bluuebunny/crossref_metadata_2025 huggingface dataset:
Bacteriocin typing of streptococcal isolates from endocarditis
Authors: Upton G W , Dalton H P , Kolstad R A
Published: May 2021

A typing system based on bacteriocin production and sensitivity for Streptococcus sanguis strains was devised. Bacteriocin producer strains were grown (37degrees C) anaerobically on brain heart infusion-yeast extract agar for 18 h. Bacteriocin indicator strains were suspended to molten brain heart infusion-yeast extract agar and then overlayed onto the producer strain. After an additional 18 to 24 h of incubation, zones of bacteriocin inhibition were recorded. After establishment of the typing system, eight Streptococcus strains from bacterial endocarditis patients were characterized by the typing system. Four patient strains had identical bacteriocin reduction patterns but could be differentiated by differences in their bacteriocin sensitivity. Two isolates from the same patient had identical production and sensitivity patterns. By including both bacteriocin production and bacteriocin sensitivity, all seven epidemiologically unrelated isolates could be differentiated. On the basis of these results, there does not appear to be a correlation between bacteriocin production and infectivity, but the usefulness of the application of a typing system to a clinical situation is demonstrated.
New method for the isolation of Streptococcus mutans and its differentiation from other oral streptococci
Authors: Linke H A
Published: May 2021

A new, improved agar medium for the isolation of Streptococcus mutans, the etiological agent of dental caries, was developed. In contrast to mitis-salivarius agar, this medium not only recovers a greater number of S. mutans strains from most oral specimens but, because of its mannitol and sorbitol content, it also facilitates the differentiation of S. mutans from other oral streptococci, e.g., S. salivarius, S. mitis, and S. sanguis, which do not grow or produce scanty growth only after 10 days of incubation. The medium is easy to prepare because of its simple and unique composition, is characterized by the presence of an acid indicator, and can be utilized under aerobic and anaerobic conditions as well. The medium cannot be used to distinguish among the eight serotypes, a to g and SL-1, of S. mutans. Mannitol-utilizing bacteria such as streptococci (e.g., S. faecalis) and other microorganisms (e.g., Staphylococcus aureus) are able to grow on this medium and can be distinguished from S. mutans by their unique colony morphology.
Isolation of Francisella tularensis from infected frozen human blood
Authors: Pittman B , Shaw E B , Cherry W B
Published: May 2021

Francisella tularensis was isolated from human blood that was frozen for 3 months before it was examined. Before he became ill, the patient operated a "bush-hog" in an area thickly populated with rabbits. His illness was undiagnosed and untreated before his death. Portions of blood and tissue homogenates from necropsy were injected intraperitoneally into mice and inoculated onto glucose-cysteine-blood agar plates. F. tularensis did not grow from the culture plates, but mice inoculated with the blood died in 48 to 72 h. Fluorescent-antibody stains of mouse liver and spleen impression smears showed clumps of cells or amorphous masses of brightly staining envelope material around the cells. Tissue impressions of liver, spleen, and heart blood inoculated onto glucose-cysteine-blood agar yielded pure cultures of F. tularensis.
Solid-phase enzyme immunoassay for immunoglobulin M antibodies to cytomegalovirus
Authors: Schmitz H , Doerr H W , Kampa D , Vogt A
Published: May 2021

A sensitive, solid-phase enzyme immunoassay for the detection of immunoglobulin M antibodies to cytomegalovirus is described. The results of the enzyme immunoassay correlated well with those obtained by an indirect immunofluorescence method. Horseradish peroxidase proved to be a more sensitive label than alkaline phosphatase. Nonspecific reactions, occurring with commercially available cytomegalovirus antigens, could be avoided by using a nuclear antigen prepared from sonically disrupted nuclei of cytomegalovirus-infected cells.
AB0610 NORMOCALCAEMIC HYPERPARATHYROIDISM AND BONE HEALTH – WORSE THAN ANTICIPATED?
Authors: Masieh D. , Deshpande S. , Nisar M. K.
Published: May 2021

Background:

Since the formal recognition of normocalcaemic hyperparathyroidism (nHPT) as a distinct entity in 2008, several studies have been published describing the characteristics of these individuals. Controversy exists regarding diagnostics and the role of parathyroidectomy in such cases. A chief reason for lack of consensus is the disagreement among experts regarding the potential complications and a bias towards perhaps benign nature of this condition.

Objectives:

In order to understand the challenges posed by this cohort, we aim to characterise these patients at presentation to our metabolic bone diseases unit with a focus on bone health.

Methods:

We interrogated our departmental database and undertook retrospective analysis of all patients presenting to metabolic bone service at our large university teaching hospital with a catchment population of 350,000. Individuals were included in the survey based on criteria of Vit D >70 nmol/L, normal calcium (2.20-2.60 mmol/L), eGFR>60ml/min and PTH >6.9 pmol/L measured twice at least three months apart.

Results:

Over six months review period, of 134 referrals, 42 (31%) were identified with nHPT. Follow up duration was two years. Mean age was 60 years (25-86). 38 (90%) were women with 31 (81%) post menopause. 34 (80%) were of Caucasian descent. All had comorbidities with median of five (1-14). Polypharmacy (>4 prescribed medicines) was common (36/42, 85%) with mean of seven prescribed medications (0-22). Mean Vit D was 88 (70.4-133.6), calcium 2.43 (2.26-2.58), creatinine 69.8 (48-115) and PTH 8.8 (7.2-14.2). Ten (24%) had already had fragility fractures with mean of two (0-4). 21 had DXA scan with mean T score of -3.78 (-2.1 - -6.0). 13/21(31%) had osteoporosis. Oral and IV bisphosphonates, denosumab and teriparatide were prescribed to 12 (28.5%), 14 (33%), 4 (10%) and one patient respectively.

Conclusion:

Our study suggests high prevalence of nHPT among patients referred to metabolic bone service with confirmed bone health issues. Nearly a third of patients have nHPT in this secondary care setting and a quarter have already suffered fragility fractures. These patients carry high comorbidity, polypharmacy and osteoporosis burden. Management of such patients is challenging owing to complex interplay of various ailments. Bone active agents are required for nearly two-thirds of this group. Though the natural course of nHPT is an area of active research, our data adds to the growing body of evidence that this is not a benign condition with particularly high fracture burden and poor bone quality. nHPT is perhaps responsible for the onset and progression of the similar osseous complications as described in classical PHPT. Further longitudinal studies are required to help devise best management plan to mitigate against the skeletal encumbrance of nHPT.

Disclosure of Interests:

None declared.
AB0611 OSTEOPOROSIS IN RHEUMATOID ARTHRITIS: A NECESSARY EVIL?
Authors: Athimni S. , Bouden S. , Ben Tekaya A. , Dghais A. , Saidane O. , Tekaya R. , Mahmoud I. , Abdelmoula L.
Published: May 2021

Background:

Rheumatoid arthritis (RA) is a chronic inflammatory disease that is characterized by local and general bone loss. Osteoporosis (OP) is one of the most frequent comorbidities associated with RA. Many factors are incriminated in bone loss in RA such as inflammation, glucocorticoid (GC) use, and immobility.

Objectives:

-To determine the prevalence of OP in a population of actual RA patients.

-To determine the risk factors of bone mineral density (BMD) reduction

Methods:

One hundred-fifty-two RA followed in the rheumatology department between 2015-2020 were enrolled in the study. The diagnosis of RA was established according to the American College of rheumatology/European League Against Rheumatism (ACR/EULAR) criteria 2010. BMD in lumbar spine and total hip was systematically measured in the recruited patients. Measures were taken with dual-energy x-ray absorptiometry (DEXA), and age-specific values were compared with pooled values from a local population of healthy subjects free from earlier fractures.

Results:

The mean age was 42.7±13 years. The sex ratio M/F was 0.24. The mean onset disease was 6±1.8 years. Fifty-sex patients (36.3%) were receiving conventional treatment DMARDs and 96 (63.6%) were under biological treatment. 35.5% were taken steroids with mean doses at 7.7±3.3mg/day. RF and ACPA were positive respectively in 87.3% and 82.4% of the patients. The mean disease activity score DAS28CRP was 4.8 ±2.7.

Sixty-eight point eight 68.8% of the RA population had bone loss: 37.5% had osteopenia and 31.3% had OP. Regarding the OP group, sex ratio M/F was 0.45. The mean age was 42±5.3 years. Among the 31 women, 77.4% had postmenopausal OP. The BMI average was 31.18 ± 6.19 kg/m2. Fifteen patients (33.33%) had OP in the hip site and 20 patients had OP in the lumbar site (48.8%). Ten patients had both trabecular and cortical OP.

Advanced age, glucocorticoid use and high DAS28CRP were independent risk factors for OP (respectively p=0.04, p=0.02 and p=0.01). Body mass index, smoking, disease duration high Health Assessment Questionnaire (HAQ) score (p=0.545) and smoking (p=0.326) were not associated with high risk of OP. The biological treatment was not a protective factor in OP (p=0.972). All the population subjects were free from earlier fractures, the fractural risk estimated by dint of the mean FRAXTM score was at 1.4 ± 2.3.

Conclusion:

Previous studies estimated that, approximately, osteoporosis affected one-third of RA patients which is in concordance with our study. Advanced age, glucorticoid treatment and severe disease were the most common risk factor in our study.

Disclosure of Interests:

None declared.
AB0768 NEUROLOGICAL MANIFESTATIONS IN GRANULOMATOSIS WITH POLYANGIITIS: ABOUT 11 CASES
Authors: Jomaa O. , Berriche O. , Arfa S. , Fraj A. , Belkhiri M. , Makhloufi R. , Romdhane W. , Hermassi M.
Published: May 2021

Background:

Granulomatosis with polyangiitis (GPA) is a rare systemic vasculitis, affecting mainly the superior airways, lungs and kidneys. Neurological impairment is frequent, described in 22 to 54% of cases, and rarely inaugurates the disease.

Objectives:

The objective of our work was to evaluate its prevalence and its different aspects.

Methods:

A retrospective study including 11 files of GPA patients followed over a period of 10 years in The Internal Medecine Department at Tahar Sfar Hospital Mahdia TUNISIA.

Results:

Neurological manifestations were reported in 5 patients: a pyramidal syndrome was noted in 3 patients with a normal cerebral MRI, a disabled headache was described in one patient with a normal cerebral MRI. Peripheral neuropathy in 2 cases, and the Electroneuromyogram objectified a mononeuropathy affecting the ulnar nerve, peroneal nerve, and musculocutaneous nerve in one patient and a distal sensitivomotor poly neuropathy in one patient. Cranial nerves damage was noted in two cases, one VII (1 case) and one V (1 case).

Conclusion:

Our study results, show the importance of timely diagnosis of these neurological manifestations, as their evolution will depend on the early GPA treatment.

References:

[1]doi: 10.1016/j.autrev.2017.07.007

Disclosure of Interests:

None declared
AB0614 DENSITOMETRIC VERTEBRAL FRACTURE ASSESSMENT: FACTORS LIMITING GOOD VISIBILITY OF THE VERTEBRA
Authors: Mariem S. , Yasmine M. , Miladi S. , Fazaa A. , Frigui E. , Souebni L. , Ouenniche K. , Kassab S. , Chekili S. , Ben Abdelghani K. , Laatar A.
Published: May 2021

Background:

The radiograph of the spine is the gold standard for identifying vertebral fractures (VF). Vertebral Fracture Assessment (VFA) is a new feature available on modern densitometers that could assess VF. This technique offers the advantage of low irradiation over standard radiography but at the cost of lower image quality.

Objectives:

The aim of this study was to assess factors associated with good vertebra visibility when using VFA.

Methods:

This is a cross-sectional study including patients referred by their physicians for bone mineral density (BMD) measurement. Anthropometric data were recorded. BMD was measured using standard methods over the lumbar spine L1-L4, the total proximal femur. Results were expressed as T-scores using Dual-energy X-ray absorptiometry (DEXA). The screening for VF was performed by VFA. A professional operator analyses VFA scans and assessed the good visibility of the vertebra.

Results:

The study included 100 patients. The mean age was 61.7 ±12.6 years [18-83].The average body mass index (BMI) was 28.9 ± 24.2 kg/m2 [14.2-45.3]. The mean T-score at the vertebral site was -1.5 DS [-4.9-1.5] with a mean mass of 0.95g/cm2 [0.58-1.371]. Osteoporosis was found in 27.7 % of patients. A vertebral fracture was diagnosed in 25% of cases. The visualization of the vertebra was impaired in the upper thoracic region in 60% of cases. Poor visibility was observed in 19% of cases in the mid-thoracic spine and only in 2% of cases in the lumbar spine. No statistically significant correlation was found between good vertebral visibility and age (p=0.2), weight (p=0.5), or BMI (p=0.7). However, good visibility of the vertebra was associated with a lower height (1.7 m vs 1.5 m, p=0.03). A better vertebrae visualization was correlated neither to the BMD of the right hip (0.84 vs 0.87, p=0.4) nor to the left hip (0.85 vs 0.89, p= 0.3). Similarly, the absence of vertebral osteoporosis was not correlated with a better vertebral visualization (p=0.6).

Conclusion:

Visibility of the vertebra on VFA does not appear to be altered by the BMD and vertebral osteoporosis, suggesting safe use in the elderly. However, precautions may be taken when interpreting VFA in patients with high heights.

Disclosure of Interests:

None declared.
Multisectoral action for health in low-income and middle-income settings: how can insights from social science theories inform intragovernmental coordination efforts?
Authors: Ssennyonjo Aloysius , Van Belle Sara , Titeca Kristof , Criel Bart , Ssengooba Freddie
Published: May 2021

There is consensus in global health on the need for multisectoral action (MSA) to address many contemporary development challenges, but there is limited action. Examples of issues that require coordinated MSA include the determinants of health conditions such as nutrition (malnutrition and obesity) and chronic non-communicable diseases. Nutrition, tobacco control and such public health issues are regulated separately by health, trade and treasury ministries. Those issues need to be coordinated around the same ends to avoid conflicting policies. Despite the need for MSA, why do we see little progress? We investigate the obstacles to and opportunities for MSA by providing a government perspective. This paper draws on four theoretical perspectives, namely (1) the political economy perspective, (2) principal–agent theory, (3) resource dependence theory and (4) transaction cost economics theory. The theoretical framework provides complementary propositions to understand, anticipate and prepare for the emergence and structuring of coordination arrangements between government organisations at the same or different hierarchical levels. The research on MSA for health in low/middle-income countries needs to be interested in a multitheory approach that considers several theoretical perspectives and the contextual factors underlying coordination practices.
The evolution of parents’ beliefs about childhood cancer during diagnostic communication: a qualitative study in Guatemala
Authors: Graetz Dylan , Rivas Silvia , Fuentes Lucia , Cáceres-Serrano Ana , Ferrara Gia , Antillon-Klussmann Federico , Metzger Monika , Rodriguez-Galindo Carlos , Mack Jennifer W
Published: May 2021

Introduction

Fatalistic cancer beliefs may contribute to delayed diagnosis and poor outcomes, including treatment abandonment, for children with cancer. This study explored Guatemalan parents’ cancer beliefs during initial paediatric cancer communication, and the sociocultural and contextual factors that influence these beliefs.

Methods

Twenty families of children with cancer were included in this study. We audio-recorded psychosocial conversations with psychologists and diagnostic conversations with oncologists, then conducted semi-structured interviews with parents to explore the evolution of their cancer beliefs. Audio-recordings were transcribed and translated from Spanish into English, with additional review in both languages by bilingual team members. All 60 transcripts were thematically analysed using a priori and novel codes.

Results

Guatemalan parents’ beliefs evolve as they learn about cancer through various sources. Sources of information external to the cancer centre, including prior experiences with cancer, media exposure, community discussion and clinical encounters, contribute to pre-existing beliefs. Many parents’ pre-existing cancer beliefs are fatalistic; some are influenced by Mayan spirituality. Sources internal to the cancer centre include psychologists and oncologists, other providers, other patients and families. Psychologists acknowledge pre-existing beliefs and deliver cancer education using verbal explanations and hand-drawings. Oncologists provide diagnostic information and outline treatment plans. Both support hope by providing a path toward cure. Parents’ lived experience is a culmination of sources and simultaneously independent. Ultimately most parents arrive at an understanding of cancer that is consistent with an allopathic medical model and offers optimism about outcomes.

Conclusion

An interdisciplinary communication process that includes cancer education, is attentive to pre-existing beliefs, and supports hope may encourage acceptance of the allopathic medical model and need for treatment. Providers in settings of all resource levels may be able to use these techniques to support cross-cultural cancer communication, reduce treatment abandonment and improve therapy adherence.
Safe opioid prescribing: a prognostic machine learning approach to predicting 30-day risk after an opioid dispensation in Alberta, Canada
Authors: Sharma Vishal , Kulkarni Vinaykumar , Eurich Dean T , Kumar Luke , Samanani Salim
Published: May 2021

Objective

To develop machine learning models employing administrative health data that can estimate risk of adverse outcomes within 30 days of an opioid dispensation for use by health departments or prescription monitoring programmes.

Design, setting and participants

This prognostic study was conducted in Alberta, Canada between 2017 and 2018. Participants included all patients 18 years of age and older who received at least one opioid dispensation. Pregnant and cancer patients were excluded.

Exposure

Each opioid dispensation served as an exposure.

Main outcomes/measures

Opioid-related adverse outcomes were identified from linked administrative health data. Machine learning algorithms were trained using 2017 data to predict risk of hospitalisation, emergency department visit and mortality within 30 days of an opioid dispensation. Two validation sets, using 2017 and 2018 data, were used to evaluate model performance. Model discrimination and calibration performance were assessed for all patients and those at higher risk. Machine learning discrimination was compared with current opioid guidelines.

Results

Participants in the 2017 training set (n=275 150) and validation set (n=117 829) had similar baseline characteristics. In the 2017 validation set, c-statistics for the XGBoost, logistic regression and neural network classifiers were 0.87, 0.87 and 0.80, respectively. In the 2018 validation set (n=393 023), the corresponding c-statistics were 0.88, 0.88 and 0.82. C-statistics from the Canadian guidelines ranged from 0.54 to 0.69 while the US guidelines ranged from 0.50 to 0.62. The top five percentile of predicted risk for the XGBoost and logistic regression classifiers captured 42% of all events and translated into post-test probabilities of 13.38% and 13.45%, respectively, up from the pretest probability of 1.6%.

Conclusion

Machine learning classifiers, especially incorporating hospitalisation/physician claims data, have better predictive performance compared with guideline or prescription history only approaches when predicting 30-day risk of adverse outcomes. Prescription monitoring programmes and health departments with access to administrative data can use machine learning classifiers to effectively identify those at higher risk compared with current guideline-based approaches.
Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 ‘lockdown’ policy in 10 UK sites: a regression discontinuity in time design
Authors: Bakolis Ioannis , Stewart Robert , Baldwin David , Beenstock Jane , Bibby Paul , Broadbent Matthew , Cardinal Rudolf , Chen Shanquan , Chinnasamy Karthik , Cipriani Andrea , Douglas Simon , Horner Philip , Jackson Caroline A , John Ann , Joyce Dan W , Lee Sze Chim , Lewis Jonathan , McIntosh Andrew , Nixon Neil , Osborn David , Phiri Peter , Rathod Shanaya , Smith Tanya , Sokal Rachel , Waller Rob , Landau Sabine
Published: May 2021

Objectives

To investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 ‘lockdown’ policy in Spring 2020.

Design

A regression discontinuity in time (RDiT) analysis of daily service-level activity.

Setting and participants

Mental healthcare data were extracted from 10 UK providers.

Outcome measures

Daily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads) and community services (face-to-face (f2f)/non-f2f contacts, caseloads): Adult, older adult and child/adolescent mental health; early intervention in psychosis; home treatment teams and liaison/Accident and Emergency (A&E). Data were extracted from 1 Jan 2019 to 31 May 2020 for all sites, supplemented to 31 July 2020 for four sites. Changes around the commencement and lifting of COVID-19 ‘lockdown’ policy (23 March and 10 May, respectively) were estimated using a RDiT design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites.

Results

Pooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86 to 2.87), reduced referrals (IRR 0.62, 95% CI 0.55 to 0.70) and reduced inpatient admissions (IRR 0.75, 95% CI 0.67 to 0.83) and caseloads (IRR 0.85, 95% CI 0.79 to 0.91) compared with the pre lockdown period. All community services saw shifts from f2f to non-f2f contacts, but varied in caseload changes. Lift of lockdown was associated with reduced deaths (IRR 0.42, 95% CI 0.27 to 0.66), increased referrals (IRR 1.36, 95% CI 1.15 to 1.60) and increased inpatient admissions (IRR 1.21, 95% CI 1.04 to 1.42) and caseloads (IRR 1.06, 95% CI 1.00 to 1.12) compared with the lockdown period. Site-wide activity, inpatient care and community services did not return to pre lockdown levels after lift of lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect.

Conclusions

MH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences.
Nodal and paranodal antibody-associated neuropathies
Authors: Fehmi Janev , Vale Tom , Keddie Stephen , Rinaldi Simon
Published: May 2021

Within the last decade, antibodies targeting the node and paranode of myelinated peripheral nerves have been increasingly identified in patients with acquired immune-mediated neuropathies, commonly termed ‘nodo-paranodopathies’. Crucially, these patients often present with additional clinical features not usually seen with the most common immune-mediated neuropathies, Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy, and respond poorly to conventionally used immunomodulatory therapies. Emerging evidence that these are pathologically distinct diseases has further prompted the use of more targeted treatment, such as the B cell depleting monoclonal antibody rituximab, which has been reported to significantly improve functional outcomes in this subset of patients. We provide an overview of the emerging clinical and serological phenotypes in patients with specific nodal/paranodal antibodies, the practicalities of antibody testing and current evidence supporting the use of non-standard therapies.
Percutaneous radiofrequency treatment of the gasserian ganglion for trigeminal neuralgia complicated by trochlear nerve palsy: a case report
Authors: Smulders Pascal SH , Terheggen Michel AMB , Geurts José W , Kallewaard Jan Willem
Published: May 2021

Background

Trigeminal neuralgia (TN) has the highest incidence of disorders causing facial pain. TN is provoked by benign stimuli, like shaving, leading to severe, short-lasting pain. Patients are initially treated using antiepileptic drugs; however, multiple invasive options are available when conservative treatment proves insufficient. Percutaneous radiofrequency treatment of the trigeminal, or gasserian, ganglion (RF-G) is a procedure regularly used in refractory patients with comorbidities. RF-G involves complex needle maneuvering to perform selective radiofrequency heat treatment of the affected divisions. We present a unique case of cranial nerve 4 (CN4) paralysis after RF-G.

Case presentation

A male patient in his 60s presented with sharp left-sided facial pain and was diagnosed with TN, attributed to the maxillary and mandibular divisions. MRI showed a vascular loop of the anterior inferior cerebellar artery without interference of the trigeminal complex. The patient opted for RF-G after inadequate conservative therapy. The procedure was performed by an experienced pain physician and guided by live fluoroscopy. The patient was discharged without problems but examined the following day for double vision. Postprocedural MRI showed enhanced signaling between the trigeminal complex and the brainstem. Palsy of CN4 was identified by a neurologist, and spontaneous recovery followed 5 months after the procedure.

Conclusions

Mention of postprocedural diplopia in guidelines is brief, and the exact incidence remains unknown. Different mechanisms for cranial nerve (CN) palsy have been postulated: incorrect technique, anatomical variations, and secondary heat injury. We observed postprocedural hemorrhage and hypothesized that bleeding might be a contributing factor in injury of CNs after RF-G.
Comparison of Touhy and Quincke needles on intravascular injection rate in lumbar transforaminal epidural block: a randomized prospective trial
Authors: Soh Hyojung , Jeong Yujin , Kim Eung Don
Published: May 2021

Background

Transforaminal epidural steroid injection is widely used in clinical practice to effectively deliver injectate into the ventral epidural space. Complications associated with intravascular injection such as spinal cord infarction and paraplegia can occur during transforaminal epidural steroid injection. To improve the safety of the procedure, avoidance of intravascular injection is crucial, for which appropriate needle selection is important. The primary aim of this study was to compare intravascular injection rates during transforaminal epidural steroid injection between commonly used Quincke and Tuohy needles.

Method

Two hundred and four transforaminal epidural steroid injection cases were randomly assigned to one of two needle groups (22-gage Quincke needle or 22-gage Tuohy needle). Intravascular injection was evaluated using digital subtraction angiography. Spread of contrast medium to the ventral and medial epidural spaces was evaluated. Procedure time was compared between the two needle types.

Results

The overall incidence of intravascular injection was 7.8%. The rate of intravascular injection was significantly lower in the Tuohy needle group than the Quincke needle group (2.9% vs 12.7%, p=0.009). The ventral and medial epidural spread rates of the Tuohy needle group were 92.2% and 95.1%, respectively, significantly higher than those of the Quincke needle group. The procedure time was shorter in the Tuohy needle group than in the Quincke needle group (97.4 (19.3) seconds vs 117.8 (31.9) s; mean difference −20.40 (95% CI −34.35 to −6.45), p=0.005).

Conclusions

In conclusion, Tuohy needles had a lower intravascular injection rate and higher medial and ventral epidural spreading rates than Quincke needles.

Trial registration number

KCT0002095.
The role of livestock in sustainable food production systems in Canada
Authors: Ominski Kim , Gunte Kebebe , Wittenberg Karin , Legesse Getahun , Mengistu Genet , McAllister Tim
Published: May 2021

Global drivers such as the growing human population, evolving consumer preferences, globalization, and climate change have put pressure on the agri-food sector to produce more livestock products with less land, feed, and water. Taste, nutritional value, cost, convenience, source, animal welfare, and environmental sustainability of food are criteria upon which purchasing decisions are made. In response, an environmental footprint analysis composed of greenhouse gas emissions, nutrient and water use efficiency, water quality, carbon storage, and biodiversity has been completed for many commodities. However, as livestock production systems occur within complex agro-ecosystems, it is extremely challenging to formulate a single overall sustainability metric. There is no “silver bullet” to solve the environmental concerns of all livestock production systems as they operate under different constraints on different landscapes, with different water and nutrient cycles, and soil types. Furthermore, the lack of scientific evidence regarding the interactions between livestock production, human nutritional adequacy, and the health of our environment makes it difficult for consumers to interpret this information and make informed food choices. This review examines these complex interactions and trade-offs, as well as the potential impacts of changes in consumer dietary choice on environmental sustainability, nutritional adequacy, and land use.
Impact of manure and biochar additions on annual crop growth, nutrient uptake, and fate of 15N-labelled fertilizer in two contrasting temperate prairie soils after four years
Authors: Hangs R.D. , Schoenau J.J. , Knight J.D.
Published: May 2021

Liquid hog manure (LHM) and solid cattle manure (SCM) co-applied with biochar could beneficially influence soil nitrogen (N) and phosphorus (P) dynamics. A split-plot design was used at two sites (Brown and Black) in Saskatchewan to assess LHM and SCM (100 kg N·ha−1) applied alone or in combination with biochars (8 Mg carbon·ha−1) produced using slow or fast pyrolysis. Crop growth and nutrient uptake, along with fertilizer 15N recovery, were followed over four years in a cereal–oilseed rotation. Crop growth on the Brown soil was more responsive to the treatments than the Black soil, reflecting lower fertility of the Brown soil. The manure and biochar, applied alone or in combination, had little impact on available soil P. Manure and biochar effects on crop growth and nutrient uptake were attributed to temporal effects on soil N immobilization–mineralization influencing plant-available soil N. A negative impact of the fast pyrolysis biochar on growth and plant uptake was observed and attributable to its greater labile-carbon content, which likely promoted soil N immobilization. Synergism observed between SCM and the slow pyrolysis biochar may reflect enhanced net SCM-N mineralization and increased water-holding capacity. The majority (55%–80%) of plant 15N recovery occurred during the first year, with 86% of fertilizer 15N conserved within the soil–plant system after four years. Greater (40%) plant 15N recovery without biochar addition, coupled with increased (38%) soil 15N recovery with added biochar, suggests biochar-related immobilization and (or) sorption in the biochar-amended soils.
Factors affecting individual foraging behavior in a threatened seabird: Olrog’s Gull (Larus atlanticus) as a case study
Authors: Zumpano Francisco , Castano Melina V. , Favero Marco , García Germán O.
Published: May 2021

The analysis of feeding strategies in animals is one of the most important topics in foraging ecology. The individual’s foraging behavior depends on both the individual’s own actions and the behavior of other foragers. Here we analyse the effect of the sex and group size on the foraging behavior of immature Olrog’s Gull (Larus atlanticus Olrog, 1958), endemic to the Atlantic coast of southern South America and regionally listed a threatened species. Birds were captured, banded, sexed, and aged during the non-breeding season in Mar Chiquita coastal lagoon, Argentina. The foraging behavior was quantified by observations made on individuals of known identity, recording the size of foraging groups, as well as prey size and type. Foraging parameters estimated were foraging effort, capture rate, and foraging efficiency. Males spent more time in agonistic behavior and captured larger prey. With an increase in group size, the capture rate, the capture of small crabs by males, and the foraging effort were higher. The agonistic behaviors, size of consumed prey, and foraging effort were affected by individual identity. Our study pinpoints factors underlying variation in the foraging behavior of Olrog’s Gulls and illustrates the importance of modelling individual variation when analyzing foraging behavior.
Acheulian artefacts and tephra from Upland Western Maharashtra (Deccan Volcanic Province), Peninsular India
Authors: Deo Sushama G. , Baptista Andre , Rajaguru Sharad N.
Published: May 2021

The two Early Acheulian sites of Bori and Morgaon in the Deccan Volcanic Province in Upland Maharashtra, India bear some association with an acidic tephra deposit in a fluvial context. Acheulian artefacts in association with tephra were first reported in India from the Bori site and numerous efforts to date this tephra have since been undertaken. These efforts employed various dating methods and produced a total of 10 absolute dates ranging from the Early Pleistocene with a maximum age of 1.4 Ma to the Late Pleistocene with a minimum age of 23.4 ± 2.4 ka. However, field observations and a typo-technological analysis strongly suggests that these Early Acheulian artefacts occur in a semi-primary context, and thus contest the Late Pleistocene age of the tephra and redeposition of the artefacts as argued by some scholars.

At Morgaon, the Acheulian artefacts have been recovered from basal fluvial sediments that contain clasts of laterite. These sediments are capped by two low-energy clay facies that are separated by high-energy gravel lenses. The tephra at Morgaon has been reported from the upper clay facies and has produced absolute dates ranging from the Matuyama period (>0.78 Ma) to the Late Pleistocene (41 ka).

After more than two decades of investigation at these sites, the number of absolute dates procured through methods such as electron spin resonance (ESR),
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Ar–
40
Ar, U–Th and palaeomagnetism, although encouraging, are inconclusive. This paper is therefore an attempt to gauge the nature of the palaeolandscapes that most probably existed during the Early Quaternary. This will be achieved by studying local geomorphological variability between the two sites, along with a preliminary analysis of lithic morphology.
A Neural Joint Model with BERT for Burmese Syllable Segmentation, Word Segmentation, and POS Tagging
Authors: Mao Cunli , Man Zhibo , Yu Zhengtao , Gao Shengxiang , Wang Zhenhan , Wang Hongbin
Published: May 2021

The smallest semantic unit of the Burmese language is called the syllable. In the present study, it is intended to propose the first neural joint learning model for Burmese syllable segmentation, word segmentation, and
part-of-speech
(
POS
) tagging with the BERT. The proposed model alleviates the error propagation problem of the syllable segmentation. More specifically, it extends the neural joint model for Vietnamese word segmentation, POS tagging, and dependency parsing [28] with the pre-training method of the Burmese character, syllable, and word embedding with BiLSTM-CRF-based neural layers. In order to evaluate the performance of the proposed model, experiments are carried out on Burmese benchmark datasets, and we fine-tune the model of multilingual BERT. Obtained results show that the proposed joint model can result in an excellent performance.
A Framework for Indonesian Grammar Error Correction
Authors: Lin Nankai , Chen Boyu , Lin Xiaotian , Wattanachote Kanoksak , Jiang Shengyi
Published: May 2021

Grammatical Error Correction (GEC) is a challenge in Natural Language Processing research. Although many researchers have been focusing on GEC in universal languages such as English or Chinese, few studies focus on Indonesian, which is a low-resource language. In this article, we proposed a GEC framework that has the potential to be a baseline method for Indonesian GEC tasks. This framework treats GEC as a multi-classification task. It integrates different language embedding models and deep learning models to correct 10 types of Part of Speech (POS) error in Indonesian text. In addition, we constructed an Indonesian corpus that can be utilized as an evaluation dataset for Indonesian GEC research. Our framework was evaluated on this dataset. Results showed that the Long Short-Term Memory model based on word-embedding achieved the best performance. Its overall macro-average F
0.5
in correcting 10 POS error types reached 0.551. Results also showed that the framework can be trained on a low-resource dataset.
Sentiment Analysis of Sinhala News Comments
Authors: Ranathunga Surangika , Liyanage Isuru Udara
Published: May 2021

Sinhala is a low-resource language, for which basic language and linguistic tools have not been properly defined. This affects the development of NLP-based end-user applications for Sinhala. Thus, when implementing NLP tools such as sentiment analyzers, we have to rely only on language-independent techniques. This article presents the use of such language-independent techniques in implementing a sentiment analysis system for Sinhala news comments. We demonstrate that for low-resource languages such as Sinhala, the use of recently introduced word embedding models as semantic features can compensate for the lack of well-developed language-specific linguistic or language resources, and text classification with acceptable accuracy is indeed possible using both traditional statistical classifiers and Deep Learning models. The developed classification models, a corpus of 8.9 million tokens extracted from Sinhala news articles and user comments, and Sinhala Word2Vec and fastText word embedding models are now available for public use; 9,048 news comments annotated with POSITIVE/NEGATIVE/NEUTRAL polarities have also been released.
Cross-lingual Adaptation Using Universal Dependencies
Authors: Taghizadeh Nasrin , Faili Heshaam
Published: May 2021

We describe a cross-lingual adaptation method based on syntactic parse trees obtained from the Universal Dependencies (UD), which are consistent across languages, to develop classifiers in low-resource languages. The idea of UD parsing is to capture similarities as well as idiosyncrasies among typologically different languages. In this article, we show that models trained using UD parse trees for complex NLP tasks can characterize very different languages. We study two tasks of paraphrase identification and relation extraction as case studies. Based on UD parse trees, we develop several models using tree kernels and show that these models trained on the English dataset can correctly classify data of other languages, e.g., French, Farsi, and Arabic. The proposed approach opens up avenues for exploiting UD parsing in solving similar cross-lingual tasks, which is very useful for languages for which no labeled data is available.
Modern Clinical Text Mining: A Guide and Review
Authors: Percha Bethany
Published: May 2021

Electronic health records (EHRs) are becoming a vital source of data for healthcare quality improvement, research, and operations. However, much of the most valuable information contained in EHRs remains buried in unstructured text. The field of clinical text mining has advanced rapidly in recent years, transitioning from rule-based approaches to machine learning and, more recently, deep learning. With new methods come new challenges, however, especially for those new to the field. This review provides an overview of clinical text mining for those who are encountering it for the first time (e.g., physician researchers, operational analytics teams, machine learning scientists from other domains). While not a comprehensive survey, this review describes the state of the art, with a particular focus on new tasks and methods developed over the past few years. It also identifies key barriers between these remarkable technical advances and the practical realities of implementation in health systems and in industry.
Photo-Electrochemical Performance of Interpenetration-Structured Heterojunction by Overlapping CuO and ZnO Nanorod Arrays
Authors: Wu Fan , Pathak Rajesh , Zhang Tiansheng , Xu Haibing , Tong Yanhua , Jian Ronghua , Qiao Qiquan (Quinn)
Published: May 2021

A facile design of interpenetration-structured p–n heterojunction device was fabricated by overlapping p-CuO and n-ZnO nanorod arrays directly. The design showed weak photovoltaic performance. However, the p-n heterojunction system shows the significantly enhanced photocurrent and photovoltage with the assistance of filling electrolyte (I3
−/I−). The charge carrier dynamics indicates that the reversible redox couple (I3
−/I−) electrolyte can promote electron transfer from CuO to ZnO better, i.e. better charge separation efficiency and photocurrent.
The Influence of Leveler on the Impurity Behavior of Electroplated Cu Films During Laser Annealing
Authors: Tan Lingyue , Han Silin , Chen Shuhui , Hang Tao , Ling Huiqin , Wu Yunwen , Li Ming
Published: May 2021

Leveler is one of the key factors for the fabrication of electroplated Cu with superior electrical properties in Cu interconnect metallization. Rarely notice has been paid on the influence of leveler on the impurity behavior of electroplated Cu during recrystallization. In this study, the impacts of five different levelers on the impurity behavior during recrystallization of the electrochemical deposited Cu films are studied in terms of microstructure and electrochemical behavior. Five levelers perform differences in molecular types and inhibition ability on Cu deposition. The former will affect the initial impurity content of the original crystal, while the latter is directly related to the amount of impurity diffusion during recrystallization. This study shows the direct evidence that two factors affect the impurity behavior of the electroplated Cu films during laser annealing and thus affect the resistance performance. We find that the films obtained by using leveler that has a reasonable inhibitory ability and incorporates the lowest initial impurity content shows the largest resistance drop during recrystallization. We believe the findings are meaningful for the selection of levelers to improve electrical property in the metallization of electroplated copper interconnects.
Development of New Robust Optimal Score Function for the Weibull Distributed Error Term in Multilevel Models
Authors: Saleem Sehar , Sherwani Rehan Ahmad Khan , Amin Muhammad , Khalid Maryam , Ali Nouman
Published: May 2021

A popular robust estimation technique for linear models is the rank-based method as an alternative to the ordinary least square (OLS) and restricted maximum likelihood (REML) in the presence of extreme observations. This method is applied in machine reliability analysis and quantum engineering, especially in artificial intelligence and optimization problems where outliers are commonly observed. This technique is also extended for the multilevel model, where the shape of error distribution contributes a significant role in more efficient estimation. In this study, we proposed the Weibull score function for the Weibull distributed error terms in the multilevel model. The efficiency of the proposed score function is compared with the existing Wilcoxon score function and the traditional method REML via Monte Carlo simulations after adding simulated extreme observations. For small values of shape parameter in Weibull distribution of error term showing the presence of outliers, the Weibull score function was found to be efficient as compared to the Wilcoxon and REML methods. However, for a large value of shape parameter, Wilcoxon score appeared either equally efficient than the Weibull score function. REML is observed least precise in all situations. These findings are verified through a real application on test scores data, with a small value of shape parameter, and the Weibull score function turned out the most efficient.
Simulation of Motion Behavior of Concrete in Pump Pipe by DEM
Authors: Hao Ji , Jin Caiyun , Li Yue , Wang Zigeng , Liu Jianglin , Li Hongwen
Published: May 2021

In this paper, the mesocalibration test was used to measure the contact parameters (restitution coefficient, rolling friction coefficient, static friction coefficient, and surface energy) between coarse aggregate particles and mortar particles in Discrete Element Method (DEM) model of concrete. Then, the DEM model of concrete slump was established according to the coarse aggregate gradation to study the flow behavior of coarse aggregate in fresh concrete. The slump test result was compared with the output of the slump DEM model with high consistent, indicating the promising reliability of the mesocalibration test. Finally, based on the mesocalibration test results, the DEM model of pumping concrete was established. It was obtained that the pumping pressure calculated by the numerical model was similar to that of the pumping test with satisfactory accuracy better than the concrete pumping pressure calculated according to the rheological test results of concrete and lubricating layer. On this basis, the movement trajectory of coarse aggregate in the pump pipe was analyzed and the influence of coarse aggregate on the pumping performance of concrete was revealed.
Degradation Behaviour of Deteriorated RC Beams Strengthened with CFRP under the Compound Effects of Acid‐Salt Mist and Carbon Dioxide
Authors: Wang Wei , Wu Yuan-zhou , Fang Zhongnian
Published: May 2021

The reinforcement effect and durability of carbon fibre‐reinforced polymer (CFRP) sheets are important indicators that affect its promotion and application. This study conducted an experimental investigation of the degradation behavior of reinforced concrete (RC) beams strengthened with CFRP. The RC beams were deteriorated under the compound effects of acid‐salt mist and carbon dioxide for a time period t1i, then strengthened with one or two layers of CFRP sheets, and placed in the same deterioration environment for an additional time period t2i. The failure modes, load‐deflection curves, rigidity, and flexural carrying capacity changes were studied after the deteriorated RC beams were loaded to failure. Three combinations of deterioration periods were considered in this study: different t1i and same t2i, same t1i and different t2i, and same total time (t1i + t2i). This study found that the U‐shaped hoops and the side concrete peeled off gradually as the CFRP‐strengthened RC beams were deteriorated again with time. Under the ultimate load, the strengthening layer in the tension zone stripped. The strengthened layer, which consisted of CFRP, a binder, and the concrete cover, was stripped from the RC beam during loading. The deflection of the strengthened layer behaved differently from the other part; this disharmony prevented the mobilization of the tensile advantage of CFRP. The mechanism of RC beam’s mechanical behaviour was analyzed in terms of the degrees of deterioration of RC beams and CFRP and their coupled effects. The conclusions of this study can be used as references in the prediction of strength changing and service life of strengthened RC beams.