bluuebunny/crossref_metadata_2025 huggingface dataset:
Computational Fluid Dynamics Investigation on Catalytic Hydrodeoxygenation of a Bio-Oil Model Compound in a Fluidized Bed Reactor
Authors: Fortunate Ogene , Kishore Nanda
Published: March 2021

Bio-oil produced from waste biomass by various thermochemical approaches possess several drawbacks primarily due to the presence of oxygenated compounds. These compounds render bio-oil difficult to be used as normal fuel for combustion. Thus, bio-oil must be processed to remove oxygenated compounds from it. One important process found suitable to deoxygenate bio-oil is the catalytic hydrodeoxygenation (HDO) using an appropriate catalyst. In literature, limited studies exist on the application of computational fluid dynamics (CFD) on hydrodeoxygenation of bio-oil model compounds. Therefore, authors utilized the computational fluid dynamics framework to delineate effect of process variables on the catalytic hydrodeoxygenation of 2-hydroxybenzaldehyde (2-HB) which is a bio-oil model compound in this study. The range of conditions considered herein are weight hourly space velocity (WHSV) = 1 h−1, 3 h−1, and 5 h−1; superficial hydrogen gas velocity, u = 0.075 m/s, 0.15 m/s, and 0.25 m/s; Pd/Al2O3 catalyst load = 0.06 kg and temperature, T = 498 K, 598 K, and 698 K. The present solution approach has also been applied to reproduce literature results on hydrodynamics of multiphase fluidized bed systems for comparison purpose. The hydrodynamics inside the fluidized bed reactor have been compared with and without HDO of 2-HB. The HDO of 2-HB yield phenol as the most dominant constitute of the products. Other products include benzene and benzaldehyde but in less fractions. Disclosing a few important results one can find that at constant low temperature (498 K), by increasing the values of WHSV the phenol fraction decreases, whereas those of benzene and benzaldehyde increases when u = 0.25 m/s. This effect becomes more rigorous at high constant temperature (698 K) especially in the case of phenol and benzene fractions. Moreover, most of the conversion of 2-HB and formation of products (phenol, benzene, and benzaldehyde) occurs within 2 s of fluidization time.
Efficacy of boron nitride encapsulation against plasma-processing of 2D semiconductor layers
Authors: Kumar Pawan , Figueroa Kelotchi S. , Foucher Alexandre C. , Jo Kiyoung , Acero Natalia , Stach Eric A. , Jariwala Deep
Published: March 2021

Two-dimensional (2D) transition metal dichalcogenides (TMDCs) are the subject of intense investigation for applications in optics, electronics, catalysis, and energy storage. Their optical and electronic properties can be significantly enhanced when encapsulated in an environment that is free of charge disorder. Because hexagonal boron nitride (h-BN) is atomically thin, highly crystalline, and is a strong insulator, it is one of the most commonly used 2D materials to encapsulate and passivate TMDCs. In this report, we examine how ultrathin h-BN shields an underlying MoS2 TMDC layer from the energetic argon plasmas that are routinely used during semiconductor device fabrication and postprocessing. Aberration-corrected scanning transmission electron microscopy is used to analyze defect formation in both the h-BN and MoS2 layers, and these observations are correlated with Raman and photoluminescence spectroscopy. Our results highlight that h-BN is an effective barrier for short plasma exposures (<30 s) but is ineffective for longer exposures, which result in extensive knock-on damage and amorphization in the underlying MoS2.
Scaling of atomic layer etching of SiO2 in fluorocarbon plasmas: Transient etching and surface roughness
Authors: Wang Xifeng , Wang Mingmei , Biolsi Peter , Kushner Mark J.
Published: March 2021

Fabricating sub-10 nm microelectronics places plasma processing precision at atomic dimensions. Atomic layer etching (ALE) is a cyclic plasma process used in semiconductor fabrication that has the potential to remove a single layer of atoms during each cycle. In self-limiting ideal ALE, a single monolayer of a material is consistently removed in each cycle, typically expressed as EPC (etch per cycle). In plasma ALE of dielectrics, such as SiO2 and Si3N4, using fluorocarbon gas mixtures, etching proceeds through deposition of a thin polymer layer and the process is not strictly self-terminating. As a result, EPC is highly process dependent and particularly sensitive to the thickness of the polymer layer. In this paper, results are discussed from a computational investigation of the ALE of SiO2 on flat surfaces and in short trenches using capacitively coupled plasmas consisting of a deposition step (fluorocarbon plasma) and an etch step (argon plasma). We found that ALE performance is a delicate balance between deposition of polymer during the first half cycle and etching (with polymer removal) during the second half cycle. In the absence of complete removal of the overlying polymer in each cycle, ALE may be transient as the polymer thickness grows with each cycle with a reduction in EPC until the thickness is too large to enable further etching. Small and statistical amounts of polymer left from a previous cycle can produce statistical variation in polymer thickness on the next cycle, which in turn can lead to a spatially dependent EPC and ALE roughness. Based on synergy between Ti (sputtering time) and Tp (passivation time), dielectric ALE can be described as having three modes: deposition, roughening surface (transitioning to etch-stop), and smooth surface with steady-state EPC.
Closed-aperture unbounded acoustics experimentation using multidimensional deconvolution
Authors: Li Xun , Becker Theodor , Ravasi Matteo , Robertsson Johan , van Manen Dirk-Jan
Published: March 2021

In physical acoustic laboratories, wave propagation experiments often suffer from unwanted reflections at the boundaries of the experimental setup. We propose using multidimensional deconvolution (MDD) to post-process recorded experimental data such that the scattering imprint related to the domain boundary is completely removed and only the Green's functions associated with a scattering object of interest are obtained. The application of the MDD method requires in/out wavefield separation of data recorded along a closed surface surrounding the object of interest, and we propose a decomposition method to separate such data for arbitrary curved surfaces. The MDD results consist of the Green's functions between any pair of points on the closed recording surface, fully sampling the scattered field. We apply the MDD algorithm to post-process laboratory data acquired in a two-dimensional acoustic waveguide to characterize the wavefield scattering related to a rigid steel block while removing the scattering imprint of the domain boundary. The experimental results are validated with synthetic simulations, corroborating that MDD is an effective and general method to obtain the experimentally desired Green's functions for arbitrary inhomogeneous scatterers.
Brownian dynamics simulation on orthogonal superposition rheology: Time–shear rate superposition of colloidal gel
Authors: Lee Young Jin , Jin Howon , Kim Sunhyung , Myung Jin Suk , Ahn Kyung Hyun
Published: March 2021

The dynamics of model colloidal gels under a steady shear flow is studied by means of a Brownian dynamics (BD) simulation while applying orthogonal superposition rheometry, which superimposes a small amplitude oscillatory flow orthogonal to the main flow direction. Orthogonal dynamic frequency sweep (ODFS) curves are obtained at various magnitudes of the main flow, which shows shear thinning behavior of the colloidal gel. The viscoelastic spectra of the ODFS can be superimposed onto a master curve by the horizontal shift factor, which is equivalent to particle viscosity. That is, the shear rate controls a single master clock for all viscoelastic spectra of the ODFS in the form of a time–shear rate superposition, which bears an analogy with the time–temperature superposition of polymeric systems. In the low-frequency region of the master curve, both orthogonal moduli are well superimposed onto a single master curve, whereas the loss modulus deviates slightly from the master curve in the high-frequency region, which coincides with the experimental findings. We observe spatial and time-varying structural properties in both low- and high-frequency regions on the ODFS curves by decomposing the pair distribution function. It is verified that each flow condition shifted onto the same stress level on the master curve shows identical spatial orthogonal moduli at all radial distances despite the differences in the aggregate size and average particle connectivity.
Long-term drying of Mars by sequestration of ocean-scale volumes of water in the crust
Authors: Scheller E. L. , Ehlmann B. L. , Hu Renyu , Adams D. J. , Yung Y. L.
Published: March 2021

Burying Mars' ancient water in the crust

Mars once had oceans of liquid water on its surface but little of that water remains today in the planet's ice caps and atmosphere. This discrepancy is usually interpreted as loss of water to space, supported by the atmospheric deuterium/hydrogen (D/H) ratio, but this has been difficult to reconcile with other constraints. Scheller
et al.
propose that water could instead have been incorporated into minerals in the planet's crust, which were later buried (see the Perspective by Kurokawa). They simulated the evolution of the D/H ratio and atmospheric loss rates for a range of plausible conditions, finding that 30 to 99% of Mars' initial water was buried in the crust.

Science
, this issue p.
56
; see also p.
27
Structural impact on SARS-CoV-2 spike protein by D614G substitution
Authors: Zhang Jun , Cai Yongfei , Xiao Tianshu , Lu Jianming , Peng Hanqin , Sterling Sarah M. , Walsh Richard M. , Rits-Volloch Sophia , Zhu Haisun , Woosley Alec N. , Yang Wei , Sliz Piotr , Chen Bing
Published: March 2021

How an early variant got ahead

Throughout the COVID-19 pandemic, epidemiologists have monitored the evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with particular focus on the spike protein. An early variant with an aspartic acid (D) to glycine (G) mutation at position 614, D614G, rapidly became dominant and is maintained in current variants of concern. Zhang
et al.
investigated the structural basis for the increased spread of this variant, which does so even though it binds less tightly to the host receptor (see the Perspective by Choe and Farzan). Structural and biochemical studies on a full-length G614 spike trimer showed that there are interactions not present in D614 that prevent premature loss of the S1 subunit that binds angiotensin-converting enzyme 2. This stabilization effectively increases the number of spikes that can facilitate infection.

Science
, this issue p.
525
; see also p.
466
A ligand-receptor interactome platform for discovery of pain mechanisms and therapeutic targets
Authors: Wangzhou Andi , Paige Candler , Neerukonda Sanjay V. , Naik Dhananjay K. , Kume Moeno , David Eric T. , Dussor Gregory , Ray Pradipta R. , Price Theodore J.
Published: March 2021

Single-cell gene expression analysis predicts pain signaling pathways between sensory neurons and peripheral cell types.
Thin-Layer-Agar-Based Direct Phenotypic Drug Susceptibility Testing on Sputum in Eswatini Rapidly Detects Mycobacterium tuberculosis Growth and Rifampicin Resistance Otherwise Missed by WHO-Endorsed Diagnostic Tests
Authors: Ardizzoni E. , Ariza E. , Mulengwa D. , Mpala Q. , de La Tour R. , Maphalala G. , Varaine F. , Kerschberger B. , Graulus P. , Page A. L. , Niemann S. , Dreyer V. , Van Deun A. , Decroo T. , Rigouts L. , de Jong B. C.
Published: March 2021

Xpert MTB/RIF rapidly detects resistance to rifampicin (RR); however, this test misses I491F-RR conferring the
rpoB
mutation, common in southern Africa. In addition, Xpert MTB/RIF does not distinguish between viable and dead
Mycobacterium tuberculosis
(MTB).
Murine Intrarectal Instillation of Purified RecombinantClostridioides difficileToxins Enables Mechanistic Studies of Pathogenesis
Authors: Markham Nicholas O. , Bloch Sarah C. , Shupe John A. , Laubacher Erin N. , Thomas Audrey K. , Kroh Heather K. , Childress Kevin O. , Peritore-Galve F. Christopher , Washington M. Kay , Coffey Robert J. , Lacy D. Borden
Published: March 2021

Clostridioides difficileis linked to nearly 225,000 antibiotic-associated diarrheal infections and almost 13,000 deaths per year in the United States. Pathogenic strains ofC. difficileproduce toxin A (TcdA) and toxin B (TcdB), which can directly kill cells and induce an inflammatory response in the colonic mucosa.
Protein and DNA Biosynthesis Demonstrated in Host Cell-Free Phagosomes Containing Anaplasma phagocytophilum or Ehrlichia chaffeensis in Axenic Media
Authors: Zhang Yuntao , Chen Li , Kondethimmanahalli Chandramouli , Liu Huitao , Ganta Roman R.
Published: March 2021

Rickettsiae belong to the
Anaplasmataceae
family, which includes mostly tick-transmitted pathogens causing human, canine, and ruminant diseases. Biochemical characterization of the pathogens remains a major challenge because of their obligate parasitism.
Sex Differences in Population Dynamics during Formation of Kidney Bacterial Communities by Uropathogenic Escherichia coli
Authors: McLellan Lisa K. , Daugherty Allyssa L. , Hunstad David A.
Published: March 2021

Uropathogenic
Escherichia coli
(UPEC), the primary etiologic agent of urinary tract infections (UTIs), encounters a restrictive population bottleneck within the female mammalian bladder. Its genetic diversity is restricted during establishment of cystitis because successful UPEC must invade superficial bladder epithelial cells prior to forming clonal intracellular bacterial communities (IBCs).
A SNP in the Cache 1 Signaling Domain of Diguanylate Cyclase STM1987 Leads to Increased
In Vivo
Fitness of Invasive
Salmonella
Strains
Authors: Sokaribo Akosiererem S. , Balezantis Lindsay R. , MacKenzie Keith D. , Wang Yejun , Palmer Melissa B. , Chung Beatrice , Herman Nancy J. , McCarthy Madeline C. , Chen Jeffrey M. , White Aaron P.
Published: March 2021

Nontyphoidal
Salmonella
(NTS) strains are associated with gastroenteritis worldwide but are also the leading cause of bacterial bloodstream infections in sub-Saharan Africa. The invasive NTS (iNTS) strains that cause bloodstream infections differ from standard gastroenteritis-causing strains by >700 single-nucleotide polymorphisms (SNPs).
Clinical and Analytical Evaluation of the Alinity m HR HPV Assay within the VALGENT-3 Framework
Authors: Dhillon Sharonjit K. , Oštrbenk Valenčak Anja , Xu Lan , Poljak Mario , Arbyn Marc
Published: March 2021

Only clinically validated human papillomavirus (HPV) tests should be used in cervical cancer screening. VALGENT provides a framework to validate new HPV tests.
Epigenetic Reprogramming of Host and Viral Genes by Human Cytomegalovirus Infection in Kasumi-3 Myeloid Progenitor Cells at Early Times Postinfection
Authors: Forte Eleonora , Ayaloglu Butun Fatma , Marinaccio Christian , Schipma Matthew J. , Piunti Andrea , Schroeder Mark W. , Kandpal Manoj , Shilatifard Ali , Abecassis Michael , Hummel Mary
Published: March 2021

Human cytomegalovirus (HCMV) is an important human pathogen in immunocompromised hosts and developing fetuses. Current antiviral therapies are limited by toxicity and emergence of resistant strains.
Streptococcus suis MsmK: Novel Cell Division Protein Interacting with FtsZ and Maintaining Cell Shape
Authors: Tan Mei-Fang , Hu Qiao , Hu Zhe , Zhang Chun-Yan , Liu Wan-Quan , Gao Ting , Zhang Liang-Sheng , Yao Lun , Li Hai-Qin , Zeng Yan-Bin , Zhou Rui
Published: March 2021

Bacterial cell division is a highly ordered process regulated in time and space and is a potential target for the development of antimicrobial drugs. Bacteria of distinct shapes depend on different cell division mechanisms, but the mechanisms used by ovococci remain largely unknown.
Staphylococcus aureus Responds to Physiologically Relevant Temperature Changes by Altering Its Global Transcript and Protein Profile
Authors: Bastock Raeven A. , Marino Emily C. , Wiemels Richard E. , Holzschu Donald L. , Keogh Rebecca A. , Zapf Rachel L. , Murphy Erin R. , Carroll Ronan K.
Published: March 2021

Enteric bacterial pathogens, like
Escherichia coli
, are known to experience large temperature differences as they are transmitted through the fecal oral route. This change in temperature has been demonstrated to influence bacterial gene expression and facilitate infection.
Staphylococcus aureus
is a human-associated pathogen that can live as a commensal on the skin and nares or cause invasive infections of the deeper tissues and blood.
Three stages of arc migration in the Carboniferous-Triassic in northern Qiangtang, central Tibet, China: Ridge subduction and asynchronous slab rollback of the Jinsha Paleotethys
Authors: Liu Yin , Xiao Wenjiao , Windley Brian F. , Zhou Kefa , Li Rongshe , Zhan Mingguo , Sang Miao , Yang He , Jia Xiaoliang , Chen Yichao , Ji Wenhua , Ao Songjian
Published: March 2021

Carboniferous-Triassic magmatism in northern Qiangtang, central Tibet, China, played a key role in the evolution of the Tibetan Plateau yet remains a subject of intense debate. New geochronological and geochemical data from adakitic, Nb-enriched, and normal arc magmatic rocks, integrated with results from previous studies, enable us to determine the Carboniferous-Triassic (312–205 Ma), arc-related, plutonic-volcanic rocks in northern Qiangtang. Spatial-temporal relationships reveal three periods of younging including southward (312–252 Ma), rapid northward (249–237 Ma), and normal northward (234–205 Ma) migrations that correspond to distinct slab geodynamic processes including continentward slab shallowing, rapid trenchward slab rollback, and normal trenchward rollback of the Jinsha Paleotethys rather than the Longmuco-Shuanghu Paleotethys, respectively. Moreover, varying degrees of coexistence of adakites/High-Mg andesites (HMAs)/Nb-enriched basalt-andesites (NEBs) and intraplate basalts in the above-mentioned stages is consistent with the magmatic effects of slab window triggered by ridge subduction, which probably started since the Late Carboniferous and continued into the Late Triassic. The Carboniferous-Triassic multiple magmatic migrations and ridge-subduction scenarios provide new insight into the geodynamic processes of the Jinsha Paleotethys and the growth mechanism of the Tibetan Plateau.
Intracranial hypertension and papilloedema as a complication to low antiretroviral therapy adherence in a man living with chronic HIV
Authors: Gynthersen Rosa Maja Møhring , Mens Helene , Wegener Marianne , Wareham Neval Ete
Published: March 2021

We describe a 61-year-old man living with HIV on antiretroviral therapy (ART), who presented with headache, dizziness and blurred vision. Latest CD4+cell count 3 months prior to admission was 570×106 cells/mL and HIV viral load <20 copies/mL. The patient was diagnosed with cerebrospinal fluid (CSF) lymphocytic pleocytosis, raised intracranial pressure and papilloedema. Neuroimaging showed normal ventricular volume and no mass lesions, suggesting (1) neuroinfection (2) idiopathic intracranial hypertension or (3) retroviral rebound syndrome (RRS) as possible causes. Neuroinfection was ruled out and idiopathic intracranial hypertension seemed unlikely. Elevated plasma HIV RNA level was detected consistent with reduced ART adherence prior to admission. RRS is a virological rebound after ART interruption, which can mimic the acute retroviral syndrome of acute primary infection. To the best of our knowledge, we describe the second case of RRS presenting as CSF lymphocytic pleocytosis and elevated intracranial pressure after low ART adherence.
Adult-onset Kawasaki disease: A great masquerader
Authors: Datta Amlan Kusum , Debnath Partha , Chaudhuri Jasodhara , Mukherjee Adreesh
Published: March 2021

Kawasaki disease is a necrotising small-to-medium vessel vasculitis affecting children between age groups of 6 months and 5 years. Following the first description in Japanese infants, it has been recognised as the single most common cause of non-infectious vasculitis in children worldwide. Presentation in adult age groups, although described, is rare. Herein, we report a case about a 19-year-old female Indian patient diagnosed with Kawasaki disease and managed with antiplatelets and intravenous immunoglobulin, without further sequalae. We aim to highlight the importance of recognising this entity in adult age groups in day-to-day clinical practice.
Wernicke’s encephalopathy post hyperemesis gravidarum misdiagnosed as Guillain-Barre syndrome: lessons for the frontline
Authors: Kirty Kaushiki , Sarda Yashendu , Jacob Annu , Venugopala Delanthabettu
Published: March 2021

We report a case of a 26-year-old pregnant woman, who presented with subacute limb weakness. This was initially suspected to be Guillain-Barre syndrome but subsequently found to be the motor neuropathy of dry beriberi (vitamin B1, thiamine deficiency) along with associated Wernicke’s encephalopathy (WE). The underlying cause was revealed as hyperemesis gravidarum (HG). HG complicates up to 3% of pregnancies and if severe, without nutritional supplements, may lead to electrolyte disturbances, calorie loss and vitamin deficiency. Although the association of HG and WE was first reported in 1939, it remains an under diagnosed condition with potential for serious and permanent neurological deficits, and some mortality, in both mother and baby. Early recognition of the problem, with timely and careful fluid, electrolyte, glucose and vitamin replacement is needed to avoid complications. We highlight current best practice in the treatment of WE. An open mind to the possibility of HG complications in any pregnant woman presenting with neurological symptoms is probably the most important lesson to learn from the front line.
Delayed-onset constrictive pericarditis associated with trauma
Authors: Suetani Yuto , Arita Yoh , Marumoto Akira , Hasegawa Shinji
Published: March 2021

A 59-year-old man presented with exertional dyspnoea and pretibial oedema that had lasted 6 months. He was referred to our hospital with suspected constrictive pericarditis (CP). Several examinations, including CT, echocardiography and cardiac catheterisation, indicated heart failure associated with CP that had been induced by trauma 13 years prior. The CP and heart failure were unresponsive to medical treatment, therefore, a surgical pericardiectomy was performed, which is considered the only definitive treatment. Pathological examination of the resected pericardium revealed a fatty texture and dense fibrous connective tissues, which are associated with old haemorrhage and focal calcification. The patient’s symptoms were improved to New York Heart Association Class I, and his peripheral oedema disappeared 6 months after leaving hospital.
Amelanotic anorectal malignant melanoma in an ulcerative colitis patient: a rare coincidence or a rare association
Authors: Kuriakose Kuzhiyanjal Anish John , Nigam Gaurav Bhaskar , Afzal Muhammad
Published: March 2021

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal system, known to be associated with increased risk of carcinogenesis. We report the case of a 55-year-old woman, presenting with symptoms of increased bowel frequency, per rectal bleeding and rectal pain with a background of ulcerative colitis (UC). This was presumptively managed as UC flare, with titration of her medications to control the symptoms. However, a flexible sigmoidoscopy revealed an ulceroproliferative lesion in the rectum, which was identified as an amelanotic anorectal malignant melanoma on immunohistochemistry. No local or distant metastases were noted on radiological imaging. The tumour enlarged progressively and was managed with laparotomy and defunctioning stoma followed by palliative chemotherapy and immunotherapy. This is the first such case reported in literature, highlighting the importance of endoscopic assessment and the need to consider other differential diagnosis in patients with symptoms of IBD flare.
Rasburicase-induced haemolysis and methemoglobinemia: an ongoing issue
Authors: Madanat Luai , Schoenherr Daniel , Wey Elizabeth , Gupta Ruby
Published: March 2021

We report a case of a 91-year-old Caucasian woman with a history of chronic lymphocytic leukaemia who developed acute hypoxic respiratory failure (AHRF) requiring intubation for less than 24 hours after receiving rasburicase. Laboratory workup was significant for methemoglobinemia and acute anaemia, and blood film demonstrated evidence of oxidative haemolysis with bite cells. The patient was given a presumptive diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency and was managed conservatively with successful resolution of AHRF and stabilisation of haemoglobin level. Seven days after admission, she passed away due to subsequent complications; hence, follow-up G6PD level could not be obtained. Haemolytic anaemia and methemoglobinemia in the setting of recent rasburicase administration should raise clinical suspicion for G6PD deficiency. In non-emergent cases, patients should be screened prior to receiving rasburicase regardless of risk factors. Because rasburicase is often needed emergently, patients at high risk of tumour lysis syndrome should be screened early for G6PD deficiency.
Pemphigoid gestationis: a rare pregnancy dermatosis treated with a combination of IVIg and rituximab
Authors: Narayanan Arunachalam , Pangti Rashi , Agarwal Shipra , Bhari Neetu
Published: March 2021

Pemphigoid gestationis is a rare autoimmune subepidermal bullous dermatosis occurring during pregnancy and post partum. A 32-year-old woman developed itchy urticarial wheals over the trunk and extremities at 6 months of gestation. This was not controlled with antihistamines, and 2 months later, the patient developed multiple vesiculobullous lesions. The patient had an exacerbation 3 weeks post-delivery. She did not go into remission for 6 months post partum despite treatment with prednisolone 40 mg/day, doxycycline 100 mg two times per day and dapsone 100 mg/day. The patient went into remission following treatment with three courses of intravenous immunoglobulin 2 mg/kg/course and 2 doses of rituximab 1 g at a 2-week interval.
Partial breast resection for multifocal lower quadrant breast tumour using virtual reality
Authors: Laas Enora , El Beheiry Mohamed , Masson Jean-Baptiste , Malhaire Caroline
Published: March 2021

Oncoplastic surgery allows an increase in the number of indications for conservative breast cancer treatments. However, uncertainty as to whether it can be performed still exists in certain situations such as with multicentric or multifocal lesions, even when the breast volume can accommodate it. With the aid of a virtual reality software, DIVA, allowing the precise visualisation of tumours and breast volumes based entirely on the patient’s MRI, we report the ability to rapidly confirm and secure an indication for partial surgery of multiple lesions in a 31-year-old patient. With the described approach, the patient did not have to suffer significant disfigurement from cancerous breast surgery without compromising safety.
‘Fat but powerful’ paradox: association of muscle power and adiposity markers with all-cause mortality in older adults from the EXERNET multicentre study
Authors: Alcazar Julian , Navarrete-Villanueva David , Mañas Asier , Gómez-Cabello Alba , Pedrero-Chamizo Raquel , Alegre Luis M , Villa Gerardo , Gusi Narcís , González-Gross Marcela , Casajús Jose Antonio , Vicente-Rodriguez German , Ara Ignacio
Published: March 2021

Objectives

To assess the influence of muscle power and adiposity on all-cause mortality risk and to evaluate the ‘fat but powerful’ (F+P) (or ‘fat but fit’) paradox in older adults.

Methods

A total of 2563 older adults (65‒91 years old) from the EXERNET multicentre study were included. Adiposity (body mass index (BMI), waist circumference, body fat percentage (BF%) and fat index), allometric and relative power (sit-to-stand muscle power test) and various covariates (age, sex, hypertension, smoking status and walking and sitting times per day) were registered at baseline. All-cause mortality was recorded during a median follow-up of 8.9 years. Participants were classified into four groups: lean and powerful (L+P), F+P, lean but weak and fat and weak (F+W). Cox proportional hazard regression models and adjusted HRs were calculated.

Results

According to BMI and waist circumference, all-cause mortality risk was reduced in the F+P (HR=0.55 and 0.63, p=0.044 and 0.049, respectively) and L+P (HR=0.57 and 0.58, p=0.043 and 0.025, respectively) groups. According to BF%, all-cause mortality decreased in the L+P group (HR=0.53; p=0.021), and a trend for a reduction was reported in the F+P group (HR=0.57; p=0.060). According to fat index, a survival benefit was only noted in the L+P group (HR=0.50; p=0.049). Higher levels of relative power reduced all-cause mortality risk among older people (HR=0.63 and 0.53, p=0.006 and 0.011, respectively).

Conclusion

Powerful older people exhibited a reduced 9-year all-cause mortality regardless of BMI, waist circumference and BF%. Obesity according to fat index blunted the survival benefits of being powerful.
Trends in obesity and adiposity measures by race or ethnicity among adults in the United States 2011-18: population based study
Authors: Liu Buyun , Du Yang , Wu Yuxiao , Snetselaar Linda G , Wallace Robert B , Bao Wei
Published: March 2021

Objective

To examine the trends in obesity and adiposity measures, including body mass index, waist circumference, body fat percentage, and lean mass, by race or ethnicity among adults in the United States from 2011 to 2018.

Design

Population based study.

Setting

National Health and Nutrition Examination Survey (NHANES), 2011-18.

Participants

A nationally representative sample of US adults aged 20 years or older.

Main outcome measures

Weight, height, and waist circumference among adults aged 20 years or older were measured by trained technicians using standardized protocols. Obesity was defined as body mass index of 30 or higher for non-Asians and 27.5 or higher for Asians. Abdominal obesity was defined as a waist circumference of 102 cm or larger for men and 88 cm or larger for women. Body fat percentage and lean mass were measured among adults aged 20-59 years by using dual energy x ray absorptiometry.

Results

This study included 21 399 adults from NHANES 2011-18. Body mass index was measured for 21 093 adults, waist circumference for 20 080 adults, and body fat percentage for 10 864 adults. For the overall population, age adjusted prevalence of general obesity increased from 35.4% (95% confidence interval 32.5% to 38.3%) in 2011-12 to 43.4% (39.8% to 47.0%) in 2017-18 (P for trend<0.001), and age adjusted prevalence of abdominal obesity increased from 54.5% (51.2% to 57.8%) in 2011-12 to 59.1% (55.6% to 62.7%) in 2017-18 (P for trend=0.02). Age adjusted mean body mass index increased from 28.7 (28.2 to 29.1) in 2011-12 to 29.8 (29.2 to 30.4) in 2017-18 (P for trend=0.001), and age adjusted mean waist circumference increased from 98.4 cm (97.4 to 99.5 cm) in 2011-12 to 100.5 cm (98.9 to 102.1 cm) in 2017-18 (P for trend=0.01). Significant increases were observed in body mass index and waist circumference among the Hispanic, non-Hispanic white, and non-Hispanic Asian groups (all P for trend<0.05), but not for the non-Hispanic black group. For body fat percentage, a significant increase was observed among non-Hispanic Asians (30.6%, 29.8% to 31.4% in 2011-12; 32.7%, 32.0% to 33.4% in 2017-18; P for trend=0.001), but not among other racial or ethnic groups. The age adjusted mean lean mass decreased in the non-Hispanic black group and increased in the non-Hispanic Asian group, but no statistically significant changes were found in other racial or ethnic groups.

Conclusions

Among US adults, an increasing trend was found in obesity and adiposity measures from 2011 to 2018, although disparities exist among racial or ethnic groups.
Occurrence and timely management of problems requiring prompt intervention among Indigenous compared with non-Indigenous Australian palliative care patients: a multijurisdictional cohort study
Authors: Woods John A , Katzenellenbogen Judith M , Murray Kevin , Johnson Claire E , Thompson Sandra C
Published: March 2021

Objectives

Anticipation and prompt relief of symptoms among patients with a life-limiting illness is a core element of palliative care. Indigenous Australians commonly encounter cultural barriers in healthcare that may impair outcomes. The Palliative Care Outcomes Collaboration collects patient care data for the purposes of continuous quality improvement and benchmarking, with each recorded care episode divided into phases that reflect a patient’s condition. We aimed to investigate differences between Indigenous and non-Indigenous patients in the occurrence and duration of ‘unstable’ phases (which indicate unanticipated deterioration in a patient’s condition or circumstances), and determine attainment of the relevant benchmark (resolution of unstable phases in ≤3 days in 90% of cases) for both groups.

Design

Cohort study.

Setting

Australia-wide hospital-based and community-based specialist palliative care (1 January 2010 to 30 June 2015).

Participants

139 556 (1502 Indigenous and 138 054 non-Indigenous) adult patients.

Outcome measures

Indigenous and non-Indigenous patients were compared on (1) the risk of a phase being categorised as unstable, (2) the duration of unstable phases, and (3) the risk of unstable phases being prolonged (>3 days). Crude and adjusted estimates were produced from three-level robust Poisson regression and complementary log-log discrete time survival models.

Results

Unstable phases occurred with similar frequency overall among Indigenous and non-Indigenous patients (adjusted relative risks 1.06; 95% CI 1.00 to 1.11; not significant after correction for multiple comparisons). The duration and risk of prolongation of unstable phases were similar in both patient groups, with no significant differences evident among subgroups. The benchmark was not met for either Indigenous or non-Indigenous patients (unstable phase duration >3 days in 24.3% vs 25.5%; p=0.398).

Conclusions

Despite well-documented shortcomings of healthcare for Indigenous Australians, there is no clear evidence of greater occurrence or prolongation of unanticipated problems among Indigenous patients accessing specialist palliative care services in hospital or the community.
Impact of a videoconferencing educational programme for the management of concurrent disorders on nurses’ competency development and clinical practice: protocol for a convergent mixed methods study
Authors: Chicoine Gabrielle , Côté José , Pepin Jacinthe , Pluye Pierre , Boyer Louise , Fontaine Guillaume , Rouleau Geneviève , Dubreucq Simon , Jutras-Aswad Didier
Published: March 2021

Introduction

Extension for Community Healthcare Outcomes (Project ECHO©) is an innovative model for continuing professional development that uses videoconferencing technology to support and train general practitioners remotely. The model has been replicated to a variety of settings and locations for capacity building in healthcare professionals caring for patients with chronic and complex health conditions. Limited research has been conducted so far on the impact of ECHO in the field of concurrent mental health and substance use disorders (ie, concurrent disorders (CDs)). Therefore, this mixed methods study aims to develop a comprehensive understanding of an ECHO programme impact for CD management on nurses’ competency development and clinical practice.

Methods and analysis

The proposed mixed methods study, based on a convergent parallel design, will be conducted in the province of Quebec, Canada, to collect, analyse and interpret quantitative (QUAN) and qualitative (QUAL) data from a specific ECHO Program on CDs. In the QUAN component, an observational prospective cohort study will be conducted over a 12-month period. All nurses who participated in the programme between 2018 and 2020 and who consent to research will be recruited to collect data on the extent of their learning and practice outcomes at three time points. Alongside the surveys, nurses will be invited to participate in individual semistructured interviews. In-depth QUAL data will be subjected to a thematic analysis and will assist in exploring how and in which conditions nurses developed and mobilised their competencies in clinical practice. A comparison-of-results strategy will be used in the final integration component of the study.

Ethics and dissemination

This study protocol was approved by the Ethics Committee of the Université de Montréal Hospital Center (#19.295) and the Université de Montréal Ethics Committee (CERSES-20–017 R). We aim to disseminate the findings through international academic conferences, international peer-reviewed journals and professional media.
Timing of evidence-based non-surgical interventions as part of multimodal treatment guidelines for the management of cervical radiculopathy: a Delphi study protocol
Authors: Thoomes Erik , Thoomes-de Graaf Marloes , Cleland Joshua , Gallina Alessio , Falla Deborah
Published: March 2021

Introduction

Cervical radiculopathy (CR) is a clinical condition whereby motor, reflex and/or sensory changes such as radicular pain, paraesthaesia or numbness can exist. Conservative management is a preferred first treatment option as the risk–benefit ratio for surgery is less favourable. Systematic reviews and treatment guidelines gather evidence on the effectiveness of non-surgical management of patients with CR from randomised controlled trials, which do not consider the natural course of recovery to modify the management strategy accordingly. The aim of this study is to establish consensus on effective non-surgical treatment modalities for patients in different stages (acute, subacute and chronic) of CR, using the Delphi method approach.

Methods and analysis

Through an iterative multistage process, experts within the field will rate their agreement with a list of proposed treatment modalities and suggest any missing treatment modalities during each round. Agreement will be measured using a five-point Likert scale. Descriptive statistics will be used to measure agreement (median, IQR and percentage of agreement). Consensus criteria will be defined a priori for each round. Data analysis at the end of round three will produce a consensus list of effective treatment modalities for the management of patients with CR in different stages of recovery.

Ethics and dissemination

Ethical approval has been granted from the University of Birmingham ethics committee under ERN_20-1121. The study findings will be submitted to a peer-reviewed journal and to relevant conferences for dissemination of the study results.
Beyond the European Union Tobacco Products Directive: smokers’ and recent quitters’ support for further tobacco control measures (2016–2018)
Authors: Nogueira Sarah O , Driezen Pete , Fu Marcela , Hitchman Sara C , Tigova Olena , Castellano Yolanda , Kyriakos Christina N , Zatoński Mateusz Zygmunt , Mons Ute , Quah Anne C K , Demjén Tibor , Trofor Antigona Carmen , Przewozniak Krzysztof , Katsaounou Paraskevi , Fong Geoffrey , Vardavas Constantine I , Fernández Esteve
Published: March 2021

Background

Several measures recommended by the WHO Framework Convention on Tobacco Control have not been implemented in the European Union, despite changes in the legislation such as the Tobacco Products Directive (TPD). This study aims to understand smokers’ and recent quitters’ levels of support for tobacco control measures that go beyond the TPD during and after its implementation.

Methods

Data from wave 1 (2016, n=6011) and wave 2 (2018, n=6027) of the EUREST-PLUS International Tobacco Control Policy Evaluation Project Six European Countries Survey, a cohort of adult smokers in Germany, Greece, Hungary, Poland, Romania, Spain were used to estimate the level of support for seven different tobacco control measures, overall and by country.

Results

In 2018, the highest support was for implementing measures to further regulate tobacco products (50.5%) and for holding tobacco companies accountable for the harm caused by smoking (48.8%). Additionally, in 2018, 40% of smokers and recent quitters supported a total ban on cigarettes and other tobacco products within ten years, if assistance to quit smoking is provided. Overall, support for tobacco control measures among smokers and recent quitters after the implementation of the TPD remained stable over time.

Conclusion

There is considerable support among smokers and recent quitters for tobacco control measures that go beyond the current measures implemented. A significant percentage of smokers would support a ban on tobacco products in the future if the government provided assistance to quit smoking. This highlights the importance of implementing measures to increase smoking cessation in conjunction with other policies.
The influence of exercise intensity and exercise mode on gastrointestinal damage
Authors: Edwards Kate H. , Ahuja Kiran D. , Watson Greig , Dowling Courtney , Musgrave Harrison , Reyes Jessica , Cherry James , Kitic Cecilia M.
Published: March 2021

Strenuous exercise increases gastrointestinal damage, but the dose–response relationship is yet to be elucidated. It is also commonly believed that running causes greater gastrointestinal damage than cycling. Two randomised, crossover studies aimed to 1) quantify gastrointestinal damage with increasing exercise intensity, and 2) determine if running was associated with greater gastrointestinal damage than cycling. Following a maximal oxygen uptake (V̇O2max) test, participants completed 3 cycling trials at different intensities (60 min at 40%, 60% and 80% V̇O2max; n = 10 (5 female, 5 male)) (INTENSITY), or 1 running and 1 cycling trial (45 min at 70% V̇O2max; n = 11 (3 female, 8 male)) (MODE). Venous blood samples were collected pre- and post-exercise to measure gastrointestinal damage via intestinal fatty acid binding protein (I-FABP). In INTENSITY, I-FABP magnitude of change was greater at 80% V̇O2max than 40% V̇O2max (p < 0.01). In MODE, I-FABP magnitude of change was greater with cycling (mean (SD)) (84.7 (133.2)% d = 1.07) compared with running (19.3 (33.1)%, d = 0.65) with a moderate effect (d = 0.68, p = 0.024). Rating of perceived exertion (RPE) and heart rate (HR) were higher during cycling (RPE p < 0.0001; HR p < 0.0001) but rectal temperature was not different between modes (p = 0.94). While gastrointestinal damage increases with increasing exercise intensity, running was not associated with greater gastrointestinal damage than cycling.

Novelty: A fraction of the anaerobic threshold, rather than a fraction of V̇O2max, may be more predictive of intensity that results in exercise induced gastrointestinal damage. The mode of exercise may not be as important as intensity for inducing gastrointestinal damage. Improving anaerobic threshold may reduce susceptibility to gastrointestinal damage when exercising at high intensities.
A dynamic modelling of labor productivity impacts arising from change orders in road projects
Authors: Ghazi Al-Kofahi Zain , Mahdavian Amirsaman , Oloufa Amr
Published: March 2021

It is vital to investigate the system dynamics (SD) between change orders and labor productivity to identify the causes of productivity loss in construction projects. Most productivity loss studies are financed by the contractor and rely on the contractor’s data. There is a gap in the literature concerning the labor productivity impacts of change orders on the part of the owner. This research utilizes a previously developed SD model to highlight the problem of productivity loss resulting from issuance of a change order. We conducted a sensitivity analysis to evaluate the impact of overtime, overmanning, temperature, and learning on the behavior of the SD model quantifying change orders’ impact on labor productivity when their effects are simulated. Based on the results, SD is more reliable than the measured mile analysis (MMA) approach for the compensation request, considering the leading factors affecting the productivity loss other than the change order. The model developed in this study can accept or reject the responsibility of a change order for the occurrence of productivity loss.
Landscape-scale habitat associations of small mammals on the western coast of Hudson Bay
Authors: Hawkshaw Kevin A. , Foote Lee , Franke Alastair
Published: March 2021

Availability of suitable habitat affects the distribution and abundance of Arctic fauna, influencing how species respond to climate change and disturbance from resource extraction in the region. We surveyed Arctic ground squirrels (Urocitellus parryii (Richardson, 1825)) using distance sampling transects and concurrently counted microtine rodent burrows. Abundance of Arctic ground squirrels and microtine burrows was positively correlated with terrain ruggedness. Microtine burrows were more abundant inland and in areas with freshwater, whereas Arctic ground squirrels were more often found at low elevation without freshwater. Arctic ground squirrel abundance was positively related to the normalized difference water index, a proxy for vegetation water content, whereas microtine burrows were weakly correlated with the normalized difference vegetation index. Our study highlights the habitat associations of ecologically significant small mammals in an underrepresented Arctic study area.
DESICCATION–REHYDRATION STRESS REVEALED BY SUGAR-METABOLITE-RESERVE MODEL
Authors: BERBERT JULIANA M. , OLIVEIRA KAREN A. , MARTIN RAFAELA F. , CENTENO DANILO C.
Published: March 2021

We focus on the evaluation of photosynthetic organisms. Some species and tissues can endure periods of the dry season because they rely on a robust dynamics of metabolites. The metabolic dynamics are complex and challenging to address because it involves several steps, usually with hundreds of metabolites. The metabolites densities vary among species and tissues and respond to external conditions, such as an environmental stimulus like water supply. Understanding these responses, particularly the desiccation–rehydration processes, are important both economically and evolutionarily, especially in the presence of climate change. Therefore, we propose a new way to analyze the dynamics of metabolites with a compartmental model which explores the metabolites densities’ dependence on water explicitly. We use a mathematical formulation to model the dynamics among three essential metabolites classes: sugar ([Formula: see text]), active metabolite ([Formula: see text]), and reserve accumulation ([Formula: see text]). Through stability analysis and numerical solutions, we characterize regions on the phase space, defined by the transition rates between the classes [Formula: see text] to [Formula: see text] and [Formula: see text] to [Formula: see text], where the system diverges or approaches zero. We show that different species and tissues respond distinctly to desiccation processes, being more or less resilient according to the transitions rate between the compartments of the model. Furthermore, the effects of water supply fluctuation, due to the desiccation–rehydration processes, show that unless the organism has a robust reservoir metabolism, the system cannot support itself for a long time. Many results corroborate experimental observations, and others provide a new perspective on the studies of metabolic dynamics, such as the significance of the reservoir metabolism. We understand that knowing the organism’s response to abiotic changes, particularly that of the water supply, may improve our management of the use of these organisms, for example, in the crop field during climate changes.