bluuebunny/crossref_metadata_2025 huggingface dataset:
#1: Pediatrics Institutional COVID-19 review
Authors: Hasan Uzma , Karna Prakash
Published: June 2021

Background

Coronavirus disease (COVID-19) caused by SARS-COV2 represents global public health concern, with varied severity of illness in different ages and racial groups. This study aims to describe clinical presentation and outcomes in children aged 0–18 years in a community hospital setting in the United States.

Methods

This is a retrospective medical record review of pediatric patients (0–18 years) admitted to Saint Barnabas Medical Center between March 2020- August 2020 with confirmed diagnosis of COVID-19 infection. Diagnosis of COVID-19 infection is based on ICD-10 diagnosis code from the coding abstract data of the hospital, and data analysis is based on retrospective chart review using electronic medical records for the patients included in the study. Patient data include demographics (age, sex, race), pre-existing conditions, presenting symptoms, treatments used and outcomes.

Findings

We identified 27 cases of pediatric COVID-19 patients at Saint Barnabas Medical Center during period of March 2020- August 2020. Fever (74%) was the most frequent symptom identified, followed by cough (44%), nausea/vomiting (30%), abdominal pain (19%), headache (19%), diarrhea (15%), shortness of breath (15%), red eyes (15%), rash (11%), chest pain (4%), and loss of taste/smell (4%). 13 out of 27 patients had imaging with chest X-ray, and 7 (54%) had findings of lung infiltrates or opacities. 6 of 27 patients had echocardiogram, and 4 (67%) had positive echocardiogram findings. 11 of 27 patients had some comorbid condition. 17 of 27 (63%) received no treatment. 3 patients (11%) were treated with IVIG + steroids, 2 (7%) received steroids only, 2 (7%) received Remdesivir, 1 (4%) received HCQ, and 1 (4%) received Tocilizumab along with IVIG+ steroids. Only 3 of 27 patients (11%) required supplemental oxygen treatment. No deaths were reported. Of 27 patients, 11 (41%) received inpatient care in general pediatrics, 10 (37%) received care only in ER, 4 (15%) received ICU level of care, and 2 (7%) received care in newborn nursery. Of 27 patients, 17 (63%) were female, and 10 (37%) were male. Race distribution was 48% black, 22% white, 4 % Asian Indian, and 26% others/unknown. Age distribution was 41% aged >15 yrs, 19% aged 6–10 yrs, 15% aged 1–5 yrs, 11% aged 11–15 yrs, 11% newborn, and 4% 0–1 yr.

Interpretation

This review supports findings from other studies in children showing overall good prognosis in children diagnosed with COVID-19 infection. This study also shows that there is some racial component involved as black children were infected twice as much as white children. However, it requires more longitudinal studies to confirm these findings, and better understand symptomatology and disease course in children with COVID-19 infection.
#27: Comparison of RT-PCR Cycle Threshold Values from Respiratory Specimens in Symptomatic and Asymptomatic Children with SARS CoV-2 Infection
Authors: Strutner John , Ramchandar Nanda , Dubey Shruti , Gamboa Mary , Vanderpool Michelle K , Mueller Teresa , Wang Wei , Cannavino Christopher , Padua Leidy Tovar , Malicki Denise , Pong Alice
Published: June 2021

Background

Understanding viral kinetics of SARS-CoV-2 is important to assess risk of transmission, manage treatment, and determine the need for isolation and protective equipment. Children have been noted to have less severe illness than adults and may have less transmission potential. We sought to determine whether children deemed to be asymptomatic had a difference in the PCR cycle threshold (Ct) value of respiratory samples from symptomatic children with SARS CoV-2 infection.

Methods

This was a retrospective cross-sectional study to compare PCR Ct values of 728 children who tested positive for SARS-CoV-2 by respiratory samples collected over a 4-month period. The study was a single center review of patients who tested positive for SARS-CoV-2 by RT-PCR from a respiratory specimen at a large tertiary care children’s hospital. Inclusion criteria included children 0–18 years of age who tested positive for SARS-CoV-2 by RT-PCR from a respiratory specimen for whom clinical information was available in the electronic medical record.

Results

We analyzed 728 children who tested positive for SARS-CoV-2 by RT-PCR from a respiratory sample over a 4-month period and for whom data was available in the electronic medical record. Overall, 71.2% of infected children were symptomatic. The mean Ct value for symptomatic patients (Ct mean 19.9, SD 6.3) was significantly lower than asymptomatic patients (Ct mean 23.5, SD 6.5) (P value < 0.001, CI95th 2.6 - 4.6). The mean PCR Ct value was lowest in children less than 5 years of age.

Conclusions and Relevance

In this retrospective review of children who tested positive by RT-PCR for SARS CoV-2, the mean Ct was significantly lower in symptomatic children and was lowest in children under 5 years of age.
Large anterior tibial artery pseudoaneurysm as a rare complication to vascular surgery
Authors: Eilersen Emilie Nøddeskov , Strøm Michael
Published: June 2021

A pseudoaneurysm is a rare complication to vascular reconstruction and may be limb threatening if not treated. A patient previously treated for an aneurysm of the left popliteal artery presented to our outpatient clinic with swelling and reduced active movement. Computed Tomography Angiography revealed an 8.1 cm large pseudoaneurysm of the anterior tibial artery (ATA). The pseudoaneurysm was successfully treated with an interposition vascular graft to the patent ATA. Open surgical repair was the only option with resection of the pseudoaneurysm and insertion of an interposition vascular graft with and end-to-side anastomosis. The giant ATA pseudoaneurysm was successfully treated with insertion of a new end-to-side graft anastomosis with interposition to the old patent vascular graft.
Rethinking Suicide
Authors: Bryan Craig J.
Published: June 2021

This book presents a critical evaluation of conventional wisdom and traditional assumptions about suicide, with particular attention focused on the assumed centrality of mental illness. It argues that suicide prevention efforts have disproportionately emphasized mental health-focused solutions, notably access to treatment and crisis services, based on research studies that are susceptible to bias and faulty interpretations of research findings. Instead of viewing suicide as a mental health issue, suicide should instead be seen as a “wicked problem” that defies ordinary solutions. Wicked problems cannot be definitively solved or eliminated by conventional solution-oriented thinking, and require process-based thinking that may, in some cases, defy or contradict many of our long-held assumptions about suicide. To flesh out this alternative approach to suicide prevention, the book interweaves historical accounts and personal stories with explanations of scientific findings to illustrate the limitations of widely-used practices and introduce alternative perspectives that could catalyze a paradigm shift in how we think about and prevent suicide.
Marshmallows and Braking Systems
Authors: Bryan Craig J.
Published: June 2021

This chapter argues that suicide can be more usefully understood as a consequence of decision-making processes that are vulnerable to environmental and social influence rather than a consequence of internal states or traits such as mental illness. Mental illness and emotional distress more generally are better understood as one particular context within which the decision to make a suicide attempt or not often presents itself, but this does not mean that mental illness is the only context within which this choice is considered. This also does not mean that mental illness causes suicide. The basic concept involved in the marshmallow experiment—decision-making under different conditions—has received increased attention in the past decade among suicide researchers. Studies reveal that the decision-making process of someone who almost died as a result of a suicide attempt was no different from the decision-making process of someone who had never attempted suicide, was not currently suicidal, and did not have a mental illness. This finding lines up with the idea that there can be multiple pathways to suicide.
Creating Lives Worth Living
Authors: Bryan Craig J.
Published: June 2021

This chapter explains that suicide prevention is more than just stopping people from dying; it is also about reducing the social conditions that negatively affect quality of life while strengthening the conditions that promote and foster meaningful lives that are worth living. Targeting multiple environmental hazards that increase the risk of suicidal behaviors is necessary to maximize the likelihood of impacting the many different types of individuals who are vulnerable to suicidal behavior. For many Americans, raising the minimum wage could either remove or reduce the hazards of economic insecurity and financial strain, and thereby may reduce their risk for suicide, even if only slightly. Making health insurance more accessible could reduce suicide rates by a few more percentage points. Environmental physical-health hazards warrant attention as well. These strategies address social and environmental hazards that cannot be remedied with mental health treatment.
Mentalising and Epistemic Trust
Authors: Duschinsky Robbie , Foster Sarah
Published: June 2021

The theory of mentalizing and epistemic trust introduced by Peter Fonagy and colleagues at the Anna Freud Centre has been an important perspective on mental health and illness. This book is the first comprehensive account and evaluation of this perspective. The book explores 20 primary concepts that organize the contributions of Fonagy and colleagues: adaptation, aggression, the alien self, culture, disorganized attachment, epistemic trust, hypermentalizing, reflective function, the p-factor, pretend mode, the primary unconscious, psychic equivalence, mental illness, mentalizing, mentalization-based therapy, non-mentalizing, the self, sexuality, the social environment, and teleological mode. The biographical and social context of the development of these ideas is examined. The book also specifies the current strengths and limitations of the theory of mentalizing and epistemic trust, with attention to the implications for both clinicians and researchers.
Conceptualizing the ‘self’
Authors: Duschinsky Robbie , Foster Sarah
Published: June 2021

The idea of ‘the self’ has been a critical one for Fonagy and colleagues for over 30 years. Consideration of the theory of the self is essential for understanding how Fonagy and colleagues believe thoughts and feelings are constructed, the relationship between conscious and unconscious aspects of the self, and their account of what we glean and protect ourselves from within present or past experience. This chapter will begin by considering broader currents in social science and psychology that made the concept of ‘self’ salient at the point that mentalization theory was being developed, and the ways that Fonagy and colleagues have conceptualized the self. We discuss the concept of ‘alien self’, introduced by Fonagy and colleagues to describe the experience of desires and elements of personal experience that disturb self-representations. We will then explore the account they offer of sexuality and aggression, as two inevitable and especially potent components of the alien self.
Conclusions
Authors: Duschinsky Robbie , Foster Sarah
Published: June 2021

The Conclusion draws together the threads of the book. It emphasises the goal of the book as constructive appraisal. Some outstanding questions for work on mentalisation and epistemic trust are raised, and future directions considered. The book ends by highlighting some of the most enduring contributions of work by Fonagy and colleagues.
Mixing matters
Authors: Rennehan Douglas
Published: June 2021

All hydrodynamical simulations of turbulent astrophysical phenomena require sub-grid scale models to properly treat energy dissipation and metal mixing. We present the first implementation and application of an anisotropic eddy viscosity and metal mixing model in Lagrangian astrophysical simulations, including a dynamic procedure for the model parameter. We compare these two models directly to the common Smagorinsky and dynamic variant. Using the mesh-free finite mass method as an example, we show that the anisotropic model is best able to reproduce the proper Kolmogorov inertial range scaling in homogeneous, isotropic turbulence. Additionally, we provide a method to calibrate the metal mixing rate that ensures numerical convergence. In our first application to cosmological simulations, we find that all models strongly impact the early evolution of galaxies, leading to differences in enrichment and thermodynamic histories. The anisotropic model has the strongest impact, with little difference between the dynamic variant and the constant-coefficient variant. We also find that the metal distribution functions in the circumgalactic gas are significantly tighter at all redshifts, with the anisotropic model providing the tightest distributions. This is contrary to a recent study that found metal mixing to be relatively unimportant on cosmological scales. In all of our experiments, the constant-coefficient Smagorinsky and anisotropic models rivalled their dynamic counterparts, suggesting that the computationally inexpensive constant-coefficient models are viable alternatives in cosmological contexts.
Improved gravitational radiation time-scales II: Spin–orbit contributions and environmental perturbations
Authors: Zwick Lorenz , Capelo Pedro R , Bortolas Elisa , Vázquez-Aceves Verónica , Mayer Lucio , Amaro-Seoane Pau
Published: June 2021

Peters’ formula is an analytical estimate of the time-scale of gravitational wave (GW)-induced coalescence of binary systems. It is used in countless applications, where the convenience of a simple formula outweighs the need for precision. However, many promising sources of the Laser Interferometer Space Antenna (LISA), such as supermassive black hole binaries and extreme mass-ratio inspirals (EMRIs), are expected to enter the LISA band with highly eccentric (e ≳ 0.9) and highly relativistic orbits. These are exactly the two limits in which Peters’ estimate performs the worst. In this work, we expand upon previous results and give simple analytical fits to quantify how the inspiral time-scale is affected by the relative 1.5 post-Newtonian (PN) hereditary fluxes and spin–orbit couplings. We discuss several cases that demand a more accurate GW time-scale. We show how this can have a major influence on quantities that are relevant for LISA event-rate estimates, such as the EMRI critical semimajor axis. We further discuss two types of environmental perturbations that can play a role in the inspiral phase: the gravitational interaction with a third massive body and the energy loss due to dynamical friction and torques from a surrounding gas medium ubiquitous in galactic nuclei. With the aid of PN corrections to the time-scale in vacuum, we find simple analytical expressions for the regions of phase space in which environmental perturbations are of comparable strength to the effects of any particular PN order, being able to qualitatively reproduce the results of much more sophisticated analyses.
Updated values of solar gravitational moments J2n using HMI helioseismic inference of internal rotation
Authors: Mecheri R , Meftah M
Published: June 2021

The solar gravitational moments J2n are important astronomical quantities whose precise determination is relevant for solar physics, gravitational theory and high precision astrometry, and celestial mechanics. Accordingly, we propose in the present work to calculate new values of J2n (for n = 1, 2, 3, 4, and 5) using recent two-dimensional rotation rates inferred from the high-resolution Solar Dynamics Observatory / Helioseismic and Magnetic Imager helioseismic data spanning the whole solar activity cycle 24. To this aim, a general integral equation relating J2n to the solar internal density and rotation is derived from the structure equations governing the equilibrium of slowly rotating stars. For comparison purpose, the calculations are also performed using rotation rates obtained from a recently improved analysis of Solar and Heliospheric Observatory / Michelson Doppler Imager heliseismic data for solar cycle 23. In agreement with earlier findings, the results confirmed the sensitivity of high-order moments (n > 1) to the radial and latitudinal distribution of rotation in the convective zone. The computed value of the quadrupole moment J2 (n = 1) is in accordance with recent measurements of the precession of Mercury’s perihelion deduced from high precision ranging data of the MESSENGER spacecraft. The theoretical estimate of the related solar oblateness Δ⊙ is consistent with the most accurate space-based determinations, particularly the one from Reuven Ramathy High-Energy Solar Spectroscopic Imager/Solar Aspect Sensor.
The detectability of strong 21 centimetre forest absorbers from the diffuse intergalactic medium in late reionisation models
Authors: Šoltinskí Tomáš , Bolton James S , Hatch Nina , Haehnelt Martin G , Keating Laura C , Kulkarni Girish , Puchwein Ewald , Chardin Jonathan , Aubert Dominique
Published: June 2021

A late end to reionisation at redshift z ≃ 5.3 is consistent with observed spatial variations in the Lyα forest transmission and the deficit of Lyα emitting galaxies around extended Lyα absorption troughs at z = 5.5. In this model, large islands of neutral hydrogen should persist in the diffuse intergalactic medium (IGM) until z ≃ 6. We use a novel, hybrid approach that combines high resolution cosmological hydrodynamical simulations with radiative transfer to predict the incidence of strong $21\rm \, cm$ forest absorbers with optical depths τ21 > 10−2 from the diffuse IGM in these late reionisation models. We include the effect of redshift space distortions on the simulated $21\rm \, cm$ forest spectra, and treat the highly uncertain heating of the pre-reionisation IGM by soft X-rays as a free parameter. For a model with only modest IGM pre-heating, such that average gas kinetic temperatures in the diffuse IGM remain below $T_{\rm K}\simeq 10^{2} \rm \, K$, we find that strong $21\rm \, cm$ forest absorption lines should persist until z = 6. For a sample of ∼10 sufficiently radio loud background sources, a null-detection of $21\rm \, cm$ forest absorbers at z ≃ 6 with SKA1-low or possibly LOFAR should provide an informative lower limit on the still largely unconstrained soft X-ray background at high redshift and the temperature of the pre-reionisation IGM.
Surrogate modelling the Baryonic Universe II: On forward modelling the colours of individual and populations of galaxies
Authors: Chaves-Montero Jonás , Hearin Andrew
Published: June 2021

Among the properties shaping the light of a galaxy, the star formation history (SFH) is one of the most challenging to model due to the variety of correlated physical processes regulating star formation. In this work, we leverage the stellar population synthesis model fsps, together with SFHs predicted by the hydrodynamical simulation IllustrisTNG and the empirical model universemachine, to study the impact of star formation variability on galaxy colours. We start by introducing a model-independent metric to quantify the burstiness of a galaxy formation model, and we use this metric to demonstrate that universemachine predicts SFHs with more burstiness relative to IllustrisTNG. Using this metric and principal component analysis, we construct families of SFH models with adjustable variability, and we show that the precision of broad-band optical and near-infrared colours degrades as the level of unresolved short-term variability increases. We use the same technique to demonstrate that variability in metallicity and dust attenuation presents a practically negligible impact on colours relative to star formation variability. We additionally provide a model-independent fitting function capturing how the level of unresolved star formation variability translates into imprecision in predictions for galaxy colours; our fitting function can be used to determine the minimal SFH model that reproduces colours with some target precision. Finally, we show that modelling the colours of individual galaxies with per cent-level precision demands resorting to complex SFH models, while producing precise colours for galaxy populations can be achieved using models with just a few degrees of freedom.
Sulfur chemistry in the atmospheres of warm and hot Jupiters
Authors: Hobbs Richard , Rimmer Paul B , Shorttle Oliver , Madhusudhan Nikku
Published: June 2021

We present and validate a new network of atmospheric thermochemical and photochemical sulfur reactions. We use a 1D chemical kinetics model to investigate these reactions as part of a broader HCNO chemical network in a series of hot and warm Jupiters. We find that temperatures approaching $1400\, \mathrm{K}$ are favourable for the production of H2S and HS around $\mathrm{10^{-3}\, bar}$ at mixing ratios of around 10−5, an atmospheric level where detection by transit spectroscopy may be possible. At $\mathrm{10^{-3}\, bar}$ and at lower temperatures, down to $1000\, \mathrm{K}$, mixing ratios of S2 can be up to 10−5, at the expense of H2S and HS, which are depleted down to a mixing ratio of 10−7. We also investigate how the inclusion of sulfur can manifest in an atmosphere indirectly, by its effect on the abundance of non-sulfur-bearing species. We find that in a model of the atmosphere of HD 209458 b, the inclusion of sulfur can lower the abundance of NH3, CH4, and HCN by up to two orders of magnitude around $\mathrm{10^{-3}\, bar}$. In the atmosphere of the warm Jupiter 51 Eri b, we additionally find the inclusion of sulfur depletes the peak abundance of CO2 by a factor of 5, qualitatively consistent with prior models. We note that many of the reactions used in the network have poorly determined rate constants, especially at higher temperatures. To obtain an accurate idea of the impact of sulfur chemistry in hot and warm Jupiter atmospheres, experimental measurements of these reaction rates must take place.
Transmission spectroscopy with VLT FORS2: a featureless spectrum for the low-density transiting exoplanet WASP-88b
Authors: Spyratos Petros , Nikolov Nikolay , Southworth John , Constantinou Savvas , Madhusudhan Nikku , Carter Aarynn L , de Mooij Ernst J W , Fortney Jonathan J , Gibson Neale P , Goyal Jayesh M , Helling Christiane , Mayne Nathan J , Mikal-Evans Thomas
Published: June 2021

We present ground-based optical transmission spectroscopy of the low-density hot Jupiter WASP-88b covering the wavelength range of 4413−8333  Å with the FOcal Reducer Spectrograph (FORS2) on the Very Large Telescope. The FORS2 white light curves exhibit a significant time-correlated noise that we model using a Gaussian process and remove as a wavelength-independent component from the spectroscopic light curves. We analyse complementary photometric observations from the Transiting Exoplanet Survey Satellite and refine the system properties and ephemeris. We find a featureless transmission spectrum with increased absorption towards shorter wavelengths. We perform an atmospheric retrieval analysis with the aura code, finding tentative evidence for haze in the upper atmospheric layers and a lower likelihood for a dense cloud deck. While our retrieval analysis results point towards clouds and hazes, further evidence is needed to definitively reject a clear-sky scenario.
The paternal toolbox for embryo development and health
Authors: Tarozzi Nicoletta , Nadalini Marco , Coticchio Giovanni , Zacà Carlotta , Lagalla Cristina , Borini Andrea
Published: June 2021

The sperm is essential for reconstitution of embryonic diploidy and highly specialized developmental functions. Immediately after gamete fusion, the sperm-borne PLC-zeta triggers activation, generating intracellular free Ca2+ oscillations. Mutations in the PLC-zeta encoding gene are associated with the absence of this factor in mature sperm and inability to achieve fertilization. Sperm play also a role in the greater game of the choreography of fertilization. In the human, the sperm centrioles are introduced into the oocyte environment with gamete fusion. They interact with the oocyte cytoskeletal apparatus to form a functional pair of centrosomes and ultimately regulate pronuclear juxtaposition in preparation for the first cleavage. As a consequence, the fidelity of chromosome segregation during the first cell divisions depends on the function of sperm centrioles. Sperm DNA integrity is essential for embryo development and health. Damaged DNA does not impact on the sperm fertilization ability following ICSI. However, detrimental effects emerge at pre- and post-implantation stages. Sperm-specific epigenetic factors also play an active role in the regulation of embryonic development, as shown by correlations between reduced embryo morphological quality and incorrect chromatin packaging during spermiogenesis or abnormal methylation of sperm CpG islands. This functional landscape demonstrates that the contribution of the sperm to development goes far beyond its well-established role in fertilization. Clinical studies confirm this view and indicate sperm function as a crucial aspect of research to increase the efficacy of assisted reproduction treatments.
The phase separation-dependent FUS interactome reveals nuclear and cytoplasmic function of liquid–liquid phase separation
Authors: Reber Stefan , Jutzi Daniel , Lindsay Helen , Devoy Anny , Mechtersheimer Jonas , Levone Brunno Rocha , Domanski Michal , Bentmann Eva , Dormann Dorothee , Mühlemann Oliver , Barabino Silvia M L , Ruepp Marc-David
Published: June 2021

Liquid–liquid phase separation (LLPS) of proteins and RNAs has emerged as the driving force underlying the formation of membrane-less organelles. Such biomolecular condensates have various biological functions and have been linked to disease. The protein Fused in Sarcoma (FUS) undergoes LLPS and mutations in FUS have been causally linked to the motor neuron disease Amyotrophic Lateral Sclerosis (ALS-FUS). LLPS followed by aggregation of cytoplasmic FUS has been proposed to be a crucial disease mechanism. However, it is currently unclear how LLPS impacts the behaviour of FUS in cells, e.g. its interactome. Hence, we developed a method allowing for the purification of LLPS FUS-containing droplets from cell lysates. We observe substantial alterations in the interactome, depending on its biophysical state. While non-LLPS FUS interacts mainly with factors involved in pre-mRNA processing, LLPS FUS predominantly binds to proteins involved in chromatin remodelling and DNA damage repair. Interestingly, also mitochondrial factors are strongly enriched with LLPS FUS, providing a potential explanation for the observed changes in mitochondrial gene expression in mouse models of ALS-FUS. In summary, we present a methodology to investigate the interactomes of phase separating proteins and provide evidence that LLPS shapes the FUS interactome with implications for function and disease.
The impact of machine learning on UK financial services
Authors: Buchanan Bonnie G , Wright Danika
Published: June 2021

Machine learning is an increasingly key influence on the financial services industry. In this paper, we review the roles and impact of machine learning (ML) and artificial intelligence (AI) on the UK financial services industry. We survey the current AI/ML landscape in the UK. ML has had a considerable impact in the areas of fraud and compliance, credit scoring, financial distress prediction, robo-advising and algorithmic trading. We examine these applications using UK examples. We also review the importance of regulation and governance in ML applications to financial services. Finally, we assess the performance of ML during the Covid-19 pandemic and conclude with directions for future research.
Regularized Brascamp–lieb Inequalities and an Application
Authors: Maldague Dominique
Published: June 2021

We present a certain regularized version of Brascamp–Lieb inequalities studied by Bennett, Carbery, Christ and Tao. Using the induction-on-scales method of Guth, these regularized inequalities lead to a generalization of the multilinear Kakeya inequality.
Corruption and Firms
Authors: Colonnelli Emanuele , Prem Mounu
Published: June 2021

We estimate the causal real economic effects of a randomized anti-corruption crackdown on local governments in Brazil using rich micro-data on corruption and firms. After anti-corruption audits, municipalities experience an increase in the number of firms concentrated in sectors most dependent on government relationships and public procurement. Through the estimation of geographic spillovers and additional tests, we show that audits operate via both a direct detection effect as well as through indirect deterrence channels. Politically connected firms suffer after the audits. Our estimates indicate the anti-corruption program generates significant local multipliers which are consistent with the presence of a large corruption tax on government-dependent firms.
The Extensive Margin of Aggregate Consumption Demand
Authors: Michelacci Claudio , Paciello Luigi , Pozzi Andrea
Published: June 2021

About half of the change in U.S. non-durable consumption expenditure is due to changes in the products entering households’ consumption basket (the extensive margin). Changes in the basket are driven by fluctuations in the rate at which households add products; removals fluctuate little. These patterns reflect that, in response to income increases, households adopt consumer products already available in the market. Household adoption amplifies the effects of fiscal transfers on consumption by more than 30%. Cyclical household adoption of products also implies that inflation measures based on a representative household consuming all varieties available in the market underestimate true household-level inflation by as much as 1% per year over the Great Recession in the consumption categories covered by our data.
EFFECTIVE DOSE COEFFICIENTS FOR RADON AND PROGENY: A REVIEW OF ICRP AND UNSCEAR VALUES
Authors: Marsh James W , Tomášek Ladislav , Laurier Dominique , Harrison John D
Published: June 2021

The International Commission on Radiological Protection (ICRP) publishes guidance on protection against radon exposure in homes and workplaces. ICRP Publication 137 recommends a dose coefficient of 3 mSv per mJ h m−3 (~10 mSv WLM−1) to be used in most circumstances of radon exposure, for workers in buildings and in underground mines. Recently, United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) reviewed radon epidemiology and dosimetry and concluded that its established dose coefficient of 1.6 mSv per mJ h m−3 (5.7 mSv WLM−1) should be retained for use in its comparisons of radiation exposures from different sources in a population. This paper explains and compares the reviews of the scientific evidence from UNSCEAR and ICRP. It is shown that the UNSCEAR and ICRP reviews are consistent and support the use of the ICRP reference dose coefficients for radiation protection purposes. It is concluded that the ICRP dose coefficient should be used to calculate doses to workers.
Phenotypic Spectrum of Peters Anomaly: Implications for Management
Authors: Elbaz Uri , Ali Asim , Strungaru Hermina , Mireskandari Kamiar
Published: June 2021

Purpose:

The aim of this study was to characterize the wide phenotypic spectrum of Peters anomaly and to suggest a management algorithm based on disease phenotype.

Methods:

The charts of all children diagnosed with Peters anomaly between January 2000 and December 2013 were reviewed retrospectively. Anterior segment color photographs, anterior segment optical coherence tomography, and ultrasound biomicroscopy images were used to phenotype disease severity and to guide management. Disease severity was categorized to Peters anomaly type I and II according to lens involvement. Peters anomaly type I and II were further categorized from mild to severe disease according to the size and location of corneal opacity. Associated systemic findings were also documented.

Results:

Eighty eyes of 54 patients with Peters anomaly were identified, of which 28 (51.9%) had unilateral disease. Peters anomaly type I was present in 40 patients (57 eyes, 71.2%) and Peters anomaly type II in 14 patients (23 eyes, 28.8%). Nine eyes (11.3%) had phenotypic features that required observation only, 24 eyes (30%) were amenable to pupillary dilation, 43 eyes (53.8%) with large, dense central opacity required penetrating keratoplasty, and 4 eyes (5.0%) had no intervention because of very poor prognostic features. Associated systemic abnormalities occurred frequently in Peters anomaly (n = 20, 37.0%), with congenital heart defect being the most common morbidity (n = 10, 18.5%).

Conclusions:

Peters anomaly presents with a variable phenotype ranging from minimal peripheral corneal opacity to extensive iris and lens adhesions with dense central corneal opacity detrimental to vision. Management can be standardized and guided by an algorithm based on phenotypic severity. Systemic abnormalities should be ruled out, regardless of the severity of Peters anomaly.
Atypical Corneal Phenotype in Patients With Trachoma and Secondary Amyloidosis
Authors: Gupta Noopur , Yadav Saumya , Solomon Anthony W. , Jain Shubhi , Kashyap Seema , Vanathi Murugesan , Tandon Radhika
Published: June 2021

Purpose:

To report clinical presentation, in vivo confocal microscopic features, and corneal phenotype in patients with trachomatous keratopathy (TK) and secondary amyloidosis.

Methods:

Histopathological records of all patients undergoing keratoplasty at the Dr. Rajendra Prasad Centre for Ophthalmic Sciences over a 3-year period were scanned retrospectively for a diagnosis of TK and amyloidosis. Demographic profile and details of preoperative comprehensive ophthalmic assessment were extracted. The histopathology was freshly reviewed.

Results:

Fifteen patients (29 eyes) with TK and atypical corneal involvement due to amyloid deposition were identified. Herbert's pits and upper palpebral conjunctival scarring were present in all cases. Central or total diffuse corneal scarring was present involving the anterior stroma in 5 (31%) and the full thickness of the cornea in 11 (69%) of the eyes. Eight (73%) of 11 patients with deep stromal amyloid deposits revealed bilateral, discrete, blue-white opacities at the level of deep stroma and Descemet membrane (DM). Endothelial cells were atrophic and flattened with gutta formation. Confoscans revealed hyperreflective, needle-shaped crystalline deposits of extracellular amyloid at various depths of the corneal stroma up to DM. All host corneal buttons demonstrated Congo red–positive amyloid deposits on histopathological examination.

Conclusions:

We describe a distinct form of TK unlike the usual presentation of dense, leucomatous, vascularized corneal scarring in trachoma. We believe that amyloid deposits in DM and the corneal endothelium have not previously been reported in patients with trachoma.
Maximizing Effectiveness of Examination of Patients With Acute Dizziness in the Emergency Department
Authors: Corsino John
Published: June 2021

Physical therapists practicing on hospital units or in emergency departments must be prepared to do more than simply treat vestibular disorders diagnosed by other providers; we need to help care teams identify the source of a dizzy patient's complaints. Because the consequences of delayed or erroneous diagnosis may be catastrophic for the dizzy patient, the evaluating therapist's responsibility is to minimize the likelihood of inaccuracy in the diagnostic process. Practice standards, which involve both examination techniques and reasoning frameworks, are not widely used. Therapists who apply these standards can reduce diagnostic error. Understanding the strategies described within is essential for therapists who evaluate acutely dizzy patients and contribute diagnostic information to care teams.
Expedited Cross-Training
Authors: Patel Sapna , Hartung Benjamin , Nagra Roxana , Davignon Amy , Dayal Taranvir , Nelson Maria
Published: June 2021

Cross-training of nurses is an approach used by hospitals to mitigate anticipated nurse staffing shortages. This article provides professional practice nurse educators guidance on how to plan, implement, and evaluate expedited cross-training that integrate the principles of just-in-time training. Sixty-one nurses in a postacute care hospital setting were cross-trained over the course of 8 weeks using a six-step method.
Decision-Making in Adult Cranial Vault Reconstruction
Authors: Brichacek Michal , Antonyshyn Oleh , Edwards Glenn , Mainprize James G. , da Costa Leo
Published: June 2021

Learning Objectives:

After studying this article, the participant should be able to: 1. Define and classify different types of cranial defects 2. Compare both autologous and alloplastic options for reconstruction 3. Develop an optimal approach for cranial vault reconstruction in various clinical scenarios.

Defects of the cranium result from various causes, including traumatic loss, neurosurgical intervention, skull tumors, and infection. Cranial vault reconstruction aims to restore both the structural integrity and surface morphology of the skull. To ensure a successful outcome, the choice of appropriate cranioplasty reconstruction will vary primarily based on the cause, location, and size of the defect. Other relevant factors that must be considered include adequacy of soft-tissue coverage, presence of infection, and previous or planned radiation therapy. This article presents an algorithm for the reconstruction of various cranial defects using both autologous and alloplastic techniques, with a comparison of their advantages and disadvantages.
Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy Improves the Accuracy of Sentinel Lymph Node Biopsy in Melanoma
Authors: Knackstedt Rebecca , Gastman Brian R.
Published: June 2021

Background:

Despite advances in melanoma management, there remains room for improvement in the accuracy of sentinel lymph node biopsy. The authors analyzed a prospective cohort of patients with primary cutaneous melanoma who underwent sentinel lymph node biopsy with lymphoscintigraphy and indocyanine green fluorescence to evaluate the quality and accuracy of this technique.

Methods:

Consecutive primary cutaneous melanoma patients who underwent sentinel lymph node biopsy with radioisotope lymphoscintigraphy and indocyanine green fluorescence from 2012 to 2018 were prospectively enrolled. Analysis was performed of melanoma characteristics, means of identifying sentinel lymph nodes, sentinel lymph node status, and recurrence.

Results:

Five hundred ninety-four melanomas and 1827 nodes were analyzed; 1556 nodes (85.2 percent) were identified by radioactivity/fluorescence, 255 (14 percent) by radioactivity only, and 16 (0.9 percent) with indocyanine green only. There were 163 positive sentinel nodes. One hundred forty-seven (90.2 percent) were identified by radioactivity/fluorescence, 13 (8 percent) by radioactivity only, and three (0.6 percent) with fluorescence only. Of the 128 patients with a positive biopsy, eight patients’ (6.3 percent) nodes were identified by radioactivity only and four (3.4 percent) with fluorescence only. There were 128 patients with a positive biopsy, 454 with a negative biopsy, and 12 patients who had a negative biopsy with subsequent nodal recurrence. Mean follow-up was 2.8 years.

Conclusions:

In the study of the largest cohort of patients with primary cutaneous melanoma who underwent a sentinel lymph node biopsy with radioisotope lymphoscintigraphy and indocyanine green–based technology, the quality and accuracy of this technique are demonstrated. This has important implications for melanoma patients, as the adoption of this approach with subsequent accurate staging, adjuvant workup, and treatment may improve survival outcomes. 

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, II.
Nasal Reconstruction after Mohs Cancer Resection: Lessons Learned from 2553 Consecutive Cases
Authors: Halani Sameer H. , Ma Connie , Pierce Joshua , Sanniec Kyle , Thornton James F.
Published: June 2021

Background:

Nasal defects following Mohs resection are a reconstructive challenge, demanding aesthetic and functional considerations. Many reconstructive modalities are available, each with varying utility and efficacy. The goal of this study was to provide an algorithmic approach to nasal reconstruction and illustrate lessons learned from decades of reconstructing Mohs defects.

Methods:

A retrospective review was conducted of consecutive patients who underwent nasal reconstruction after Mohs excision from 2003 to 2019 performed by the senior author (J.F.T.). Data were collected and analyzed regarding patient and clinical demographics, defect characteristics, reconstructive modality used, revisions, and complications.

Results:

A total of 2553 cases were identified, among which 1550 (1375 patients) were analyzed. Defects most commonly affected the nasal ala (48.1 percent); 74.8 percent were skin-only. Full-thickness skin-grafts were the most common reconstructive method (36.2 percent); 24.4 percent of patients underwent forehead flaps and 17.0 percent underwent nasolabial flaps. The overall complication rate was 11.6 percent (n = 181), with poor wound healing being most common. Age older than 75 years, defects larger than 2 cm2, and active smoking were associated with increased complication rates.

Conclusions:

Nasal reconstruction can be divided based on anatomical location, and an algorithmic approach facilitates excellent results. Although local flaps may be suitable for some patients, they are not always the most aesthetic option. The versatility and low risk-to-benefit profile of the forehead flap make it a suitable option for elderly patients. Although reconstruction is still safe to be performed without discontinuation of anticoagulation, older age, smoking, and large defect size are predictors of complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Respective Roles of Craniosynostosis and Syndromic Influences on Cranial Fossa Development
Authors: Lu Xiaona , Forte Antonio Jorge , Wilson Alexander T. , Park Kitae Eric , Allam Omar , Alperovich Michael , Steinbacher Derek M. , Alonso Nivaldo , Persing John A.
Published: June 2021

Background:

Little is known about the detailed growth of the cranial fossae, even though they provide an important structural connection between the cranial vault and the facial skeleton. This study details the morphologic development of isolated cranial vault synostosis and associated syndromes on cranial fossa development.

Methods:

A total of 125 computed tomographic scans were included (nonsyndromic bicoronal synostosis, n = 36; Apert syndrome associated with bicoronal synostosis, n = 24; Crouzon syndrome associated with bicoronal synostosis, n = 11; and controls, n = 54). Three-dimensional analyses were produced using Materialise software.

Results:

The regional anterior and middle cranial fossae volumes of nonsyndromic bicoronal synostosis are characterized by significant increases of 43 percent (p < 0.001) and 60 percent (p < 0.001), respectively, and normal posterior cranial fossa volume. The cranial fossae depths of nonsyndromic bicoronal synostosis were increased, by 37, 42, and 21 percent (all p < 0.001) for anterior, middle, and posterior cranial fossae, respectively, accompanying the shortened cranial fossae lengths. The volume and morphology of all cranial fossae in Apert syndrome nearly paralleled nonsyndromic bicoronal synostosis. However, Crouzon syndrome had reduced depths of cranial fossae, and more restricted fossa volumes than both Apert syndrome and nonsyndromic bicoronal synostosis.

Conclusions:

Cranial vault suture synostosis is likely to be more influential on cranial fossae development than other associated influences (genetic, morphologic) in Apert and Crouzon syndromes. Isolated Apert syndrome pathogenesis is associated with an elongation of the anterior cranial fossa length in infants, whereas in Crouzon syndrome, there is a tendency to reduce cranial fossa depth, suggesting individual adaptability in cranial fossae development related to vault synostosis.
Lateral Domal Translocation and Medial Crural Transection: A Reliable Method for Nasal Tip Deprojection
Authors: Cochran C. Spencer , Afrooz Paul N.
Published: June 2021

Nasal tip deprojection is a common goal in rhinoplasty. Several techniques have been described, many of which require destructive techniques that compromise the intrinsic integrity and morphology of the lateral crura. Through lateral translocation of the domes and shortening of the medial crura, nasal tip deprojection can be achieved without disrupting the integrity of the lateral crura. The domes are recreated lateral to the intrinsic domes with a standard transdomal suture, and excess length of the middle and medial crura is managed through transection and shortening of the medial crura. This technique preserves the morphology of the nasal base without altering the position of the medial crural footplates. Deprojection of 4 to 5 mm can be readily achieved with this technique.
Initial Experience With Low-Dose 18F-Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance Imaging With Deep Learning Enhancement
Authors: Park Christian J. , Chen Weijie , Pirasteh Ali , Kim David H. , Perlman Scott B. , Robbins Jessica B. , McMillan Alan B.
Published: June 2021

Objective

To demonstrate the utility of deep learning enhancement (DLE) to achieve diagnostic quality low-dose positron emission tomography (PET)/magnetic resonance (MR) imaging.

Methods

Twenty subjects with known Crohn disease underwent simultaneous PET/MR imaging after intravenous administration of approximately 185 MBq of 18F-fluorodeoxyglucose (FDG). Five image sets were generated: (1) standard-of-care (reference), (2) low-dose (ie, using 20% of PET counts), (3) DLE-enhanced low-dose using PET data as input, (4) DLE-enhanced low-dose using PET and MR data as input, and (5) DLE-enhanced using no PET data input. Image sets were evaluated by both quantitative metrics and qualitatively by expert readers.

Results

Although low-dose images (series 2) and images with no PET data input (series 5) were nondiagnostic, DLE of the low-dose images (series 3 and 4) achieved diagnostic quality images that scored more favorably than reference (series 1), both qualitatively and quantitatively.

Conclusions

Deep learning enhancement has the potential to enable a 90% reduction of radiotracer while achieving diagnostic quality images.
CT Evaluation of Variations in the Middle Cranial Fossa Foramina: A Potential Guide for Skull Base Surgery
Authors: Orhan Soylemez Umut Percem , Atalay Basak
Published: June 2021

Objectives

To evaluate and classify the variations of foramen ovale (FO), foramen spinosum (FS).

Methods

Six hundred fifty-eight computed tomographies (CTs) were evaluated by 2 observers. Foramen ovale was classified as oval, almond, round, and slit-like. Duplication, absence, and confluence for FS were noted. Bony outgrowths were categorized as tubercule, bony plate, and spine.

Results

Oval shaped FO was the most common subgroup. Most common FS variation was the confluence with FO. Of bony outgrowths, tubercule-shaped were the most common type and spine-shaped ones were the least. Substantial agreement for bony plate and tubercule, almost excellent agreement for all the other parameters were found between 2 observers.

Conclusions

Foramen ovale called lobulated and had not classified previously was described in this study. Computed tomography is a reliable tool for anatomical evaluation of FO and FS, which would effect the methods of middle cranial fossa surgery. Thus, radiologists should be a pathfinder about the variations of these structures.