous PA and hospitalisations for severe AECOPD. This difference could partially be attributed to the imprecision of our measurements for both the exposure and outcome.
Teaching old dogs new tricks: an updated consensus on the management of mitral valve disease
Authors: Borgeat Kieran
Published: May 2020

Background: In 2019, the American College of Veterinary Internal Medicine (ACVIM) updated its decade‐old consensus statement on the approach to managing myxomatous mitral valve disease (MVD) in dogs. The updated statement reflects the latest thinking on canine MVD to help practitioners take a rational approach to managing the condition.

Aim of the article: This article reviews the updated ACVIM consensus statement on MVD, with the aim of highlighting key points in decision making for patients in veterinary clinics.
Immune gene expression profiles in high-grade urothelial carcinoma of the bladder: a NanoString study
Authors: Olkhov-Mitsel Ekaterina , Hodgson Anjelica , Liu Stanley K , Vesprini Danny , Bayani Jane , Bartlett John , Xu Bin , Downes Michelle R
Published: May 2020

Aims

The advent of immune checkpoint inhibitor therapy has proven beneficial in a subset of high-grade urothelial carcinomas (HGUC) of the bladder. Although treatment selection is currently largely determined by programmed death-ligand 1 (PD-L1) status, multiple factors in the immune system may modulate the host immune response to HGUC and immunotherapy. In this pilot study, we used a transcriptomic approach to identify the immune milieu associated with PD-L1 expression to enhance our understanding of the HGUC immune evasion network.

Methods

The immune transcriptome of 40 HGUC cystectomy cases was profiled using the NanoString nCounter Human V.1.1 PanCancer Panel. All cases were assessed for associated PD-L1 status (SP263) using whole tissue sections. PD-L1 status was determined as high or low using 25% tumour and/or immune cell staining.

Results

The most significantly differentially expressed gene was PD-L1 messenger RNA (CD274), which strongly correlated with protein expression (r=0.720, p<0.001). The sensitivity, specificity, positive and negative predictive values ofCD274for PD-L1 expression were 85%, 96%, 92% and 93%, respectively. The PD-L1 associated gene signature also included complement componentsC1QAandCD46andNOD2(innate immune system), proinflammatory cytokinesCXCL14, CXCL16, CCL3, CCL3L1andOSMalong with the immune response mediatorSMAD3,among others. Pathway analysis determined enrichment of these genes in interleukin-10 production, lymphocyte chemotaxis and aberrant IFNγ, NF-κB and ERK signalling networks.

Conclusions

We report key genes and pathways in the immune transcriptome and their association with PD-L1 status, which may be involved in immune evasion of HGUC and warrants further investigation.
Historical perspectives in clinical pathology: Bence Jones protein—early urine chemistry and the impact on modern day diagnostics
Authors: Sewpersad Sheromna , Pillay Tahir S
Published: May 2020

This is the third in the series of historical articles dealing with developments in clinical pathology. Bence Jones proteins are immunoglobulin light chains found in excessive quantities in urine in multiple myeloma and are believed to be one of the first tumour markers ever discovered . Dr Henry Bence Jones is credited with the discovery of this protein in 1847 that bears his name and he can also be regarded as the first chemical pathologist/clinical chemist. Since then, numerous advances and refinements have been made in the measurement and detection of urine light chain proteins which have resulted in the current sensitive serum free light chain assays used today.
‘[Her] hostess … is anxious to have her back when she is cured’: The impact of the evacuation of children on wartime local services, England, 1939–1945
Authors: Taylor Jonathan
Published: May 2020

World War II had a profound, but uneven, impact on the delivery of services designed to support the bodies and minds of English children. This article, which is based on a study of a rural local authority located in North-West England, explores the influence of World War II on children's welfare services. Drawing on detailed case files relating to individual children and reports published by local and national policy makers, the article advances three related arguments which together nuance existing understandings of the conflict and its longer-term consequences. First, the article argues that many of the problems associated with evacuees were already familiar to medical and social work professionals. This awareness has important consequences for how we conceptualise the wartime proposals that attracted policy makers’ attention. Second, the article shows that the arrival of evacuees into reception areas initially resulted in an expansion of children’s services. A fuller understanding of Britain's welfare state, however, must acknowledge that local authorities continued to wield significant influence over the delivery of specialist services once the conflict ended. As a result, the priorities of local officials could lead to the needs of looked after children being overlooked despite wartime improvements to children's services. Finally, the article argues that amidst the totality of World War II, the British state remained unwilling to intrude on the rights of parents to influence the care of their children. Closer examination of the implementation of evacuation and the experiences of individuals reveals that important tensions existed between the state appointed experts and the civilians they were tasked with supporting.
Potential of deep learning in assessing pneumoconiosis depicted on digital chest radiography
Authors: Wang Xiaohua , Yu Juezhao , Zhu Qiao , Li Shuqiang , Zhao Zanmei , Yang Bohan , Pu Jiantao
Published: May 2020

Objectives

To investigate the potential of deep learning in assessing pneumoconiosis depicted on digital chest radiographs and to compare its performance with certified radiologists.

Methods

We retrospectively collected a dataset consisting of 1881 chest X-ray images in the form of digital radiography. These images were acquired in a screening setting on subjects who had a history of working in an environment that exposed them to harmful dust. Among these subjects, 923 were diagnosed with pneumoconiosis, and 958 were normal. To identify the subjects with pneumoconiosis, we applied a classical deep convolutional neural network (CNN) called Inception-V3 to these image sets and validated the classification performance of the trained models using the area under the receiver operating characteristic curve (AUC). In addition, we asked two certified radiologists to independently interpret the images in the testing dataset and compared their performance with the computerised scheme.

Results

The Inception-V3 CNN architecture, which was trained on the combination of the three image sets, achieved an AUC of 0.878 (95% CI 0.811 to 0.946). The performance of the two radiologists in terms of AUC was 0.668 (95% CI 0.555 to 0.782) and 0.772 (95% CI 0.677 to 0.866), respectively. The agreement between the two readers was moderate (kappa: 0.423, p<0.001).

Conclusion

Our experimental results demonstrated that the deep leaning solution could achieve a relatively better performance in classification as compared with other models and the certified radiologists, suggesting the feasibility of deep learning techniques in screening pneumoconiosis.
Exposure–response assessment of cancer mortality in styrene-exposed boatbuilders
Authors: Daniels Robert Douglas , Bertke Stephen J
Published: May 2020

Objectives

To improve exposure estimates and reexamine exposure–response relationships between cumulative styrene exposure and cancer mortality in a previously studied cohort of US boatbuilders exposed between 1959 and 1978 and followed through 2016.

Methods

Cumulative styrene exposure was estimated from work assignments and air-sampling data. Exposure–response relationships between styrene and select cancers were examined in Cox proportional hazards models matched on attained age, sex, race, birth cohort and employment duration. Models adjusted for socioeconomic status (SES). Exposures were lagged 10 years or by a period maximising the likelihood. HRs included 95% profile-likelihood CIs. Actuarial methods were used to estimate the styrene exposure corresponding to 10-4extra lifetime risk.

Results

The cohort (n= 5163) contributed 201 951 person-years. Exposures were right-skewed, with mean and median of 31 and 5.7 ppm-years, respectively. Positive, monotonic exposure–response associations were evident for leukaemia (HR at 50 ppm-years styrene = 1.46; 95% CI 1.04 to 1.97) and bladder cancer (HR at 50 ppm-years styrene =1.64; 95% CI 1.14 to 2.33). There was no evidence of confounding by SES. A working lifetime exposure to 0.05 ppm styrene corresponded to one extra leukaemia death per 10 000 workers.

Conclusions

The study contributes evidence of exposure–response associations between cumulative styrene exposure and cancer. Simple risk projections at current exposure levels indicate a need for formal risk assessment. Future recommendations on worker protection would benefit from additional research clarifying cancer risks from styrene exposure.
Analgesic efficacy of cannabinoids for acute pain management after surgery: a systematic review and meta-analysis
Authors: Abdallah Faraj W , Hussain Nasir , Weaver Tristan , Brull Richard
Published: May 2020

Background

Evidence regarding the role of cannabinoids in managing acute postoperative pain is conflicting. The purpose of this systematic review and meta-analysis was to determine the analgesic efficacy of perioperative cannabinoid compounds for acute pain management after surgery.

Methods

Original research articles evaluating the addition of cannabinoids to standard opioid-based systemic analgesia (Control) in the postoperative period were sought. Our primary outcomes were cumulative oral morphine equivalent consumption and rest pain severity at 24 hours postoperatively. We also assessed analgesic consumption in the postanesthesia care unit (PACU), pain scores in PACU, 6 and 12 hours postoperatively, and opioid-related and cannabinoid-related side effects, patient satisfaction, and quality of recovery as secondary outcomes.

Results

Eight randomized controlled trials (924 patients) and four observational studies (4259 patients) were analyzed and included. There were insufficient data to pool for quantification of differences in cumulative oral morphine equivalent consumption and rest pain severity at 24 hours postoperatively with the addition of cannabinoids in comparison to Control. Qualitative synthesis revealed no differences in cumulative oral opioid consumption or pain at rest 24 hours postoperatively with the addition of cannabinoids in comparison to Control. Patients receiving cannabinoids appeared to have an increased weighted mean difference 95% CI of pain at 12 hours by 0.83 cm (0.04 to 1.63) (p=0.04). Patients receiving cannabinoids also appeared to have 3.24 times increased odds of developing hypotension postoperatively (95% CI 1.12 to 9.36) (p=0.03). Qualitative and quantitative synthesis revealed no differences in any other secondary outcomes.

Conclusions

Our quantitative and qualitative review of the literature suggests that the analgesic role of perioperative cannabinoid compounds is limited, with no clinically important benefits detected when cannabinoids are added to traditional systemic analgesics compared with traditional systemic analgesics alone. Notably, there appears to be a signal towards increased postoperative pain and hypotension associated with the addition of perioperative cannabinoids to traditional systemic analgesics. These results do not support the routine use of cannabinoids to manage acute postoperative pain at the present time.
Anatomy of the brachial plexus and its implications for daily clinical practice: regional anesthesia is applied anatomy
Authors: Feigl Georg C , Litz Rainer J , Marhofer Peter
Published: May 2020

Safety and effectiveness are mandatory requirements for any technique of regional anesthesia and can only be met by clinicians who appropriately understand all relevant anatomical details. Anatomical texts written for anesthetists may oversimplify the facts, presumably in an effort to reconcile extreme complexity with a need to educate as many users as possible. When it comes to techniques as common as upper-extremity blocks, the need for customized anatomical literature is even greater, particularly because the complex anatomy of the brachial plexus has never been described for anesthetists with a focus placed on regional anesthesia. The authors have undertaken to close this gap by compiling a structured overview that is clinically oriented and tailored to the needs of regional anesthesia. They describe the anatomy of the brachial plexus (ventral rami, trunks, divisions, cords, and nerves) in relation to the topographical regions used for access (interscalene gap, posterior triangle of the neck, infraclavicular fossa, and axillary fossa) and discuss the (interscalene, supraclavicular, infraclavicular, and axillary) block procedures associated with these access regions. They indicate allowances to be made for anatomical variations and the topography of fascial anatomy, give recommendations for ultrasound imaging and needle guidance, and explain the risks of excessive volumes and misdirected spreading of local anesthetics in various anatomical contexts. It is hoped that clinicians will find this article to be a useful reference for decision-making, enabling them to select the most appropriate regional anesthetic technique in any given situation, and to correctly judge the risks involved, whenever they prepare patients for a specific upper-limb surgical procedure.
Daring discourse – no: cannabinoids should not be used for acute postoperative pain management
Authors: Meeker Jennifer D , Ayrian Eugenia , Mariano Edward R
Published: May 2020

As anesthesiologists and acute pain medicine specialists, we will care for patients in the perioperative period who use cannabinoids for chronic pain and/or marijuana recreationally. We will have to address difficult questions from patients regarding the potential applications for cannabinoids in acute pain management. While we must remain compassionate and understand our patients’ desire to find relief from suffering using available non-opioid medications, we are ethically bound to do no harm and provide them with treatment options supported by the best available evidence. Today, we cannot support cannabinoids in the management of acute postoperative pain.
Successful transforaminal epidural blood patch in a patient with multilevel spinal fusion
Authors: Choi Hanwool Ryan , Fuller Benjamin , Bottros Michael Magdy
Published: May 2020

Introduction

Epidural blood patch (EBP) is a vital tool in treating postdural puncture headache (PDPH). Traditional interlaminar epidural needle insertion into the epidural space, however, may be challenging due to anatomical variations. As an alternative method, we successfully performed an EBP via transforaminal approach.

Case report

A mid-50-year-old male patient with multilevel spinal fusion developed PDPH after a failed spinal cord stimulator electrode placement. A transforaminal EBP was carried out by injecting a total of 8 mL of autologous blood into the neuroforamen at the L1–L2 level bilaterally. Our patient’s positional headache resolved immediately after the procedure.

Discussion

To our knowledge, this is the first case reported of a transforaminal EBP in a patient with diffuse epidural adhesive fibrosis secondary to multilevel laminectomies and spinal fusion. This case report highlights potential risks and benefits of this novel technique and also discusses its therapeutic mechanism of action. We believe that a transforaminal EBP should be considered in patients who are poor candidates for the traditional interlaminar EBP.
Reconfiguring the scope and practice of regional anesthesia in a pandemic: the COVID-19 perspective
Authors: Ashokka Balakrishnan , Chakraborty Arunangshu , Subramanian Balavenkat J , Karmakar Manoj Kumar , Chan Vincent
Published: May 2020

The COVID-19 outbreak is on the world. While many countries have imposed general lockdown, emergency services are continuing. Healthcare professionals have been infected with the virulent severe acute respiratory syndrome coronavirus-2 (SARS), which spreads by close contact and aerosols. The anesthesiologist is particularly vulnerable to aerosols while performing intubation and other airway related procedures. Regional anesthesia (RA) minimizes the need for airway manipulation and the risks of cross infection to other patients, and the healthcare personnel. In this context, for prioritizing RA over general anesthesia, wherever possible, a structured algorithmic approach is outlined. The role of percentage saturation of hemoglobin with oxygen (oxygen saturation), blood pressure and early use of point-of-care ultrasound in differential diagnosis and specific management is detailed. The perioperative anesthetic implications of multisystem manifestations of COVID-19, anesthetic management options, the scope of RA and considerations for its safe conduct in operating rooms is described. An outline for safe and rapid training of healthcare personnel, with an Entrustable Professional Activity framework for ascertaining the practice readiness among trained residents for RA in COVID-19, is suggested. These are the authors’ experiences gained from the current pandemic and similar SARS, Middle East Respiratory Syndrome and influenza outbreaks in recent past faced by our authors in Singapore, India, Hong Kong and Canada.