bluuebunny/crossref_metadata_2025 huggingface dataset:
less-than-human academia
Authors: Kallio Kirsi Pauliina , Häkli Jouni , Riding James
Published: July 2022

The editorial discusses the impacts of the global pandemic to human agency, through the authors self-reflection of academic work during the past two years accompanied two philosophical perspectives. First, we return to Chris Philo’s (2017) conception of ‘less-than-human geographies’, and secondly, to Helmuth Plessner’s (2019) conception of the sociality of human embodiment. What these perspectives have helped us to see is that people, including academic communities, need embodied encounters to fully experience ourselves and others as humans – humans whose exceptionality is not about superiority over non-human nature but eccentricity that offers us possibilities to avoid inhumanity. In conclusion we note the value of embodied encounters as a constitutive aspec of humane social life, particularly in the current times of war in Europe.
Aproximaciones des-antrópicas: contrarrelatos, desobediencias y visualidades otras
Authors: Fernández Eva Natalia , Vázquez Estrada Alejandro
Published: July 2022

En este artículo, reflexionamos sobre lo que denominamos aproximaciones des-antrópicas, categoría que proponemos para caracterizar aquellas iniciativas que desobedecen a la excepcionalidad de lo humano. Planteamos que esa construcción civilizatoria y antropocéntrica que subyuga a todos los seres al dominio y poder de lo humano debe revisarse y transformarse de manera continua. El itinerario que proponemos atraviesa distintos momentos. En primer lugar, haremos una descripción de lo que entendemos por aproximaciones des-antrópicas, lo que nos permitirá analizar y comprender, a partir de dos ejemplos: los mitos de origen y las intervenciones vinculadas con el bioarte, el modo en que se transforman, reconfiguran y migran los relatos y las imágenes. En segundo lugar, a través de un análisis hermenéutico-visual de la bioinstalación Desbosque: Desenterrando señales en el Museo de Arte Contemporáneo de Lima (MAC Lima), trazaremos un recorrido desde los elementos que componen la instalación donde los hongos ostra aparecen como sujetos de acción minúscula que pueden hacer frente a la devastación mayúscula provocada por el modelo hegemónico de las economías del mundo occidental. Finalmente, en nuestros apuntes de cierre, reflexionaremos sobre las posibilidades que tiene estas aproximaciones des-antrópicas como una forma de evidenciar el posicionamiento de artistas y colectivos (en el espacio) que median por un llamado a la consciencia a través de la práctica artística atravesada por una posición ecopolítica para resistir a la sobreexplotación, la transgresión y la usurpación de la tierra, de la naturaleza y del medio ambiente.
¿Por qué a mí? Vislumbres del trayecto a una humanidad terrestre
Authors: Ortega Sáchica Margarita
Published: July 2022

Los significados sociales asociados a las nociones de enfermedad y dolor han sido usualmente reconocidas como experiencias ajenas al cuerpo, son identificadas como intrusas o como algo que hay que evitar, sanar o curar. Esta mirada ha crecido debido a “la cultura de la felicidad” que cada vez más se impone y ha impedido que la naturaleza terrestre de los cuerpos humanos puedan incluirse en miradas ecológicas de los diagnósticos. De esta manera, el artículo busca compartir las huellas de mi experiencia con la enfermedad, algunas revelaciones conversadas con el Chulajuan (una reserva natural), la palmera de la esquina de mi sala y algunos autores y amigos que posibilitaron una mirada ecológica de cómo abordar los problemas humanos. Asimismo, compartiré el contacto reflexivo que generaron tales revelaciones y las pistas que he venido construyendo en relación con las prácticas como improvisadora de las artes vivas y como psicoterapeuta. Finalmente, el artículo propone la inclusión de las prácticas ecológicas de las artes vivas tales como la improvisación y el divagar, como una manera de entrecruzar las disciplinas, expandir las escuchas hacia organismos vivos y no vivos, humanos y no humanos en los trayectos que en tanto seres de la tierra habitamos. También vislumbra la pasión como una pista que disuelve la postura estereotipada y binaria del humano-racional y del animal/planta-salvaje y, al contrario, resiste a las lógicas de disciplinamiento propias de la cultura de las fórmulas mágicas, la felicidad como último objetivo y el individualismo como triunfo del modelo neoliberal.
Identification Method for Material Constants in Johnson–Cook Model Associated With Strain-Rate and Temperature Sensitivities Using Ball Impact and Indentation Tests
Authors: Ito Kiyohiro
Published: July 2022

The Johnson–Cook (JC) flow stress model can simply express the strain-rate and temperature dependencies of the flow stress. We previously proposed a concept of a simple identification method for material constants in the JC model associated with the strain-rate and temperature sensitivities (JC parameters C and m) at high-strain rates. However, several issues still exist in our method for practical use. In this study, we modified our method to identify both the JC parameters C and m. The fundamental concept was formulated based on the requirement that the normalized indentation depths obtained from the ball impact and instrumented ball indentation tests are equal to each other. In addition, the conversion factor was derived to transfer from the impact velocity to the strain rate. The ball indentation and impact analyses based on a finite element method were conducted to verify the established method. The analysis results obtained under idealized conditions demonstrated that C and m can be accurately identified using the established method, even at exceeding 104 s−1. Changes in the radius of the impactor are more effective in obtaining different strain rates than changes in the impact velocity because the identification accuracy can be ensured at lower than 200 m/s.
Broadband Electromechanical Diode: Acoustic Non-Reciprocity in Weakly Nonlinear Metamaterials With Electromechanical Resonators
Authors: Bukhari Mohammad , Barry Oumar
Published: July 2022

Recent attention has been given to acoustic non-reciprocity in metamaterials with nonlinearity. However, the study of asymmetric wave propagation has been limited to mechanical diodes only. Prior works on electromechanical rectifiers or diodes using passive mechanisms are rare in the literature. This problem is investigated here by analytically and numerically studying a combination of nonlinear and linear metamaterials coupled with electromechanical resonators. The nonlinearity of the system stems from the chain in one case and from the electromechanical resonator in another. The method of multiple scales is used to obtain analytical expressions for the dispersion curves. Numerical examples show potential for wider operation range of electromechanical diode, considerable harvested power, and significant frequency shift. The observed frequency shift is demonstrated using spectro-spatial analyses and it is used to construct an electromechanical diode to guide the wave to propagate in one direction only. This only allows signal sensing for waves propagating in one direction and rejects signals in any other direction. The performance of this electromechanical diode is evaluated using the transmission ratio and the asymmetric ratio for a transient input signal. Design guidelines are provided to obtain the best electromechanical diode performance. The presented analyses show high asymmetry ratio for directional-biased wave propagation in the medium-wavelength limit for the case of nonlinear chain. Indeed, the present asymmetric and transmission ratios are higher than those reported in the literature for a mechanical diode. The operation frequencies can also be broadened to the long-wavelength limit frequencies using the resonator nonlinearity.
Two new eriophyoid mite records (Acari: Acariformes: Eriophyoidea) from Hungary with neotype redescription of Proiectus farkasi (Boczek, 1969) comb. nov. and supplementary description of Trisetacus confusus Livshits et Vasilieva, 1982
Authors: Lewandowski Mariusz , Ripka Geza
Published: July 2022

We reported two new records of eriophyoid mites from Hungary—Proiectus farkasi (Boczek) comb. nov. collected from Pinus nigra J.F. Arnold (neotype), which was transferred from Phyllocoptes, and Trisetacus confusus Livshits et Vasilieva found on Pinus nigra and P. nigra subsp. salzmannii (Dunal) Franco (Pinaceae). We redescribed P. farkasi and T. confusus in detail, including morphological descriptions of the female, male, and nymph.
HP1 oligomerization compensates for low-affinity H3K9me recognition and provides a tunable mechanism for heterochromatin-specific localization
Authors: Biswas Saikat , Chen Ziyuan , Karslake Joshua D. , Farhat Ali , Ames Amanda , Raiymbek Gulzhan , Freddolino Peter L. , Biteen Julie S. , Ragunathan Kaushik
Published: July 2022

HP1 proteins traverse a complex and crowded chromatin landscape to bind with low affinity but high specificity to histone H3K9 methylation (H3K9me) and form transcriptionally inactive genomic compartments called heterochromatin. Here, we visualize single-molecule dynamics of an HP1 homolog, the fission yeast Swi6, in its native chromatin environment. By tracking single Swi6 molecules, we identify mobility states that map to discrete biochemical intermediates. Using Swi6 mutants that perturb H3K9me recognition, oligomerization, or nucleic acid binding, we determine how each biochemical property affects protein dynamics. We estimate that Swi6 recognizes H3K9me3 with ~94-fold specificity relative to unmodified nucleosomes in living cells. While nucleic acid binding competes with Swi6 oligomerization, as few as four tandem chromodomains can overcome these inhibitory effects to facilitate Swi6 localization at heterochromatin formation sites. Our studies indicate that HP1 oligomerization is essential to form dynamic, higher-order complexes that outcompete nucleic acid binding to enable specific H3K9me recognition.
Rapid adaptive radiation of Darwin’s finches depends on ancestral genetic modules
Authors: Rubin Carl-Johan , Enbody Erik D. , Dobreva Mariya P. , Abzhanov Arhat , Davis Brian W. , Lamichhaney Sangeet , Pettersson Mats , Sendell-Price Ashley T. , Sprehn C. Grace , Valle Carlos A. , Vasco Karla , Wallerman Ola , Grant B. Rosemary , Grant Peter R. , Andersson Leif
Published: July 2022

Recent adaptive radiations are models for investigating mechanisms contributing to the evolution of biodiversity. An unresolved question is the relative importance of new mutations, ancestral variants, and introgressive hybridization for phenotypic evolution and speciation. Here, we address this issue using Darwin’s finches and investigate the genomic architecture underlying their phenotypic diversity. Admixture mapping for beak and body size in the small, medium, and large ground finches revealed 28 loci showing strong genetic differentiation. These loci represent ancestral haplotype blocks with origins predating speciation events during the Darwin’s finch radiation. Genes expressed in the developing beak are overrepresented in these genomic regions. Ancestral haplotypes constitute genetic modules for selection and act as key determinants of the unusual phenotypic diversity of Darwin’s finches. Such ancestral haplotype blocks can be critical for how species adapt to environmental variability and change.
Molecular doped, color-tunable, high-mobility, emissive, organic semiconductors for light-emitting transistors
Authors: Qin Zhengsheng , Gao Can , Gao Haikuo , Wang Tianyu , Dong Huanli , Hu Wenping
Published: July 2022

Developing high-mobility emissive organic semiconductors with tunable colors is crucial for organic light-emitting transistors (OLETs), a pivotal component of integrated optoelectronic devices, but remains a great challenge. Here, we demonstrate a series of color-tunable, high-mobility, emissive, organic semiconductors via molecular doping with a high-mobility organic semiconductor, 2,6-diphenylanthracene, as the host. The well-matched molecular structures and sizes with efficient energy transfer between the host and guest enable the intrinsically high charge transport with tunable colors. High mobility with the highest value >2 cm
2
V
−1
s
−1
and strong emission with photoluminescence quantum yield >15.8% are obtained for these molecular-doped organic semiconductors. Last, a large color gamut for constructed OLETs is up to 59% National Television System Committee standard, meanwhile with an extremely high current density approaching 326.4 kA cm
−2
, showing great potential for full-color smart display, organic electrically pumped lasers and other related logic circuitries.
HINGEneering IgG for enhanced immune activation
Authors: Werner Anja , Nimmerjahn Falk
Published: July 2022

Two recent studies in
Science Immunology
by Orr
et al.
and Foss
et al.
demonstrate that the hinge region of immunoglobulin G (IgG) is a major regulator of IgG2 and IgG3 activity, respectively. Engineering of the IgG hinge may therefore be useful for optimizing the activity of IgG subclasses.
Fifteen-minute consultation: Diagnosing serious pathology in children with headaches presenting to the emergency department
Authors: Alhashem Roqiah , Byrne Susan , Hall Dani
Published: July 2022

Headache is one of the most common presentations to the paediatric emergency department. Although challenging, it is important to differentiate serious secondary headaches requiring emergency treatment from primary headache disorders. A detailed history and neurological examination can be used to identify children at higher risk of serious underlying pathology. Neuroimaging decisions should be taken carefully, weighing risk versus benefit in each case. This article will discuss five patient scenarios highlighting red flags and differential diagnoses in children presenting with headache in the emergency department.
Hungry bone syndrome like presentation following single-dose denosumab for hypercalcaemia secondary to sarcoidosis with IgA nephropathy
Authors: Nachankar Amit , Katyal Amit , Bansal Naresh , Bishnoi Alka
Published: July 2022

A woman in her mid-50s with IgA nephropathy, sarcoidosis and steroid-induced diabetes mellitus presented with generalised paraesthesia and spontaneous tetany. She had received denosumab 60 mg subcutaneously 8 weeks previously for parathyroid hormone independent hypercalcaemia.

At admission, she had severe hypocalcaemia (5 mg/dL), hypophosphataemia (1.9 mg/dL), hypomagnesaemia (1.4 mg/dL) and elevated serum creatinine (1.48 mg/dL) with prolonged QTc (corrected QT interval) on electrocardiograph. She initially received intravenous calcium and magnesium followed by oral calcium carbonate and calcitriol. Her prednisolone dose was tapered to 5 mg/day. Evaluation showed secondary hyperparathyroidism (1474 pg/mL) and elevated 1,25-dihydroxy vitamin D (195 pg/mL). After 1 week of oral calcium carbonate (3000 mg/day) and calcitriol (1.5 µg/day), she achieved normocalcaemia (8.1 mg/dL).

To conclude, denosumab for hypercalcaemia with renal insufficiency causes prolonged severe symptomatic hypocalcaemia and hypophosphataemia mimicking hungry bone syndrome. It is important to periodically monitor for hypocalcaemia after denosumab.
Effects of biophilic virtual reality on cognitive function of patients undergoing laparoscopic surgery: study protocol for a sham randomised controlled trial
Authors: Zhu Binbin , Zhou Yanling , Weng Qiuyan , Luo Wenjun , He Xiuchao , Jin Lufei , Wang Qinwen , Gao Bin , Harb Ahmad Khaled Ahmad , Wang Jianhua
Published: July 2022

Introduction

Virtual reality (VR) is already being used for cognitive or emotional rehabilitation. However, its role in postoperative cognitive dysfunction (POCD) has not been fully recognised. Due to the lack of an effective postoperative follow-up system, the incidence of POCD in China is not clear, and although many drugs have been proposed to improve POCD in the animal study, their clinical applications are limited, while VR provides an innovative method to provide non-pharmacological management.

Methods and design

This is a single-centre, randomised, double-blind, sham-controlled clinical trial. In this study, 600 patients over 55 years old undergoing laparoscopic surgery will be recruited. Participants will be randomly assigned to receive biophilic VR or sham VR (1:1 ratio), all patients have 20 min of exposure per day during the hospital stay. The primary outcome is the impact of VR on the incidence of POCD. Secondary outcomes include perioperative anxiety and instrumental activities of daily living. Changes in the performance of the neurocognitive batteries are measured by a local resident doctor. Serum samples will be collected on the day before surgery and 7 days after surgery.

Ethics and dissemination

This trial has ethical approval from the Medical Ethics Committee of the Affiliated Hospital of Medical School of Ningbo University (KY20210302). The study is sponsored by Ningbo University and Ningbo Science and Technology Bureau. Contact: Dr. Mao Haijiao, Chair of the hospital medical Ethics committee (ndfylunli@126.com). Trial results will be submitted for publication in peer-reviewed journals, patient recruitment began in April 2021. Written informed consent is obtained for all participants. All information acquired will be disseminated via national or international conferences and published in peer-reviewed journals.

Trial registration number

ChiCTR2000040919.
Daily versus three-times-weekly azithromycin in Chinese patients with non-cystic fibrosis bronchiectasis: protocol for a prospective, open-label and randomised controlled trial
Authors: Mao Yanxiong , Chen Lan , He Ting , Li Jing , Zou Aiping , Li Feng , Chen Fei , Fan Bo , Ni Weihao , Xiao Wei , You Huimin , Fu Wenjiang
Published: July 2022

Introduction

Non-cystic fibrosis bronchiectasis (NCFB) brought a heavy healthcare burden worldwide. Macrolide maintenance therapy was proved to be helpful in reducing exacerbation of NCFB. However, the optimal dosing regimens of macrolides have not been determined, and its efficacy in Chinese NCFB population has not been validated. This protocol describes a head-to-head clinical trial designed to compare the efficacy of two dosing regimens of azithromycin in Chinese NCFB population.

Methods and analysis

This prospective, open-label and randomised controlled trial will be conducted in the First People’s Hospital of Jiashan, China. Eligible patients with high-resolution CT defined NCFB will be randomly divided into three groups, which will receive either 250 mg daily azithromycin, or 500 mg three-times-weekly azithromycin or no treatment for 6 months. They will be followed up for another 6 months without treatment. The primary outcome is the mean rate of protocol-defined pulmonary exacerbation at 6 months.

Ethics and dissemination

Ethical approval was obtained from the First People’s Hospital of Jiashan Ethics Committee. The findings will be disseminated in peer-reviewed publications.

Trial registration number

ChiCTR2100052906.
Opinions on hypertension care and therapy adherence at the healthcare provider and healthcare system level: a qualitative study in the Hague, Netherlands
Authors: van Grondelle Saskia E , van Bruggen Sytske , Meijer Judith , van Duin Erik , Bots Michiel L , Rutten Guy , Vos Hedwig M M , Numans Mattijs E , Vos Rimke C
Published: July 2022

Objectives

Hypertension is a common cause of cardiovascular morbidity and mortality. Although hypertension can be effectively controlled by blood pressure-lowering drugs, uncontrolled blood pressure is common despite use of these medications. One explanation is therapy non-adherence. Therapy non-adherence can be addressed at the individual level, the level of the healthcare provider and at the healthcare system level. Since the latter two levels are often overlooked, we wished to explore facilitators and barriers on each of these levels in relation to hypertension care for people with hypertension, with a specific focus on therapy adherence.

Design

Qualitative study using focus groups of healthcare providers. Data were analysed using the theoretical domains framework (TDF) and the behaviour change wheel.

Setting and participants

Participants were from a highly urbanised city environment (the Hague, Netherlands), and included nine primary care physicians, six practice nurses and five secondary care physicians involved in hypertension care.

Results

Nine domains on the TDF were found to be relevant at the healthcare provider level (‘knowledge’, ‘physical, cognitive and interpersonal skills’, ‘memory, attention and decision processes’, ‘professional, social role and identity’, ‘optimism’, ‘beliefs about consequences’, ‘intention’, ‘emotion’ and ‘social influences’) and two domains (‘resources’ and ‘goals’) were found to be relevant at the system level. Facilitators for these domains were good interpersonal skills, paying attention to behavioural factors such as medication use, and the belief that treatment improves health outcomes. Barriers were related to time, interdisciplinary collaboration, technical and financial issues, availability of blood pressure devices and education of people with hypertension.

Conclusions

This study highlighted a need for better collaboration between primary and secondary care, for more team-based care including pharmacists and social workers, tools to improve interpersonal skills and more time for patient–healthcare provider communication.
Primary care experiences of providing mental healthcare for children in the USA during the COVID-19 pandemic: a qualitative study
Authors: Garbutt Jane , Dodd Sherry , Rook Shannon , Ericson Lauren , Sterkel Randall , Plax Katie
Published: July 2022

Background

The increased demand for mental healthcare associated with the COVID-19 pandemic adds to the already high unmet mental health needs among paediatric patients, resulting in a declared ‘mental health emergency’. The study objective was to describe paediatric primary care providers (PCPs’) experience of meeting their patients’ needs for mental healthcare during the pandemic and to identify opportunities to optimise care.

Methods

19 paediatricians and 2 nurse practitioners completed a 30 min video interview in May 2021. Interviews were recorded and transcribed, and transcripts were analysed using consensual qualitative research methods.

Results

Participants reported marked increases in patient mental health needs during the COVID-19 pandemic. These included new diagnoses of anxiety and depression and increased treatment needs for patients with a prior mental health diagnosis. They identified that the mental health needs of their patients were greater, more severe and more challenging to manage with the resources currently available. While they were frustrated with the lack of communication and support from their mental health colleagues, and felt isolated and overwhelmed, they approached the increased demand for mental healthcare with a growth mindset. This outlook included providing care, seeking help to improve their skills and engaging with local resources such as the Child Psychiatry Access Project (CPAP).

Conclusions

Our findings suggest that urgent action is needed to better support paediatric PCPs to provide mental healthcare in our community. Providers identified an ongoing need for timely access to and effective communication with mental health providers to guide care in the medical home. This need could be addressed immediately by providing training for new and experienced clinicians, expanding the scope of CPAP programmes to include patient assessment and supporting implementation of integrated behavioural health programmes into the medical home.
Evaluation of intervertebral body implant performance using active surveillance of electronic health records
Authors: Frankenberger Edward A , Resnic Frederic S , Ssemaganda Henry , Robbins Susan , Dunbar Melissa R , Coplan Paul , Zhang Shumin , Bruno Cortney , Maltenfort Mitchell , Benedetti Jillian B , Matheny Michael E , Ghogawala Zoher
Published: July 2022

Objectives

To assess the feasibility of using electronic health record (EHR) derived clinical data within an active surveillance setting to evaluate the safety of a novel intervertebral body implant (IVBI) stabilization device.

Design

Retrospective, longitudinal observational cohort study comparing clinical outcomes for patients seen through 1 year following spinal fusion surgery.

Setting

Lahey Health network, which includes academic tertiary hospitals, outpatient clinics, and independent provider offices in the New England region of the USA.

Participants

All spine surgery patients aged 18 or older who underwent thoracic or lumbar spinal arthrodesis surgeries were included.

Main outcome measures

The clinical outcomes of patients treated with the CONCORDE Bullet (CB) interbody spine system (DePuy) between April 2015 and December 2018 were compared with those patients receiving alternative spine stabilization interbody device implants. The primary endpoint was reoperation rate at 1 year, with secondary endpoints including the requirement for blood transfusion during index hospitalization, 1 year rate of any cause hospitalization, 1 year rate of surgical site infection, and mortality at 1 year.

Results

Among the 606 patients undergoing thoracic or lumbar spinal fusion surgery during the study period, 136 received only the CB. In comparison with patients who did not receive the CB, no significant differences were found in the rate of reoperation at 1 year or the rates of secondary safety outcomes.

Conclusions

Data derived from the EHR can be successfully leveraged to assess the safety of IVBI devices, in this case demonstrating no significant differences in the rates of risk-adjusted safety endpoints between patients undergoing spinal surgery with the CB as compared with alternative spinal implants.
A novel peptide protects against diet-induced obesity by suppressing appetite and modulating the gut microbiota
Authors: Li Zhanzhan , Zhang Bing , Wang Ning , Zuo Zhenqiang , Wei Hong , Zhao Fangqing
Published: July 2022

Objective

The obesity epidemic and its metabolic complications continue to be a major global public health threat with limited effective treatments, especially drugs that can be taken orally. Peptides are a promising class of molecules that have gained increased interest for their applications in medicine and biotechnology. In this study, we focused on looking for peptides that can be administrated orally to treat obesity and exploring its mechanisms.

Design

Here, a 9-amino-acid peptide named D3 was designed and administered orally to germ-free (GF) mice and wild-type (WT) mice, rats and macaques. The effects of D3 on body weight and other basal metabolic parameters were evaluated. The effects of D3 on gut microbiota were evaluated using 16S rRNA amplicon sequencing. To identify and confirm the mechanisms of D3, transcriptome analysis of ileum and molecular approaches on three animal models were performed.

Results

A significant body weight reduction was observed both in WT (12%) and GF (9%) mice treated with D3. D3 ameliorated leptin resistance and upregulated the expression of uroguanylin (UGN), which suppresses appetite via the UGN-GUCY2C endocrine axis. Similar effects were also found in diet-induced obese rat and macaque models. Furthermore, the abundance of intestinalAkkermansia muciniphilaincreased about 100 times through the IFNγ-Irgm1 axis after D3 treatment, which may further inhibit fat absorption by downregulating Cd36.

Conclusion

Our results indicated that D3 is a novel drug candidate for counteracting diet-induced obesity as a non-toxic and bioactive peptide. Targeting the UGN-GUCY2C endocrine axis may represent a therapeutic strategy for the treatment of obesity.
Aortic cusp abnormalities in patients with trileaflet aortic valve and root aneurysm
Authors: Ehrlich Tristan , Hagendorff Andreas , Abeln Karen , Froede Lennart , Giebels Christian , Schäfers Hans-Joachim
Published: July 2022

Background

The frequency of concomitant cusp pathology in aortic root aneurysm with or without aortic regurgitation is not well known, and the sensitivity and specificity of two-dimensional trans-oesophageal echocardiography (2D TEE) in its detection has not yet been specified.

Objectives

We analysed the type and frequency of concomitant cusp alterations in root aneurysm referred for surgery. Sensitivity and specificity of 2D TEE in detecting these alterations were determined.

Methods

In 582 patients (age 56.8±15.4 years, 453 male) with trileaflet aortic valves undergoing root replacement for regurgitation (n=347) or aneurysm (n=235), details of valve morphology were analysed. In a subcohort (n=281), intraoperative TEEs were analysed retrospectively and correlated with the intraoperative findings.

Results

Any cusp pathology was present in 90.9% (prolapse: n=473; retraction: n=30; calcification: n=14; fenestration: n=12), morphologically normal cusps were seen in only 52 patients (8.93%). Valve-sparing surgery was performed in 525 (90.2%) instances, composite replacement in 57 (9.8%). Preoperative TEE correctly identified any postroot repair prolapse in 70.6% and any retraction in 85%. The sensitivity of TEE in detecting any prolapse was 68.6% (specificity of 79.5%). The sensitivity was highest for the right cusp and intermediate for the non-coronary.

Conclusions

Cusp prolapse is frequent in root aneurysm and trileaflet aortic valves. Prolapse is underdiagnosed by 2D TEE in many cases because pre-existent stretching of cusp tissue is masked by the geometric effects of root dilatation.
Organisational failure: rethinking whistleblowing for tomorrow’s doctors
Authors: Taylor Daniel James , Goodwin Dawn
Published: July 2022

The duty to protect patient welfare underpins undergraduate medical ethics and patient safety teaching. The current syllabus for patient safety emphasises the significance of organisational contribution to healthcare failures. However, the ongoing over-reliance on whistleblowing disproportionately emphasises individual contributions, alongside promoting a culture of blame and defensiveness among practitioners. Diane Vaughan’s ‘Normalisation of Deviance’ (NoD) provides a counterpoise to such individualism, describing how signals of potential danger are collectively misinterpreted and incorporated into the accepted margins of safe operation. NoD is an insidious process that often goes unnoticed, thus minimising the efficacy of whistleblowing as a defence against inevitable disaster. In this paper, we illustrate what can be learnt by greater attention to the collective, organisational contributions to healthcare failings by applying NoD to The Morecambe Bay Investigation. By focusing on a cluster of five ‘serious untoward incidents’ occurring in 2008, we describe a cycle of NoD affecting trust handling of events that allowed poor standards of care to persist for several years, before concluding with a poignant example of the limitations of whistleblowing, whereby the raising of concerns by a senior consultant failed to generate a response at trust board level. We suggest that greater space in medical education is needed to develop a thorough understanding of the cultural and organisational processes that underpin healthcare failures, and that medical education would benefit from integrating the teaching of medical ethics and patient safety to resolve the tension between systems approaches to safety and the individualism of whistleblowing.
Endocrine and behavioural features of Lowe syndrome and their potential molecular mechanisms
Authors: Sena Cecilia , Iannello Grazia , Skowronski Alicja A , Dannheim Katelyn , Cheung Leonard , Agrawal Pankaj B , Hirschhorn Joel N , Zeitler Phillip , LeDuc Charles A , Stratigopoulos George , Thaker Vidhu V
Published: July 2022

Background

Lowe syndrome (LS) is an X linked disease caused by pathogenic variants in theOCRLgene that impacts approximately 1 in 500 000 children. Classic features include congenital cataract, cognitive/behavioural impairment and renal tubulopathy.

Methods

This study is a retrospective review of clinical features reported by family based survey conducted by Lowe Syndrome Association. Frequency of non-ocular clinical feature(s) of LS and their age of onset was summarised. An LS-specific therapy effectiveness scale was used to assess the response to the administered treatment. Expression ofOCRLand relevant neuropeptides was measured in postmortem human brain by qPCR. Gene expression in the mouse brain was determined by reanalysis of publicly available bulk and single cell RNA sequencing.

Results

A total of 137 individuals (1 female, 89.1% white, median age 14 years (range 0.8–56)) were included in the study. Short stature (height <3rd percentile) was noted in 81% (n=111) individuals, and 15% (n=20) received growth hormone therapy. Undescended testis was reported in 47% (n=64), and median age of onset of puberty was 15 years. Additional features were dental problems (n=77, 56%), bone fractures (n=63, 46%), hypophosphataemia (n=60, 44%), developmental delay and behavioural issues.OCRLis expressed in human and mouse hypothalami, and in hypothalamic cell clusters expressingGhrh,Sst,Oxt,Pomcand pituitary cells expressingGhandPrl.

Conclusions

There is a wide spectrum of the clinical phenotype of LS. Some of the features may be partly driven by the loss of function ofOCRLin the hypothalamus and the pituitary.
Job control, job demands and job strain and suicidal behaviour among three million workers in Sweden
Authors: Almroth Melody , Hemmingsson Tomas , Kjellberg Katarina , Sörberg Wallin Alma , Andersson Tomas , van der Westhuizen Amanda , Falkstedt Daniel
Published: July 2022

Objective

To investigate the association between job control, job demands and their combination (job strain) and suicide attempts and deaths among male and female workers in Sweden.

Methods

Job control and demands were measured separately for men and women using a job exposure matrix, which was linked to around three million individuals based on their occupational title in 2005. Suicide attempts and deaths were measured in the hospital and cause of death registers from 2006 to 2016. HRs were estimated using discrete proportional hazards models with annually updated age as the time axis. Models were adjusted for sociodemographic, family, health, labour market and childhood factors, as well as the time-varying effects of unemployment, sick leave and family factors during follow-up.

Results

Low job control was associated with an increased risk of suicide attempts and deaths among both men and women while high job demands tended to be associated with a decreased risk. The combination of job control and job demands (job strain) reflected the increased risk of low control jobs and the decreased risk of high demand jobs. Associations were attenuated but still present after adjustments.

Conclusions

Low job control is related to suicide attempts and deaths, and this is only partially explained by important covariates measured both prebaseline and during follow-up. Attempts to increase job control among workers may be beneficial in preventing suicide.
Late-onset cobalamin C disease: rare but treatable
Authors: Aliyar Aminu , Endrakanti Mounika , Singh Rajesh K , Elavarasi Arunmozhimaran , Gupta Neerja , Vibha Deepti , Tripathi Manjari
Published: July 2022

Cobalamin C disease is the most common inborn error of cobalamin metabolism, resulting from mutations in methylmalonic aciduria and homocystinuria type C protein(MMACHC) gene. There is associated elevation of homocysteine and methylmalonic acid and decreased synthesis of methionine. It is a multisystem disorder characterised by cognitive impairment, psychiatric manifestations, haematological manifestations and thromboembolic phenomena. Its variable clinical presentation and wide age distribution at presentation necessitates a high index of diagnostic suspicion. The diagnosis is suggested by amino acid chromatography and confirmed by sequencing analysis of theMMACHC gene. Parenteral hydroxycobalamin and betaine can bring significant clinical and biochemical improvement and is the recommended long-term therapy.
Neutropenic versus regular diet for acute leukaemia induction chemotherapy: randomised controlled trial
Authors: Radhakrishnan Venkatraman , Lagudu Perraju Bhaskar Bhuvan , Gangopadhyay Devleena , Vijaykumar Varalakshmi , Rajaraman Swaminathan , Perumal Kalaiyarasi Jayachandran , Ganesan Prasanth , Ganesan Trivadi S
Published: July 2022

Objectives

Restriction of raw fruits and vegetables (neutropenic diet) is advised for patients receiving treatment for acute leukaemia in low-income and middle-income countries (LMICs) to reduce infections despite evidence to the contrary from high-income countries. We, therefore, conducted a randomised controlled trial to ascertain the efficacy of the neutropenic diet in an LMIC setting.

Methods

Patients aged 1–60 years receiving induction chemotherapy for acute leukaemia were randomised to a regular or neutropenic diet. The study’s primary objective was to compare the incidence of major infections among patients receiving the two diets during induction chemotherapy. The secondary objectives were to compare stool microbial flora and induction mortality rates.

Results

We randomised 200 patients, 98 patients to the regular diet arm and 102 to the neutropenic diet arm. Major infections occurred in 32 (32%) patients in the regular diet arm and 26 (25%) patients in the neutropenic diet arm (p=0.26). There were no statistically significant differences between patients receiving a regular diet versus neutropenic diet for blood culture positivity (n=6 vs 9), inotropic support (17 vs 12), mechanical ventilation (8 vs 5), third-line antibiotic use (28 vs 20), minor infections (12 vs 9), induction mortality (9 vs 4) and remission status (94% vs 94%). The stool culture on day 15 of induction grew multidrug-resistant bacteria in 38% of patients in the regular diet arm and 35% in the neutropenic diet arm (p=0.67).

Conclusions

A neutropenic diet did not prevent infections, reduce mortality or change stool microbial flora in patients with acute leukaemia.
Longitudinal changes in sputum and blood inflammatory mediators during FeNO suppression testing
Authors: Couillard Simon , Shrimanker Rahul , Lemaire-Paquette Samuel , Hynes Gareth M , Borg Catherine , Connolly Clare , Thulborn Samantha Jane , Moran Angela , Poole Sarah , Morgan Sophie , Powell Timothy , Pavord Ian , Hinks Timothy
Published: July 2022

To explore whether fractional exhaled nitric oxide (FeNO) non-suppression identifies corticosteroid resistance, we analysed inflammatory mediator changes during a FeNO suppression test with monitored high-intensity corticosteroid therapy. In linear mixed-effects models analysed over time, the 15 clinically distinct ‘suppressors’ (ie,≥42% FeNO suppression) normalised Asthma Control Questionnaire scores (mean±SD, start to end of test: 2.8±1.4 to 1.4±0.9, p<0.0001) and sputum eosinophil counts (median (IQR), start to end of test: 29% (6%–41%) to 1% (1%–5%), p=0.0003) while significantly decreasing sputum prostaglandin D2(254 (89–894) to 93 (49–209) pg/mL, p=0.004) and numerically decreasing other type-2 cytokine, chemokine and alarmin levels. In comparison, the 19 non-suppressors had persistent sputum eosinophilia (10% (1%–67%) despite high-intensity therapy) with raised end-test inflammatory mediator levels (1.9 (0.9–2.8)-fold greater than suppressors). FeNO non-suppression during monitored treatment implies biological corticosteroid resistance.
The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda
Authors: Otim Paul , Elobu Emmanuel Alex , Mbiine Ronald , Kakembo Nasser , Komakech David
Published: July 2022

Background

Bowel obstruction is a common surgical emergency in newborns. One-fourth of neonates with obstruction suffer postoperative complications, with high mortality, especially in low-income countries. Factors attributed to mortality include prematurity, late presentation and associated multiple congenital anomalies. The prevalence and the predictors of mortality in our setting have not been well studied. We aimed to describe the early postoperative outcomes and to determine the predictors of mortality among neonates with bowel obstruction.

Methods

We conducted a prospective cohort study during 4 months, when we recruited postoperative neonates from the pediatric surgery unit of Mulago Hospital. We collected data on demographics, clinical presentations, maternal characteristics, the surgical procedure performed, postoperative outcomes, etc. After follow-up for 2 weeks, we analyzed the data using Cox proportional hazards regression models of predictors of mortality.

Results

A total of 76 neonates were recruited, with a male-to-female ratio of 2.2:1. The age ranged from 1 to 26 days, a median of 3 [interquartile range (IQR): 2, 7]. About 67.1% had birth weights ranging between 2.5 kg and 3.5 kg, a mean of 2.8 [standard deviation(SD)=0.64]; 76.3% were termed; with anorectal malformation (ARM), 31.6% as the leading cause, followed by jejunoileal atresia (JIA), 25%. Nearly 55.3% of neonates developed complications; 53.9% with post-operative fever, 15.8% had wound sepsis. The mortality rate was 44.7% (34/76) and was highest among cases of JIA, 41.2%. The predictors of mortality included prematurity, fever at admission, breastfeeding status, and mother’s parity as well as the cadre of healthcare providers (p<0.005).

Conclusions

ARM is the predominant cause of bowel obstruction among neonates, followed by JIA. The morbidity and mortality due to bowel obstruction among neonates are unacceptably high. The major predictors of mortality were prematurity, fever at admission, and the cadre of the healthcare providers.
Application of computational fluid dynamics for detection of high risk region in middle cerebral artery (MCA) aneurysm
Authors: Rostamian Ali , Fallah Keivan , Rostamiyan Yasser , Alinejad Javad
Published: July 2022

In the recent decades, the main reason for the high death rate is related to cardiovascular disease and stroke. In this paper, numerical studies have been done to investigate the hemodynamic effects on the rupture of middle cerebral artery (MCA) in different working conditions. In this work, the effects of the blood viscosity and velocity on the pressure distribution and average wall shear stress (AWSS) are fully investigated. Also, the flow pattern inside the aneurysm is investigated to obtain the high-risk regions for the rupture of the aneurysm. Our findings show that the wall shear stress increases with increasing the blood flow velocity. Meanwhile, the risk of aneurysm rupture is considerably increased when the AWSS increases more than 0.6. In fact, the blood flow with high viscosity expands the high-risk region on the wall of the aneurysm. Blood flow indicates that the angle of the incoming bloodstream is substantially effective in the high-risk region on the aneurysm wall. The augmentation of the blood velocity and vortices considerably increases the risk of hemorrhage of the aneurysm.
Toward Improving the Security of IoT and CPS Devices: An AI Approach
Authors: Albasir Abdurhman , Naik Kshirasagar , Manzano Ricardo
Published: July 2022

Detecting anomalously behaving devices in security-and-safety-critical applications is an important challenge. This article presents an off-device methodology for detecting the anomalous behavior of devices considering their power consumption data. The methodology takes advantage of the fact that every action on-board a device will be reflected in its power trace. This argument makes it inevitable for anomalously behaving device to go undetected. We transform the device’s one-dimensional (1D) instantaneous power consumption signals to 2D time–frequency images using Constant Q Transformation (CQT). The CQT images capture valuable information about the tasks performed on-board a device. By applying Histograms of Oriented Gradients (HOG) on the CQT images, we extract robust features that preserve the edges of time–frequency structures and capture the directionality of the edge information. Consequently, we transform the anomaly detection problem into an image classification problem. We train a Convolutional Neural Network on the HOG images to classify the power signals to detect anomaly. We validated the methodology using a wide spectrum of emulated malware scenarios, five real malware applications from the well-known Drebin dataset, Distributed Denial of Service attacks, cryptomining malware, and faulty CPU cores. Across 18 datasets, our methodology demonstrated detection performance of ∼88% accuracy and 85% F-Score, resulting in improvements of 9–17% over other methods using power signals.
Location Contact Tracing: Penetration, Privacy, Position, and Performance
Authors: Bedogni Luca , Montori Federico , Salim Flora
Published: July 2022

The 2020 COVID-19 pandemic radically changed the world and how people interact, move, and behave. Following a lockdown that was imposed worldwide, although with different timing, Mobile Contact Tracing Apps (MCTAs) were proposed to digitally trace contacts between individuals while gradually releasing mobility constraints mandated to contain the spread of disease. General concern for privacy regarding the use of GPS data shifted the efforts toward distributed applications, which use Bluetooth technology to trace proximity and potential infections. Nonetheless, GPS data would help more health operators to understand where hotbeds are and to what extent the spread is progressing and at what pace. In addition to these issues, in this work we take a closer look at the major pillars of MCTA: Penetration, Privacy, Position, and Performance. We focus on (i) how the penetration rate affects the ability of a tracing application to work; (ii) the proposal of a novel method of tracing, which builds on the GPS technology; (iii) how the position of infections is beneficial to rapidly reduce the infection; and (iv) the discussion of the effects of such paradigms in different scenarios.
Risks to the Public
Authors: Neumann Peter G.
Published: July 2022

Edited by PGN (Risks Forum Moderator, with contribu- tions by others as indicated. Opinions are individual rather than organizational, with usual disclaimers implied. We ad- dress problems relating to software, hardware, people, and other circumstances relevant to computer systems. Ref- erences (R i j) to the online Risks Forum denote RISKS vol i number j. Cited RISKS items generally identify contributors and sources, together with URLs. Official RISKS archives are available at www.risks.org, with nice html formatting and search engine courtesy of Lindsay Mar- shall at Newcastle:; http://catless.ncl.ac.uk/Risks/i.j.html (also ftp://www.sri.com/risks). CACM Inside Risks: http://www.csl.sri.com/neumann/insiderisks.html
Academic Freedom, Deemed Exports and International Students, Part 2
Authors: Schaefer Robert
Published: July 2022

"Scholarship cannot flourish in an atmosphere of suspicion and distrust. Teachers and students must always remain free to inquire, to study and to evaluate to gain new maturity and understanding; otherwise, civilization will stagnate and die." -- Wyman, Attorney General, in Sweezy v. New Hampshire, 1957
Summary of the Third International Workshop on Bots in Software Engineering (BotSE 2021)
Authors: Wagner Stefan , Gerosa Marco A. , Wessel Mairieli
Published: July 2022

Bots automate tasks in software engineering projects and interact with software developers. Bots have been proposed, for example, for testing, maintenance, and automating bug fixes. The research community has been discussing these bots in the International Workshop on Bots in Software Engineering (BotSE), collocated with ICSE (the International Conference on Software Engineering). The workshop participants share experiences and challenges, discuss new usages of bots, and map out future directions. In this paper, we present a summary of the 3rd edition of the workshop, which comprised nine papers, one journal-first presentation, and two keynotes, followed by extensive discussion. More details can be found at http://botse.org/