bluuebunny/crossref_metadata_2025 huggingface dataset:
Body Mass Index, Sarcopenia, and Their Variations in Predicting Outcomes for Patients Treated with Nivolumab for Metastatic Renal Cell Carcinoma
Authors: Herrmann Tressie , Mione Cécile , Montoriol Pierre-François , Molnar Ioana , Ginzac Angeline , Durando Xavier , Mahammedi Hakim
Published: November 2021

Introduction: The advent of immune checkpoint inhibitors (ICIs) such as nivolumab has enabled outcomes for metastatic renal cell carcinoma (mRCC) to be improved. However, only around 25% of patients respond to these therapies without being able to formally identify them. Data on relevant predictive markers are still lacking. The obesity paradox has been shown as a relevant prognostic marker in mRCC with better outcomes for obese patients. Nevertheless, the impact of weight variation and the presence of sarcopenia during ICI treatment is not known for now. Methods: In a retrospective study, weight and its variations were collected at first day of ICI and at 6 weeks of treatment. Scanographic imagery was used to define the skeletal muscle index (SMI) as a reflect of sarcopenia. The impact of these parameters as predictive and prognostic factors for mRCC with nivolumab was evaluated. Results: A higher body mass index (BMI) at baseline was significantly associated with response at the first scan (p = 0.036). Longer overall survival (OS) was observed for patients with a weight gain compared to the group with weight loss (p = 0.00028). Median OS for sarcopenic patients was 17.2 months and 31.6 months for the non-sarcopenic group of patients, but there was no statistical difference. Conclusion: This trial showed that a higher BMI and weight gain during nivolumab treatment were good predictive markers for outcomes in mRCC with nivolumab. Sarcopenia and variations in SMI could thus be of interest, but further studies are required.
A Systematic Review of Augmented Reality Applications for Automated Driving: 2009–2020
Authors: Riegler Andreas , Riener Andreas , Holzmann Clemens
Published: November 2021

While augmented reality (AR) interfaces have been researched extensively over the last decades, studies on their application in vehicles have only recently advanced. In this article, we systematically review 12 years of AR research in the context of automated driving (AD), from 2009 to 2020. Due to the multitude of possibilities for studies with regard to AR technology, at present, the pool of findings is heterogeneous and non-transparent. From a review of the literature we identified N=156 papers with the goal to analyze the status quo of existing AR studies in AD, and to classify the related literature into application areas. We provide insights into the utilization of AR technology used at different levels of vehicle automation, and for different users (drivers, passengers, pedestrians) and tasks. Results show that most studies focused on safety aspects, driving assistance, and designing non-driving-related tasks. AR navigation, trust in automated vehicles (AVs), and interaction experiences also marked a significant portion of the published papers; however, a wide range of different parameters was investigated by researchers. Among other things, we find that there is a growing trend toward simulating AR content within virtual driving simulators. We conclude with a discussion of open challenges, and give recommendations for future research in automated driving at the AR side of the reality-virtuality continuum.
Distinct Impacts of ENSO on Haze Pollution in the Beijing–Tianjin–Hebei Region between Early and Late Winters
Authors: Zhao Wei , Chen Shangfeng , Zhang Hengde , Wang Jikang , Chen Wen , Wu Renguang , Xing Wanqiu , Wang Zhibiao , Hu Peng , Piao Jinling , Ma Tianjiao
Published: November 2021

The Beijing–Tianjin–Hebei (BTH) region has encountered increasingly severe and frequent haze pollution during recent decades. This study reveals that El Niño–Southern Oscillation (ENSO) has distinctive impacts on interannual variations of haze pollution over BTH in early and late winters. The impact of ENSO on the haze pollution over the BTH is strong in early winter, but weak in late winter. In early winter, ENSO-related sea surface temperature anomalies generate double-cell Walker circulation anomalies, with upward motion anomalies over the tropical central-eastern Pacific and tropical Indian Ocean, and downward motion anomalies over the tropical western Pacific. The ascending motion and enhanced atmospheric heating anomalies over the tropical Indian Ocean trigger atmospheric teleconnection propagating from the north Indian Ocean to East Asia, and result in the generation of an anticyclonic anomaly over Northeast Asia. The associated southerly anomalies to the west side lead to more serious haze pollution via reducing surface wind speed and increasing low-level humidity and the thermal inversion. The strong contribution of the Indian Ocean heating anomalies to the formation of the anticyclonic anomaly over Northeast Asia in early winter can be confirmed by atmospheric model numerical experiments. In late winter, vertical motion and precipitation anomalies are weak over the tropical Indian Ocean related to ENSO. As such, ENSO cannot induce a clear anticyclonic anomaly over Northeast Asia via atmospheric teleconnection, and thus has a weak impact on the haze pollution over BTH. Further analysis shows that stronger ENSO-induced atmospheric heating anomalies over the tropical Indian Ocean in early winter are partially due to higher mean SST and precipitation there.

Significance Statement

There exist large discrepancies regarding the contribution of El Niño–Southern Oscillation (ENSO) events to the wintertime haze pollution over North China. Several studies have indicated that ENSO has a weak impact on the haze pollution over North China. However, some studies have argued that ENSO events can exert impacts on the occurrence of haze pollution over North China. In this study, we present evidence to demonstrate that ENSO has distinctive impacts on interannual variations of the haze pollution over the Beijing–Tianjin–Hebei (BTH) region in North China in early and late winters. Specifically, ENSO has a strong impact on the haze pollution over BTH in early winter, whereas the impact of ENSO on the haze pollution over BTH is fairly weak in late winter. Results of this study could reconcile the discrepancy of previous studies about the impact of ENSO on the haze pollution over North China.
The Implication of Outflow Structure for the Rapid Intensification of Tropical Cyclones under Vertical Wind Shear
Authors: Shi Donglei , Chen Guanghua
Published: November 2021

The implication of outflow structure for tropical cyclone (TC) rapid intensification (RI) is investigated via a climatological study using the best track, reanalysis, and infrared brightness temperature data during 1980–2019. Composite analyses are performed in a shear-relative framework for the RI events under different strengths of environmental shear. Results show that for the RI events under moderate (4.5–11 m s−1) or strong (>11 m s−1) environmental shear the RI onset follows a significant increase of upper-level outflow upshear of the storm, which is intimately linked with the increasing active convection upshear. The intensified outflow blocks the upper-level environmental flow and thus decreases the local shear, building an environment favorable for RI. In contrast, the RI under weak environmental shear (<4.5 m s−1) is found to be less attributed to this outflow-blocking mechanism. Comparison between the RI and non-RI cases under moderate or strong environmental shear reveals that the RI cases tend to have stronger outflow and convection in the upshear flank than the non-RI cases, confirming the importance of outflow blocking on the occurrence of RI. Statistical analysis further indicates that the 24-h future intensity change under moderate or strong shear is more negatively correlated with the local shear than with the environmental shear, implicating the potential of local shear and upshear outflow as predictors to improve the forecasting of TC intensity change and especially RI. Further analysis suggests that the environmental thermodynamic conditions may play an important role in modulating the upshear convection and thus outflow blocking.
Leadership for Family and Community Engagement: A Qualitative Policy Analysis of State Principal Evaluation Processes
Authors: Mayger Linda , Provinzano Kathleen
Published: November 2021

Purpose: The primary purpose of this policy analysis is to examine how states changed their principal performance evaluation systems since the passage of Every Student Succeeds Act in 2015. In particular, we focus on whether states have capitalized on the flexible policy landscape to make space for meaningful family and community engagement (FCE) in assessing principals’ effectiveness. Research Methods: This study uses document analysis to review the structure of principal evaluation systems in all 50 states and selects 17 revised systems for a deeper review of their approach to leadership for partnering with families and communities. Findings: A plurality of states have not substantively revised their evaluation systems. Several of the revised systems narrowly focused on instructional leadership and student achievement measures and were thus unsupportive of meaningful FCE and federal policy aims for schools to work in partnership with family and community stakeholders. The principal evaluation systems most supportive of authentic family and community engagement allowed for flexible goal setting and explicitly encouraged the use of stakeholder feedback as evidence of principals’ effectiveness. Implications for Research and Policy: The authors discuss the implications of the results in terms of 1.) expanding definitions of educational leadership to include tenets of authentic FCE, 2.) creating coherent yet compendious systems for school improvement, and 3.) planning for and implementing a developmental approach to the evaluation of school leaders.
‘I’m Mum and Dad in One, Basically’: Doing and Displaying ‘Good Lone Motherhood’
Authors: Carroll Nicola , Yeadon-Lee Tray
Published: November 2021

Popular discourse continues to equate ‘good’ motherhood with middle class, heterosexual coupledom and lone motherhood with dysfunctionality, despite ever-increasing diversity in family life. Drawing on interviews with lone mothers in two locations in the north of England, this article introduces the concept of ‘good lone motherhood’ to capture a process whereby women internalise nuclear family ideology while simultaneously resisting stigma and taking pride in their achievements in fulfilling practical and emotional demands of lone parenting. Application of a family practices framework is expanded through insights into what ‘doing’ good lone motherhood entails in everyday life and how it is ‘displayed’ to different audiences. Taking a comparative approach involving women in areas with contrasting socio-economic profiles highlights the contextual nature of display. Analysis of agential reflexivity and structural constraints demonstrates ways in which gender and class disadvantages can undermine capacity to ‘successfully’ convey a positive maternal identity.
Method Bias Mechanisms and Procedural Remedies
Authors: Yao Minghui , Xu Yunjie (Calvin)
Published: November 2021

As a crucial method in organizational and social behavior research, self-report surveys must manage method bias. Method biases are distorted scores in survey response, distorted variance in variables, and distorted relational estimates between variables caused by method designs. Studies on method bias have focused on post hoc statistical control, but integrated analyses of the sociopsychological mechanism of method bias are lacking. This review proposes a framework for method bias and offers a relatively complete and detailed review of the sociopsychological and statistical mechanisms of four main types of method bias and their procedural remedies. This review proposes “reduce, remove, and rectify” as a guideline for researchers in survey design to address method bias. Finally, this review presents two directions for future methodology research.
Speculative Empiricism, Nature and the Question of Predatory Abstractions: A Conversation with Didier Debaise
Authors: Debaise Didier , Keating Thomas P.
Published: November 2021

In conversation 1 with Didier Debaise, this piece thinks transversally across Nature as Event (2017a) and Speculative Empiricism (2017b) to explore some of the key stakes in his philosophy, namely: the relationship between the task of thinking a speculative empiricism and the problem of the bifurcation of nature. Engaging with the themes of nature, abstraction, dualism, pragmatism, and the role of stories in dramatizing our sensitivity to the world, the conversation develops Debaise’s contribution to theorising alternative modes of knowledge and experience capable of admitting those infra-sensible, inaudible, or imperceptible qualities of events. Distinctly, Debaise introduces here the problem of ‘predatory abstractions’ as one way to understand the problem of bifurcation. Ethically, the question of predatory abstractions makes new demands on the social sciences: to story new abstractions capable of deepening our experience of nature.
Children’s experiences of their learning environment: Psychometric properties of a questionnaire evaluating classroom environment, activities and interactions
Authors: Brännström Karl Jonas , Karjalainen Suvi , Sahlén Birgitta , Andersson Ketty , Lyberg-Åhlander Viveka , Christensson Jonas
Published: November 2021

The present study reports on the development of a questionnaire that evaluates children's experiences of their physical classroom environment, activities and interactions. It also explores the psychometric properties of the questionnaire and how acoustical characteristics of the classroom, class size and student characteristics (age, sex and Swedish as a second language) influence the self-reported outcomes. After development, the questionnaire name should read Activities and Interactions in the Classroom were administered to 101 students (7.9–10.7 years old). Demographic information about the students was collected from parents. The psychometric properties including test–retest reliability are good but can be improved by reducing the number of items. Acoustical characteristics of the classrooms and student characteristics did not predict questionnaire outcomes. As the acoustical conditions in students’ classrooms were close to optimal, communication fostering support should be in focus. The present questionnaire can be used to assess young students’ experiences of their classroom environment and learning situations.
Temperature effects on ageing properties and diffusivity of a HDPE GM in landfill
Authors: Wang Shengwei , Guo Tao , Tian Huan , Li Zhigang , Fei Kang
Published: November 2021

High-density polyethylene (HDPE) geomembranes (GMs) play a crucial role in preventing the leakage and migration of pollutants. GM service life and ageing properties are the main concerns for the choice of materials. However, it is not clear how the mechanical properties and anti-fouling performance of geomembranes change with ageing time. To solve this problem, a HDPE GM was selected for testing under exposed air condition. The tests included oxidation induction time (OIT), melt flow index (MFI), tensile properties and diffusivity under four temperature conditions for 1½ years. The test results showed that the GM has higher OIT degradation rates. Stage I – depletion of antioxidants occurred at only 10 years for the GM, which was approximately 1/4 that of the GM-GSE. The GM engineering properties index showed the same changes as those of the GM-GSE. However, MI rapidly decreased with the incubation time. The molecular weight degradation of the GM was approximately 57% and far greater than that of GM-GSE after 15 months, but the tensile properties of the two GMs showed little change. The diffusion coefficient Di of GM increases gradually with the increase of temperature in methane and trichloromethane. Under the same conditions, the diffusion coefficient Di of the GM in methane is significantly higher than that in trichloromethane, indicating that the GM has better barrier to trichloromethane.
Démystifier la valeur cocréée digitale du consommateur : cadre et propositions fondées sur la théorie de la présence sociale
Authors: Hollebeek Linda D , Clark Moira K , Macky Keith
Published: November 2021

Alors que la recherche sur la cocréation est prolifique, les travaux existants ne particularisent pas la manière dont elle se manifeste sur les plateformes digitales. De plus, ces travaux ont essentiellement examiné le processus de cocréation en lui-même, et non le résultat de ce processus, c’est-à-dire, la valeur cocréée. Un examen plus approfondi s’avère donc nécessaire, en particulier dans un contexte digital. A ce titre, nous nous focalisons dans cet article sur la Valeur Cocréée Digitale du Consommateur (ou « VCDC »), qui désigne la valeur perçue par le consommateur telle qu’elle résulte de l’interaction, de la collaboration ou de la communication avec ou via des plateformes digitales. Nous distinguons les plateformes digitales (i) homme-homme (H2HP ; par exemple, les médias sociaux) et (ii) homme-machine (H2MP), celles-ci comprenant (a) les plateformes à base d’automatisation des processus robotiques (par exemple, les centres d’appels) et (b) les plateformes à base d’apprentissage automatique/en profondeur (par exemple, les robots de service). Nous proposons en outre un cadre d’analyse fondé sur la théorie de la présence sociale qui examine l’effet de l’intimité et de l’immédiateté perçues sur la VCDC, et ce, pour chacun des types de plateformes identifiés. Enfin, nous formalisons nos réflexions dans des propositions de recherche et en discutons les implications.
Initial Derivation of a Predictive Model for Left Ventricular Longitudinal Strain (LS) in Early Sepsis
Authors: Knox Daniel B. , Lanspa Michael J. , Wilson Emily , Haaland Benjamin , Beesley Sarah , Hirshberg Eliotte , Abraham Theodore P. , Vallabhajosyula Saraschandra , Grissom Colin K. , Drakos Stavros G. , Brown Samuel M.
Published: November 2021

Septic shock is a common deadly disease often associated with cardiovascular dysfunction. Left ventricular longitudinal strain (LV LS) has been proposed as a sensitive marker to measure cardiovascular function; however, it is not available universally in standard clinical echocardiograms. We sought to derive a predictive model for LV LS, using machine learning techniques with the hope that we may uncover surrogates for LV LS. We found that left ventricular ejection fraction, tricuspid annular plane systolic excursion, sepsis source, height, mitral valve Tei index, LV systolic dimension, aortic valve ejection time, and peak acceleration rate were all predictive of LV LS in this initial exploratory model. Future modeling work may uncover combinations of these variables which may be powerful surrogates for LV LS and cardiovascular function.
A Review of Platelet-Activating Factor As a Potential Contributor to Morbidity and Mortality Associated with Severe COVID-19
Authors: Klein Mark , Dao Vinh , Khan Fatima
Published: November 2021

The precise mechanisms of pathology in severe COVID-19 remains elusive. Current evidence suggests that inflammatory mediators are responsible for the manifestation of clinical symptoms that precedes a fatal response to infection. This review examines the nature of platelet activating factor and emphasizes the similarities between the physiological effects of platelet activating factor and the clinical complications of severe COVID-19.
Predictive Value of Immune Cell Subsets for Mortality Risk in Patients With Sepsis
Authors: Zhang Ying , Wang Jia , Hu Le , Xuan Jingchao , Qu Yifan , Li Yixuan , Ye Xinghua , Yang Long , Yang Jun , Zhang Xiangqun , Wang Junyu , Wei Bing
Published: November 2021

This study investigates the prognostic value of immune cell subsets in assessing the risk of death in patients with sepsis. This retrospective study collected 169 patients from March 2020 to February 2021 at our hospital. Baseline data were collected from patients. The absolute values (Abs) and percentages (%) of immune cell subsets for lymphocytes, T cells, CD4+ cells, CD8+, B cells, NK cells, and NKT cells were measured using flow Cytometry. Among the included patients, 43 patients were in the nonsurvivor group and 126 patients were in the survivor group. The age of patients in the nonsurvivor survivor was higher than that of survivor group patients ( P = .020). SOFA, APACHE II, C-reactive protein, and procalcitonin were higher in the nonsurvivor group than in the survivor group (all P values < .05). Multivariate regression analysis showed that lymphocytes (%) and SOFA were independent risk factors affecting patients’ prognosis. Lymphocytes (%) have the highest area under the receiver operating characteristic (ROC) curve (0.812). The model area under the ROC curve for immune cell subsets was 0.800, with a sensitivity of 72.09%, and specificity of 79.27% ( z = 7.796, P <  .001). Analysis of patient prognosis by immune cell subsets diagnostic showed statistically significant differences in the grouping of cut-off values for all 5 indicators (all P < .05). The lymphocytes (%) and SOFA score are independent risk factors affecting the prognosis of patients. A moderate predictive power for mortality in sepsis patients by immune cell subsets model.
The need to include indigenous peoples as ‘expert’ consultants in India's Apex Committee for Implementation of the Paris Agreement
Authors: Jamwal Kanika
Published: November 2021

This opinion argues for including indigenous peoples as ‘expert’ consultants in India's Apex Committee for Implementation of Paris Agreement. Alongside its monitoring and reporting functions, the Apex Committee for Implementation of Paris Agreement is expected to perform substantive functions, including, developing policies and programmes to make India's domestic climate actions compliant with its international obligations under the Paris Agreement. The argument is based on the understanding that indigenous peoples possess a deeper understanding of their ecosystems and share a special relationship with it. Therefore, their knowledge is key to sustainable ecosystem management. At the same time, a co-dependent relationship with Nature makes them disproportionately vulnerable to the impacts of climate change. Unlike other vulnerable groups, the impact on indigenous peoples ripples beyond their economic survival, and threatens their collective physical and spiritual identity. Accordingly, this opinion suggests direct participation of indigenous peoples in conceptualising and implementing policies and programmes aimed at addressing climate change. To that end, it problematizes the narrow understanding of ‘experts’ reflected in the gazette notification establishing the Apex Committee for Implementation of Paris Agreement, and draws upon United Nations’ practice(s) enabling participation of indigenous peoples as 'experts' in its specialised agencies and organs. Accordingly, the opinion also suggests a potential means to operationalize their inclusion in the Apex Committee for Implementation of Paris Agreement.
Managing categories: The role of social technology in kindergarten teachers’ work to promote early intervention and integration
Authors: Kimathi Eric , Nilsen Ann Christin Eklund
Published: November 2021

Early intervention and integration are highly valued ideals in kindergartens in Norway. Building on two research projects informed by institutional ethnography, the authors address how kindergarten teachers ‘do’ early intervention and integration in their everyday work. They argue that this work largely revolves around managing categories, whether making categories fit people or making people fit categories. In this work, the kindergarten teachers rely on social technology that is influenced by a ‘psy-discourse’. Despite good intentions, the social technology and the professionals’ use of it ends up constructing the categories they are intended to help or ‘heal’.
Support vector machine based emissions modeling using particle swarm optimization for homogeneous charge compression ignition engine
Authors: Gordon David , Norouzi Armin , Blomeyer Gero , Bedei Julian , Aliramezani Masoud , Andert Jakob , Koch Charles R
Published: November 2021

The internal combustion engine faces increasing societal and governmental pressure to improve both efficiency and engine out emissions. Currently, research has moved from traditional combustion methods to new highly efficient combustion strategies such as Homogeneous Charge Compression Ignition (HCCI). However, predicting the exact value of engine out emissions using conventional physics-based or data-driven models is still a challenge for engine researchers due to the complexity the of combustion and emission formation. Research has focused on using Artificial Neural Networks (ANN) for this problem but ANN’s require large training datasets for acceptable accuracy. This work addresses this problem by presenting the development of a simple model for predicting the steady-state emissions of a single cylinder HCCI engine which is created using an metaheuristic optimization based Support Vector Machine (SVM). The selection of input variables to the SVM model is explored using five different feature sets, considering up to seven engine inputs. The best results are achieved with a model combining linear and squared inputs as well as cross correlations and their squares totaling 26 features. In this case the model fit represented by R2 values were between 0.72 and 0.95. The best model fits were achieved for CO and CO2, while HC and NOx models have reduced model performance. Linear and non-linear SVM models were then compared to an ANN model. This comparison showed that SVM based models were more robust to changes in feature selection and better able to avoid local minimums compared to the ANN models leading to a more consistent model prediction when limited training data is available. The proposed machine learning based HCCI emission models and the feature selection approach provide insight into optimizing the model accuracy while minimizing the computational costs.
“How am I supposed to do this on my own?”: A case study on perspectives of preschool teachers regarding integrative STEM practices
Authors: Demircan Hasibe Özlen
Published: November 2021

This article analyzes the perspectives of three preschool teachers on integrative STEM practices and the facilitating and hindering factors in their implementation. The participants were preschool teachers working at public preschools. They volunteered to participate in a 14-hour STEM professional development program and to share their perspectives on the implementation of integrative STEM practice. Here a case-study method is used to conduct an in-depth investigation. Data was collected from teachers through interviews, informal classroom observations, and document analysis. The factors facilitating or hindering the teachers’ implementation of integrative STEM practice were analyzed in three aspects: curriculum, pedagogy, learning environment, and the needs they observed while implementing these practices identified. The findings revealed that though the practices are developmentally appropriate to support active learning and time-effectiveness, teachers find it challenging to integrate STEM into education by their own efforts alone. Daily routines, differences between individual children, and material and storage issues are major hindering factors they faced while implementing integrative STEM practices. According to findings, teachers need the support of administration, parents, and colleagues to implement integrative STEM practices. In the short term and the long term, to see a positive impact of integrative STEM practices, there is a need for a better quality context in the curriculum, pedagogy, and learning environment.
Association between proton-pump inhibitors and the risk of gastric cancer: a systematic review with meta-analysis
Authors: Segna Daniel , Brusselaers Nele , Glaus Damian , Krupka Niklas , Misselwitz Benjamin
Published: November 2021

Introduction:

The use of proton-pump inhibitors (PPI) may be associated with an increased risk of gastric cancer (GC).

Objective:

To review and meta-analyse available literature investigating the association between PPI use and GC risk.

Methods:

Two independent reviewers systematically searched Ovid MEDLINE, EMBASE, and Cochrane Library (inception to July 2020) for case-control and cohort studies assessing the association between PPI use and GC according to a predefined protocol in PROSPERO (CRD42018102536). Reviewers independently assessed study quality, extracted data, and meta-analysed available and newly calculated odds ratios (ORs) using a random-effects model, and stratified for GC site (cardia versus non-cardia) and PPI duration (<1 year, 1–3 years, >3 years).

Results:

We screened 2,396 records and included five retrospective cohort and eight case-control studies comprising 1,662,881 individuals in our meta-analysis. In random-effect models, we found an increased GC risk in PPI users [OR: 1.94, 95% confidence interval (95% CI): 1.47–2.56] with high statistical heterogeneity ( I2 = 82%) and overall moderate risk of bias. Stratified analyses indicated a significant risk increase in non-cardia (OR: 2.20, 95% CI: 1.44–3.36, I2 = 77%) with a similar non-significant trend in cardia regions (OR: 1.77, 95% CI: 0.72–4.36, I2 = 66%). There was no GC increase with longer durations of PPI exposure (<1 year: OR: 2.29, 95% CI: 2.13–2.47, I2 = 0%; 1–3 years: OR: 1.46, 95% CI: 0.53–4.01, I2 = 35%; >3 years: OR: 2.08, 95% CI: 0.56–7.77, I2 = 61%).

Conclusion:

We found a twofold increased GC risk among PPI users, but this association does not confirm causation and studies are highly heterogeneous. PPI should only be prescribed when strictly indicated.
Assessing Preparedness of Labor and Delivery Personnel in Transferring to a New Unit
Authors: Simmons Cassandra , Allison Claire , Kee Jayde , Ballas Derek
Published: November 2021

Objectives:

This case study intends to examine how staff characteristics, training methods, and duration of training impact overall staff preparedness and comfortability when transitioning to a new Labor and Delivery.

Background:

A new medical facility offers an opportunity for greater capacity and expanding services, but it also poses new challenges for staff. Success in this transition depends on how quickly the staff can adapt to their new environment and how prepared they are to deliver high-quality care to patients.

Methods:

An optional survey was conducted to determine the staff’s confidence in their training using a 5-point Likert-type scale.

Results:

After responses were collected, a paired samples two-sided t test revealed that there was no statistically significant change in the confidence and preparedness for staff.

Conclusions:

With this overall outcome, medical facilities will have more discernment on ways to improve their employees’ trust and confidence in performing their tasks and providing care while in a new environment. This will then be reflected in the care given toward patients in the future.
Gender Equality in Plastic Surgery Training: A Canadian Nationwide Cross-sectional Analysis
Authors: ElHawary Hassan , Salimi Ali , Alam Peter , Karir Aneesh , Mitchell Eric , Huynh Minh NQ , Leveille Cameron F. , Halyk Laura , St. Denis-Katz Hannah , Iyer Hari , Padeanu Stefan , Adibfar Alexander , Valiquette Chantal , Morzycki Alexander , Janis Jeffrey E. , Thibaudeau Stephanie
Published: November 2021

Introduction: One of the important factors in achieving gender equity is ensuring equitable surgical training for all. Previous studies have shown that females get significantly lower surgical exposure than males in certain surgical specialties. Gender gap in surgical exposure has never been assessed in plastic surgery. To that end, the goal of this study was to assess if there are any differences in plastic surgery training between male and female residents. Methods: A survey was sent to all plastic surgery residency programs in Canada to assess the No. of surgeries residents operated on as a co-surgeon or primary assistant during their training. The survey also assessed career goals, level of interest in the specialty, and subjective perception of gender bias. Results: A total of 89 plastic surgery residents (59.3% participation rate) completed the survey and were included in the study. The average No. of reconstructive cases residents operated on as a co-surgeon or primary assistant was 245 ± 312 cases. There was no difference in either reconstructive or aesthetic surgery case logs between male and female residents ( p > .05). However, a significantly larger proportion of females (39%) compared to males (4%) felt that their gender limited their exposure to surgical cases and led to a worsening of their overall surgical training ( p < .001). Finally, a larger proportion of male residents were interested in academic careers while a larger proportion of female residents were interested in a community practice ( p = .024). Conclusion: While there is no evidence of differences in the volume of logged cases between genders, female surgical residents still feel that their respective gender limits their overall surgical training. Gender inequalities in training should be addressed by residency programs.
Pitt Hopkins-Like Syndrome 1 with Novel CNTNAP2 Mutation in Siblings
Authors: Mittal Rea , Kumar Ashutosh , Ladda Roger , Mainali Gayatra , Aliu Ermal
Published: November 2021

Pitt Hopkins-like syndrome 1 (PTHLS1, OMIM # 610042) is an ultra-rare autosomal recessive condition with a prevalence of <1/1,000,000. Intragenic deletions of CNTNAP2 has been implicated in PTHLS1, however to our knowledge a compound heterozygous deletion of exon 4 and a c.1977_1989del13; p.V660Ffsx9 frameshift variant have not been published previously. In this case report, the proband is a seven year old female with PTHLS1, developmental delay, autism spectrum disorder, focal epilepsy, hypotonia, refractory errors, strabismus, and obstructive sleep apnea. Whole exome sequencing analysis revealed biallelic pathogenic variants of the CNTNAP2 gene. Proband has a three year old sister who has who has a similar phenotype including, developmental delay, epilepsy, gait abnormality, refractory errors, strabismus. Family variants were tested and she shared the same CNTNAP2 variants as her sister. The sisters described highlight two novel variants leading to PTHLS1. Genetic workup is essential in identification and management guidance in these populations.
Effect of bidirectional excitation on seismic performance of regular RC frame buildings designed for modern codes
Authors: Gwalani Payal , Singh Yogendra , Varum Humberto
Published: November 2021

The existing practice to estimate seismic performance of a regular building is to carry out nonlinear time history analysis using two-dimensional models subjected to unidirectional excitations, even though the multiple components of ground motion can affect the seismic response, significantly. During seismic shaking, columns are invariably subjected to bending in two orthogonal vertical planes, which leads to a complex interaction of axial force with the biaxial bending moments. This article compares the seismic performance of regular and symmetric RC moment frame buildings for unidirectional and bidirectional ground motions. The buildings are designed and detailed according to the Indian codes, which are at par with the other modern seismic codes. A fiber-hinge model, duly calibrated with the biaxial experimental results, is utilized to simulate the inelastic behavior of columns under bidirectional bending. A comparison of the estimated seismic collapse capacity is presented, illustrating the importance of considering the bidirectional effects. The results from fragility analysis indicate that the failure probabilities of buildings under the bidirectional excitation are significantly higher as compared to those obtained under the unidirectional excitation.
Germline GATA1s-generating mutations predispose to leukemia with acquired trisomy 21 and Down syndrome-like phenotype
Authors: Hasle Henrik , Kline Ronald M. , Kjeldsen Eigil , Nik-Abdul-Rashid Nik F. , Bhojwani Deepa , Verboon Jeffrey M. , DiTroia Stephanie P. , Chao Katherine R. , Raaschou-Jensen Klas , Palle Josefine , Zwaan C. Michel , Nyvold Charlotte Guldborg , Sankaran Vijay G. , Cantor Alan B.
Published: November 2021

Individuals with Down syndrome are at increased risk of myeloid leukemia in early childhood, which is associated with acquisition of GATA1 mutations that generate a short GATA1 isoform called GATA1s. Germline GATA1s-generating mutations result in congenital anemia in males. We report on 2 unrelated families that harbor germline GATA1s-generating mutations in which several members developed acute megakaryoblastic leukemia in early childhood. All evaluable leukemias had acquired trisomy 21 or tetrasomy 21. The leukemia characteristics overlapped with those of myeloid leukemia associated with Down syndrome, including age of onset at younger than 4 years, unique immunophenotype, complex karyotype, gene expression patterns, and drug sensitivity. These findings demonstrate that the combination of trisomy 21 and GATA1s-generating mutations results in a unique myeloid leukemia independent of whether the GATA1 mutation or trisomy 21 is the primary or secondary event and suggest that there is a unique functional cooperation between GATA1s and trisomy 21 in leukemogenesis. The family histories also indicate that germline GATA1s-generating mutations should be included among those associated with familial predisposition for myelodysplastic syndrome and leukemia.
Endoscopic gluteus maximus tendon release for external snapping hip syndrome: a functional assessment
Authors: Randelli Filippo , Fioruzzi Alberto , Magnani Mauro , Mazzoleni Manuel , Elhiny Mohammad , Via Alessio Giai , Ayeni Olufemi R. , Di Benedetto Paolo
Published: November 2021

Purpose

The aim of this retrospective study was to investigate the clinical follow-up of patients with external snapping hip syndrome (ESHS) treated with endoscopic gluteus maximus tendon release and to compare the residual muscular strength and thigh circumference as an indirect outcome measure.

Methods

Patients of all ages with external snapping hip syndrome were treated with endoscopic gluteus maximus tendon release. Outcome measures evaluated included: visual analog scale (VAS), modified Harris Hip Score (mHHS), and Non-Arthritic Hip Score (NAHS). The gluteus maximus strength and the circumference of the thigh were also evaluated.

Results

Among 25 patients, 23 fulfilled the inclusion criteria and one patient was lost to follow-up. The series included 22 patients, 6 males and 16 females with a mean age of 27.9 ± 13.4 years (range 16–76 years). All patients had resolution of the snapping symptoms after the procedure. The mean follow-up was 18 ± 9.3 months. All outcomes improved in a statistically significant manner: VAS value decreased from 6.8 (range 6–8) to 0.6 (range 0–4) (p  < 0.001), mHHS increased from 48.6 (range 17.6–67) to 88.2 (range 67–94.6) (p  <  0.001), NAHS increased from 49.0 (range 21.5–66) to 90.8 (range 66–98.75) (p  <  0.001). A statistically significant reduction of operated limb thigh circumference compared to the contralateral side (3.7%) was also found, while there were no statistical differences regarding the strength of gluteus maximus muscles.

Conclusions

Endoscopic gluteus maximus tendon release is an excellent surgical option to treat snapping hip syndrome. The evaluated muscle strength revealed no functional impairment. The significance of the limb circumference reduction has yet to be determined.

Level of evidence

IV: retrospective comparative trial.
PangenomeNet: a pan-genome-based network reveals functional modules on antimicrobial resistome for Escherichia coli strains
Authors: Her Hsuan-Lin , Lin Po-Ting , Wu Yu-Wei
Published: November 2021

Background

Discerning genes crucial to antimicrobial resistance (AMR) mechanisms is becoming more and more important to accurately and swiftly identify AMR pathogenic strains. Pangenome-wide association studies (e.g. Scoary) identified numerous putative AMR genes. However, only a tiny proportion of the putative resistance genes are annotated by AMR databases or Gene Ontology. In addition, many putative resistance genes are of unknown function (termed hypothetical proteins). An annotation tool is crucially needed in order to reveal the functional organization of the resistome and expand our knowledge of the AMR gene repertoire.

Results

We developed an approach (PangenomeNet) for building co-functional networks from pan-genomes to infer functions for hypothetical genes. UsingEscherichia colias an example, we demonstrated that it is possible to build co-functional network from its pan-genome using co-inheritance, domain-sharing, and protein–protein-interaction information. The investigation of the network revealed that it fits the characteristics of biological networks and can be used for functional inferences. The subgraph consisting of putative meropenem resistance genes consists of clusters of stress response genes and resistance gene acquisition pathways. Resistome subgraphs also demonstrate drug-specific AMR genes such as beta-lactamase, as well as functional roles shared among multiple classes of drugs, mostly in the stress-related pathways.

Conclusions

By demonstrating the idea of pan-genome-based co-functional network on theE. colispecies, we showed that the network can infer functional roles of the genes, including those without functional annotations, and provides holistic views on the putative antimicrobial resistomes. We hope that the pan-genome network idea can help formulate hypothesis for targeted experimental works.
Employing phylogenetic tree shape statistics to resolve the underlying host population structure
Authors: Kayondo Hassan W. , Ssekagiri Alfred , Nabakooza Grace , Bbosa Nicholas , Ssemwanga Deogratius , Kaleebu Pontiano , Mwalili Samuel , Mango John M. , Leigh Brown Andrew J. , Saenz Roberto A. , Galiwango Ronald , Kitayimbwa John M.
Published: November 2021

Background

Host population structure is a key determinant of pathogen and infectious disease transmission patterns. Pathogen phylogenetic trees are useful tools to reveal the population structure underlying an epidemic. Determining whether a population is structured or not is useful in informing the type of phylogenetic methods to be used in a given study. We employ tree statistics derived from phylogenetic trees and machine learning classification techniques to reveal an underlying population structure.

Results

In this paper, we simulate phylogenetic trees from both structured and non-structured host populations. We compute eight statistics for the simulated trees, which are: the number of cherries; Sackin, Colless and total cophenetic indices; ladder length; maximum depth; maximum width, and width-to-depth ratio. Based on the estimated tree statistics, we classify the simulated trees as from either a non-structured or a structured population using the decision tree (DT), K-nearest neighbor (KNN) and support vector machine (SVM). We incorporate the basic reproductive number ($$R_0$$

R
0

) in our tree simulation procedure. Sensitivity analysis is done to investigate whether the classifiers are robust to different choice of model parameters and to size of trees. Cross-validated results for area under the curve (AUC) for receiver operating characteristic (ROC) curves yield mean values of over 0.9 for most of the classification models.

Conclusions

Our classification procedure distinguishes well between trees from structured and non-structured populations using the classifiers, the two-sample Kolmogorov-Smirnov, Cucconi and Podgor-Gastwirth tests and the box plots. SVM models were more robust to changes in model parameters and tree size compared to KNN and DT classifiers. Our classification procedure was applied to real -world data and the structured population was revealed with high accuracy of $$92.3\%$$

92.3
%

using SVM-polynomial classifier.
Focal IgG4-related autoimmune pancreatitis with distal choledochal adenocarcinoma: a rare case report
Authors: Wang Han , Yao Lan , Wang Ligang , Sun Xixi , Huang Bin
Published: November 2021

Background

Autoimmune pancreatitis (AIP) is a rare disease that manifests as pancreatic involvement in systemic IgG4-related disease (IgG4-RD), a special type of chronic pancreatitis caused by autoimmune abnormalities. The main imaging manifestations of IgG4-related AIP consist of diffuse or localized pancreatic enlargement and irregular pancreatic duct narrowing. The diagnosis of AIP is challenging because it can present with focal lesions,
similar to radiologically bile duct cancer or pancreatic cancer.

Case presentation

A 55-year-old male patient was admitted with painless jaundice and multiple radiographic findings of pancreatic head mass, as well as intrahepatic and extrahepatic bile duct dilatation. Various imaging methods indicated pancreatic cancer. However, the endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) and a laparoscopic pancreatic biopsy suggested an IgG4-related AIP. After one month, magnetic resonance imaging showed that the lesion had slightly grown. Combined with CA19-9 and other indexes, the possibility of malignancy was high and there were still surgical indications. The pathological analysis following a pancreaticoduodenectomy revealed poorly differentiated adenocarcinoma in the distal common bile duct.

Conclusion

To date, few reports have described pancreatic or extrapancreatic malignancies in AIP patients, and no association between AIP and bile duct adenocarcinoma has been previously confirmed. This case discuss the differentiation between AIP and malignancy, recent research progress, and the correlation between the two diseases, highlights the importance of carefully evaluating patients with AIP to rule out potential tumors, as well as the critical need for follow up treatment.