bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-label classification of reduced-lead ECGs using an interpretable deep convolutional neural network
Authors: Wickramasinghe Nima L , Athif Mohamed
Published: May 2022

Objective. We propose a model that can perform multi-label classification on 26 cardiac abnormalities from reduced lead Electrocardiograms (ECGs) and interpret the model. Approach. PhysioNet/computing in cardiology (CinC) challenge 2021 datasets are used to train the model. All recordings shorter than 20 s are preprocessed by normalizing, resampling, and zero-padding. The frequency domains of the recordings are obtained by applying fast Fourier transform. The time domain and frequency domain of the signals are fed into two separate deep convolutional neural networks. The outputs of these networks are then concatenated and passed through a fully connected layer that outputs the probabilities of 26 classes. Data imbalance is addressed by using a threshold of 0.13 to the sigmoid output. The 2-lead model is tested under noise contamination based on the quality of the signal and interpreted using SHapley Additive exPlanations (SHAP). Main results. The proposed method obtained a challenge score of 0.55, 0.51, 0.56, 0.55, and 0.56, ranking 2nd, 5th, 3rd, 3rd, and 3rd out of 39 officially ranked teams on 12-lead, 6-lead, 4-lead, 3-lead, and 2-lead hidden test datasets, respectively, in the PhysioNet/CinC challenge 2021. The model performs well under noise contamination with mean F1 scores of 0.53, 0.56 and 0.56 for the excellent, barely acceptable and unacceptable signals respectively. Analysis of the SHAP values of the 2-lead model verifies the performance of the model while providing insight into labeling inconsistencies and reasons for the poor performance of the model in some classes. Significance. We have proposed a model that can accurately identify 26 cardiac abnormalities using reduced lead ECGs that performs comparably with 12-lead ECGs and interpreted the model behavior. We demonstrate that the proposed model using only the limb leads performs with accuracy comparable to that using all 12 leads.
Quantum many-body scars and Hilbert space fragmentation: a review of exact results
Authors: Moudgalya Sanjay , Bernevig B Andrei , Regnault Nicolas
Published: May 2022

The discovery of quantum many-body scars (QMBS) both in Rydberg atom simulators and in the Affleck–Kennedy–Lieb–Tasaki spin-1 chain model, have shown that a weak violation of ergodicity can still lead to rich experimental and theoretical physics. In this review, we provide a pedagogical introduction to and an overview of the exact results on weak ergodicity breaking via QMBS in isolated quantum systems with the help of simple examples such as the fermionic Hubbard model. We also discuss various mechanisms and unifying formalisms that have been proposed to encompass the plethora of systems exhibiting QMBS. We cover examples of equally-spaced towers that lead to exact revivals for particular initial states, as well as isolated examples of QMBS. Finally, we review Hilbert space fragmentation, a related phenomenon where systems exhibit a richer variety of ergodic and non-ergodic behaviors, and discuss its connections to QMBS.
Manipulation of breather waves with split-dispersion cascaded fibers
Authors: Deng Zhixiang , Zhang Jin , Fan Dianyuan , Zhang Lifu
Published: May 2022

A stabilization scheme is proposed for the dynamics of breather waves induced by the coherent-seed modulation instability based on manipulation of phase-space trajectory. Theoretical and numerical analysis show that carefully dispersion- and nonlinearity-managed cascades of fiber configuration allows the system evolution to be stabilized around an elliptic center point, forming stable pulse trains with ultrahigh contrast efficiently. We also demonstrate that the scheme proposed works equally well for near-separatrix dynamics. Our results provide an alternative means to control the unsteady nonlinear waves by abruptly changing the waveguide properties.
Design and simulation of a gas sensitive junctionless FinFET based on conducting polymer as the gate material
Authors: Mehrdad Farzad , Ahangari Zahra
Published: May 2022

In this study, we demonstrate a multi-gas sensing device utilizing junctionless Fin-shaped Field Effect Transistor (FinFET) with conducting polymer as the gate material. The higher gas response is explained based on workfunction modulation of the conducting polymer gate, Poly(p-phenylene), upon gas molecule absorption. By definition, threshold voltage and off-state current variation before and after gas absorption are considered as two different measures for assessing the responsivity and sensitivity of the sensor. Basically, the main focus of this paper is designing a low power device, in which the change in the electrical characteristics of the device under gas exposure can be detected even in the absence of the gate bias. The high sensitivity of the proposed FinFET device as a gas sensor is mainly attributed to the large surface area of the 3D structure. We optimize the gas-sensing properties by investigating impact of critical physical and structural design parameters on the responsivity and selectivity of the sensor. In addition, statistical analysis is carried out to calculate coefficient of variation (CV) measure, for assessing the change in the responsivity of the gas sensor based on variation of main design parameters. Our results provide a route to design a low power CMOS compatible gas sensor that has fast response with high distinguishing selectivity and can be scaled down to nanoscale regime.
Fishing activities of Kinh people1 in the Southwest Sea: Ethnic knowledge approach
Authors: Thu H N , Loc D H
Published: May 2022

Ethnic knowledge is accumulated based on the practical experience of that ethnic group in a specific ecological and cultural environment and is transmitted from generation to generation. Ethnic knowledge is cognitive and affects behaviour in people’s lives. Based on previous studies on Vietnamese fishermen in the Southwest Sea, ethnic knowledge is essential in fishing activities. The fishermen have accumulated and thoroughly applied this knowledge system to forecast the weather and classify marine resources to exploit the fish populations in the best way. By primary data collected in the community for two years, from 2019 to 2020, the article describes this particular knowledge system to realise its importance in the fishing activities of Kinh fishermen.
The SLIQ Approach to Sustainable Tourism Development: Case Study of Hai Tac Islands
Authors: Nghia L H
Published: May 2022

Island tourism has always been one of the most attractive kinds of tourism globally. However, it is challenging to analyze tourist development on an island since it is a dynamic entity with unique characteristics. In recent years, island tourism development has faced some challenges, such as climate change, environmental degradation, economic downturns, cultural erosion, and diseases like the COVID-19 pandemic. Thus, sustainable development is key to ensuring the destination can keep up with demand. The author opted for the SLIQ concept as a new approach while seeking innovative ways to tackle old problems. The paper selected Hai Tac Islands, Vietnam, as a case study, using qualitative research and conducting in-depth interviews with six residents. The findings showed that local authorities should govern the island as living entity requiring a distinct way of thinking because island destinations are susceptible to economic perils and environmental issues. The paper also confirmed that sustainable economic growth, environmental protection, and human fairness should be the three goals of public policy when it comes to planning and managing inclusive tourism island development.
Accuracy assessment of land use land cover LULC 2020 (ESRI) data in Con Dao island, Ba Ria – Vung Tau province, Vietnam
Authors: Huan V D
Published: May 2022

Managing land use in an efficient way results in food security and economic development. Recently, the Environmental Systems Research Institute (ESRI) announced a new product, LULC 2020 (ESRI), that has been produced by the classification with Artificial Intelligence (AI) technique of satellite data at 10-meter resolution. This data has global coverage and is freely available on the internet, but the questions are how good the data is and how to apply it to local practice and land use system. This study aims to answer those questions by emphasizing the accuracy assessment of the LULC 2020 (ESRI) data. The systematic samples of 281 test sites and the Geographic Information Systems (GIS) analysis have been conducted by using the Confusion matrix method in comparison with the visualization of high-resolution data from Google Earth images and field survey data. Topographic information data such as Digital Elevation Model (DEM) and slope data have been integrated for achieving better data accuracy, with overall accuracy increasing from 79.72% (Overall Kappa Statistic 0.421) to 84.34% (Overall Kappa Statistic 0.589). The improved land use types are hilly non-forest, other agricultural, and flat unused types that are typical for the local land use classification system. The study provides a new data processing method to apply LULC 2020 (ESRI) for land use mapping in Con Dao island, Ba Ria - Vung Tau province in the East Sea of Vietnam.
Bilayer silk fibroin/sodium alginate scaffold promotes vascularization and advances inflammation stage in full-thickness wound
Authors: Shen Ying , Wang Xinyu , Wang Yiyu , Guo Xiaodong , Yu Keda , Dong Kuo , Guo Yajin , Cai Cuiling , Li Binbin
Published: May 2022

An ideal wound dressing for full-thickness wound regeneration should offer desirable biocompatibility, adequate mechanical properties, barrier function, and cellular regulation. Here, a bilayer scaffold resembling the hierarchical structure of human skin was developed using silk fibroin and sodium alginate. The upper membrane was prepared through casting and functioned as the epidermis, whereas the lower porous scaffold was prepared by freeze-drying and mimicked extracellular matrix structures. The membrane had nonporous structure, desirable mechanical properties, moderate hydrophilic surface, and suitable water vapor transmission rate, whereas the porous scaffold revealed 157.61 ± 41.67 µm pore size, 86.10 ± 3.60% porosity, and capability of stimulating fibroblast proliferation. The combination of the two structures reinforced the tensile strength by five-fold and provided protection from wound dehydration. A suitable degradation rate reduced potential administration frequency. Furthermore, an in vivo rabbit full-thickness wound healing test demonstrated that the bilayer scaffold facilitated wound closure, granulation tissue formation, re-epithelialization and skin component transition towards normal skin by providing a moist wound environment, advancing the inflammation stage, and stimulating angiogenesis. Collectively, as an off-the-shelf and cell-free wound dressing with single topical administration, the bilayer scaffold is a promising wound dressing for full-thickness wound regeneration.
On the dynamic wear behavior of misaligned journal bearing with profile modification under mixed lubrication
Authors: Guo Juan , Xiang Guo , Wang Jiaxu , Song Yankui , Cai Jianlin , Dai Haiming
Published: May 2022

In this paper, we introduce a method of one-side profile modification for the misaligned journal bearing to reduce the edge wear caused by the journal defection under the external load. To predict the bearing wear behavior, a dynamic wear model considering mixed lubrication based on friction fatigue mechanism is applied. The positive role of the one-side profile modification in mitigating the negative effects caused by journal misalignment is confirmed by numerical calculations. The optimal modification parameter setting is determined with the calculation results, and the dependence of the optimal modification parameters on the different operating conditions, including external force and shaft length, are explored. The results indicate that the reasonable design of one-sided profile modification can effectively increase the minimum film thickness at the edge of the bearing and reduce the rough contact, thereby improve the anti-wear performance of the misaligned journal bearing under mixed lubrication. The present study could provide an engineering approach for the anti-wear optimal design in misaligned journal bearing applications.
Plasma jet printing of metallic patterns in zero gravity
Authors: Gutierrez Daniel H , Doshi Pranay , Nordlund Dennis , Gandhiraman Ram P
Published: May 2022

Printing of metallic, semiconducting and other materials is a key step in printed and flexible electronics. Plasma jet printing is emerging as an alternative to inkjet, aerosol and other competing printing techniques since it is a single step process that does not require post-thermal annealing to obtain consolidated printed films with good adhesion. Here, we provide results for printing metallic films and patterns from flight tests with varying gravity from 0 to 2 G. The conductivity of the as-printed silver film without any post-sintering was 12% of the bulk value for silver. As expected, the absence of gravity has no adverse impact on the print quality since the ink content along with the plasma is forcefully ejected by the applied electric field towards the substrate, while the successful flight test itself attests to the robustness of the printer and the printing technique.
Electron transport tuning of graphene by helium ion irradiation
Authors: Nakaharai Shu , Iwasaki Takuya , Morita Yoshifumi , Moriyama Satoshi , Ogawa Shinichi
Published: May 2022

This article reviews charge carrier transport phenomena in single-layer graphene, in which crystalline defects are generated by helium-ion-beam irradiation using a helium-ion microscope. Crystalline defects work as electron scatterers, and the conductivity drastically decays as ion dose increases. Moreover, real-time conductivity monitoring during ion beam scans over the graphene surface is demonstrated. In cryogenic measurements under magnetic fields, defective graphene exhibits negative magnetoresistance, suggesting that strong localization occurred in this two-dimensional electron system, which survived even at room temperature. The localized state contributes to inducing a transport gap around the Dirac point, where the density of states is at its minimum, and it enables field-effect control of the carrier transport by tuning the carrier density. The fabrication and operation of field-effect transistors with defective graphene channels are demonstrated.
Kac-Rice formulas and the number of solutions of parametrized systems of polynomial equations
Authors: Feliu Elisenda , Sadeghimanesh AmirHosein
Published: May 2022

Kac-Rice formulas express the expected number of elements a fiber of a random field has in terms of a multivariate integral. We consider here parametrized systems of polynomial equations that are linear in enough parameters, and provide a Kac-Rice formula for the expected number of solutions of the system when the parameters follow continuous distributions. Combined with Monte Carlo integration, we apply the formula to partition the parameter region according to the number of solutions or find a region in parameter space where the system has the maximal number of solutions. The motivation stems from the study of steady states of chemical reaction networks and gives new tools for the open problem of identifying the parameter region where the network has at least two positive steady states. We illustrate with numerous examples that our approach successfully handles a larger number of parameters than exact methods.
Sub-critical exponential random graphs: concentration of measure and some applications
Authors: Ganguly Shirshendu , Nam Kyeongsik
Published: May 2022

The exponential random graph model (ERGM) is a central object in the study of clustering properties in social networks as well as canonical ensembles in statistical physics. Despite some breakthrough works in the mathematical understanding of ERGM, most notably by Bhamidi, Bresler, and Sly [Ann. Appl. Probab. 21 (2011), pp. 2146–2170] through the analysis of a natural Heat-bath Glauber dynamics, and by Chatterjee and Diaconis [Ann. Statist. 41 (2013), pp. 2428–2461; Eldan [Geom. Funct. Anal. 28 (2018), pp. 1548–1596; and Eldan and Gross [Ann. Appl. Probab. 28 (2018), pp. 3698–3735] via a large deviation theoretic perspective, several basic questions have remained unanswered owing to the lack of exact solvability unlike the much studied Curie-Weiss model (Ising model on the complete graph). In this paper, we establish a series of new concentration of measure results for the ERGM throughout the entire sub-critical phase, including a Poincaré inequality, Gaussian concentration for Lipschitz functions, and a central limit theorem. In addition, a new proof of a quantitative bound on the

W
1

−

W_1-

Wasserstein distance to Erdős-Rényi graphs, previously obtained by Reinert and Ross [Ann. Appl. Probab. 29 (2019), pp. 3201–3229], is also presented. The arguments rely on translating temporal mixing properties of Glauber dynamics to static spatial mixing properties of the equilibrium measure and have the potential of being useful in proving similar functional inequalities for other Gibbsian systems beyond the perturbative regime.
Finitude homologique des foncteurs sur une catégorie additive et applications
Authors: Djament Aurélien , Touzé Antoine
Published: May 2022

We give sufficient conditions which ensure that a functor of finite length from an additive category to finite-dimensional vector spaces has a projective resolution whose terms are finitely generated. For polynomial functors, we study also a weaker homological finiteness property, which applies to twisted homological stability for matrix monoids. This is inspired by works by Schwartz and Betley-Pirashvili, which are generalised; this also uses decompositions à la Steinberg over an additive category that we recently obtained with Vespa. We show also, as an application, a finiteness property for stable homology of linear groups on suitable rings.
Explaining Public Organization Adaptation to Climate Change: Configurations of Macro- and Meso-Level Institutional Logics
Authors: Zhang Fengxiu , Welch Eric W
Published: May 2022

Climate change can bring about large-scale irreversible physical impacts and systemic changes in the operating environment of public organizations. Research on preconditions for organizational adaptation to climate change has produced two parallel lines of inquiry, one focusing on macro-level norms, rules, and expectations and the other on meso-level culture, design, and structure within the organization. Drawing on the meta-theory of institutional logics, this study proposes a configurational approach to link institutionally aware top managers with the combination and reconciliation of macro- and meso-level logics. We identify government authority, professionalism, and market as macro-level institutional logics, and risk-based logic and capacity-based logic as critical meso-level institutional logics. Our theory proposes that (1) the macro- and meso-level institutional logics co-exist in systematic ways as to produce identifiable configurations, (2) the configurations are differentially associated with climate adaptation, and (3) the effects of each logic differ across the configurations. Using a 2019 national survey on approximately 1000 top managers in the largest U.S. transit agencies, we apply latent profile analysis to identify three distinct clusters: forerunner, complacent, and market-oriented. Only the forerunner cluster is adaptive to climate change, whereas the two others are maladaptive. Findings from the multigroup structural equation model also demonstrate varied effects of each institutional logic on adaptation across the clusters, confirming institutional work at play to reconcile and integrate co-existing and potential contradictory logics.
Accretion rates in hierarchical triple systems with discs
Authors: Ceppi Simone , Cuello Nicolás , Lodato Giuseppe , Clarke Cathie , Toci Claudia , Price Daniel J
Published: May 2022

Young multiple systems accrete most of their final mass in the first few Myr of their lifetime, during the protostellar and protoplanetary phases. Previous studies showed that in binary systems the majority of the accreted mass falls on to the lighter star, thus evolving to mass equalization. However, young stellar systems often comprise more than two stars, which are expected to be in hierarchical configurations. Despite its astrophysical relevance, differential accretion in hierarchical systems remains to be understood. In this work, we investigate whether the accretion trends expected in binaries are valid for higher order multiples. We performed a set of three-dimensional smoothed particle hydrodynamics simulations of binaries and of hierarchical triples (HTs) embedded in an accretion disc, with the code phantom. We identify for the first time accretion trends in HTs and their deviations compared to binaries. These deviations, due to the interaction of the small binary with the infalling material from the circumtriple disc, can be described with a semi-analytical prescription. Generally, the smaller binary of an HT accretes more mass than a single star of the same mass as the smaller binary. We found that in an HT, if the small binary is heavier than the third body, the standard differential accretion scenario (whereby the secondary accretes more of the mass) is hampered. Reciprocally, if the small binary is lighter than the third body, the standard differential accretion scenario is enhanced. The peculiar differential accretion mechanism we find in HTs is expected to affect their mass ratio distribution.
Mass-loss implementation and temperature evolution of very massive stars
Authors: Sabhahit Gautham N , Vink Jorick S , Higgins Erin R , Sander Andreas A C
Published: May 2022

Very massive stars (VMS) dominate the physics of young clusters due to their ionizing radiation and extreme stellar winds. It is these winds that determine their lifepaths until expiration. Observations in the Arches Cluster show that VMS all have similar temperatures. The VLT-FLAMES Tarantula Survey analysed VMS in the 30 Doradus (30 Dor) region of the Large Magellanic Cloud (LMC) also finding a narrow range of temperatures, albeit at higher values – likely a metallicity effect. Using mesa, we study the main-sequence evolution of VMS with a new mass-loss recipe that switches from optically thin O-star winds to optically thick Wolf–Rayet-type winds through the model-independent transition mass-loss rate of Vink & Gräfener. We examine the temperature evolution of VMS with mass loss that scales with the luminosity-over-mass (L/M) ratio and the Eddington parameter (Γe), assessing the relevance of the surface hydrogen (H) abundance that sets the number of free electrons. We present grids of VMS models at Galactic and LMC metallicity and compare our temperature predictions with empirical results. Models with a steep Γe dependence evolve horizontally in the Hertzsprung–Russel (HR) diagram at nearly constant luminosities, requiring a delicate and unlikely balance between envelope inflation and enhanced mass loss over the entire VMS mass range. By contrast, models with a steep L/M-dependent mass loss are shown to evolve vertically in the HR diagram at nearly constant Teff, naturally reproducing the narrow range of observed temperatures, as well as the correct trend with metallicity. This distinct behaviour of a steeply dropping luminosity is a self-regulatory mechanism that keeps temperatures constant during evolution in the HR diagram.
Accumulation
Authors: Bailey David
Published: May 2022

Accumulation—as both a process and a concept—has been of central importance to International Political Economy (IPE), especially for those approaches informed by Marxism and critical political economy. Whilst the concept has its roots in some of the key contributions to classical political economy, and especially that of Marx, it remains central to a rich stream of research within the field of IPE. This chapter sets out the importance and meaning of accumulation as a concept within IPE, both tracing its roots within the critical “wing” of the field, before proceeding to consider ways in which it informs ongoing research and scholarship. Accumulation, the chapter argues, is necessarily central to any attempt to delineate the scope of IPE, rightly drawing our attention towards a (the?) fundamental mechanism driving the uneven, changing, and contested expansion of global capitalism, as it develops over time.
Is minocycline effective for treating depression?
Authors: Kacal Michael J.
Published: May 2022

Minocycline HCl, a tetracycline antibiotic, commonly is prescribed to treat acne, but also has substantial antidepressant effects, possibly because inflammation plays a key role in depression. The drug has an acceptable safety profile, but more research is needed to determine how best to use it in treating patients with depression.
Structural racism, health disparities, and opportunities for PA practice
Authors: Fleming Shani , Coplan Bettie , Najera Deanna Bridge , Dominguez Delilah , Devine Patricia J.
Published: May 2022

Social determinants of health are rooted in structural racism. The healthcare community has long recognized the existence of significant race- and ethnicity-related health disparities. Yet pervasive disparities persist despite ongoing calls for institutions and healthcare professionals to promote health equity by addressing bias, discrimination, and social determinants of health. All PAs must take responsibility for the various ways in which we may unwittingly reinforce racism in our profession, and must shift our focus from treating the effects of racism to preventing them.
Providing advanced hospital care at home
Authors: Felix Heidi , Wieringa Kim , Monnig Belinda
Published: May 2022

Interest is growing in hospital-at-home as a model of patient care. Given the pandemic, various entities are exploring methods to deliver hospital-level care in nontraditional settings to clinically stable patients with adequate home support.
Supine Posterior Hoop Plating of Bicondylar Posterior Coronal Shear Tibial Plateau Fractures Without Fibular Osteotomy
Authors: Foos Julia K. , Josifi Erlena , Large Thomas M.
Published: May 2022

Tibial plateau posterolateral fragments, especially those associated with articular depression, are difficult to capture and support with anteriorly or lateral based implants. Applying implants to the posterior plateau has traditionally involved a prone approach or fibular osteotomy, especially when access to both the medial and lateral sides is necessary, such as a bicondylar posterior coronal shear fracture pattern. By combining two previously described techniques for posterolateral rim plating and bicondylar hoop plating, we describe a novel technique to apply a posterior bicondylar hoop implant in the supine position without fibular osteotomy for bicondylar posterior coronal shear injuries.
Acute Liver Failure
Authors: Ledgerwood Chelsea , Villgran Vipin , Mardirossian Nicholas , Dumont Tiffany , DiSilvio Briana
Published: May 2022

Acute liver failure (ALF) is a rare but life-threatening disease process that can result in rapidly progressive encephalopathy, elevated intracranial pressure, and multiorgan failure. In the United States, the 2 most common causes of ALF in the intensive care unit (ICU) are acetaminophen overdose and hypoxic-ischemic hepatopathy. Less common causes of ALF include alcoholic hepatitis, nonacetaminophen drug-induced liver injury, acute viral hepatitis, Wilson's disease, autoimmune hepatitis, and acute fatty liver of pregnancy. Unfortunately, there are many cases in which the cause of liver failure is indeterminate. ALF is an ICU emergency that requires close monitoring, extensive workup to determine etiology, frequent support of hemodynamic, respiratory, and renal function, administration of targeted therapies depending on the cause, utilization of N-acetylcysteine if appropriate, and consideration for liver transplant in select cases. The primary objective of this article is to define, diagnose, and detail the management of ALF in an ICU setting.
Evaluation of Semicircular Canal Function by Video Head Impulse Test in Patients With Labyrinthine Fistula Due to Cholesteatoma
Authors: Fujiwara Keishi , Morita Shinya , Fukuda Atsushi , Hoshino Kimiko , Nakamaru Yuji , Homma Akihiro
Published: May 2022

Objectives:

To evaluate semicircular canal function in patients with labyrinthine fistula (LF) due to cholesteatoma by the video Head Impulse Test (vHIT).

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Ten patients with LF due to cholesteatoma and six without LF underwent vestibular examination.

Intervention:

Diagnostic.

Main Outcome Measures:

The gain in vestibulo-ocular reflex (VOR) and the presence of catch-up saccade were examined for the semicircular canals in patients with LF.

Results:

Seven of 10 cases (70.0%) in the fistula group were judged to have semicircular canal dysfunction based on preoperative evaluation. VOR gains in the patients with LF were significantly lower than those in the patients without LF. VOR gain decreased significantly in accordance with the severity of the LF. The postoperative VOR gain more than 6 months after surgery was significantly improved compared with the preoperative VOR gain.

Conclusions:

The vHIT is thought to be the most suitable method for evaluating semicircular canal function in patients with LF due to cholesteatoma as it is not influenced by middle ear pathology and can evaluate the function of the vertical canals. The vHIT could predict whether a LF is present or not before surgery, and the vHIT is essential for surgery for patients with LF.
Breastfeeding Among Pediatric Emergency Physicians
Authors: Hendrickson Marissa , Davey Cynthia S. , Harvey Brian A. , Schneider Kari
Published: May 2022

Objectives

Physician mothers are at risk for early cessation of breastfeeding, in part because of challenges associated with returning to work. Given the inherent unpredictability of emergency medicine practice, we hypothesized that pediatric emergency medicine (PEM) physicians would face unique challenges in continuing breastfeeding while working in their field. The aims of this study were to determine the 6-month breastfeeding rates of PEM physicians, gain insight into their experiences expressing breast milk while working in pediatric emergency departments, and determine factors that support or discourage successful breastfeeding.

Methods

This study was a cross-sectional survey of members of the American Academy of Pediatrics Section on Emergency Medicine via its quarterly membership survey program. Separate survey pathways were developed for respondents who had ever breastfed and those who had not.

Results

One hundred ninety-three responded; 91 had breastfed, and 102 had not. Of those who breastfed, 90% did so for 6 months or longer. Mean (SD) duration was 12.5 (7.1) months (range, 2–48 months). Of those who expressed milk at work, only 7.6% felt they “always” had sufficient time to pump; 32% felt they “always” had what they considered to be an appropriate location to pump. Breastfeeding duration rate of at least 6 months was higher for those (66%) who “sometimes” to “always” had access to what they felt were appropriate locations to pump than for those (34%) who “never” or “occasionally” did (98 vs 85%, P = 0.048). Eighty-six percent of respondents who had never breastfed reported being “very supportive” of expressing milk at work.

Conclusions

Breastfeeding PEM physicians have high 6-month breastfeeding rates, and many express milk at work. Although colleagues report being supportive, barriers of perceived lack of sufficient time to pump and appropriate pumping locations remain.
Resetting the Course for Foundational Public Health Services (FPHS) During COVID-19
Authors: Tilgner Susan A. , Bickford Beth E. , Beaudrault Sara , Bodden Jaime , Courogen Maria , Flake Marie
Published: May 2022

Context:

Underfunding of the governmental public health system in the United States has been a problem for many years, and the COVID-19 pandemic revealed the significant gaps in public health infrastructure that have resulted from this inadequate funding.

Program:

The states of Ohio, Oregon, and Washington received funding in 2016 to define, measure, and advocate for the foundational public health services (FPHS) delivered by the governmental public health system. They have taken unique but related approaches to strengthening work in the areas of categorical public health programs and the underlying infrastructure and capabilities that support the programmatic work.

Implementation:

All 3 states conducted assessments of gaps and funding needs that have allowed them to advocate for, and receive, limited resources for the governmental public health system. These resources were used to strengthen the public health system in ways that assisted with pandemic response. The pandemic also provided many opportunities for the states to demonstrate the importance of the foundational capabilities (assessment, communications, partnership development, policy, leadership, quality improvement, emergency response planning) and public health infrastructure in the areas of information technology and laboratory capacity. These opportunities allowed states to make progress in obtaining funding for FPHS.

Conclusion:

While heavily focused on the program area of communicable disease control, the pandemic response highlighted the importance of having a robust public health infrastructure that is well supported in the areas of foundational capabilities. Substantial infrastructure investments will allow health departments to close gaps in health inequities; contribute to the significant work needed postpandemic in the areas of chronic disease, behavioral health, climate change, and social determinants of health; and be better prepared for future emergencies.
Sharing Power to Improve Population Health: Participatory Budgeting and Policy Making
Authors: Bittle Benjii Bryan
Published: May 2022

In Pierce County, Washington, 6 Communities of Focus face tough health disparities. To engage members of communities that have been marginalized for generations, Tacoma-Pierce County Health Department piloted participatory budgeting. Through this 5-step process, the health department and its partners make investments significant enough to bring community members to the table, codesign solutions, and put the final decision-making power to fund programs and services in their hands. Sharing power through this process is an innovative approach and has been adapted during the COVID-19 pandemic to build trust essential to resilience and recovery. After a series of successful projects bringing participatory budgeting to scale, the Public Health Centers for Excellence is piloting participatory policy making and disseminating both practices broadly.
Using Community-Based System Dynamics to Address Structural Racism in Community Health Improvement
Authors: Gullett Heidi L. , Brown Gregory L. , Collins Delores , Halko Martha , Gotler Robin S. , Stange Kurt C. , Hovmand Peter S.
Published: May 2022

Context:

Structural racism is a profound determinant of health resulting in pervasive health inequities for people of color. Despite the recognition of structural racism as a complex, dynamic system, we lack a shared vision of the system that would enable identification of solutions for equitable systems transformation.

Policy:

Through a public health–led community health improvement planning process, a cross-sector consortium implemented community-based system dynamics to provide a systems science lens to guide efforts to eliminate structural racism.

Implementation:

In group model building sessions involving diverse stakeholders, community-based system dynamics was used to bring together cross-sector stakeholders to create causal loop diagrams of the system of structural racism. Participants identified potential leverage points for actionable focus to eliminate structural racism.

Evaluation:

Causal loop diagrams of structural racism generated through group model building demonstrate complex dynamics in the areas of criminal justice, education and economic opportunity, health and health care, quality of life, racial trauma and healing, and a promising system transformative solution through perspective transformation.

Discussion:

Community-based system dynamics, employed in the context of local community health improvement planning, engages stakeholders in systems thinking through sharing lived experience to create system maps of structural racism and identify leverage points and transportable solutions that foster health equity. These informal maps serve as the foundation for formal computer simulation models that will guide systemic action on high-yield, community-driven solutions to eliminate structural racism.
Lincoln Trail District Health Department's Innovative Shift to Public Health 3.0
Authors: Poynter Elizabeth W. , Goff Stefanie P. , Pollock Lisa C. , Blair Lyndsey K. , Phillips Melissa D. , Best Sara J.
Published: May 2022

The Lincoln Trail District Health Department's (LTDHD) transformation into the Public Health 3.0 model was applied from frameworks established through public health accreditation standards and innovative strategies. The awareness of strengths and weaknesses discovered through strategic planning and a culture of quality improvement built over time has created numerous performance improvement opportunities. Those opportunities established greater collaboration and transparency between departments. The shift to the Public Health 3.0 and focus on Foundational Public Health Services model made for an easier transition into Kentucky's larger plan for public health transformation. LTDHD continues to provide public health protection by preventing the spread of disease, ensuring the safety of food, air, and water quality, supporting maternal and child health, improving access to clinical care services, and preventing chronic disease and injury.
Bridging the Gap Between Transformative Practices and Traditional Public Health Approaches
Authors: Egbuonye Nafissa Cisse , Sesterhenn Lisa , Goldman Bailey , Pikora Joshua , Parmater Jared
Published: May 2022

Context:

The release of the 24/7 Wall Street publication in November 2018 labeling the Waterloo-Cedar Falls, Iowa, community as the worst city for Black Americans to live in the United States sparked conversations and calls to action across the community—from the kitchen table to the boardroom. It became clear that this was a critical moment for innovative leadership from public health.

Program:

To bring together these individual efforts, and diverse perspectives, toward deeper understanding and system transformation, Black Hawk County Public Health, with support from Engaging Inquiry, adopted a participatory action approach of dynamic system mapping and systemic strategy design.

Implementation:

Using participatory methodologies and tools for systems analysis, stakeholders developed a system map visualizing the patterns driving inequitable outcomes, but also the bright spots and resiliencies, identified and experienced across the community. This map, populated with local stories and data, represents a “theory of context,” and offered a foundation of understanding and connectivity upon which high-impact opportunities for engagement could be identified and developed. By working across sectors and building on existing energy and resources present within the community, systemic strategies were designed to foster critical shifts toward a healthier community.

Evaluation:

A developmental evaluation approach is applied throughout the mapping process to maximize rapid learning and adaption of a complex challenge when stakeholder engagement and trust building is essential.

Discussion:

Participatory systems mapping shows promise as an adaptive approach to allow public health departments to go beyond the traditional roles of public health practice, to collaborate with nontraditional partners, and implement strategies, initiatives, and/or policies that explicitly address inequity and the social determinants of health. Adaptive strategies provide opportunities for the local public health system to identify community health improvement strategies that align with Public Health 3.0.
A National Study of Patient Safety Culture and Patient Safety Goal in Chinese Hospitals
Authors: Huang Huanhuan , Xiao Ling , Chen Zhiyu , Cao Songmei , Zheng Shuangjiang , Zhao Qinghua , Xiao Mingzhao
Published: May 2022

Objectives

This study aimed to measure the patient safety culture and the current practice of patient safety goals in China.

Methods

This cross-sectional survey was conducted between November 2020 and November 2021. The 12-dimensions Hospital Survey on Patient Safety Culture questionnaire and the 14-items Survey on the Current Practice of Patient Safety Goal questionnaire were electronically distributed to 8164 healthcare providers across 26 provinces in China. Data were analyzed using descriptive statistics, correlation analysis, and multivariate linear regression.

Results

A total of 8164 surveys were received, of which 7765 were valid and analyzed. The average positive response rate for the Hospital Survey on Patient Safety Culture survey was 69.68% (43.41%–91.54%). The percentage of positive responses in 5 dimensions (organizational learning, teamwork within units, feedback about error, management support for safety, and teamwork across units) was above the control limits, and 3 (nonpunitive response to error, staffing, and frequency of event reporting) were below the control limits. The average positive response rate for the Survey on the Current Practice of Patient Safety Goal survey was 96.11%. Patient safety culture was positively related to the current practice of patient safety goals (r = 0.34, P < 0.001).

Conclusions

Our study concludes that although healthcare providers in China feel positively toward patient safety culture and practicably toward patient safety goals, considerable work is still needed to promote a patient safety movement.
The Safety of Continued Oral Anticoagulation Therapy in Joint Injections and Aspirations
Authors: Kotecha Jalpa , Gration Betty , Hunt Beverley J. , Goodman Anna L. , Malaiya Ritu
Published: May 2022

Performing joint aspirations and injections on patients taking long-term oral anticoagulants poses a clinical conundrum. This review aimed to quantify the safety of performing joint procedures in these patients in terms of bleeding risk. In addition, it aimed to identify, in those receiving vitamin K antagonists, what level of international normalized ratio (INR) is the safest.

A review of the medical literature was performed (electronic searches in Ovid [MEDLINE], EMBASE, and the Cochrane Library). English language original reports of patients undergoing joint injections or aspirations performed on anticoagulant therapy, published within the last 10 years, were included.

Seven studies met the inclusion criteria. Patients were taking a variety of anticoagulants: warfarin, acenocoumarol, and direct oral anticoagulants. Four cases of hemorrhage were reported after 5427 procedures, over a pooled 32-year period, across 9 centers. The INR values were available for 3 cases with bleeding complications: values were 1.9, 2.3, and 3.4.

Authors of all studies concluded that joint injection is safe in patients on anticoagulants. A variety of joints and approaches, reversal, or withholding of anticoagulation and bridging with low molecular weight heparin did not seem to alter bleeding risk. Bleeding complications remained low even in those with renal or hepatic impairment or those taking concomitant antiplatelets.

In conclusion, joint aspiration and injection are safe in patients taking anticoagulants. Anticoagulation should not be routinely discontinued in these patients; decisions should be made on a case-by-case basis. Because of low event numbers, a recommended safe maximum INR value for joint procedures cannot be determined.
Controversies in Systemic Lupus Erythematosus 2021
Authors: Porta Sabrina Valeria , Enfrein Antoine , Houssiau Frédéric , García Mercedes , Furie Richard , Rovin Brad H. , Alarcón Graciela S. , Pons-Estel Bernardo A. , Pons-Estel Guillermo J.
Published: May 2022

Lupus nephritis (LN) affects about a third of patients with systemic lupus erythematosus. Although the use of conventional therapy has significantly improved the prognosis of LN, the response to treatment remains suboptimal, with high rates of relapse and the occurrence of end-stage kidney disease. The implementation of new diagnostic and treatment strategies aimed at improving these outcomes represents a necessary paradigm shift in the management of LN.

Herein, we discuss different points of view regarding these still unresolved issues; these comments represent a debate that took place during the virtual congress of the Pan American League of Associations for Rheumatology (PANLAR) and which was organized by the PANLAR Lupus Study Group, GLADEL (Grupo Latino Americano De Estudio del Lupus) on August 15, 2021.
SUBCLINICAL KIDNEY INJURY IS CAUSED BY A MODERATE SINGLE INFLAMMATORY EVENT
Authors: Heinzl Matthias Wolfgang , Resl Michael , Klammer Carmen , Fellinger Paul , Schinagl Lukas , Obendorf Florian , Feldbauer Roland , Pohlhammer Johannes , Wagner Thomas , Egger Margot , Dieplinger Benjamin , Clodi Martin
Published: May 2022

Background: Current means of diagnosis of acute kidney injury (AKI) based on serum creatinine have poor sensitivity and may miss possible therapeutic windows in subclinical kidney injury, especially in septic AKI. Kidney injury molecule-1 (KIM-1) may be a valuable biomarker to improve diagnostic algorithms for AKI. The understanding of septic AKI is still insufficient, and knowledge about KIM-1 kinetics in inflammation is scarce. The aim of this study was to investigate the possible effect of lipopolysaccharide (LPS) on KIM-1 as a marker of structural kidney injury in healthy volunteers. Methods: A single-blinded, placebo-controlled cross-over study using the human endotoxin model (LPS administration) was performed in 10 healthy men. Kidney injury molecule-1 and serum creatinine were measured repetitively for 48 hours. Results: We observed a significant elevation of serum KIM-1 levels after the administration of LPS (P < 0.001). Furthermore, LPS caused a significant elevation of serum creatinine at an early time point (P = 0.013) as compared with placebo. Conclusion: Even a relatively small inflammatory stimulus is sufficient to cause subclinical structural kidney injury with elevated KIM-1 and serum creatinine in healthy volunteers. This outlines the insufficiency of the current diagnostic approach regarding AKI and the urgency to develop novel diagnostic algorithms including markers of kidney injury. Clinical Trial Registration:
www.clinicaltrials.gov. Unique identifier: NCT03392701 (August 1, 2018)
Hyphopichia xiaguanensis f.a., sp. nov., an ascomycetous yeast species isolated from plant leaves
Authors: Hu Wen-Ting , Chu Shuai-Bei , Li Ying , Hui Feng-Li
Published: May 2022

Two strains representing a novel yeast species were isolated from plant leaves collected in the Baotianman Nature Reserve in Henan Province, central China. Phylogenetic analysis based on the concatenated sequences of the internal transcribed spacer (ITS) region (ITS1-5.8S–ITS2) and the D1/D2 domain of the large subunit rRNA gene revealed that the novel species belonged to the genus Hyphopichia, although the formation of ascospores was not observed. The novel species was related most closely to Hyphopichia paragotoi CBS 13913T but they differed by 0.9 % sequence divergence (five substitutions) in the D1/D2 domain and by 3.7 % sequence divergence (seven substitutions and eight gaps) in the ITS region. Furthermore, the novel species can also be differentiated from the closely related species in some biochemical and physiological characteristics. The species name of Hyphopichia xiaguanensis f.a., sp. nov. (Holotype CBS 16668, Mycobank MB 842425) is proposed to accommodate strains NYNU 20899T and NYNU 20914.