bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding pathogen population structure and virulence variation for efficient resistance breeding to control cucurbit powdery mildews
Authors: Lebeda Aleš , Sedláková Božena , Křístková Eva , Widrlechner Mark P. , Kosman Evsey
Published: April 2021

Cucurbit powdery mildew (CPM) is caused most frequently by well‐differentiated obligate erysiphaceous ectoparasites Golovinomyces orontii and Podosphaera xanthii, which vary in their ecology and virulence. All economically important cucurbit crops host both of these CPM species. Breeding of cucurbits for CPM resistance is highly important worldwide, but adequate knowledge of CPM species determination, as well as virulence structure, population dynamics, and spatiotemporal variation of these pathogens, has not yet been achieved. New tools have been developed to enhance research on CPM virulence variation for more efficient breeding and seed and crop production. A set of differential genotypes of Cucumis melo, with high differentiation capacity, may contribute substantially to understanding of variation in CPM virulence at both individual and population levels. Long‐term observations (2001–2012) of CPM pathogens in the Czech Republic were used to analyse virulence variation within and among annual CPM populations and demonstrate the utility of recently developed tools for studying species variability and virulence variation of CPM pathogens worldwide. Detailed analyses of diversity and spatiotemporal fluctuations in the composition of CPM populations provide crucial information for shaping breeding programmes and predicting the most effective sources of race‐specific resistance. The primary aim of this work was to create a uniform framework for determination of CPM species structure and diversity, virulence phenotypes, virulence and phenotype frequencies, phenotype complexity, dynamics, and variation within and among CPM populations. In addition, practical advice is presented on how to select the most relevant data and interpret them for use in cucurbit resistance breeding.
Can keto/amino acids reduce oxidative stress in peritoneal dialysis patients with hypoalbuminemia?
Authors: Çankaya Erdem , Bilen Yusuf , Uyanık Abdullah , Dogan Hasan , Kızıltunç Ahmet , Sevinç Can
Published: April 2021

Introduction

There is no consensus on an ideal marker of oxidative stress (OS). Disruption of the balance between free radical and antioxidant activity production by increasing oxidative markers results in OS. In this study, we aimed to investigate how OS, which increases mortality and morbidity due to various reasons, is affected by keto/amino therapy in patients with hypoalbuminemia undergoing peritoneal dialysis.

Materials and Method

Twenty patients who underwent peritoneal dialysis were included in the study. Before starting keto/amino acid therapy, primary kidney diseases were determined, body mass indexes, serum total protein, albumin, C‐reactive protein, ferritin, calcium, phosphorus, parathyroid hormone, paraoxonase‐1 (PON‐1), sialic acid levels, arylesterase (ARE) activities, and malondialdehyde (MDA) levels were measured, and Kt/V values were calculated. Keto/amino acid treatment was initiated for those with an albumin level of <3.5 g/dL. The same parameters of the patients, followed up for 3 months, were checked again at the end of the third month.

Results

Paraoxonase‐1 and ARE activities, which are antioxidant enzyme activities, were found to be statistically significantly increased compared to the initial period (59 ± 59, 135 ± 69, 15.8 ± 19.7, and 44.7 ± 16.4, respectively; p < 0.00). MDA and sialic acid levels were significantly lower than the initial values (109 ± 99, 23 ± 9, 2.26 ± 0.44, and 2.04 ± 0.39, respectively; p < 0.01).

Conclusion

In our study, after the initiation of keto/amino acid treatment, PON‐1, which is a significant antioxidant marker, and ARE plasma activities increased and tissue destruction product MDA and sialic acid significantly decreased. In the light of all these data, we think that this treatment can reduce OS, improve hypoalbuminemia, which causes both mortality and morbidity in patients, improve survival in PD patients, and may be an antioxidant treatment in suitable patients.
Sequence‐based typing identification of the novel allele HLA‐A*30:170
Authors: Shi Xiu‐Min , Hu Rui‐Ping , Li Pei‐Tong , Han Wei , Gao Su‐Jun
Published: April 2021

HLA‐A*30:170 has one nucleotide change from HLA‐A*30:01:01:01 at nucleotide 755 where Threonine T (228) is changed to Methionine M.
The strong Suslin reciprocity law
Authors: Rudenko Daniil
Published: April 2021

We prove the strong Suslin reciprocity law conjectured by A. Goncharov. The Suslin reciprocity law is a generalization of the Weil reciprocity law to higher Milnor$K$-theory. The Milnor$K$-groups can be identified with the top cohomology groups of the polylogarithmic motivic complexes; Goncharov's conjecture predicts the existence of a contracting homotopy underlying Suslin reciprocity. The main ingredient of the proof is a homotopy invariance theorem for the cohomology of the polylogarithmic motivic complexes in the ‘next to Milnor’ degree. We apply these results to the theory of scissors congruences of hyperbolic polytopes. For every triple of rational functions on a compact projective curve over$\mathbb {C}$we construct a hyperbolic polytope (defined up to scissors congruence). The hyperbolic volume and the Dehn invariant of this polytope can be computed directly from the triple of rational functions on the curve.
Dynamic Characteristics Analysis of the Composite Motion of Curve-Face Gear
Authors: Chao Lin , Yu Wang , Yanan Hu , Yongquan Yu
Published: April 2021

The unified model was proposed for the three configurations of the composite motion of curve-face gear pair. A coupled bending-torsional-axial dynamic model with multi degree-of-freedom transmission system was proposed comprehensively considering nonlinear parameters such as tooth mesh stiffness, static transmission error and backlash. The fourth-order Runge–Kutta numerical method was applied to solve the dimensionless dynamic differential equations of the system, and then the dynamic responses of the system were investigated by time history, phase-plane portrait, poincare map, FFT spectrum and bifurcation diagram. It was found that the dynamic responses of the three configurations were complex. It presented quasi-periodic motion only under certain configuration and parameter conditions. With the increase of meshing frequency, the system state was characterized by the alternation between chaotic motion and periodic motion. Eccentricity ratio of displacement curve of curve-face gear pair mainly affected the rotational frequency of the system. As the eccentricity ratio increased, the dominant frequency of the system gradually changed from meshing frequency to rotational frequency. The correctness of the theoretical model was verified through corresponding experimental studies.
Identification of a Pressure–Strain Correlation-Based Bypass Transition Onset Marker
Authors: Muthu Satish , Bhushan Shanti , Keith Walters D.
Published: April 2021

Temporally developing direct numerical simulations (T-DNS) are performed for freestream turbulence induced bypass transition flow with zero-pressure gradient over a flat-plate boundary layer for a range of freestream turbulence intensities (Tu) of 1.4% to 6%. The objective is to understand the role of pressure–strain terms on bypass transition onset and to propose and validate a phenomenological hypothesis for the identification of a robust transition onset marker for use in transition-sensitive Reynolds-averaged Navier–Stokes (RANS) simulations. Results show that transition initiates at a location where the slow pressure–strain term becomes more dominant than the rapid term in the pretransitional boundary layer region. A simple transition onset marker based on one-point statistical quantities is derived from the scaling of the ratio of the slow and rapid pressure fluctuation source terms. The critical value of the marker is found to vary within a narrow range (±2.8%) and satisfies previously identified criteria for a robust transition onset marker.
A Fast and Effective Method for the Optimization of the Valve Plate of Swashplate Axial Piston Pumps
Authors: Marinaro Gianluca , Frosina Emma , Senatore Adolfo , Stelson Kim A.
Published: April 2021

This research presents a lumped parameter numerical model aimed at designing and optimizing an axial piston pump. For the first time, it has been shown that a lumped parameter model can accurately model axial piston pump dynamics based on a comparison with computational fluid dynamic (CFD) models and experimental results. Since the method is much more efficient than CFD, it can optimize the design. Both steady-state and dynamic behaviors have been analyzed. The model results have been compared with experimental data, showing a good capacity in predicting the pump performance, including pressure ripple. The swashplate dynamics have been investigated experimentally, measuring the dynamic pressure which controls the pump displacement; a comparison with the numerical model results confirmed the high accuracy. An optimization process has been conducted on the valve-plate geometry to control fluid-born noise by flow ripple reduction. The nonlinear programming by quadratic Lagrangian (NLPQL) algorithm is used since it is suitable for this study. The objective function to minimize is the well-known function, the nonuniformity grade (NUG), a parameter directly correlated with flow ripple. A prototype of the best design has been realized and tested, confirming a reduction in the pressure ripple. An endurance test was also conducted. As predicted from the numerical model, a significant reduction of cavitation erosion was observed.
Sliding Wear Properties of HVOF Sprayed WC-10Co4Cr Coatings With Conventional Structure and Bimodal Structure Under Different Loads
Authors: Zhou Yong-Kuan , Kang Jia-Jie , Yue Wen , Liu Xiao-Bin , Fu Zhi-Qiang , Zhu Li-Na , She Ding-Shun , Ma Guo-Zheng , Wang Hai-Dou
Published: April 2021

The WC-10Co4Cr coatings with conventional structure and bimodal structure were sprayed by high-velocity oxygen fuel (HVOF) technology. The phase compositions and morphologies of the WC-10Co4Cr powders and coatings were analyzed by X-ray diffraction (XRD) and scanning electron microscopy (SEM). The microhardness, porosity, bonding strength, elastic modulus, and indentation fracture toughness of the conventional coating (Conventional) and the bimodal coating (Bimodal) were also studied. The sliding wear properties of the Conventional and the Bimodal against Si3N4 counterballs under different loads at room temperature (∼25 °C) were investigated using a friction and wear tester. Compared with the Conventional, the Bimodal has denser microstructure, lower porosity, more excellent mechanical properties, and the Bimodal has better wear resistance than the Conventional under different loads. The two coatings under 15 N and 30 N only exhibit abrasive and slightly adhesive wear mechanism, while in the load application of 45 N, additional mechanism which is fatigue is detected and causes flaking of the coating.
In-Hole Characteristic Interface and Film Cooling Interface Model
Authors: Zhang Zhen , Li Hui , Su Xinrong , Yuan Xin
Published: April 2021

The performance of film cooling is influenced by many parameters, and the nonuniform flow caused by the internal cooling system is found to largely affect the film cooling, which further complicates the in-hole flow and draws new difficulties in predicting the cooling performance. In this study, we find a very interesting phenomenon that there always exists an in-hole interface, on which distributions of many parameters, including the velocity and kinetic energy, are seldom affected by the mainstream. The existence of this specific interface can be observed for both cylindrical and shaped film cooling holes under most operating conditions. The theoretical analysis of this interface is conducted in this study based on the characteristic decomposition of the Navier–Stokes equation, and this interface is named as the characteristic interface. Theoretical analysis and numerical observations suggest the film cooling system can be simplified to two weakly coupled regions separated by this interface. It also explains why existing source term models for film cooling may fail. Based on these findings, a new prediction model is developed, which uses the convolutional neural networks (CNN) model to predict the boundary conditions on the characteristic interface. The new model outperforms existing source term models and yields similar accuracy as full-mesh computational fluid dynamics (CFD), while reducing the computational cost by one order of magnitude. This model is further evaluated in large eddy simulation (LES), showing moderate success. To sum up, the current work reports the characteristic interface phenomenon in the film cooling hole, based on which a new and efficient prediction model is developed and verified.
Serrated Chip Formation Induced Periodic Distribution of Morphological and Physical Characteristics in Machined Surface During High-Speed Machining of Ti6Al4V
Authors: Xu Binbin , Zhang Jun , Liu Hongguang , Xu Xiang , Zhao Wanhua
Published: April 2021

Difficult-to-cut materials are widely used in aerospace and other industries. Titanium alloys are the most popular ones among them due to their high strength-to-weight ratio and high temperature resistance. However, in high-speed machining, the alloys are prone to produce serrated chips, which have a serious influence on surface integrity. In this study, a coupled Eulerian–Lagrangian method is used to simulate the orthogonal cutting of Ti6Al4V due to its advantages of avoiding element distortion and improving the data extraction efficiency. The internal relationship between serrated chip formation and periodic profile of machined surfaces is analyzed by the simulation results and experimental data which are obtained by optical microscope and white light interferometer. Furthermore, thermal–mechanical loads on machined surfaces are reconstructed based on the simulation results, and a coupled finite element and cellular automata approach is used to describe the dynamic recrystallization process within the area of the machined surface during the formation of a single serration. According to the results, the periodic fluctuation of cutting forces is attributed to the serrated chip formation phenomenon, which then leads to the periodic profile of machined surfaces. The period is about 60–70 µm, and its amplitude decreases with the increase of cutting speeds. Moreover, the loads on machined surfaces also show the same period due to serrated chip formation. As a result, the grain refinement layer thickness (about 2 ∼ 5 µm) in machined surfaces is related to the surface temperature and exhibits the same periodic characteristics along the cutting direction.
Using 2-dimensional color superb microvascular imaging vascularization index technique in the assessment of thyroid surgical bed
Authors: Durmaz Mehmet Sedat , Kara Gedik Gonca , Batur Abdussamet , Yılmaz Farise
Published: April 2021

Aim: The purpose of this study was to investigate the effectiveness of the vascularization index (VI) obtained using color superb microvascular imaging (cSMI) technique in the assessment of thyroid surgical bed for remnant thyroid tissue (RTT). Material and methods: We evaluated the thyroid surgical bed of 65 patients who had underwent total thyroidectomy (TT) due to papillary carcinoma (PC) using thyroid scintigraphy and cSMI. Color SMI was also performed for the examination of the thyroid parenchyma of 39 healthy asymptomatic participants. VI measurements were performed by manually drawing the contours of the RTT in those with remnant thyroid, the thyroid surgical bed in the patients’ group without remnant thyroid, and normal thyroid parenchyma in the control group, using the free region of interest (ROI) with 2-dimensional color SMI VI (2DcSMIVI) mode. The volume of ROI was measured and echogenicity was evaluated. The quantitative 2DcSMIVI values of the surgical bed with RTT (Group A), the surgical bed without RTT (Group B) and normal thyroid of healthy asymptomatic participants (Group C) were compared. Results: The mean 2DcSMIVI values of Group A was significantly higher than Group B and C (p=0.001). The presence of RTT can be diagnosed with 89.1% sensitivity and 87.5% specificity when 1.75 2DcSMIVI is designated as the cut-off value. Conclusion: The 2DcSMIVI is an effective imaging technique that can be used for the diagnosis of RTT.
Famous psychologist faces posthumous reckoning
Authors: O'Grady Cathleen
Published: April 2021

Dozens of papers on personality and health by Hans Eysenck have been retracted or are under suspicion.
X-ray source gets a 100-fold boost in brightness
Authors: Cho Adrian
Published: April 2021

Rebuilt synchrotron is the first of more than a dozen of its kind in the works.
India speeds up vaccinations as cases soar again
Authors: Chandrashekhar Vaishnavi
Published: April 2021

Relaxed control measures, virus variants, and weather may drive powerful second wave.
Cancer cells deploy lipocalin-2 to collect limiting iron in leptomeningeal metastasis
Authors: Chi Yudan , Remsik Jan , Kiseliovas Vaidotas , Derderian Camille , Sener Ugur , Alghader Majdi , Saadeh Fadi , Nikishina Katie , Bale Tejus , Iacobuzio-Donahue Christine , Thomas Tiffany , Pe’er Dana , Mazutis Linas , Boire Adrienne
Published: April 2021

Ironing out a survival strategy

Metastatic cells display a notable ability to adapt to—and even thrive in—harsh microenvironments. One extreme example is leptomeningeal metastases (LM), cancer cells that enter a region of the central nervous system called the subarachnoid space, which is filled with cerebral spinal fluid (CSF). This anatomic site has a limited supply of micronutrients such as iron, and it harbors immune cells. Chi
et al.
used single-cell RNA sequencing to study CSF samples from cancer patients with LM (see the Perspective by Garzia and Taylor). They found that LM cells express and use components of a high-affinity iron-capturing system. Through this mechanism, the LM cells avoid the adverse effects of iron deprivation and potentially escape immune attack by limiting the supply of iron to macrophages.

Science
this issue p.
276
; see also p.
250
A van der Waals interface that creates in-plane polarization and a spontaneous photovoltaic effect
Authors: Akamatsu Takatoshi , Ideue Toshiya , Zhou Ling , Dong Yu , Kitamura Sota , Yoshii Mao , Yang Dongyang , Onga Masaru , Nakagawa Yuji , Watanabe Kenji , Taniguchi Takashi , Laurienzo Joseph , Huang Junwei , Ye Ziliang , Morimoto Takahiro , Yuan Hongtao , Iwasa Yoshihiro
Published: April 2021

Engineering interface polarization

Many properties can emerge at the interface of van der Waals materials created by rotating the layers of a single material or by creating heterointerfaces between different materials. Akamatsu
et al.
formed an interface that intentionally broke in-plane inversion symmetry by combining crystals of tungsten diselenide with threefold rotational symmetry and black phosphorus with twofold rotational symmetry. This interface creates in-plane electronic polarization that results in a spontaneous photovoltaic effect only along the polarization direction. This effect was explained in terms of a shift current mechanism.

Science
, this issue p.
68
Reimagining petroleum refining
Authors: Brennecke Joan F. , Freeman Benny
Published: April 2021

Rigid polymer membranes separate crude oil components without distillation
Applied pesticide toxicity shifts toward plants and invertebrates, even in GM crops
Authors: Schulz Ralf , Bub Sascha , Petschick Lara L. , Stehle Sebastian , Wolfram Jakob
Published: April 2021

A shifting burden

In 1962, Rachel Carson's
Silent Spring
was published, and the world was forced to take notice of the unintended impacts of pesticides on wildlife. Since then, there has been a perceived reduction in the amount of pesticides used and a shift in the kinds of pesticides available. Schulz
et al.
looked at the type, amount, and toxicity of pesticides applied over the last 25 years. They found that despite decreasing total amounts applied and decreased impacts on vertebrates, toxicity—in particular to insects and aquatic invertebrates—has increased substantially.

Science
, this issue p.
81
Observation of a non-Hermitian phase transition in an optical quantum gas
Authors: Öztürk Fahri Emre , Lappe Tim , Hellmann Göran , Schmitt Julian , Klaers Jan , Vewinger Frank , Kroha Johann , Weitz Martin
Published: April 2021

A dissipative quantum gas of light

Our textbook understanding of quantum systems tends to come from modeling these systems isolated from the environment. However, an emerging focus is understanding how many-body quantum systems behave when interacting with their surroundings and how they subsequently become dissipative, or non-Hermitian, systems. Öztürk
et al.
formed a quantum condensate of light by trapping photons in an optical cavity, a system that is naturally dissipative. By altering the trapping conditions, they demonstrated that the system provides a powerful platform with which to explore the complex dynamics and phase transitions occurring in dissipative quantum systems.

Science
, this issue p.
88
Laryngeal myxoedema: a literature review of an uncommon complication of hypothyroidism
Authors: Iftikhar Mian Harris , Raziq Fazal I , Coll Patrick , Dar Aneeqa Yousaf
Published: April 2021

A 59-year-old woman presented to the emergency department with shortness of breath. She had significant oropharyngeal swelling obstructing her upper respiratory tract. A diagnosis of laryngeal myxoedema was made, which was attributed to severe hypothyroidism. She required invasive ventilation and subsequently a tracheostomy. She was treated with levothyroxine and hydrocortisone. She completely recovered with this therapy. In this review, we will discuss similar cases and different therapeutic options. This case also highlights the fact that establishing a diagnosis of laryngeal myxoedema, a condition that can potentially have lethal outcomes and can be challenging.
Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study
Authors: Ayoubkhani Daniel , Khunti Kamlesh , Nafilyan Vahé , Maddox Thomas , Humberstone Ben , Diamond Ian , Banerjee Amitava
Published: April 2021

Objective

To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population.

Design

Retrospective cohort study.

Setting

NHS hospitals in England.

Participants

47 780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records.

Main outcome measures

Rates of hospital readmission (or any admission for controls), all cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity.

Results

Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 yearsv4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-whitev5.2 (5.0 to 5.5) for white individuals).

Conclusions

Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.
Regional differences in the care and outcomes of acute stroke patients in Australia: an observational study using evidence from the Australian Stroke Clinical Registry (AuSCR)
Authors: Dwyer Mitchell , Francis Karen , Peterson Gregory M , Ford Karen , Gall Seana , Phan Hoang , Castley Helen , Wong Lillian , White Richard , Ryan Fiona , Arthurson Lauren , Kim Joosup , Cadilhac Dominique A , Lannin Natasha A
Published: April 2021

Objective

To compare the processes and outcomes of care in patients who had a stroke treated in urban versus rural hospitals in Australia.

Design

Observational study using data from a multicentre national registry.

Setting

Data from 50 acute care hospitals in Australia (25 urban, 25 rural) which participated in the Australian Stroke Clinical Registry during the period 2010–2015.

Participants

Patients were divided into two groups (urban, rural) according to the Australian Standard Geographical Classification Remoteness Area classification. Data pertaining to 28 115 patients who had a stroke were analysed, of whom 8159 (29%) were admitted to hospitals located within rural areas.

Primary and secondary outcome measures

Regional differences in processes of care (admission to a stroke unit, thrombolysis for ischaemic stroke, discharge on antihypertensive medication and provision of a care plan), and survival analyses up to 180 days and health-related quality of life at 90–180 days.

Results

Compared with those admitted to urban hospitals, patients in rural hospitals less often received thrombolysis (urban 12.7% vs rural 7.5%, p<0.001) or received treatment in stroke units (urban 82.2% vs rural 76.5%, p<0.001), and fewer were discharged with a care plan (urban 61.3% vs rural 44.7%, p<0.001). No significant differences were found in terms of survival or overall self-reported quality of life.

Conclusions

Rural access to recommended components of acute stroke care was comparatively poorer; however, this did not appear to impact health outcomes at approximately 6 months.
Association between primary care physician diagnostic knowledge and death, hospitalisation and emergency department visits following an outpatient visit at risk for diagnostic error: a retrospective cohort study using medicare claims
Authors: Gray Bradley M , Vandergrift Jonathan L , McCoy Rozalina G , Lipner Rebecca S , Landon Bruce E
Published: April 2021

Objective

Diagnostic error is a key healthcare concern and can result in substantial morbidity and mortality. Yet no study has investigated the relationship between adverse outcomes resulting from diagnostic errors and one potentially large contributor to these errors: deficiencies in diagnostic knowledge. Our objective was to measure that associations between diagnostic knowledge and adverse outcomes after visits to primary care physicians that were at risk for diagnostic errors.

Setting/participants

1410 US general internists who recently took their American Board of Internal Medicine Maintenance of Certification (ABIM-IM-MOC) exam treating 42 407 Medicare beneficiaries who experienced 48 632 ‘index’ outpatient visits for new problems at risk for diagnostic error because the presenting problem (eg, dizziness) was related to prespecified diagnostic error sensitive conditions (eg, stroke).

Outcome measures

90-day risk of all-cause death, and, for outcome conditions related to the index visits diagnosis, emergency department (ED) visits and hospitalisations.

Design

Using retrospective cohort study design, we related physician performance on ABIM-IM-MOC diagnostic exam questions to patient outcomes during the 90-day period following an index visit at risk for diagnostic error after controlling for practice characteristics, patient sociodemographic and baseline clinical characteristics.

Results

Rates of 90-day adverse outcomes per 1000 index visits were 7 for death, 11 for hospitalisations and 14 for ED visits. Being seen by a physician in the top versus bottom third of diagnostic knowledge during an index visit for a new problem at risk for diagnostic error was associated with 2.9 fewer all-cause deaths (95% CI −5.0 to −0.7, p=0.008), 4.1 fewer hospitalisations (95% CI −6.9 to −1.2, p=0.006) and 4.9 fewer ED visits (95% CI −8.1% to −1.6%, p=0.003) per 1000 visits.

Conclusion

Higher diagnostic knowledge was associated with lower risk of adverse outcomes after visits for problems at heightened risk for diagnostic error.
Predicting mortality in acute ischaemic stroke treated with mechanical thrombectomy: analysis of a multicentre prospective registry
Authors: Li Hao , Ye Shi-sheng , Wu Yuan-Ling , Huang Sheng-Ming , Li Yong-Xin , Lu Kui , Huang Jing-Bo , Chen Lve , Li Hong-Zhuang , Wu Wen-Jun , Wu Zhi-Lin , Wu Jian-Zhou , Zhong Wang-Tao , Xian Wen-Chuan , Liao Feng , Tung Tao-Hsin , Wu Qiao-Ling , Chen Hai , Yuan Li , Yang Zhi , Huang Li-An
Published: April 2021

Objectives

We aimed to determine predictors of mortality within 90 days and develop a simple score for patients with mechanical thrombectomy (MT).

Design

Analysis of a multicentre prospective registry.

Setting

In six participating centres, patients who had an acute ischaemic stroke (AIS) treated by MT between March 2017 and May 2018 were documented prospectively.

Participants

224 patients with AIS were treated by MT.

Results

Of 224 patients, 49 (21.9%) patients died, and 87 (38.8%) were independent. Variables associated with 90-day mortality were age, previous stroke, admission National Institutes of Health Stroke Scale (NIHSS), fasting blood glucose and occlusion site. Logistic regression identified four variables independently associated with 90-day mortality: age ≥80 years (OR 3.26, 95% CI 1.45 to 7.33), previous stroke (OR 2.33, 95% CI 1.04 to 5.21), admission NIHSS ≥18 (OR 2.37, 95% CI 1.13 to 4.99) and internal carotid artery or basilar artery occlusion (OR 2.92, 95% CI 1.34 to 6.40). Using these data, we developed predicting 90-day mortality of AIS with MT (PRACTICE) score ranging from 0 to 6 points. The receiver operator curve analysis found that PRACTICE score (area under the curve (AUC)=0.744, 95% CI 0.669 to 0.820) was numerically better than iScore (AUC=0.661, 95% CI 0.577 to 0.745) and Predicting Early Mortality of Ischemic Stroke score (AUC=0.638, 95% CI 0.551 to 0.725) for predicting 90-day mortality.

Conclusions

We developed a simple score to estimate the 90-day mortality of patients who had an AIS treated with MT. But the score needs to be prospectively validated.

Trial registration number

Chinese Clinical Trial Registry (ChiCTR-OOC-17013052).
Translating the Symptom Screening in Pediatrics Tool (SSPedi) into Argentinian Spanish for paediatric patients receiving cancer treatments, and evaluating understandability and cultural relevance in a multiple-phase descriptive study
Authors: Gomez Sergio , Salaverria Carmen , Plenert Erin , Gonzalez Gisela , D'Angelo Gisela , Grimes Allison , Sugalski Aaron , Langevin Anne-Marie , Dupuis Lee , Sung Lillian
Published: April 2021

Objectives

To translate a symptom screening tool developed for paediatric patients receiving cancer therapies called Symptom Screening in Pediatrics Tool (SSPedi) into Argentinian Spanish and to evaluate the understandability and cultural relevance of the translated version of SSPedi among children with cancer and paediatric haematopoietic stem cell transplant (HSCT) recipients.

Methods

We conducted a multiphase, descriptive study to translate SSPedi into Argentinian Spanish. Using two translators, forward and backward translations were performed. The translated version was evaluated by Spanish-speaking paediatric patients 8–18 years of age receiving cancer treatments in two centres in Argentina and El Salvador.

Primary and secondary outcome measures

The primary outcome was patient self-reported difficulty with understanding of the SSPedi instructions and each symptom using a 5-point Likert scale. Secondary outcomes were incorrect understanding of the SSPedi instructions, symptoms and response scale determined by cognitive interviews with the patients and rated using a 4-point Likert scale. Cultural relevance was assessed qualitatively.

Results

There were 30 children enrolled and included in cognitive interviews; 16 lived in Argentina and 14 lived in El Salvador. The most common types of Spanish spoken were Central American (17, 57%) followed by South American (10, 33%) and Castilian (3, 10%). No changes to Argentinian Spanish SSPedi were required based on the outcomes or qualitative comments. No issues with cultural relevance were identified by any of the respondents.

Conclusions

We translated and finalised Argentinian Spanish SSPedi. Future research will focus on its use to describe bothersome symptoms by Argentinian Spanish-speaking children.
Variables associated with COVID-19 severity: an observational study of non-paediatric confirmed cases from the general population of the Basque Country, Spain
Authors: Vrotsou Kalliopi , Rotaeche Rafael , Mateo-Abad Maider , Machón Mónica , Vergara Itziar
Published: April 2021

Objectives

To investigate which were the most relevant sociodemographic and clinical variables associated with COVID-19 severity, and uncover how their inter-relations may have affected such severity.

Design

A retrospective observational study based on electronic health record data.

Participants

Individuals ≥14 years old with a positive PCR or serology test, between 28 February and 31 May 2020, belonging to the Basque Country (Spain) public health system. Institutionalised and individuals admitted to a hospital at home unit were excluded from the study.

Main outcome measure

Three severity categories were established: primary care, hospital/intensive care unit admission and death.

Results

A total of n=14 197 cases fulfilled the inclusion criteria. Most variables presented statistically significant associations with the outcome (p<0.0001). The Classification and Regression Trees recursive partitioning methodology (based on n=13 792) suggested that among all associations, those with, age, sex, stratification of patient healthcare complexity, chronic consumption of blood and blood-forming organ, and nervous system drugs, as well as the total number of chronic Anatomical Therapeutic Chemical types were the most relevant. Psychosis also emerged as a potential factor.

Conclusions

Older cases are more likely to experience more severe outcomes. However, the sex, underlying health status and chronic drug consumption may interfere and alter the ageing effect. Understanding the factors related to the outcome severity is of key importance when designing and promoting public health intervention plans for the COVID-19 pandemic.
Hydroxychloroquine treatment in European patients with lupus erythematosus: dosing, retinopathy screening and adherence
Authors: Osmani Zgjim , Schrama Thijs J , Zacouris-Verweij Wendy , Andersen Jeanette , Frankel Susan , Bultink Irene E M , Cornet Alain , van Vollenhoven Ronald F
Published: April 2021

Background

Use of hydroxychloroquine (HCQ) is common in patients with lupus erythematosus. Long-term use (ie, ≥5 years) and high-dose HCQ (ie, >5 mg/kg/day) are both risk factors for developing HCQ retinopathy. Advances in our understanding of HCQ retinopathy have led to changes in the recommendations for HCQ dosing and retinopathy screening. The latest EULAR guidelines for the management of SLE recommend a maximum HCQ dose of 5 mg/kg/day and ophthalmological screening at baseline and annually after 5 years of HCQ treatment.

Objectives

This study aimed to assess whether the EULAR guidelines are affecting HCQ prescription patterns and screening frequencies in Europe. Furthermore, we inventoried adherence to HCQ.

Results

The online questionnaire was completed by 2936 patients with systemic, cutaneous or juvenile lupus from 33 countries. The majority were female (86.5%) and diagnosed with SLE (81.2%). Among those taking HCQ, the median HCQ dose reported was 4.26 mg/kg/day. More than one-third of respondents (36.8%) exceeded the recommended maximal HCQ dose of 5 mg/kg/day. Baseline ophthalmological screening had been done in 857 out of 1017 respondents diagnosed in the past 10 years (84.3%). Of patients using HCQ ≥5 years, 69.2% reported yearly retinopathy screening. Lastly, 17.3% of patients reported that they skipped HCQ once a week or more often.

Conclusion

The results of our study demonstrate that higher than recommended dosages of HCQ are prescribed to more than one-third of patients with lupus in Europe. Recent recommendations regarding screening for retinopathy are incompletely implemented.
Haemostatic therapy in spontaneous intracerebral haemorrhage patients with high-risk of haematoma expansion by CT marker: a systematic review and meta-analysis of randomised trials
Authors: Nie Ximing , Liu Jingyi , Liu Dacheng , Zhou Qi , Duan Wanying , Pu Yuehua , Yang Zhonghua , Wen Miao , Sun Haixin , Wang Wenzhi , Sun Shengjun , Gu Hongqiu , Liu Liping
Published: April 2021

Background and purpose

Current randomised controlled trials (RCTs) showed an uncertain benefit of haemostatic therapy on preventing haematoma expansion and improving the outcome in patients with intracerebral haemorrhage (ICH). This meta-analysis aims to systematically evaluate the effect of haemostatic agents on the prevention of haemorrhage growth in patients with high-risk spontaneous ICH predicted by CT signs in RCTs.

Methods

A comprehensive search of PubMed, EMBASE and Cochrane library from 1 January 2005 to 30 June 2021 was conducted. RCTs that compared haemostatic agents with placebo for the treatment of spontaneous patients with ICH with high-risk haemorrhage growth were included. The primary endpoint was haematoma expansion at 24 hours. Other major endpoints of interest included 90-day functional outcome and mortality.

Results

The meta-analysis included four RCTs that randomised 2666 patients with ICH with high-risk haemorrhage growth. Haemostatic therapy reduced the rate of haematoma expansion at a marginally statistically significant level when compared with placebo (OR 0.84; 95% CI 0.70 to 1.00; p=0.051). Subgroup analysis for patients with black hole sign on CT revealed a significant reduction of haematoma expansion with haemostatic therapy (OR 0.61; 95% CI 0.39 to 0.94; p=0.03). However, both the primary analysis and subgroup analyses showed that haemostatic therapy could not reduce the rate of poor functional outcome (modified Rankin Scale >3) or death.

Conclusions

Haemostatic therapy showed a marginally significant benefit in reducing early haematoma expansion in patients with high-risk spontaneous ICH predicted by markers on CT scan. However, no significant improvement in functional outcome or reduction of mortality was observed.
Tranexamic acid for acute intracerebral haemorrhage growth based on imaging assessment (TRAIGE): a multicentre, randomised, placebo-controlled trial
Authors: Liu Jingyi , Nie Ximing , Gu Hongqiu , Zhou Qi , Sun Haixin , Tan Ying , Liu Dacheng , Zheng Lina , Zhao Jiahui , Wang Yan , Cao Yibin , Zhu Haomeng , Zhang Yunpeng , Yi Lijin , Pu Yuehua , Wen Miao , Yang Zhonghua , Sun Shengjun , Wang Wenzhi , Zhao Xingquan , Liu Liping , Wang Yongjun
Published: April 2021

Background

Studies show tranexamic acid can reduce the risk of death and early neurological deterioration after intracranial haemorrhage. We aimed to assess whether tranexamic acid reduces haematoma expansion and improves outcome in intracerebral haemorrhage patients susceptible to haemorrhage expansion.

Methods

We did a prospective, double-blind, randomised, placebo-controlled trial at 10 stroke centres in China. Acute supratentorial intracerebral haemorrhage patients were eligible if they had indication of haemorrhage expansion on admission imaging (eg, spot sign, black hole sign or blend sign), and were treatable within 8 hours of symptom onset. Patients were randomly assigned (1:1) to receive either tranexamic acid or a matching placebo. The primary outcome was intracerebral haematoma growth (>33% relative or >6 mL absolute) at 24 hours. Clinical outcomes were assessed at 90 days.

Results

Of the 171 included patients, 124 (72.5%) were male, and the mean age was 55.9±11.6 years. 89 patients received tranexamic acid and 82 received placebo. The primary outcome did not differ significantly between the groups: 36 (40.4%) patients in the tranexamic acid group and 34 (41.5%) patients in the placebo group had intracranial haemorrhage growth (OR 0.96, 95% CI 0.52 to 1.77, p=0.89). The proportion of death was lower in the tranexamic acid treatment group than placebo group (8.1% vs 10.0%), but there were no significant differences in secondary outcomes including absolute intracranial haemorrhage growth, death and dependency.

Conclusions

Among patients susceptible to haemorrhage expansion treated within 8 hours of stroke onset, tranexamic acid did not significantly prevent intracerebral haemorrhage growth. Larger studies are needed to assess safety and efficacy of tranexamic acid in intracerebral haemorrhage patients.
COVID-19 pandemic − Inequities and inequalities to exercise and their consequences on the physical and mental health of women with cardiovascular disease: recommendations on how to address the needs of women
Authors: O’Neill C.D. , Vidal-Almela S. , Tulloch H.E. , Coutinho T. , Prince S.A. , Reed J.L.
Published: April 2021

The coronavirus disease (COVID-19) pandemic disproportionately affects those with pre-existing conditions and has exacerbated gender inequalities. Cardiovascular disease (CVD) is the leading cause of death among Canadian women. Exercise improves physical and mental health and CVD management. Amid the pandemic, women are experiencing an increase in caregiving responsibilities, job insecurities, and domestic violence creating competing demands for prioritizing their health. Recommendations on how to meet the unique needs of Canadian women with CVD through exercise are provided.

Novelty: Exercise recommendations amid the pandemic for women with CVD need to be flexible, feasible, and fun.
Linking changes in sedimentary Cladocera assemblages to limnological variables in 67 Sudbury (Ontario, Canada) lakes reflecting various degrees of metal smelter impacts
Authors: Simmatis Brigitte , Paterson Andrew M. , Edwards Brie A. , Smol John P.
Published: April 2021

Despite extensive records of chemical recovery, relatively little is known about recovery of aquatic biota in Sudbury (Ontario, Canada). Cladocera (Branchiopoda) are key components of lake food webs, and understanding spatial patterns in their assemblages may emphasize ecosystem recovery challenges. Paleolimnological techniques complement and provide long-term context to modern monitoring. Cladoceran remains from the surface sediments of 67 lakes across a gradient of smelter impacts were examined to determine which measured limnological factors most influenced assemblage composition. Lakes were divided into four categories by acidification histories and location: Acidified (pH < 6) Urban, Non-urban Acidified, Acidified Killarney, and Reference (pH > 6) lakes. Specific conductance, nutrients, alkalinity, and lake depth significantly structured assemblages. Most assemblages were dominated by generalist taxa. Relative abundances of Alona taxa varied strongly along alkalinity and pH gradients. Lakes with high metal concentrations were generally less diverse and dominated by generalist taxa, although metals often co-occurred with other stressors. Recovery targets could be affected by these chemical factors. These data provide useful information for future environmental inferences from cladocerans in metal smelting regions.
Landscape use by fishers (Pekania pennanti): core areas differ in habitat than the entire home range
Authors: Kordosky Jennifer R. , Gese Eric M. , Thompson Craig M. , Terletzky Patricia A. , Purcell Kathryn L. , Schneiderman Jon D.
Published: April 2021

Home ranges have long been studied in animal ecology. Core areas may be used at a greater proportion than the rest of the home range, implying the core contains dependable resources. The Pacific fisher (Pekania pennanti (Erxleben, 1777)) is a rare mesocarnivore occupying a small area in the Sierra Nevada Mountains, California, USA. Once statewide, fishers declined in the 1900s due to trapping, habitat fragmentation, and development. Recently, drought induced by climate change may be affecting this population. We examined space use of fishers in their core versus their home range for levels of anthropogenic modifications (housing density, road density, silvicultural treatments), habitat types, and tree mortality. We found core areas contained more late-successional forest and minimal human activity compared with their territory. Their core had higher levels of dense canopy and higher amounts of conifer cover, while minimizing the amount of buildings, developed habitat, and low canopy cover. Fishers may in effect be seeking refugia by minimizing their exposure to these elements in their core. Conserving landscape components used by fishers in their core areas will be important for the persistence of this isolated population.
Gravitationally collapsing stars in f(R) gravity
Authors: Jaryal Suresh C. , Chatterjee Ayan
Published: April 2021

The gravitational dynamics of a collapsing matter configuration which is simultaneously radiating heat flux is studied in f(R) gravity. Three particular functional forms in f(R) gravity are considered to show that it is possible to envisage boundary conditions such that the end state of the collapse has a weak singularity and that the matter configuration radiates away all of its mass before collapsing to reach the central singularity.
Nonparametric Bifurcation and Anti-Control of Hyperchaos in a Memristor–Memcapacitor-Based Circuit
Authors: Deng Yue , Li Yuxia
Published: April 2021

In this paper, a new memristor model and a new memcapacitor model are proposed. Based on the two models, a simple chaotic circuit is constructed. Due to the special characteristics of the memristor and memcapacitor, the proposed circuit has two-dimensional normally hyperbolic manifolds of equilibria, and nonparametric bifurcation can occur when the conditions supporting the normal hyperbolicity of such manifolds are not satisfied. By adding a nonlinear controller to the proposed circuit, an anti-controlled system is realized, which has hyperchaotic dynamic behaviors under some suitable control parameters. The stability of equilibrium points and dynamic properties of the original system and the anti-controlled system are explored by Lyapunov exponents, bifurcation diagrams and so on. Furthermore, the anti-controlled system is applied to design a random sequence generator on digital signal processor platform.
Minimal Universal Model for Chaos in Laser with Feedback
Authors: Meucci Riccardo , Euzzor Stefano , Tito Arecchi F. , Ginoux Jean-Marc
Published: April 2021

We revisit the model of the laser with feedback and the minimal nonlinearity leading to chaos. Although the model has its origin in laser physics, with peculiarities related to the [Formula: see text] laser, it belongs to the class of the three-dimensional paradigmatic nonlinear oscillator models giving chaos. The proposed model contains three key nonlinearities, two of which are of the type [Formula: see text], where [Formula: see text] and [Formula: see text] are the fast and slow variables. The third one is of the type [Formula: see text], where [Formula: see text] is an intermediate feedback variable. We analytically demonstrate that it is essential for producing chaos via local or global homoclinic bifurcations. Its electronic implementation in the range of kilo Hertz region confirms its potential in describing phenomena evolving on different time scales.