bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of outcome in fetal autoimmune complete heart block
Authors: Sethi Neeta , Krishnan Anita , Donofrio Mary
Published: January 2020

Assessing cardiac function and risk stratification in a fetal anti‐Sjögren syndrome type A (SSA) or anti‐Sjögren syndrome type B (SSB) complete atrioventricular block (CAVB) is challenging. We aimed to evaluate the cardiovascular profile score (CVP) and its components in surveillance of fetuses with autoimmune CAVB.

Methods

Retrospective cohort review of CAVB pregnancies, excluding fetuses with significant cardiac anomalies.

Results

CAVBs are in 17 fetuses, diagnosed at mean gestational age of 23 ± 5 weeks. Overall mortality is 18%: 1 termination, 1 fetal demise (intrauterine fetal demise [IUFD]), and 1 postnatal death. Both mortalities had intrauterine growth restriction; IUFD had placental infarction.

Presenting CVP 8.7 ± 1. No fetus had CVP <7; the score correlated with increased risk of perinatal death. The 2 mortalities had initial CVP scores of 8 and 9; both increased to 10 on subsequent exams.

30% of fetuses had low middle cerebral artery pulsatility (MCA‐PI) on the last study. All had high umbilical artery pulsatility (UA‐PI) throughout gestation. The 2 deaths had the lowest MCA‐PI.

Conclusion

Despite low heart rates, high CVP scores in our cohort remained high and were not predictive of mortality. Abnormalities in MCA flow reflects fetal cerebral vasodilation that may indicate altered hemodynamics and be predictive of outcomes, but data is limited. Abnormal umbilical artery (UA) flow suggests that perinatal mortality may also be related to placental disease.
The incidence of fatal fetal anomalies associated with perinatal mortality in Ireland
Authors: Power Stacey , Meaney Sarah , O'Donoghue Keelin
Published: January 2020

Objective

The term fatal fetal anomaly (FFA) describes a condition likely to lead to death of the fetus in utero or within 28 days of birth. This study aimed to identify what congenital anomalies are responsible for perinatal death and whether they are classified as an FFA in accordance with criteria outlined in Irish legislation.

Methods

Anonymised data pertaining to perinatal deaths from 2011 to 2016 in Ireland were obtained from the National Perinatal Epidemiology Centre. Secondary data analysis was conducted using SPSS.

Results

Of the 2638 perinatal deaths, 939 (36%) had a congenital anomaly. Nearly half was chromosomal (43%, n = 406 of 939) with 36% of the cases (n = 333 of 938) having more than one anomaly. Additional information was available for 777 of these congenital anomaly, of which 42% (n = 328) could be classified an FFA.

Conclusion

This study identified that less than half of the congenital anomalies could be classified as an FFA; however, all were fatal. This acknowledges the complexity of these cases. In isolation, the congenital anomaly may not be fatal, but combined as multiorgan system anomalies, it is. Knowledge is required to inform clinical practice and counselling of parents who receive such a diagnosis.
A rapid monitoring plan following a shift in coverage from brand name to biosimilar drugs for rheumatoid arthritis in British Columbia
Authors: Dormuth Colin R. , Fisher Anat , Carney Greg
Published: January 2020

Purpose

To describe a rapid monitoring plan to assess the impacts of a shift in drug coverage for biosimilar drugs in British Columbia following the introduction of a new policy on 27 May 2019. The Biosimilars Initiative requires users of originator infliximab or etanercept to switch to biosimilar versions of those drugs to maintain coverage. We propose a signal‐detection method to provide near‐real‐time information to policymakers on the impacts of the policy change.

Methods

The exposure will be the Biosimilars Initiative, a policy affecting patients using originator infliximab (Remicade) and etanercept (Enbrel) for approved rheumatologic or dermatologic indications. Two policy cohorts and six historical control cohorts of patients using originator infliximab or etanercept will be assembled using linked and de‐identified data from the British Columbia Ministry of Health. Patients will be identified during the 6‐month period before the policy anniversary. Outcomes will include medication refills and switching, hospital admissions, emergency department visits, and physician visits. Summary outcome measures, such as cumulative incidence or average quantity as applicable, will be examined daily and reported monthly for 1 year. Outcomes in the policy cohorts will be compared with historical controls using likelihood ratios.

Results

The results of this rapid monitoring plan will be based on analyses involving approximately 9000 patients: four infliximab cohorts of approximately 430 patients and four etanercept cohorts of approximately 1800 patients.

Conclusions

Rapid monitoring results will inform ongoing policy decisions related to the Biosimilars Initiative, in terms of impacts on both patient health and health services utilization.
Electron radiation–induced degradation of GaAs solar cells with different architectures
Authors: Gruginskie Natasha , Cappelluti Federica , Bauhuis Gerard J. , Mulder Peter , Haverkamp Erik J. , Vlieg Elias , Schermer John J.
Published: January 2020

The effects of electron irradiation on the performance of GaAs solar cells with a range of architectures is studied. Solar cells with shallow and deep junction designs processed on the native wafer as well as into a thin‐film were irradiated by 1‐MeV electrons with fluence up to 1×1015 e−/cm2. The degradation of the cell performance due to irradiation was studied experimentally and theoretically using model simulations, and a coherent set of minority carriers' lifetime damage constants was derived. The solar cell performance degradation primarily depends on the junction depth and the thickness of the active layers, whereas the material damage shows to be insensitive to the cell architecture and fabrication steps. The modeling study has pointed out that besides the reduction of carriers lifetime, the electron irradiation strongly affects the quality of hetero‐interfaces, an effect scarcely addressed in the literature. It is demonstrated that linear increase with the electron fluence of the surface recombination velocity at the front and rear hetero‐interfaces of the solar cell accurately describes the degradation of the spectral response and of the dark current characteristic upon irradiation. A shallow junction solar cell processed into a thin‐film device has the lowest sensitivity to electron radiation, showing an efficiency at the end of life equivalent to 82% of the beginning‐of‐life efficiency.
A New Method for Continuous Solid‐State Biaxial Orientation of Polymeric Films
Authors: Ghazaryan Gagik , Schaller Raphael , Tervoort Theo A.
Published: January 2020

A new laboratory‐scale method for continuous solid‐state biaxial deformation of polymer materials is introduced. The tabletop biaxial drawing tool utilizes a heated metal disc‐like triangular mandrel, which allows for continuous solid‐state biaxial deformation of a precursor polymer tube with a controlled drawing speed. The new biaxial drawing tool features two independent heating zones. The main mandrel sets the biaxial drawing temperature. In addition, directly after the mandrel, an annealing unit with a separate heating zone is added for better control of important process parameters, such as post‐relaxation and strain‐induced crystallization. As such, the new biaxial drawing tool is a tabletop analogue of the industrial triple‐bubble process. Finally, a detailed theoretical model describing the deformation field and the forces needed to perform biaxial drawing as a function of the biaxial drawing ratio is presented and compared to experimental values, using isotactic polypropylene as model material. © 2020 Wiley Periodicals, Inc. J. Polym. Sci.2020,58, 352‐362
Three‐dimensional posture estimation of robot forceps using endoscope with convolutional neural network
Authors: Mikada Takuto , Kanno Takahiro , Kawase Toshihiro , Miyazaki Tetsuro , Kawashima Kenji
Published: January 2020

Background

In recent years, there has been significant developments in surgical robots. Image‐based sensing of surgical instruments, without the use of electric sensors, are preferred for easily washable robots.

Methods

We propose a method to estimate the three‐dimensional posture of the tip of the forceps tip by using an endoscopic image. A convolutional neural network (CNN) receives the image of the tracked markers attached to the forceps as an input and outputs the posture of the forceps.

Results

The posture estimation results showed that the posture estimated from the image followed the electrical sensor. The estimated results of the external force calculated based on the posture also followed the measured values.

Conclusion

The method which estimates the forceps posture from the image using CNN is effective. The mean absolute error of the estimated external force is smaller than the human detection limit.
Trust in Emergency Management Authorities and Individual Emergency Preparedness for Tornadoes
Authors: Choi Junghwa , Wehde Wesley
Published: January 2020

The risks associated with disasters can be significantly reduced if individuals are well prepared according to the orders and recommendations of emergency management authorities such as the Federal Emergency Management Agency (FEMA) and local government. Despite this fact, there is evidence that individuals are not cooperative with these authorities and are therefore underprepared for an emergency. This article argues that individual trust in emergency management authorities may affect their cooperation with emergency preparedness recommendations. Using unique survey data, this study finds a nuanced relationship between individual emergency preparedness for tornadoes and trust in emergency management authorities. Although trust in FEMA in isolation does not explain variations in individual preparedness for tornadoes, increased preparation for a tornado is explained by trust in local government contingent upon a low baseline level of trust in FEMA. This article concludes with some practical and theoretical implications for emergency management authorities and scholars.
Characterizing the formative assessment enactment of experienced science teachers
Authors: Dini Vesal , Sevian Hannah , Caushi Klaudja , Orduña Picón Raúl
Published: January 2020

Teachers' use of formative assessment (FA) has been shown to improve student outcomes; however, teachers enact FA in many ways. We examined classroom videos of nine experienced teachers of elementary, middle, and high school science, aiming to create a model of FA enactment that is useful to teachers. We developed a coding scheme through a validation‐in‐use approach to characterize teachers' practices using three streams of data that included teachers' self‐interviews about the purposes and outcomes of their FAs, our analysis of their noticing/interpreting and acting, and their comments on intentions behind the teaching acts they considered significant. In contrast to cycles of eliciting‐noticing‐interpreting‐acting, we found noticing/interpreting to be central to FA enactment, driving teachers' eliciting or advancing acts. We characterized ways of noticing/interpreting as more authoritative or dialogic and observed that eliciting acts and advancing acts occurred along a similar range. Teachers' in‐the‐moment purposes and larger learning goals were synthesized as they made choices about teaching acts. The model is framed in terms of utility to teachers to examine their own FA practices, with the aim of becoming better equipped to strategically enact FA in intentional ways to achieve their purposes.
World heritage sustainable development policy & local implementation: Site management issues using a case study of Sri Ksetra at Pyu ancient cities in Myanmar
Authors: Liljeblad Jonathan , Oo Khin Thinn Thinn
Published: January 2020

In November 2015, State Parties to the World Heritage Convention approved a resolution adopting a policy integrating sustainable development into World Heritage conservation (WH Policy). A central component of the WH Policy was an expectation for participatory models of management involving local communities in site management. This paper uses a case study of Sri Ksetra in Pyu Ancient Cities, Myanmar's first entry onto the World Heritage list, to identify how management practices toward local communities can frustrate the implementation of WH Policy goals. The paper argues that the implementation of WH Policy involves not only the contents of policy statements but also the actions of site management practices, such that efforts to promote sustainable development via community participation require consideration of both the articulation of appropriate management systems in formal policy documents as well as the practice of appropriate conduct by those systems.
Recreating Physiological Environments In Vitro: Design Rules for Microfluidic‐Based Vascularized Tissue Constructs
Authors: Tan Sin Yen , Leung Ziuwin , Wu Angela Ruohao
Published: January 2020

Vascularization of engineered tissue constructs remains one of the greatest unmet challenges to mimicking the native tissue microenvironment in vitro. The main obstacle is recapitulating the complexity of the physiological environment while providing simplicity in operation and manipulation of the model. Microfluidic technology has emerged as a promising tool that enables perfusion of the tissue constructs through engineered vasculatures and precise control of the vascular microenvironment cues in vitro. The tunable microenvironment includes i) biochemical cues such as coculture, supporting matrix, and growth factors and ii) engineering aspects such as vasculature engineering methods, fluid flow, and shear stress. In this systematic review, the design considerations of the microfluidic‐based in vitro model are discussed, with an emphasis on microenvironment control to enhance the development of next‐generation vascularized engineered tissues.
Designing Advanced Catalysts for Energy Conversion Based on Urea Oxidation Reaction
Authors: Zhu Bingjun , Liang Zibin , Zou Ruqiang
Published: January 2020

Urea oxidation reaction (UOR) is the underlying reaction that determines the performance of modern urea‐based energy conversion technologies. These technologies include electrocatalytic and photoelectrochemical urea splitting for hydrogen production and direct urea fuel cells as power engines. They have demonstrated great potentials as alternatives to current water splitting and hydrogen fuel cell systems with more favorable operating conditions and cost effectiveness. At the moment, UOR performance is mainly limited by the 6‐electron transfer process. In this case, various material design and synthesis strategies have recently been reported to produce highly efficient UOR catalysts. The performance of these advanced catalysts is optimized by the modification of their structural and chemical properties, including porosity development, heterostructure construction, defect engineering, surface functionalization, and electronic structure modulation. Considering the rich progress in this field, the recent advances in the design and synthesis of UOR catalysts for urea electrolysis, photoelectrochemical urea splitting, and direct urea fuel cells are reviewed here. Particular attention is paid to those design concepts, which specifically target the characteristics of urea molecules. Moreover, challenges and prospects for the future development of urea‐based energy conversion technologies and corresponding catalysts are also discussed.
Using an Integrated Population Model to Evaluate Yellowstone Cutthroat Trout Responses to Management Actions
Authors: McCormick Joshua L. , High Brett
Published: January 2020

The South Fork Snake River supports one of the few remaining robust populations of fluvial Yellowstone Cutthroat TroutOncorhynchus clarkii bouvieriin Idaho. Since the early to mid‐2000s, salmonid populations on the South Fork Snake River have been intensively monitored and managed to limit the abundance of introduced Rainbow TroutO. mykiss, which have been increasing in abundance relative to Yellowstone Cutthroat Trout. Integrated population models (IPMs) were built using multiple data sets (abundance, survival, and fecundity data) to evaluate the effectiveness of management actions. Modeling results suggested that Yellowstone Cutthroat Trout survival at ages 0 and 2 was influenced by inter‐ and intracohort competition with both adult Rainbow Trout and adult Yellowstone Cutthroat Trout. Decreasing minimum winter discharge from Palisades Reservoir appeared to negatively affect the population growth rate of Yellowstone Cutthroat Trout; however, the effect on survival of individual life stages was minimal. Use of theIPMallowed for evaluation of life‐stage‐specific dynamics that would be lacking when using alternative analytical methods. It is apparent from the results of this study that the population bottlenecks for Yellowstone Cutthroat Trout in the South Fork Snake River occurred at ages 0 and 2 as a result of inter‐ and intraspecific density‐dependent mechanisms. Thus, management actions that target these life stages should be continued or expanded.
Energy Density Predictors for Argentine Anchovy Engraulis anchoita, a Key Species of the Southwestern Atlantic Ocean
Authors: Ciancio Javier Ernesto , Bartes Saia , Fernández Santiago , Harillo Camila , Lancelotti Julio
Published: January 2020

Forage fishes have a cosmopolitan distribution and constitute key species in marine trophic webs throughout the world. We estimated the energy density of the Argentine Anchovy Engraulis anchoita, a key component of the base of the food web in a large fraction of the southwestern Atlantic Ocean. We also examined the relationships between energy density and different proxies (condition factor, fork length, and percent dry weight) and compared the relationship of energy density to percent dry weight for Argentine Anchovy to this relationship in other forage fishes. A regression model that includes percent dry weight and fork length was the best predictor for the energy density in this species. The Argentine Anchovy had similar energy density to percent dry weight to all species in the Engraulidae family (anchovies) and to most of the species in the Clupeidae family (sardines). Engraulidae species showed smaller mean energy density and smaller energy density to percent dry weight compared with the Clupeidae species. The difference in energy density between these two families could have direct implications on population dynamics of predators in oscillating sardine–anchovy systems or in regions where these two families are spatially segregated.
Performance analysis of vehicle detection based on spatial saliency and local image features in H.265 (HEVC) 4K video for developing a relationship between iou and subjective evaluation value
Authors: Aktar Most Shelina , Horita Yuukou
Published: January 2020

A vehicle detection method fusing spatial saliency and local image features is presented in this paper to analyze the detection performance in compressed domain. Most of the existing visual saliency models use the input images, in which salient objects are to be detected and are free from complex background and overlapping areas. Moreover, they are very sensitive to the complex scene and different illuminations. In this method, the Scale Invariant Feature Transform and Harris features in combination with spatial saliency model play an important role in detecting vehicles from the scene. A one‐to‐one symmetric search is performed on the descriptors to select a set of matched interest point pairs for vehicle detection. We use 4K video of a road scene with different types of vehicles. The proposed method is able to detect desired overlapping objects from the road scene without heavy computation like other training‐based methods. In addition, the detection performance is analyzed in a H.265 compressed domain to help construct a relationship between objective and subjective evaluation value. The performance of this method is demonstrated by the experimental results. © 2020 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.
$$ \mathcal{N} $$ = 4 conformal supergravity: the complete actions
Authors: Butter Daniel , Ciceri Franz , Sahoo Bindusar
Published: January 2020

Abstract

The most general class of 4D $$ \mathcal{N} $$
N
= 4 conformal supergravity actions depends on a holomorphic function of the scalar fields that parametrize an SU(1, 1)/U(1) coset space. The bosonic sector of these actions was presented in a letter [1]. Here we provide the complete actions to all orders in the fermion fields. They rely upon a new $$ \mathcal{N} $$
N
= 4 density formula, which permits a direct but involved construction. This density formula also recovers the on-shell action for vector multiplets coupled to conformal supergravity. Applications of these results in the context of Poincaré supergravity are briefly discussed.
DsTau: study of tau neutrino production with 400 GeV protons from the CERN-SPS
Authors:   The DsTau collaboration, Aoki Shigeki , Ariga Akitaka , Ariga Tomoko , Dmitrievsky Sergey , Firu Elena , Forshaw Dean , Fukuda Tsutomu , Gornushkin Yuri , Guler Ali Murat , Haiduc Maria , Kodama Koichi , Komatsu Masahiro , Korkmaz Muhtesem Akif , Kose Umut , Miloi Madalina , Miucci Antonio , Miyanishi Motoaki , Nakamura Mitsuhiro , Nakano Toshiyuki , Neagu Alina , Rokujo Hiroki , Sato Osamu , Sitnikova Elizaveta , Suzuki Yosuke , Takao Tomoki , Vasina Svetlana , Vladymyrov Mykhailo , Weston Thomas , Yoshida Junya , Yoshimoto Masahiro
Published: January 2020

Abstract

In the DsTau experiment at the CERN SPS (NA65), an independent and direct way to measure tau neutrino production following high energy proton interactions was proposed. As the main source of tau neutrinos is a decay of D

s
mesons, produced in proton-nucleus interactions, the project aims at measuring a differential cross section of this reaction. The experimental method is based on a use of high resolution emulsion detectors for effective registration of events with short lived particle decays. Here we present the motivation of the study, details of the experimental technique, and the first results of the analysis of the data collected during test runs, which prove feasibility of the full scale study of the process in future.
Some results on optimal stopping under phase-type distributed implementation delay
Authors: Lempa Jukka
Published: January 2020

We study optimal stopping of strong Markov processes under random implementation delay. By random implementation delay we mean the following: the payoff is not realised immediately when the process is stopped but rather after a random waiting period. The distribution of the random waiting period is assumed to be phase-type. We prove first a general result on the solvability of the problem. Then we study the case of Coxian distribution both in general and with scalar diffusion dynamics in more detail. The study is concluded with two explicit examples.
Effects of short-term cannabidiol treatment on response to social stress in subjects at clinical high risk of developing psychosis
Authors: Appiah-Kusi E. , Petros N. , Wilson R. , Colizzi M. , Bossong M. G. , Valmaggia L. , Mondelli V. , McGuire P. , Bhattacharyya S.
Published: January 2020

Rationale

Stress is a risk factor for psychosis and treatments which mitigate its harmful effects are needed. Cannabidiol (CBD) has antipsychotic and anxiolytic effects.

Objectives

We investigated whether CBD would normalise the neuroendocrine and anxiety responses to stress in clinical high risk for psychosis (CHR) patients.

Methods

Thirty-two CHR patients and 26 healthy controls (HC) took part in the Trier Social Stress Test (TSST) and their serum cortisol, anxiety and stress associated with public speaking were estimated. Half of the CHR participants were on 600 mg/day of CBD (CHR-CBD) and half were on placebo (CHR-P) for 1 week.

Results

One-way analysis of variance (ANOVA) revealed a significant effect of group (HC, CHR-P, CHR-CBD (p = .005) on cortisol reactivity as well as a significant (p = .003) linear decrease. The change in cortisol associated with experimental stress exposure was greatest in HC controls and least in CHR-P patients, with CHR-CBD patients exhibiting an intermediate response. Planned contrasts revealed that the cortisol reactivity was significantly different in HC compared with CHR-P (p = .003), and in HC compared with CHR-CBD (p = .014), but was not different between CHR-P and CHR-CBD (p = .70). Across the participant groups (CHR-P, CHR-CBD and HC), changes in anxiety and experience of public speaking stress (all p’s < .02) were greatest in the CHR-P and least in the HC, with CHR-CBD participants demonstrating an intermediate level of change.

Conclusions

Our findings show that it is worthwhile to design further well powered studies which investigate whether CBD may be used to affect cortisol response in clinical high risk for psychosis patients and any effect this may have on symptoms.
Spatial patterns of tau deposition are associated with amyloid, ApoE, sex, and cognitive decline in older adults
Authors: Pereira Joana B. , Harrison Theresa M. , La Joie Renaud , Baker Suzanne L. , Jagust William J.
Published: January 2020

Purpose

The abnormal deposition of tau begins before the onset of clinical symptoms and seems to target specific brain networks. The aim of this study is to identify the spatial patterns of tau deposition in cognitively normal older adults and assess whether they are related to amyloid-β (Aβ),APOE, sex, and longitudinal cognitive decline.

Methods

We included 114 older adults with cross-sectional flortaucipir (FTP) and Pittsburgh Compound-B PET in addition to longitudinal cognitive testing. A voxel-wise independent component analysis was applied to FTP images to identify the spatial patterns of tau deposition. We then assessed whether tau within these patterns differed by Aβ status,APOEgenotype, and sex. Linear mixed effects models were built to test whether tau in each component predicted cognitive decline. Finally, we ordered the spatial components based on the frequency of high tau deposition to model tau spread.

Results

We found 10 biologically plausible tau patterns in the whole sample. There was greater tau in medial temporal, occipital, and orbitofrontal components in Aβ-positive compared with Aβ-negative individuals; in the parahippocampal component in ε3ε3 compared with ε2ε3 carriers; and in temporo-parietal and anterior frontal components in women compared with men. Higher tau in temporal and frontal components predicted longitudinal cognitive decline in memory and executive functions, respectively. Tau deposition was most frequently observed in medial temporal and ventral cortical areas, followed by lateral and primary areas.

Conclusions

These findings suggest that the spatial patterns of tau in asymptomatic individuals are clinically meaningful and are associated with Aβ,APOEε2ε3, sex and cognitive decline. These patterns could be used to predict the regional spread of tau and perform in vivo tau staging in older adults.
The Association Between Chronic Lymphocytic Thyroiditis and the Progress of Papillary Thyroid Cancer
Authors: Lee Inhwa , Kim Hyeung Kyoo , Soh Euy Young , Lee Jeonghun
Published: January 2020

Background

Whether chronic lymphocytic thyroiditis (CLT) influences the risk of development and the progression of papillary thyroid cancer (PTC) remains uncertain. We investigated the effects of CLT on the clinicopathologic features and prognosis of PTC.

Methods

Two thousand nine hundred twenty‐eight consecutive patients with PTC treated between 2009 and 2017 were divided into two groups: one with chronic lymphocytic thyroiditis and one without; 1174 (40%) of the patients had coincident CLT.

Results

In univariate analysis, CLT correlated positively with small tumor size, frequent extrathyroidal extension, multifocal diseases, and p53 but negatively with central lymph node (LN) metastasis and BRAF mutation. In multivariate analysis, CLT was associated with extrathyroidal extension and multifocal disease; however, it was not a prognostic factor for recurrence even though it was associated with two aggressive factors. Compared with patients with PTC alone, there were more retrieved central LNs in the PTC + CLT group, and these patients also underwent more invasive diagnostic tests such as fine needle aspiration cytology and frozen biopsy of LN.

Conclusions

The CLT patients with PTC had better behavior features and prognoses than did those with PTC alone despite frequent multifocality and extrathyroidal extension. However, precaution may be necessary to avoid performing invasive diagnostic procedures for lateral LN metastasis and to manage the patients appropriately.
Surgical Task‐Sharing to Non‐specialist Physicians in Low‐Resource Settings Globally: A Systematic Review of the Literature
Authors: Falk Ryan , Taylor Robert , Kornelsen Jude , Virk Roohina
Published: January 2020

Background

As the global community increasingly recognizes the large and unmet burden of surgical disease, a new emphasis is being placed on strengthening the health system at the first‐level hospital. The shortage of surgical care providers at this district and rural level can be met by surgical task‐shifting/sharing to non‐physician clinicians (NPCs) and non‐specialist physicians (NSPs). While the role of NPCs in low–middle‐income countries (LMICs), in particular in sub‐Saharan Africa (SSA), has been well documented in the literature, there has been little focus on NSPs. In addition to providing essential surgical services, this physician cadre also practices generalist medicine, an advantage at the first‐level hospital. The present study seeks to explore where, across all country income groups, NSPs are providing surgical services and what additional surgical training, if any, is available in each identified country.

Methods

A systematic review of the literature was performed, following PRISMA guidelines. Medline, EMBASE, EBM Reviews, and CINAHL were searched. Including hand‐searching for further references, 53 publications met inclusion/exclusion criteria and were identified for data extraction purposes. Gray literature was also explored within the time limits for this study.

Results

Surgical task‐shifting/sharing to NSPs occurs across all country income groups; some provide surgical obstetrics, while others also provide a broader scope of surgical services. Within LMIC countries, the majority are in SSA. In SSA, 16 of 54 countries were included in the reviewed articles, only 4 of which (Ethiopia, Niger, Nigeria, and Sierra Leone) have a formal surgical program beyond the regular medical officer/general practitioner training. Canada and Australia have established programs for both surgical obstetrics and the broader scope, while the USA has several programs for surgical obstetrics and is developing a new, broad‐scope program.

Conclusion

This study has demonstrated that NSPs are providing surgical services across all income groups, with varying degrees of additional training specific to the surgical needs of their district/rural location. To “close the gap” in needed surgical services at the first‐level hospital, more task‐sharing needs to occur to both NSPs (the focus of this study) and NPCs. Collaboration between practitioners and training programs, given the shared challenges and practice environments, would help support task‐sharing at the first‐level hospital and improve access to the 5 billion underserved people.
Emergency Surgery for Blunt Cardiac Injury: Experience in 43 Cases
Authors: Gao Jin‐Mou , Du Ding‐Yuan , Kong Ling‐Wen , Yang Jun , Li Hui , Wei Gong‐Bin , Li Chang‐Hua , Liu Chao‐Pu
Published: January 2020

Background

Blunt cardiac injury (BCI) increases with traffic accidents and is an important cause of death in trauma patients. In particular, for patients who need surgical treatment, the mortality rate is extremely high unless the patient is promptly operated on. This study aimed to explore early recognition and expeditious surgical intervention to increase survival.

Methods

All patients with BCIs during the past 15 years were reviewed, and those who underwent operative treatment were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome.

Results

A total of 348 patients with BCIs accounted for 18.3% of 1903 patients with blunt thoracic injury (BTI). Of 348 patients, 43 underwent operative treatment. The main cause of injury was traffic accidents, with an incidence of 48.8%. Of them, steering wheel injuries occurred in 15 patients. In 26 patients, a preoperative diagnosis was obtained by echocardiography, CT scanning, etc. In the remaining 17, who had to undergo urgent thoracotomy without any preoperative imaging, a definitive diagnosis of BCI was proven during the operation. The volume of preoperative infusion or crystalloid was <1000 ml in 31 cases. Preoperative pericardiocentesis was not used in anyone. In 12 patients, the operation commenced within 1 h. Overall mortality was 32.6%. The death was caused by BCI in 9.

Conclusions

Facing a patient with BTI, a high index of suspicion for BCI must be maintained. To manage those requiring operations, early recognition and expeditious thoracotomy are essential. Preoperatively, limited fluid resuscitation is emphasized. We do not advocate preoperative pericardiocentesis.
YARS as an oncogenic protein that promotes gastric cancer progression through activating PI3K-Akt signaling
Authors: Zhang Cheng , Lin Xiaoting , Zhao Qian , Wang Yakun , Jiang Fangli , Ji Congcong , Li Yanyan , Gao Jing , Li Jian , Shen Lin
Published: January 2020

Purpose

Members of the aaRS (aminoacyl-tRNA synthetase) family are proteins controlling the aminoacylation process, in which YARS (tyrosyl-tRNA synthetase) catalyzes the binding of tyrosine to its cognate tRNA and plays an important role in basic biosynthesis. Several studies have demonstrated the association between YARS mutation and certain developmental abnormalities/diseases, yet YARS’s linkage with cancer remains uncategorized. In this study, by combining in silico, in vitro, and in vivo studies, we explored the expressions and functions of YARS in gastric cancer (GC).

Methods

We evaluated YARS’s distribution in tumor and paired normal tissues/specimens of GC by referring to large cohort online datasets and patient-derived tissue specimens. YARS-related changes were assessed by phenotypical/molecular experiments and RNA-sequencing analysis in GC cell lines harboring YARS knockdown or overexpression.

Results

Both the transcript and protein levels of YARS were evidently higher in gastric cancer tissues than in paired normal tissues. YARS knockdown induced repressed proliferation and invasiveness, as well as enhanced apoptosis in GC cell lines, while abnormally upregulating YARS expression promoted gastric cancer growth in vivo. We inferred based on RNA-sequencing that YARS modulates multiple cancerous signaling pathways and proved through cellular experiments that YARS promoted GC progression, as well as homologous recombination by activating PI3K-Akt signaling.

Conclusions

By revealing the existence of a YARS-PI3K-Akt signaling axis in gastric cancer, we discovered that tRNA synthetase YARS is a novel tumorigenic factor, characterized by its upregulation in tumor-derived specimens, as well as its functions in promoting gastric cancer progression.
Measurement of the degree of polarisation of thermally modified Scots pine using a Stokes imaging polarimeter
Authors: Niskanen Ilpo , Räty Jukka , Soetedjo Hariyadi , Hibino Kenichi , Oohashi Hiroshi , Heikkilä Rauno , Matsuda Kiyofumi , Otani Yukitoshi
Published: January 2020

This study measured the polarised light reflected from the surface of thermally modified Scots pine (Pinus sylvestris L.) wood using a Stokes imaging polarimeter. The data were analysed using the Mueller matrix method. The Scots pine boards were heat treated in an oven at temperatures of 160 ºC, 200 ºC and 220 ºC, with a heat treatment time of 3 h at the maximum temperature. The results indicated that the chemical composition of the thermally modified wood underwent a permanent transformation, leading to a change in the degree of polarisation of the reflected light. The presented method provides useful information for inspecting the quality of thermally modified wood products.
Incorporating self-reported health measures in risk equalization through constrained regression
Authors: Withagen-Koster A. A. , van Kleef R. C. , Eijkenaar F.
Published: January 2020

Most health insurance markets with premium-rate restrictions include a risk equalization system to compensate insurers for predictable variation in spending. Recent research has shown, however, that even the most sophisticated risk equalization systems tend to undercompensate (overcompensate) groups of people with poor (good) self-reported health, confronting insurers with incentives for risk selection. Self-reported health measures are generally considered infeasible for use as an explicit ‘risk adjuster’ in risk equalization models. This study examines an alternative way to exploit this information, namely through ‘constrained regression’ (CR). To do so, we use administrative data (N = 17 m) and health survey information (N = 380 k) from the Netherlands. We estimate five CR models and compare these models with the actual Dutch risk equalization model of 2016 which was estimated by ordinary least squares (OLS). In the CR models, the estimated coefficients are restricted, such that the under-/overcompensation for groups based on self-reported general health is reduced by 20, 40, 60, 80, or 100%. Our results show that CR can improve outcomes for groups that are not explicitly flagged by risk adjuster variables, but worsens outcomes for groups that are explicitly flagged by risk adjuster variables. Using a new standardized metric that summarizes under-/overcompensation for both types of groups, we find that the lighter constraints can lead to better outcomes than OLS.
Worlds apart or two sides of the same coin? Attitudes, meanings, and motives of potential oocyte and sperm donors in Austria
Authors: Flatscher-Thöni M. , Böttcher B. , Geser W. , Lampe A. , Werner-Felmayer G. , Voithofer C. , Schusterschitz C.
Published: January 2020

Purpose

Gamete donors and recipients of such donations have been explored by previous studies, which mostly focus on post-donation scenarios. Our study analyses the general willingness to donate oocytes or sperm and focuses on differences between potential female and male donors in attitudes, meanings, and motives in a pre-donation setting.

Methods

An electronic survey (n = 555 students) was used in this anonymous observational study. To enable comparisons between men and women regarding their attitudes, meanings, and motives and their willingness to donate gametes, we designed two separate questionnaires.

Results

The sample was divided into three groups based on the willingness to donate: potential donors (n = 133; women: 48.1%, men: 51.9%); doubtful donors (n = 207; women: 75.8%, men: 24.2%); and non-donors (n = 215; women: 68.3%, men: 31.7%). The group of potential male donors (39.2%) was significantly larger than the group of potential female donors (16.9%). Significant differences regarding altruism, the meaning of one’s self-worth, and passing on the own genes were found between doubtful and potential donors. Potential donors attached less value to altruism but more value to the enhancement of one’s self-worth and passing on one’s genes than doubtful donors. The motive of passing on one’s genes and altruistic motives were more important to men than to women.

Conclusion

This study helps to create a better understanding of potential donors in the existing donation framework and supports the evaluation of the given regimes in the context of designing an improved framework.
The risk of cross-border pollution and the influence of regional climate on the rainwater chemistry in the Southern Carpathians, Romania
Authors: Keresztesi Ágnes , Nita Ion-Andrei , Birsan Marius-Victor , Bodor Zsolt , Szép Róbert
Published: January 2020

The aim of this study is the assessment of rainwater composition, regarding the various sources of major ions and heavy metals, taking into account the characteristic atmospheric circulations and the main air mass transport routes. Rainwater samples were analyzed for pH, electrical conductivity, major ions, and heavy metals. At all sampling sites, the most abundant anions were SO42ˉ and Clˉ, while the dominant cations were Ca2+ and Mg2+. Regarding heavy metals, the dominance of Pb and Cd was found. The contribution of soil dust from the mining activities and the dissolution of CaCO3, MgCO3, and CaSO4·2H2O in the rainwater explains the high concentrations of Ca2+, Mg2+, and SO42−. The overall precipitation contamination with heavy metals at the three sampling sites was assessed by the degree of contamination, showing that Pb and Cd presents the highest risks of all heavy metals. The values of toxicity potential suggested an elevated risk for human health in case of rainwater ingestion, especially in rural areas. Spearman correlation and PCA indicated that the chemical characteristic of the rainwater is primarily controlled by sources such as agricultural activities, mixed and crustal sources, traffic, and other anthropogenic, industrial influences, mining activities, smelting operations, coal combustion, and metal production.
Epitaxial Growth and Optically Pumped Stimulated Emission in AlGaN/InGaN Ultraviolet Multi-Quantum-Well Structures
Authors: Chen Ping , Park Young Jae , Liu Yuh-Shiuan , Detchprohm Theeradetch , Yoder P. Douglas , Shen Shyh-Chiang , Dupuis Russell D.
Published: January 2020

The thermal effect of the growth temperature on interface morphology and stimulated emission in ultraviolet AlGaN/InGaN multiple quantum wells (MQWs) are experimentally investigated. During the MOCVD epitaxial growth of AlGaN/InGaN MQWs, the ramping rate from a lower temperature for InGaN quantum wells (QWs) to a higher one for AlGaN quantum barriers (QBs) is intentionally changed from 1.0°C/s to 4.0°C/s. Atomic force microscopy images show that the surface morphology of InGaN QWs, which is improved by a thermal effect when the growth temperature rises to the set value of the AlGaN QBs, varies with different temperature ramping rates. The results of stimulated emission indicate that the threshold pumping power density of MQWs is decreased with increasing temperature ramping rate from 1.0°C/s to 3.0°C/s and then slightly increased when the ramping rate is 4.0°C/s. This phenomenon is believed to result from the thermal degradation effect during the temperature ramp step. A long-time high-temperature annealing will reduce the density of indium-rich microstructures as well as the corresponding localized state density, which is assumed to contribute to the radiative recombination in the InGaN QWs. Given the great difference between optimal growth temperatures for AlGaN and InGaN layers, a higher ramping rate would be more appropriate for the growth of ultraviolet AlGaN/InGaN MQWs.
Battery Technologies for Grid-Level Large-Scale Electrical Energy Storage
Authors: Fan Xiayue , Liu Bin , Liu Jie , Ding Jia , Han Xiaopeng , Deng Yida , Lv Xiaojun , Xie Ying , Chen Bing , Hu Wenbin , Zhong Cheng
Published: January 2020

Grid-level large-scale electrical energy storage (GLEES) is an essential approach for balancing the supply–demand of electricity generation, distribution, and usage. Compared with conventional energy storage methods, battery technologies are desirable energy storage devices for GLEES due to their easy modularization, rapid response, flexible installation, and short construction cycles. In general, battery energy storage technologies are expected to meet the requirements of GLEES such as peak shaving and load leveling, voltage and frequency regulation, and emergency response, which are highlighted in this perspective. Furthermore, several types of battery technologies, including lead–acid, nickel–cadmium, nickel–metal hydride, sodium–sulfur, lithium-ion, and flow batteries, are discussed in detail for the application of GLEES. Moreover, some possible developing directions to facilitate efforts in this area are presented to establish a perspective on battery technology, provide a road map for guiding future studies, and promote the commercial application of batteries for GLEES.
Cutaneous squamous cell carcinoma
Authors: Seidl-Philipp Magdalena , Nguyen Van Anh
Published: January 2020

Cutaneous squamous cell carcinoma (cSCC) accounts for approximately 20% of all skin cancers. Its rising incidence represents a major public health concern. The majority of cSCC are curable by surgical resection. Although less than 5% of cSCC patients develop metastases or local recurrence after complete excision, advanced cSCC is difficult to treat. Until recently, no standard therapeutic regimen for advanced cSCC exists. Traditional therapies include chemotherapy and EGFR-targeted therapy, but their clinical benefit remains modest and has been demonstrated mostly in retrospective studies. On the contrary, PD-1 inhibitors dramatically improve outcomes in many immunocompetent cSCC patients, resulting in the approval of cemiplimab as the first FDA-approved systemic drug for patients with locally advanced or metastatic cSCC who are not candidates for curative surgery or radiation. In the coming years combination therapies are an emerging treatment strategy that could improve efficacy of PD-1 inhibitors in advanced cSCC. Moreover, several prospective controlled trials have been designed to explore the potential role of PD-1 inhibitors in the adjuvant and neodjuvant setting. Given the paucity of data, the management of immunocompromised cSCC patients requires a heightened awareness in this new era of cancer therapeutics.
Preoperatieve (directe) anticoagulantia en secundaire bloedingen na TURP
Authors: van der Velde-Kemmeren Angelique A. T. M. , Zwaan Peter J. , Bossema Ercolie R.
Published: January 2020

Samenvatting

Een transurethrale resectie van de prostaat (TURP) wordt uitgevoerd ter behandeling van een goedaardige prostaatvergroting. In dit onderzoek is nagegaan of er een relatie is tussen preoperatief gebruik van (directe) orale anticoagulantia ((D)OAC) en secundaire bloedingen na een TURP. Hiertoe zijn van alle mannen die in 2016 of 2017 in Gelre ziekenhuizen een bipolaire TURP ondergingen gegevens verzameld over preoperatief (D)OAC-gebruik, secundaire bloedingen en heropnamen tot vier weken postoperatief. Bij 15 % van de 376 geïncludeerde patiënten ontstond een secundaire bloeding, namelijk bij 24 % met preoperatief OAC-gebruik (met name DOAC) en bij 9 % zonder preoperatief OAC-gebruik (p < 0,001). Bij 5 % was heropname nodig, namelijk bij 7 % met preoperatief OAC-gebruik (met name DOAC) en bij 3 % zonder preoperatief OAC-gebruik (p = 0,10). Patiënten die een TURP ondergaan en preoperatief OAC gebruiken, in het bijzonder DOAC, hebben dus mogelijk een verhoogd risico op een secundaire bloeding. Verder onderzoek met meer patiënten is echter nodig om de resultaten te bevestigen.
Bayesian network Fisher kernel for categorical feature spaces
Authors: Leppä-aho Janne , Silander Tomi , Roos Teemu
Published: January 2020

We address the problem of defining similarity between vectors of possibly dependent categorical variables by deriving formulas for the Fisher kernel for Bayesian networks. While both Bayesian networks and Fisher kernels are established techniques, this result does not seem to appear in the literature. Such a kernel naturally opens up the possibility to conduct kernel-based analyses in completely categorical feature spaces with dependent features. We show experimentally how this kernel can be used to find subsets of observations that we see as representative for the underlying Bayesian network model.