bluuebunny/crossref_metadata_2025 huggingface dataset:
Sizing solar-based mini-grids for growing electricity demand: Insights from rural India
Authors: Sayani Reena , Ortega-Arriaga Paloma , Sandwell Philip , Babacan Oytun , Gambhir Ajay , Robinson Darren , Nelson Jenny
Published: October 2022

Mini-grids are a critical way to meet electricity access goals according to current and projected electricity demand of communities and so appropriately sizing them is essential to ensure their financial viability. However, estimation of demand for communities awaiting electricity access is uncertain and growth in demand along with the associated cost implications is rarely considered during estimation of mini-grid sizing. Using a case study of two rural communities in India, we assess the implications of demand growth on financial costs and performance of a mini-grid system consisting of solar photovoltaic (PV) panels and battery storage using two different system sizing approaches. We show a cost-saving potential of up to 12% when mini-grids are sized using a multi-stage approach where mini-grids gradually expand in several stages, rather than a single-stage optimisation approach. We perform a sensitivity analysis of the cost of the two sizing approaches by varying six key parameters: demand growth rate, logistics cost, system re-sizing frequency, likelihood of blackouts, solar PV and battery cost, and degradation rate. Of these, we find that system costs are most sensitive to variations in demand growth rates and cost decreases in solar PV and batteries. Our study shows that demand growth scenarios and choice of mini-grid sizing approaches have important financial and operational implications for the design of systems for rural electrification.
Variance of the number of zeros of dependent Gaussian trigonometric polynomials
Authors: Gass Louis
Published: October 2022

We compute the variance asymptotics for the number of real zeros of trigonometric polynomials with random dependent Gaussian coefficients and show that under mild conditions, the asymptotic behavior is the same as in the independent framework. In fact our proof goes beyond this framework and makes explicit the variance asymptotics of various models of random Gaussian processes. Our proof relies on intrinsic properties of the Kac–Rice density in order to give a short and concise proof of variance asymptotics.
Gradient estimates for Schrödinger operators with characterizations of 𝐵𝑀𝑂_{ℒ} on Heisenberg groups
Authors: Lin Qingze
Published: October 2022

Let

L

=
−

Δ

H

n

+
V

\mathcal {L}=-\Delta _{\mathbb {H}^n}+V

be a Schrödinger operator with the nonnegative potential

V
V

belonging to the reverse Hölder class

B

Q

B_{Q}

, where

Q
Q

is the homogeneous dimension of the Heisenberg group

H

n

\mathbb {H}^n

. In this paper, we obtain pointwise bounds for the spatial derivatives of the heat and Poisson kernels related to

L

\mathcal {L}

. As an application, we characterize the space

B
M

O

L

(

H

n

)

BMO_{\mathcal {L}}(\mathbb {H}^n)

, associated to the Schrödinger operator

L

\mathcal {L}

, in terms of two Carleson type measures involving the spatial derivatives of the heat kernel of the semigroup

{

e

−
s

L

}

s
>
0

\{e^{-s\mathcal {L}}\}_{s>0}

and the Poisson kernel of the semigroup

{

e

−
s

L

}

s
>
0

\{e^{-s\sqrt {\mathcal {L}}}\}_{s>0}

, respectively. At last, we pose a conjecture about the converse characterization of

B
M

O

L

(

H

n

)

BMO_{\mathcal {L}}(\mathbb {H}^n)

.
Uniqueness of extremals for some sharp Poincaré-Sobolev constants
Authors: Brasco Lorenzo , Lindgren Erik
Published: October 2022

We study the sharp constant for the embedding ofW01,p(Ω)W^{1,p}_0(\Omega )intoLq(Ω)L^q(\Omega ), in the case2>p>q2>p>q. We prove that for smooth connected sets, whenq>pq>pandqqis sufficiently close topp, extremal functions attaining the sharp constant are unique, up to a multiplicative constant. This in turn gives the uniqueness of solutions with minimal energy to the Lane-Emden equation, with super-homogeneous right-hand side.

The result is achieved by suitably adapting a linearization argument due to C.-S. Lin. We rely on some fine estimates for solutions ofp−p-Laplace–type equations by L. Damascelli and B. Sciunzi.
Role of antibody engineering in generation of derivatives starting from MOv19 MAb: 40 years of biological/therapeutic tools against folate receptor alfa
Authors: Frigerio Barbara , Montermini Matilde , Canevari Silvana , Figini Mariangela
Published: October 2022

In the 1980s, we developed and characterized numerous murine monoclonal antibodies (MAbs) directed against human tumor-associated antigens. This mini review is focused on the generation of derivatives of an anti-folate receptor α (FRα) MAbs, named MOv19, exploiting the antibody-engineering progresses in the last 40 years. The FRα location on the luminal surface of proliferating epithelial cells, inaccessible to circulation, versus its over-expression in the entire surface of numerous carcinomas suggested a role for anti-FRα MAbs in the diagnosis and/or treatment of solid tumors. Presently, two MOv19 derivatives are in clinical trials: a chimeric resurfaced version in an antibody-drug conjugate format (SORAYA trial, 2022) and the murine scFv in a second generation chimeric antigen receptor, CAR-T (Phase Ia, 2021). MOv19 and its derivatives could be considered a relevant example that well-characterized anti-tumor murine Mabs and antibody engineering could be combined to generate useful therapeutic tools.
Performance of real-time PCR in suspected haemodialysis catheter-related bloodstream infection: a proof-of-concept study
Authors: Acquier Mathieu , Zabala Arnaud , de Précigout Valérie , Delmas Yahsou , Dubois Véronique , de la Faille Renaud , Rubin Sébastien , Combe Christian , M'Zali Fatima , Kaminski Hannah
Published: October 2022

Background

Catheter-related bloodstream infections (CRBIs) remain a major cause of mortality in haemodialysis (HD) patients with central venous catheters (CVCs), especially because of the non-specific symptomatology and the delay in microbiological diagnosis with possible use of non-optimal empiric antibiotics. Moreover, empiric broad-spectrum antibiotics increase antibiotic resistance development. This study aims to evaluate the diagnostic performance of real-time polymerase chain reaction (rt-PCR) in suspected HD CRBIs compared with blood cultures.

Methods

A blood sample for rt-PCR was collected simultaneously with each pair of blood cultures for suspected HD CRBI. The rt-PCR was performed on the whole blood, without any enrichment stage and with specific DNA primers: 16S (universal bacterial), Staphylococcus spp., Staphylococcus aureus and mecA. Each successive patient with a suspected HD CRBI in the HD centre of Bordeaux University Hospital was included. Performance tests were used to compare the result obtained in each rt-PCR assay with its corresponding routine blood culture.

Results

Eighty-four paired samples were collected and compared for 40 suspected HD CRBI events in 37 patients. Among these, 13 (32.5%) were diagnosed as HD CRBI. All rt-PCRs except mecA (insufficient number of positive samples) showed high diagnostic performances within 3.5 h: 16S (sensitivity 100%, specificity 78%), Staphylococcus spp. (sensitivity 100%, specificity 97%), S. aureus (sensitivity 100%, specificity 99%). Based on the rt-PCR results, antibiotics could be more appropriately targeted, thus cutting anti-cocci Gram-positive therapy from 77% to 29%.

Conclusions

The performance of rt-PCR in suspected HD CRBI events showed fast and high diagnostic accuracy. Its use would improve HD CRBI management with an antibiotic consumption decrease.
Network reconstruction problem for an epidemic reaction--diffusion system
Authors: Beaufort Louis-Brahim , Massé Pierre-Yves , Reboulet Antonin , Oudre Laurent
Published: October 2022

We study the network reconstruction problem for an epidemic reaction–diffusion system. These systems are an extension of deterministic, compartmental models to a graph setting, where the reactions within the nodes are coupled by a diffusion dynamics. We study the influence of the diffusion rate and the network topology, on the reconstruction and prediction problems, both from a theoretical and experimental standpoint. Results first show that for almost every network, the reconstruction problem is well posed. Then, we show that the faster the diffusion dynamics, the harder the reconstruction, but that increasing the sampling rate may help in this respect. Second, we demonstrate that it is possible to classify symmetrical networks generating the same trajectories, and that the prediction problem can still be solved satisfyingly, even when the network topology makes exact reconstruction difficult.
Finance and Green Growth
Authors: De Haas Ralph , Popov Alexander
Published: October 2022

We study how countries’ financial structure affects their transition to low-carbon growth. Using global industry-level data, we document that carbon-intensive industries reduce emissions faster in economies with deeper stock markets. The main channel underpinning this stylised fact is that stock markets facilitate green innovation in carbon-intensive sectors, resulting in lower carbon emissions per unit of output. More tentative evidence indicates that stock markets also help to reallocate investment towards more energy-efficient sectors. Cross-border spillovers are limited: less than 5% of these industry-level reductions in domestic emissions are offset by carbon embedded in imports. A firm-level analysis of an exogenous shock to the cost of equity in Belgium confirms our findings.
Characteristics of symptoms and symptom change across different heart failure subtypes: a sex-stratified analysis
Authors: Seckin Muzeyyen , Johnston Bridget , Petrie Mark C , Stewart Simon , Chan Yih-Kai
Published: October 2022

Aims

To examine sex-stratified differences in the association of left ventricular ejection fraction-based heart failure (HF) subtypes and the characteristics and correlates of self-reported changes in HF symptoms.

Methods and results

We report a secondary data analysis from 528 hospitalized individuals diagnosed with HF characterised by a reduced, mildly reduced, or preserved ejection fraction [HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), or HF with preserved ejection fraction (HFpEF)] who completed 12-month follow-up within a multicentre disease management trial. There were 302 men (71.1 ± 11.9 years, 58% with HFrEF) and 226 women (77.1 ± 10.6 years, 49% with HFpEF). The characteristics of self-reported symptoms measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline and 12-month were analysed. At baseline, shortness of breath and fatigue predominated; with key differences according to HF subtypes in bilateral ankle oedema (both sexes), walking problems (women) and depressive symptoms (men). At 12-month follow-up, most KCCQ scores had not significantly changed. However, 25% of individuals reported worse symptom. In women, those with HFpEF had worse symptoms than those with HFmrEF/HFrEF (P = 0.025). On an adjusted basis, women [odds ratios (OR): 1.78, 95% confidence interval (CI): 1.00–3.16 vs. men], those with coronary artery disease (OR: 2.01, 95% CI: 1.21–3.31) and baseline acute pulmonary oedema (OR: 1.67, 95% CI: 1.02–2.75) were most likely to report worsening symptoms. Among men, worsening symptoms correlated with a history of hypertension (OR: 2.16, 95% CI: 1.07–4.35) and a non-English-speaking background (OR: 2.30, 95% CI: 1.02–5.20).

Conclusion

We found significant heterogeneity (with potential clinical implications) in the symptomatic characteristics and subsequent symptom trajectory according to the sex and HF subtype of those hospitalized with the syndrome.

Trial Registration

ANZCTR12613000921785
Willingness to pay for a National Health Insurance Scheme in The Gambia: a contingent valuation study
Authors: Njie Hassan , Wangen Knut Reidar , Chola Lumbwe , Gopinathan Unni , Mdala Ibrahimu , Sundby Johanne S , Ilboudo Patrick G C
Published: October 2022

In pursuit of universal health coverage, many low- and middle-income countries are reforming their health financing systems and introducing health insurance schemes. As part of these reforms, lawmakers in The Gambia enacted ‘The National Health Insurance Bill, 2021’. The Act will establish a National Health Insurance Scheme (NHIS) that pays for the cost of healthcare services for its members. This study assessed Gambians’ willingness to pay (WTP) for a NHIS. Using multistage sampling design with no replacement, head/co-head of households were presented with a hypothetical health insurance scheme from July to August 2020. Their WTP and factors influencing WTP were elicited using a contingent valuation method. Descriptive statistics were used to describe sample characteristics. Lopez-Feldman’s modified ordered probit model and linear regression were applied to estimate respondents’ WTP as well as identify factors that influence their WTP. More than 90% of the respondents—677 (94.4%) were willing to join and pay for the scheme. Half of these respondents—398 (58.8%) agreed to pay the first bid of US dollars (US$) 20.78 or Gambian dalasi (GMD) 1000. The average WTP was estimated at US$23.27 (GMD1119.82), whereas average maximum amount to pay was US$26.01 (GMD1251.16). Results of the two models together showed that gender, level of education and household income were statistically significant, with the latter showing negative influence on WTP. The study found that Gambians were largely receptive to the scheme and have stated their willingness to contribute. Our findings can inform policymakers in The Gambia and other sub-Saharan countries when establishing contribution rates and exemption criteria during social health insurance scheme implementation.
Acceleration of gossip algorithms through the Euler–Poisson–Darboux Equation
Authors: Berthier Raphaël , Li Mufan (Bill)
Published: October 2022

Gossip algorithms and their accelerated versions have been studied exclusively in discrete time on graphs. In this work, we take a different approach and consider the scaling limit of gossip algorithms in both large graphs and large number of iterations. These limits lead to well-known partial differential equations (PDEs) with insightful properties. On lattices, we prove that the non-accelerated gossip algorithm of Boyd et al. (2006) converges to the heat equation, and the accelerated Jacobi polynomial iteration of Berthier et al. (2020) converges to the Euler–Poisson–Darboux (EPD) equation—a damped wave equation. Remarkably, with appropriate parameters, the fundamental solution of the EPD equation has the ideal gossip behaviour: a uniform density over an ellipsoid, whose radius increases at a rate proportional to $t$—the fastest possible rate for locally communicating gossip algorithms. This is in contrast with the heat equation where the density spreads on a typical scale of $\sqrt{t}$. Additionally, we provide simulations demonstrating that the gossip algorithms are accurately approximated by their limiting PDEs.
Dedicated teams to optimize quality and safety of surgery: A systematic review
Authors: Lentz C M , De Lind Van Wijngaarden R A F , Willeboordse F , Hooft L , van der Laan M J
Published: October 2022

Background

A dedicated operating team is defined as a surgical team consisting of the same group of people working together over time, optimally attuned in both technical and/or communicative aspects. This can be achieved through technical and/or communicative training in a team setting. A dedicated surgical team may contribute to the optimization of healthcare quality and patient safety within the perioperative period.

Method

A systematic review was conducted to evaluate the effects of a dedicated surgical team on clinical and performance outcomes. MEDLINE and Embase were searched on 23 June 2022. Both randomized controlled trials (RCTs) and non-randomized studies (NRSs) were included. Primary outcomes were mortality, complications and readmissions. Secondary outcomes were costs and performance measures.

Results

Fourteen studies were included (RCTs n = 1; NRSs n = 13). Implementation of dedicated operating teams was associated with improvements in mortality, turnover time, teamwork, communication and costs. No significant differences were observed in readmission rates and length of hospital stay. Results regarding duration, glitch counts and complications of surgery were inconclusive. Limitations include study conduct and heterogeneity between studies.

Conclusions

The institution of surgical teams who followed communicative and/or technical training appeared to have beneficial effects on several clinical outcome measures. Dedicated teams provide a feasible way of improving healthcare quality and patient safety. A dose–response effect of team training was reported, but also a relapse rate, suggesting that repetitive training is of major concern to high-quality patient care. Further studies are needed to confirm these findings, due to limited level of evidence in current literature.

Prospero registration number

CRD42020145288
Objective Burn Scar Assessment in Clinical Practice Using the Cutometer©: Introduction and Validation of a Standardized Measurement Protocol
Authors: Klimitz Felix J , Neubauer Hubert , Stolle Annette , Ripper Sabine , Daeschler Simeon C , Aman Martin , Boecker Arne , Thomas Benjamin , Kneser Ulrich , Harhaus Leila
Published: October 2022

An objective burn scar assessment is essential to informed therapeutic decision-making and to monitor scar development over time. However, widely employed scar rating scales show poor inter-rater reliability. For this study we developed a standardized measurement protocol for the Cutometer© applicable for objective burn scar assessment in everyday clinical practice. We developed a measurement protocol for the Cutometer© MPA 580 including a scar site relocation technique based on anatomical landmarks. The protocol emerged through several steps: Identifying key factors for valid and reliable measurements, preliminary testing, specification of technical details, refining the protocol and final testing. Consecutively, the protocol was validated for inter-rater reliability by assessing 34 burn scars in 17 patients by four clinicians and computing an Intra-class Correlation Coefficient (ICC). Parameter R0, representing scar pliability, was identified as the best suited output parameter yielding excellent inter-rater reliability for average measures (ICC 0.92 [95% CI 0.86; 0.96]) and acceptable reliability for single measures (ICC: 0.74 [0.61; 0.84]). The pressure applied on the measuring probe was identified as an influential confounding factor for reliable measurements. Rater gender did not influence reliability of measurements. The introduced standardized measurement protocol for the Cutometer© MPA 580 enables an objective and reliable burn scar assessment for clinical as well as research purposes.
The EU Sustainable Finance Framework in Light of International Standards
Authors: Zetzsche Dirk A , Bodellini Marco , Consiglio Roberta
Published: October 2022

This paper analyses the relationship between the EU sustainable finance legal framework and the most common international environmental, social, and governance standards. We find that standards included in the EU sustainable finance legal framework partly overlap with the international environmental, social and governance standards, while diverging as to the details. This overlap creates frictions, given that financial service providers need to decide which of the overlapping, yet partly diverging, standards they apply. The EU environmental taxonomy presents unique features and a higher level of sophistication when compared to the international environmental, social and governance standards. This may result in both upsides and downsides. On the upside, the EU sustainable finance legal framework could function as a pacemaker and facilitate impact measurement across the industry, while on the downside, we see additional costs for firms and resistance against the granular EU approach. At the same time, the EU sustainable finance legal framework lacks details on the social and governance dimensions. Here, reference to the international standards compensates for the lack of an EU social and governance taxonomy. While this allows for alignment of EU and international social and governance-oriented investors, a greater degree of sophistication at the EU level could enhance the potential for impact measurement—a particularly important aspect for socially sustainable investments.
A retrospective evaluation of the effectiveness of a targeted medicines use review service in improving asthma and COPD control provided by community pharmacists in England
Authors: Dhesi Amardeep , Al-Kharsan Zainab , Chan Amy Hai Yan
Published: October 2022

Objective

Medicines Use Reviews (MUR) may benefit asthma and chronic obstructive pulmonary disease (COPD) control. The present study evaluates the effect of respiratory-targeted MUR-plus (MUR+) services delivered by community pharmacists on disease control.

Methods

A retrospective analysis of MUR+ data in the PharmOutcomes database was conducted. All patients receiving respiratory-targeted MUR+ in Milton Keynes were included. Changes in asthma control test (ACT) and COPD assessment test (CAT) scores were analysed.

Key findings

A total of 191 asthma and 81 COPD patients received MUR+. Asthma and COPD control improved as shown by the increase in mean ACT [+1.2 (95% CI, 0.6–1.8)] and decrease in mean CAT [−0.2 (95% CI, −1.4 to 1.0)]. Baseline ACT, smoking cessation, absence of change in drug therapy, patient education, healthcare professional referral, device training and baseline ACT score ≤19 were associated with change in ACT, but only smoking cessation was related to CAT change. A multivariable regression model comprising the aforementioned variables explained 19% of the variance in ACT change (P < 0.001). Only baseline ACT was associated with ACT change (beta = −0.34, P < 0.01). Baseline CAT, absence of change in drug therapy, smoking cessation and baseline CAT score >20 accounted for 12% of the variance in changes in CAT (P = 0.046). No variable was significantly associated with CAT change.

Conclusions

Respiratory-targeted MUR+ service by community pharmacists was associated with improvements in asthma control among patients with poorer baseline ACT, but not in patients with COPD. Several potentially modifiable factors such as education were associated with changes in control.
Estimation of radiological impact of the activities of Olusosun Dump Site on workers and dwellers of Olusosun, in Lagos Southwest Nigeria
Authors: Ogungbemi Kayode Idowu , Adedokun Margret Bose , Ibitoye Ayo Zaccheaus , Oyebola Olusola Olurotimi , Owoade Ronke Latifat
Published: October 2022

This study assessed the potential radiological risks associated with the activities on Olusosun dump site on workers and dwellers of Olusosun community. The activity concentrations of 238U, 232Th and 40K from of soil and water samples were determined using High-Purity Germanium (HPGe) detector. The background radiation level of Olusosun dump site was measured using a portable Geiger-Müller counter-Radeye B20 survey meter. The mean value of background radiation was 1.46 mSv/yr. This value is about 46% higher than the recommended reference level of 1.0 mSv/yr for the public. The mean activity concentrations of 238U, 232Th and 40K in the soil samples were 19.1 ± 3.2, 29.1 ± 4.4 and 171.5 ± 6.1 Bq/kg respectively which are about 45.4%, 35.3% and 59.2% lower than the world’s average levels. For the water samples, the mean activity concentrations obtained for 238U, 232Th and 40K are 0.4 ± 0.4, 0.8 ± 0.2 and 0.8 ± 0.3 Bq/l respectively. These are about 99.9% and 20% lower than WHO reference levels for 238U and 232Th. The mean absorbed dose rate in air (D), Annual effective dose (AED) outdoor, Radium Equivalent (Req), External hazard index (Hex) internal hazard index (Hin) and Excess lifetime cancer risk (ELCR) from soil samples were 33.6 nGy/h, 41.0 μSv/yr, 73.1 Bq/kg and 0.2, 0.3 and $1.4\times{10}^{-4}$, respectively. Absorbed dose in air D, AED outdoor, Req, Hex, Hin and ELCR are 41.1%, 41.4%, 80.3%, 80%, 75% and 50% lower than their corresponding world’s average and references. The estimated AEDw from ingestion of water is 148.9 ± 50.4 μSv/yr, this is about 49% higher than the WHO reference level of 100.0 μSv/y from ingestion of water. The radiological hazard indices estimated from soil samples do not indicate any potential risks to the users. The elevated background radiation level of the dump site, and AEDw from ingestion of water, however, suggest that the activities on Olusosun dump site pose potential radiological risks on workers on the site and the public from consumption of water from Olusosun community.
Delayed surgical strategy for type A aortic dissection associated with acute hepatitis C cryoglobulinaemia
Authors: Ahmed-Issap Amber , Balacumaraswami Lognathen
Published: October 2022

An aortic dissection is a condition resulting from a tunica intima tear of the aortic wall creating a ‘false lumen’. An acute Stanford type A (involves the aortic arch and/or ascending aorta) aortic dissection requires emergency surgical repair. To our knowledge, we report the first case in the literature where the treatment for an acute type A aortic dissection was intentionally delayed. This was decided following a multidisciplinary team discussion where it was agreed that the patient’s active hepatitis C infection should be treated prior to surgery. The patient re-presented to the hospital 4 months later with acute dyspnoea and orthopnoea where he was diagnosed with an acute-on-chronic type A aortic dissection with trachea compression. This was successfully treated with emergency surgery. However, the patient suffered residual dyspnoea, likely due to phrenic nerve injury demonstrating the impact of untreated aortic arch distension on the neighbouring trachea and phrenic nerve.
Metabolic link between auxin production and specialized metabolites in Sorghum bicolor
Authors: Perez Veronica C , Dai Ru , Tomiczek Breanna , Mendoza Jorrel , Wolf Emily S A , Grenning Alexander , Vermerris Wilfred , Block Anna K , Kim Jeongim
Published: October 2022

Aldoximes are amino acid derivatives that serve as intermediates for numerous specialized metabolites including cyanogenic glycosides, glucosinolates, and auxins. Aldoxime formation is mainly catalyzed by cytochrome P450 monooxygenases of the 79 family (CYP79s) that can have broad or narrow substrate specificity. Except for SbCYP79A1, aldoxime biosynthetic enzymes in the cereal sorghum (Sorghum bicolor) have not been characterized. This study identified nine CYP79-encoding genes in the genome of sorghum. A phylogenetic analysis of CYP79 showed that SbCYP79A61 formed a subclade with maize ZmCYP79A61, previously characterized to be involved in aldoxime biosynthesis. Functional characterization of this sorghum enzyme using transient expression in Nicotiana benthamiana and stable overexpression in Arabidopsis thaliana revealed that SbCYP79A61 catalyzes the production of phenylacetaldoxime (PAOx) from phenylalanine but, unlike the maize enzyme, displays no detectable activity against tryptophan. Additionally, targeted metabolite analysis after stable isotope feeding assays revealed that PAOx can serve as a precursor of phenylacetic acid (PAA) in sorghum and identified benzyl cyanide as an intermediate of PAOx-derived PAA biosynthesis in both sorghum and maize. Taken together, our results demonstrate that SbCYP79A61 produces PAOx in sorghum and may serve in the biosynthesis of other nitrogen-containing phenylalanine-derived metabolites involved in mediating biotic and abiotic stresses.
The natural product rotundic acid treats both aging and obesity by inhibiting PTP1B
Authors: Zhu Jie , An Yongpan , Wang Xin , Huang Liting , Kong Weikaixin , Gao Miaomiao , Wang Jingxiang , Sun Xinpei , Zhu Sujie , Xie Zhengwei
Published: October 2022

The occurrence of obesity is associated with age. But their interplay remains mysterious. Here, we discovered that rotundic acid (RA), a plant-derived pentacyclic triterpene, was a powerful agent for both anti-aging and treating obesity. Considering that obese individuals decrease the appetite-suppressing and energy-expenditure-enhancing functions of leptin leading to obesity, we found RA was a leptin sensitizer, evidenced by observations that RA enhanced the leptin sensitivity to normal diet-induced obese (DIO) mice, and had minimal or no use to normal lean mice, leptin receptor-deficient (db/db) mice, and leptin-deficient (ob/ob) mice. Simultaneously, RA significantly increased energy expenditure, BAT thermogenesis, and glucose metabolism in DIO mice, as the results of enhancing leptin sensitivity. Regarding mode of action, we demonstrated that RA is a noncompetitive inhibitor of leptin negative regulators protein tyrosine phosphatase 1B (PTP1B) and T-cell PTP through interaction with their C-terminus, thus leading to weight loss through enhancing leptin sensitivity. Besides, we showed that deletion of yPTP1 in yeast completely abolished the lifespan extension effect of RA, celstrol, and withaferin A, while these compounds exhibited PTP1B inhibition activity. Furthermore, PTP1B knockdown extend lifespan in yeast and human cells, indicating PTP1B is an important factor regulating cellular aging.
Cultural Humility in the Testing Context
Authors: Mercado Alfonso , Venta Amanda
Published: October 2022

This chapter highlights the difference between cultural competency and cultural humility. It explores the important role that cultural humility plays in the delivery of mental health services, specifically in the psychological assessment context, an area that has not garnered much attention in the literature.
Clinical Interviewing and Cultural Conceptualization
Authors: Mercado Alfonso , Venta Amanda
Published: October 2022

This chapter highlights the importance of cultural clinical interviewing and case conceptualization via a cultural lens. The authors present a clinical case that illustrates the importance of integrating cultural values in the clinical interview. In addition, they explore the differences between psychopathology, culturally sanctioned experiences, and culture bound syndromes among Latinx persons, and they offer suggested guidelines to effectively conduct a cultural clinical interview and culturally informed assessment.
Future Directions in Psychological Assessment with Culturally Diverse Groups
Authors: Mercado Alfonso , Venta Amanda
Published: October 2022

The final chapter discusses future directions in research with Latinx groups, highlighting acculturation and adaptations for new waves of immigrants. This chapter summarizes the importance of recognizing the within-group variability among Latinx persons and the importance of expanding training and evidenced-based practices. A call to action is illustrated, and the chapter concludes with a summary section of the book.
Waveforms and Artifacts
Authors: Rubin Devon I.
Published: October 2022

In the practice of clinical neurophysiology, spontaneously generated or stimulus-induced electrical signals from neural tissue in the central, peripheral, and autonomic systems are recorded and displayed as waveforms through digital equipment. Each recorded waveform represents a change over time in the potential difference between two recording points and reflects the summated static or propagating electrical fields generated by or along nerve or muscle structures. If no change occurs in the potential difference, a flat line with no signal is recorded, even if there is a voltage difference between the points. Changes in potential difference are broadly classified as continuous or intermittent. Continuous waveforms are characterized by a relatively smooth, continuously varying appearance. These are most commonly seen in electroencephalogram (EEG) and related studies. Intermittent waveforms are single, discrete events that occur on a flat background. These are typical of those seen in electromyography, such as the waveform of a fibrillation potential or a motor unit potential. However, there is overlap in these patterns such that an EEG can have discrete, intermittent waveforms superimposed on continuous background waveforms (e.g., the spike discharges in epilepsy). Each type of waveform can be characterized by several different parameters: firing frequency, amplitude, and morphology. Changes in each of these waveform parameters may occur in diseases, and discrete waveforms themselves may be abnormal. Artifacts can alter all of the variables used to describe the continuous and discrete waveforms recorded in clinical neurophysiology. This chapter reviews the basic concepts of waveforms recorded during clinical neurophysiology testing.
Adult EEG
Authors: Noe Katherine H. , Drazkowski Joseph F.
Published: October 2022

This chapter reviews the key characters of epileptiform activity and provides classic examples of such activity on standard electroencephalographic (EEG) recordings. The clinician evaluating patients with suspected seizures or neurologic spells typically relies on the use of standard EEG recording as a diagnostic tool, especially early in the evaluation process. Accurate recognition of true epileptiform activity versus potential mimics, combined with the proper reporting of such activity, continues to have important implications for the diagnosis and treatment of epilepsy, neurologic spells and seizures. This chapter presents common and less commonly seen examples of epileptiform activity that are often useful in clinical practice.
Pediatric EEG
Authors: Wong-Kisiel Lily C. , Wirrell Elaine C.
Published: October 2022

Electroencephalography (EEG) is an important diagnostic tool to evaluate children presenting with a variety of transient central nervous system symptoms, including suspected seizures, as well as those with altered level of consciousness or behavioral changes. The most common referral for EEG is for evaluation of possible seizures as the EEG may confirm the presence of epileptiform abnormalities and provide data on the type of seizure disorder, localization of the seizure focus, and possible etiology. This chapter reviews the various epileptiform and nonepileptiform abnormalities seen in the EEG of infants, children, and adolescents. For each abnormality, a careful electrographic description, as well as the clinical correlates of that finding are provided. Furthermore, the core electrographic features seen in specific pediatric electroclinical syndromes are summarized.
Quantitative Electromyography
Authors: Smith Benn E.
Published: October 2022

The discipline of electromyography (EMG) relies on the skillful application of a wide range of techniques, skills, and intuitions—all of which derive from practiced analysis of electrical signals recorded from muscle. A proper understanding of the available equipment as well as the current strategies to classify motor unit potentials (MUPs) and the muscles from which they are recorded as normal, neurogenic, or myopathic underlies EMG practice. This chapter reviews EMG electrodes, MUP characteristics, and a range of quantitative methods to characterize both MUPs and muscles to determine whether the muscle in question is normal or not in order to help the electromyographer achieve an accurate EMG interpretation.
Electrodiagnostic Assessment of Polyneuropathies
Authors: Mauermann Michelle L.
Published: October 2022

Peripheral neuropathy is one of the most common reasons for referral for electrodiagnostic testing. Nerve conduction studies and needle electromyography aid in diagnosing peripheral neuropathy and defining important features that help to refine the differential diagnosis. Electrodiagnostic testing helps not only to confirm the diagnosis but also to exclude alternative diagnoses. It provides important information regarding type of nerve fibers involved, severity, duration, pathophysiology and prognosis. The electrodiagnostic approach to peripheral neuropathy is based on the typical length-dependent sensory greater than motor pattern; however, modifications are needed when the neuropathy phenotype differs. Autonomic testing is helpful in patients with a small-fiber neuropathy.
Somatosensory Evoked Potentials
Authors: Watson James C. , Rubin Devon I.
Published: October 2022

Somatosensory evoked potentials (SEPs, sometimes called SSEPs) provide a noninvasive, sensitive, and quantitative way of assessing the functional integrity of the peripheral and central proprioceptive, somatosensory conduction pathways. SEP localizing ability is improved when interpreted in the context of other electrophysiologic tests (e.g., sensory nerve conduction studies, which assess peripheral nerve integrity through the dorsal root ganglion) and neuroimaging. Despite the advancements in neuroimaging, SEPs are still useful in the outpatient setting to assess for functional impairment (or preservation) of the proprioceptive pathways in the setting of known central nervous system structural (intrinsic or extrinsic) pathology (spinal stenosis or tumor, e.g.). SEPs are one of the most important diagnostic studies in identifying sensory-predominant polyradiculopathies (e.g., chronic inflammatory sensory polyradiculopathy). SEPs are now routinely used for intraoperative monitoring during spine surgery and in determining prognosis in postanoxic coma.
Quantitative Sudomotor Axon Reflex and Related Tests
Authors: Low Phillip A. , Coon Elizabeth A.
Published: October 2022

Small-fiber nerves may be selectively involved in various disorders. The function of the postganglionic sympathetic sudomotor C fibers can be assessed using the quantitative sudomotor axon reflex test (QSART), noninvasively and reproducibly, to define the severity and distribution of sudomotor failure. The neural pathway evaluated by QSART consists of an axon reflex mediated by the postganglionic sympathetic sudomotor axon. The axon terminal is activated by iontophoresis of acetylcholine, which leads to an impulse that travels antidromically to the branch point, then orthodromically to release acetylcholine from the nerve terminal to stimulate muscarinic receptors on eccrine sweat glands and evoke a sweat response. Normal responses indicate integrity of the postganglionic sympathetic sudomotor axon, while abnormal QSART patterns can indicate sudomotor damage, such as length-dependent reduction responses, indicating distal small-fiber neuropathy. Concomitant use of QSART and a thermoregulatory sweat test may help determine the site of the lesion.
Thermoregulatory Sweat Test
Authors: Fealey Robert D.
Published: October 2022

The thermoregulatory sweat test, when performed correctly, continues to be an excellent test for small-fiber neuropathy, autonomic failure diagnosis, and evaluation of other neurological and dermatological disorders. A dedicated cabinet or room with control of ambient humidity and temperature is important. To achieve a maximal sweat response, elevation and control of skin temperature remain critical components, as does attaining a core temperature of 38.0º C (or raising core temperature by 1.0ºC, whichever is highest) when significant anhidrosis is present. Documentation of the test result includes quantification of anterior body surface anhidrosis and a report displaying a graphical image and interpretation of the result. Parameters for cabinet humidity and temperature, skin temperature control, and the software and hardware currently in use are detailed within.
Cerebral Function Monitoring and Cortical Mapping for Nonepilepsy Surgery
Authors: So Elson L. , Hoffman E. Matthew
Published: October 2022

The purpose of intraoperative neurophysiological monitoring is to optimize postsurgical outcome by guiding the course of surgery. This chapter critically examines the principles and applications of different neurophysiological monitoring techniques in nonepilepsy surgeries. For some time, the use of electroencephalography has been widely established for carotid endarterectomy and cardiac surgery. Other modalities of neurophysiological monitoring have emerged, such as somatosensory evoked potentials (SSEPs), carotid stump pressure measurement, transcranial Doppler, and near-infrared spectrophotometry. More recent studies in the literature compared the yield of some of these techniques. A few studies suggested the usefulness of monitoring surgery with a combination of modalities. This chapter also examines the technical and clinical aspects of neurophysiological monitoring during surgical resection of brain lesions, such as tumors and vascular malformations. When the lesion is near eloquent cortex, electrical stimulation mapping of the cortex and SSEPs are used to guide surgical resection in order to maximize the extent of the resection and minimize the risk of impairing critical cortical functions such as language and motor functions.
Electrical Safety
Authors: Lagerlund Terrence D. , Lundstrom Brian Nils
Published: October 2022

Electrical Safety reviews procedures and standards used to ensure the safety of patients undergoing clinical neurophysiologic studies and of technicians or others performing studies from the standpoint of avoiding electrical shock or injury, as well as safety considerations for electrical stimulation of neural tissue. Electric power distribution in a hospital or clinic and mechanisms of electric shock are discussed, including factors increasing the risk of electric shock in hospitals. Leakage current is defined, and the mechanisms by which leakage current reaches patients and methods to reduce leakage current are discussed. Equipment grounding principles are explained. Tests for equipment grounding and leakage current are described, and rules and procedures to ensure electrical safety are specified. Safety considerations for electrical stimulation near pacemakers and implanted electrical devices are discussed, as well as safety considerations for transcranial electric and magnetic stimulation and for cortical and deep brain stimulation.
Abdominal compartment syndrome
Authors: Navsaria Pradeep , McPherson Deidre , Jonas Eduard
Published: October 2022

The abdominal compartment syndrome (ACS) can be defined as a state of acute organ dysfunction, predominantly affecting the cardiovascular, respiratory, and renal systems from a sustained increase in intra-abdominal pressure (IAP) causing intra-abdominal hypertension (IAH). The early recognition, prompt diagnosis, and immediate intervention of ACS can improve organ dysfunction. Intra-abdominal pressure and the abdominal compartment syndrome are separate, distinct clinical entities. Intra-abdominal pressure is the steady-state pressure concealed within the abdominal cavity. Intra-abdominal hypertension is defined by a sustained or repeated pathological elevation in IAP ≥ 12 mmHg. Abdominal compartment syndrome is defined as a sustained increase of IAP over 20 mmHg that is associated with new or worsening organ function. The effects of IAH are not limited to the intra-abdominal organs but have an impact either directly or indirectly on other organ systems in the body. The definitive diagnosis of IAH/ACS requires a measurement of the IAP. The intra-vesicular technique is a minimally invasive, easy, precise, reliable, and reproducible way of measuring IAP. The development of IAH/ACS during a critical care unit stay is an independent predictor of a patient’s outcome. Medical interventions target three critical contributors to IAH; solid organ and hollow-viscera volume, space-occupying lesions, such as ascites, blood, abdominal packs and tumours, and conditions that limit abdominal wall compliance. Surgical decompression of the abdominal cavity is considered the definitive management of ACS. Temporary abdominal wall closure using negative pressure wound therapy has the highest fascial closure and lowest mortality rates.
Ventral hernia
Authors: Arora Eham , Pauli Eric
Published: October 2022

Hernia repairs are amongst the most common procedures performed in surgical practice. Over 600,000 repairs are performed annually in the United States alone, of which about 175,000 are for ventral hernias. Despite their sheer numbers, cases exhibit a wide variability in morphology and clinical presentation. There exists a wide gamut of available surgical options with little consensus to help choose between them. The last few years have witnessed a substantial growth of our understanding of the abdominal wall’s surgical anatomy and dynamics. This has led to a surge in available technologies—surgical approaches, myofascial advancement flaps, prosthetic devices—which allow the modern surgeon to repair cases which were hitherto deemed irreparable. More importantly, a clearer understanding of the pathology and prudent employment of repairs has the potential to improve outcomes in all patients in terms of surgical site infections, chronic pain, and recurrence. This chapter will serve as an updated reference for surgical residents and seasoned practitioners helping them evaluate and manage ventral hernias with greater confidence.
Surgical access to the abdomen
Authors: Agrawal Abhishek , Mullick Shweta , Dhar Puneet
Published: October 2022

Anatomy of abdominal wall encountered changes with the site of approach. Clearly understanding the anatomy of the abdominal wall is crucial to the art of making the incision for access to the abdomen and has been briefly outlined. The location and type of incision depends on the urgency of surgery, target organ, habitus, cosmesis, and previous scars. The usage of laparoscopic access has increased dramatically and modes of access have been outlined. It is imperative to have safe peritoneal access and achieve requisite closure. The principle of closure rests mostly on the musculoaponeurotic layer. Common complications include haematoma or seroma, surgical site Infections and wound dehiscence.
Peritoneal malignancy
Authors: Godbole Chintamani , Hallam Sally , Antoun Lina , Youssef Haney
Published: October 2022

Malignancy can result from primary or secondary tumours of the peritoneum. Traditionally the discovery of peritoneal cancer at operation was thought to be a terminal event. These patients were offered palliative care with either systemic chemotherapy or best supportive care. However, the last 30 years have seen exciting developments in the surgical and medical treatment of peritoneal malignancy with significant improvements in survival. A few have even achieved cure with this devastating condition. This chapter describes the assessment and management of common primary and secondary peritoneal malignancies. Colorectal peritoneal metastases, pseudomyxoma peritonei, peritoneal mesothelioma, and ovarian cancer are discussed in detail. It also describes the advances in surgical and oncological treatments for these conditions.
Retroperitoneum
Authors: Yadav Amitabh
Published: October 2022

The retroperitoneum is the space in the abdominal cavity, which lies behind the parietal peritoneum. It is of surgical importance because it can be the site for the accumulation of inflammatory or traumatic fluids and, unlike the peritoneal cavity, access to it is difficult. A gastrointestinal surgeon encounters problems affecting this site when he or she has to deal with pancreatitis, trauma, or malignant tumours. A knowledge and understanding of the anatomy, of its various potential spaces and of the communications between them, is essential for the adequate management of diseases in this area. This chapter discusses the embryology, anatomy, fascial structures, compartments, and spaces spread across these inter-fascial planes. It also describes the diseases which are important to a gastro-intestinal surgeon and various approaches to the retroperitoneum, including open and minimally invasive techniques. Finally, it explores the various operative approaches to deal with the pancreatitis with special emphasis on minimally invasive techniques and the common complications of these procedures.