bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations of Serum Nonesterified Fatty Acids With Coronary Heart Disease Mortality and Nonfatal Myocardial Infarction: The CHS (Cardiovascular Health Study) Cohort
Authors: Huang Neil K. , Bůžková Petra , Matthan Nirupa R. , Djoussé Luc , Hirsch Calvin H. , Kizer Jorge R. , Longstreth W. T. , Mukamal Kenneth J. , Lichtenstein Alice H.
Published: March 2021

Background

Significant associations have been reported between serum total nonesterified fatty acid (NEFA) concentrations and coronary heart disease (CHD) mortality and incident nonfatal myocardial infarction (MI) in some prospective cohort studies. Little is known about whether individual or subclasses (saturated, polyunsaturated [n‐6 and n‐3], and
trans
fatty acids) of serum NEFAs relate to CHD mortality and nonfatal MI.

Methods and Results

CHS (Cardiovascular Health Study) participants (N=1681) who had no history of MI, angina, or revascularization or were free of MI at baseline (1996–1997) were included. NEFAs were quantified using gas chromatography. Cox regression analysis was used to evaluate associations of 5 subclasses and individual NEFAs with CHD composite (CHD mortality and nonfatal MI), CHD mortality, and incident nonfatal MI. During a median follow‐up of 11.7 years, 266 cases of CHD death and 271 cases of nonfatal MI occurred. In the fully adjusted model, no significant associations were identified between individual NEFA and CHD composite. Exploratory analyses indicated that lauric acid (12:0) was negatively associated (hazard ratio [HR], 0.76; 95% CI, 0.59–0.98;
P
=0.0328) and dihomo‐γ‐linolenic acid (20:3n‐6) was positively associated with CHD mortality (HR, 1.34; 95% CI, 1.02–1.76;
P
=0.0351). Elaidic acid (18:1n‐7
t
) was positively associated with incident nonfatal MI (HR, 1.46; 95% CI, 1.01–2.12;
P
=0.0445). No significant associations were observed for NEFA subclass and any outcomes.

Conclusions

In CHS participants, 2 NEFAs, dihomo‐γ‐linolenic and elaidic acids, were positively associated with CHD mortality and nonfatal MI, respectively, suggesting potential susceptibility biomarkers for risks of CHD mortality and nonfatal MI.
Newly Diagnosed Atrial Fibrillation After Transient Ischemic Attack Versus Minor Ischemic Stroke in the POINT Trial
Authors: Kamel Hooman , Farrant Mary , Easton J. Donald , Sposato Luciano A. , Elm Jordan J. , Underwood Ellen , Johnston S. Claiborne
Published: March 2021

Background

Atrial fibrillation/flutter (AF) after transient ischemic attack (TIA) has not been well studied. We compared the likelihood of new AF diagnosis after ischemic stroke versus TIA.

Methods and Results

The POINT (Platelet‐Oriented Inhibition in New TIA and Minor Ischemic Stroke) trial enrolled adults within 12 hours of minor ischemic stroke or high‐risk TIA. Our exposure was index event type (ischemic stroke versus TIA). The primary analysis used the original trial definition of TIA (resolution of symptoms/signs). In secondary analyses, TIA cases with infarction on neuroimaging were reclassified as strokes. Our primary outcome was a new AF diagnosis, ascertained from adverse event and treatment interruption/discontinuation reports. We calculated C‐statistics for variables associated with newly diagnosed AF. We used Kaplan‐Meier survival statistics and Cox models adjusted for demographics and vascular risk factors. Excluding 49 subjects with baseline AF, 2746 patients had index stroke and 2086 patients had index TIA. During the 90‐day follow‐up, 106 patients had newly diagnosed AF. Cumulative risks of AF were 2.7% (95% CI, 2.1%–3.4%) after stroke and 2.0% (95% CI, 1.5%–2.7%) after TIA (
P
=0.15). After reclassifying index events by neuroimaging, cumulative AF risk was higher after stroke (2.7%; 95% CI, 2.2%–3.4%) than TIA (1.8%; 95% CI, 1.3%–2.5%) (
P
=0.04). Index event type had negligible predictive utility (C‐statistic, 0.54).

Conclusions

Among patients with cerebral ischemia, the distinction between TIA versus minor stroke did not stratify the risk of subsequent AF diagnosis, implying that patients with TIA should undergo similar heart‐rhythm monitoring strategies as patients with ischemic stroke.
Long‐Term Dipeptidyl Peptidase 4 Inhibition Worsens Hypertension and Renal and Cardiac Abnormalities in Obese Spontaneously Hypertensive Heart Failure Rats
Authors: Jackson Edwin K. , Mi Zaichuan , Gillespie Delbert G. , Cheng Dongmei , Tofovic Stevan P.
Published: March 2021

Background

The long‐term effects of dipeptidyl peptidase 4 (DPP4) inhibitors on blood pressure and cardiovascular and renal health remain controversial. Herein, we investigated the extended (>182 days) effects of DPP4 inhibition in a model of spontaneous hypertension, heart failure, diabetes mellitus, obesity and hyperlipidemia.

Methods and Results

Adult obese spontaneously hypertensive heart failure rats (SHHF) were implanted with radio transmitters for measurement of arterial blood pressures. Two weeks later, SHHF were randomized to receive either a DPP4 inhibitor (sitagliptin, 80 mg/kg per day in drinking water) or placebo. At the end of the radiotelemetry measurements, renal and cardiac function and histology, as well as other relevant biochemical parameters, were assessed. For the first 25 days, mean arterial blood pressures were similar in sitagliptin‐treated versus control SHHF; afterwards, mean arterial blood pressures increased more in sitagliptin‐treated SHHF (
P
<0.000001). The time‐averaged mean arterial blood pressures from day 26 through 182 were 7.2 mm Hg higher in sitagliptin‐treated SHHF. Similar changes were observed for systolic (8.6 mm Hg) and diastolic (6.1 mm Hg) blood pressures, and sitagliptin augmented hypertension throughout the light‐dark cycle. Long‐term sitagliptin treatment also increased kidney weights, renal vascular resistances, the excretion of kidney injury molecule‐1 (indicates injury to proximal tubules), renal interstitial fibrosis, glomerulosclerosis, renal vascular hypertrophy, left ventricular dysfunction, right ventricular degeneration, and the ratios of collagen IV/collagen III and collagen IV/laminin in the right ventricle.

Conclusions

These findings indicate that, in some genetic backgrounds, long‐term DPP4 inhibitor treatment is harmful and identify an animal model to study mechanisms of, and test ways to prevent, DPP4 inhibitor–induced pathological conditions.
Water for the Saints of Baghdad: The Hydrology of a Sacred Ottoman Geography
Authors: Husain Faisal H.
Published: March 2021

Following the conquest of Baghdad in 1534, the Ottoman Empire pursued a wide range of policies to maintain the shrines of Muslim saints buried in the province, many of whom were revered by both the Sunni Ottomans and the Shiʿi Safavids. Ottoman endeavors entailed active management of the Tigris and Euphrates waters to provision inland shrines with water and guard those on the riverbanks from damaging floods. With a hydraulic infrastructure, the Ottomans appropriated the memories of the saints of Baghdad and reinforced their territorial claims to the province in the face of a rising Shiʿi power in Persia. The story highlights the political and religious dimensions of water control in a sacred geography as imperial conflicts within Islamdom and Christendom redrew the map of Eurasia.
Random Forest Model to Assess Predictor Importance and Nowcast Severe Storms using High-Resolution Radar–GOES Satellite–Lightning Observations
Authors: Mecikalski John R. , Sandmæl Thea N. , Murillo Elisa M. , Homeyer Cameron R. , Bedka Kristopher M. , Apke Jason M. , Jewett Chris P.
Published: March 2021

Few studies have assessed combined satellite, lightning, and radar databases to diagnose severe storm potential. The research goal here is to evaluate next-generation, 60-second update frequency geostationary satellite and lightning information with ground-based radar to isolate which variables, when used in concert, provide skillful discriminatory information for identifying severe (hail ≥2.5 cm in diameter, winds ≥25 m s–1, tornadoes) versus non-severe storms. The focus of this study is predicting severe thunderstorm and tornado warnings. A total of 2,004 storms in 2014–2015 were objectively tracked with 49 potential predictor fields related to May, daytime Great Plains convective storms. All storms occurred when 1-min Geostationary Operational Environmental Satellite (GOES)–14 “super rapid scan” data were available. The study used three importance methods to assess predictor importance related to severe warnings, and random forests to provide a model and skill evaluation measuring the ability to predict severe storms. Three predictor importance methods show that GOES mesoscale atmospheric motion vector derived cloud-top divergence and above anvil cirrus plume presence provide the most satellite-based discriminatory power for diagnosing severe warnings. Other important fields include Earth Networks Total Lightning flash density, GOES estimated cloud-top vorticity, and overshooting-top presence. Severe warning predictions are significantly improved at the 95% confidence level when a few important satellite and lightning fields are combined with radar fields, versus when only radar data are used in the random forests model. This study provides a basis for including satellite and lightning fields within machine-learning models to help forecast severe weather.
Assessment of engineered nanosilver as an alternative nano-antibiotic in marine water pollution using biomarker of fish cell line
Authors: BiBi Tayyaba , Khan Taj Muhammad
Published: March 2021

A large volume of antibiotics is used in fish farms to treat diseases because the farmed fish are fully affected by diseases and parasites in the aquaculture and particularly in the ocean environment where disease pathogens multiply quickly. The frequent use of these antibiotics in aquaculture has resulted in animal; stress, infection, and their dissemination in the form of antibiotic resistant genes to other bacteria including human and animal pathogens. The problems arising with antibiotics can be overcome by using silver nanoparticles (AgNPs) due to their physiochemical properties and low toxicity. So AgNPs could be combined with antibiotics to induce infections in fish cell lines and to protect dissemination of antibiotics in the form of antibiotics resistant genes. We expose AgNPs on fish cell lines as a new nano-antibacterial agent to investigate and obtain findings in terms of the cell viability and toxicity. The experimental data is analyzed to examine the antibacterial effects of nanosilver as a replacement agent and discuss the complex scenario, drawbacks, techniques, methods, main mechanisms, and procedures to perform antibacterial tests of exposed AgNPs. There would be an attempt to deal with the AgNPs antibacterial therapies for the fish cell lines.
A systematic review and meta-analysis on adoption of WHO-recommended infant feeding practices among HIV positive mothers in Ethiopia
Authors: Dagnew Amare Belachew , Teferi Mulat Dagnew
Published: March 2021

Background

The prevalence of the World Health Organization (WHO) recommended infant feeding practices for HIV exposed infants is low in developing countries. There is no nationwide representative study was done in Ethiopia. Therefore, this study aimed to assess the pooled prevalence of WHO-recommended infant feeding practices among HIV-positive mothers in Ethiopia.

Methods

EMBASE, PubMed, Google Scholar, CINHAL, Web of Science, Cochrane library, and hand searches of references were extensively searched to find out the primary articles. This study was included in all primary articles published in peer review journals regarding the recommended infant feeding practices in Ethiopia. Reviewers were used a standardized Microsoft Excel format to extract the data and analyzed it with Stata 11 version software. The pooled prevalence of recommended infant feeding practices among HIV exposed infants was estimated by a random-effect model. The sources of variation between the studies were identified by the I2 statistics test. Furthermore, the source of heterogeneity was checked by subgroup and meta-regression analyses. Sensitivity analysis was also carried out for included articles to identify extreme values that affect the outcome of pooled results.

Results

A total of twenty-one articles were included in this study. The random effect pooled prevalence of WHO-recommended infant feeding practices in Ethiopia was 82.76% (95% Confidence Interval [CI]: 75.4, 90.11) with the heterogeneity of I2 = 93.7 with a value of p < 0.001. The subgroup analysis result showed that the highest prevalence of WHO-recommended infant feeding practices was observed in the retrospective cohort study design, 89.45%, and the lowest prevalence was found in cross-sectional studies, 80.67%. Mothers who disclosed their HIV serostatus to their spouses OR = 2.88(2.27, 3.66) and attended antenatal care visits OR = 4.62(3.13, 6.83) were more likely to follow the WHO-recommended infant feeding practices than their counterparts.

Conclusion

Two out of ten HIV exposed infants received mixed feeding in Ethiopia. Health professionals should support and counsel HIV positive mothers to disclose their HIV serostatus to their spouses and advertisements in general or community health workers can get this message out to encourage using antenatal care services during the pregnancy period were recommended to increase the adoption of WHO recommended infant feeding practices and decrease their infant’s risk of morbidity, including HIV infection.
Correction to: Development and evaluation of an interactive web-based decision-making programme on relapse management for people with multiple sclerosis (POWER@MS2)—study protocol for a randomised controlled trial
Authors: Rahn Anne Christin , Wenzel Lisa , Icks Andrea , Stahmann Alexander , Scheiderbauer Jutta , Grentzenberg Kristina , Vomhof Markus , Montalbo Joseph , Friede Tim , Heesen Christoph , Köpke Sascha
Published: March 2021

An amendment to this paper has been published and can be accessed via the original article.
Progress towards reduced-crude protein diets for broiler chickens and sustainable chicken-meat production
Authors: Liu Sonia Yun , Macelline Shemil P. , Chrystal Peter V. , Selle Peter H.
Published: March 2021

The prime purpose of this review is to explore the pathways whereby progress towards reduced-crude protein (CP) diets and sustainable chicken-meat production may be best achieved. Reduced-CP broiler diets have the potential to attenuate environmental pollution from nitrogen and ammonia emissions; moreover, they have the capacity to diminish the global chicken-meat industry’s dependence on soybean meal to tangible extents. The variable impacts of reduced-CP broiler diets on apparent amino acid digestibility coefficients are addressed. The more accurate identification of amino acid requirements for broiler chickens offered reduced-CP diets is essential as this would diminish amino acid imbalances and the deamination of surplus amino acids. Deamination of amino acids increases the synthesis and excretion of uric acid for which there is a requirement for glycine, this emphasises the value of so-called “non-essential” amino acids. Starch digestive dynamics and their possible impact of glucose on pancreatic secretions of insulin are discussed, although the functions of insulin in avian species require clarification. Maize is probably a superior feed grain to wheat as the basis of reduced-CP diets; if so, the identification of the underlying reasons for this difference should be instructive. Moderating increases in starch concentrations and condensing dietary starch:protein ratios in reduced-CP diets may prove to be advantageous as expanding ratios appear to be aligned to inferior broiler performance. Threonine is specifically examined because elevated free threonine plasma concentrations in birds offered reduced-CP diets may be indicative of compromised performance. If progress in these directions can be realised, then the prospects of reduced-CP diets contributing to sustainable chicken-meat production are promising.
Safety-enhanced control strategy of a power soft robot driven by hydraulic artificial muscles
Authors: Feng Yunhao , Ide Tohru , Nabae Hiroyuki , Endo Gen , Sakurai Ryo , Ohno Shingo , Suzumori Koichi
Published: March 2021

Power soft robots—defined as novel robots driven by powerful soft actuators, achieving both powerfulness and softness—are potentially suitable for complex collaborative tasks, and an approach to actuating a power soft robot is the McKibben artificial muscle. This study aims to show the potential of hydraulic artificial muscles to be implemented in a power soft robot with high safety, including higher stability against sudden load separation or impact disturbance, and appropriate dynamic compliance. The stability of a manipulator arm driven by hydraulic muscle actuators is experimentally proven to be higher than that of pneumatic muscle actuators when the stored elastic energy is instantaneously released. Therefore, the hydraulic muscle actuator is a better candidate for actuating a power soft robot. By taking advantage of the incompressible liquid medium and the compliant structure of a hydraulic muscle, a second-order impedance control strategy with a braking method is proposed to improve dynamic compliance without sacrificing the safety features of hydraulic muscles. The results show that the manipulator can be easily shifted by a several-kilogram-level external force and react safely against sudden load change with low angular velocity by the proposed impedance control.
Improved PET/MRI accuracy by use of static transmission source in empirically derived hardware attenuation correction
Authors: Farag Adam , Thompson R. Terry , Thiessen Jonathan D. , Prato Frank S. , Théberge Jean
Published: March 2021

Background

Accurate quantification of radioactivity, measured by an integrated positron emission tomography (PET) and magnetic resonance imaging (MRI) system, is still a challenge. One aspect of such a challenge is to correct for the hardware attenuation, such as the patient table and radio frequency (RF) resonators. For PET/MRI systems, computed tomography (CT) is commonly used to produce hardware attenuation correction (AC) maps, by converting Hounsfield units (HU) to a linear attenuation coefficients (LAC) map at the PET energy level 511 keV, using a bilinear model. The model does not address beam hardening, nor higher density materials, which can lead to inaccurate corrections.

Purpose

In this study, we introduce a transmission-based (TX-based) AC technique with a static Germanium-68 (Ge-68) transmission source to generate hardware AC maps using the PET/MRI system itself, without the need for PET or medical CT scanners. The AC TX-based maps were generated for a homogeneous cylinder, made of acrylic as a validator. The technique thereafter was applied to the patient table and posterior part of an RF-phased array used in cardiovascular PET/MRI imaging. The proposed TX-based, and the CT-based, hardware maps were used in reconstructing PET images of one cardiac patient, and the results were analysed and compared.

Results

The LAC derived by the TX-based method for the acrylic cylinder is estimated to be 0.10851 ± 0.00380 cm−1 compared to the 0.10698 ± 0.00321 cm−1 theoretical value reported in the literature. The PET photon counts were reduced by 8.7 ± 1.1% with the patient table, at the region used in cardiac scans, while the CT-based map, used for correction, over-estimated counts by 4.3 ± 1.3%. Reconstructed in vivo images using TX-based AC hardware maps have shown 4.1 ± 0.9% mean difference compared to those reconstructed images using CT-based AC.

Conclusions

The LAC of the acrylic cylinder measurements using the TX-based technique was in agreement with those in the literature confirming the validity of the technique. The over-estimation of photon counts caused by the CT-based model used for the patient table was improved by the TX-based technique. Therefore, TX-based AC of hardware using the PET/MRI system itself is possible and can produce more accurate images when compared to the CT-based hardware AC in cardiac PET images.
Twenty years of drought‐mediated change in snag populations in mixed‐conifer and ponderosa pine forests in Northern Arizona
Authors: Ganey Joseph L. , Iniguez Jose M. , Vojta Scott C. , Iniguez Amy R.
Published: March 2021

Background

Snags (standing dead trees) are important biological legacies in forest systems, providing numerous resources as well as a record of recent tree mortality. From 1997 to 2017, we monitored snag populations in drought-influenced mixed-conifer and ponderosa pine (Pinus ponderosa) forests in northern Arizona.

Results

Snag density increased significantly in both forest types. This increase was driven largely by a pulse in snag recruitment that occurred between 2002 and 2007, following an extreme drought year in 2002, with snag recruitment returning to pre-pulse levels in subsequent time periods. Some later years during the study also were warmer and/or drier than average, but these years were not as extreme as 2002 and did not trigger the same level of snag recruitment. Snag recruitment was not equal across tree species and size classes, resulting in significant changes in species composition and size-class distributions of snag populations in both forest types. Because trees were far more abundant than snags in these forests, the effect of this mortality pulse on tree populations was far smaller than its effect on snag populations. Snag loss rates increased over time during the study, even though many snags were newly recruited. This may reflect the increasing prevalence of white fir snags and/or snags in the smaller size classes, which generally decay faster than snags of other species or larger snags. Thus, although total numbers of snags increased, many of the newly recruited snags may not persist long enough to be valuable as nesting substrates for native wildlife.

Conclusions

Increases in snag abundance appeared to be due to a short-term tree mortality “event” rather than a longer-term pattern of elevated tree mortality. This mortality event followed a dry and extremely warm year (2002) embedded within a longer-term megadrought. Climate models suggest that years like 2002 may occur with increasing frequency in the southwestern U.S. Such years may result in additional mortality pulses, which in turn may strongly affect trajectories in abundance, structure, and composition of snag populations. Relative effects on tree populations likely will be smaller, but, over time, also could be significant.
Psychometric characteristics of the of COVID Stress Scales-Arabic version (CSS-Arabic) in Egyptian and Saudi university students
Authors: Abbady Adel S. , El-Gilany Abdel-Hady , El-Dabee Fathy A. , Elsadek Adel M. , ElWasify Mahmoud , Elwasify Mohamed
Published: March 2021

Background

Mental health sufferings due to the COVID-19 pandemic were reported in many countries worldwide. However, there is a lack of a validated Arabic tool to measure stress related to this pandemic in the Arab countries. This study aims to translate into Arabic and measure the psychometric characteristics of the previously developed English COVID Stress Scales (CSS). Using a forward-backward translation, the CSS was translated into Arabic and 22 jurors assessed its content validity. An online-based survey was carried out among 1080 university students (Egyptian and Saudi) to assess internal consistency and validity of the Arabic version (CSS-Arabic) using Cronbach’s α and factor analysis.

Results

The content validity indices of the scale were 0.943 and 0.932 for both relevance and clarity. The internal consistency of the total CSS-Arabic was satisfactory (with α = 0.94) within the acceptable range for different subscales. Confirmatory factor analysis reveals 5-factor model with 36 retained items similar to the original English CSS.

Conclusions

CSS-Arabic is a reliable and valid self-reporting tool for screening of stress due to COVID-19 among the university students. Further work should be done by healthcare providers to assess the magnitude of the stress during the COVID-19 pandemic.
Evaluation of glycemic abnormalities in children and adolescents with β-thalassemia major
Authors: M. Diab Aliaa , S. Abdelmotaleb Ghada , Abdel-Azim Eid Khaled , Sebaey S. Mostafa Enas , Sabry Ahmed Eman
Published: March 2021

Background

The quality of life of B-thalassemia major (β-TM) patients has improved with the use of frequent blood transfusions. However, this leads to chronic iron overload with its sequelae, as prediabetes and diabetes mellitus. This study aimed to assess insulin resistance and glucose abnormalities in a sample of B-thalassemia major patients in Benha, Egypt.

Results

This case-control study included 40 B-thalassemia major patients on regular blood transfusion and iron chelation. Their ages ranged from 8 to 16 years, and 30 normal age and sex-matched controls. Thorough clinical examination was performed including weight (kg), height (m), body mass index (BMI) (kg/m2), and liver and spleen size. Laboratory investigations were done in the form of complete blood count, liver enzymes, serum ferritin, fasting plasma insulin, and fasting, and 2 h postprandial plasma glucose. Insulin resistance (IR) was calculated using the Homeostasis Model Assessment of insulin resistance (HOMA-IR) index. Insulin resistance was found in 27.5% of thalassemic patients; 18.2% of them had diabetes, 72.7% were prediabetics (with impaired fasting glycemia), and 9.1% had normal fasting and 2 h postprandial plasma glucose level. Insulin resistance increased significantly with increased blood transfusion duration, serum ferritin, liver enzymes, fasting plasma insulin, fasting plasma glucose, and 2 h postprandial plasma glucose (ROC). The curve analysis showed that the duration of blood transfusion, serum ferritin, fasting plasma insulin, fasting, and 2 h postprandial plasma glucose could significantly predict insulin resistance at a certain cut-off point.

Conclusion

Our data show that HOMA-IR can be used to detect insulin resistance in β-TM patients on long-term blood transfusions, especially patients with high serum ferritin and impaired liver enzymes.
Identification and expression analysis of antigenic sites of hepatitis C virus genotype 3a NS3 and NS5A genes of local isolate
Authors: Sabri Sabeen , Khan Muhammad Idrees , Rafique Shazia , Ali Amjad , Khan Muhammad Saleem
Published: March 2021

Background

Hepatitis C virus, a silent killer, has infected 71 million people globally. The recombinant viral antigenic proteins might be used in the early diagnosis of HCV infection. The NS3 and NS5A genes of HCV function in HCV replication and influence host cellular factors that are involved in HCV pathogenesis. The current study was designed to select NS3 and NS5A antigenic sites, amplified, cloned, and expressed in order to find out better assays for diagnosis or drug and vaccine development. The antigenic sites within NS3 and NS5A genes were selected and confirmed through sequencing and were cloned. The antigenic recombinant proteins were expressed in bacterial strain E. coli BL21ply*, and the expression was confirmed by western blotting by using gene-specific and vector-specific antibodies.

Results

Specific antigenic regions within the NS3 and NS5A genes of the HCV 3A genotype were amplified. PCR results showed 328 bp and 747 bp antigenic regions, respectively. The regions were confirmed by DNA sequencing and cloned into a bacterial expression vector. Expression analysis showed 12 kDa and 28 kDa of NS3 and NS5A antigenic recombinant proteins, respectively. Taken together, these studies will help to analyze the genetic variability within the local HCV isolates as these antigenic recombinant proteins were quite important in the screening of HCV-infected patients.

Conclusions

This study might help to enhance the progress in the treatment of HCV infection through the modeling of HCV non-structural genes (NS3 and NS5A) from local isolate, and it might also present the viral genes as potential therapeutic targets.
Using epidemiological evidence to forecast population need for early treatment programmes in mental health: a generalisable Bayesian prediction methodology applied to and validated for first-episode psychosis in England
Authors: McDonald Keltie , Ding Tao , Ker Hannah , Dliwayo Thandiwe Rebecca , Osborn David P.J. , Wohland Pia , Coid Jeremy W. , French Paul , Jones Peter B. , Baio Gianluca , Kirkbride James B.
Published: March 2021

Background

Mental health policy makers require evidence-based information to optimise effective care provision based on local need, but tools are unavailable.

Aims

To develop and validate a population-level prediction model for need for early intervention in psychosis (EIP) care for first-episode psychosis (FEP) in England up to 2025, based on epidemiological evidence and demographic projections.

Method

We used Bayesian Poisson regression to model small-area-level variation in FEP incidence for people aged 16–64 years. We compared six candidate models, validated against observed National Health Service FEP data in 2017. Our best-fitting model predicted annual incidence case-loads for EIP services in England up to 2025, for probable FEP, treatment in EIP services, initial assessment by EIP services and referral to EIP services for ‘suspected psychosis’. Forecasts were stratified by gender, age and ethnicity, at national and Clinical Commissioning Group levels.

Results

A model with age, gender, ethnicity, small-area-level deprivation, social fragmentation and regional cannabis use provided best fit to observed new FEP cases at national and Clinical Commissioning Group levels in 2017 (predicted 8112, 95% CI 7623–8597; observed 8038, difference of 74 [0.92%]). By 2025, the model forecasted 11 067 new treated cases per annum (95% CI 10 383–11 740). For every 10 new treated cases, 21 and 23 people would be assessed by and referred to EIP services for suspected psychosis, respectively.

Conclusions

Our evidence-based methodology provides an accurate, validated tool to inform clinical provision of EIP services about future population need for care, based on local variation of major social determinants of psychosis.
Bedtime Salivary Cortisol as a Screening Test for Cushing Syndrome in Children
Authors: Ueland Grethe Å , Kellmann Ralf , Jørstad Davidsen Melissa , Viste Kristin , Husebye Eystein S , Almås Bjørg , Storr Helen L , Sagen Jørn V , Mellgren Gunnar , Júlíusson Petur B , Methlie Paal
Published: March 2021

Background

Diagnosing Cushing syndrome (CS) can be challenging. The 24-hour urine free cortisol (UFC) measurement is considered gold standard. This is a laborious test, dependent on correct urine collection. Late-night salivary cortisol is easier and is used as a screening test for CS in adults, but has not been validated for use in children.

Objective

To define liquid chromatography tandem mass spectrometry (LC-MS/MS)-based cutoff values for bedtime and morning salivary cortisol and cortisone in children, and validate the results in children with and without CS.

Methods

Bedtime and morning salivary samples were collected from 320 healthy children aged 4 to 16 years. Fifty-four patients from the children’s outpatient obesity clinic and 3 children with pituitary CS were used for validation. Steroid hormones were assayed by LC-MS/MS. Cutoff levels for bedtime salivary cortisol and cortisone were defined by the 97.5% percentile in healthy subjects.

Results

Bedtime cutoff levels for cortisol and cortisone were 2.4 and 12.0 nmol/L, respectively. Applying these cutoff levels on the verification cohort, 1 child from the obesity clinic had bedtime salivary cortisol exceeding the defined cutoff level, but normal salivary cortisone. All 3 children with pituitary CS had salivary cortisol and cortisone far above the defined bedtime cutoff levels. Healthy subjects showed a significant decrease in salivary cortisol from early morning to bedtime.

Conclusions

We propose that bedtime salivary cortisol measured by LC-MS/MS with a diagnostic threshold above 2.4 nmol/L can be applied as a screening test for CS in children. Age- and gender-specific cutoff levels are not needed.
A Case Report on Papillary Muscle Rupture Following Mitral Valve Replacement in the Setting of Previously Undiagnosed Amyloidosis
Authors: Choudhury Nadim , Munoz Acuna Ronny , Chaudhary Omar , Chu Louis , VanderLaan Paul , Mahmood Feroze , Sharkey Aidan
Published: March 2021

This case describes a patient who underwent mitral valve replacement (MVR) surgery with preservation of the subvalvular apparatus who suffered anterolateral papillary muscle rupture (PMR) postseparation from cardiopulmonary bypass. This patient had no history of coronary artery disease (CAD); subsequent pathology of the papillary muscle showed evidence of amyloid deposition. Although most PMRs are caused by ischemia from CAD, cardiac amyloidosis must be considered in the absence of CAD and worked up appropriately as cardiac involvement of amyloidosis, especially the amyloid light-chain (AL) subtype, is prognostic of increased mortality that can be mitigated with therapy.
The Answer to the Silent “Super Spreader”: An Innovative Way to Manage Chest Drains on Coronavirus Patients With Active Air Leaks
Authors: Angeles Clara , Magharious Peter , Cvetkovic Draginja , Weigel Tracey
Published: March 2021

The risk of aerosol transmission has been a key factor for the rapid dissemination of the coronavirus pandemic. Transportation of coronavirus disease 2019 (COVID-19)–infected patients with active air leaks could expose unprotected health care personnel and other patients to aerosolized viral particles. We devised a way to avoid aerosolization while the chest tube drain is on water seal. It involves placing an Ultipor100 viral filter on the suction port of the drain system as well as sealing off the safety valve. This mechanism allows positive pressure from an air leak to escape while on water seal while trapping viral particles.
Behavioral and Experimental Macroeconomics and Policy Analysis: A Complex Systems Approach
Authors: Hommes Cars
Published: March 2021

This survey discusses behavioral and experimental macroeconomics, emphasizing a complex systems perspective. The economy consists of boundedly rational heterogeneous agents who do not fully understand their complex environment and use simple decision heuristics. Central to our survey is the question of under which conditions a complex macro-system of interacting agents may or may not coordinate on the rational equilibrium outcome. A general finding is that under positive expectations feedback (strategic complementarity)—where optimistic (pessimistic) expectations can cause a boom (bust)—coordination failures are quite common. The economy is then rather unstable, and persistent aggregate fluctuations arise strongly amplified by coordination on trend-following behavior leading to (almost-)self-fulfilling equilibria. Heterogeneous expectations and heuristics switching models match this observed micro and macro behavior surprisingly well. We also discuss policy implications of this coordination failure on the perfectly rational aggregate outcome and how policy can help to manage the self-organization process of a complex economic system. (JEL C63, C90, D91, E12, E71, G12)
Planning on the Potomac: A Review Essay on Jason E. Taylor’sDeconstructing the Monolith: The Microeconomics of the National Industrial Recovery Act
Authors: Hausman Joshua K.
Published: March 2021

Taylor (2019) details heterogeneity in the effects of the National Industrial Recovery Act (NIRA) across industries and across time. Through first the President’s Reemployment Act (PRA) and then industry-specific “codes of fair competition,” the NIRA raised wages and restricted working hours. In some—but far from all—cases industries also used a NIRA code to collude, raising prices and restricting output. The effect of the NIRA peaked in fall 1933 and winter 1934; thereafter, compliance declined. I review the intellectual history of the NIRA, the implementation of the PRA and the NIRA codes, and Taylor’s econometric evidence on their effects. I end with a discussion of the implications of Taylor’s book for understanding the effect of the NIRA on US recovery from the Great Depression. (JEL D72, G01, H50, N32, N42)
Computation of epistemic uncertainty due to limited data samples in small field dosimetry using Fuzzy Set Theory
Authors: Chaudhary Rahul Kumar , Kumar Rajesh , Sharma SD , Datta D
Published: March 2021

Objective:

To estimate the epistemic (or fuzzy) uncertainty, arising due to limited data samples in the measurement of the output factors (OFs) of the small fields using Fuzzy Set Theory (FST).

Methods:

EBT3 film samples of size 50 × 50 mm2 were used for the measurement of the OF of stereotactic radiosurgery (SRS) cones of size 4, 6, 7.5, 10, 12.5 and 15 mm diameter, normalized with respect to the output of 100 × 100 mm2 open field size. Three measurements were done per cone/field size. Red color channel was chosen for the dosimetry purpose, net optical density (NOD) was converted to the dose using non-linear relation. To estimate the epistemic uncertainty associated with the measured OFs due to limited number of data samples, a triangular fuzzy number (TFN) was assumed as the fuzziness in the dose delivered by the individual SRS cone/field. Uncertainty in the OF was estimated by applying the Fuzzy Vertex Method (FVM). The membership functions of the OF were constructed for each cone size and the nature of the uncertainty in the OF of the cones was expressed in the terms of its fuzziness. For the sake of completeness of the study, the statistical uncertainty involved in the procedure has also been calculated.

Results:

The statistical and fuzzy uncertainties in the measurement of OF of cones range from 3.28 to 6.25% and 2.58 to 5.44% respectively. The smallest cone of 4 mm has the largest values of statistical and fuzzy uncertainties. The membership functions of the OF for the studied cones were triangular in nature.

Conclusion:

The epistemic uncertainty arising due to limited number of data samples holds a significant fraction of the prescribed dose, and therefore, should not be ignored in the total uncertainty estimation.

Advances in knowledge:

This study highlights the significance of epistemic component of measurement uncertainty arising out due to the insufficient/limited number of measurements of a quantity.
PRISMA flow diagrams for living systematic reviews: a methodological survey and a proposal
Authors: Kahale Lara A. , Elkhoury Rayane , El Mikati Ibrahim , Pardo-Hernandez Hector , Khamis Assem M. , Schünemann Holger J. , Haddaway Neal R. , Akl Elie A.
Published: March 2021

Background: While the PRISMA flow diagram is widely used for reporting standard systematic reviews (SRs), it was not designed for capturing the results of continual searches for studies in living systematic reviews (LSRs). The objectives of this study are (1) to assess how published LSRs report on the flow of studies through the different phases of the review for the different updates; (2) to propose an approach to reporting on that flow.

Methods: For objective 1, we identified all LSRs published up to July 2020. We abstracted information regarding their general characteristics and how they reported on search results. For objective 2, we based our proposal for tailored PRISMA approaches on the findings from objective 1, as well as on our experience with conducting Cochrane LSRs.

Results: We identified 108 living publications relating to 32 LSRs. Of the 108 publications, 7% were protocols, 24% were base versions (i.e., the first version), 62% were partial updates (i.e., does not include all typical sections of an SR), and 7% were full updates (i.e., includes all typical sections of an SR). We identified six ways to reporting the study flow: base separately, each update separately (38%); numbers not reported (32%); latest update separately, all previous versions combined (20%); base separately, all updates combined (7%); latest update version only (3%);  all versions combined (0%). We propose recording in detail the results of the searches to keep track of all identified records. For structuring the flow diagram, we propose using one of four approaches.

Conclusion: We identified six ways for reporting the study flowthrough the different phases of the review for the different update versions. We propose to document in detail the study flow for the different search updates and select one of our four tailored PRISMA diagram approaches to present that study flow.
Statistical Query Algorithms for Mean Vector Estimation and Stochastic Convex Optimization
Authors: Feldman Vitaly , Guzmán Cristóbal , Vempala Santosh
Published: March 2021

Stochastic convex optimization, by which the objective is the expectation of a random convex function, is an important and widely used method with numerous applications in machine learning, statistics, operations research, and other areas. We study the complexity of stochastic convex optimization given only statistical query (SQ) access to the objective function. We show that well-known and popular first-order iterative methods can be implemented using only statistical queries. For many cases of interest, we derive nearly matching upper and lower bounds on the estimation (sample) complexity, including linear optimization in the most general setting. We then present several consequences for machine learning, differential privacy, and proving concrete lower bounds on the power of convex optimization–based methods. The key ingredient of our work is SQ algorithms and lower bounds for estimating the mean vector of a distribution over vectors supported on a convex body in Rd. This natural problem has not been previously studied, and we show that our solutions can be used to get substantially improved SQ versions of Perceptron and other online algorithms for learning halfspaces.
Budget-Management Strategies in Repeated Auctions
Authors: Balseiro Santiago , Kim Anthony , Mahdian Mohammad , Mirrokni Vahab
Published: March 2021

Managing Advertisers’ Budgets in Online Advertising Platforms
Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery
Authors: Ahmed Imran , Chawla Amit , Underwood Martin , Price Andrew J. , Metcalfe Andrew , Hutchinson Charles E. , Warwick Jane , Seers Kate , Parsons Helen , Wall Peter D. H.
Published: March 2021

Aims

Many surgeons choose to perform total knee arthroplasty (TKA) surgery with the aid of a tourniquet. A tourniquet is a device that fits around the leg and restricts blood flow to the limb. There is a need to understand whether tourniquets are safe, and if they benefit, or harm, patients. The aim of this study was to determine the benefits and harms of tourniquet use in TKA surgery.

Methods

We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, and trial registries up to 26 March 2020. We included randomized controlled trials (RCTs), comparing TKA with a tourniquet versus without a tourniquet. Outcomes included: pain, function, serious adverse events (SAEs), blood loss, implant stability, duration of surgery, and length of hospital stay.

Results

We included 41 RCTs with 2,819 participants. SAEs were significantly more common in the tourniquet group (53/901 vs 26/898, tourniquet vs no tourniquet respectively) (risk ratio 1.73 (95% confidence interval (CI) 1.10 to 2.73). The mean pain score on the first postoperative day was 1.25 points higher (95% CI 0.32 to 2.19) in the tourniquet group. Overall blood loss did not differ between groups (mean difference 8.61 ml; 95% CI -83.76 to 100.97). The mean length of hospital stay was 0.34 days longer in the group that had surgery with a tourniquet (95% CI 0.03 to 0.64) and the mean duration of surgery was 3.7 minutes shorter (95% CI -5.53 to -1.87).

Conclusion

TKA with a tourniquet is associated with an increased risk of SAEs, pain, and a marginally longer hospital stay. The only finding in favour of tourniquet use was a shorter time in theatre. The results make it difficult to justify the routine use of a tourniquet in TKA surgery. Cite this article: Bone Joint J 2021;103-B(5):830–839.
Influence of Boundary Conditions on the Accuracy of Pulsation Dampers Characteristics in Analytical Models
Authors: Warzyńska Urszula , Siwulski Tomasz
Published: March 2021

A pressure pulsation phenomenon in positive displacement machinery and resulting from that noise and vibration problems are well-known and still unsolved issues. The article concerns modeling pressure pulsation dampers used for fluid machinery, in particular in gas systems. The currently used mathematical models based on the plane wave theory are verified in the special laboratory conditions with no flow and no wave reflections at the system outlet. The use of a compressor as an excitation source significantly influences the characteristics of a damper installed in a system. In this study, a measurement of common type dampers transmission loss characteristics with the use of pressure transducers is proposed. The article discusses the influence of boundary conditions in analytical models based on the plane wave theory on the accuracy of dampers characteristics. Basing on the measurements results some improvements in the analytical model are proposed.
Xanthogranulomatous pyelonephritis: a rare presentation of disbelieved renal cell cancer recurrence after nephron-sparing surgery
Authors: Abhishek Choube , Kalpesh Parmar , Saket Singh , Naik Bhoopal , Santosh Kumar
Published: March 2021

Xanthogranulomatous pyelonephritis is a rare, painful inflammatory subtype of chronic renal infection, which can lead to severe parenchymal destruction. It imitates virtually every other renal inflammatory disease. We report a 51-year-old male presenting with left flank pain, on evaluation found to have a renal mass with a history of nephron-sparing surgery in the same kidney performed 6 months previously. Radical nephrectomy was carried out and histopathology was suggestive of xanthogranulomatous pyelonephritis rather than renal cell cancer recurrence.
Patterns of referral for fractured nose during major sporting events: a 10-year follow up
Authors: Hamrang-Yousefi S , Kingsley-Smith H , Munroe-Gray T , Anyanechi M , Rollin M
Published: March 2021

Introduction

Nasal fracture is a common form of ear, nose and throat (ENT) trauma with prompt referral required for assessment and potentially manipulation of nasal bones. The aetiology of nasal fracture is multifactorial, and injury occurs across all ages. Previous study has suggested a temporal relationship between nasal injury and major sporting events.

Methods

A total of 1966 adult patients with nasal injuries referred to emergency clinics across three London ENT centres between September 2016 and August 2019 were analysed.

Results

The majority of those referred were male (66.58%). Mean age at referral was 36.29±18.38 in males and 49.14±21.43 in females; 10.27% were 75 years and over. Incidence was highest during April–September 2018 (p=0.02). Mean incidence was higher in this period in the male 16–35 subgroup (p=0.039), with 53.1% of their injuries concentrated between Friday and Sunday.

Conclusions

Most nasal injuries occurred in young males. Mean age at referral was higher in females, and there was slightly increased incidence in over-75s, predominantly females. This incidence could be due to increased longevity or greater tendency to injury in females of this age. The injury patterns across the week also differed, with males injured proportionately more at the weekend. Nasal injury referrals of young men increased around the 2018 summer period, coinciding with the 2018 FIFA World Cup. This lends support to the association between major sporting events and the incidence of nasal injury, particularly in young males.
Caecal volvulus on a background of recurrent caecocolic torsion
Authors: Knowles CH , Walker JA
Published: March 2021

Caecal volvulus is an uncommon cause of intestinal obstruction. Diagnosis may be challenging due to lack of clinical familiarity, variable clinical presentation and misinterpretation of diagnostic imaging and procedures. This case report describes a 29-year-old male with acute intestinal obstruction secondary to caecal volvulus, on a background of recurrent caecocolic torsion. Diagnosis required repeat axial imaging and endoscopy when initial imaging studies were misinterpreted.