bluuebunny/crossref_metadata_2025 huggingface dataset:
Discovery and origins of giant optical nebulae surrounding quasar PKS 0454−22
Authors: Helton Jakob M , Johnson Sean D , Greene Jenny E , Chen Hsiao-Wen
Published: June 2021

We report optical integral-field spectroscopy in the field of one of the most luminous quasars in the z < 1 Universe, PKS 0454−22, with the Multi-Unit Spectroscopic Explorer. These data enable the discovery of three large ionized nebulae emitting in [O ii], H β, and [O iii] with projected areas of 1720, 1520, and 130 pkpc2, which we refer to as N1, N2, and N3, respectively. N1 spatially and kinematically surrounds the quasar host and five nearby galaxies. The morphology and kinematics of N1 are most consistent with stripped interstellar medium resulting from ongoing interactions. Its ionization properties can be explained by quasar photoionization. N2 spatially and kinematically surrounds two galaxies that are at projected distances of d ≈ 90 pkpc and line-of-sight velocities of Δv ≈+1410 km s−1 from the quasar. The morphology and kinematics of N2 are also consistent with stripped interstellar medium. However, its ionization state requires additional ionization sources beyond the quasar, likely from fast shocks as it moves through the hot halo associated with a galaxy overdensity around the quasar. N3 is not coincident with any galaxies with secure redshifts, and may arise from a cool gas structure in the intragroup medium or a dwarf galaxy. These large ionized nebulae demonstrate that interactions can produce cool gas structures on halo scales, while also possibly facilitating quasar fueling. The growing availability of wide-area integral field spectroscopic data will continue to reveal the morphologies, kinematics, and conditions of the gas flows, which may fuel galaxy and black hole growth.
A computational method for rotating, multilayer spheroids with internal jumps
Authors: Basillais B , Huré J-M
Published: June 2021

We discuss the structure of differentially rotating, multilayer spheroids containing mass–density jumps and rotational discontinuities at the interfaces. The study is based upon a scale-free, numerical method. Polytropic equations of state and cylindrical rotation profiles are assumed. The Bernoulli equation and the Poisson equation for the gravitational potential are solved for each layer separately on a common computational grid. The two-layer (core-envelope) case is first investigated in detail. We find that the core and the envelope are not, in general, homothetical in shape (cores are more than spherical than the envelope). Besides, the occurrence of a mass–density jump all along the interface is prone to a rotational discontinuity (unless the polytropic indices are the same). In particular, for given rotation laws, the mass–density jump is not uniform along the interface. Tests, trends and examples (e.g. false bipolytrope, critical rotation, degenerate configurations) are given. Next, we consider the general case of systems made of ${\cal L}\gt 2$ layers. This includes the full equation set, the virial equation, a comprehensive step-by-step procedure, and two examples of tripolytropic systems. The properties observed in the two-layer case hold for any pairs of adjacent layers. In spite of a different internal structure, two multilayer configurations can share the same mass, same axial ratio, same size, and same surface velocity (which is measured through a degeneracy parameter). Applications concern the determination of the interior of planets, exoplanets, stars, and compact objects.
Assessing tension metrics with dark energy survey and Planck data
Authors: Lemos P , Raveri M , Campos A , Park Y , Chang C , Weaverdyck N , Huterer D , Liddle A R , Blazek J , Cawthon R , Choi A , DeRose J , Dodelson S , Doux C , Gatti M , Gruen D , Harrison I , Krause E , Lahav O , MacCrann N , Muir J , Prat J , Rau M M , Rollins R P , Samuroff S , Zuntz J , Aguena M , Allam S , Annis J , Avila S , Bacon D , Bernstein G M , Bertin E , Brooks D , Burke D L , Carnero Rosell A , Carrasco Kind M , Carretero J , Castander F J , Conselice C , Costanzi M , Crocce M , Pereira M E S , Davis T M , De Vicente J , Desai S , Diehl H T , Doel P , Eckert K , Eifler T F , Elvin-Poole J , Everett S , Evrard A E , Ferrero I , Ferté A , Flaugher B , Fosalba P , Frieman J , García-Bellido J , Gaztanaga E , Gerdes D W , Giannantonio T , Gruendl R A , Gschwend J , Gutierrez G , Hartley W G , Hinton S R , Hollowood D L , Honscheid K , Hoyle B , Huff E M , James D J , Jarvis M , Lima M , Maia M A G , March M , Marshall J L , Martini P , Melchior P , Menanteau F , Miquel R , Mohr J J , Morgan R , Myles J , Ogando R L C , Palmese A , Pandey S , Paz-Chinchón F , Plazas Malagón A A , Rodriguez-Monroy M , Roodman A , Sanchez E , Scarpine V , Schubnell M , Secco L F , Serrano S , Sevilla-Noarbe I , Smith M , Soares-Santos M , Suchyta E , Swanson M E C , Tarle G , Thomas D , To C , Troxel M A , Varga T N , Weller J , Wester W ,   (DES Collaboration)
Published: June 2021

Quantifying tensions – inconsistencies amongst measurements of cosmological parameters by different experiments – has emerged as a crucial part of modern cosmological data analysis. Statistically significant tensions between two experiments or cosmological probes may indicate new physics extending beyond the standard cosmological model and need to be promptly identified. We apply several tension estimators proposed in the literature to the dark energy survey (DES) large-scale structure measurement and Planck cosmic microwave background data. We first evaluate the responsiveness of these metrics to an input tension artificially introduced between the two, using synthetic DES data. We then apply the metrics to the comparison of Planck and actual DES Year 1 data. We find that the parameter differences, Eigentension, and Suspiciousness metrics all yield similar results on both simulated and real data, while the Bayes ratio is inconsistent with the rest due to its dependence on the prior volume. Using these metrics, we calculate the tension between DES Year 1 3 × 2pt and Planck, finding the surveys to be in ∼2.3σ tension under the ΛCDM paradigm. This suite of metrics provides a toolset for robustly testing tensions in the DES Year 3 data and beyond.
Galaxy and mass assembly (GAMA): the clustering of galaxy groups
Authors: Riggs S D , Barbhuiyan R W Y M , Loveday J , Brough S , Holwerda B W , Hopkins A M , Phillipps S
Published: June 2021

We explore the clustering of galaxy groups in the Galaxy and Mass Assembly (GAMA) survey to investigate the dependence of group bias and profile on separation scale and group mass. Due to the inherent uncertainty in estimating the group selection function, and hence the group autocorrelation function, we instead measure the projected galaxy–group cross-correlation function. We find that the group profile has a strong dependence on scale and group mass on scales $r_\bot \lesssim 1 h^{-1}$. We also find evidence that the most massive groups live in extended, overdense, structures. In the first application of marked clustering statistics to groups, we find that group-mass marked clustering peaks on scales comparable to the typical group radius of r⊥ ≈ 0.5 h−1. While massive galaxies are associated with massive groups, the marked statistics show no indication of galaxy mass segregation within groups. We show similar results from the IllustrisTNG simulations and the L-Galaxies model, although L-Galaxies shows an enhanced bias and galaxy mass dependence on small scales.
Merging filaments I: a race against collapse
Authors: Hoemann Elena , Heigl Stefan , Burkert Andreas
Published: June 2021

The interstellar medium is characterized by an intricate filamentary network that exhibits complex structures. These show a variety of different shapes (e.g. junctions, rings, etc.) deviating strongly from the usually assumed cylindrical shape. A possible formation mechanism are filament mergers that we analyse in this study. Indeed, the proximity of filaments in networks suggests mergers to be rather likely. As the merger has to be faster than the end dominated collapse of the filament along its major axis, we expect three possible results: (a) The filaments collapse before a merger can happen, (b) the merged filamentary complex shows already signs of cores at the edges, or (c) the filaments merge into a structure which is not end-dominated. We develop an analytic formula for the merging and core-formation time-scale at the edge and validate our model via hydrodynamical simulations with the adaptive-mesh-refinement-code ramses. This allows us to predict the outcome of a filament merger, given different initial conditions which are the initial distance and the respective line-masses of each filament as well as their relative velocities.
A spectrally stratified hot accretion flow in the hard state of MAXI J1820+070
Authors: Dziełak Marta A , De Marco Barbara , Zdziarski Andrzej A
Published: June 2021

We study the structure of the accretion flow in the hard state of the black hole X-ray binary MAXI J1820+070 with NICER data. The power spectra show broad-band variability which can be fit with four Lorentzian components peaking at different time-scales. Extracting power spectra as a function of energy enables the energy spectra of these different power spectral components to be reconstructed. We found significant spectral differences among Lorentzians, with the one corresponding to the shortest variability time-scales displaying the hardest spectrum. Both the variability spectra and the time-averaged spectrum are well-modelled by a disc blackbody and thermal Comptonization, but the presence of (at least) two Comptonization zones with different temperatures and optical depths is required. The disc blackbody component is highly variable, but only in the variability components peaking at the longest time-scales ($\lower.5ex\hbox{$\,\, \buildrel\gt \over \sim \,\,$}1$ s). The seed photons for the spectrally harder zone come predominantly from the softer Comptonization zone. Our results require the accretion flow in this source to be structured, and cannot be described by a single Comptonization region upscattering disc blackbody photons, and reflection from the disc.
Globular cluster numbers in dark matter haloes in a dual formation scenario: an empirical model within emerge
Authors: Valenzuela Lucas M , Moster Benjamin P , Remus Rhea-Silvia , O’Leary Joseph A , Burkert Andreas
Published: June 2021

We present an empirical model for the number of globular clusters (GCs) in galaxies based on recent data showing a tight relationship between dark matter halo virial masses and GC numbers. While a simple base model forming GCs in low-mass haloes reproduces this relation, we show that a second formation pathway for GCs is needed to account for observed younger GC populations. We confirm previous works that reported the observed linear correlation as being a consequence of hierarchical merging and its insensitivity to the exact GC formation processes at higher virial masses, even for a dual formation scenario. We find that the scatter of the linear relation is strongly correlated with the relative amount of smooth accretion: the more dark matter is smoothly accreted, the fewer GCs a halo has compared to other haloes of the same mass. This scatter is smaller than that introduced by halo mass measurements, indicating that the number of GCs in a galaxy is a good tracer for its dark matter mass. Smooth accretion is also the reason for a lower average dark matter mass per GC in low-mass haloes. Finally, we successfully reproduce the observed general trend of GCs being old and the tendency of more massive haloes hosting older GC systems. Including the second GC formation mechanism through gas-rich mergers leads to a more realistic variety of GC age distributions and also introduces an age inversion in the halo virial mass range log Mvir/M⊙ = 11–13.
Comparative potency analysis of whole smoke solutions in the bacterial reverse mutation test
Authors: Meng Fanxue , Mei Nan , Yan Jian , Guo Xiaoqing , Richter Patricia A , Chen Tao , De Mamata
Published: June 2021

Short-term in vitro genotoxicity assays are useful tools to assess whether new and emerging tobacco products potentially have reduced toxicity. We previously demonstrated that potency ranking by benchmark dose (BMD) analysis quantitatively identifies differences among several known carcinogens and toxic chemicals representing different chemical classes found in cigarette smoke. In this study, six whole smoke solution (WSS) samples containing both the particulate and gas phases of tobacco smoke were generated from two commercial cigarette brands under different smoking-machine regimens. Sixty test cigarettes of each brand were machine-smoked according to the International Organization for Standardization (ISO) puffing protocol. In addition, either 60 or 20 test cigarettes of each brand were machine-smoked with the Canadian Intense (CI) puffing protocol. All six WSSs were evaluated in the bacterial reverse mutation (Ames) test using Salmonella typhimurium strains, in the presence or absence of S9 metabolic activation. The resulting S9-mediated mutagenic concentration–responses for the four WSSs from 60 cigarettes were then compared using BMD modelling analysis and the mutagenic potency expressed as number of revertants per μl of the WSS. The quantitative approaches resulted in a similar rank order of mutagenic potency for the Ames test in both TA98 and TA100. Under the conditions of this study, these results indicate that quantitative analysis of the Ames test data can discriminate between the mutagenic potencies of WSSs on the basis of smoking-machine regimen (ISO vs. CI), and cigarette product (differences in smoke chemistry).
Poor Fusion Rates Following Cervical Corpectomy Reconstructed With an Expandable Cage: Minimum 2-Year Radiographic and Clinical Outcomes
Authors: Byvaltsev Vadim A , Kalinin Andrei A , Aliyev Marat A , Azhibekov Nurzhan O , Shepelev Valerii V , Riew K Daniel
Published: June 2021

BACKGROUND

Expandable cages are often used to reconstruct cervical corpectomies but there are few long-term follow-up studies with large numbers.

OBJECTIVE

To analyze the clinical and radiographic results of cervical corpectomy reconstructed with expandable cages for degenerative stenosis.

METHODS

We performed a retrospective analysis of 78 patients with degenerative cervical stenosis treated with a corpectomy reconstructed with an expandable cage. We evaluated the clinical and radiographic outcomes, as well as complications of the procedure at a minimum 2-yr follow-up.

RESULTS

There was a decrease in the visual analog scale pain average from 75 mm to 8.5 mm (P = .02); a decrease in the Neck Disability Index average from 55% to 12% (P = .009); and improvement in the Japanese Orthopaedic Association average from 12 to 14 points (P = .01). There was a change in cervical lordosis (Cobb method) average from −9.3° to −15.1° (P = .002), without significant loss of lordosis (P = .63). The fusion rate, by criteria of the Cervical Spine Research Society (CSRS), was low: using dynamic X-rays – 50% (n = 39/78) and using computed tomography (CT) – 47.4% (n = 37/78). A total of 11 patients (14.1%) suffered complications.

CONCLUSION

To our knowledge, this is the largest series (78) with a minimum 2-yr follow-up in the literature and the first using the dynamic radiographic and CT criteria endorsed by the CSRS. Using these criteria, our fusion rates were much lower than all previous reports in the literature. Despite this, patient-reported outcomes were reasonable. There was a relatively low incidence of perioperative complications, most of which were likely not implant-specific and there was only 1 case of implant failure.
Nicotine and Tobacco Product Use and Dependence Symptoms Among US Adolescents and Adults: Differences by Age, Sex, and Sexual Identity
Authors: Evans-Polce Rebecca J , Veliz Philip , Kcomt Luisa , Boyd Carol J , McCabe Sean Esteban
Published: June 2021

Introduction

Sexual minorities are at increased risk for tobacco use; however, there is heterogeneity in this risk by sociodemographic factors.

Aims and Methods

This study sought to understand if vulnerability to tobacco use among US sexual minorities varies by age group. For this study we used data from wave 4 of the Population Assessment of Tobacco and Health adolescent and adult surveys (n = 37 959), a nationally representative survey. We examined five nicotine/tobacco use outcomes by sex and sexual identity across four age groups. The five outcomes included past 30-day e-cigarette use, past 30-day cigarette use, past 30-day other tobacco use, the number of tobacco products used, and nicotine dependence symptoms.

Results

For males, sexual identity differences were greatest in middle adulthood, particularly for bisexual males; adjusted odds ratios and adjusted incident rate ratios ranged from 2.08 to 5.59 in middle adulthood compared to 0.83–1.62 in adolescence. For females, sexual identity differences were persistent from adolescence through middle adulthood. We found significant differences most consistently for nicotine dependence symptoms when comparing gay/lesbian and bisexual females across multiple age groups; adjusted incident rate ratios ranged from 1.90 in middle adulthood to 3.26 in adolescence.

Conclusions

Risk among sexual minorities varied considerably across age groups and by nicotine/tobacco product and severity of symptoms. Our findings underscore the importance of looking beyond single tobacco products when examining nicotine/tobacco differences related to sexual identity and in examining differences by age group. Our results demonstrating age-varying risk among sexual minorities have important implications for tobacco prevention and cessation efforts.

Implications

This study identifies important age variation in sexual minority differences in tobacco use, particularly among males. This study also shows that many sexual minorities not only have higher risk for tobacco and nicotine product use but also use significantly more tobacco products and have higher nicotine dependence symptom scores. These results have important implications for implementation of nicotine and tobacco prevention and cessation strategies for sexual minority adolescents and adults.
A Group-Based Modeling Approach to Identify Developmental Trajectories of Nicotine Dependence Among Lebanese Adolescents Waterpipe Smokers
Authors: Ebrahimi Kalan Mohammad , Bahelah Raed , Bursac Zoran , Ward Kenneth D , Ben Taleb Ziyad , Tleis Malak , Jebai Rime , Asfar Taghrid , Eissenberg Thomas , Maziak Wasim
Published: June 2021

Introduction

Adolescence represents a critical period in which nicotine dependence (ND) symptoms are developing. Little is known about waterpipe (WP) smoking and developmental trajectories of ND criteria across adolescence.

Aims and Methods

Here, we aimed to identify ND trajectories from early- to late-adolescence in current (past 30 days) WP smokers and examine baseline correlates of each identified trajectory, using the International Classification of Diseases, 10th Revision (ICD-10). The analytical sample consisted of 278 current WP smokers from eight waves of an ongoing longitudinal cohort of eighth to ninth graders in Lebanon. Group-based trajectory modeling was estimated to identify trajectory classes for ICD-10-ND criteria over ages 11–18.

Results

A group-based modeling approach yielded a four-class solution that best fit the data and reflected differences in the timing of ND onset during adolescence: no-onset of ND (43.9%), early-onset (16.2%), mid-onset (26.6%), and late-onset (13.3%) of ND criteria. Having a less-educated mother (adjusted odds ratio [aOR] = 4.08, 95% confidence interval [95% CI] = 1.01% to 16.53%) and siblings who smoke WP (aOR = 3.95, 95% CI = 1.08% to 14.42%), exposure to favorite WP-specific advertisements (aOR = 3.33, 95% CI = 1.03% to 10.85%), and being a novelty seeker (aOR = 1.12, 95% CI = 1.02% to 1.23%) were associated with early-onset of ND. Daily (aOR = 3.48, 95% CI = 1.08% to 11.23%) or weekly (aOR = 2.20, 95% CI = 1.05% to 4.62%) WP smokers (vs. monthly) and having higher stress level (aOR = 1.07, 95% CI = 1.00% to 1.14%) were associated with mid-onset trajectory. Believing that WP smoking is not harmful to health (aOR = 0.11, 95% CI = 0.02% to 0.82%) and spending less than 60 minutes on a WP smoking session (aOR = 5.62, 95% CI = 1.20% to 26.44%) were associated with late-onset ND trajectory class.

Conclusions

Monitoring the development of ND trajectories among WP smokers may identify an individual as belonging to one of these four groups with distinct individual and socioenvironmental factors and allow the individual and health care providers opportunities to inform initiate on-time WP-specific tailored prevention and cessation interventions.

Implications

The results from this study showed a four-class trajectory of ICD-10-ND criteria and suggested that every ND trajectory class during adolescence could have distinctive characteristics and therefore provides new insights into the process of ND in terms of when and what specific interventions are needed to curb the development of ND and long-term WP smoking among youth.
Climate Crisis
Authors: Graham Erin R.
Published: June 2021

International relations scholarship on climate change exists primarily in the field of Global Environmental Politics (GEP) and outside the substantive purview of mainstream International Political Economy (IPE). This chapter argues that the climate crisis is fundamentally an IPE problem, and it requires attention from IPE scholars as a primary subject of interest. To facilitate engagement, the chapter reviews a diverse literature at the intersection of IPE and climate across three substantive areas: the global climate regime, trade, and renewable energy transitions. Each section offers avenues for research, and provides ideas on how to put concepts and ideas from IPE to work in climate crisis scholarship.
From Silos to Barns?
Authors: Solingen Etel
Published: June 2021

The explosion of research on regional economic institutions (REI) over the last two decades has led to a richer understanding of why they emerge, what form they take, and what effects they have. This chapter argues that research on REI is not a monopoly of any particular theoretical, methodological, or epistemological approach. Ongoing work leans not merely on standard political science and economics but on sociology, psychology, and critical theory. Yet, REI studies cluster in silos more often than barns, although this chapter highlights some research programs with potential for fostering barns. Exclusive attention to power, economic efficiency, transaction costs, and transnational normative diffusion—the common analytical currency in standard accounts of REI—may conceal deeper domestic drivers underlying REI dynamics.
Conceptualizing Organizational Change Through the Lens of Complexity Science
Authors: Dooley Kevin J.
Published: June 2021

Organizational scholars interested in organizational change and learning have been inspired by the mathematics, concepts, models, and metaphors of complexity science since the 1990s. Time is a fundamental variable in all complexity science models, so descriptions of change follow naturally. Complexity science builds upon systems theory to provide a more nuanced and thick causal narrative of change. Researchers in the organizational sciences have used four different types of complexity science based models to conceptualize organizational change: agent-based, computational, dynamical, and far-from-equilibrium. These different approaches hold the common assumptions that change is both continuous and discontinuous, and nonlinear dynamics arising from complex interactions can make organizational change difficult to predict or control. Studies of organizational change using complexity science models may be deductive or inductive and may engage quantitative or qualitative data. This chapter reviews these models and their application to the study of organizational change and assesses what influence complexity science has had on organizational studies since its own emergence.
Adrenal suppression from exogenous glucocorticoids: Recognizing risk factors and preventing morbidity
Authors: Ahmet Alexandra , Rowan-Legg Anne , Pancer Larry
Published: June 2021

Adrenal suppression (AS), a potential side effect of glucocorticoid therapy (including inhaled corticosteroids), can be associated with significant morbidity and even death. In Canada, adrenal crisis secondary to AS continues to be reported in children. Being aware of symptoms associated with AS, understanding the risk factors for developing this condition, and familiarity with potential strategies to reduce risks associated with AS, are essential starting points for any clinician prescribing glucocorticoids.
La suppression surrénalienne causée par les glucocorticoïdes exogènes : en reconnaître les facteurs de risque et en prévenir les effets
Authors: Ahmet Alexandra , Rowan-Legg Anne , Pancer Larry
Published: June 2021

La suppression surrénalienne, un effet secondaire potentiel du traitement aux glucocorticoïdes (y compris les corticostéroïdes inhalés), peut avoir des conséquences graves et même fatales. Au Canada, on continue de déclarer des poussées d’insuffisance corticosurrénalienne consécutives à une suppression surrénalienne chez les enfants. Avant de prescrire des glucocorticoïdes, le clinicien doit absolument connaître les symptômes de suppression surrénalienne, comprendre les facteurs de risque de cette affection et être au courant des stratégies susceptibles d’en réduire les risques.
ASSESSMENT OF THE AWARENESS LEVEL OF RADIATION PROTECTION AMONG RADIOGRAPHERS WORKING IN THE MEDICAL IMAGING WARDS OF THE HOSPITALS IN ZANJAN, IRAN
Authors: Moghimi Parastoo , Hajimiri Khadijeh , Saghatchi Franak , Rezaeejam Hamed
Published: June 2021

X-ray usage in medical diagnosis could have hurtful effects for both patient and medical imaging wards’ personnel as a result of failure to follow radiation protection (RP) principles (shielding, distance and time) by radiographers. This cross-sectional descriptive–analytical study was carried out by valid and reliable online questionnaire, which was completed by 103 radiographers. Data were analyzed by using descriptive statistics (mean, standard deviation and frequency) and analytical statistics (Pearson’s correlation coefficient test, Student’s independent t-test and analysis of variance test) in the Statistical Package for Social Sciences version 20 (sig: P < 0.05). The study’s response rate was 67.32%. The mean scores of participants’ total, RP and device knowledge were 42.76, 42.86 and 42.72 out of 100, respectively. Work experience and age of participants were significantly related to device and total knowledge (P < 0.01). Results revealed an undesirable level of participants’ awareness, indicating the necessity of holding training courses, especially for less experienced radiographers.
Color Polymorphism is a Driver of Diversification in the Lizard Family Lacertidae
Authors: Brock Kinsey M , McTavish Emily Jane , Edwards Danielle L
Published: June 2021

Color polymorphism—two or more heritable color phenotypes maintained within a single breeding population—is an extreme type of intraspecific diversity widespread across the tree of life. Color polymorphism is hypothesized to be an engine for speciation, where morph loss or divergence between distinct color morphs within a species results in the rapid evolution of new lineages, and thus, color polymorphic lineages are expected to display elevated diversification rates. Multiple species in the lizard family Lacertidae are color polymorphic, making them an ideal group to investigate the evolutionary history of this trait and its influence on macroevolution. Here, we produce a comprehensive species-level phylogeny of the lizard family Lacertidae to reconstruct the evolutionary history of color polymorphism and test if color polymorphism has been a driver of diversification. Accounting for phylogenetic uncertainty with multiple phylogenies and simulation studies, we estimate an ancient origin of color polymorphism (111 Ma) within the Lacertini tribe (subfamily Lacertinae). Color polymorphism most likely evolved few times in the Lacertidae and has been lost at a much faster rate than gained. Evolutionary transitions to color polymorphism are associated with shifts in increased net diversification rate in this family of lizards. Taken together, our empirical results support long-standing theoretical expectations that color polymorphism is a driver of diversification.[Color polymorphism; Lacertidae; state-dependent speciation extinction models; trait-dependent diversification.]
Saddle Pulmonary Embolism: Demographics, Clinical Presentation, and Outcomes
Authors: Wong Kevin J. , Kushnir Margarita , Billett Henny H.
Published: June 2021

OBJECTIVES:

Saddle pulmonary embolism is an uncommon type of venous thromboembolism that can lead to sudden hemodynamic collapse and death. Saddle pulmonary embolism can be difficult to recognize, and data on its presentation, clinical features, and associated complications are sparse. We sought to characterize patients with saddle pulmonary embolism.

DESIGN:

The Montage software (Nuance, Burlington, MA) was used to identify patients to create a retrospective cohort study.

SETTING:

Montefiore Medical Center from January 1, 2012, to December 31, 2018.

PATIENTS:

All subjects diagnosed with saddle pulmonary embolism in above time period.

INTERVENTIONS:

Charts were reviewed for demographics, diagnostics, laboratory data, presenting vital signs, inhospital mortality, 6-month survival, and prevalence of recurrent venous thromboembolism.

MEASUREMENTS AND MAIN RESULTS:

About 120 patients with saddle pulmonary embolism were identified. Median age was 61 years and 57.5% were women. Events were provoked by a transient risk factor in 43.3%. On presentation, median mean arterial pressures were normal (93 mm Hg). Only five of 120 of patients (4.2%) presented with vitals concerning for massive pulmonary embolism. We found a 9.2% inhospital mortality; an additional 8.6% died within 6 months of discharge. Inhospital mortality was higher in women (11.6%), compared with men (3.9%), but this was not significant (p = 0.28). In 10 patients, both ventilation/perfusion scans and computed tomography pulmonary angiogram were performed. None of the ventilation/perfusion scans diagnosed saddle pulmonary embolism. Thrombus was visualized in the right heart in eight of 105 (7.6%), and this group had a higher inhospital mortality (37.5%). Recurrent venous thromboembolism occurred in 13 of 85 of survivors (15.3%).

CONCLUSIONS:

Despite presenting without the accepted clinical criteria for massive pulmonary embolism, saddle pulmonary embolism has a very high inhospital mortality. Ventilation/perfusion scan is unable to diagnose saddle pulmonary embolism. Visualized right heart thrombi portend an even higher inhospital mortality.
Validation of a Crisis Standards of Care Model for Prioritization of Limited Resources During the Coronavirus Disease 2019 Crisis in an Urban, Safety-Net, Academic Medical Center*
Authors: Nadjarian Albert , LeClair Jessica , Mahoney Taylor F. , Awtry Eric H. , Bhatia Jasvinder S. , Caruso Lisa B. , Clay Alexis , Greer David , Hingorani Karan S. , Horta L. F. B. , Ibrahim Michel , Ieong Michael H. , James Thea , Kulke Matthew H. , Lim Remington , Lowe Robert C. , Moses James M. , Murphy Jaime , Nozari Ala , Patel Anuj D. , Silver Brent , Theodore Arthur C. , Wang Ryan Shufei , Weinstein Ellen , Wilson Stephen A. , Cervantes-Arslanian Anna M.
Published: June 2021

OBJECTIVES:

The coronavirus disease 2019 pandemic has overwhelmed healthcare resources even in wealthy nations, necessitating rationing of limited resources without previously established crisis standards of care protocols. In Massachusetts, triage guidelines were designed based on acute illness and chronic life-limiting conditions. In this study, we sought to retrospectively validate this protocol to cohorts of critically ill patients from our hospital.

DESIGN:

We applied our hospital-adopted guidelines, which defined severe and major chronic conditions as those associated with a greater than 50% likelihood of 1- and 5-year mortality, respectively, to a critically ill patient population. We investigated mortality for the same intervals.

SETTING:

An urban safety-net hospital ICU.

PATIENTS:

All adults hospitalized during April of 2015 and April 2019 identified through a clinical database search.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Of 365 admitted patients, 15.89% had one or more defined chronic life-limiting conditions. These patients had higher 1-year (46.55% vs 13.68%; p < 0.01) and 5-year (50.00% vs 17.22%; p < 0.01) mortality rates than those without underlying conditions. Irrespective of classification of disease severity, patients with metastatic cancer, congestive heart failure, end-stage renal disease, and neurodegenerative disease had greater than 50% 1-year mortality, whereas patients with chronic lung disease and cirrhosis had less than 50% 1-year mortality. Observed 1- and 5-year mortality for cirrhosis, heart failure, and metastatic cancer were more variable when subdivided into severe and major categories.

CONCLUSIONS:

Patients with major and severe chronic medical conditions overall had 46.55% and 50.00% mortality at 1 and 5 years, respectively. However, mortality varied between conditions. Our findings appear to support a crisis standards protocol which focuses on acute illness severity and only considers underlying conditions carrying a greater than 50% predicted likelihood of 1-year mortality. Modifications to the chronic lung disease, congestive heart failure, and cirrhosis criteria should be refined if they are to be included in future models.
Case–control study about magnitude of exposure to wood smoke and risk of developing lung cancer
Authors: Báez-Saldaña Renata , Canseco-Raymundo Alejandro , Ixcot-Mejía Belizario , Juárez-Verdugo Iván , Escobar-Rojas Araceli , Rumbo-Nava Uriel , Castillo-González Patricia , León-Dueñas Santiago , Arrieta Oscar
Published: June 2021

Introduction

Exposure to biomass combustion products, particularly firewood, has been considered as a potential carcinogen for developing lung cancer. In this regard, current evidence is widely heterogeneous; besides, in most studies, wood smoke exposure is not appropriately quantified, which further complicates the analysis of wood smoke as a potential carcinogen. The aim of the present study was to estimate the risk of developing lung cancer according to the degree of exposure to wood smoke in patients who use firewood for cooking.

Material and methods

We performed a case-control study that included 482 patients with lung cancer (cases) and 592 hospital controls. Exposure to wood smoke was evaluated as a dichotomous variable (i.e. yes or no); in patients with prior wood smoke exposure, an index of exposure in hours per year was calculated (WSEI). Using bivariate and multivariate logistic regression analyses, the odds ratio (OR) between wood smoke exposure and lung cancer were calculated.

Results

The ORs for developing lung cancer (raw and adjusted) for a WSEI > 100 h/year were OR 1.55 [95% confidence interval (CI), 1.06–2.26) and OR 2.26 (95% CI, 1.50–3.40), respectively; the ORs (raw and adjusted) for WSEI >300 h/year were OR 1.76 (95% CI, 1.06–2.91) and OR 3.19 (95% CI, 1.83–5.55), respectively.

Conclusions

Exposure to wood smoke is a risk factor for lung cancer; furthermore, this effect maintains a dose–response relationship which has a multiplicative effect with smoking.
The development, implementation, and efficacy of a perioperative briefing communication and treatment planning tool and its adaptation to the COVID-19 pandemic
Authors: Rassekh Christopher H. , Atkins Joshua H. , O’Malley Bert W. , Chalian Ara A. , Brody Robert M. , Basu Devraj , Paul Ellen A. , Weinstein Gregory S.
Published: June 2021

Background:

Effective communication and team alignment are critical elements in overall preparedness for surgery. We sought to assess staff perceptions of a newly implemented perioperative communication mechanism and evaluate its ongoing efficacy.

Methods:

A perioperative email briefing tool was developed as a virtual “huddle” process. A survey of the care team was then done after the first 6 months of its use. Implementation of the briefing for new faculty and a pandemic was observed.

Results:

After 6 months, all 4 head and neck surgeons had adopted this tool and utilized it for nearly 100% of cases, and the instrument was adopted by all other faculty subsequently joining the practice group. In the initial assessment, 98% of all respondents felt the process should continue. In a follow-up survey, over 88% believed the briefings reduced the risk of serious errors, near misses, and complications.

Conclusions:

An email perioperative briefing is feasible and improved workflow and safety.
Experience With, Knowledge of, and Attitudes Toward Complementary and Alternative Medicine Among Pre-Nursing and Nursing Students
Authors: Reuter Peter R. , Turello Arianna E. , Holland Leia M.
Published: June 2021

Our study explored pre-nursing and graduating nursing students' experience with, knowledge of, and attitude toward complementary and alternative medicine (CAM). Both pre-nursing and nursing students reported positive attitudes toward CAM in general, indicated being interested in learning about CAM, and planned on making CAM practices part of their future careers.
Hypotony-associated Complications After Deep Sclerectomy: Incidence, Risk Factors, and Long-term Outcomes
Authors: Rabiolo Alessandro , Leadbetter Duncan , Anand Nitin
Published: June 2021

Precis:

Chronic hypotony is not uncommon following deep sclerectomy (DS), but only a minor proportion of patients develop hypotony-associated complications. Numerical hypotony does not affect the visual outcomes. This study identifies factors associated with hypotony.

Purpose:

To investigate the incidence and risk factors of hypotony and hypotony-associated complications after DS.

Methods:

Retrospective cohort study of 1765 eyes (1385 patients) undergoing DS with or without cataract extraction between 2001 and 2020 in 2 UK centers. Chronic hypotony was defined as intraocular pressure (IOP) ≤5 mm Hg in ≥2 consecutive visits lasting >90 days or as any IOP ≤5 mm Hg associated with hypotony-related complications or requiring surgical intervention. Clinical hypotony was defined as the presence of: serous or hemorrhagic choroidal detachment, hypotony maculopathy, flat anterior chamber requiring reformation, decompression retinopathy. The incidence of hypotony was calculated with Kaplan-Meier statistics, and Cox regression was used to identify risk factors.

Results:

The median (interquartile range) age and follow-up were 76 (67 to 82) years and 45.4 (20.9 to 79.8) months, respectively. The incidence (95% confidence interval) of chronic and clinical hypotony at 5 years was 13.4% (11.5%-15.3%) and 5.6% (4.3%-6.9%), respectively. Sixteen eyes (15.7%) with hypotony-associated complications had IOP >5 mm Hg. Male sex (hazard ratio [HR]: 1.89, P=0.018), non-Caucasian ethnicity (HR: 2.49, P=0.046), intraoperative bevacizumab (HR: 3.96, P=0.01), pigmentary glaucoma (HR: 3.59, P=0.048), previous vitreoretinal surgery (HR: 5.70, P=0.009), intraoperative microperforation (HR: 4.17, P<0.001) and macroperforation (HR: 20.76, P<0.001), and avascular bleb (HR: 1.80, P=0.036) were associated with clinical hypotony.

Discussion:

Chronic hypotony is not uncommon following DS, but clinical hypotony is infrequent. Hypotony associated-complications can occur in eyes without statistical hypotony.
Prevalence and Factors Affecting Postoperative Delirium in a Neurosurgical Intensive Care Unit
Authors: Kose Gulsah , Şirin Keziban , Inel Mehtap Balin , Mertoglu Sevcan , Aksakal Raziye , Kurucu Şule
Published: June 2021

PURPOSE: The aim of this study was to identify the prevalence of, and factors affecting, postoperative delirium (POD) in patients in the neurosurgical intensive care unit. METHODS: A cross-sectional study of 127 Turkish neurosurgical intensive care unit patients admitted between May 2018 and May 2019 was conducted. Patients were assessed for the development of POD using the Intensive Care Delirium Screening Checklist. We collected other independent data variables daily. Data were analyzed using independent sample t test, χ2 test, and logistic regression. RESULTS: The prevalence rates of POD on the first and second postoperative days were 18.9% and 8.7%, respectively. Logistic regression analysis showed that the Glasgow Coma Scale score, albumin level, Spo
2 level, hemoglobin values, undergoing cranial surgery, and having intra-arterial catheter were the independent risk factors for POD. CONCLUSION: These findings may contribute to identifying patients at risk for developing POD and developing strategies to improve patient outcomes.
Gender Difference in the Association Between Stroke Knowledge and Health Behavior Before the Onset of Stroke Among Chinese Hypertensive Patients
Authors: Li Zhuo-Ran , Ruan Heng-Fang , Shen Li-Ping , Zhang Xiao-Pei , Wan Li-Hong
Published: June 2021

BACKGROUND: Previous research has shown that men and women have different levels of stroke knowledge and differing health behaviors, which are important factors affecting blood pressure, as hypertension is a key risk factor for stroke occurrence. There has been little research on the effects of sex on the association between these 2 variables before the onset of stroke among Chinese hypertensive patients. METHODS: A cross-sectional study and a convenience sampling method were used. 272 male and 118 female hypertensive stroke patients were recruited. Each patient completed the Stroke Knowledge Questionnaire and the Health Behavior Scale for stroke patients. RESULTS: Compared with female patients, male patients had greater stroke knowledge and worse prestroke health behavior. The Pearson correlation coefficient between stroke knowledge and prestroke health behavior was 0.149 and 0.223 in male and female participants, respectively, P < .05. The results of a multiple regression analysis showed that Chinese hypertensive stroke patients' prestroke health behavior was significantly influenced by sex and stroke knowledge. CONCLUSION: Chinese male and female hypertensive stroke patients had disparities in stroke knowledge and prestroke health behavior; moreover, the correlation between these 2 variables before experiencing a hypertensive stroke was different between men and women. Men with hypertension should be considered at a higher risk for an initial or recurrent stroke. Developing sex-specific intervention for primary or secondary stroke prevention in China is essential.
Prophylactic dialysis improves short-term clinical outcome in patients with non-dialysis-dependent chronic kidney disease undergoing cardiac surgery: a meta-analysis of randomized controlled trials
Authors: An Xiuping , Ye Nan , Bian Weijing , Cheng Hong
Published: June 2021

Background

Several studies have reported that prophylactic dialysis can reduce the mortality of non-dialysis-dependent chronic kidney disease (CKD) patients after cardiac surgery. However, the results of complications in these randomized controlled trials (RCTs) were not consistent. We aimed to perform a meta-analysis to systematically evaluate the effect of prophylactic dialysis in these non-dialysis-dependent CKD patients.

Methods

We systematically searched Medline, Embase, Cochrane’s Library and other online sources for related RCTs. Effects of prophylactic dialysis on the incidence of 30 days’ mortality and postoperative complications were analyzed.

Results

Four RCTs comprising 395 patients were included, all of them treated by coronary artery bypass grafting. Treatment of preoperative and intraoperative prophylactic dialysis significantly reduced the rate of 30-day all-cause mortality (risk ratio [RR]: 0.27, 95% confidence interval [CI], 0.13–0.58, P < 0.001, I
2 = 0%) and the incidence of pulmonary complications (RR: 0.39, 95% CI, 0.20–0.77, P = 0.007, I
2 = 0%), low cardiac output (RR: 0.29, 95% CI, 0.09–0.99, P = 0.05, I
2 = 0%), and acute kidney injury (RR: 0.19, 95% CI: 0.07–0.52, P = 0.001, I
2 = 0%). However, there were no statistically significant differences between the dialysis group and the control group in gastrointestinal bleeding, sepsis or multiple organ failure, wound infection, arrhythmia, transient neurologic deficit, stroke and re-exploration for bleeding.

Conclusion

Prophylactic dialysis can improve the 30-day clinical outcomes of non-dialysis-dependent CKD patients undergoing cardiac surgery, it was associated with the 30-day mortality benefit and led to a decrease in the incidence of pulmonary complications, as well as low cardiac output, and acute kidney injury.
Relationship between autoimmune thyroid disease and nephropathy
Authors: Zhao Liping , Liu Yunxiao , Su Hongchang , Shi Xiangzhen
Published: June 2021

The association of nephropathy with autoimmune thyroid disease (AITD) has been reported previously. However, there is limited information on the relationship between thyroid autoantibodies and nephropathy. A retrospective study was conducted using the medical records of 246 patients with nephropathy, 82 of whom had concurrent AITD. General characteristics, thyroid function, autoantibodies, and the pathological types of nephropathy were analyzed. Immunohistochemistry was used to detect the thyroglobulin antibody (TG-Ab) and thyroid peroxidase antibody (TPO-Ab) in the kidneys. We found nephropathy patients with AITD exhibited higher serum levels of TPO-Ab, TG-Ab, thyroid-stimulating hormone receptor antibody (TR-Ab), and immunoglobulin G (IgG) (P < .05). Compared with the nephropathy without AITD group, the nephropathy with AITD group exhibited higher proportions of membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS), and relatively lower proportions of mesangial proliferative glomerulonephritis (MsPGN) and minimal change nephropathy (MCN) (P = .005). TPO-Ab and TG-Ab levels in the kidney were more prevalent in nephropathy patients with AITD than those without AITD (P = .015 and P = .026, respectively). Subgroup analysis demonstrated that serum levels of thyroid stimulating hormone (TSH), TG-Ab, TPO-Ab, immunoglobulin M (IgM), and IgG in the MN group were significantly higher, whereas the levels of free thyroxine (FT4) and estimated glomerular filtration rate (eGFR) were lower, as compared with MN with Hashimoto thyroiditis (HT) group (P < .05). TPO-Ab and TG-Ab expression levels in the kidneys were more prevalent in the MN group than in the MN with HT group (P = .034). The expression levels of FT4, TG-Ab, TPO-Ab, and thyroid-stimulating hormone receptor antibody (TSHR-Ab) in the serum were significantly higher in the MN group than in the MN with Graves disease (GD) group (P < .05). The expression of TPO-Ab in the kidneys was more prevalent in the MN group than in the MN with GD group (P = .011). In sum, the expressions of TPO-Ab and TG-Ab were more prevalent in the kidneys of patients with nephropathy and AITD. Our findings indicate that TPO-Ab and TG-Ab may play a role in the development of AITD-related nephropathy.