bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Affect Balance on Cognitive and Physical Function in Adults With and Without Fibromyalgia
Authors: Quinn Taylor , Aquino Jordan , Marelich William , Rutledge Dana N. , Zettel‐Watson Laura , Cherry Barbara J.
Published: August 2021

Objective

To identify the potential benefits of heightened levels of affect balance in older adults with and without chronic pain on various cognitive domains, physical performance, and perceived cognitive and physical health.

Method

Ninety‐one older adults, some with and some without fibromyalgia (FM) participated. Objective tests included cognitive (immediate and delayed recall, delayed recognition—CERAD 10‐item word list) and physical measures (Fullerton Advanced Balance Scale; lower body strength—30‐s chair stand; gait velocity—30‐ft. walk). Self‐report measures were problems with forgetting, activities of daily living (perceived function), and affect (Positive and Negative Affect Scale [PANAS]). Affect balance was calculated as positive minus negative affect from the PANAS.

Results

Hierarchical regression analyses revealed that—regardless of FM status—higher affect balance was associated with better episodic memory performance (immediate recall, delayed recognition), better balance, enhanced lower body strength (more chair stands), and healthier gait (30‐ft. walk), as well as less forgetfulness and better perceived functional health.

Conclusion

Increased affect balance was associated with better objective and subjective health in older adults both without and with chronic pain. Positive psychology treatments which increase affect balance are easy to administer, cost effective, and may add an important, additional treatment modality for maintaining health in normal aging adults as well as those with chronic pain.

Clinical Relevance

In order to help patients with healthy aging, nurses need to be aware of the potential long‐term effect of emotional state on overall function and be able to counsel patients regarding potential treatments to enhance positive global emotions such as resilience.
Obstructive sleep apnea and injury events in Taiwanese adults: A retrospective cohort study
Authors: Lin Chia‐Ling , Su Mei‐Chen , Lin Chun‐Ping , Sun Chien‐An , Chung Chi‐Hsiang , Chien Wu‐Chien
Published: August 2021

Purpose

The aim of this study was to examine the association between obstructive sleep apnea (OSA) diagnosis and diverse types of injuries.

Design

This population‐based retrospective cohort study compared records from 2000 to 2013 in the Taiwan National Health Insurance Research Database.

Methods

3025 patients identified with OSA were compared against the control cohort consisting of 12,100 age‐ and sex‐matched patients. Cox proportional hazards regression analysis was performed to estimate the effects of OSA on injury risk.

Findings

Patients with OSA exhibited a significantly higher overall incidence of injury of 2599 per 100,000 person‐years compared to the control cohort (2248 per 100,000 person‐years). After the confounding factors were considered, subjects with OSA showed a higher risk of injury than subjects in the control group (adjusted hazard ratio [HR] = 1.78, 95% confidence interval [CI] = 1.64–1.93). The risk of unintentional injury (traffic, poisoning, falls) and intentional injury (suicide) in the group of patients with OSA was higher than that in the controls.

Conclusions

Our study strongly supports the conclusion that adults with OSA are at increased risk of injury.

Clinical relevance

The present results indicate the significance of OSA as a predictor of injury risk, which will provide valuable information for clinical practice and injury prevention.
The need for improved management of status epilepticus in children in Australia: Time from seizure onset to treatment is consistently delayed
Authors: Uppal Preena , Cardamone Michael , Fonseca Bob , Briggs Nancy , A Lawson John
Published: August 2021

Aim

To determine if the management of paediatric status epilepticus (SE) follows accepted clinical practice guidelines.

Methods

Retrospective, consecutive series of patients with SE who attended the emergency departments from two NSW sites over a 12‐month period. SE was defined as a convulsive seizure, 5 min or more in duration. Time to presentation to the ED, time to first‐ and second‐line treatment, number of benzodiazepine (BZD) doses given prior to intubation and adherence to guidelines were evaluated. The outcomes included seizure duration, need for respiratory support, admission to intensive care, morbidity and mortality.

Results

The time from onset of seizure to ED presentation was a median (p25–p75) time of 22 (15–40) min. Forty‐eight of 59 presentations received pre‐hospital midazolam. The median (p25–p75) time to first‐line treatment was 15 (8–25) min and to second‐line treatment was 43.5 (35–59) min. There was no significant difference in the results in the two hospitals. The total number of BZD doses ranged from 1 to 7 (median 3). There was non‐adherence to the clinical practice guidelines in 55 (93.2%) of 59 presentations.

Conclusions

We found excessive benzodiazepine use and delay in both definitive treatment of status epilepticus and in escalation from first‐ to second‐line anticonvulsant treatment. This raises the need for rapid escalation of treatment. We propose a ‘status epilepticus code’ for emergency departments.
Evaluation of antimicrobial prescriptions in dogs with suspected bacterial urinary tract disease
Authors: Weese Jeffrey Scott , Webb Jinelle , Ballance Dennis , McKee Talon , Stull Jason W. , Bergman Philip J.
Published: August 2021

Background

Antimicrobials are commonly used to treat urinary tract disease in dogs. Understanding antimicrobial use is a critical component of antimicrobial stewardship efforts.

Hypothesis/Objectives

To evaluate antimicrobial prescriptions for dogs diagnosed with acute cystitis, recurrent cystitis, and pyelonephritis.

Animals

Dogs prescribed antimicrobials for urinary tract disease at veterinary practices in the United States and Canada.

Materials and Methods

A retrospective review of antimicrobial prescriptions was performed.

Results

The main clinical concerns were sporadic bacterial cystitis (n = 6582), recurrent cystitis (n = 428), and pyelonephritis (n = 326). Amoxicillin/clavulanic acid (2702, 41%), cefpodoxime (1024, 16%), and amoxicillin (874, 13%) were most commonly prescribed for sporadic bacterial cystitis. The median prescribed duration was 12 days (range, 3‐60 days; interquartile range [IQR], 4 days). Shorter durations were used in 2018 (median, 10 days; IQR, 4 days) compared to both 2016 and 2017 (both median, 14 days; IQR, 4 days; P ≤ .0002).

Amoxicillin/clavulanic acid (146, 33%), marbofloxacin (95, 21%), and cefpodoxime (65, 14%) were most commonly used for recurrent cystitis; median duration of 14 days (range, 3‐77 days; IQR, 10.5 days). Amoxicillin/clavulanic acid (86, 26%), marbofloxacin (56, 17%), and enrofloxacin (36, 11%) were most commonly prescribed for pyelonephritis; however, 93 (29%) dogs received drug combinations. The median duration of treatment was 14 days (range, 3‐77 days; IQR, 11 days).

Conclusions and Clinical Importance

Decreases in duration and increased use of recommended first‐line antimicrobials were encouraging. Common drug choices and durations should still be targets for antimicrobial stewardship programs that aim to optimize antimicrobial use, concurrently maximizing patient benefits while minimizing antimicrobial use and use of higher tier antimicrobials.
Phylogeography of the wide‐host range panglobal plant pathogen Phytophthora cinnamomi
Authors: Shakya Shankar K. , Grünwald Niklaus J. , Fieland Valerie J. , Knaus Brian J. , Weiland Jerry E. , Maia Cristiana , Drenth André , Guest David I. , Liew Edward C.Y. , Crane Colin , Chang Tun‐Tschu , Fu Chuen‐Hsu , Minh Chi Nguyen , Quang Thu Pham , Scanu Bruno , von Stowasser Eugenio Sanfuentes , Durán Álvaro , Horta Jung Marilia , Jung Thomas
Published: August 2021

Various hypotheses have been proposed regarding the origin of the plant pathogen Phytophthora cinnamomi. P. cinnamomi is a devastating, highly invasive soilborne pathogen associated with epidemics of agricultural, horticultural and forest plantations and native ecosystems worldwide. We conducted a phylogeographic analysis of populations of this pathogen sampled in Asia, Australia, Europe, southern and northern Africa, South America, and North America. Based on genotyping‐by‐sequencing, we observed the highest genotypic diversity in Taiwan and Vietnam, followed by Australia and South Africa. Mating type ratios were in equal proportions in Asia as expected for a sexual population. Simulations based on the index of association suggest a partially sexual, semi‐clonal mode of reproduction for the Taiwanese and Vietnamese populations while populations outside of Asia are clonal. Ancestral area reconstruction provides new evidence supporting Taiwan as the ancestral area, given our sample, indicating that this region might be near or at the centre of origin for this pathogen as speculated previously. The Australian and South African populations appear to be a secondary centre of diversity following migration from Taiwan or Vietnam. Our work also identified two panglobal, clonal lineages PcG1‐A2 and PcG2‐A2 of A2 mating type found on all continents. Further surveys of natural forests across Southeast Asia are needed to definitively locate the actual centre of origin of this important plant pathogen.
Healthier and more sustainable diets: What changes are needed in high‐income countries?
Authors: Steenson Simon , Buttriss Judith L.
Published: August 2021

Debate persists around the food production and dietary changes needed to improve sustainability of our global food system. We reviewed 29 studies in high‐income countries that used various methodologies to define a healthier, more sustainable diet. Diets aligned with dietary guidelines, containing less meat and higher amounts of plant‐derived foods (vegetables, pulses [beans/lentils], fruit, wholegrains, nuts, seeds) would likely offer environmental benefits (~20–50% lower greenhouse gas emissions [GHGE] and land use) and improve population health, although may not reduce water footprint. Changes in consumption of milk products and eggs were inconsistent in optimisation studies, perhaps reflecting trade‐offs between their nutrient contribution and environmental impact. Foods high in fat, salt and/or sugar, and beverages (e.g. tea, coffee and fruit juices) contributed substantially to environmental footprints in some studies. Vegetarian and vegan diets may deliver larger environmental benefits, but are unlikely to be widely adopted, and may reduce intakes and/or bioavailability of some essential nutrients (e.g. iron, zinc, iodine and B12). We recommend adherence to existing government dietary guidelines as a more realistic goal to improve environmental (e.g. 30% lower GHGE in the UK) and health impacts of diets, recognising that adherence is currently relatively poor. Wider considerations include: context‐specific nutritional, health, cost and cultural needs; need for public engagement to understand barriers/motivators; better understanding of the wider implications and trade‐offs linked to dietary and food system changes and how these can be managed, so that benefits in high‐income countries do not come at the expense of greater ‘outsourced’ environmental impacts in other regions.
The fragility of randomized placebo‐controlled trials for irritable bowel syndrome
Authors: Williams MaryJane O. , Sedarous Mary , Dennis Brittany , Dlamini Vanessa , Nwaiwu Obioma , Nguyen Linda , Okafor Philip N.
Published: August 2021

Background

The fragility index (FI) represents the number of participants whose status in a trial would have to change from a non‐event (not experiencing the primary endpoint) to an event (experiencing the primary endpoint) in order to turn a statistically significant result into a non‐significant result. We sought to evaluate the fragility indices of irritable bowel syndrome [IBS‐mixed (IBS‐M), IBS‐constipation (IBS‐C), & IBS‐diarrhea (IBS‐D)] trials.

Methods

Irritable bowel syndrome trials published in high‐impact journals were identified from Medline. Trials had to be in adults, randomized, parallel‐armed, with at least one statistically significant binary outcome, and an achieved primary endpoint of therapeutic efficacy. FI and correlation coefficients were calculated, and regression modeling used to identify predictors of a high FI.

Key Results

Twelve trials were analyzed with a median FI of 6 (range: 0–38). Median sample size in all trials was 366 (range: 44–856). Trial publication year (p = 0.71), journal impact factor (p = 0.52), duration of study (p = 0.12), and number need to treat [NNT] (p = 0.29) were not predictive of a high FI. While a lower p‐value correlated with a higher FI (p = 0.039), no correlation was noted between FI and impact factor (R = −0.20, p = 0.52), trial publication year (R = 0.12, p = 0.71), duration of trial (R = −0.46, p = 0.13), NNT (R = −0.34, p = 0.29), and sample size (R = 0.23, p = 0.5). The highest FI was in a Ramosetron trial (FI = 30) for IBS‐D.

Conclusion & Inferences

A median of six participants is needed to nullify results in the included IBS trials suggesting how easily statistical significance based on a threshold p‐value may be overturned.
An invasive alien Proteaceae lures some, but not all nectar‐feeding bird pollinators away from native Proteaceae in South African fynbos
Authors: Adedoja O. , Erckie L. , Boatwright J. S. , van Wyk E. , Geerts S.
Published: August 2021

Invasive alien plants often influence pollinator visitation to native plants when sharing pollinator guilds. It is of conservation concern when the invasive alien plant is characterized by floral resources that attract pollinators, thereby reducing the reproductive success of native species. This is well studied for insects, but whether the same is true for bird pollinators is largely unknown. We address this by considering the impact of an invasive alien plant (Banksia speciosa) on visitation rates of nectar‐feeding bird pollinators to native Protea compacta in the Cape Floristic Region of South Africa.

We determined bird pollinator visitation rate to B. speciosa and P. compacta over 21 h of observation at three sites. We also quantified how visitation rate influenced reproductive success of both study species through different breeding experiments.

Sugarbird visitation to P. compacta was significantly lower in the presence of B. speciosa, while there was no effect for sunbirds as they mostly avoided B. speciosa. Protea compacta had higher nectar volumes and sucrose per flower than B. speciosa. Sucrose per hectare was higher in all P. compacta plots compared to B. speciosa. Neither study species is pollen limited and they are self‐compatible to some extent. But pollinator visitation enhanced seed production in both species.

We show here that the invasive alien B. speciosa flowers attract sugarbirds – but not sunbirds – away from native P. compacta. The long‐term effect of reduced pollinator visitation may reduce the fitness of P. compacta, but the long‐term demographic impact is unknown and would require further study.
State‐ledbricolage and the extension of collective governance: Hybridity in the Swiss skill formation system
Authors: Graf Lukas , Strebel Alexandra , Emmenegger Patrick
Published: August 2021

This paper explores the extension of collective governance to sectors without collective governance tradition. We introduce the concept of state‐led bricolage to analyze the expansion of the Swiss apprenticeship training system – in which employer associations fulfill core collective governance tasks – to economic sectors in which training had previously followed a school‐based and state‐oriented logic. In deindustrializing societies, these sectors are key for the survival of collectively governed training systems. Through a mixed‐methods analysis, we examine the reform process that led to the creation of new intermediary organizations that enable collective governance in these sectors. In addition, we compare the organizational features of these organizations with the respective organizations in the traditional crafts and industry sectors. We find that the new organizations result from state‐led bricolage. They are hybrid organizations that reflect some of the bricoleur's core policy goals and critically build on the combination of associational and state‐oriented institutional logics.
High B‐cell activating factor levels in multi‐transfused thalassemia patients
Authors: Watanaboonyongcharoen Phandee , Akkawat Benjaporn , Tohthong Thanida , Rojnuckarin Ponlapat
Published: August 2021

Objectives

To assess the associations between B‐cell activating factor (BAFF) and alloimmunisation in multi‐transfused thalassemia.

Background

Red blood cell (RBC) alloimmunisation is a complication of multi‐transfused thalassemia. BAFF is promoting B cells that produce alloantibodies.

Methods/Materials

Multi‐transfused thalassemia, 15 years or older, were recruited in the cohort study. Alloantibodies and BAFF levels were analysed.

Results

Of 114 patients, the overall prevalence of RBC alloimmunisation was 29.8%. The most common alloantibodies were anti‐E, anti‐Mia and anti‐c. BAFF levels were different among the three groups; the patients with baseline alloantibodies (median ± interquartile range 1251 ± 474 pg/ml), without alloantibodies (1098 ± 453) and healthy controls (719 ± 306), p < 0.001. The BAFF level was elevated in the >25 years old patients (vs. the <25, p = 0.011) and the buffy‐coat‐reduced blood recipients (vs. the pre‐storage leukocyte‐depletion, p = 0.005). Absolute lymphocyte count was higher in the patients without baseline alloantibodies (vs. with baseline alloantibodies, p = 0.049) and the splenectomised patients (vs. the non‐splenectomised patients, p < 0.001). Of the 72 patients without baseline antibodies, four who developed new antibodies showed no statistically different BAFF levels compared with those without new antibodies after 40‐month follow‐up (1296 ± 734 vs. 1062 ± 460, p = 0.491). In multivariate analysis, BAFF to absolute lymphocyte ratio was independently associated with RBC alloimmunisation (odds ratio 3.07, 95% confidence interval 1.124–8.369, p = 0.029).

Conclusion

B‐cell activating factor (BAFF) levels were elevated in multi‐transfused thalassemia and the BAFF to absolute lymphocyte ratio was associated with red blood cell (RBC) alloimmunisation.
The intragenic suppressor mutation Leu59Phe compensates for the effect of detrimental mutations in the jasmonate receptor COI1
Authors: Song Susheng , Liu Bei , Zhai Jiaqi , Zhang Yue , Wang Kai , Qi Tiancong
Published: August 2021

The phytohormones jasmonates (JAs) control plant development, growth, and defense against insects and pathogens. The Arabidopsis JA receptor Coronatine Insensitive 1 (COI1) interacts with ARABIDOPSIS SKP‐LIKE1 (ASK1)/ASK2 to form the SCFCOI1 E3 ligase and mediate JA responses. Here, we performed a genetic suppressor screen using the leaky coi1‐2 (COI1Leu245Phe) mutant for restored sensitivity to JA, and identified the intragenic suppressor mutation Leu59Phe, which was in the region connecting the F‐box and leucine‐rich repeats domains of COI1. The L59F substitution not only restores the COI1L245F function, but also the COI1Gly434Glu (coi1‐22rsp) function in JA responses, through recovering their interactions with ASK1 or ASK2 and their protein levels. The L59F change itself could not enhance the interactions between COI1 and ASK1/2, nor affect JA responses. The present study reveals that the Leu59Phe substitution compensates for the effect of some deleterious mutations in the JA receptor COI1.
Prior secondary cell wall formation is required for gelatinous layer deposition and posture control in gravi‐stimulated aspen
Authors: Takata Naoki , Tsuyama Taku , Nagano Soichiro , Baba Kei'ichi , Yasuda Yuko , Sakamoto Shingo , Mitsuda Nobutaka , Taniguchi Toru
Published: August 2021

Cell walls, especially secondary cell walls (SCWs), maintain cell shape and reinforce wood, but their structure and shape can be altered in response to gravity. In hardwood trees, tension wood is formed along the upper side of a bending stem and contains wood fiber cells that have a gelatinous layer (G‐layer) inside the SCW. In a previous study, we generated nst/snd quadruple‐knockout aspens (Populus tremula × Populus tremuloides), in which SCW formation was impaired in 99% of the wood fiber cells. In the present study, we produced nst/snd triple‐knockout aspens, in which a large number of wood fibers had thinner SCWs than the wild type (WT) and some had no SCW. Because SCW layers are always formed prior to G‐layer deposition, the nst/snd mutants raise interesting questions of whether the mutants can form G‐layers without SCW and whether they can control their postures in response to changes in gravitational direction. The nst/snd mutants and the WT plants showed growth eccentricity and vessel frequency reduction when grown on an incline, but the triple mutants recovered their upright growth only slightly, and the quadruple mutants were unable to maintain their postures. The mutants clearly showed that the G‐layers were formed in SCW‐containing wood fibers but not in those lacking the SCW. Our results indicate that SCWs are essential for G‐layer formation and posture control. Furthermore, each wood fiber cell may be able to recognize its cell wall developmental stage to initiate the formation of the G‐layer as a response to gravistimulation.
A retrospective comparison of first and second opinion histopathology with patient outcomes in veterinary oncology cases (2011–2019)
Authors: Laliberté Sarah M. , Poirier Valerie J. , Pinard Christopher J. , Hocker Samuel E. , Foster Robert A.
Published: August 2021

Mandatory second opinion histopathology is common practice in human surgical pathology. It is intended to confirm the original diagnosis or identify clinically significant discrepancies, which could alter the course of disease, cost of treatment, patient management or prognosis. This retrospective analysis aimed to evaluate agreement between first and second opinion histopathology cases, examine their correlation with natural history of disease and investigate the rationale for pursuing this test. Medical records from 2011 to 2019 were reviewed, identifying 109 cases where second opinion histopathology was sought. Reasons for seeking second opinion and clinical disease course were also reviewed to determine whether case progression favoured first or second opinion findings in cases of diagnostic disagreement. Diagnostic disagreement was found in 49.5% of cases. Complete diagnostic disagreement (a change in degree of malignancy or tumour type) occurred in 15.6% cases and partial disagreement (a change in tumour subtype, grade, margins and mitotic count) occurred in 33.9%. Major disagreement (a change in diagnosis resulting in alteration of treatment recommendations) occurred in 38.5% of cases. The most common reasons for seeking second opinion were an atypical/poorly differentiated tumour (31.2%; 34/109) or a discordant clinical picture (24.8%; 27/109). Among cases with any form of disagreement, natural history of disease favoured second opinion findings in 33.3%. The first opinion was favoured over the second in a single case. These findings reinforce previous literature supporting a role for second opinion histopathology in optimizing therapy and predicting outcomes in veterinary oncology, particularly in cases where diagnosis is in question based on the overall clinical picture.
Estudo do metamorfismo nas formações proterozóicas no quadrilátero Ferrífero, MG
Authors: Pires F.R.M. , Bertolino L.C.
Published: August 2021

The study of the metamorphism of Proterozoic units of the Quadrilátero Ferrífero is revisited in terms of the historical evolution and the application of the carbonate geothermometry method. Previous work indicates an eastward increase of the metamorphic grade and the relative distribuition of the chlorite, biotite, kyanite and staurolite zones. Oxygen isotope and carbonate geothermometry values corroborate previous investigations. Microprobe analysis of coexisting calcite and dolomite indicate attainment of exchange equilibrium for samples of Aguas Claras, Morro Agudo mines and Dom Bosco area. Temperatures of equilibrium obtained from calcite-dolomite pairs range from 283ºC to 547º.
Os equinóides albianos (cretáceo inferior) do Brasil e seu possível valor estratigráfico
Authors: Brito Ignacio Machado
Published: August 2021

The occurrence of Albian Echinoids in Brazil has been reported in the Santana Formation (Araripe basin), the Riachuelo Formation (Sergipe basin) and the Algodões Formation (Camamu basin). In this paper we discuss the possibility of a wide distribution of the brazilian species in other continents such as North America and West Africa.
Comprehensive Characterization Investigation of Multiple Time-Varying Rock-Fluid Properties in Waterflooding Development
Authors: Lin Jingqi , Jiang Ruizhong , Shen Zeyang , Wang Qiong , Cui Yongzheng , Ni Qingdong , Zhang Fengbo
Published: August 2021

In this paper, the characterization parameter “effective displacement flux” is employed to describe the flushing intensity, and a new numerical simulator in which the rock-fluid properties considered functions of the effective displacement flux is developed based on the black oil model. Additionally, a conceptual reservoir model is established to validate the effective characterization of the time-varying mechanisms: the time-varying oil viscosity can characterize the viscous fingering of the water phase and the time-varying absolute permeability can present the aggravation of reservoir heterogeneity, the alteration of wettability is characterized with the time-varying relative permeability, and the ultimate recovery will increase with the combined effect of all three time-varying factors. Eventually, the new simulator is applied to the simulation of an actual waterflooding reservoir to illustrate the assistance in history matching. The simulation results of our simulator can readily match the history data, which proves that the consideration of comprehensive time-varying rock-fluid properties can significantly improve the accuracy during the numerical simulation of waterflooding reservoirs.
Update on
Shigella
and Nontyphoidal Salmonella Antimicrobial Drug Resistance: Implications on Empirical Treatment of Acute Infectious Diarrhea in Cambodia
Authors: Poramathikul Kamonporn , Wojnarski Mariusz , Sok Somethy , Sokh Vannara , Chiek Sivhour , Seng Heng , Krang Sidonn , Ly Sovann , Nou Samon , Chann Soklyda , Sornsakrin Siriporn , Lurchachaiwong Woradee , Kuntawunginn Worachet , Lertsethtakarn Paphavee , Farmer Aaron , Swierczewski Brett , Waters Norman , Demons Samandra , Vesely Brian , Prom Satharath , Lon Chanthap , Bodhidatta Ladaporn
Published: August 2021

Information on causative diarrheal pathogens and their associated antimicrobial susceptibility remains limited for Cambodia. This study describes antimicrobial resistance patterns for
Shigella
and nontyphoidal
Salmonella
isolates collected in Cambodia over a 5-year period.
Deletion of Yersinia pestis
ail
Causes Temperature-Sensitive Pleiotropic Effects, Including Cell Lysis, That Are Suppressed by Carbon Source, Cations, or Loss of Phospholipase A Activity
Authors: Kolodziejek Anna M. , Hovde Carolyn J. , Bohach Gregory A. , Minnich Scott A.
Published: August 2021

The Gram-negative pathogen
Yersinia pestis
transitions between a flea vector (ambient temperature) and a mammalian host (37°C). In response to 37°C,
Y. pestis
modifies its outer membrane (OM) by reducing the fatty acid content in lipid A, changing the outer leaflet from being predominantly hexaacylated to being predominantly tetraacylated.
Epidemiology of paediatric pain-related visits to emergency departments in the USA: a cross-sectional study
Authors: Anderson Jana L , Oliveira J. e Silva Lucas , Funni Shealeigh A. , Bellolio Fernanda , Jeffery Molly Moore
Published: August 2021

Objective

To describe the epidemiology of paediatric pain-related visits to emergency departments (EDs) across the USA.

Design

Cross-sectional study.

Setting

A representative sample of US ED visits using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS).

Participants

Paediatric (age ≤18 years) ED visits in the 2017 NHAMCS data set.

Data analysis

Each visit was coded as pain-related or non-pain-related using the ‘reason for visit’ variable. Weighted proportions were calculated with 95% CIs. Logistic regression was used to compare odds of pain-related visits.

Outcome measures

Prevalence of pain-related visits among paediatric ED visits.

Results

There were an estimated 35 million paediatric ED visits in the USA in 2017, 55.6% (CI 53.3% to 57.8%) were pain related, which equates to 19.7 million annual visits. The prevalence of pain-related visits reached more than 50% of visits at age 6–7 and plateaued at relatively high proportions. Children of races other than white or black had lower odds of having a pain-related visit (OR 0.48, CI 0.29 to 0.81) than white children, as did children who were black, though the difference was not statistically significant (OR 0.88, CI 0.73 to 1.06). Relative to children covered by private insurance, children with Medicaid or CHIP (Children’s Health Insurance Program) coverage had lower odds of a pain-related visit (OR 0.75, CI 0.60 to 0.93). Injuries represented 46.5% (CI 42.0% to 51.0%) of pain-related visits. Pain scores were reported in less than 50% of pain-related visits.

Conclusion

Pain is the reason for visit in 55.6% of paediatric ED visits across the USA. The prevalence of pain-related visits peak before adolescence and it continues relatively high until the age 18. Injury, racial disparities in pain and poor pain score reporting should remain major topics of study in the paediatric population.
Treatment of postoperative delirium with continuous theta burst stimulation: study protocol for a randomised controlled trial
Authors: Wei Xiaoyi , Wang Meijuan , Ma Xin , Tang Tianyi , Shi Jingqing , Zhao Di , Yuan Tifei , Xie Zhongcong , Shen Yuan
Published: August 2021

Introduction

Postoperative delirium is one of the most common postoperative complications among elderly patients (65 years old or older). However, there are no effective treatments for this condition. Recent research suggests that continuous theta burst stimulation (cTBS), a non-invasive brain stimulation, can reduce pain level, improve cognitive function and affective symptoms in multiple diseases or dysfunctions, including anxiety disorders, major depressive disorder, sleep disorders and pain. But the potential benefits of cTBS in reducing postoperative delirium have not been investigated. Therefore, we propose determining whether cTBS can prevent and/or treat postoperative delirium in senior patients.

Methods and analysis

The study will be a double-blind, randomised controlled trial. Participants (65 years old or older) undergoing scheduled orthopaedic surgery (≥2 hours, general anaesthesia) will be randomised to receive either cTBS or sham stimulation with a focal figure-of-eight coil over the right dorsolateral prefrontal cortex at 80% of the resting motor threshold. Every patient will receive 2–3 sets of stimulations during postoperative days (40 s per session, 3 sessions per set, 1 set per day). Participants will be assessed twice daily by a research assistant blinded to allocation. The primary outcome will be the incidence of postoperative delirium measured by the Confusion Assessment Method on postoperative days 1, 2 and 3. The secondary outcomes will be the severity and duration of postoperative delirium, cognitive function, pain, sleep quality, activities of daily living, length of hospital stay, discharge-to-facility or home, and rate of complication and mortality during the hospital stay.

Ethics and dissemination

Ethical approval has been obtained from the ethics committee of Shanghai 10th People’s Hospital. The principal investigator will submit a research progress report to the ethics committee regularly. All participants will provide written informed consent. Study results will be published in a peer-reviewed journal.

Trial registration number

NCT04661904.
Adapting behavioural interventions to compensate for cognitive dysfunction in persons with opioid use disorder
Authors: Mistler Colleen B , Shrestha Roman , Gunstad John , Sanborn Victoria , Copenhaver Michael M
Published: August 2021

Treatment for opioid use disorder (OUD) is often in the context of biobehavioural interventions, consisting of medication for OUD (for example, methadone and buprenorphine), which is accompanied by psychoeducation and/or behavioural therapies. Patients with OUD often display weaknesses in cognitive function that may impact the efficacy of such behavioural interventions.

A review of the literature was conducted to: (1) describe common cognitive dysfunction profiles among patients with OUD, (2) outline intervention approaches for patients with OUD, (3) consider the cognitive demands that interventions place on patients with OUD and (4) identify potential accommodation strategies that may be used to optimise treatment outcomes.

Cognitive profiles of patients with OUD often include weaknesses in executive function, attention, memory and information processing. Behavioural interventions require the patients’ ability to learn, understand and remember information (placing specific cognitive demands on patients). Accommodation strategies are, therefore, needed for patients with challenges in one or more of these areas. Research on accommodation strategies for patients with OUD is very limited. We applied research from populations with similar cognitive profiles to form a comprehensive collection of potential strategies to compensate for cognitive dysfunction among patients with OUD. The cognitive profiles and accommodation strategies included in this review are intended to inform future intervention research aimed at improving outcomes among patients with OUD.
Association between cardiologist evaluation and mortality in myocardial injury after non-cardiac surgery
Authors: Park Jungchan , Oh Ah Ran , Kwon Ji-hye , Kim Sojin , Kim Jeayoun , Yang Kwangmo , Choi Jin-Ho , Kim Kyunga , Ahn Joonghyun , Sung Jidong , Lee Seung-Hwa
Published: August 2021

Objective

Myocardial injury after non-cardiac surgery (MINS) is strongly associated with mortality, but few studies assessed treatment strategies. This study aimed to identify whether evaluation by cardiologists could reduce mortality in MINS patients.

Methods

From a single-centre retrospective cohort, we enrolled a total of 5633 adult patients diagnosed with MINS between January 2010 and June 2019. The patients were divided into two groups based on evaluation by cardiologist, which was defined as a cardiology consultation or transfer to the cardiology department. For the outcome, 30-day mortality was compared in crude and propensity-score matched populations.

Results

Of a total of 5633 patients, 2120 (37.6%) were evaluated by cardiologists and 3513 (62.4%) were not. Mortality during the first 30 days after surgery was significantly lower in MINS patients who were evaluated by cardiologists compared with those who were not (5.8% vs 8.3%; HR, 0.64; 95% CI 0.51 to 0.80; p<0.001 for all-cause mortality and 1.6% vs 2.0; HR 0.62; 95% CI 0.40 to 0.96; p=0.03 for cardiovascular mortality). The propensity score matched analysis showed similar results (5.6% vs 8.6%; HR 0.64; 95% CI 0.50 to 0.81; p<0.001 for all-cause mortality and 1.3% vs 2.2%; HR 0.58; 95% CI 0.35 to 0.95; p=0.03 for cardiovascular mortality).

Conclusions

Cardiologist evaluation was associated with lower mortality in patients diagnosed with MINS. Further studies are needed to identify effective treatment strategies for MINS.

Trial registration number

KCT0004244.
3D few cycle optical pulses in carbon nanotube-based photonic crystal with allowance for mechanical stress
Authors: Dvuzhilova Yu. V. , Dvuzhilov I. S. , Belonenko M. B. , Galkina E. N.
Published: August 2021

This paper constructs and numerically analyzes a theoretical model of three-dimensional few cycle optical pulse dynamics in semiconductor carbon nanotube-based spatially-modulated refractive index medium. It takes into account external deformation in terms of the gauge theory. It identifies the stable propagation of that kind of pulses in photonic crystal. The paper also reveals the dependence of pulse dynamics on photonic crystal characteristics (refractive index depth and modulation period in particular).
Attention, Consciousness, and Linguistic Cooperation with AI
Authors: Montemayor Carlos
Published: August 2021

Contemporary debates on Artificial General Intelligence (AGI) center on what philosophers classify as descriptive issues. These issues concern the architecture and style of information processing required for multiple kinds of optimal problem-solving. This paper focuses on two topics that are central to developing AGI regarding normative, rather than descriptive, requirements for AGIs epistemic agency and responsibility. The first is that a collective kind of epistemic agency may be the best way to model AGI. This collective approach is possible only if solipsistic considerations concerning phenomenal consciousness are ignored, thereby focusing on the cognitive foundation that attention and access consciousness provide for collective rationality and intelligence. The second is that joint attention and motivation are essential for AGI in the context of linguistic artificial intelligence. Focusing on GPT-3, this paper argues that without a satisfactory solution to this second normative issue regarding joint attention and motivation, there cannot be genuine AGI, particularly in conversational settings.
A Square Equal-Area Map Projection with Low Angular Distortion, Minimal Cusps, and Closed-Form Solutions
Authors: Petroff Matthew A.
Published: August 2021

A novel square equal-area map projection is proposed. The projection combines closed-form forward and inverse solutions with relatively low angular distortion and minimal cusps, a combination of properties not manifested by any previously published square equal-area projection. Thus, the new projection has lower angular distortion than any previously published square equal-area projection with a closed-form solution. Utilizing a quincuncial arrangement, the new projection places the north pole at the center of the square and divides the south pole between its four corners; the projection can be seamlessly tiled. The existence of closed-form solutions makes the projection suitable for real-time visualization applications, both in cartography and in other areas, such as for the display of panoramic images.
A Practical Approach to Subset Selection for Multi-objective Optimization via Simulation
Authors: Currie Christine S. M. , Monks Thomas
Published: August 2021

We describe a practical two-stage algorithm, BootComp, for multi-objective optimization via simulation. Our algorithm finds a subset of good designs that a decision-maker can compare to identify the one that works best when considering all aspects of the system, including those that cannot be modeled. BootComp is designed to be straightforward to implement by a practitioner with basic statistical knowledge in a simulation package that does not support sequential ranking and selection. These requirements restrict us to a two-stage procedure that works with any distributions of the outputs and allows for the use of common random numbers. Comparisons with sequential ranking and selection methods suggest that it performs well, and we also demonstrate its use analyzing a real simulation aiming to determine the optimal ward configuration for a UK hospital.
Combining Polygon Schematization and Decomposition Approaches for Solving the Cavity Decomposition Problem
Authors: Cicerone Serafino , D’emidio Mattia , Frigioni Daniele , Pascucci Filippo Tirabassi
Published: August 2021

The
cavity decomposition problem
is a computational geometry problem, arising in the context of modern electronic CAD systems, that concerns detecting the generation and propagation of electromagnetic noise into multi-layer printed circuit boards. Algorithmically speaking, the problem can be formulated so as to contain, as sub-problems, the well-known
polygon schematization
and
polygon decomposition
problems. Given a polygon
P
and a finite set
C
of given directions, polygon schematization asks for computing a
C
-oriented polygon
P
′ with “low complexity” and “high resemblance” to
P
, whereas polygon decomposition asks for partitioning
P
into a set of basic polygonal elements (e.g., triangles) whose size is as small as possible.

In this article, we present three different solutions for the cavity decomposition problem, which are obtained by suitably combining existing algorithms for polygon schematization and decomposition, by considering different input parameters, and by addressing both methodological and implementation issues. Since it is difficult to compare the three solutions on a theoretical basis, we present an extensive experimental study, employing both real-world and random data, conducted to assess their performance. We rank the proposed solutions according to the results of the experimental evaluation, and provide insights on natural candidates to be adopted, in practice, as modules of modern printed circuit board design software tools, depending on the observed performance and on the different constraints on the desired output.
Temporal Geo-Social Personalized Keyword Search Over Streaming Data
Authors: Almaslukh Abdulaziz , Kang Yunfan , Magdy Amr
Published: August 2021

The unprecedented rise of social media platforms, combined with location-aware technologies, has led to continuously producing a significant amount of geo-social data that flows as a user-generated data stream. This data has been exploited in several important use cases in various application domains. This article supports geo-social personalized queries in streaming data environments. We define temporal geo-social queries that provide users with real-time personalized answers based on their social graph. The new queries allow incorporating keyword search to get personalized results that are relevant to certain topics. To efficiently support these queries, we propose an indexing framework that provides lightweight and effective real-time indexing to digest geo-social data in real time. The framework distinguishes highly dynamic data from relatively stable data and uses appropriate data structures and a storage tier for each. Based on this framework, we propose a novel geo-social index and adopt two baseline indexes to support the addressed queries. The query processor then employs different types of pruning to efficiently access the index content and provide a real-time query response. The extensive experimental evaluation based on real datasets has shown the superiority of our proposed techniques to index real-time data and provide low-latency queries compared to existing competitors.
Meeting Online Learners Where They Are: e-Learning during a time of pandemic
Authors: Correia Ana-Paula , Hickey Sean , Lepicki Traci , Willis Alicia
Published: August 2021

While adult and workplace training were quick to adopt the use of online learning, many of these efforts have not advanced far beyond taking presentation slides or video recordings from formerly in-person training and making them available on learning-management systems. Compared to formal education, adult and workplace training has been much slower to iterate and improve upon early digital and virtual educational methods, leaving online learning that is viewed as neither engaging for the end-user nor effective at achieving intended outcomes. The COVID-19 pandemic and resulting lockdown added urgency to this problem, with many organizations being forced to either improve upon existing virtual training methods or finally completely replace in-person training with online options. The Ohio State University?s Center on Education and Training for Employment used evidence-based practices to develop a training collection specifically aimed at trainers, learning designers, and learning and development professionals. Translating the latest e-learning research into practical solutions, making use of proven instructional strategies, center learning designers created online training materials that are well-positioned to be effective at engaging adult learners, simultaneously instructing learners and demonstrating the learning content being delivered.
A 36 kg Giant Ovarian Fibroma with Meigs Syndrome: A Case Report and Literature Review of Extremely Giant Ovarian Tumor
Authors: Tanaka Miyu , Yamanoi Koji , Kitamura Sachiko , Horikawa Naoki , Chigusa Yoshitsugu , Horie Akihito , Yamaguchi Ken , Hamanishi Junzo , Kondoh Eiji , Mandai Masaki
Published: August 2021

Ovarian tumors can get extremely giant to occupy the whole abdominal cavity. We report a case of 36 kg solid ovarian tumor, which was the largest ovarian solid tumor that have been ever reported. A 54-year-old woman presented to our hospital with a chief complaint of markedly distended abdominal wall. Preoperative imaging examinations revealed that most of the tumor was uniform and its density was like that of subcutaneous fat. Pleural effusion was detected in the right thoracic region. We organized a multidisciplinary team and successfully resected the right adnexa. The patient had an uneventful postoperative course, and she was discharged on the 7th postoperative day and diagnosed with a fibroma of the ovary with Meigs syndrome. A comprehensive literature search revealed 48 cases of extremely giant ovarian tumor in these 20 years. Six out of 48 cases are solid. Twelve out of 48 cases are malignant or borderline malignant, and patients’ age and tumor size/weight were not related to the frequency of malignancy/borderline malignancy. As many as 4 out of 48 patients died before their first hospital visit or early after surgery. Clinicians should consider a considerable high mortality and frequency of severe surgical complications when planning the treatment strategy for extremely giant ovarian tumors.
Pituitary Macroadenoma and Severe Hypothyroidism: The Link between Brain Imaging and Thyroid Function
Authors: Ciancia Silvia , Cesari Silvia , Predieri Barbara , Bernasconi Sergio , Iughetti Lorenzo
Published: August 2021

In case of primary hypothyroidism, reactive pituitary hyperplasia can manifest as pituitary (pseudo) macroadenoma. We report the case of a 12-year-old boy who was evaluated for impaired growth velocity and increased body weight. Because of low insulin-like growth factor 1 levels and poor response to the growth hormone stimulation test, brain magnetic resonance imaging was performed and a pituitary macroadenoma was found. Treatment with levothyroxine was started, and thyroid function was evaluated approximately every 40 days to titrate the dosage. After few months of therapy, the size of the macroadenoma decreased and growth hormone secretion normalized. The pituitary returned to normal size in approximately 5 years. The boy went through puberty spontaneously and reached a normal adult height. In a patient affected by primary hypothyroidism, reactive pituitary hyperplasia can cause growth hormone deficiency; however, growth hormone secretion usually normalizes after starting levothyroxine treatment. Pituitary macroadenoma can be difficult to distinguish from severe pituitary hyperplasia; however, pituitary macroadenomas are rare in childhood, and our clinical case underlines how the hormonal evaluation is essential to achieve a correct diagnosis and prevent unnecessary surgery in a context of pituitary mass.