bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility of energy‐guided short duration protocol of laser balloon based pulmonary vein isolation for atrial fibrillation (EG‐Laser Study)
Authors: Sano Makoto , Naruse Yoshihisa , Kaneko Yutaro , Sakakibara Tomoaki , Narumi Taro , Urushida Tsuyoshi , Maekawa Yuichiro
Published: June 2023

Background

Laser balloon‐based pulmonary vein isolation (LB‐PVI) is available for atrial fibrillation (AF) ablation. The lesion size depends on laser energy; however, the default protocol is not an energy‐based setting. We hypothesized that an energy‐guided (EG) short‐duration protocol may be an alternative to shorten the procedure time without affecting efficacy and safety.

Methods

We evaluated the efficacy and safety of the EG short‐duration protocol (EG group) (target energy 120 J/site [12W/10s; 10W/12s; 8.5W/14s; 5.5W/22s]) compared with the default protocol (control group) (12W/20s; 10W/20s; 8.5W/20s; 5.5W/30s).

Results

A total of 52 consecutive patients (EG: n = 27 [103veins] and control: n = 25 [91veins]) undergoing LB‐PVI (64 ± 10 years, 81% male, 77% paroxysmal) were enrolled. The EG group had a shorter total time in the pulmonary vein (PV) (43.0 ± 13.9 min vs. 61.1 ± 16.0 min, p < .0001), a shorter total laser application time (1348 ± 254 sec vs. 2032 ± 424 sec, p < .0001), and lower total laser energy (12455 ± 2284J vs. 18084 ± 3746J, p < .0001). There was no difference in the total number of laser applications (p = 0269) or first‐pass isolation (p = .725). Acute reconduction was identified only in one vein in the EG. No significant differences were observed in the incidence of pinhole rupture (7.4% vs. 4%, p = 1.000) or phrenic nerve palsy (3.7% vs. 12%, p = .341). During a mean follow‐up of 13.5 ± 6.1 months, Kaplan‐Meier analysis revealed no significant difference in atrial tachyarrhythmia recurrence (p = .227).

Conclusion

LB‐PVI with the EG short‐duration protocol may be achieved in a shorter procedure time to avoid deterioration of efficacy and safety. The EG protocol is feasible as a novel point‐by‐point manual laser‐application approach.
Monitoring anesthesia depth with patient state index during pediatric surgery
Authors: Ricci Zaccaria , Robino Chiara , Rufini Paolo , Cumbo Silvia , Cavallini Sara , Gobbi Lorenzo , Brocchi Agata , Serio Paola , Romagnoli Stefano
Published: June 2023

Background

Monitoring anesthesia depth in children is challenging. Pediatric anesthesiologists estimate general anesthesia depth using indirect methods such as pharmacokinetic models and neurovegetative reflexes. The application of processed electroencephalography may help to identify the correct anesthesia depth (i.e., patient state index between 25 and 50).

Aims

To determine the median values of patient state index and spectral edge frequency 95% in children undergoing general anesthesia conducted according to indirect evaluation of depth. The relationships between patient state index and spectral edge frequency 95% and indirect monitoring of anesthesia depth, type of anesthesia, age subgroups, and postoperative delirium were also assessed.

Methods

A prospective observational study on children (aged 1–18 years) undergoing surgery longer than 60 min. The SedLine monitor and the novel SedLine pediatric sensors (Masimo Inc., Irvine California) were applied. Patient state index levels were recorded for the duration of the anesthesia until the discharge to the ward at predefined time points.

Results

In the 111 enrolled children, median patient state index level at the end of anesthesia induction was 25 (22–32) and ranged from 26 (23–34) to 28 (25–36) in the maintenance phase. Patient state index at extubation was 48 (35–60) and 69 (62–75) at discharge from the operatory room. Median right/left spectral edge frequency 95% values at the end of induction were 10 (6–14)/9 (5–14) Hz and median right/left spectral edge frequency 95% values in the maintenance phase ranged from 10 (6–14) to 12 (11–15) Hz in both hemispheres. At extubation, right/left spectral edge frequency 95% levels were 18 (15–21)/17 (15–21) Hz. We observed 39 episodes of burst suppression in 20 patients (19%). Median patient state index levels were not different between patients undergoing inhalational and intravenous anesthesia and between those undergoing general anesthesia and general anesthesia added to locoregional anesthesia. Children <2 years displayed significantly higher patient state index levels than older patients (p = .0004). The presence of a burst suppression episode was not associated with PAED levels (OR 1.58, 95% CI 0.14–16.74, p` = .18).

Conclusions

NonpEEG‐guided anesthesia in children led to median patient state index levels at the low range of recommended unconsciousness values with frequent episodes of burst suppression. Patient state index levels were generally higher in children below 2 years.
Soil invertebrate and microbial activity rehabilitation by compost application after road construction and volcanic disturbance
Authors: Ferreiro Nicolás , Satti Patricia , Mazzarino María J.
Published: June 2023

Topsoil and plants had been removed for the construction of the “De los Siete Lagos” road when the June 2011 Puyehue–Cordón Caulle Complex volcanic eruption deposited 30 cm of tephra. Our objective was to study the active rehabilitation of substrate on roadsides simultaneously affected by road construction and volcanic eruption by compost addition. We studied two biological communities frequently forgotten by rehabilitation measures: invertebrates (density, richness) and microorganisms (enzymatic activities); both in the surface organic matter created by compost addition and the tephra substrate. In December 2012, we installed control, biosolids compost (BC) and municipal waste compost (MC) plots on roadside exclosures. Forest reference sites were also studied. Samplings were performed in spring 2013 and summer 2014. No surface organic matter was found in control plots, and no invertebrates were detected in the tephra layer of control plots in both samplings. BC and MC promoted the formation of a surface organic matter layer that harbored invertebrate and enzymatic activity in both sampling seasons. There were no significant differences in invertebrate density among BC, MC, and forest both in the surface organic matter and the tephra substrate. However, BC and MC invertebrate communities, dominated by springtails, did not resemble the forest community, where oribatids were the most common taxa. Statistically significant differences in total (surface organic matter + tephra substrate) microbial activities indicated a treatment order of forest > BC ≥ MC > control for enzymes related with the mineralization of nitrogen (leucine‐aminopeptidase) and phosphorus (acid phosphomonoesterase).
Taming the real estate boom in the EU: Pathways to macroprudential (in)action
Authors: Lepers Etienne , Thiemann Matthias
Published: June 2023

In the fallout of the 2008 crisis, macroprudential policy has been installed as the policy remedy against future financial instability, a primary focus being developments in the real estate sector. With house prices consistently rising in the EU since 2014, causing alarm among macroprudential supervisory bodies, a core question of EU regulatory governance is how far macroprudential bodies have been capable of bringing about countercyclical actions against the build‐up of such vulnerabilities. This paper investigates this question using a novel dataset of macroprudential intensity coded for the 17 EU countries that experienced real estate vulnerabilities post‐euro crisis. Specifically, it asks which configuration of conditions account for the (in)capacity of countries to impose stringent countercyclical regulations against housing booms? Using fuzzy set qualitative comparative analysis technics coupled with qualitative analysis of country cases using expert interviews, we find that the absence of political salience of homeownership and the political independence of macroprudential authorities to be crucial conditions that jointly explain countercyclical macroprudential activity. These findings, which show two pathways to action have implications for the capacity of the EU to prevent future crises and future reform of the EU prudential framework.
“They'll take a gun to me before I get that shot”: Rationalization, emotions, and misinformation in COVID‐19 vaccine hesitancy
Authors: George Michaela F. , Rosenberg Benjamin D. , Dale Savannah N. , Kirkland Lauren H. , Culross Patti L. , Chen Rong
Published: June 2023

Vaccine hesitancy—the reluctance, delay, or refusal to vaccinate regardless of availability—is not a new concept in psychology, medicine, or public health. However, given the emotions surrounding the COVID‐19 vaccine, hesitancy has proven difficult to overcome. To‐date, the bulk of available data on vaccine hesitancy are quantitative, leaving room for exploratory investigations into the reasons adults remain unvaccinated. This qualitative study assessed the motivations, beliefs, and perceptions of individuals who have decided to remain unvaccinated against COVID‐19. We had one exploratory research question: What social psychological justifications emerge from vaccine hesitant people's explanations of their decisions to remain unvaccinated? To assess this question, we conducted 18 interviews with unvaccinated adults throughout 2021–2022. The interviews consisted of 20 questions regarding participants' perceptions of the COVID‐19 vaccine and their intentions to get vaccinated. Thematic analysis revealed four main themes in the answers provided by participants: rationalization; identity, beliefs and potential modifiers; emotional responses; and information sources. These results offer insight for future vaccination efforts.
Bertini theorems revisited
Authors: Ghosh Mainak , Krishna Amalendu
Published: June 2023

We prove several new Bertini theorems over arbitrary fields and discrete valuation rings.
On the distribution of equivalence classes of random symmetricp‐adic matrices
Authors: Kovaleva Valeriya
Published: June 2023

We consider random symmetric matrices with independent entries distributed according to the Haar measure on for odd primespand derive the distribution of their canonical form with respect to several equivalence relations. We give a few examples of applications including an alternative proof for the result of Bhargava, Cremona, Fisher, Jones and Keating on the probability that a random quadratic form over has a non‐trivial zero.
A Compliant Manipulator for Confined Space Tissue Diagnostics: Kinematic and Force Analyses and Initial Characterization Experiments
Authors: Adejokun Samson A. , Shiakolas Panos S.
Published: June 2023

Minimally invasive procedures employ continuum manipulators, however internal human anatomy presents challenges relating to size, dexterity, and workspace for these manipulators. This paper presents modeling, kinematic analysis, prototyping, and characterization of a micro-robotic manipulator for transurethral palpation of bladder tissue. The proposed micro-robot consists of two subsystems: a tendon-driven continuum segment with an elastic tube encompassing each joint for compliance and structural integrity, and a hyper-spherical joint ensuring higher dexterity and manipulability with a comprehensive actuation and modeling approach. The forward kinematics follow the Denavit–Hartenberg formulation. A developed differential Jacobian inverse kinematics formulation prevents motion singularities for desired poses while operating in the confined space. The simulated kinematic results confirm the dexterity and reach of the proposed micro-robot. A strain energy quasi-static model is developed for a single continuum module. The model is evaluated for tension-bend angle relationships as function of tube material and geometry, and joint length. Limited functionality continuum modules (4 mm outside diameter) with four different joint lengths, (3, 6, 9, 12) mm, are prototyped for tension-bend angle characterization using a computer vision outfitted experimental setup. An equivalent bending modulus relationship for the joint system for selected joint length values and bend angles is developed using experimental results. The tension-bend angle response is nonlinear and function of tube properties and geometry, joint geometry, and their interactions. The comparison of the experimental and quasi-static model results shows high fidelity for use in predicting the robot continuum segment behavior.
The Value of Agile Thermal Systems: A Real-World Approach to Modeling and Prioritizing Agility Versus Efficiency
Authors: Goldfarbmuren Russell
Published: June 2023

A modeling architecture is presented to better understand the value of thermomechanical systems with agility: the ability to provide an uninterrupted service to a customer while simultaneously adjusting their own energy consumption based on price signals. The results of this modeling show a significant opportunity for devices with increased thermal agility to provide both financial and environmental benefits to customers who adopt them. Systems with multiple hours of agility via storage, advanced controls, fuel switching, or other means could decrease utility costs by up to 50%.
Subsection NF—Supports
Authors: Deubler R. Peter , Bandyopadhyay Uma S.
Published: June 2023

ASME Boiler and Pressure Vessel Code Section III, Division 1, Subsection NF, was developed in an attempt to provide rules for the estimated 10,000 piping and component supports existing in a typical nuclear power plant. This chapter provides information on the origins and evolution of design rules and is intended to allow designers, engineers, and fabricators to make better use of Subsection NF of the ASME Code. It begins with an introduction to Article NF-1000, focusing on the scope, types of supports, and boundaries of jurisdiction for supports. The chapter then describes the NF-2000 material requirements, providing information on permitted and exempt materials, material certification requirements, and impact testing of materials. Next, it discusses the design rules for supports—both plate-and-shell and linear. All aspects of design are considered, including stress theory, loadings, welding, bolting, load testing, and functional requirements. The chapter then addresses rules for NF-4000 fabrication and installation. These rules provide requirements for the entire fabrication cycle, including forming, fitting, aligning, welding, heat treatment, and bolted connections. The chapter also describes methods for nondestructive examination of support welds and relevant acceptance standards. It provides cross-referencing to Subsections NB, NC, ND, NE, and NG, as well as to the B31.1 and B31.3 Codes. The closing pages of this chapter address Code Cases and Interpretations. Discussions include Subsection NF Appendices, and with the help of Figures, Tables, and references, it is anticipated that the reader will develop a better understanding of Subsection NF and appreciate its complexities and usefulness.

History

Robert J. Masterson was the author of this Chapter for the first edition, Uma S. Bandyopadhyay updated it for the second edition thru the fifth edition and R. Peter Deubler updated it for the current online edition.
Subsection NG—Core Support Structures
Authors: Keck David
Published: June 2023

This chapter provides commentary and some practical examples on the materials, design, fabrication, installation, and examination requirements for core support structures (CSS) in pressurized water reactors and boiling water reactors in Section III, Division 1, Subsection NG of the ASME Boiler and Pressure Vessel Code. It begins with background information on the development of Subsection NG and the definition of CSS, internal structures (IS), and threaded structural fasteners (TSF). The chapter then outlines the jurisdictional boundaries between CSS and reactor pressure vessels and the unique service loadings for reactor internals. The chapter details the material requirements in NG-2000; describes the examples of typical materials used in CSS, IS, and TSF; and discusses the salient subarticles of NG-3000 with regards to the design intent. Guidance is provided on specifying load combinations for the various service loadings and on development of the Owner’s Design Specification and Code Design Report. The chapter lists the requirements for fabrication and installation, including forming, fitting, and aligning; examining and repairing welds; and heat treatment and mechanical joining. The differences between NG-5000 and NB-5000 in the context of examination and repair during manufacture are also summarized. In addition, the chapter outlines requirements for hot functional testing for reactor terminals and the environmental effects that can lead to premature failures in CSS and IS. It also summarizes some notable Code Cases applicable to Subsection NG as well as some notable interpretations that apply to Subsection NG, most of which are related to materials, inspection procedures, and documentation. Finally, the chapter discusses the current and future issues and recommendations associated with Subsection NG in the design and manufacture of CSS and IS.

History

John T. Land was the author of this chapter for the original, second, and third ediYons. This chapter was revised and updated in the 4th and 5th editions by Richard O. Vollmer, and then revised by David Keck in the current online edition.
Nonmetallic Pressure Piping System Components
Authors: Rowley C. Wesley , Musto Thomas M.
Published: June 2023

This chapter discusses the current and future nonmetallic construction codes and standards using nonmetallic plastic polymers. It is divided into four parts. Part A provides an overview of the major nonmetallic materials used in structural applications, namely, thermoplastic materials, thermoset plastic materials, and graphite materials. It describes the importance of a design specification as well as its recommended contents and major aspects. Part A also provides information on two extensively utilized thermoplastic jointing techniques: butt fusion and electro-fusion. Part B and C cover NM-1 and NM-2 Standards, which prescribe requirements for the design, materials, fabrication, erection, inspections, examination, and testing of thermoplastic piping systems and glass-fiber-reinforced thermosetting-plastic piping systems, respectively. Included within the scope of the NM-1 Standard is thermoplastic piping which interconnects pieces or stages within a packaged equipment assembly. The contents and coverage of the NM-2 Standard address pipe and piping components that are produced as standard products, as well as custom products that are designed for a specific application. Fiberglass-reinforced plastic pipe and piping components manufactured by contact molding, centrifugal casting, filament winding, and other methods are covered. The organization of the NM-3 Standard, addressed in Part D, is modeled on the ASME Boiler and Pressure Vessel Code, Section II – Materials. ASME NM-3 addresses material specifications and material properties for both thermoplastic and thermoset plastic with glass reinforcing fibers. The NM-1 and NM-2 Standards reference NM-3 Standard for applicable material specifications and material physical and engineering property data.

History

Some of the material in this chapter had been originally covered in Chapter 3.6 in the Fourth Edition of the Companion Guide but consistent with the current activity of the ASME Code Committees it was considered appropriate by the authors to cover the efforts of the committee in a separate chapter. The current online edition was updated by C. Wesley Rowley and Thomas M. Musto
Nuclear Pumps
Authors: Klein Ross R. , Gregg John V.
Published: June 2023

This chapter focuses on specific aspects that are the driving and controlling forces in hydraulic systems for nuclear power plants. It discusses how the ASME Boiler and Pressure Vessel Code requirements are implemented for Class 1, 2, and 3 nuclear pumps designed to meet the requirements of the Code. The Design Specification defines the applicable Code, the class of construction for the pump, and all operational requirements which define how the components function in their applications. The Owner’s Responsibilities for the system design play an important part in establishing the rules applicable to the Design Specification for each safety-related pump. The chapter provides a historical perspective for the Code rules, cross-referencing other Subsections of the Code. It is written to refer to and explain the requirements for pump Subarticles NB, NC, and ND-3400, and Articles NB, NC, and ND-7000 of the 2015 Edition of the Code. A Nonmandatory Appendix divides pump internal parts into various categories and sets up requirements for appropriate quality levels.

History

Douglas B. Nickerson was the original author of this chapter. The second and third editions were updated by Marcus N. Bressler. The fourth edition was updated by Robert E. Comman. The fifth edition was updated by Ross R. Klein. The current online edition was updated by Ross R. Klein and John V. Gregg Jr.
Code for Concrete Containments
Authors: Eberhardt Arthur C. , Jones Christopher A. , Smith Clayton T. , Jovall Ola
Published: June 2023

This chapter describes the bases and provisions of the ASME Boiler and Pressure Vessel Code for Concrete Containments. It describes the concrete containment general environment, types of existing containments, future containment configurations, and background development including the regulatory bases of concrete containment construction code requirements. The chapter addresses reinforced-concrete containment behavior under internal pressure and temperatures of up to about 100°C. The discussion presented includes a comparison between prestressed and deformed-bar concrete reinforcements, the effects of elevated temperature on concrete, and the effect of radial and tangential shear in containment shells. It explains the analysis, design, and testing of concrete containment structures and provides information on the organization of the Concrete Containment Design Code contained in the Code Section III, Division 2, Subsection CC. The chapter summarizes the following requirements for concrete containments: general and specific construction or placement requirements for concrete, including the fabrication and placing requirements for steel reinforcement systems and the fabrication and welding requirements for liners; requirements for nondestructive examinations, procedure qualifications and evaluations; requirements for qualification and certification of nondestructive personnel; and general requirements for containment structural integrity test. The major areas to be considered in the future revisions of the Code are also highlighted in this chapter.on and certification of nondestructive personnel; and general requirements for containment structural integrity test. The major areas to be considered in the future revisions of the Code are also highlighted in this chapter.

History

John D. Stevenson was the original author of this chapter and updated it for the second edition. The third edition was updated by Joseph F. Artuso, Hansraj Ashar and Barry Scott. The fourth edition was updated by Arthur Eberhardt, Michael Hessheimer, Ola Jovall and Clayton Smith. The fifth edition was updated by Arthur C. Eberhardt, Clayton T. Smith, Ola Jovall and Christopher A. Jones. The current online edition was updated by Arthur C. Eberhardt and Christopher A. Jones.
Nondestructive Examination (NDE)
Authors: Batey Jon E. , Hembree G. Wayne
Published: June 2023

This chapter provides users of the ASME Boiler and Pressure Vessel Code Section V, Nondestructive Examination (NDE), an insight into the significant Section V requirements, the NDE methods addressed therein, and the applicability of the ASME Code NDE methodology to Section V and other sections of the ASME book. It explains when and how to use the American Society for Testing Materials (ASTM) Standards. The chapter traces the history of Section V and outlines its organization. It highlights the need for users to understand the relationship of Section V to other ASME Code sections to ensure that all contract requirements are satisfied. Section V is divided into two basic subsections. Subsection A contains Articles 1 through 19, including Mandatory and Nonmandatory appendices that address general requirements, test methods, and specific Code requirements. Subsection B contains the ASTM Standards (Articles 22 through 31 with Mandatory Appendix II – Standard Units Used in Equations and Nonmandatory Appendix A, Guidance for the Use of U.S. Customary and SI Units in the ASME). The chapter covers each of the 19 articles, including the various NDE techniques such as radiographic examination, ultrasonic examination for welds and materials, liquid penetrant examination, magnetic particle examination, eddy current examination, visual examination, and leak testing. Additional NDE techniques discussed in the chapter are acoustic emission examination for fiber-reinforced plastic vessels and metallic vessels, acoustic emission monitoring of pressure boundary components, alternating current field measurement, magnetic flux leakage examination, remote field testing examination, acoustic pulse reflectometry examination, and guide wave examination for pipe testing. Eddy current array examination methodology is being considered for incorporation into Section V.
Subsection NCA—General Requirements for Division 1 and Division 2
Authors: Lambin Jason , Swayne Richard W.
Published: June 2023

Subsection NCA provides the general requirements for both Divisions 1 and 2 of Section III. It is applicable to all Classes of construction, covering steel vessels, storage tanks, piping, pumps, valves, core support structures, and concrete containment vessels. This chapter identifies how to classify components and how the jurisdictional boundaries of Section III define what is within and outside the scope of the Code. It discusses the use of Code Editions, Addenda, and Code Cases, and the requirements for Design Basis, Design and Construction Specifications, and Design Reports. The chapter addresses the responsibilities and Quality Assurance Program requirements of the different entities involved in constructing a nuclear power plant, from the manufacturer of materials to the Owner. Requirements for ASME accreditation, application of the ASME Code Symbol Stamp, and use of Code Data Reports are also described. The chapter then outlines the basis for exemptions, load combinations, responsibilities of the different entities involved in nuclear power plant construction, Certificate of Authorization Holders, and Quality System Certificate Holders. Finally, it provides cross-referencing to other Code Sections and Subsections, such as Sections III and XI, as well as to pertinent Regulatory Guides, such as the U.S. Code of Federal Regulations.

History

The current online edition has been updated by Jason Lambin and reviewed by Kyle Blan.
Section III: Subsections NC and ND—Class 2 and 3 Components
Authors: Basavaraju Chakrapani , Lambin Jason
Published: June 2023

This chapter addresses unique features of pressure vessels and atmospheric and 0–15 psi flat bottom storage tanks, as presented in the ASME Boiler and Pressure Vessel Code, Section III, Rules for Construction of Nuclear Power Plant Components, Division 1, Subsections NC (Class 2) and ND (Class 3) Components. Emphasis is directed at discussing the generic design issues of flat bottom tanks. Subsections NC and ND are a combination of rules and requirements taken from Section III, Subsection NB and Section VIII. In addressing the Articles of Subsections NC and ND, the chapter presents comparisons, the most probable source of origin of the Code requirements, certain insights as well as contradictions that seem to exist, and the specific source document and some of the underlying theory. The chapter begins with a discussion on the material selection and qualification requirements as defined in NC-2000 AND ND-2000. It then describes the requirements for fabrication and installation, including forming, cutting, and aligning. In addition, the chapter outlines the requirements for nondestructive examination of NC for vessels and sidewall of tanks. It also discusses the requirements for hydrostatic testing and overpressure and vacuum protection of 0–15 psi tanks and atmospheric tanks. The rules governing nameplates, stamping, and data reports are then presented. Finally, the chapter provides a summary of changes made to the various editions of this Code.

History

John Hechmer was the original author of this chapter that was authored by Greg L. Hollinger for the second edition and David P. Jones for the third edition. The fourth edition is authored by David P. Jones and Chakrapani Basavaraju.

Chakrapani Basavaraju edited the fifth and sixth editions. The current online edition has been updated by Chakrapani Basavaraju and Jason Lambin.
Intravascular leiomyomatosis with extension to the inferior vena cava
Authors: Garratt Jayna-Lee , Naiqiso Silipa , Hockley Joe , Mohan Ganendra Raj Kader Ali
Published: June 2023

Intravascular leiomyomatosis (IVL) is a rare benign smooth muscle neoplasm growing within the pelvic venous system, often with caval and intracardiac extension. It frequently coexists with uterine leiomyomas or occurs in women with a history of myomectomy or hysterectomy. IVL is often asymptomatic until intracardiac extension occurs, and carries a risk of sudden death, necessitating timely diagnosis and management. We present a case of IVL diagnosed on hysterectomy specimen with extension to the inferior vena cava found on follow-up imaging. The patient underwent complete resection with multidisciplinary involvement of Gynaecological Oncology and Vascular Surgery and remains disease free following 12 months of follow-up.
‘Juvenile’ nasal angiofibroma presenting in adulthood
Authors: Cleere Eoin F , McLoughlin Laura , Lacy Peter D
Published: June 2023

Juvenile nasopharyngeal angiofibromas (JNAs) are rare hyper vascular, benign tumours typically demonstrating a locally aggressive growth pattern. The cardinal presenting symptoms are unilateral nasal obstruction and recurrent, spontaneous epistaxis. Cases outside the adolescent male population are exceedingly rare and present a diagnostic challenge. We present the case of a man in his 30s referred to our tertiary skull base centre, presenting with left nasal obstruction. Examination showed left nasopharyngeal fullness without a discrete mass. Cross-sectional imaging detailed a 2.5×2.1×1.3 cm mass localised to his left sphenoid sinus with bony erosion. Due to the suspicion of malignancy, multidisciplinary consensus was to perform a diagnostic excisional biopsy and this revealed a JNA. He remains clinically well and asymptomatic following surgery. This case highlights the potential for subtle symptomatology in the presentation of these tumours and the challenge in diagnosing a JNA outside the adolescent male population.
The rise and fall of troponin in a patient with polymyositis
Authors: Javed Faiza , Leung Stephanie
Published: June 2023

Troponins are an excellent sensitive marker for myocardial ischaemic damage. However, there are several non-ischaemic cardiac and non-cardiac reasons for troponin elevation. Many cases of troponin T elevation and some troponin I cases have been reported in the literature due to inflammatory muscle disease. Here, we report a woman in her 50s who initially presents with fatigue and weakness, and is found to have elevated troponin T. The patient was appropriately worked up for cardiac causes with ECG and echocardiogram. She had positive antinuclear antibodies, antineutrophil cytoplasmic antibody and myositis panel. The elevation of troponins was attributed to polymyositis and treated with methotrexate and prednisone with recovery of patient’s symptoms. This article emphasises the struggle of diagnosis in a patient with no reported medical history, having low to moderate risk of silent myocardial infarction.
Association between estimated cardiorespiratory fitness and breast cancer: a prospective cohort study
Authors: Christensen Rebecca A G , Knight Julia A , Sutradhar Rinku , Brooks Jennifer D
Published: June 2023

Objective

To examine the association between cardiorespiratory fitness (CRF) and the risk of breast cancer in postmenopausal women.

Methods

This study used data from 17 840 cancer-free postmenopausal women with a CRF assessment from the UK Biobank. High estimated CRF (eCRF) was categorised as being>80th percentile within 10-year age bands. Fine and Gray regression was used to examine the association between eCRF and breast cancer risk, accounting for both non-breast cancer diagnoses and all-cause mortality as competing risks. Age was used as the time scale. Several different models were produced, including those adjusting for known breast cancer risk factors, and stratified by measures of body fat (body mass index and per cent body fat).

Results

Over a median follow-up of 11.0 years there were 529 cases of invasive breast cancer, 1623 cases of non-breast cancer disease and 241 deaths. With adjustment for breast cancer risk factors, high eCRF was associated with a 24% (subdistribution HR (SDHR) 0.76, 95% CI 0.60 to 0.97) lower risk of breast cancer. When stratified by measures of body fat, we found evidence of effect measure modification. Mainly, having high eCRF was only associated with a lower risk of breast cancer among those classified as having overweight/obesity (SDHR 0.33, 95% CI 0.11 to 1.01) or percentage body fat above the 1st quintile (SDHR 0.65, 95% CI 0.45 to 0.94).

Conclusion

Having higher CRF may be a protective factor against breast cancer in postmenopausal women but only for women with elevated body fat.
Mental health problems among healthcare professionals during COVID-19 in Africa: a protocol for umbrella review
Authors: Hasen Aragaw Asfaw , Seid Abubeker Alebachew , Mohammed Ahmed Adem
Published: June 2023

Introduction

COVID-19 pandemic is a global health problem. In Africa, healthcare professionals face mental health problems due to COVID-19. But little was done on the prevalence of mental disorders among healthcare professionals during COVID-19 in Africa. This umbrella review of meta-analysis aimed to provide the pooled prevalence of anxiety, depression, stress, suicide, demoralisation and insomnia during COVID-19 pandemic in Africa.

Methods and analysis

We will search the African Journals Online, MedRxiv, PubMed and Google Scholar to identify studies published from the occurrence of the pandemic to March 2023. Systematic review and meta-analysis studies assessing mental health problems among healthcare professionals in Africa will be considered. The outcomes of interest include prevalence of mental health problems on healthcare professionals following COVID-19. Two researchers will extract data and execute quality assessment independently. The Joanna Briggs Institute critical appraisal checklist will be used to assess the quality of studies. Stata V.16.0 software will be used for statistical analysis. The I² and Cochran’s Q-statistics will be used for analysis of heterogeneity. Publication bias will be examined by DOI plot and Luis Furuya Kanamori (LFK) index.

Ethics and dissemination

Ethical approval and informed consent are not required as this is a literature review. The final results will be published in a peer-reviewed journal and presented at relevant conferences.

PROSPERO registration number

CRD42022383939.
How large language models can augment perioperative medicine: a daring discourse
Authors: Gabriel Rodney A , Mariano Edward R , McAuley Julian , Wu Christopher L
Published: June 2023

Interest in natural language processing, specifically large language models, for clinical applications has exploded in a matter of several months since the introduction of ChatGPT. Large language models are powerful and impressive. It is important that we understand the strengths and limitations of this rapidly evolving technology so that we can brainstorm its future potential in perioperative medicine. In this daring discourse, we discuss the issues with these large language models and how we should proactively think about how to leverage these models into practice to improve patient care, rather than worry that it may take over clinical decision-making. We review three potential major areas in which it may be used to benefit perioperative medicine: (1) clinical decision support and surveillance tools, (2) improved aggregation and analysis of research data related to large retrospective studies and application in predictive modeling, and (3) optimized documentation for quality measurement, monitoring and billing compliance. These large language models are here to stay and, as perioperative providers, we can either adapt to this technology or be curtailed by those who learn to use it well.
Association between antidepressants with pneumonia and exacerbation in patients with COPD: a self-controlled case series (SCCS)
Authors: Siraj Rayan A , Bolton Charlotte E , McKeever Tricia M
Published: June 2023

Objective

To assess whether antidepressant prescriptions are associated with an increased risk of pneumonia and chronic obstructive pulmonary disease (COPD) exacerbation.

Methods

A self-controlled case series was performed to investigate the rates of pneumonia and COPD exacerbation during periods of being exposed to antidepressants compared with non-exposed periods. Patients with COPD with pneumonia or COPD exacerbation and at least one prescription of antidepressant were ascertained from The Health Improvement Network in the UK. Incidence rate ratios (IRR) and 95% CI were calculated for both outcomes.

Results

Of 31 253 patients with COPD with at least one antidepressant prescription, 1969 patients had pneumonia and 18 483 had a COPD exacerbation. The 90-day risk period following antidepressant prescription was associated with a 79% increased risk of pneumonia (age-adjusted IRR 1.79, 95% CI 1.54 to 2.07). These associations then disappeared once antidepressants were discontinued. There was a 16% (age-adjusted IRR 1.16, 95% CI 1.13 to 1.20) increased risk of COPD exacerbation within the 90 days following antidepressant prescription. This risk persisted and slightly increased in the remainder period ((age-adjusted IRR 1.38, 95% CI 1.34 to 1.41), but diminished after patients discounted the treatment.

Conclusion

Antidepressants were associated with an increased risk of both pneumonia and exacerbation in patients with COPD, with the risks diminished on stopping the treatment. These findings suggest a close monitoring of antidepressant prescription side effects and consideration of non-pharmacological interventions.
Future-proofing the emergency recovery plan for freshwater biodiversity
Authors: Lynch Abigail J. , Hyman Amanda A. , Cooke Steven J. , Capon Samantha J. , Franklin Paul A. , Jähnig Sonja C. , McCartney Matthew , Hòa Nguyễn Phú , Owuor Margaret Awuor , Pittock Jamie , Samways Michael J. , Silva Luiz G. M. , Steel E. Ashley , Tickner David
Published: June 2023

Freshwater biodiversity loss is accelerating globally, but humanity can change this trajectory through actions that enable recovery. To be successful, these actions require coordination and planning at a global scale. The Emergency Recovery Plan for global freshwater biodiversity aims to reduce the risk for freshwater biodiversity loss through six priority actions: (1) accelerate implementation of environmental flows; (2) improve water quality to sustain aquatic life; (3) protect and restore critical habitats; (4) manage exploitation of freshwater species and riverine aggregates; (5) prevent and control nonnative species invasions in freshwater habitats; and (6) safeguard and restore freshwater connectivity. These actions can be implemented using future-proofing approaches that anticipate future risks (e.g., emerging pollutants, new invaders, and synergistic effects) and minimize likely stressors to make conservation of freshwater biodiversity more resilient to climate change and other global environmental challenges. While uncertainty with respect to past observations is not a new concern for freshwater biodiversity, future-proofing has the distinction of accounting for the uncertainty of future conditions that have no historical baseline. The level of uncertainty with respect to future conditions is unprecedented. Future-proofing of the Emergency Recovery Plan for freshwater biodiversity will require anticipating future changes and developing and implementing actions to address those future changes. Here, we showcase future-proofing approaches likely to be successful using local case studies and examples. Ensuring that response options within the Emergency Recovery Plan are future-proofed will provide decision makers with science-informed choices, even in the face of uncertain and potentially new future conditions. We are at an inflection point for global freshwater biodiversity loss; learning from defeats and successes can support improved actions toward a sustainable future.
Evaluation of Spiking Neural Nets-Based Image Classification Using the Runtime Simulator RAVSim
Authors: Sanaullah  , Koravuna Shamini , Rückert Ulrich , Jungeblut Thorsten
Published: June 2023

Spiking Neural Networks (SNNs) help achieve brain-like efficiency and functionality by building neurons and synapses that mimic the human brain’s transmission of electrical signals. However, optimal SNN implementation requires a precise balance of parametric values. To design such ubiquitous neural networks, a graphical tool for visualizing, analyzing, and explaining the internal behavior of spikes is crucial. Although some popular SNN simulators are available, these tools do not allow users to interact with the neural network during simulation. To this end, we have introduced the first runtime interactive simulator, called Runtime Analyzing and Visualization Simulator (RAVSim),adeveloped to analyze and dynamically visualize the behavior of SNNs, allowing end-users to interact, observe output concentration reactions, and make changes directly during the simulation. In this paper, we present RAVSim with the current implementation of runtime interaction using the LIF neural model with different connectivity schemes, an image classification model using SNNs, and a dataset creation feature. Our main objective is to primarily investigate binary classification using SNNs with RGB images. We created a feed-forward network using the LIF neural model for an image classification algorithm and evaluated it by using RAVSim. The algorithm classifies faces with and without masks, achieving an accuracy of 91.8% using 1000 neurons in a hidden layer, 0.0758 MSE, and an execution time of ∼10[Formula: see text]min on the CPU. The experimental results show that using RAVSim not only increases network design speed but also accelerates user learning capability.
Exponential distribution of sales per employee (per capita) of top state-owned and public companies in Mexico
Authors: Liprandi-Cortes N. , Núñez-Ramírez A. , Castillo-Mussot M. del
Published: June 2023

Magazine Expansión publishes yearly its list of leading 500 top companies in Mexico. Its cumulative probability sales distribution per employee (per capita) exhibits a two-class structure: a quasi-Pareto power-law in the higher part and an exponential in the lower part which is qualitatively similar to income and wealth distributions in many countries of the world. Therefore, we posit that the income in wages and salaries of many Mexican workers is correlated to the sales revenue per employee of their corresponding employer firms. The relatively small number of state-owned enterprises (SOE) in this list is due to the privatization of most of the Mexican SOE during the past decades.
Thin film flow of blood-based hybrid nanoparticles subject to slip effects: A stability assessment
Authors: Lund Liaquat Ali , Ghoto Abbas Ali , Al-Khaled Kamel , Ghachem Kaouther , Fadhel Mustafa Abbas , Khan Sami Ullah , Kolsi Lioua
Published: June 2023

The objective of this research is to predict the thermal observations for hybrid nanofluid conveying the thin film flow influenced by the suction phenomenon and slip consequences. The copper and aluminum nanoparticles are utilized to explore the hybrid nanofluid features. In addition, a uniform magnetic field perpendicular to the motion of the nanoliquid has been generated. By utilizing appropriate dimensionless quantities, partial differential equations (PDEs) are transformed into nonlinear ordinary differential equations (ODEs). The controlling method for boundary value problems (BVP4C) has been applied against the thermal profile. The coating film’s thickness has been kept fixed. The skin friction and Nusselt number distribution are calculated for blood over the shrinking sheet in the attendance of the radiation and velocity slip parameters. The effects of various variables and spray rate through coating are clearly represented. The numerical calculation is computed for assessing the wall shear force. It is observed that a dual branch has been discovered. In addition, a stability analysis has been conducted and the upper branch has been determined to be the stable branch.
Free convection analysis for a nanofluid in a wavy porous domain subject to shape of nanoparticle and internal heat generation
Authors: Fereidooni Jalil
Published: June 2023

Natural convection takes up the attention of researchers due to its expansive industrial and engineering utilizations i.e., heat exchangers and electronic cooling. In this work, free convection of Cu-H2O nanoliquid flow and heat transfer (HT) in porous circular wavy domain under the internal heat generation has been perused by finite element method (FEM). The shape factor of nanomaterials is also considered. The influences of active factors like Rayleigh number Ra, nanofluid concentration, wavy wall’s contraction ratio A, number of undulations D, and shape factor of nanomaterials m are explored on flow and HT specifications. Moreover, the correlations for average Nusselt number Nuave have been attained with regard to impressive parameters of current study. Findings show that Nuave soars with soaring nanofluid concentration and nanoparticles’ shape factor. Further, the outcomes characterize that Nuave may lessen up to 15.11% and 9.95% by detracting A from 0.1 to 0.3 and by mounting D from 4 to 12, respectively.