bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of arbuscular mycorrhizal fungi in nonnative plant invasion along mountain roads
Authors: Clavel Jan , Lembrechts Jonas , Alexander Jake , Haider Sylvia , Lenoir Jonathan , Milbau Ann , Nuñez Martin A. , Pauchard Anibal , Nijs Ivan , Verbruggen Erik
Published: September 2020

Plant associated mutualists can mediate invasion success by affecting the ecological niche of nonnative plant species. Anthropogenic disturbance is also key in facilitating invasion success through changes in biotic and abiotic conditions, but the combined effect of these two factors in natural environments is understudied.

To better understand this interaction, we investigated how disturbance and its interaction with mycorrhizas could impact range dynamics of nonnative plant species in the mountains of Norway. Therefore, we studied the root colonisation and community composition of arbuscular mycorrhizal (AM) fungi in disturbed vs undisturbed plots along mountain roads.

We found that roadside disturbance strongly increases fungal diversity and richness while also promoting AM fungal root colonisation in an otherwise ecto‐mycorrhiza and ericoid‐mycorrhiza dominated environment. Surprisingly, AM fungi associating with nonnative plant species were present across the whole elevation gradient, even above the highest elevational limit of nonnative plants, indicating that mycorrhizal fungi are not currently limiting the upward movement of nonnative plants.

We conclude that roadside disturbance has a positive effect on AM fungal colonisation and richness, possibly supporting the spread of nonnative plants, but that there is no absolute limitation of belowground mutualists, even at high elevation.
Infochemicals in terrestrial plants and seaweed holobionts: current and future trends
Authors: Schmidt Ruth , Saha Mahasweta
Published: September 2020

Since the holobiont concept came into the limelight ten years ago, we have become aware that responses of holobionts to climate change stressors may be driven by shifts in the microbiota. However, the complex interactions underlying holobiont responses across aquatic and terrestrial ecosystems remain largely unresolved. One of the key factors driving these responses is the infochemical‐mediated communication in the holobiont. In order to come up with a holistic picture, in this Viewpoint we compare mechanisms and infochemicals in the rhizosphere of plants and the eco‐chemosphere of seaweeds in response to climate change stressors and other environmental stressors, including drought, warming and nutrient stress. Furthermore, we discuss the inclusion of chemical ecology concepts that are of crucial importance in driving holobiont survival, adaptation and/or holobiont breakdown. Infochemicals can thus be regarded as a ‘missing link’ in our understanding of holobiont response to climate change and should be investigated while investigating the responses of plant and seaweed holobionts to climate change. This will set the basis for improving our understanding of holobiont responses to climate change stressors across terrestrial and aquatic ecosystems.
Nearly Unbiased Estimation of Autoregressive Models for Bounded Near‐Integrated Stochastic Processes*
Authors: Carrion‐i‐Silvestre Josep Lluís , Gadea María Dolores , Montañés Antonio
Published: September 2020

The paper investigates the estimation bias of autoregressive models for bounded near‐integrated stochastic processes and the performance of the standard procedures in the literature that aim to correct the estimation bias. In some cases, the bounded nature of the stochastic processes worsens the estimation bias effect. The paper extends two popular autoregressive estimation bias correction procedures to cover bounded stochastic processes. Monte Carlo simulations reveal that accounting for the bounded nature of the stochastic processes leads to improvements in the estimation of autoregressive models. Finally, an illustration is given using the unemployment rate of the G7 countries.
Tooth extraction without discontinuation of oral antithrombotic treatment: A prospective study
Authors: Pippi Roberto , Scorsolini Maria Giulia , Luigetti Luca , Pietrantoni Alessandra , Cafolla Arturo
Published: September 2020

Objective

To identify which variable, among those related to surgeries, to patients, or to antithrombotic treatments, could be considered as a bleeding indicator, and to analyze effectiveness of the local hemostatic protocols used, incidence of bleeding and healing index, depending on the number of extracted teeth, and patient antithrombotic treatment.

Methods

Patients who underwent tooth extractions without interruption or reduction of antithrombotic treatment were prospectively followed. The exact two‐tailed Fisher test was used to investigate the relationship between presence/absence of bleeding and type of hemostatic material. The effect of variables on the probability of bleeding and healing index was assessed by means of a multivariate logistic regression.

Results

Two hundred and fifty‐four procedures were analyzed. The incidence of bleeding was 15.75%. Severe bleeding occurred in only 6 patients (2.34%). The number of involved dental quadrants and pre‐surgical antibiotic treatments were found to be positively related with bleeding. The use of vasoconstrictors during surgery resulted in a reduction of healing index scores.

Conclusions

Tooth extractions in patients on antithrombotic treatment were found to be free from significant bleeding although the involvement of more than 1 quadrant in the same procedure should be avoided.
Targeting dissociation using cognitive behavioural therapy in voice hearers with psychosis and a history of interpersonal trauma: A case series
Authors: Varese Filippo , Douglas Maggie , Dudley Robert , Bowe Samantha , Christodoulides Thomas , Common Stephanie , Grace Tim , Lumley Victoria , McCartney Laura , Pace Sonia , Reeves Thomas , Morrison Anthony P. , Turkington Douglas
Published: September 2020

Objectives

Previous studies have suggested that dissociation might represent an important mechanism in the maintenance of auditory verbal hallucinations (i.e., voices) in people who have a history of traumatic life experiences. This study investigated whether a cognitive behavioural therapy (CBT) intervention for psychosis augmented with techniques specifically targeting dissociative symptoms could improve both dissociation and auditory hallucination severity in a sample of voice hearers with psychosis and a history of interpersonal trauma (e.g., exposure to sexual, physical, and/or emotional abuse).

Design

Case series.

Methods

A total of 19 service users with psychosis were offered up to 24 therapy sessions over a 6‐month intervention window. Participants were assessed four times over a 12‐month period using measures of dissociation, psychotic symptoms severity, and additional secondary mental‐health and recovery measures.

Results

Sixteen participants engaged in the intervention and were included in last‐observation‐carried‐forward analyses. Dropout rates were in line with those of other CBT for psychosis trials (26.3%). Repeated measures ANOVAs revealed large and significant improvements in dissociation (drm = 1.23) and hallucination severity (drm = 1.09) by the end of treatment; treatment gains were maintained 6 months following the end of therapy. Large and statistically significant gains were also observed on measures of post‐traumatic symptoms, delusion severity, emotional distress, and perceived recovery from psychosis.

Conclusions

The findings of this case series suggest that the reduction of dissociation represents a valuable and acceptable treatment target for clients with auditory verbal hallucinations and a trauma history. Future clinical trials might benefit from considering targeting dissociative experiences as part of psychological interventions for distressing voices.

Practitioner points

Practitioners should consider the role of dissociation when assessing and formulating the difficulties of voice hearers with a history of trauma.

Techniques to reduce dissociation can be feasibly integrated within psychological interventions for voices.

Voice hearers with histories of trauma can benefit from psychological interventions aimed at reducing dissociation.
Genetics of neuropsychiatric symptoms in patients with Alzheimer's disease: A 1‐year follow‐up study
Authors: Huang Mei‐Feng , Lee Wei‐Ju , Yeh Yi‐Chun , Liao Yi‐Chu , Wang Shuu‐Jiun , Yang Yi‐Hsin , Chen Cheng‐Sheng , Fuh Jong‐Ling
Published: September 2020

Aim

The aim of this study was to investigate the associations between candidate gene variants and domains of neuropsychiatric symptoms (NPS) and the changes in these associations over a 1‐year period.

Methods

Seven hundred and ninety‐three Taiwanese participants (47.8% female) with Alzheimer's disease (AD) were enrolled. Genes associated with a risk of developing AD were selected as candidate genes. NPS were assessed using the Neuropsychiatric Inventory Questionnaire (NPI‐Q), and the NPI‐Q total score and sub‐scores for the Psychosis, Mood, and Frontal Syndrome domains were calculated.

Results

Patients with AD and the APOE ε4 allele exhibited more obvious symptoms of psychosis. Mood symptoms were associated with CD33 rs3865444 and EPHA1 rs11767557, and frontal symptoms were associated with SORL1 rs3824968. A 1‐year Time × Alleles interaction effect of CD33 rs3865444 on mood symptoms was discerned.

Conclusion

Risk genes of AD, which are also associated with NPS, are APOE ε4 for psychosis, CD33 and EPHA1 for mood symptoms, and SORL1 for frontal symptoms. The association between CD33 and mood symptoms is dynamic and could change over 1 year; however, the results should be interpreted with caution because corrections for multiple comparisons were not performed.
Acute kidney injury and chronic kidney disease after combined heart‐liver transplant in patients with congenital heart disease: A retrospective case series
Authors: Lee Angela , Concepcion Waldo , Gonzales Selena , Sutherland Scott M. , Hollander Seth A.
Published: September 2020

Although it is known that children undergoing heart transplantation are at increased risk for both AKI and CKD, renal function following CHLT remains understudied. All pediatric CHLT patients from 2006 to 2019 were included. The prevalence of AKI in the first 7 post‐operative days, renal recovery at 30 post‐operative days, and CKD were ascertained. AKI was defined as an increase in creatinine greater than 1.5 times baseline, and CKD, as an eCrCl less than 90 mL/min/1.73 m2. The need for RRT was also analyzed. 10 patients were included, with an average age of 20 years and an average listing time of 130 days. Preoperatively, the median eCrCl was 91.12 mL/min/m2 (IQR 70.51, 127.75 min/mL/m2). 5 (50%) patients had CKD, with 4 at stage 2 and 1 at stage 3. AKI occurred post‐operatively in 3 of 9 (33%) patients: 2 at stage 1 and 1 at stage 2. 2 (67%) resolved by 7 days. Of the 5 patients who reached their 1‐year follow‐up, 1 (20%) had stage 3 CKD. Among 2 patients, neither had CKD at 5 years. One patient required RRT 2 weeks after CHLT. Despite an increased prevalence of preoperative CKD, patients undergoing CHLT have a lower AKI prevalence than those receiving an isolated heart or liver transplant. Of those with AKI, early renal recovery is common, although at 1 year CKD remains present in 20%. Among long‐term survivors, normal renal function is achievable.
Unmanipulated haploidentical hematopoietic stem cell transplantation for children with myelodysplastic syndrome
Authors: Suo Pan , Wang Shasha , Xue Yujuan , Cheng Yifei , Kong Jun , Yan Chenhua , Zhao Xiangyu , Chen Yao , Han Wei , Xu Lanping , Zhang Xiaohui , Liu Kaiyan , Zhang Leping , Huang Xiaojun , Wang Yu
Published: September 2020

Myelodysplastic syndrome (MDS) is a heterogeneous group of clonal disorders and is rare in children. Allogeneic hematopoietic stem cell transplantation (HSCT) is commonly used in children with MDS with excess blasts and in patients with refractory cytopenia of childhood (RCC) associated with monosomy 7, complex karyotype, severe neutropenia, or transfusion dependence. We recruited 27 children with MDS who received haploidentical hematopoietic stem cell transplantation (haplo‐HSCT). At transplantation, 10 patients had RCC, 12 patients had advanced MDS (RAEB and RAEB‐T), and 5 patients had myelodysplasia‐related acute myeloid leukemia (MDR‐AML). All patients received granulocyte colony‐stimulating factor (G‐CSF)–mobilized bone marrow cells and peripheral blood stem cells. At a median follow‐up of 24.1 months (range: 2.0‐74.5 months) after HSCT, the estimated probabilities of 3‐year disease‐free survival (DFS) and overall survival (OS) were both 81.9% (95% CI, 66.8‐100.0%). The estimated 3‐year incidences of relapse (CIR) and non‐relapse mortality (NRM) were both 7.4% (95% CI, 1.2%‐21.4%). The 100‐day cumulative incidence of grade II–IV aGVHD was 52.6% (95% CI, 42.9‐62.3%), while that of grade III–IV aGVHD was 11.1% (95% CI, 5.1‐17.1%). The 3‐year cumulative incidences of overall and extensive cGVHD were 42.3% (95% CI, 19.8%‐57.5%) and 21.1% (95% CI, 2.5%‐63.2%), respectively. Univariate analysis showed that chronic GVHD significantly affected OS and DFS. Haploidentical HSCT may be an effective treatment option with easier donor availability for pediatric patients with MDS.
Histological evaluation of tumor differentiation score and prognosis of extrahepatic bile duct cancer: A proposal for a new histological grading system
Authors: Komatsubara Toshihide , Sakuma Yasunaru , Sata Naohiro , Fukushima Noriyoshi
Published: September 2020

Extrahepatic bile duct (EHBD) cancer is a devastating cancer, and more common in Asian countries than in Western countries. Histological grading continues to be a highly relevant factor in prognosis and management of many kinds of cancer, however no uniform histological grading system exists for EHBD cancer. Histological heterogeneity within tumors is a problem in the evaluation of EHBD cancer. We developed an EHBD histological grading scheme to evaluate tumor differentiation pattern, and statistically analyzed its relationship with prognosis. In the present study, 257 surgically resected EHBD cancers were reviewed and their histological glandular differentiation (HGD) pattern was scored, and then we summed up the most and second most predominant scores. These scores were statistically analyzed for their relationship with patient prognosis. Patients showed a trend of shortening recurrence‐free survival (RFS) and overall survival (OS) in association with higher HGD scores. In multivariate analyses, HGD score was determined to be an influential factor in RFS (P = 0.00041) and OS (P < 0.0001). In addition, combining HGD score and lymph node status correctly stratified patient prognosis in RFS. In conclusion, this new HGD scoring system is highly practical and has powerful prognostic value for EHBD cancer.
The burden of immune‐mediated refractoriness to platelet transfusions in myelodysplastic syndromes
Authors: Cheok Kathleen P. L. , Chhetri Rakchha , Wee Li Yan A. , Friel Oisin , Pham Anh , Salvi Arabelle , McRae Simon , Bardy Peter , Singhal Deepak , Roxby David J. , Wood Erica M. , Hiwase Devendra K.
Published: September 2020

Background

Up to 65% of patients with myelodysplastic syndromes (MDS) have thrombocytopenia and require platelet (PLT) transfusion. The current standard of practice is to provide random‐ or single‐donor PLT transfusion and manage PLT refractoriness (PLT‐R) if and when it develops. This study assessed the prevalence and risk factors for immune‐mediated PLT‐R in patients in the South Australian (SA) MDS Registry.

Study Design and Methods

A retrospective analysis of MDS patients enrolled in the SA‐MDS registry was performed. HLA data was analyzed from January 2003 to 30 June 2017 to ensure minimum follow‐up of 2 years.

Results

During the study period, 341 of 681 (50%) MDS patients required at least one PLT transfusion, with 29 of 341 (9%) of all PLT transfusion patients requiring HLA‐matched PLT transfusion for PLT‐R. Of these 29 patients, 70% were females treated with disease‐modifying therapies suggesting that these patients are at high risk of HLA alloimmunization.

Conclusions

Immune‐mediated PLT‐R is common in MDS and can be expensive and difficult to manage once it occurs. Therefore, PLT transfusion practices should be optimized, especially for female MDS patients planned for disease‐modifying therapies. This can help save time and streamline management, especially in the provision of PLT products for these patients, where the consequences of alloimmunization and PLT‐R can be severe.
Backchannels and the pragmatics of South Asian Englishes
Authors: Kraaz Michelle , Bernaisch Tobias
Published: September 2020

The pragmatics of postcolonial Englishes including backchannels have so far remained in the periphery of academic inquiry. As pragmatic principles may be regarded as culture‐sensitive and various cultural differences have been attested between Great Britain and South Asia, the present paper studies backchannels in British, Indian and Sri Lankan English. Drawn from the respective spoken parts of the International Corpus of English, 3,212 backchannels are multifactorially modelled via a conditional inference tree and random forests including recent methodological improvements. Indications of pragmatic nativisation with backchannels are evident in Indian and Sri Lankan English with their distributions and forms in the light of various sociobiographic factors such as age and gender, but also type‐token ratio and conversational topic resonate with cultural differences across the speech communities. Lexical echo backchannels only attestable in the South Asian varieties instantiate a creative pragmatic innovation adding to the existing repertoire of backchannels in world Englishes.
TOWARDS EFFECTIVENESS OF INTEGRATION AND INTEROPERABILITY OF ONE-STOP E-GOVERNMENT PORTAL
Authors: Sedek Khairul Anwar , Omar Mohd Adib , Sulaiman Shahida
Published: September 2020

An effective one-stop e-government portal requires a system with good integration and interoperability. However, most e-government portals lack in integration and interoperability. This work aims to find an effective approach for e-government integration and interoperability for one-stop e-government portal. This paper presents a hybrid e-government architecture based on architectural principles, enterprise operational interoperability architecture and service component architecture (SCA). The experiment shows the proposed architecture is able to satisfy interoperation in terms of potentiality, compatibility, and performance tests for integration and interoperability e-government applications and services. The architecture is suitable for the development of one-stop e-government portal.
MULTI ATTRIBUTE ARCHITECTURE DESIGN DECISION FOR CORE ASSET DERIVATION
Authors: A. Halim Shahliza , N. A. Jawawi Dayang , Ibrahim Noraini , M. Zaki M. Zulkifli , Deris Safaai
Published: September 2020

Software Product Line (SPL) is an effective approach in software reuse in which core assets can be shared among the members of the product line with an explicit treatment of variability. Core assets, which are developed for reuse in domain engineering, are selected for product specific derivation in application engineering. Decision making support during product derivation is crucial to assist in making multiple decisions during product specific derivation. Multiple decisions are to be resolved at the architectural level as well as the detailed design level, address the need for assisting the decision making process during core asset derivation. Architectural level decision making is based on imprecise, uncertain and subjective nature of stakeholder for making architectural selection based on non- functional requirements (NFR). Furthermore, detail design level involves the selection of suitable features which have the rationale behind each decision. The rationale for the selection, if not documented properly, will also result in loss of tacit knowledge. Therefore, a multi-attribute architecture design decision technique is proposed to overcome the above mentioned problem. The technique combines Fuzzy Analytical Hierarchy Process (FAHP) with lightweight architecture design decision documentation to support the decision making during core asset derivation. We demonstrate our approach using the case study of Autonomous Mobile Robot (AMR). The case study implementation shows showed that the proposed technique supports software engineer in the process of decision making at the architecture and detail design levels.
A Method to Determine the Geometry-Dependent Bending Stiffness of Multilayer Graphene Sheets
Authors: Ma Xiaojie , Liu Luqi , Zhang Zhong , Wei Yueguang
Published: September 2020

We consider how the bending stiffness of a multilayer graphene sheet relies on its bending geometry, including the in-plane length L and the curvature κ. We use an interlayer shear model to characterize the periodic interlayer tractions due to the lattice structure. The bending stiffness for the sheet bent along a cylindrical surface is extracted via an energetic consideration. Our discussion mainly focuses on trilayer sheets, particularly the complex geometry-dependency of their interlayer stress transfer behavior and the overall bending stiffness. We find that L and κ dominate the bending stiffness, respectively, in different stable regions. These results show good quantitative agreement with recent experiments where the stiffness was found to be a non-monotonic function of the bending angle (i.e., Lκ). Besides, for a given in-plane length, the trilayer graphene in the flat state (κ → 0) is found to have the maximum bending stiffness. According to our analytical solution to the flat state, the bending stiffness of trilayer graphene sheet can vary by two orders of magnitude. Furthermore, once multilayer graphene sheets are bent along a cylindrical surface with small curvature, the sheets perform similar characteristics. Though the discussion mainly focuses on the trilayer graphene, the theoretical framework presented here can be readily extended for various van der Waals materials beyond graphene of arbitrary layer numbers.
Effects of Robust Convex Optimization on Early-Stage Design Space Exploratory Behavior
Authors: Pillai Priya P. , Burnell Edward , Wang Xiqing , Yang Maria C.
Published: September 2020

Engineers design for an inherently uncertain world. In the early stages of design processes, they commonly account for such uncertainty either by manually choosing a specific worst-case and multiplying uncertain parameters with safety factors or by using Monte Carlo simulations to estimate the probabilistic boundaries in which their design is feasible. The safety factors of this first practice are determined by industry and organizational standards, providing a limited account of uncertainty; the second practice is time intensive, requiring the development of separate testing infrastructure. In theory, robust optimization provides an alternative, allowing set-based conceptualizations of uncertainty to be represented during model development as optimizable design parameters. How these theoretical benefits translate to design practice has not previously been studied. In this work, we analyzed the present use of geometric programs as design models in the aerospace industry to determine the current state-of-the-art, then conducted a human-subjects experiment to investigate how various mathematical representations of uncertainty affect design space exploration. We found that robust optimization led to far more efficient explorations of possible designs with only small differences in an experimental participant’s understanding of their model. Specifically, the Pareto frontier of a typical participant using robust optimization left less performance “on the table” across various levels of risk than the very best frontiers of participants using industry-standard practices.
Surface Curvature Effects on Film Cooling Performance for Shaped Holes on a Model Turbine Blade
Authors: Moore Jacob D. , Yoon Christopher , Bogard David G.
Published: September 2020

Surface curvature has been shown to have significant effects on the film cooling performance of round holes, but the literature include few studies of its effects on shaped holes despite their prevalence in gas turbines. Experiments were performed using two rows of holes placed on the suction side of a scaled-up turbine blade in a low Mach number linear cascade wind tunnel with low freestream turbulence. The rows were placed in regions of high and low convex surface curvature. Geometries and flow conditions for the rows were matched to those from previous flat plate studies. Comparison of the adiabatic effectiveness results from the high curvature and flat plate rows revealed the same trends as those in the literature using round holes, with increased performance for the high curvature row at lower blowing ratios and the opposite at higher ones. The low curvature row had similar performance to the flat plate row at lower blowing ratios, suggesting the mild convex curvature had little beneficial effect. At higher blowing ratios, the low curvature row had inferior performance, which was attributed to the local freestream adverse pressure gradient that generated additional turbulence, promoting jet-to-mainstream mixing and decreasing performance.
Preparation of clean MgO surface by oxygen plasma: Comparison with standard substrate cleaning procedures
Authors: Geler-Kremer Jacqueline , Posadas Agham B. , Demkov Alexander A.
Published: September 2020

Different surface preparation methods for cleaning MgO, a widely used substrate in oxide epitaxy, are summarized and compared. We find that in situ surface preparation methods are preferable to ex situ preparation methods. We show that the complete removal of hydroxide, carbonate, and adventitious carbon from the MgO surface can be achieved via oxygen plasma exposure at 200 °C without high temperature annealing. Using this process, an atomically flat surface with root mean square roughness values of ∼0.1 nm is demonstrated. Surfaces treated thus also exhibit sharp RHEED streaks indicating good crystalline order of the surface. We also show that high temperature annealing of MgO, either by itself or following other ex situ cleaning methods, such as solvent cleaning, is a reasonably effective method for the removal of surface contaminants, enabling one to achieve a surface roughness of ∼0.2 nm. We show that wet etching or other ex situ cleaning methods alone without annealing cannot eliminate all surface contaminants and may even worsen the surface roughness significantly.
Structural breakdown in high power GaN-on-GaN p-n diode devices stressed to failure
Authors: Peri Prudhvi , Fu Kai , Fu Houqiang , Zhao Yuji , Smith David J.
Published: September 2020

The morphology of GaN-on-GaN vertical p-i-n diode devices after reverse-bias electrical stressing to breakdown has been investigated. All failed devices had irreversible structural damage, showing large surface craters that were ∼15–35 μm deep with lengthy surface cracks. Cross-sectional electron micrographs of failed devices showed substantial concentrations of threading dislocations around the cracks and near the crater surfaces. Progressive ion-milling across damaged devices revealed high densities of threading dislocations and the presence of voids beneath the surface cracks; these features were not observed in any unstressed devices. These results should serve as a useful reference for future reliability studies of vertical high-power GaN devices.
Fabrication of free-standing silicon carbide on silicon microstructures via massive silicon sublimation
Authors: Amjadipour Mojtaba , MacLeod Jennifer , Motta Nunzio , Iacopi Francesca
Published: September 2020

Heteroepitaxial thin films of cubic silicon carbide (3C-SiC) on silicon offer a promising platform for leveraging the properties of SiC, such as wide bandgap, high mechanical strength, and chemical stability on a silicon substrate. Such heteroepitaxial films also attract considerable interest as pseudosubstrates for the growth of GaN as well as graphene on silicon wafers. However, due to a substantial lattice mismatch, the growth of 3C-SiC on silicon leads to a considerable amount of stresses, defects, and diffusion phenomena at the heterointerface. We show here that the extent of such interface phenomena and stresses is so large that, after patterning of the SiC, a massive sublimation of the silicon underneath the SiC/Si interface is promoted via a high-temperature anneal, either in high or medium vacuum ambient. A micrometer-thick air gap can be formed below the SiC structures, making them suspended. Hence, the described approach can be used as a straightforward methodology to form free-standing silicon carbide structures without the need for wet or anisotropic etching and could be of great interest for devices where suspended moving parts are needed, such as micro- and nanoelectromechanical systems.
Mitigating self-excited thermoacoustic oscillations in a liquid fuel combustor using dual perforated plates
Authors: Zhou Hao , Liu Zihua , Tao Chengfei , Zhou Mingxi
Published: September 2020

Perforated plates are widely used in many practical burners to attenuate noise emissions. In this study, the acoustic absorption capability of dual perforated plates (DPPs) with different porosities and aperture diameters was evaluated and tested in an impedance tube, and the damping performance of the DPPs located in a liquid fuel combustor inlet section was experimentally studied. The DPPs have an adjustable first cavity and can mitigate the thermoacoustic oscillations within a wide sound absorption bandwidth. The DPPs can absorb 95% of the specified incident sound energy. The combustion results indicated that the installation of DPPs at the inlet section has two effects: sound attenuation and the frequency shift of the combustor. The maximum reduction in dynamic pressure and CH* chemiluminescence intensity inside the chamber were 14 and 19 dB, respectively. When the primary air flow rate deviates from the optimal value, the DPPs can reduce the pressure amplitude in the combustion chamber by almost 80%. In general, this study may promote the application of DPPs under bias flow for the stabilization of spray combustion.
Depression in Individuals Coinfected with HIV and HCV Is Associated with Systematic Differences in the Gut Microbiome and Metabolome
Authors: Taylor Bryn C. , Weldon Kelly C. , Ellis Ronald J. , Franklin Donald , Groth Tobin , Gentry Emily C. , Tripathi Anupriya , McDonald Daniel , Humphrey Gregory , Bryant MacKenzie , Toronczak Julia , Schwartz Tara , Oliveira Michelli F. , Heaton Robert , Grant Igor , Gianella Sara , Letendre Scott , Swafford Austin , Dorrestein Pieter C. , Knight Rob
Published: September 2020

The human gut microbiome influences depression. Differences between the microbiomes of HIV-infected and uninfected individuals have been described, but it is not known whether these are due to HIV itself, or to common HIV comorbidities such as HCV coinfection. Limited research has explored the influence of the microbiome on depression within these groups. Here, we characterized the microbial community and metabolome in the stools from 373 people, noting the presence of current or lifetime depression as well as their HIV and HCV infection status. Our findings provide additional evidence that individuals with HIV have different microbiomes which are further altered by HCV coinfection. In individuals coinfected with both HIV and HCV, we identified microbes and molecules that were associated with depression. These results suggest that the interplay of HIV and HCV and the gut microbiome may contribute to the HIV-associated neuropsychiatric problems.
It is never too late to start: adherence to physical activity recommendations for 11–22 years and risk of all-cause and cardiovascular disease mortality. The HUNT Study
Authors: Moholdt Trine , Skarpsno Eivind Schjelderup , Moe Børge , Nilsen Tom Ivar Lund
Published: September 2020

Objectives

To examine associations between long-term (11–22 years) adherence to physical activity recommendations and mortality from all causes and from cardiovascular disease.

Design

Prospective population-based study with repeated assessments of self-reported physical activity (1984–86, 1995–97 and 2006–08) and follow-up until the end of 2013.

Setting

County of Nord-Trøndelag, Norway.

Participants

Men and women aged ≥20 years; 32 811 who participated in 1984–86 and 1995–97; 22 058 in 1984–86 and 2006–08; 31 948 in 1995–97 and 2006–09 and 19 349 in all three examinations (1984–1986, 1995–95 and 2006–08).

Main outcome measures

All-cause mortality and cardiovascular disease mortality from the national Cause of Death Registry.

Results

Compared with the reference category comprising individuals who adhered to the physical activity recommendations (≥150 min of moderate intensity or ≥60 min of vigorous intensity physical activity per week) over time, individuals who remained inactive (reporting no or very little physical activity) from 1984–86 to 1995–97 had HRs (95% CI) of 1.56 (1.40 to 1.73) for all-cause mortality and 1.94 (1.62 to 2.32) for cardiovascular disease mortality. Individuals who were inactive in 1984–86 and then adhered to recommendations in 2006–08 had HRs of 1.07 (0.85 to 1.35) for all-cause mortality and 1.31 (0.87 to 1.98) for cardiovascular disease mortality. In a subsample of individuals who participated at all three time points, those who were inactive or physically active below the recommended level across three decades (1984–86, 1995–97 and 2006–2008) had an HR of 1.57 (1.22 to 2.03) for all-cause mortality and 1.72 (1.08 to 2.73) for cardiovascular disease mortality.

Conclusion

Individuals who remained, or became, physically inactive had substantially greater risk of all-cause and cardiovascular disease mortality compared with those who met the physical activity recommendations throughout the lifespan.
Impact and efficacy of mobile health intervention in the management of diabetes and hypertension: a systematic review and meta-analysis
Authors: Mao Yaqian , Lin Wei , Wen Junping , Chen Gang
Published: September 2020

With the continuous development of science and technology, mobile health (mHealth) intervention has been proposed as a treatment strategy for managing chronic diseases. In some developed countries, mHealth intervention has been proven to remarkably improve both the quality of care for patients with chronic illnesses and the clinical outcomes of these patients. However, the effectiveness of mHealth in developing countries remains unclear. Based on this fact, we conducted this systematic review and meta-analysis to evaluate the impact of mHealth on countries with different levels of economic development. To this end, we searched Pubmed, ResearchGate, Embase and Cochrane databases for articles published from January 2008 to June 2019. All of the studies included were randomized controlled trials. A meta-analysis was performed using the Stata software. A total of 51 articles (including 13 054 participants) were eligible for our systematic review and meta-analysis. We discovered that mHealth intervention did not only play a major role in improving clinical outcomes compared with conventional care, but also had a positive impact on countries with different levels of economic development. More importantly, our study also found that clinical outcomes could be ameliorated even further by combining mHealth with human intelligence rather than using mHealth intervention exclusively. According to our analytical results, mHealth intervention could be used as a treatment strategy to optimize the management of diabetes and hypertension in countries with different levels of economic development.
Improving the American Diabetes Association Framework for individualizing treatment in older adults: evaluating life expectancy
Authors: Lee Alexandra K , Steinman Michael A , Lee Sei J
Published: September 2020

Introduction

For older adults with type 2 diabetes, the American Diabetes Association (ADA) Framework uses comorbidities and functional status to categorize patients by estimated life expectancy to guide individualization of glycemic treatment. We evaluated whether modifying the ADA Framework by removing three comorbidities and incorporating age could improve life expectancy stratification and better identify patients likely to benefit from intensive treatment.

Research design and methods

We examined 3166 Health and Retirement Study participants aged ≥65 with diabetes from 1998 to 2004, using a prospective cohort design with mortality follow-up through 2016. We classified participants into one of three ADA Framework categories: Healthy, Intermediate Health, and Poor Health. We created modified categories by excluding comorbidities weakly associated with mortality (hypertension, arthritis, and incontinence). Using Gompertz regression, we estimated life expectancy across age strata for both original and modified ADA Framework categories.

Results

The original ADA Framework classified 34% as Healthy (likely to benefit from intensive treatment), 50% as Intermediate Health, and 16% as Poor Health (unlikely to benefit from intensive treatment). Our comorbidity modification reclassified 20% of participants from Intermediate Health to Healthy. Using the modified ADA Framework, median life expectancy of the Healthy varied greatly by age (aged 65–69: 16.3 years; aged ≥80: 7.6 years), indicating differing likelihood of benefit. Additionally, age ≥80 made extended life expectancy unlikely (median life expectancy for Healthy 7.6 years, Intermediate Health 5.9 years, Poor Health 2.5 years), suggesting adults ≥80 are unlikely to benefit from intensive treatment.

Conclusions

Modifying the ADA Framework by incorporating age and focusing on comorbidities associated with mortality improved life expectancy stratification, resulting in different treatment recommendations for many older adults.
Elective cardiovascular care in the era of the COVID-19 pandemic: managing tragic choices
Authors: Berman Adam E , Miller Douglas , Sorrentino Robert A , Mossialos Elias A
Published: September 2020

The COVID-19 pandemic has led to significant morbidity and mortality globally. As health systems grapple with caring for patients affected with COVID-19, cardiovascular procedures that are deemed ‘elective’ have been postponed. Guidelines concerning which cardiac procedures should be performed during the pandemic vary by specialty and geography in the USA. We propose a clinical heuristic to guide individual physicians and governing bodies in their decision making regarding which cardiac procedures should be performed during the COVID-19 pandemic using the behavioural economics concept of heuristics and ecological rationality.
Study of Natural products Adverse Reactions (SONAR) in children seen in mental health clinics: a cross-sectional study
Authors: Sparks Emma , Zorzela Liliane , Necyk Candace , Khamba Baljit , Urichuk Liana , Barnes Joanne , Vohra Sunita
Published: September 2020

Background

Paediatric mental health patients frequently use natural health products (NHP) in addition to prescription medications, but very little is known about adverse events and possible NHP–drug interactions.

Objective

To determine: (1) the prevalence of paediatric mental health patients taking prescription medications only, NHP only, both NHP and prescription medications concurrently or neither; (2) which prescription medications and NHP are most commonly used in paediatric mental health populations and (3) adverse events experienced in the last 30 days (serious and non-serious).

Design

Cross-sectional surveillance study.

Setting

Paediatric mental health clinics.

Population/intervention

On their first clinic visit, paediatric mental health patients were provided with a form inquiring about prescription drug use, NHP use and any undesirable event experienced in the last month.

Results

Of the 536 patients included in this study, 23% (n=120) reported taking only prescription medication(s), 21% (n=109) reported only NHP use, 21% (n=112) reported using both NHP and prescription drugs concurrently, and 36% (n=191) reported using neither. Overall, there were 23 adverse events reported; this represents 6.3%, 2.8%, 10.8% and 0.6% of each population, respectively. The majority of patients who experienced an adverse event reported taking more than one NHP or prescription drug. No serious adverse events were reported.

Conclusion

Nearly half of the paediatric mental health patients in this study were taking NHPs alone or in addition to prescription medications. Active surveillance identified multiple adverse events associated with NHP and prescription drug use; none were serious. Healthcare professionals were encouraged to initiate conversations regarding NHP use.
Place and causes of acute cardiovascular mortality during the COVID-19 pandemic
Authors: Wu Jianhua , Mamas Mamas A , Mohamed Mohamed O , Kwok Chun Shing , Roebuck Chris , Humberstone Ben , Denwood Tom , Luescher Thomas , de Belder Mark A , Deanfield John E , Gale Chris P
Published: September 2020

Objective

To describe the place and causes of acute cardiovascular death during the COVID-19 pandemic.

Methods

Retrospective cohort of adult (age ≥18 years) acute cardiovascular deaths (n=5 87 225) in England and Wales, from 1 January 2014 to 30 June 2020. The exposure was the COVID-19 pandemic (from onset of the first COVID-19 death in England, 2 March 2020). The main outcome was acute cardiovascular events directly contributing to death.

Results

After 2 March 2020, there were 28 969 acute cardiovascular deaths of which 5.1% related to COVID-19, and an excess acute cardiovascular mortality of 2085 (+8%). Deaths in the community accounted for nearly half of all deaths during this period. Death at home had the greatest excess acute cardiovascular deaths (2279, +35%), followed by deaths at care homes and hospices (1095, +32%) and in hospital (50, +0%). The most frequent cause of acute cardiovascular death during this period was stroke (10 318, 35.6%), followed by acute coronary syndrome (ACS) (7 098, 24.5%), heart failure (6 770, 23.4%), pulmonary embolism (2 689, 9.3%) and cardiac arrest (1 328, 4.6%). The greatest cause of excess cardiovascular death in care homes and hospices was stroke (715, +39%), compared with ACS (768, +41%) at home and cardiogenic shock (55, +15%) in hospital.

Conclusions and relevance

The COVID-19 pandemic has resulted in an inflation in acute cardiovascular deaths, nearly half of which occurred in the community and most did not relate to COVID-19 infection suggesting there were delays to seeking help or likely the result of undiagnosed COVID-19.
Rocky road to digital diagnostics: implementation issues and exhilarating experiences
Authors: Stathonikos Nikolaos , Nguyen Tri Q , van Diest Paul J
Published: September 2020

Since 2007, we have gradually been building up infrastructure for digital pathology, starting with a whole slide scanner park to build up a digital archive to streamline doing multidisciplinary meetings, student teaching and research, culminating in a full digital diagnostic workflow where we are currently integrating artificial intelligence algorithms. In this paper, we highlight the different steps in this process towards digital diagnostics, which was at times a rocky road with definitely issues in implementation, but eventually an exciting new way to practice pathology in a more modern and efficient way where patient safety has clearly gone up.
Hormonal contraception and risk of STIs and bacterial vaginosis in South African adolescents: secondary analysis of a randomised trial
Authors: Balle Christina , Gill Katherine , Konstantinus Iyaloo N , Jaumdally Shameem Z , Lennard Katie , Esra Rachel , Happel Anna-Ursula , Barnabas Shaun L , Gamieldien Hoyam , Pidwell Tanya , Maseko Venessa , Lesosky Maia , Myer Landon , Passmore Jo-Ann S , Bekker Linda-Gail , Jaspan Heather B
Published: September 2020

Objectives

Young women in sub-Saharan Africa are at high risk of STIs and unintended pregnancies, yet hormonal contraceptive (HC) use may affect STI risk. We compared the influence of three HCs on the incidence and prevalence of STIs and bacterial vaginosis (BV) in South African adolescents.

Methods

One hundred and thirty adolescents between 15 and 19 years were randomised to the injectable norethisterone enanthate (Net-En), combined oral contraceptives (COC) (Triphasil or Nordette) or a combined contraceptive vaginal ring (CCVR; NuvaRing) for 16 weeks (clinicaltrials.gov/
NCT02404038
). Vaginal samples were collected at baseline and 16 weeks post contraceptive initiation for STI and BV testing.

Results

In an intention-to-treat analysis, no significant differences in BV prevalence were found between study arms. The overall incidence of any STI at follow-up was high: 16.2% in the COC arm; 25.7% in the Net-En arm; and 37.1% in the CCVR arm. The incidence rate (IR) of any STI was similar between Net-En (IR 0.74 (95% CI 0.34 to 1.41)) and the oestrogen-containing contraceptives (IR 0.78 (95% CI 0.47 to 1.22)). A lower IR of
Chlamydia trachomatis
(incidence rate ratio (IRR) 0.68 (95% CI 0.19 to 1.99)) and
Neisseria gonorrhoeae
(IRR 0.25 (95% CI 0.01 to 1.35)) but a higher IR of
Mycoplasma genitalium
(IRR 16.0 (95% CI 2.96 to 400)), was observed in the Net-En arm compared with the oestrogen-containing contraceptives, although the overall incidence of
M. genitalium
was low (4.7%). In an exploratory analysis, the risk of any STI and
N. gonorrhoeae
was lower in the COC arm compared with CCVR. A per-protocol analysis yielded similar results.

Conclusion

Our results suggest that use of Net-En may be associated with increased risk of
M. genitalium
compared with oestrogen-containing contraceptives but not with overall STI risk. COC use may decrease STI risk relative to CCVR.
Impact of COVID-2019 on stroke services in China: survey from the Chinese Stroke Association
Authors: Wang Xia , Ouyang Menglu , Carcel Cheryl , Chen Chen , Sun Lingli , Yang Jie , Zhang Yao , Chen Guofang , You Shoujiang , Cao Yongjun , Ma Lu , Hu Xin , Sui Yi , Anderson Craig , Song Lili , Wang Yongjun , Wang David
Published: September 2020

Background

The COVID-19 pandemic and physical distancing guidelines have compelled stroke practices worldwide to reshape their delivery of care significantly. We aimed to illustrate how the stroke services were interrupted during the pandemic in China.

Methods

A 61-item questionnaire designed on Wenjuanxing Form was completed by doctors or nurses who were involved in treating patients with stroke from 1 February to 31 March 2020.

Results

A total of 415 respondents completed the online survey after informed consent was obtained. Of the respondents, 37.8%, 35.2% and 27.0% were from mild, moderate and severe epidemic areas, respectively. Overall, the proportion of severe impact (reduction >50%) on the admission of transient ischaemic stroke, acute ischaemic stroke (AIS) and intracerebral haemorrhage (ICH) was 45.0%, 32.0% and 27.5%, respectively. Those numbers were 36.9%, 27.9% and 22.3%; 36.5%, 22.1% and 22.6%; and 66.4%, 47.5% and 41.1% in mild, moderate and severe epidemic areas, respectively (all p<0.0001). For AIS, thrombolysis was moderate (20%–50% reduction) or severely impacted (>50%), as reported by 54.4% of the respondents, while thrombectomy was 39.3%. These were 44.4%, 26.3%; 44.2%, 39.4%; and 78.2%, 56.5%, in mild, moderate and severe epidemic areas, respectively (all p<0.0001). For patients with acute ICH, 39.8% reported the impact was severe or moderate for those eligible for surgery who had surgery. Those numbers were 27.4%, 39.0% and 58.1% in mild, moderate and severe epidemic areas, respectively. For staff resources, about 20% (overall) to 55% (severe epidemic) of the respondents reported moderate or severe impact on the on-duty doctors and nurses.

Conclusion

We found a significant reduction of admission for all types of patients with stroke during the pandemic. Patients were less likely to receive appropriate care, for example, thrombolysis/thrombectomy, after being admitted to the hospital. Stroke service in severe COVID-19 epidemic areas, for example, Wuhan, was much more severely impacted compared with other regions in China.