bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in phototherapy among skin diseases and genders in real‐life conditions—A retrospective analysis of the cumulative doses, numbers of sessions, side effects and costs in 561 patients
Authors: Merkel Tamara Alessia , Navarini Alexander , Mueller Simon
Published: April 2021

Background

Phototherapy has been a mainstay therapy for dermatological diseases since more than a century. Although phototherapy is still extensively used and some recommendations exist, only scarce data are available addressing disease‐specific differences in cumulative doses, treatment durations and costs. Knowledge of such differences could help to avoid over‐/undertreatment, predict treatment duration and costs.

Therefore, we sought to determine differences in cumulative doses, numbers of sessions, side effects and costs among different skin diseases and genders in real‐life conditions.

Methods

In this single‐centre, retrospective study, patients treated with phototherapy between March 2014 and April 2019 were classified into seven diagnostic groups and analysed according to the study goals.

Results

Out of 561 patients (age 53.9 ± 20.3 yrs; 52.9% females), 83.7% percent were treated with cabin NB‐UVB (mean cumulative dose 17.79 ± 17.11 J/cm2). Patients with vitiligo and psoriasis were treated with significantly higher cumulative NB‐UVB doses (cabin, local) in comparison with the five other diagnostic groups as were males in comparison with females. Consequently, significantly higher UV‐related costs resulted in patients with vitiligo, psoriasis and males.

Patients with atopic dermatitis and pruritus were treated with significantly higher cumulative UVA1 doses compared to patients with non‐atopic eczema.

The complication rate (pooled from all UV modalities) in our population was 3.8% (erythema 3.4%, aggravated itch 0.4% and worsening of symptoms 0.2%).

Conclusions

Our results demonstrate that cumulative doses and phototherapy‐related costs vary strongly among skin diseases–a fact not adequately considered in recommendations. A more disease‐specific stratification of phototherapy could not only help to optimize outcomes, but also to facilitate comparability of clinical trials using phototherapy.
A case of Epstein–Barr virus‐associated lymphoepithelioma‐like carcinoma of the colon
Authors: Kanno‐Okada Hiromi , Takahashi Kenta , Katano Harutaka , Shimizu Ai , Takakuwa Emi , Miyamoto Shuichi , Abiko Satoshi , Yamamoto Keiko , Shimoda Tadakazu , Mitsuhashi Tomoko , Hasegawa Hideki , Matsuno Yoshihiro
Published: April 2021

Lymphoepithelioma‐like carcinoma is a poorly differentiated carcinoma with prominent lymphoid infiltration occurring in various organs but is exceedingly rare in the colorectal region. This malignancy is frequently associated with Epstein–Barr virus (EBV). Here we report a case of EBV‐associated lymphoepithelioma‐like carcinoma of the cecum in an 84‐year‐old male who presented with occult blood. In situ hybridization for EBV‐encoded small RNAs (EBER) in an endoscopic submucosal dissection specimen showed that the tumor consisted of EBER‐negative well‐differentiated tubular adenocarcinoma and EBER‐positive lymphoepithelioma‐like carcinoma. Real‐time PCR detected 7.16 copies of the EBV genome per cell in a sample microdissected from the latter component. Genotyping analysis demonstrated EBV genotype 1, and viral protein/transcript expression in the tumor showed EBV latency I. Expression of Ephrin receptor A2, a recently reported receptor for EBV, was demonstrated in the tumor cells by immunohistochemistry. To our knowledge, this is the first report of lymphoepithelioma‐like carcinoma in the colorectal region showing a definite association with EBV infection.
Vitamin D status at birth and acute respiratory infection hospitalisation during infancy
Authors: Saraf Rajneeta , Jensen Berit P. , Camargo Carlos A. , Morton Susan M.B. , Jing Ma , Sies Chris W. , Grant Cameron C.
Published: April 2021

Background

Hospital admission for acute respiratory infections (ARIs) during early childhood is a global public health concern. Vitamin D deficiency is prevalent during pregnancy and infancy. Evidence indicates that vitamin D supplementation prevents ARIs.

Objectives

To determine whether vitamin D deficiency at birth is associated with ARI hospitalisations during infancy.

Methods

We performed a nested case–control study in children aged 0‐12 months. Cases had ≥1 ARI hospitalisation and 4 controls were individually matched to each case. Newborn 25(OH)D concentration was measured on dried blood spots using two‐dimensional liquid chromatography–tandem mass spectrometry. Hospital admissions were measured using health care records. Median serum 25(OH)D concentration in cases and controls was compared, and covariates of ARI hospitalisation during infancy were assessed using conditional logistic regression analysis.

Results

Six per cent of the cohort (n = 384) had an ARI hospitalisation during infancy, and 1536 controls were matched to cases. Median DBS [25(OH)D] was lower among ARI cases than controls (46 nmol/l vs. 61 nmol/L). Median 25(OH)D levels were lower for those hospitalised ≥2 times (47, IQR 36, 58) vs. those hospitalised once (52, IQR 42, 62) vs. the controls and also lower for those who stayed in the hospital for ≥3 days (45, IQR 36, 54) vs 1‐2 days (48, IQR 38, 59) compared to the controls. After adjustment for season of birth and covariates describing demographic, antenatal, perinatal, and infant characteristics, DBS 25(OH)D concentration (<50 nmol/L) at birth was associated with increased odds of ARI hospitalisation during infancy (odds ratio 2.20, 95% confidence interval 1.48, 2.91).

Conclusions

Vitamin D deficiency at birth is associated with increased odds of ARI hospitalisations in infants. The findings have implications for a developed country like New Zealand where vitamin D supplementation is not routinely recommended and the burden of ARI hospitalisation in young children is high.
Effect of surgical intervention for mild childhood obstructive sleep apnoea on attention and behavioural outcomes: A randomized controlled study
Authors: Au Chun T. , Chan Kate C. C. , Lee Dennis L. Y. , Leung Natalie , Chow Samuel M. W. , Chow Judy S. , Wing Yun K. , Li Albert M.
Published: April 2021

Background and objective

We evaluated inattention and behavioural outcomes following surgery versus watchful waiting (WW) in school‐aged children with mild obstructive sleep apnoea (OSA).

Methods

A prospective randomized controlled study was performed in pre‐pubertal children aged 6–11 years with polysomnography (PSG)‐confirmed mild OSA. They were assigned randomly to early surgical intervention (ES) or WW. The surgical intervention consisting of tonsillectomy with or without adenoidectomy and turbinate reduction was carried out within 4–6 weeks after randomization. Both groups underwent PSG, attention and behavioural assessment and review by an otorhinolaryngologist at baseline and 9‐month follow‐up. The primary outcome was omission T score from Conners' continuous performance test (CPT). Secondary outcomes were parent‐reported behaviours, quality of life, symptoms and PSG parameters.

Results

A total of 114 participants were randomized. Data of 35 subjects from the ES and 36 from the WW group were available for final analysis. No significant treatment effect could be found in all CPT parameters and behavioural outcomes. Nevertheless, significantly greater reductions were seen in PSG parameters (obstructive apnoea–hypopnoea index [−1.4 ± 2.0 cf. +0.3 ± 4.1/h, p = 0.038] and arousal index [−1.3 ± 4.4 cf. +1.4 ± 4.5/h, p = 0.013]) and OSA‐18 total symptom score (−17.3 ± 19.7 cf. −3.6 ± 14.1, p = 0.001) in the ES group. Subjects who underwent surgery also had significantly greater weight gain (+3.3 ± 2.1 cf. +2.2 ± 1.5 kg, p = 0.014) and increase in systolic blood pressure (+5.1 ± 12.4 cf. −1.2 ± 8.7 mm Hg, p = 0.016).

Conclusion

Despite improvements in PSG parameters and parent‐reported symptoms, surgical treatment did not lead to parallel improvements in objective attention measures in school‐aged children with mild OSA.
One year of Football Fitness improves L1–L4 BMD, postural balance, and muscle strength in women treated for breast cancer
Authors: Uth Jacob , Fristrup Bjørn , Sørensen Victor , Helge Eva Wulff , Christensen Maja Kjærgaard , Kjærgaard Julie Boye , Møller Trine Kjeldgaard , Helge Jørn Wulff , Jørgensen Niklas Rye , Rørth Mikael , Vadstrup Eva Soelberg , Krustrup Peter
Published: April 2021

Purpose

To examine efficacy of 12 months Football Fitness offered twice per week on bone mineral density (BMD), bone turnover markers (BTM), postural balance, muscle strength, and body composition in women treated for early‐stage breast cancer (BC).

Methods

Women treated for early‐stage BC were randomized to Football Fitness (FFG, n = 46) or control (CON, n = 22) in a 2:1 ratio for 12 months, with assessments performed at baseline, 6 months and 12 months. Outcomes were total body‐, lumbar spine‐ and proximal femur BMD, total body lean and fat mass, leg muscle strength, postural balance, and plasma amino‐terminal propeptide of type 1 procollagen (P1NP), osteocalcin, and C‐terminal telopeptide of type 1 collagen (CTX). Intention‐to‐treat (ITT) analyses and per‐protocol analyses (≥50% attendance in FFG) were performed using linear mixed models.

Results

Participants in FFG completing the 12‐month intervention (n = 33) attended 0.8 (SD = 0.4) sessions per week. Intention to treat analysis of mean changes over 12 months showed significant differences (p<.05) in L1–L4 BMD (0.029 g/cm2, 95%CI: 0.001 to 0.057), leg press strength (7.2 kg, 95%CI: 0.1 to 14.3), and postural balance (−4.3 n need of support, 95%CI: −8.0 to −0.7) favoring FFG compared to CON. In the per‐protocol analyses, L1–L4 and trochanter major BMD were improved (p = .012 and .030, respectively) in FFG compared with CON. No differences were observed between groups in BTMs in the ITT or per protocol analyses.

Conclusion

One year of Football Fitness training may improve L1–L4 BMD, leg muscle strength, and postural balance in women treated for early‐stage breast cancer.
The agencies of landscape in rural gentrification: Impressions from the wood, the village and the moortop
Authors: Phillips Martin , Smith Darren , Brooking Hannah , Duer Mara
Published: April 2021

This paper brings together research on rural gentrification with emerging work on lived landscapes that has emphasized the intertwining of the human and more‐than‐human with the performance of activities of everyday living and their affective significance. It draws on research examining rural gentrification in three contrasting landscapes, termed ‘the wood’, ‘the village’ and ‘the moortop’. These landscapes connect to earlier studies of rural social change and gentrification in England, with ‘the wood’ and ‘the village’ being sites research by Ray Pahl and the ‘moortop’ one of the landscapes identified in Darren Smith and Deborah Phillips' examination of the role of representations of rurality in processes of rural gentrification. The paper draws on research that returned to the locations of this earlier research, and seeks to re‐examine arguments advanced by these studies about the formation of socially differentiated worlds and representations of rurality through a lived‐landscape perspective.
Temporal and spatial diversification of rural social structure: The case of Poland
Authors: Halamska Maria , Stanny Monika
Published: April 2021

The article presents a temporal and spatial analysis of the social structure of rural Poland – currently a home to two‐fifths of the national population. In the first – temporal – dimension, the focus is on changes that have taken place since the post‐communist transformation. The aim of the analysis was to explain the mechanisms of change, that is, identify the processes that brought about those changes. We assumed that transitions in the rural social structure progressed differently than in the rest of society: they were deeper, followed different trajectories and resulted in fundamentally changed proportions between the rural structure's elements. In the other – spatial –dimension, we investigated the territorial diversity of the contemporary social structure. The social structure morphology was analysed on the basis of the proportions between three major social/occupational segments: farmers, workers and the middle class. Their distinction was determined by the trajectories of social structure change starting from the 1990s: depeasantisation, proletarianisation and gentrification. The study has revealed the complexity of the process of change as well as the unique character of the process of deagrarianisation, its depth/intensity being determined by the spatial diversity of types of rural social structure.
Food poverty and informal network support in a changing Portuguese rural area
Authors: Ramos Vasco , Truninger Monica
Published: April 2021

Different representations of the ‘countryside’ coexist in contemporary Portugal, from idyllic depictions to portrayals of emptiness and loneliness. Rural contexts close to urban areas are assumed to have informal support networks that can alleviate poverty and exclusion when institutional support fails. The incidence and intensity of food poverty are presumed to be lessened by proximity to food production sites and land ownership. In this article, we aim to analyse how living in an intermediate area shapes the experience of food poverty. We draw on qualitative case studies of low‐income families living in between a predominantly rural and a predominantly urban territory in Portugal, which has been through a process of restructuring of its rural territory since the second half of the 20th century. Paying attention to the specificities of this intermediate context, including the availability of formal support, we will investigate to what extent informal support networks alleviate food poverty for these families. Our discussion adds to the scientific debate on food poverty and its links to social networks in intermediate areas previously embedded in predominantly rural territories. We also discuss the highly gendered nature of informal support and its significance for women enduring food poverty.
The invisible (woman) entrepreneur? Shifting the discourse from fisheries diversification to entrepreneurship
Authors: Gustavsson Madeleine
Published: April 2021

In response to ongoing economic downturns in the small‐scale fishing sector, there have been calls for fishing businesses to add value to fishing catches. Whilst such activities would have gendered implications, such proposals often do not consider the gendered contexts in which entrepreneurship is placed, nor how this form of entrepreneurship works for the women involved. The article draws on in‐depth narrative interviews with women in fishing families in England and Wales who have started, initiated or explored entrepreneurial opportunities to examine (i) whether entrepreneurship enables a (re)negotiation of gender relations within families and (ii) how entrepreneurship develops over the lifecourse. The research is conceptually framed through the literature on women's ‘entrepreneurship’, family embedded perspectives of entrepreneurship, ‘Mumpreneurship’ combined with a lifecourse approach. I found that although women's traditional invisibility often became reproduced through their entrepreneurship in fishing family contexts, women's fisheries entrepreneurship challenged traditional gender relations. In becoming entrepreneurs women negotiated their entrepreneurship with other gendered roles, such as motherhood, over the lifecourse. I argue that shifting the discourse from fisheries diversification to entrepreneurship make it possible to take women seriously by fully viewing them as fisheries workers in their own right in both research and policy.
Export volatility with trade policy uncertainty: Evidence from China*
Authors: Chen Xiaoping , Zhao Xiaotao
Published: April 2021

This paper studies the effect of trade policy uncertainty on firm‐level export volatility. Using data on Chinese exporters around China's WTO accession, we find that a reduction of trade policy uncertainty between China and the United States decreases the volatility of firm‐level export to the United States and increases the volatility of export to the rest of the world. In the aggregate firm level, this shock in trade policy uncertainty has no significant effect on the volatility of total export or the volatility of total sales. Our finding suggests a risk‐sharing effect among export destinations.
Melting corneal ulcers (keratomalacia) in dogs: A 5‐year clinical and microbiological study (2014–2018)
Authors: Tsvetanova Agata , Powell Roger M. , Tsvetanov Kamen A. , Smith Kerry M. , Gould David J.
Published: April 2021

Objectives

To identify bacterial microorganisms associated with canine keratomalacia, review their antimicrobial sensitivity, and evaluate clinical outcomes compared to results of microbial culture.

Methods

Retrospective analysis of clinical records of dogs diagnosed with a melting corneal ulcer presented to a referral hospital in Hertfordshire, UK between 2014 and 2018.

Results

One hundred and ten melting corneal ulcers were sampled in 106 dogs. The most common pure bacterial isolate wasPseudomonas aeruginosa(n = 26) followed by β‐hemolyticStreptococcus(n = 12). Melting corneal ulcers that cultured coagulase‐positiveStaphylococcus, coliform bacteria,Pasteurella multocida,Enterococcus, andStreptococcus viridanspresented in smaller numbers and were analyzed together (n = 16). Multiple cultures were identified in nine cases (n = 9). Forty‐seven cultures yielded no bacterial growth (n = 47). The susceptibility to fluoroquinolones remained high with the exception ofβ‐hemolyticStreptococci. There was no significant difference in the ulcer severity at presentation in regard to the cultured bacteria. Overall, 63 eyes (57%) received surgical grafting in addition to medical treatment. In 14 cases (13%), the progression of corneal melting despite medical ± surgical treatment resulted in enucleation. Fifty‐seven percent (8/14) of the enucleated eyes cultured purePseudomonas aeruginosaisolates. In contrast, all β‐hemolyticStreptococcus‐associated ulcers healed.

Conclusions

The most common bacterial species associated with canine keratomalacia werePseudomonas aeruginosaand β‐hemolyticStreptococcus. Because of the variation in antibacterial sensitivity between these two species, bacterial culture and sensitivity testing should be performed in all dogs presenting with keratomalacia. Melting corneal ulcers associated with purePseudomonasinfection were significantly more likely to result in globe loss than melting corneal ulcers associated with other cultures.
Effect of pretreatment and co‐substrate addition on biogas production from pig slurry
Authors: Arhoun Brahim , Malpartida García Irene , Villen‐Guzman Maria , Abdala Diaz Roberto Teofilo , Garcia‐Herruzo Francisco , Rodriguez‐Maroto Jose Miguel
Published: April 2021

The anaerobic digestion of pig slurry samples collected from different points of a farm and raw pig slurry pretreated by centrifugation and decantation was first studied. The specific methane production of raw pig slurry and after centrifugation and decantation pretreatment was 158, 24 and 42.34 L kgVS−1, respectively. Second, the anaerobic digestion of the mixture of raw pig slurry and decanted solid fraction at different organic loading rate (1.364–3.41 gVS·L−1·d−1) results in a specific methane production of 249 ± 37·L kgVS −1. The concentration of ammonium ion in the digester increased to 2500 mg L−1 without inhibition. Lastly, the co‐digestion of pear waste and raw pig slurry was also analysed, which enhanced the specific methane production (243 L kgVS−1). This work deals with the integral management of pig slurry and points out the possibility of revalorization of other wastes in the same digester.
Prototyping Human-Centered Products in the Age of Industry 4.0
Authors: Ahmed Salman , Irshad Lukman , Demirel H. Onan
Published: April 2021

Industry 4.0 promises better control of the overall product development process; however, there is a lack of computational frameworks that can inject human factors engineering principles early in the design. This shortage is particularly crucial for prototyping human-centered products where the stakes are high. Thus, a smooth Industry 4.0 transformation requires keeping ergonomics in the loop, specifically to address the needs in the digitized prototyping process. In this paper, we explore a computational prototyping approach that focuses on various fidelity levels and different human–product interaction levels when conducting ergonomics assessments. Three computational prototyping strategies were explored, including (1) a digital sketchpad-based tool, (2) computer-aided design and digital human modeling-based approach, and (3) a combination of computer-aided design, digital human modeling, and surrogate modeling. These strategies are applied to six case studies to perform various ergonomics assessments (reach, vision, and lower-back). The results from this study show that the designers need to consider the tradeoffs between the accuracy of ergonomic outcomes and resource availability when determining the fidelity level of prototypes. Understanding the intricacies between the fidelity level, type of ergonomic assessment, and human–product interaction level helps designers in getting one step closer to digitizing human-centered prototyping and meeting Industry 4.0 objectives.
Multi-Model Bayesian Optimization for Simulation-Based Design
Authors: Tao Siyu , van Beek Anton , Apley Daniel W. , Chen Wei
Published: April 2021

We enhance the Bayesian optimization (BO) approach for simulation-based design of engineering systems consisting of multiple interconnected expensive simulation models. The goal is to find the global optimum design with minimal model evaluation costs. A commonly used approach is to treat the whole system as a single expensive model and apply an existing BO algorithm. This approach is inefficient due to the need to evaluate all the component models in each iteration. We propose a multi-model BO approach that dynamically and selectively evaluates one component model per iteration based on the uncertainty quantification of linked emulators (metamodels) and the knowledge gradient of system response as the acquisition function. Building on our basic formulation, we further solve problems with constraints and feedback couplings that often occur in real complex engineering design by penalizing the objective emulator and reformulating the original problem into a decoupled one. The superior efficiency of our approach is demonstrated through solving two analytical problems and the design optimization of a multidisciplinary electronic packaging system.
Contrast-enhanced ultrasound algorithm (ACR CEUS LI-RADSv 2017)– a valuable tool for the noninvasive diagnosis of hepatocellular carcinoma in patients with chronic liver disease
Authors: Ghiuchici Ana Maria , Dănilă Mirela , Popescu Alina , Șirli Roxana , Moga Tudor , Topan Mădălina , Bende Felix , Sporea Ioan
Published: April 2021

Aims: to evaluate the accuracy of LR-5 category from the latest Contrast-Enhanced Ultrasound algorithm (ACR CEUS LI-RADSv 2017) for the noninvasive diagnosis of hepatocellular carcinoma (HCC), in a real-life cohort of high-risk patients. Material and methods: We retrospectively re-analysed the CEUS studies of 464 focal liver lesions (FLL) in 382 patients at high-risk for HCC (liver cirrhosis of any aetiology, chronic B or C hepatitis with severe fibrosis) using the ACR CEUS LI-RADSv 2017 algorithm. CEUS LI-RADS categories used for the diagnosis of HCC were: CEUS LR-5 (definitely HCC) and CEUS LR-TIV (HCC with macrovascular invasion). Contrast-enhanced CT, contrast-enhanced MRI, or histology were used as diagnostic reference methods to evaluate the CEUS LI-RADS classification of the 464 lesions. Results: According to the reference method, the 464 lesions were classified as follows: 359 HCCs, 68 non-HCC-non-malignant lesions and 37 non-HCC malignant lesions. The diagnostic accuracy of LR-5 category for the diagnosis of hepatocellular carcinoma was 76.9%. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 71.9%, 94.3 %, 97.7% and 49.5%, respectively. Conclusions: LR-5 category from ACR CEUS LI-RADSv 2017 algorithm, has good sensitivity, excellent specificity, and PPV for the diagnosis of HCC. The HCC rate increases from LR-3 to LR-5.
The role of intracardiac echocardiography in reducing radiation exposure during atrial fibrillation ablation
Authors: Minciuna Ioan-Alexandru , Puiu Mihai , Cismaru Gabriel , Roșu Radu , Tomoaia Raluca , Simu Gelu , Istrătoaie Sabina , Caloian Bogdan , Comșa Horatiu , Gușetu Gabriel , Zdrenghea Dumitru , Pop Dana
Published: April 2021

Aims: Intracardiac echocardiography (ICE) is a relatively young technique used during complex electrophysiology proce-dures, such as atrial fibrillation (AF) ablation. The aim of this study was to assess whether the use of ICE modifies the radia-tion exposure at the beginning of the learning curve in AF ablation. Materials and methods: In this retrospective study, 52 patients, in which catheter ablation for paroxysmal or persistent AF was performed, were included. For 26 patients we used ICE guidance together with fluoroscopy, whereas for the remaining 26 patients we used fluoroscopy alone, all supported by electroanatomical mapping. We compared total procedure time and radiation exposure, including fluoroscopy dose and time between the two groups and along the learning curve. Results: Most of the patients included were suffering from paroxysmal AF (40, 76%), pulmonary vein isolation being performed in all patients, without secondary ablation sites. The use of ICE was associated with a lower fluoroscopy dose (11839.60±6100.6 vs. 16260.43±8264.5 mGy, p=0.041) and time (28.00±12.5 vs. 42.93±12.7 minutes, p=0.001), whereas the mean procedure time was similar between the two groups (181.54±50.3 vs 197.31±49.8 minutes, p=0.348). Radiation exposure was lower in the last 9 months compared to the first 9 months of the study (p<0.01), decreasing gradually along the learning curve. Conclusions: The use of ICE lowers radiation exposure in AF catheter ablation from the beginning of the learning curve, without any difference in terms of acute safety or efficacy. Aware-ness towards closest to zero radiation exposure during electrophysiology procedures should increase in order to achieve better protection for both patient and medical staff.
Diagnostic value of endobronchial ultrasound elastography for differentiating benign and malignant hilar and mediastinal lymph nodes: a systematic review and meta-analysis
Authors: Wu Jiangfeng , Sun Yue , Wang Yunlai , Ge Lijing , Jin Yun , Wang Zhengping
Published: April 2021

Aims: In the present study, a meta-analysis was performed to evaluate the diagnostic value of endobronchial ultrasound (EBUS) elastography for differentiating benign and malignant hilar and mediastinal lymph nodes (LNs). Material and methods: A comprehensive literature search was carried out through PubMed, Embase, and Cochrane Library. Two authors screened the papers and extracted the data independently and any discrepancies were resolved by discussion. The methodolog-ical quality of each included study was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the curve were calculated to evaluate the value of EBUS elastography for hilar and mediastinal LNs. Results: Seventeen studies with the number of 2307 LNs were included. There was significant heterogeneity across the included studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio for the diagnosis of hilar and mediastinal LNs by EBUS elastography were 0.90 (95% confidence interval [CI], 0.84-0.94), 0.78 (95% CI, 0.74-0.81), 4.1 (95% CI, 3.4-4.9), 0.12 (95% CI, 0.07-0.21) and 33 (95% CI, 17-64), respectively. Furthermore, area under the curve was calculated to be 0.86 (95% CI, 0.82-0.88). Conclusion: EBUS elastography is a valuable technology in the differentiation of benign and malignant hilar and mediastinal LNs and could provide supplementary diagnostic information during endobronchial ultrasound-guided transbronchial needle aspiration. The combination of EBUS elastography and B-mode EBUS could improve the diagnostic accuracy for hilar and mediastinal LNs.
Effects of Pacific Summer Water layer variations and ice cover on Beaufort Sea underwater sound ducting
Authors: Duda Timothy F. , Zhang Weifeng Gordon , Lin Ying-Tsong
Published: April 2021

A one-year fixed-path observation of seasonally varying subsurface ducted sound propagation in the Beaufort Sea is presented. The ducted and surface-interacting sounds have different time behaviors. To understand this, a surface-forced computational model of the Chukchi and Beaufort Seas with ice cover is used to simulate local conditions, which are then used to computationally simulate sound propagation. A sea ice module is employed to grow/melt ice and to transfer heat and momentum through the ice. The model produces a time- and space-variable duct as observed, with Pacific Winter Water (PWW) beneath a layer of Pacific Summer Water (PSW) and above warm Atlantic water. In the model, PSW moves northward from the Alaskan coastal area in late summer to strengthen the sound duct, and then mean PSW temperature decreases during winter and spring, reducing the duct effectiveness, one cause of a duct annual cycle. Spatially, the modeled PSW is strained and filamentary, with horizontally structured temperature. Sound simulations (order 200 Hz) suggest that ducting is interrupted by the intermittency of the PSW (duct gaps), with gaps enabling loss from ice cover (set constant in the sound model). The gaps and ducted sound show seasonal tendencies but also exhibit random process behavior.
Nearly 40 years of domination by electret microphones
Authors: Busch-Vishniac Ilene J. , Elko Gary W.
Published: April 2021

The Reflections series takes a look back on historical articles from The Journal of the Acoustical Society of America that have had a significant impact on the science and practice of acoustics.
Notes on Rayleigh's hypothesis and the extended boundary condition method
Authors: Rother Tom , Hawkins Stuart C.
Published: April 2021

Regarding wave scattering on a three-dimensional nonspherical obstacle, the Rayleigh hypothesis states that the scattered field can be expanded everywhere outside the obstacle using only outgoing eigensolutions of the underlying Helmholtz equation. However, the correctness of this assumption has not yet been finally clarified, although it is important for the near-field analysis of scattering processes and for multiple scattering. To circumvent this uncertainty, Waterman introduced the extended boundary condition to develop his T-matrix method. This approach leads to the restriction that, when modeling multiple scattering processes using this T-matrix, the smallest circumscribing spheres of the individual obstacles must not overlap. The purpose of this paper is to provide a justification of the correctness of Rayleigh's hypothesis and clarify its implications for modeling multiple scattering. We show that Waterman's T-matrix can in fact be used inside the critical region between the surface of the obstacle and its smallest circumscribing sphere to represent the near-field and that one does not necessarily have to exclude an overlap of these spheres in the multiple scattering modeling. The theoretical considerations in the first part of this paper are supplemented by a numerical study of a benchmark configuration for multiple scattering in the last part.
An optimist takes the helm at NSF
Authors: Mervis Jeffrey
Published: April 2021

Sethuraman Panchanathan has spent his career finding "win-win" situations.
Not open and shut
Authors: Couzin-Frankel Jennifer , Vogel Gretchen , Weiland Meagan
Published: April 2021

School openings across the globe suggest ways to keep the coronavirus at bay, despite outbreaks.
Side effect worry grows for AstraZeneca vaccine
Authors: Vogel Gretchen , Kupferschmidt Kai
Published: April 2021

Some nations limit shot to older people, as probe of clotting disorders continues.
Underwater neutrino traps take shape
Authors: Clery Daniel
Published: April 2021

Detectors aim to trace high-energy particles to violent cosmic accelerators in deep space.
U.S. needs solar geoengineering research program, report says
Authors: Voosen Paul
Published: April 2021

Proposed $200 million effort could include limited field studies of ways to dim sunlight.
Aging immunity may exacerbate COVID-19
Authors: Akbar Arne N. , Gilroy Derek W.
Published: April 2021

Increased general inflammation in aging inhibits immunity and affects responses to infections
Nailing a Fe-rocious form of cancer
Authors: Garzia Livia , Taylor Michael D.
Published: April 2021

Disseminated cancer cells in brain fluids hijack iron from macrophages for metastatic survival
A synapse census for the ages
Authors: Micheva Kristina D. , Weinberg Richard J. , Smith Stephen J
Published: April 2021

A molecular imaging survey reveals the evolution of mouse brain synapse populations from birth through old age
Advice for the new NSF director
Authors: Coleman Mary Sue
Published: April 2021

A new director, Dr. Sethuraman Panchanathan, takes the helm of the U.S. National Science Foundation (NSF) during a pivotal time for the future of scientific research in the United States. This month marks the 75th anniversary of the seminal report “Science—The Endless Frontier” by Vannevar Bush, director of the Office of Scientific Research and Development, submitted in 1945. The treatise laid the groundwork for the NSF and many other investments that have kept the United States at the forefront of scientific advancement and economic innovation. Today, American science and the United States face similar challenges that center around national security, economic strength, and social justice. To renovate the NSF in ways that address current issues, Dr. Panchanathan should use his position to build on the time-tested partnership between science and the U.S. government. To this end, I offer the following advice for improving the NSF in the coming years.
Achieving fairness in medical devices
Authors: Kadambi Achuta
Published: April 2021

Learning from computer science can make medical devices fair for all races and sexes
Stephen Hawking, celebrity scientist
Hawking Hawking: The Selling of a Scientific Celebrity
Charles Seife
Basic Books, 2021. 400 pp.
Authors: Fahy Declan
Published: April 2021

A new biography considers the cosmologist's reputation while placing his work in context
How dopamine leads to hallucinations
Authors: Matamales Miriam
Published: April 2021

An increase of dopamine in the striatum virtualizes a nonexistent auditory signal in mice
Distinguishing
bla
KPC
Gene-Containing IncF Plasmids from Epidemiologically Related and Unrelated
Enterobacteriaceae
Based on Short- and Long-Read Sequence Data
Authors: Stohr Joep J. J. M. , Kluytmans-van den Bergh Marjolein F. Q. , Weterings Veronica A. T. C. , Rossen John W. A. , Kluytmans Jan A. J. W.
Published: April 2021

Limited information is available on whether
bla
KPC
-containing plasmids from isolates in a hospital outbreak can be differentiated from epidemiologically unrelated
bla
KPC
-containing plasmids based on sequence data. This study aimed to evaluate the performance of three approaches to distinguish epidemiologically related from unrelated
bla
KPC
-containing pKpQiL-like IncFII(k2)-IncFIB(pQiL) plasmids.
Repeated Exposure of Aspergillus niger Spores to the Antifungal Bacterium Collimonas fungivorans Ter331 Selects for Delayed Spore Germination
Authors: Mosquera Sandra , Leveau Johan H. J. , Stergiopoulos Ioannis
Published: April 2021

The use of antagonistic bacteria for managing fungal diseases is becoming increasingly popular, and thus there is a need to understand the implications of their long-term use against fungi. Most efforts have so far focused on characterizing the antifungal properties and mode of action of the bacterial antagonists, but the possible outcomes of the persisting interaction between antagonistic bacteria and fungi are not well understood.
Sulfate Import inSalmonellaTyphimurium Impacts Bacterial Aggregation and the Respiratory Burst in Human Neutrophils
Authors: Westerman T. L. , Sheats M. K. , Elfenbein J. R.
Published: April 2021

During enteric salmonellosis, neutrophil-generated reactive oxygen species alter the gut microenvironment, favoring survival ofSalmonellaTyphimurium. While type 3 secretion system 1 (T3SS-1) and flagellar motility are potentSalmonellaTyphimurium agonists of the neutrophil respiratory burstin vitro,neither of these pathways alone is responsible for stimulation of a maximal respiratory burst.
The Small Molecule H89 Inhibits
Chlamydia
Inclusion Growth and Production of Infectious Progeny
Authors: Muñoz Karissa J. , Wang Kevin , Sheehan Lauren M. , Tan Ming , Sütterlin Christine
Published: April 2021

Chlamydia
is an obligate intracellular bacterium and the most common reportable cause of human infection in the United States. This pathogen proliferates inside a eukaryotic host cell, where it resides within a membrane-bound compartment called the chlamydial inclusion.
HIF1α-Regulated Expression of the Fatty Acid Binding Protein Family Is Important for Hypoxic Reactivation of Kaposi’s Sarcoma-Associated Herpesvirus
Authors: Singh Rajnish Kumar , Bose Dipayan , Robertson Erle S.
Published: April 2021

Hypoxia is a detrimental stress to eukaryotes and inhibits several cellular processes, such as DNA replication, transcription, translation, and metabolism. Interestingly, the genome of Kaposi’s sarcoma-associated herpesvirus (KSHV) is known to undergo productive replication in hypoxia.
Prednisolone: role in amoxicillin–clavulanate-induced cholestatic liver injury
Authors: Lee Melvin Qiyu , Chigozie Royale , Khan Irfan , O'Mara Gerard
Published: April 2021

A 68-year-old patient presented with symptoms of a urinary tract infection. A deterioration in the patient’s liver function tests (LFTs) was noted 1 week following completion of a course of amoxicillin–clavunalate. This progressively worsened, reaching its peak by day 30. Our investigations excluded other possible causes for deranged LFTs and there was no improvement of same despite reduced dosing of potentially hepatotoxic medications.

A trial of 30 mg/day prednisolone was commenced, resulting in an immediate and progressive improvement in LFTs to baseline over a period of 22 days and an improvement in constitutional symptoms such as tiredness and poor appetite. Drug-induced liver injury (DILI) is one of the common causes of acute hepatitis and a leading cause of acute liver failure in the US and Europe. Patterns of DILI can be generally divided into: (1) hepatocellular injury, (2) cholestatic injury and (3) mixed injury.
Primary clear cell carcinoma of gallbladder arising in porcelain gallbladder
Authors: Sarangi Sujata , Rao Meenakshi , Vishnoi Jeewan Ram , Kumar Garg Pawan
Published: April 2021

Gallbladder carcinomas (GBCs) are the most common carcinomas of the biliary tract. The clear cell variant is encountered rarely, accounting for approximately 1% of all GBCs.Due to its rarity, the exact incidence and pathogenesis of this variant are unknown. Though hyalinising cholecystitis (porcelain gallbladder) is an established risk factor for development of conventional adenocarcinomas of the gallbladder, its role in the pathogenesis of the rare variants of GBC is not well-established. The current case raises the possibility that clear cell carcinoma of the gallbladder may arise through the same pathways as conventional adenocarcinomas of the gallbladder.
Unintentional ingestion of a high dose of acenocoumarol in a young child
Authors: Brands Martijn R , Sytema Jelmer , van Hulst Marinus , Kamps Arvid WA
Published: April 2021

Acute intoxication with a vitamin K antagonist may cause serious coagulopathy. We report the accidental ingestion of a high dose of acenocoumarol in a young child. Two intravenous administrations of 5 mg of vitamin K, in combination with fast and repeated administration of activated charcoal and sodium sulfate, were sufficient to prevent coagulopathy and related symptoms, despite a confirmed elevated blood acenocoumarol concentration (260 µg/L).
Juvenile dermatomyositis: a case of delayed recognition with unusual complication of nephrocalcinosis
Authors: Sangeetha Geminiganesan , Dhanabal Divya , Mouttou Prebagarane Saktipriya , Janarthanan Mahesh
Published: April 2021

Juvenile dermatomyositis (JDM) is the most common inflammatory myopathy in children and is characterised by the presence of proximal muscle weakness, heliotrope dermatitis, Gottron’s papules and occasionally auto antibodies. The disease primarily affects skin and muscles, but can also affect other organs. Renal manifestations though common in autoimmune conditions like lupus are rare in JDM. We describe a child whose presenting complaint was extensive calcinosis cutis. Subtle features of proximal muscle weakness were detected on examination. MRI of thighs and a muscle biopsy confirmed myositis. Nephrocalcinosis was found during routine ultrasound screening. We report the first case of a child presenting with rare association of dermatomyositis, calcinosis cutis and bilateral medullary nephrocalcinosis.
Multimethods study comparing the experiences of medical clinical academics with nurses, midwives and allied health professionals pursuing a clinical academic career
Authors: Trusson Diane , Rowley Emma , Barratt Jonathan
Published: April 2021

Objectives

This study aimed to compare experiences of medical clinical academics (MCAs) with those of nurses, midwives and allied health professionals (NMAHPs) pursuing a clinical academic career.

Design

A multimethods approach was used to elicit qualitative data. Both sets of participants completed similar online surveys followed by in-depth interviews to explore emerging themes.

Setting

The research was conducted in the East Midlands of England, encompassing two Higher Education Institutions and four National Health Service Trusts.

Participants

Surveys were completed by 67 NMAHPs and 73 MCA trainees. Sixteen participants from each group were interviewed following a similar interview schedule.

Results

The survey data revealed notable differences in demographics of the two study populations, reflecting their different career structures. MCAs were younger and they all combined clinical and academic training, lengthening the time before qualification. In contrast, most NMAHPs had been in their clinical post for some years before embarking on a clinical academic pathway. Both routes had financial and personal repercussions and participants faced similar obstacles. However, there was also evidence of wide-ranging benefits from combining clinical and academic roles.

Conclusions

Variations in experiences between the two study populations highlight a need for a clear academic pathway for all health professionals, as well as sufficient opportunities post-PhD to enable clinical academics to fully use their dual skills.
Adaptation and evaluation of the Chinese hospital nursing department disaster preparedness scale: a cross-sectional scale development study
Authors: Shi Lan , Li Mingxuan , Xu Xiaofeng , Wang Zhengdong , Li Sijian , Feng Xianqiong
Published: April 2021

Aim

The aim of this study was to adapt the Chinese version of Hospital Nursing Department Disaster Preparedness Scale (HNDDPS) and evaluate the psychometric properties among hospital nurses in China. Two specific objectives were (1) to adapt the HNDDPS from Sadiq’s Organisational Disaster Preparedness Scale (SODPS) to fit the context of Chinese hospital nursing system and (2) to establish its validity and reliability.

Design

Instrument design study.

Settings and participants

2657 nurses belonging to 50 nursing organisations of tertiary hospitals spread across seven administrative regions of China.

Methods

We adapted the Chinese version of HNDDPS through translation of the SODPS, back translation and cultural adaptation. Subsequently, we evaluated the validity of the scale through exploratory factor analysis and confirmatory factor analysis (CFA), each performed on half of the original sample. We also evaluated the internal consistency reliability of the scale.

Results

The Chinese version of HNDDPS comprised five dimensions, with 72 items. Exploratory factor analysis yielded five factors explaining 61% of the items’ variance. CFA confirmed five dimensions of the scale and produced appropriate Goodness of Fit Indexes. Cronbach’s α-coefficient was 0.930 for the total scale and ranged from 0.908 to 0.964 for the five dimensions of the scale.

Conclusion

HNDDPS demonstrates good internal consistency and construct validity. It is a promising, valid and reliable tool for nurses and nursing managers to evaluate hospital nursing department disaster preparedness.
Deprescribing tool for use in older Australians with life-limiting illnesses and limited life expectancy: a modified-Delphi study protocol
Authors: Shrestha Shakti , Poudel Arjun , Steadman Kathryn J , Nissen Lisa M
Published: April 2021

Background

Making a meaningful decision on deprescribing of potentially inappropriate medications in older adults with life-limiting illnesses (LLIs) and limited life expectancy (LLE) is often challenging. Therefore, we aimed to elicit opinion and gain consensus on a deprescribing tool for use in this population.

Methods and analysis

A modified-Delphi method will be used to obtain a consensus from a panel of experts in geriatric therapeutics on a deprescribing tool for use in people aged ≥65 years with LLIs and LLE. Through an online survey, in the initial round, the panel will anonymously elicit their opinion on a series of items related to the conceptual model of the deprescribing tool, its practicality and deprescribing of medications, while on the controlled feedback in subsequent rounds till a consensus is reached or the panellists stop revising their answers. In each round, panel members will be using a 5-point Likert scale to rate their agreement with the statement. Consensus will be considered on ≥75% of agreement on the statements.

Ethics and dissemination

All the participants will receive an invitation and participant information but they need to consent for the participation. Ethics approval has been granted from the University of Queensland Health and Behavioural Sciences, Low and Negligible Risk Ethics Sub-Committee (reference: 2020001069). The results of this project will be disseminated through conferences and a peer-reviewed clinical journal.