bluuebunny/crossref_metadata_2025 huggingface dataset:
BETWEEN ‘URBILD’ AND ‘ABBILD’: THE CONCEPTION OF THE IMAGE IN CELAN'S POEMS ‘BEI WEIN UND VERLORENHEIT’, ‘TENEBRAE’, AND ‘HALBZERFRESSENER’
Authors: Koch Julian Johannes Immanuel
Published: April 2021

This article contends that the image is a central trope in Paul Celan's poetry. It suggests that Celan's rejection of metaphor and his opposition to readings of his poetry as mere imagery constitute only one side of his understanding of the image. On the other hand, Celan embraces the image when it goes beyond the merely figurative or imitative and approaches a form of ‘Urbild’. This article traces Celan's understanding of the image as split between ‘Urbild’ and ‘Abbild’ in his mature poems ‘Bei Wein und Verlorenheit’, ‘Tenebrae’, and ‘Halbzerfressener’, through which we will also gain a fuller sense of how Celan conceives of language and poetic voice.
Improving Risk‐Based Screening at Vapor Intrusion Sites in California
Authors: Lahvis Matthew A. , Ettinger Robert A.
Published: April 2021

The attenuation factor (AF) of 0.03 recommended by the U.S. Environmental Protection Agency (USEPA) is increasingly being used by regulatory agencies for the development of subsurface vapor screening levels for vapor intrusion (VI). There are concerns, however, over the database used to derive the AF and the AF's applicability to building types and geographies not included in USEPA database. To derive a more technically defensible AF for subsurface vapor screening in California, a database consisting of 8415 paired indoor and subsurface vapor samples collected from 485 buildings at 36 sites in California was compiled. Filtering was applied to remove data of suspect quality that were potentially affected by background (non‐VI) sources. Filtering reduced the size of the database to 788 indoor air and subsurface vapor pairs, 80% of which were trichloroethylene (TCE) measurements. An AF of 0.0008 was derived from only TCE vapor data, based on the ability of the AF to reliably identify buildings with indoor air concentrations above screening levels in 95% of cases where subsurface vapor screening levels were exceeded. The AF derived from this study demonstrated limited sensitivity to the variables typically considered important in VI characterization, which was partially attributed to relatively weak correlation of indoor air and subsurface vapor concentration data. The results of this study can be used to improve VI screening in California and other states and help focus limited resources on sites posing the greatest potential risk.
Novel Wx alleles generated by base editing for improvement of rice grain quality
Authors: Huang Xiaorui , Su Fei , Huang Sheng , Mei Fating , Niu Xiaomu , Ma Changle , Zhang Hui , Zhu Xiaoguo , Zhu Jian‐Kang , Zhang Jinshan
Published: April 2021

Amylose content (AC), which is regulated by the Waxy (Wx) gene, is a major indicator of eating and cooking quality (ECQ) in rice (Oryza sativa). Thus far, only a limited number of mutations in the N‐terminal domain of Wx were found to have a major impact on the AC of rice grains and no mutations with such effects were reported for other regions of the Wx protein. Here, nucleotide substitutions in the middle region of Wx were generated by adenine and cytosine base editors. The nucleotide substitutions led to changes in 15 amino acid residues of Wx, and a series of novel Wx alleles with ACs of 0.3%–29.43% (wild type with AC of 19.87%) were obtained. Importantly, the waxyabe2 allele showed a “soft rice” AC, improved ECQ, favorable appearance, and no undesirable agronomic traits. The transgenes were removed from the waxyabe2 progeny, generating a promising breeding material for improving rice grain quality.
Body composition assessment in children with inflammatory bowel disease: A comparison of different methods
Authors: von Graffenried Thea , Godin Jean‐Philippe , Schoepfer Alain , Breton Isabelle , Martin Francois‐Pierre , Nydegger Andreas
Published: April 2021

Aim

To assess different techniques to measure body composition in paediatric patients with inflammatory bowel disease using dual energy X‐ray absorptiometry as a reference method. We hypothesised that a three‐compartment model may demonstrate superiority over other methods as skinfold thickness equations and bioelectrical impedance analysis.

Methods

Body composition was assessed using skinfold thickness equations, bioelectrical impedance analysis and the three‐compartment model. Data obtained with these methods were compared to the results obtained by dual energy X‐ray absorptiometry. Statistical analysis was performed using Spearman's correlation and Bland–Altman's limits of agreement method.

Results

Twenty‐one paediatric patients with inflammatory bowel disease were included: 11 females and 10 males; mean age for the entire group: 14.3 years, range 12–16 years. In children with inflammatory bowel disease, skinfold thickness equations, bioelectrical impedance analysis and the three‐compartment model showed reliable measurements with small differences in the percentage of total body fat and good limits of agreements.

Conclusion

The assessment of body composition using bioelectrical impedance analysis provides a valid and accurate method in children with inflammatory bowel disease as compared to dual energy X‐ray absorptiometry. In the future, superiority of 3‐compartment model in research and clinical settings of nutritional intervention and disease status in children with inflammatory bowel disease remains to be demonstrated.
Proactive proximity monitoring with instance segmentation and unmanned aerial vehicle‐acquired video‐frame prediction
Authors: Bang Seongdeok , Hong Yeji , Kim Hyoungkwan
Published: April 2021

To prevent struck‐by accidents at construction sites, construction object movement should be predicted to avoid dangerous situations. This paper proposes a vision‐based proactive proximity‐monitoring method based on predictions of unmanned aerial vehicle (UAV)‐acquired video frames. The method has three modules. The first module recognizes workers, excavators, and dump trucks on a pixel level. The second module predicts construction objects’ future locations and postures. The third module generates proactive safety information, including the future direction and speed of objects moving toward the worker. For the evaluation of the method, 1,940 images extracted from nine UAV‐acquired videos recorded at real construction sites were used as the dataset. The method recognized construction objects with a mean average precision of 94.32%, predicted the future frame after 1 s with an F‐measure of 80.59%, and recorded mean proximity errors of 0.43, 0.91, and 1.22 m for the frames after 1, 2, and 3 s, respectively.
An accelerated boundary element method via cross approximation of integral kernels for large‐scale cathodic protection problems
Authors: Gortsas Theodore V. , Tsinopoulos Stephanos V. , Polyzos Demosthenes
Published: April 2021

The boundary element method (BEM), combined with hierarchical matrices (HM) and adaptive cross approximation (ACA) techniques, is a powerful tool for treating large‐scale cathodic protection (CP) problems in offshore engineering. Although HM‐ACA/BEM achieves significant memory and time reduction compared to conventional BEM, its application to large‐scale CP problems remains time consuming. In this work, a new, more efficient HM‐ACA/BEM is proposed. The linear system coefficient matrix, obtained by BEM, is partitioned hierarchically into admissible and nonadmissible submatrices. The low‐rank approximation of the admissible submatrices is accomplished indirectly, via a hybrid approach, utilizing approximations of the fundamental solutions and performing only a small number of integrations. The approximation of the fundamental solutions is obtained by a novel, two‐step procedure, which uses a small number of Lebedev points. The proposed methodology is general and integral kernel independent, and thus can be applied to all differential equations solved by BEM. The efficiency of the proposed method is demonstrated by solving a large‐scale CP problem dealing with the protection of an oil–steel offshore platform by sacrificial anodes.
Genetic diversity of alpine Dryas octopetala populations at their southern distribution limit in Europe
Authors: Varsamis Georgios , Merou Theodora , Karapatzak Eleftherios , Papageorgiou Aristotelis C. , Fotiadis Georgios , Tsiftsis Spyros
Published: April 2021

The arctic–alpine species Dryas octopetala has its southernmost European distribution in the northern part of Greece, where it forms isolated populations in three mountainous regions: Falakron, Tzena and Orvilos. This study aimed at estimating the intrapopulation genetic diversity and the overall genetic structure of these populations. A total of 20 randomly amplified polymorphic DNA (RAPD) markers were used. RAPD marker profiles revealed population differentiation, with Orvilos being the most differentiated population, indicating either genetic divergence or an independent origin. Intrapopulation genetic diversity indices were relatively low in all populations. Although isolation seem to have affected the genetic structure of D. octopetala populations at their southernmost European distribution limit, clonality and longevity of individuals might have contributed to maintaining their genetic diversity. The results emphasize the need for designing ex situ conservation management plans for conserving isolated alpine D. octopetala populations in the face of climate change.
The IC‐D score for predicting prophylactic cardioverter‐defibrillator implantation following acute myocardial infarction
Authors: Clementy Nicolas , Bensaid Reda , Bouteau Jérémie , Fedida Joël , Kiavue Yoann , Socie Pierre , Ackermann Romain , Goralski Marc , Fauchier Laurent , Bernard Anne , Angoulvant Denis , Babuty Dominique
Published: April 2021

Background

A reduced left ventricular ejection fraction (LVEF) ≤35% ≥6 weeks following an acute myocardial infarction (MI) may indicate prophylactic implantation of a cardioverter‐defibrillator (ICD). We sought to find predictors of absence of significant left ventricular (LV) remodeling post‐MI.

Methods

All consecutive patients hospitalized for acute MI with an LVEF ≤35% at discharge in our institution from 2010 were retrospectively included. Patients were assigned to two groups according to the persistence of an LVEF ≤35% (ICD+) or a recovery >35% (ICD‐). Logistic regression was performed to build a predictive score, which was then externally validated.

Results

Among a total of 1533 consecutive MI patients, 150 met inclusion criteria, 53 (35%) in the ICD+ group and 97 in the ICD group. After multivariable analyses, an LVEF ≤25% at discharge (adjusted OR 6.23 [2.47 to 17.0], p < .0001) and a CPK peak at the MI acute phase >4600 UI/L (adjusted OR 9.99 [4.27 to 25.3], p < .0001) both independently predicted non‐recovery at 6 weeks. The IC‐D (Increased Cpk—LV Dysfunction) score predicted persistent LVEF ≤35% with areas under curve of 0.83 and 0.73, in the study population and in a multicenter validation cohort of 150 patients, respectively (p < .0001).

Conclusions

The association of a severely reduced LVEF and a major release of myocardial necrosis biomarkers at the acute phase of MI predict unfavorable remodeling, and prophylactic ICD implantation.
Practitioners' identification of informal caregivers' difficulties with activities of daily living interventions for older people with dementia in Japan
Authors: Suwa Sayuri , Yumoto Akiyo , Ueno Mari , Yamabe Tomoko , Hoshishiba Yumiko , Sato Mihoko
Published: April 2021

Background

Older people with dementia who cannot perform daily activities independently due to cognitive impairment need support at home and in the community. This study identified aspects of activities of daily living (ADL) interventions that advanced dementia care practitioners recognise as challenging for informal caregivers to perform.

Methods

We conducted a self‐administered cross‐sectional survey on advanced dementia care practitioners, including certified nurses, specialising in gerontological, community health, home care, and visiting nursing, nurses specialising in dementia certified by the Japanese Nursing Association, and dementia care leaders certified by prefectural governors. The participants rated a caregivers' extent of difficulty in aspects of ADL interventions on a four‐point Likert scale. Factor analysis was performed to determine ADL intervention aspects that are recognised by advanced dementia care practitioners as challenging for informal caregivers.

Results

The highest loaded factors for mild, moderate, and severe cognitive impairment stages were ‘right time to draw attention,’ ‘opportunities to perform ADL,’ and ‘communicating how to perform ADL without giving up,’ respectively. Therefore, it is imperative to educate informal caregivers about the effects of cognitive impairment on ADL performance in people with dementia and enable them to provide concrete ADL interventions and tips to support the persons' autonomy and independence. The Cronbach's alpha values of the highest loaded factors for mild, moderate, and severe cognitive impairment stages were 0.851, 0.925, and 0.946, respectively. Moreover, the cumulative contribution ratios of each stage were 46.04%, 50.52%, and 47.36%, respectively.

Conclusion

This study dealt with identifying informal caregivers' difficulties with ADL interventions across the stages of dementia. Informal caregivers should be supported on aspects of ADL interventions that are potentially difficult for them to perform. Useful educational content and approaches in training programs for informal caregivers should be developed to enable them to help people with Alzheimer's disease maintain ADL performance toward ‘ageing in place’ even as the disease progresses.
Diagnostic performance of routine electrophoresis and immunofixation for the detection of immunoglobulin paraproteins (M‐Proteins) in dogs with multiple myeloma and related disorders: Part 1 – Current performance
Authors: Moore A Russell , Harris R. Adam , Jeffries Christina , Ashton Laura , Avery Paul R.
Published: April 2021

Background

Routine electrophoresis [agarose gel electrophoresis (AGE) and capillary zone electrophoresis (CZE)] and species‐specific immunofixation (IF) can be used alone or in combination to detect immunoglobulin paraprotein (M‐protein) and diagnose secretory myeloma‐related disorders (sMRD).

Objective

We aimed to evaluate the performance of AGE, CZE, CZE plus IF (CZE‐IF), and AGE plus IF (AGE‐IF) for detecting canine serum M‐proteins.

Methods

One hundred canine cases that had AGE, CZE, and routine IF performed on serum, and where B‐cell lineage neoplasia (such as B‐cell lymphoma and plasma cell tumors) had been diagnosed or excluded, were evaluated. Routine IF protocols targeted IgG‐FC, IgA, and IgM heavy chains and light chains. IgG4 IF and free light chain IF were also performed. B‐cell lineage neoplasms with an M‐protein detected, using any available method, were classified as sMRD. Datasets from AGE, CZE, IF, CZE‐IF, and AGE‐IF (electrophoretograms, gel images, and fraction concentrations) were composed and reviewed. The sensitivity, specificity, and Youden's index for M‐protein detection were determined for each dataset.

Results

The combination of AGE‐IF or CZE‐IF was more sensitive (82.9%) than CZE alone (72.0%) or AGE alone (64.6%) and more specific (66.1%, 48.3%, 51.7%, respectively). Immunofixation could be used alone to detect M‐proteins (sensitivity 82.9%, specificity 61.9%), but there were technical challenges that complicated the performance and evaluation of the test. Myeloma with free light chains only was found in 5/41 cases of sMRD.

Conclusions

Adding routine IF to routine electrophoresis increases the ability to accurately identify M‐proteins; however, there is still room for further diagnostic performance improvements.
Sisters Who Make Waves and Contemporary Female Identity
Authors: Xu Fangyi
Published: April 2021

The online variety show Sisters Who Make Waves has rapidly become highly popular and is one of many online shows dominated by young idols creating a group portrait of many successful sister identities. Various film and television dramas such as Nothing But Thirty and To Dear Myself have also depicted middle-aged and adult women. From the feminist perspective, mature and independent female images are a new feature of these online film and television shows. We found that women who participate in literary and creative activities are increasingly speaking in their own voices, that the sisters’ independent images have important cultural symbolic significance, and that these new images form an imagined community among the audience. However, we must be vigilant about the impact of new media’s commercialization on new women’s images.
Visibility as a Requirement for Protection of the Surroundings of Immovable Cultural Property: Paradigm, Incomprehension and Questions
Authors: Touil Amel , Chabou Meriem
Published: April 2021

The legal protection of historic monuments, under the framework of Algerian legislation, automatically implies the protection of the surroundings of the latter, defined in relation to a visibility relationship, determined at a distance of at least 200 m. Strongly influenced by the French colonial legislative heritage, does this approach really beocme valid and justified? Especially for listed buildings included in the medinas? What dimension should visibility have and how should it be addressed to ensure the effective enhancement of cultural heritage?
MXene Nanoflakes Confined in Multichannel Carbon Nanofibers as Electrocatalysts for Lithium–Sulfur Batteries
Authors: Tian Yaxi , Huang Huawen , Chen Chen , Deng Yuanfu , Zhang Lei
Published: April 2021

Lithium–sulfur (Li–S) batteries have been research hotspots because of their significant advantages in high-energy density and low cost. However, the notorious shuttle effect results in poor electrochemical performance, which is a serious obstacle for their practical application. The delicate design of sulfur hosts is a very important strategy to suppress the shuttle effect. Herein, MXene nanoflakes confined within multichannel carbon nanofibers (MXene@MCNF) have been successfully synthesized as robust electrocatalysts for Li–S batteries based on a simple electrospun method followed by a carbonization process. This unique structure effectively prevents the restacking of MXene nanoflakes, which is conducive to improve the electrocatalytic activity of MXene for propelling the redox reaction of polysulfides owing to the abundant exposure of surface active sites. Moreover, the multichannel hollow structure can inhibit the outward dissolution of polysulfides via the physical confinement caused by their abundant pore structures and alleviate the huge volume change of sulfur cathode. Benefiting from these aforementioned advantages, MXene@MCNF-sulfur (MXene@MCNF-S) cathode delivers a high capacity of 1177 mA h/g at 0.2 C and excellent cycling stability after 200 cycles at 2.0 C.
Near-Optimal Receding Horizon Control of Thermal Energy Storage
Authors: Qureshi O. A. , Armstrong P. R.
Published: April 2021

Efficient plant operation can be achieved by properly loading and sequencing available chillers to charge and discharge thermal energy storage (TES) reservoirs at optimal rates and times. TES charging sequences are often determined by heuristic rules that typically aim to reduce utility costs under the time-of-use rates. However, such rules of thumb may result in significantly suboptimal performance on some days. Rigorous optimization, on the other hand, is computationally expensive and can be unreliable if not carefully implemented. A novel receding-horizon control (RHC) algorithm is developed to reliably compute near-optimal control for charging and discharging the stratified sensible cool storage reservoir of a chiller plant. The algorithm provides a constant coefficient-of-performance (or cost-per-ton-hour) 24 h dispatch plan under which chillers operate at higher capacity during more favorable weather conditions. The algorithm uses a one-dimensional search requiring at most N2/2 evaluations per day of chiller performance where N is the number of planning horizon time-steps and chiller performance is modeled as a function of capacity fraction and ambient wet- or dry-bulb temperature. Analysis of four hot climates, ranging from dry to humid, indicates 2.4–2.6% energy savings under a flat electricity rate relative to the same plant operating without TES. Annual cost savings from 6% to 9% were found for electricity billed under a simple (10 a.m.–10 p.m.) time-of-use rate with no demand or ratchet components.
Theoretical and Experimental Studies of Impact Energy and Rock-Drilling Efficiency in Vibro-Impact Drilling
Authors: Cao Quan , Shi Huaizhong , Xu Weiqiang , Xiong Chao , Yang Zhaoliang , Ji Ran
Published: April 2021

Vibro-impact drilling has been proven to be a viable technique for enhancing the rate of penetration (ROP) in deep and ultra-deep well drilling. It is essential to study the effects of impact parameters on impact energy and rock-drilling efficiency for impact tool design and operating parameter optimization. In this paper, the influences of impact parameters including impact frequency, dynamic loading amplitude, and loading on impact energy were analyzed by a theoretical method. Then, a full-scale drilling experiment was conducted to study the rock-drilling efficiency. The results are as follows: the optimal frequency is higher than the resonance frequency of the rock. The impact energy increases with the dynamic loading amplitude. The penetration rate at dynamic loading amplitude of 4 kN (0.13137 mm/s) is 38.7% higher than that of 2 kN (0.09473 mm/s). When the impact frequency is lower than 150 Hz, the rock-drilling efficiency increases with the impact frequency and dynamic loading amplitude. The penetration rate is 0.1051 mm/s at impact frequency of 150 Hz, which is 29.8% higher than that of 10 Hz. The impact energy and penetration rate at square loading waveform are the largest. The impact energy per second at loading waveform of square, sine, and triangle is 19.6 J, 12 J, and 7.91 J, respectively, when the impact frequency is set to optimal frequency of impact energy. This study provides a theoretical guidance for the optimization design of vibro-impact drilling technology.
A note on the sound transmission of a spherical sound wave through a double plate structure
Authors: Wang Xiaofeng , Liu Bilong , Zhang Hongbo
Published: April 2021

The sound transmission of a spherical wave through a double plate structure is theoretically and numerically analyzed. Unlike the plane wave incidence, it is demonstrated that the sound transmission loss due to the spherical sound wave incidence follows a law of 9 dB/oct for a double-layered infinite plate. For a double-layered finite plate, the sound transmission loss is lying in between 9 dB/oct and 18 dB/oct in most frequency ranges, and depends heavily on the size and position of the plate relative to the source.
DDAH2 suppresses RLR-MAVS–mediated innate antiviral immunity by stimulating nitric oxide–activated, Drp1-induced mitochondrial fission
Authors: Huang Shan , Li Zexing , Wu Zewen , Liu Chang , Yu Minghang , Wen Mingjie , Zhang Liyun , Wang Xi
Published: April 2021

DDAH2 inhibits antiviral signaling by promoting mitochondrial fission.
Effects of PatU3 Peptides on Cell Size and Heterocyst Frequency of
Anabaena
sp. Strain PCC 7120
Authors: Li Chao , Zhang He , Du Yaru , Zhang Wei , Xu Xudong
Published: April 2021

PatU (or split into PatU5 and PatU3) is distributed in almost all filamentous cyanobacteria, including those that do not form heterocysts (except
Pseudanabaena
); however, its functions other than heterocyst differentiation/patterning have not been reported before. In this study, we found that PatU3 in
Anabaena
sp. strain PCC 7120 is involved in cell size determination.
Epidemiology and Molecular Basis of Multidrug Resistance in Rhodococcus equi
Authors: Álvarez-Narváez Sonsiray , Huber Laura , Giguère Steeve , Hart Kelsey A. , Berghaus Roy D. , Sanchez Susan , Cohen Noah D.
Published: April 2021

The development and spread of antimicrobial resistance are major concerns for human and animal health. The effects of the overuse of antimicrobials in domestic animals on the dissemination of resistant microbes to humans and the environment are of concern worldwide.Rhodococcus equiis an ideal model to illustrate the spread of antimicrobial resistance at the animal-human-environment interface because it is a natural soil saprophyte that is an intracellular zoonotic pathogen that produces severe bronchopneumonia in many animal species and humans.
mSphere of Influence: an Army Marching on Its Stomach—Malaria Parasites Sense and Subvert Host Nutrition
Authors: Harding Clare R.
Published: April 2021

Clare Harding works on the metal biology of the parasite
Toxoplasma gondii
. In this mSphere of Influence article, she reflects on how two papers from the laboratory of Maria Mota, “Host-mediated regulation of superinfection in malaria” by Portugal et al. (S).
Clustering and Erratic Movement Patterns of Syringe-Injected versus Mosquito-Inoculated Malaria Sporozoites Underlie Decreased Infectivity
Authors: de Korne C. M. , Winkel B. M. F. , van Oosterom M. N. , Chevalley-Maurel S. , Houwing H. M. , Sijtsma J. C. , Azargoshasb S. , Baalbergen E. , Franke-Fayard B. M. D. , van Leeuwen F. W. B. , Roestenberg M.
Published: April 2021

Malaria still causes a major burden on global health and the economy. The efficacy of live, attenuated malaria sporozoites as vaccine candidates critically depends on their ability to migrate to and infect the host liver.
Complete Genetic Analysis of Plasmids Carrying
mcr-1
and Other Resistance Genes in Avian Pathogenic Escherichia coli Isolates from Diseased Chickens in Anhui Province in China
Authors: Yin Dongdong , Cheng Baoyan , Yang Kankan , Xue Mei , Lin Yanfeng , Li Zhonghong , Song Xiangjun , Shao Ying , Tu Jian , Li Peng , Qi Kezong
Published: April 2021

In this study, three plasmids carrying
mcr-1
were isolated and characterized from APEC isolates from Anhui Province in China. The
mcr-1
genes were located on IncI2 plasmids, and these plasmids were transferrable.
Genome-Based Targeted Sequencing as a Reproducible Microbial Community Profiling Assay
Authors: Benjamino Jacquelynn , Leopold Benjamin , Phillips Daniel , Adams Mark D.
Published: April 2021

New methods for profiling the microbial communities can create new approaches to understanding the composition and function of those communities. In this study, we combined bacterial genome-specific probe design with a highly multiplexed single primer extension reaction as a new method to profile microbial communities, using stool from various mouse strains as a test case.
Supplemental Material: How Himalayan collision stems from subduction
Authors: Soret Mathieu , al. et
Published: April 2021

Methods, Figures S1, S2, and S3 (petrology, microphotographs, and a larger version of Figure 3 with full references), and Tables S1–S4 (sample description and petrochronology).
Association of maternal body mass index with intellectual disability risk
Authors: Lee Priscilla Ming Yi , Tse Lap Ah , László Krisztina D , Wei Dang , Yu YongFu , Li Jiong
Published: April 2021

Objectives

The study aimed to investigate the association between maternal body mass index (BMI) in early pregnancy and children’s intellectual disability (ID) risk in the absence of chromosomal disorders, neurofibromatosis and tuberous sclerosis, taking adverse birth outcomes, maternal hypertension/diabetes and maternal socioeconomic status into consideration.

Methods

We conducted a cohort study of singletons without common genetic defects born in Sweden during 1992–2006, and followed them from birth until 31 December 2014 (n=1 186 836). Cox proportional hazards models were used to analyse the association between maternal BMI in early pregnancy and the risk of offspring’s ID.

Results

The risk of ID was higher in children born to mothers who were underweight (HR=1.21, 95% CI=1.07 to 1.36), overweight (HR=1.28, 95% CI=1.21 to 1.34) or had obesity class I (HR=1.63, 95% CI=1.53 to 1.74), obesity class II (HR=2.08, 95% CI=1.88 to 2.30) and obesity class III (HR=2.31, 95% CI=1.46 to 3.65) than in children born to normal weight mothers. Results remained consistent after excluding children with adverse birth outcome or born to mothers with gestational hypertension/diabetes. Analysis stratified by maternal education and annual household income showed that the association between maternal underweight and children’s ID risk was attenuated among children of mothers with tertiary education or with high income.

Conclusions

Our findings suggest that maternal underweight or overweight/obesity in early pregnancy was associated with the development of ID in their offspring. This association was independent of the effect of adverse birth outcomes and maternal hypertension/diabetes. High socioeconomic status may attenuate the risk of ID among children of underweight mothers. This study highlights the importance of improving health education before conception to reduce children’s ID risk.
Rare presentation of subglottic soft-tissue swelling following FOLFOX therapy in a patient with metastatic oesophageal cancer
Authors: Yarrarapu Siva Naga S , Govero Austin B , Kukhon Faeq R , Sanghavi Devang K
Published: April 2021

Oesophageal cancer is categorised among the most fatal cancers across the world with a mortality ranking of sixth position. Chemotherapy with FOLFOX—a regimen of fluorouracil, leucovorin, and oxaliplatin—has been approved in the treatment of oesophageal cancer owing to its lower toxicity compared with the previous regimens. We report the first case of a patient with oesophageal cancer metastatic to the hyoid presenting with sudden-onset shortness of breath and anterior neck swelling secondary to treatment with FOLFOX-6. CT was notable for subglottic soft-tissue swelling and cystic necrosis of the hyoid bone tumour, and the patient subsequently required placement of a definitive airway via tracheostomy. This case illustrates the importance of anticipating the need for pre-emptive tracheostomy in patients with hyoid bone tumours receiving treatment with FOLFOX.
Diaphragmatic paralysis resulting in respiratory failure as a feature of hepatitis E virus-associated neuralgic amyotrophy
Authors: Noushad Muhammed Ameen , Limnatitou Demetra , Bhattacharjee Shakya , Mohd Nor Azlisham
Published: April 2021

Hepatitis E virus (HEV)-associated neuralgic amyotrophy (NA) is often bilateral and severe, involving structures outside the brachial plexus, such as the phrenic nerves or the lumbosacral plexus. We report a case of an HEV-positive man who had presented with brachial neuritis, with significant phrenic nerve involvement, resulting in diaphragmatic paralysis requiring non-invasive ventilation. Prognosis of HEV-associated NA is often unfavourable and recovery is usually incomplete. Identifying HEV-associated NA early could potentially aid in prognostication and management planning, as clinicians and patients would be expectant of its potential features and severity. Respiratory function should be monitored in patients with HEV who suffer from NA, as diaphragmatic paralysis could potentially lead to severe respiration difficulties requiring ventilatory support.
Treatment-resistant schizophrenia characterised by dopamine supersensitivity psychosis and efficacy of asenapine
Authors: Takao Nagara , Murai Toshiya , Fujiwara Hironobu
Published: April 2021

Dopamine supersensitivity psychosis (DSP) frequently arises with long-term antipsychotic treatment and accounts for a significant proportion of treatment-resistant schizophrenia. The mechanism underlying DSP is thought to be a compensatory increase in dopamine receptor density in the striatum caused by long-term antipsychotic treatment. Previous animal studies have reported that antipsychotics increase serotonin 5-HT2A receptor density in the striatum and that 5-HT2A receptor blockers suppress dopamine-sensitive psychomotor activity, which may be linked to the pathophysiology of DSP. In this paper, we describe a patient who was hospitalised with treatment-resistant schizophrenia. Following treatment with high-dose antipsychotic polypharmacy for 10 weeks, the patient experienced worsening of psychotic and extrapyramidal symptoms. The patient was then started on second-generation antipsychotic asenapine while other antipsychotics were tapered off, resulting in improvement of these symptoms. Retrospectively, we presumed that the high-dose antipsychotic polypharmacy caused DSP, which was effectively treated by the potent 5-HT2A receptor antagonism of asenapine.
Impact of cardiac rehabilitation on mortality and morbidity in diabetic versus non-diabetic patients: protocol for a systematic review and meta-analysis
Authors: Dababneh Emad Hanna , Saha Sumanta , Östlundh Linda , Al-Rifai Rami H , Oulhaj Abderrahim
Published: April 2021

Background

Cardiac rehabilitation (CR) decreases the morbidity and mortality risk among patients with cardiac diseases; however, the impact of CR on patients with diabetes remains underexplored. This is a protocol for a systematic review and meta-analysis methodology to explore if the effect of CR on mortality and morbidity is the same in patients with type 2 diabetes compared with patients without diabetes.

Methods and analysis

Interventional and non-interventional studies comparing the effect of CR, for at least 1 month, on all-cause mortality and cardiovascular outcomes including fatal and non-fatal myocardial infarction, revascularisation and rehospitalisation in adults with cardiac diseases will be deemed eligible for inclusion. Studies published between 1990 and 2020 will be searched in PubMed, Embase, Cochrane, CINAHL, Scopus and in registries for randomised controlled trials. Eligible studies will be selected using the Covidence software, and their salient details regarding the design, population, tested interventions and outcomes of interest will be gathered. The quality of studies to be deemed eligible and reviewed will be assessed using the Cochrane Collaboration and National Heart, Lung, and Blood Institute’s tools. The appraisal process will be based on the study design (interventional and non-interventional). In the meta-analysis step, the pooled effect of CR on the outcomes will be estimated. All meta-analyses will be done using the random-effects model approach (inverse-variance method).I2and p value of χ2statistics will guide the heterogeneity assessment. Subgroup analyses will also be performed. The small study effect will be investigated by generating the funnel plots. The symmetry of the latter will be tested by performing Egger’s test.

Ethics and dissemination

The systematic review will use data from published literature; hence, no ethical approval will be required. Findings of the systematic review and meta-analysis will be published in peer-reviewed international journals and will be disseminated in local and international scientific meetings.

PROSPERO registration number

CRD42020148832.
Risks and benefits of antioxidant dietary supplement use during cancer treatment: protocol for a scoping review
Authors: Wieland L. Susan , Moffet Ilana , Shade Sydney , Emadi Ashkan , Knott Cheryl , Gorman Emily F. , D"Adamo Christopher
Published: April 2021

Introduction

Antioxidant dietary supplements are used by many patients with cancer to reduce the side effects of chemotherapy and improve prognosis. While some research indicates oral antioxidant supplementation reduces side effects and improves patient survival, other studies suggest the use of antioxidant dietary supplements may interfere with chemotherapy and reduce its curative effects. There is a need to clarify the evidence base on the impact of dietary antioxidant supplementation during chemotherapy on both side effect and treatment efficacy outcomes. We will use a scoping review approach to identify what systematic review evidence exists regarding beneficial and harmful effects of dietary antioxidant supplements when used during cancer treatment.

Methods and analysis

We will use Arksey & O’Malley and Joanna Briggs Institute methods for scoping reviews. We will systematically search PubMed, Embase, CINAHL, Scopus, Dissertations & Theses Global and the Cochrane Library from inception to October 2020. Systematic reviews of randomised controlled trials of oral dietary antioxidant supplements used by participants receiving curative chemotherapy, radiotherapy or other biological therapy for cancer will be eligible. Two reviewers will screen citations and full texts for inclusion and chart data on research questions from included reviews. Two reviewers will assess the overall confidence in systematic review results using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2), and summarised evidence will focus on reviews rated at high or moderate overall confidence. Tables will be used to map existing evidence and identify evidence gaps for safety and effectiveness outcomes.

Ethics and dissemination

This scoping review does not require ethical approval as it is a secondary assessment of available literature. The results will be presented at conferences and submitted for publication in a peer-reviewed journal. We will also disseminate results to community and clinical stakeholders and involve them in developing subsequent research to address critical existing gaps in the evidence as identified by the scoping review.
Acoustic analysis of surgeons’ voices to assess change in the stress response during surgical in situ simulation
Authors: Hall Andrew , Kawai Kosuke , Graber Kelsey , Spencer Grant , Roussin Christopher , Weinstock Peter , Volk Mark S
Published: April 2021

Introduction

Stress may serve as an adjunct (challenge) or hindrance (threat) to the learning process. Determining the effect of an individual’s response to situational demands in either a real or simulated situation may enable optimisation of the learning environment. Studies of acoustic analysis suggest that mean fundamental frequency and formant frequencies of voice vary with an individual’s response during stressful events. This hypothesis is reviewed within the otolaryngology (ORL) simulation environment to assess whether acoustic analysis could be used as a tool to determine participants’ stress response and cognitive load in medical simulation. Such an assessment could lead to optimisation of the learning environment.

Methodology

ORL simulation scenarios were performed to teach the participants teamwork and refine clinical skills. Each was performed in an actual operating room (OR) environment (in situ) with a multidisciplinary team consisting of ORL surgeons, OR nurses and anaesthesiologists. Ten of the scenarios were led by an ORL attending and ten were led by an ORL fellow. The vocal communication of each of the 20 individual leaders was analysed using a long-term pitch analysis PRAAT software (autocorrelation method) to obtain mean fundamental frequency (F0) and first four formant frequencies (F1, F2, F3 and F4). In reviewing individual scenarios, each leader’s voice was analysed during a non-stressful environment (WHO sign-out procedure) and compared with their voice during a stressful portion of the scenario (responding to deteriorating oxygen saturations in the manikin).

Results

The mean unstressed F0 for the male voice was 161.4 Hz and for the female voice was 217.9 Hz. The mean fundamental frequency of speech in the ORL fellow (lead surgeon) group increased by 34.5 Hz between the scenario’s baseline and stressful portions. This was significantly different to the mean change of −0.5 Hz noted in the attending group (p=0.01). No changes were seen in F1, F2, F3 or F4.

Conclusions

This study demonstrates a method of acoustic analysis of the voices of participants taking part in medical simulations. It suggests acoustic analysis of participants may offer a simple, non-invasive, non-intrusive adjunct in evaluating and titrating the stress response during simulation.
Radiomics analysis for predicting pembrolizumab response in patients with advanced rare cancers
Authors: Colen Rivka R , Rolfo Christian , Ak Murat , Ayoub Mira , Ahmed Sara , Elshafeey Nabil , Mamindla Priyadarshini , Zinn Pascal O , Ng Chaan , Vikram Raghu , Bakas Spyridon , Peterson Christine B , Rodon Ahnert Jordi , Subbiah Vivek , Karp Daniel D , Stephen Bettzy , Hajjar Joud , Naing Aung
Published: April 2021

Background

We present a radiomics-based model for predicting response to pembrolizumab in patients with advanced rare cancers.

Methods

The study included 57 patients with advanced rare cancers who were enrolled in our phase II clinical trial of pembrolizumab. Tumor response was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and immune-related RECIST (irRECIST). Patients were categorized as 20 “controlled disease” (stable disease, partial response, or complete response) or 37 progressive disease). We used 3D-slicer to segment target lesions on standard-of-care, pretreatment contrast enhanced CT scans. We extracted 610 features (10 histogram-based features and 600 second-order texture features) from each volume of interest. Least absolute shrinkage and selection operator logistic regression was used to detect the most discriminatory features. Selected features were used to create a classification model, using XGBoost, for the prediction of tumor response to pembrolizumab. Leave-one-out cross-validation was performed to assess model performance.

Findings

The 10 most relevant radiomics features were selected; XGBoost-based classification successfully differentiated between controlled disease (complete response, partial response, stable disease) and progressive disease with high accuracy, sensitivity, and specificity in patients assessed by RECIST (94.7%, 97.3%, and 90%, respectively; p<0.001) and in patients assessed by irRECIST (94.7%, 93.9%, and 95.8%, respectively; p<0.001). Additionally, the common features of the RECIST and irRECIST groups also highly predicted pembrolizumab response with accuracy, sensitivity, specificity, and p value of 94.7%, 97%, 90%, p<0.001% and 96%, 96%, 95%, p<0.001, respectively.

Conclusion

Our radiomics-based signature identified imaging differences that predicted pembrolizumab response in patients with advanced rare cancer.

Interpretation

Our radiomics-based signature identified imaging differences that predicted pembrolizumab response in patients with advanced rare cancer.
Longitudinal observational study investigating outcome measures for clinical trials in inclusion body myositis
Authors: Sangha Gina , Yao Bohao , Lunn Daniel , Skorupinska Iwona , Germain Louise , Kozyra Damian , Parton Matt , Miller James , Hanna Michael G , Hilton-Jones David , Freebody Jane , Machado Pedro M
Published: April 2021

Objective

To describe decline in muscle strength and physical function in patients with sporadic inclusion body myositis (IBM).

Methods

Manual muscle testing (MMT), quantitative muscle testing (QMT) and disability scoring using the IBM Functional Rating Scale (IBMFRS) were undertaken for 181 patients for up to 7.3 years. The relationship between MMT, QMT and IBMFRS composite scores and time from onset were examined using linear mixed effects models adjusted for gender and age of disease onset. Adaptive LASSO regression analysis was used to identify muscle groups that best predicted the time elapsed from onset. Cox proportional hazards regression was used to evaluate time to use of a mobility aid.

Results

Multilevel modelling of change in percentage MMT, QMT and IBMFRS score over time yielded an average decline of 3.7% (95% CI 3.1% to 4.3%), 3.8% (95% CI 2.7% to 4.9%) and 6.3% (95% CI 5.5% to 7.2%) per year, respectively. The decline, however, was not linear, with steeper decline in the initial years. Older age of onset was associated with a more rapid IBMFRS decline (p=0.007), but did not influence the rate of MMT/QMT decline. Combination of selected muscle groups allowed for generation of single measures of patient progress (MMT and QMT factors). Median (IQR) time to using a mobility aid was 5.4 (3.6–9.2) years, significantly affected by greater age of onset (HR 1.06, 95% CI 1.04 to 1.09, p<0.001).

Conclusion

This prospective observational study represents the largest IBM cohort to date. Measures of patient progress evaluated in this study accurately predict disease progression in a reliable and useful way to be used in trial design.
Living with systemic lupus erythematosus in 2020: a European patient survey
Authors: Cornet Alain , Andersen Jeanette , Myllys Kirsi , Edwards Angela , Arnaud Laurent
Published: April 2021

Objective

The aim of this study was to analyse the 2020 burden of Systemic Lupus Erythematosus (SLE) in Europe, from the patients’ perspective.

Methods

In May 2020, Lupus Europe, the European umbrella patient association for SLE, designed and disseminated a multilingual anonymous online survey to individuals with a self-reported physician’s diagnosis of SLE living in Europe.

Results

Data from 4375 SLE survey respondents (95.9% women, median age: 45 (IQR: 36–54) years, 70.7% Caucasians) from 35 European countries were analysed. The median age at SLE diagnosis was 30 years (IQR: 22–40) and the median diagnosis delay was 2 years (IQR: 0–6). The most commonly affected organ-systems included the joints (81.8%) and skin (59.4%), with renal involvement in 30%. Another diagnosis was given before that of SLE in 45.0%, including psychological/mental disorders in 9.1% and fibromyalgia in 5.9%. The median number of symptoms reported was 9 (IQR: 6–11) out of 21, with fatigue most common (85.3%) and most bothersome. The median number of SLE-related medications was 5 (IQR: 3–7), including antimalarials (75%), oral glucocorticoids (52.4%), immunosuppressants (39.8%) and biologics (10.9%). Respondents reported significant impact over their studies, career and emotional/sexual life in 50.7%, 57.9% and 38.2%, respectively. Appropriate access to care was highly variable across countries and care component.

Conclusion

This survey underlines the 2020 burden and strong heterogeneity in the care of SLE across Europe, from the patient’s perspective. Altogether, these data may prove crucial to physicians, patients and policy-makers to improve the diagnosis and management of this rare and complex disease.
Spherically symmetric analytic solutions and naked singularities in Einstein–Aether theory
Authors: Chan R. , Silva M. F. A. da , Satheeshkumar V. H.
Published: April 2021

We analyze all the possible spherically symmetric exterior vacuum solutions allowed by the Einstein–Aether theory with static aether. We show that there are three classes of solutions corresponding to different values of a combination of the free parameters, $$c_{14}=c_1+c_4$$

c
14

=

c
1

+

c
4

, which are: $$ 0< c_{14}<2$$

0
<

c
14

<
2

, $$c_{14} < 0$$

c
14

<
0

, and $$c_{14}=0$$

c
14

=
0

. We present explicit analytical solutions for $$c_{14}=3/2, 16/9, 48/25, -16$$

c
14

=
3
/
2
,
16
/
9
,
48
/
25
,
-
16

and 0. The first case has some pathological behavior, while the rest have all singularities at $$r=0$$

r
=
0

and are asymptotically flat spacetimes. For the solutions $$c_{14}=16/9, 48/25\, \mathrm {\, and \,}\, -16$$

c
14

=
16
/
9
,
48
/
25

and

-
16

we show that there exist no horizons, neither Killing horizon nor universal horizon, thus we have naked singularities. This characteristic is completely different from general relativity. We briefly discuss the thermodynamics for the case $$c_{14}=0$$

c
14

=
0

where the horizon exists.