bluuebunny/crossref_metadata_2025 huggingface dataset:
VIARS: An Intelligent Voice Agent to Prevent Inappropriate Content Display for Restricted Users
Authors: Kang Rui , Rau Pei-Luen P
Published: July 2022

The wide usage of voice intelligent assistants (VIAs), such as Siri, brings lots of convenience to our daily life. However, there are also kinds of issues related to VIAs displaying inappropriate contents to restricted users such as children. To address this problem, we developed a system that detects the inappropriate contents and rates them with defined ranks. In this manner, a threshold or suggestion could be given in order to avoid displaying inappropriate contents to restricted users. This evaluation system is called Voice Intelligent Aid Rating System (VIARS). With a developed VIARS prototype, we further tested its effectiveness with a designed experiment that consisted of several tasks. As a result, VIARS’s intelligent rating results were proven to be highly consistent with the experts’ manual rating results, indicating the reliability of the VIARS classification mechanism. It is also notable that when compared with experts’ manual rating, VIARS’s automatic rating mechanism showed significant advantages in response time.
Prevalence of femoroacetabular impingement in elite baseball players
Authors: Uquillas Carlos A , Sun Yuhang , Van Sice Wade , ElAttrache Neal S , Banffy Michael B
Published: July 2022

CAM-type femoroacetabular impingement continues to be an underrecognized cause of hip pain in elite athletes. Properties inherent to baseball such as throwing mechanics and hitting may enhance the risk of developing a cam deformity. Our goal is to gain an appreciation of the radiographic prevalence of cam deformities in elite baseball players. Prospective evaluation and radiographs of 80 elite baseball players were obtained during the 2016 preseason entrance examination. A sports medicine fellowship-trained orthopedic surgeon with experience treating hip disorders used standard radiographic measurements to assess for the radiographic presence of cam impingement. Radiographs with an alpha angle >55° on modified Dunn views were defined as cam positive. Of the 122 elite baseball players included in our analysis, 80 completed radiographic evaluation. Only 7.3% (9/122) of players reported hip pain and 1.6% (4/244) had a positive anterior impingement test. The prevalence of cam deformities in right and left hips were 54/80 (67.5%) and 40/80 (50.0%), respectively. The mean alpha angle for cam-positive right and left hips were 64.7 ± 6.9° and 64.9 ± 5.8°, respectively. Outfielders had the highest risk of right-sided cam morphology (Relative Risk (RR) = 1.6). Right hip cam deformities were significantly higher in right-handed pitchers compared with left-handed pitchers (P = 0.02); however, there was no significant difference in left hip cam deformities between left- and right-handed pitchers (P = 0.307). Our data suggest that elite baseball players have a significantly higher prevalence of radiographic cam impingement than the general population.
Ask BERT: How Regulatory Disclosure of Transition and Physical Climate Risks Affects the CDS Term Structure
Authors: Kölbel Julian F , Leippold Markus , Rillaerts Jordy , Wang Qian
Published: July 2022

We use BERT, an AI-based algorithm for language understanding, to quantify regulatory climate risk disclosures and analyze their impact on the term structure in the credit default swap (CDS) market. Risk disclosures can either increase or decrease CDS spreads, depending on whether the disclosure reveals new risks or reduces uncertainty. Training BERT to differentiate between transition and physical climate risks, we find that disclosing transition risks increases CDS spreads after the Paris Climate Agreement of 2015, while disclosing physical risks decreases the spreads. In addition, we also find that the election of Trump had a negative impact on CDS spreads for firms exposed to transition risk. These impacts are consistent with theoretical predictions and economically and statistically significant.
Combined Diagnosis of SARS-CoV-2: Rapid Antigen Detection as an Adjunct to Nucleic Acid Detection
Authors: Li Xuewen , Wang Yiting , Pan Junqi , Xu Jiancheng , Zhou Qi
Published: July 2022

Coronavirus disease 2019 is a serious threat to human life, and early diagnosis and screening can help control the COVID-19 pandemic. The high sensitivity of reverse transcriptase–polymerase chain reaction (RT-PCR) assay is the gold standard for the diagnosis of COVID-19, but there are still some false-negative results. Rapid antigen detection (RAD) is recommended by the World Health Organization (WHO) as a screening method for COVID-19. This review analyzed the characteristics of RDT and found that although the overall sensitivity of RAD was not as high as that of RT-PCR, but RAD was more sensitive in COVID-19 patients within 5 days of the onset of symptoms and in COVID-19 patients with Ct ≤ 25. Therefore, RAD can be used as an adjunct to RT-PCR for screening patients with early COVID-19. Finally, this review provides a combined diagnostic protocol for RAD and nucleic acid testing with the aim of providing a feasible approach for COVID-19 screening.
Of violence and (in)visibility: the securitisation of climate change in international law
Authors: Cusato Eliana
Published: July 2022

Drawing upon critical security studies, I explore the political stakes involved in characterising climate change as a peace and security issue. I argue that international law is involved in the constitution and embedding of specific climate security discourses, which have an impact on whose violence is seen and, thus, condemned.
Functional Performance Outcomes of a Powered Knee–Ankle Prosthesis in Service Members With Unilateral Transfemoral Limb Loss
Authors: Knight Ashley D , Jayaraman Chandrasekaran , Elrod Jonathan M , Schnall Barri L , McGuire Matt S , Sleeman Todd J , Hoppe-Ludwig Shenan , Dearth Christopher L , Hendershot Brad D , Jayaraman Arun
Published: July 2022

Introduction

Clinical knowledge surrounding functional outcomes of a powered knee–ankle (PKA) device is limited, particularly among younger and active populations with limb loss. Here, three service members (SM) with unilateral transfemoral limb loss received an optimally tuned PKA prosthesis and device-specific training.

Materials and Methods

Once proficiency with the PKA device was demonstrated on benchmark activities, and outcomes with the PKA and standard-of-care (SoC) prostheses were obtained via a modified graded treadmill test, 6-minute walk test, and overground gait assessment.

Results

All SM demonstrated proficiency with the PKA prosthesis within the minimum three training sessions. With the PKA versus SoC prosthesis, cost of transport during the modified graded treadmill test was 4.0% ± 5.2% lower at slower speeds (i.e., 0.6-1.2 m/s), but 7.0% ± 5.1% greater at the faster walking speeds (i.e., ≥1.4 m/s). For the 6-minute walk test, SM walked 83.9 ± 13.2 m shorter with the PKA versus SoC prosthesis. From the overground gait assessment, SM walked with 20.6% ± 10.5% greater trunk lateral flexion and 31.8% ± 12.8% greater trunk axial rotation ranges of motion, with the PKA versus SoC prosthesis.

Conclusions

Compared to prior work with the PKA in a civilian cohort, although SM demonstrated faster device proficiency (3 versus 12 sessions), SM walked with greater compensatory motions compared to their SoC prostheses (contrary to the civilian cohort). As such, it is important to understand patient-specific factors among various populations with limb loss for optimizing device-specific training and setting functional goals for occupational and/or community reintegration, as well as reducing the risk for secondary complications over the long term.
Cycle dependence of a quasi-biennial variability in the solar interior
Authors: Mehta T , Jain K , Tripathy S C , Kiefer R , Kolotkov D , Broomhall A-M
Published: July 2022

We investigated the solar cycle dependence on the presence and periodicity of the Quasi-Biennial Oscillation (QBO). Using helioseismic techniques, we used solar oscillation frequencies from the Global Oscillations Network Group (GONG), Michelson Doppler Imager (MDI), and Helioseismic and Magnetic Imager (HMI) in the intermediate-degree range to investigate the frequency shifts over Cycles 23 and 24. We also examined two solar activity proxies, the F10.7 index and the Mg ii index, for the last four solar cycles to study the associated QBO. The analyses were performed using Empirical Mode Decomposition (EMD) and the Fast Fourier Transform (FFT). We found that the EMD analysis method is susceptible to detecting statistically significant Intrinsic Mode Functions (IMFs) with periodicities that are overtones of the length of the data set under examination. Statistically significant periodicities, which were not due to overtones, were detected in the QBO range. We see a reduced presence of the QBO in Cycle 24 compared to Cycle 23. The presence of the QBO was not sensitive to the depth to which the p-mode travelled, nor the average frequency of the p-mode. The analysis further suggested that the magnetic field responsible for producing the QBO in frequency shifts of p-modes is anchored above approximately 0.95 R⊙.
Evolutionary Genomics of a Subdivided Species
Authors: Maruki Takahiro , Ye Zhiqiang , Lynch Michael
Published: July 2022

The ways in which genetic variation is distributed within and among populations is a key determinant of the evolutionary features of a species. However, most comprehensive studies of these features have been restricted to studies of subdivision in settings known to have been driven by local adaptation, leaving our understanding of the natural dispersion of allelic variation less than ideal. Here, we present a geographic population-genomic analysis of 10 populations of the freshwater microcrustacean Daphnia pulex, an emerging model system in evolutionary genomics. These populations exhibit a pattern of moderate isolation-by-distance, with an average migration rate of 0.6 individuals per generation, and average effective population sizes of ∼650,000 individuals. Most populations contain numerous private alleles, and genomic scans highlight the presence of islands of excessively high population subdivision for more common alleles. A large fraction of such islands of population divergence likely reflect historical neutral changes, including rare stochastic migration and hybridization events. The data do point to local adaptive divergence, although the precise nature of the relevant variation is diffuse and cannot be associated with particular loci, despite the very large sample sizes involved in this study. In contrast, an analysis of between-species divergence highlights positive selection operating on a large set of genes with functions nearly nonoverlapping with those involved in local adaptation, in particular ribosome structure, mitochondrial bioenergetics, light reception and response, detoxification, and gene regulation. These results set the stage for using D. pulex as a model for understanding the relationship between molecular and cellular evolution in the context of natural environments.
Thermotaxis of mammalian sperm
Authors: Xiao Wanglong , Yu Mengdi , Yuan Yan , Liu Xingzhu , Chen Ying
Published: July 2022

Sperm are guided through the female reproductive tract. A temperature difference of about 2°C exists between the storage site and fertilization site of the mammalian oviduct, leading to the hypothesis that sperm can sense and swim towards the oocyte along a rising temperature gradient, known as thermotaxis. Research over the past two decades has reported that sperm feature a sophisticated thermal detection system to detect and track ambient temperature gradients. More recently, thermotaxis is expected to be added to the microfluidic isolation method based on sperm tactic responses for sperm selection. In this article, mammalian sperm thermotaxis is discussed, explaining the underlying behavioural mechanisms and molecular basis, according to the latest research. Finally, this article explores the possible application of sperm thermotaxis in ART.
National and Regional Fraction of Cancer Incidence and Death Attributable to Current Tobacco and Water-Pipe Smoking in the Eastern Mediterranean Countries in 2020
Authors: Nemati Saeed , Naji Parnian , Abdi Sepideh , Lotfi Fereshte , Saeedi Elnaz , Mehravar Sepideh A , Fattahi Pedram , Sheikh Mahdi , Vand Rajabpour Mojtaba , Eftekharzadeh Anita , Zendehdel Kazem
Published: July 2022

Introduction

We aimed to calculate the Population Attributable Fraction (PAF) of cancers due to tobacco use in the Eastern Mediterranean Region (EMRO), where water-pipe smoking is prevalent but its effect was not considered in previous studies.

Aims and Methods

We applied Levin’s formula to estimate PAFs of cancers due to tobacco use (defined as all type tobacco including both cigarette and water-pipe). We also calculated PAF of water-pipe smoking separately. Exposure prevalence data were retrieved from representative national and subnational surveys. Data on cancer incidence and death were also and cancer cases were obtained GLOBOCAN 2020. We also obtained associated relative risks from published meta-analyses.

Results

Of the total 715 658 incident adult cancer cases that were reported in 2020 in EMRO, 14.6% (n = 104 800) was attributable to tobacco smoking (26.9% [n = 92 753]) in men versus 3.3% (n = 12 048) in women. Further, 1.0% of incident adult cancers were attributable to current water-pipe use (n = 6825) (1.7% [n = 5568]) in men versus 0.4% (n = 1257 in women).

Conclusions

PAFs of cancers due to tobacco smoking in EMRO were higher in our study than previous reports. This could be due to the neglected role of water-pipe in previous studies that is a common tobacco smoking method in EMRO. The proportion of cancers attributable to water-pipe smoking in EMRO might be underestimated due to lack of research on the risk of cancers associated with water-pipe smoking and also less developed cancer registries in EMRO.

Implications

In this study, we found higher PAFs for cancers due to tobacco smoking in the Eastern Mediterranean (EMR) region than previous reports. This difference could be due to ignoring the role of water-pipe smoking in previous studies. In 2020, 1% of incident cancers and 1.3% of cancer-related deaths in EMRO were attributable to water-pipe smoking. We also found a big difference in PAFs of cancers due to tobacco and water-pipe smoking across EMRO countries, with Tunisia, Lebanon, and Jordan having the highest, and Djibouti, Sudan, and Somalia having the lowest proportions of cancers attributable to tobacco and water-pipe smoking.
Sex and Sexual Identity Differences in Poly-tobacco Use and Psychological Distress in U.S. Adults: Results From the National Health Interview Survey
Authors: Harper Leia A , Beck Kira C , Drazdowski Tess K , Li Christina
Published: July 2022

Introduction

Poly-tobacco use (PTU), or the concomitant use of two or more nicotine and tobacco products, are a growing public health concern. Adults reporting increased psychological distress (PD) experience profound nicotine and tobacco health-related disparities. Sexual minority (SM) adults report more PTU and higher levels of PD than heterosexuals, yet little is known about patterns of nicotine and tobacco use and its relationship to PD in SM populations.

Aims and Methods

The purpose of this study was to investigate sexual identity differences in PD and PTU. Data were drawn from the 2016–2018 National Health Interview Survey (N = 83 017), an annual cross-sectional survey of a nationally representative sample of U.S. adults. PD was assessed using the Kessler Psychological Distress Scale (K6). We fit sex-stratified, weighted, adjusted logistic models to compare PTU and PD by sexual identity.

Results

PTU was more prevalent in adults with higher K6 scores. Female adults and SM adults had significantly higher K6 scores and were significantly more likely to experience serious PD when compared to their male and heterosexual counterparts.

Conclusions

The current study provides a snapshot of trends in PTU in relation to PD, gender, and sexual identity. Findings suggest higher rates of both PD and PTU in SM adults. Further research examining the mechanisms underlying this disparity is critical to the development of effective intervention and prevention strategies.

Implications

Little is known about sex and sexual identity differences in the relations between patterns of tobacco product use and PD. This study is the first to examine the effect of gender and sexual identity on both PD and PTU. SMs reported higher rates of PD and were more likely to be poly-tobacco users. As new ways of engaging nicotine/tobacco continue to proliferate, health risks will endure especially for marginalized populations. An increased understanding of the psychological and social correlates of PTU in SMs is warranted.
Functions of Lipids in Development and Reproduction of Arbuscular Mycorrhizal Fungi
Authors: Kameoka Hiromu , Gutjahr Caroline
Published: July 2022

Arbuscular mycorrhizal fungi (AMF) form mutualistic associations with most land plants. The symbiosis is based on the exchange of nutrients: AMF receive photosynthetically fixed carbon from the plants and deliver mineral nutrients in return. Lipids are important players in the symbiosis. They act as components of the plant-derived membrane surrounding arbuscules, as carbon sources transferred from plants to AMF, as a major form of carbon storage in AMF and as triggers of developmental responses in AMF. In this review, we describe the role of lipids in arbuscular mycorrhizal symbiosis and AMF development.
Cold-induced [Ca2+]cyt elevations function to support osmoregulation in marine diatoms
Authors: Kleiner Friedrich H , Helliwell Katherine E , Chrachri Abdul , Hopes Amanda , Parry-Wilson Hannah , Gaikwad Trupti , Mieszkowska Nova , Mock Thomas , Wheeler Glen L , Brownlee Colin
Published: July 2022

Diatoms are a group of microalgae that are important primary producers in a range of open ocean, freshwater, and intertidal environments. The latter can experience substantial long- and short-term variability in temperature, from seasonal variations to rapid temperature shifts caused by tidal immersion and emersion. As temperature is a major determinant in the distribution of diatom species, their temperature sensory and response mechanisms likely have important roles in their ecological success. We examined the mechanisms diatoms use to sense rapid changes in temperature, such as those experienced in the intertidal zone. We found that the diatoms Phaeodactylum tricornutum and Thalassiosira pseudonana exhibit a transient cytosolic Ca2+ ([Ca2+]cyt) elevation in response to rapid cooling, similar to those observed in plant and animal cells. However, [Ca2+]cyt elevations were not observed in response to rapid warming. The kinetics and magnitude of cold-induced [Ca2+]cyt elevations corresponded with the rate of temperature decrease. We did not find a role for the [Ca2+]cyt elevations in enhancing cold tolerance but showed that cold shock induces a Ca2+-dependent K+ efflux and reduces mortality of P. tricornutum during a simultaneous hypo-osmotic shock. As intertidal diatom species may routinely encounter simultaneous cold and hypo-osmotic shocks during tidal cycles, we propose that cold-induced Ca2+ signaling interacts with osmotic signaling pathways to aid in the regulation of cell volume. Our findings provide insight into the nature of temperature perception in diatoms and highlight that cross-talk between signaling pathways may play an important role in their cellular responses to multiple simultaneous stressors.
Quarantine and serial testing for variants of SARS-CoV-2 with benefits of vaccination and boosting on consequent control of COVID-19
Authors: Wells Chad R , Pandey Abhishek , Gokcebel Senay , Krieger Gary , Donoghue A Michael , Singer Burton H , Moghadas Seyed M , Galvani Alison P , Townsend Jeffrey P
Published: July 2022

Quarantine and serial testing strategies for a disease depend principally on its incubation period and infectiousness profile. In the context of COVID-19, these primary public health tools must be modulated with successive SARS CoV-2 variants of concern that dominate transmission. Our analysis shows that (1) vaccination status of an individual makes little difference to the determination of the appropriate quarantine duration of an infected case, whereas vaccination coverage of the population can have a substantial effect on this duration, (2) successive variants can challenge disease control efforts by their earlier and increased transmission in the disease time course relative to prior variants, and (3) sufficient vaccine boosting of a population substantially aids the suppression of local transmission through frequent serial testing. For instance, with Omicron, increasing immunity through vaccination and boosters—for instance with 100% of the population is fully immunized and at least 24% having received a third dose—can reduce quarantine durations by up to 2 d, as well as substantially aid in the repression of outbreaks through serial testing. Our analysis highlights the paramount importance of maintaining high population immunity, preferably by booster uptake, and the role of quarantine and testing to control the spread of SARS CoV-2.
Charge-based interactions through peptide position 4 drive diversity of antigen presentation by human leukocyte antigen class I molecules
Authors: Jackson Kyle R , Antunes Dinler A , Talukder Amjad H , Maleki Ariana R , Amagai Kano , Salmon Avery , Katailiha Arjun S , Chiu Yulun , Fasoulis Romanos , Rigo Maurício Menegatti , Abella Jayvee R , Melendez Brenda D , Li Fenge , Sun Yimo , Sonnemann Heather M , Belousov Vladislav , Frenkel Felix , Justesen Sune , Makaju Aman , Liu Yang , Horn David , Lopez-Ferrer Daniel , Huhmer Andreas F , Hwu Patrick , Roszik Jason , Hawke David , Kavraki Lydia E , Lizée Gregory
Published: July 2022

Human leukocyte antigen class I (HLA-I) molecules bind and present peptides at the cell surface to facilitate the induction of appropriate CD8+ T cell-mediated immune responses to pathogen- and self-derived proteins. The HLA-I peptide-binding cleft contains dominant anchor sites in the B and F pockets that interact primarily with amino acids at peptide position 2 and the C-terminus, respectively. Nonpocket peptide–HLA interactions also contribute to peptide binding and stability, but these secondary interactions are thought to be unique to individual HLA allotypes or to specific peptide antigens. Here, we show that two positively charged residues located near the top of peptide-binding cleft facilitate interactions with negatively charged residues at position 4 of presented peptides, which occur at elevated frequencies across most HLA-I allotypes. Loss of these interactions was shown to impair HLA-I/peptide binding and complex stability, as demonstrated by both in vitro and in silico experiments. Furthermore, mutation of these Arginine-65 (R65) and/or Lysine-66 (K66) residues in HLA-A*02:01 and A*24:02 significantly reduced HLA-I cell surface expression while also reducing the diversity of the presented peptide repertoire by up to 5-fold. The impact of the R65 mutation demonstrates that nonpocket HLA-I/peptide interactions can constitute anchor motifs that exert an unexpectedly broad influence on HLA-I-mediated antigen presentation. These findings provide fundamental insights into peptide antigen binding that could broadly inform epitope discovery in the context of viral vaccine development and cancer immunotherapy.
Women in rheumatology: major contributions and key discoveries of the twentieth century
Authors: Ishchenko Alla , Scriffignano Silvia , Coates Laura
Published: July 2022

In the twentieth century, rheumatology saw an exponential growth. Discoveries in the pathophysiology of rheumatic diseases, progress in research methodology and novel treatments cardinally changed the natural course of rheumatic diseases and revolutionized patient management. Although underrepresented in this field, women have made considerable input in advancing our specialty towards the new era. In this article we acknowledge key scientific discoveries and major contributions made by 18 brilliant women scientists that shaped the field of rheumatology in the twentieth century. We hope that the achievements of these remarkable women will inspire young rheumatologists and researchers.
ESTIMATION OF PEDIATRIC DOSE DESCRIPTORS ADAPTED TO INDIVIDUAL SPECIFIC SIZE FROM CT EXAMINATIONS
Authors: Abdulkadir Muhammad Kabir , Shuaib Ibrahim Lutfi , Achuthan Anusha , Nasirudin Radin A , Samsudin Ahmad Hadif Zaidin , Osman Noor Diyana
Published: July 2022

Clinical challenges in pediatrics dose estimation by the displayed computed tomography (CT) dose indices may lead to inaccuracy, and thus size-specific dose estimate (SSDE) is introduced for better-personalized dose estimation. This study aims to estimate pediatric dose adapted to specific size. This retrospective study involved pediatric population aged 0–12 y. SSDE was derived from scanner reported volume CT dose index (CTDIvol), based on individual effective diameter (Deff) with corresponding size correction factors. The correlations of Deff with other associated factors such as age, exposure setting, CTDIvol and SSDE were also studied. The average Deff of Malaysian pediatric was smaller than reference phantom size (confidence interval, CI = 0.28, mean = 14.79) and (CI = 0.51, mean = 16.33) for head and abdomen, respectively. These have led to underestimation of pediatric dose as SSDE was higher than displayed CTDIvol. The percentage differences were statistically significant (p < .001) ranged from 0 to 17% and 37 to 60% for head and abdominal CT, respectively. In conclusion, the clinical implementation of SSDE in pediatric CT imaging is highly relevant to reduce radiation risk.
The multiple ‘epidemic’: debating responsibility in US medicine, media and the law
Authors: Lambe Jennifer
Published: July 2022

This article examines the medical, legal and social discourses attached to the so-called multiple ‘epidemic’ in the mid- to late- twentieth-century USA. Such discussions were transformed by the development of the first hormonal remedies for infertility in the early 1960s and the debut of IVF in 1978. These debates, I propose, were shaped by racialised discourses of motherhood on one hand and the market imperatives of US medicine and fertility medicine on the other. These influences coincided to produce a unique emphasis on cost, responsibility and blame in discussions of the multiple ‘epidemic’. In the absence of government regulation, a common response in many European countries, doctors and parents assumed unique ethical burdens in managing multiple pregnancies. Following the debut of multifetal pregnancy reduction in the 1980s, these came to include the difficult decision as to whether they should be brought to term at all.
Comparative associations of oximetry patterns in Obstructive Sleep Apnea with incident cardiovascular disease
Authors: Sutherland Kate , Sadr Nadi , Bin Yu Sun , Cook Kristina , Dissanayake Hasthi U , Cistulli Peter A , de Chazal Philip
Published: July 2022

Study Objectives

Intermittent hypoxia is a key mechanism linking Obstructive Sleep Apnea (OSA) to cardiovascular disease (CVD). Oximetry analysis could enhance understanding of which OSA phenotypes are associated with CVD risk. The aim of this study was to compare associations of different oximetry patterns with incident CVD in men and women with OSA.

Methods

Sleep Heart Health Study data were used for analysis. n = 2878 Participants (51.8% female; mean age 63.5 ± 10.5 years) with OSA (Apnea Hypopnea Index [AHI] ≥ 5 events/h) and no pre-existing CVD at baseline or within the first 2 years of follow-up were included. Four oximetry analysis approaches were applied: desaturation characteristics, time series analysis, power spectral density, and non-linear analysis. Thirty-one resulting oximetry patterns were compared to incident CVD using proportional hazards regression models adjusted for age, race, smoking, BMI, and sex.

Results

There were no associations between OSA oximetry patterns and incident CVD in the total sample or in men. In women, there were some associations between incident CVD and time series analysis (e.g. SpO2 distribution standard deviation, HR 0.81, 95% CI 0.68–0.96, p = 0.014) and power spectral density oximetry patterns (e.g. Full frequency band mean HR 0.75; 95% CI 0.59–0.95; p = 0.015).

Conclusions

Comprehensive comparison of baseline oximetry patterns in OSA found none were related to development of CVD. There were no standout individual oximetry patterns that appear to be candidates for CVD risk phenotyping in OSA, but some showed marginal relationships with CVD risk in women. Further work is required to understand whether OSA phenotypes can be used to predict susceptibility to cardiovascular disease.
Impact of camphor on the in vitro mixed ruminal microorganism fermentation from goats selected for consumption of low and high levels of Juniperus spp. 1
Authors: Seidel Darren S , Walker John W , Musser Jeffrey M , Whitney Travis R , Callaway Todd R
Published: July 2022

Encroaching plant species in West Texas continues to significantly reduce livestock production capacity and cause an imbalance between plant and livestock ecology. Juniperus ashei and Juniperus pinchotii are encroaching species rarely used by browsing animals, mainly due to phytochemical defenses. Juniperus spp. contain large concentrations of monoterpenes in their essential oil profiles to deter herbivory. Since 2003, two divergent bloodlines of meat goats have been selected to consume low or high (LJC or HJC) amounts of juniper foliage, through screening fecal samples with near-infrared reflectance spectroscopy. However, it remains unclear whether HJC goats expressed a physiological ability to consume a greater amount of juniper or if they were colonized by a ruminal microbial population that could detoxify juniper phytochemicals. Therefore, this study aimed to investigate the impact of 0.00 and 1.97 mM of camphor on the mixed ruminal microorganism fermentation after 0, 1, 2, 4, 12, and 24 h of incubation. Five LJC and five HJC goats were fed a juniper-free diet (n = 10) and five LJC and five HJC goats (n = 10), were fed a diet containing 30% fresh J. ashei leaves for 21 days prior to ruminal fluid collection. In vitro fermentations used LJC and HJC, ruminal fluid inoculum was added (33% v/v) to anoxic media in sealed Balch tubes. Total short-chain fatty acid (SCFA) production and acetate to propionate ratio were increased (P < 0.05), but there was no effect on pH (6.56 ± 0.09). Goats that received the juniper-free diet had higher (P < 0.05) SCFA production than juniper-containing diets. There was no consistent difference in LJC and HJC microbial fermentation end products caused by the addition of 1.97 mM of camphor, and goats receiving a juniper-free diet consistently generated more SCFAs in the presence of 1.97 mM of camphor. Furthermore, bloodline differences in juniper consumption were likely related to physiological adaption capacities within the animal and not a ruminal microbial detoxification advantage.
Impact of concentrations of camphor on the in vitro mixed ruminal microorganism fermentation from goats selected for consumption of low and high levels of Juniperus spp.-2
Authors: Seidel Darren S , Walker John W , Musser Jeffrey M , Lourenco Jeferson M , Welch Christina B , Whitney Travis R , Callaway Todd R
Published: July 2022

The microbial population in the gastrointestinal tract of ruminant animals aids in the utilization of forages with high levels of secondary plant compounds. Two divergent bloodlines of meat goats have been selected by screening fecal samples with near-infrared reflectance spectroscopy to assess the goat’s consumption of high or low levels of Juniperus sp. leaves containing several monoterpenes, including camphor. The mechanism by which these goats can consume greater concentrations of Juniperus spp. leaves than their counterparts is unclear, and therefore, this study was designed to determine if differences existed between the ruminal microbial populations of the low and high juniper-consuming bloodlines (LJC vs. HJC) by analyzing their ruminal microbiota and fermentation end products. In the present study, concentrations (0.00, 0.5, 0.99, 1.97, or 5.91 mM) of camphor were added to mixed ruminal microorganism fermentation. Five LJC and five HJC goats were fed a juniper-free diet (n = 10), and five LJC and five HJC goats (n = 10) were fed a diet that contained 30% fresh Juniperus ashei leaves for 21 d prior to ruminal fluid collection. In vitro fermentations used LJC and HJC, ruminal fluid inoculum added (33% v/v) to anoxic media in sealed Balch tubes. Camphor increased (P < 0.05) total short-chain fatty acid (SCFA) concentrations for all but one experimental group. Between the main dietary and bloodline goat effects, the diet was significant for all SCFA results except butyrate. In contrast, bloodline was only significant for acetate and butyrate molar proportions. Rumen fluid from juniper-free-fed goats exhibited greater concentrations of Ruminococcaceae, whereas juniper-fed goats contained more Coriobacteriaceae. Results demonstrated that mixed ruminal microorganisms fermentations from HJC goats did not produce greater concentrations of SCFAs or have the ability to degrade camphor at a higher rate than did that from LJC goats. Results suggest that camphor tolerance from J. ashei, was related to hepatic catabolic mechanisms instead of ruminal microbial degradation; however, further in vivo work is warranted.
Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19
Authors: Gupta Neha , Settle Lisa , Brown Brent R. , Armaignac Donna L. , Baram Michael , Perkins Nicholas E. , Kaufman Margit , Melamed Roman R. , Christie Amy B. , Danesh Valerie C. , Denson Joshua L. , Cheruku Sreekanth R. , Boman Karen , Bansal Vikas , Kumar Vishakha K. , Walkey Allan J. , Domecq Juan P. , Kashyap Rahul , Aston Christopher E. ,   on behalf of the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group
Published: July 2022

OBJECTIVES:

To determine the association of prior use of renin-angiotensin-aldosterone system inhibitors (RAASIs) with mortality and outcomes in hospitalized patients with COVID-19.

DESIGN:

Retrospective observational study.

SETTING:

Multicenter, international COVID-19 registry.

Subjects:

Adult hospitalized COVID-19 patients on antihypertensive agents (AHAs) prior to admission, admitted from March 31, 2020, to March 10, 2021.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Data were compared between three groups: patients on RAASIs only, other AHAs only, and those on both medications. Multivariable logistic and linear regressions were performed after controlling for prehospitalization characteristics to estimate the effect of RAASIs on mortality and other outcomes during hospitalization. Of 26,652 patients, 7,975 patients were on AHAs prior to hospitalization. Of these, 1,542 patients (19.3%) were on RAASIs only, 3,765 patients (47.2%) were on other AHAs only, and 2,668 (33.5%) patients were on both medications. Compared with those taking other AHAs only, patients on RAASIs only were younger (mean age 63.3 vs 66.9 yr; p < 0.0001), more often male (58.2% vs 52.4%; p = 0.0001) and more often White (55.1% vs 47.2%; p < 0.0001). After adjusting for age, gender, race, location, and comorbidities, patients on combination of RAASIs and other AHAs had higher in-hospital mortality than those on RAASIs only (odds ratio [OR] = 1.28; 95% CI [1.19–1.38]; p < 0.0001) and higher mortality than those on other AHAs only (OR = 1.09; 95% CI [1.03–1.15]; p = 0.0017). Patients on RAASIs only had lower mortality than those on other AHAs only (OR = 0.87; 95% CI [0.81–0.94]; p = 0.0003). Patients on ACEIs only had higher mortality compared with those on ARBs only (OR = 1.37; 95% CI [1.20–1.56]; p < 0.0001).

CONCLUSIONS:

Among patients hospitalized for COVID-19 who were taking AHAs, prior use of a combination of RAASIs and other AHAs was associated with higher in-hospital mortality than the use of RAASIs alone. When compared with ARBs, ACEIs were associated with significantly higher mortality in hospitalized COVID-19 patients.
Operationalizing Whole-Person Postpartum Care: Health Care Provider-Level Strategies
Authors: Fahey Jenifer O.
Published: July 2022

Postpartum mothers report feeling unsupported and unprepared by their health care providers to meet the challenges of the postpartum period. This gap perpetuates a cycle of disappointment with and disengagement from postpartum care services. The need to revamp postpartum care has been recognized at the population level but implementing changes at the health care provider level is challenging without practical guidance. The needs of new mothers are broad in scope and variable between individuals, requiring a whole-person care approach that is comprehensive yet nimble. Presented here are provider-level strategies to promote care that both elicits and is responsive to the unique care goals of this population.
Usefulness of the Parental Electronic Diary During Medical Rounds in a NICU
Authors: Taittonen Leena , Pärus Malin , Lahtinen Maija , Ahola Jaana , Bartocci Marco
Published: July 2022

Parental involvement in the care of their baby in family rooms in neonatal intensive care units (NICUs) can be improved. This could be done with an electronic medical report completed by the parents, which is then linked to the patient record system. The parents selected for this study completed an electronic diary during their stay in the NICU, while the staff answered a questionnaire about their opinion on the usefulness of the parents' diary. The length of stay, length of time the baby spent in Kangaroo care, breastfeeding, time given to breastfeeding, feeling of tiredness, the capability of identifying the newborn's signals, and parents' opinion on the diary were variables in the study. The NICU staff's opinion about the usefulness of the diary in decision-making was sought using a questionnaire. Eleven mothers and three fathers completed the diary. The median time for staying in the ward was 20 hours/day. The median time in Kangaroo care was 3 hours/day. The majority of mothers were breastfeeding on average 5 times per day. The commonest length of time for breastfeeding was 1 to 2 hours/day. The parents felt somewhat tired during their stay. All parents recognized their child's signals mostly or all the time. Most parents were happy with the diary. The nursing staff's opinions on the usefulness of the diary too were uniformly positive, whereas the doctors' opinions varied from positive to critical in nature. In conclusion, the diaries provided us with new information about parents' perceptions in the NICU. The nurses found the diary useful whereas the doctors were more critical.
Nonpharmacological Applications During the Retinopathy of Prematurity Examination and Their Effects on Pain Control
Authors: Erçelik Zübeyde Ezgi , Yilmaz Diler
Published: July 2022

Examination for retinopathy of prematurity (ROP) is a very painful procedure. Therefore, pain management is essential given the possibility of sensory and behavioral problems in newborns, who are constantly exposed to painful stimuli. In this light, the use of nonpharmacological methods alone or in combination with pharmacological methods is recommended for pain control. This systematic review and meta-analysis was to evaluate the effects of nonpharmacological treatments on pain during ROP examination. Randomized controlled trials published in English between 2011 and 2021 and available in the electronic databases of Medline, Web of Science, Nursing & Allied Health, and PubMed were reviewed. The meta-analysis was performed using Review Manager 5.4. Six randomized controlled studies were included. Glucose (mean difference [MD]: −1.64, 95% confidence interval [CI]: −2.34 to 0.94, P < .0001) and sucrose (MD: −2.50, 95% CI: −3.20 to −1.79, P < .0001) solutions were effective in reducing pain. However, breast milk did not reduce the Premature Infant Pain Profile score (MD: −2.50, 95% CI: −6.10 to 1.10, P > .05). The application of sucrose and glucose solutions for pain management during ROP examination can be effective and safe.
Oral Ibuprofen Versus Oral Paracetamol in Pain Management During Screening for Retinopathy of Prematurity
Authors: Bulut Ozgul , Tarak Bozkurt Ozge , Arslanoglu Sertac
Published: July 2022

Screening examinations for retinopathy of prematurity (ROP) are critical to reduce ROP-related vision loss; however, the procedure is painful and uncomfortable, and topical anesthetics do not completely suppress the pain responses. The number of safe and effective pharmacological options to reduce pain during eye examinations for ROP screening in preterm infants is limited. This study compared the efficacy of oral ibuprofen and oral paracetamol in reducing pain during screening for ROP in preterm infants. This prospective observational study was conducted at a tertiary-care neonatal intensive care unit. Forty-four preterm infants with gestational age of 32 weeks and less undergoing ROP screening were included. Each enrolled infant received either oral ibuprofen 10 mg/kg (n = 22) or oral paracetamol 10 mg/kg (n = 22) 1 hour before eye examination. The primary outcome measure was pain assessed by the Neonatal Pain, Agitation, and Sedation Scale (N-PASS). Secondary outcome measures were tachycardia, bradycardia, desaturations, and crying time. The groups were similar for gestational age, birth weight, and postnatal age at examination (P > .05). The mean N-PASS scores were not significantly different between the oral ibuprofen and oral paracetamol groups (8.64 ± 1.57 vs 8.50 ± 1.71, respectively, P = .605). Moreover, no significant intergroup differences were observed in the crying time and the incidence of tachycardia/bradycardia and desaturation (P > .05). Ibuprofen or paracetamol administered orally before ROP screening in preterm infants had similar analgesic effects and did not significantly alleviate pain during eye examination.
Electrolytes disturbances in cancer patients
Authors: Turcotte Anna , Achi Sai , Mamlouk Omar , Mandayam Sreedhar
Published: July 2022

Purpose of review

Hypernatremia, hyperphosphatemia, hypocalcaemia, hyperkalaemia and hypermagnesemia are electrolytes disturbances that can arise in cancer patients in relation to unique causes that are related to the cancer itself or its treatment and can lead to delay or interruption of cancer therapy. This article summarizes these main causes, the proposed pathophysiology and the recommended management for these disturbances.

Recent findings

There have been many cancer drugs approved in the field of oncology over the past several years and a subset of these drugs have been associated with electrolytes disturbances. This includes, for example, immune checkpoint inhibitor related hyperkalemia, fibroblast growth factor 23 inhibitor associated hyperphosphatemia and epidermal growth factor receptor inhibitor associated hypomagnesemia and hypocalcaemia.

This article provides an updated review of certain electrolytes disturbance in cancer patients and allows clinicians to have a greater awareness and knowledge of these electrolyte abnormalities in efforts to early recognition and timely management.
High-Dose Midazolam for Pediatric Refractory Status Epilepticus: A Single-Center Retrospective Study*
Authors: Daniels Zachary S. , Srdanovic Nina , Rychlik Karen , Smith Craig , Goldstein Joshua , George Alfred L.
Published: July 2022

Objectives:

We sought to describe the prevalence of midazolam treatment failure in children with refractory status epilepticus (RSE) and define a threshold dose associated with diminishing frequency of seizure cessation.

Design:

Single center retrospective cohort study.

Setting:

Single-center, quaternary-care PICU.

Patients:

Children younger than 18 years old admitted to the PICU from 2009 to 2018 who had RSE requiring a continuous midazolam infusion.

Interventions:

None.

Measurements and Main Results:

We identified individuals with RSE through a data analytics inquiry. Receiver operating characteristic (ROC) curve analysis and Youden’s index were used to assess the midazolam dose threshold associated with the highest sensitivity and specificity in identifying seizure cessation. A logistic regression model was used to determine if there was an association between maximum midazolam dose and seizure cessation. Of the 45 patients who met inclusion criteria for this study, 27 (60%) had seizure cessation with a midazolam infusion, whereas 18 (40%) required an additional pentobarbital infusion for seizure cessation. There was an association between maximum midazolam dose and seizure cessation, with patients more likely to fail treatment when midazolam was administered at higher doses. The maximum midazolam dose displayed high area under the ROC curve value for seizure cessation, and the Youden’s J index cut-off point was 525 μg/kg/hr. Treatment above this dose was associated with diminishing frequency of seizure cessation. The median time spent titrating midazolam above 500 μg/kg/hr for those patients who required pentobarbital for seizure cessation was 3.83 hours (interquartile range, 2.28–5.58 hr).

Conclusions:

In pediatric patients with RSE requiring high dose midazolam, considerable time is spent titrating doses in a range (above 500 µg/kg/hr) that is associated with diminishing frequency of seizure cessation.