bluuebunny/crossref_metadata_2025 huggingface dataset:
Eutrophication on Coral Reefs: What Is the Evidence for Phase Shifts, Nutrient Limitation and Coral Bleaching
Authors: Lesser Michael P
Published: September 2021

Coral reefs continue to experience extreme environmental pressure from climate change stressors, but many coral reefs are also exposed to eutrophication. It has been proposed that changes in the stoichiometry of ambient nutrients increase the mortality of corals, whereas eutrophication may facilitate phase shifts to macroalgae-dominated coral reefs when herbivory is low or absent. But are corals ever nutrient limited, and can eutrophication destabilize the coral symbiosis making it more sensitive to environmental stress because of climate change? The effects of eutrophication are confounded not just by the effects of climate change but by the presence of chemical pollutants in industrial, urban, and agricultural wastes. Because of these confounding effects, the increases in nutrients or changes in their stoichiometry in coastal environments, although they are important at the organismal and community level, cannot currently be disentangled from each other or from the more significant effects of climate change stressors on coral reefs.
A Science Agenda to Inform Natural Resource Management Decisions in an Era of Ecological Transformation
Authors: Crausbay Shelley D , Sofaer Helen R , Cravens Amanda E , Chaffin Brian C , Clifford Katherine R , Gross John E , Knapp Corrine N , Lawrence David J , Magness Dawn R , Miller-Rushing Abraham J , Schuurman Gregor W , Stevens-Rumann Camille S
Published: September 2021

Earth is experiencing widespread ecological transformation in terrestrial, freshwater, and marine ecosystems that is attributable to directional environmental changes, especially intensifying climate change. To better steward ecosystems facing unprecedented and lasting change, a new management paradigm is forming, supported by a decision-oriented framework that presents three distinct management choices: resist, accept, or direct the ecological trajectory. To make these choices strategically, managers seek to understand the nature of the transformation that could occur if change is accepted while identifying opportunities to intervene to resist or direct change. In this article, we seek to inspire a research agenda for transformation science that is focused on ecological and social science and based on five central questions that align with the resist–accept–direct (RAD) framework. Development of transformation science is needed to apply the RAD framework and support natural resource management and conservation on our rapidly changing planet.
Mobile health technology for remote home monitoring after surgery: a meta-analysis
Authors: Dawes A J , Lin A Y , Varghese C , Russell M M , Lin A Y
Published: September 2021

Background

Mobile health (mHealth) technology has been proposed as a method of improving post-discharge surveillance. Little is known about how mHealth has been used to track patients after surgery and whether its use is associated with differences in postoperative recovery.

Methods

Three databases (PubMed, MEDLINE and the Cochrane Central Registry of Controlled Trials) were searched to identify studies published between January 1999 and February 2021. Mobile health was defined as any smartphone or tablet computer capable of electronically capturing health-related patient information and transmitting these data to the clinical team. Comparable outcomes were pooled via meta-analysis with additional studies compiled via narrative review. The quality of each study was assessed based on Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

Results

Forty-five articles met inclusion criteria. While the majority of devices were designed to capture general health information, others were specifically adapted to the expected outcomes or potential complications of the index procedure. Exposure to mHealth was associated with fewer emergency department visits (odds ratio 0.42, 95 per cent c.i. 0.23 to 0.79) and readmissions (odds ratio 0.47, 95 per cent c.i. 0.29 to 0.77) as well as accelerated improvements in quality of life after surgery. There were limited data on other postoperative outcomes.

Conclusion

Remote home monitoring via mHealth is feasible, adaptable, and may even promote more effective postoperative care. Given the rapid expansion of mHealth, physicians and policymakers need to understand these technologies better so that they can be integrated into high-quality clinical care.
Early postoperative arterial lactate concentrations to stratify risk of post-hepatectomy liver failure
Authors: Niederwieser Thomas , Braunwarth Eva , Dasari Bobby V M , Pufal Kamil , Szatmary Peter , Hackl Hubert , Haselmann Clemens , Connolly Catherine E , Cardini Benno , Öfner Dietmar , Roberts Keith , Malik Hassan , Stättner Stefan , Primavesi Florian
Published: September 2021

Background

Post-hepatectomy liver failure (PHLF) represents the major determinant for death after liver resection. Early recognition is essential. Perioperative lactate dynamics for risk assessment of PHLF and associated morbidity were evaluated.

Methods

This was a multicentre observational study of patients undergoing hepatectomy with validation in international high-volume units. Receiver operating characteristics analysis and cut-off calculation for the predictive value of lactate for clinically relevant International Study Group of Liver Surgery grade B/C PHLF (clinically relevant PHLF (CR-PHLF)) were performed. Lactate and other perioperative factors were assessed in a multivariable CR-PHLF regression model.

Results

The exploratory cohort comprised 509 patients. CR-PHLF, death, overall morbidity and severe morbidity occurred in 7.7, 3.3, 40.9 and 29.3 per cent of patients respectively. The areas under the curve (AUCs) regarding CR-PHLF were 0.829 (95 per cent c.i. 0.770 to 0.888) for maximum lactate within 24 h (Lactate_Max) and 0.870 (95 per cent c.i. 0.818 to 0.922) for postoperative day 1 levels (Lactate_POD1). The respective AUCs in the validation cohort (482 patients) were 0.812 and 0.751 and optimal Lactate_Max cut-offs were identical in both cohorts. Exploration cohort patients with Lactate_Max 50 mg/dl or greater more often developed CR-PHLF (50.0 per cent) than those with Lactate_Max between 20 and 49.9 mg/dl (7.4 per cent) or less than 20 mg/dl (0.5 per cent; P < 0.001). This also applied to death (18.4, 2.7 and 1.4 per cent), severe morbidity (71.1, 35.7 and 14.1 per cent) and associated complications such as acute kidney injury (26.3, 3.1 and 2.3 per cent) and haemorrhage (15.8, 3.1 and 1.4 per cent). These results were confirmed in the validation group. Combining Lactate_Max with Lactate_POD1 further increased AUC (ΔAUC = 0.053) utilizing lactate dynamics for risk assessment. Lactate_Max, major resections, age, cirrhosis and chronic kidney disease were independent risk factors for CR-PHLF. A freely available calculator facilitates clinical risk stratification (www.liver-calculator.com).

Conclusion

Early postoperative lactate values are powerful, readily available markers for CR-PHLF and associated complications after hepatectomy with potential for guiding postoperative care.

Presented in part as an oral video abstract at the 2020 online Congress of the European Society for Surgical Research and the 2021 Congress of the Austrian Surgical Society.
Laparoscopic and open surgery in patients with transverse colon cancer: short-term and oncological outcomes
Authors: Matsumoto A , Shinohara H , Suzuki H
Published: September 2021

Background

Studies evaluating the outcomes after laparoscopic resections of transverse colon cancers are scant. This manuscript aimed to compare surgical and oncological outcomes after laparoscopic (Lap) and open procedures for transverse colon carcinomas.

Methods

All consecutive patients who underwent resection for a cancer located in the transverse colon between 2003 and 2019 were reviewed. Patients were categorized according to the surgical approach (Lap versus open) and groups were compared. Outcome measures were the short-term results, complications and functional recovery; moreover, recurrence-free survival (RFS) and overall survival (OS) rates were compared overall and after propensity score matching (PSM) based on age, sex, ASA classification, BMI, carcinoembryonic antigen (CEA) level, use of postoperative chemotherapy, location of tumour, stage and grading, operation time, blood loss and complications.

Results

Of 248 transverse resections reviewed, 146 (81 Lap and 65 open) were selected for data analysis. Blood loss, fluid intake and the incidence of wound infection were significantly lower and the hospital stay was significantly shorter in the Lap group (P < 0.001). The operation time and incidence of complications (Clavien–Dindo classification grade 3 or above) did not differ significantly between the two groups. Mean follow-up was of 75.4 months in the Lap group and 78.6 months in the open group. Regression analyses showed that OS was associated with the postoperative carcinoembryonic antigen (CEA) level (hazard ratio 1.18 (95 per cent c.i. 1.10 to 1.27); P < 0.001), BMI (hazard ratio 0.81 (95 per cent c.i. 0.68 to 0.96); P = 0.017), operation time (hazard ratio 0.99 (95 per cent c.i. 0.97 to 1.00; P = 0.010), and postoperative chemotherapy (hazard ratio 0.27 (95 per cent c.i. 0.08 to 0.96); P = 0.042), while RFS was associated with the postoperative CEA level (hazard ratio 1.13 (95 per cent c.i. 1.07 to 1.20); P < 0.001). PSM selected 42 patients for data comparison of long-term results, and showed no significant differences between groups (RFS: P = 0.530; OS: P = 0.561).

Conclusion

Lap and open resections for transverse colon cancer provided similar outcomes in terms of severe post-operative complication and long-term results.
Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement
Authors: Grove T N , Kontovounisios C , Montgomery A , Heniford B T , Windsor A C J , Warren O J ,   AWR Europe Collaborative, de Beaux A , Boermeester M , Bougard H , Butler C , Chintapatla S , Chitsabesan P , Cuccurullo D , Daniels I , van Dellen D , Dumanian G , East B , Efron D , Friis-Andersen H , Heniford B T , Henriksen N , Horgan L , Ibrahim N , Janis J , Montgomery A , Nahabedian M , Nowitsky Y , Parker S , van Ramshorst G , Renard Y , Ross D , Sanders D , Slade D , Talbot S , Torkington J , Warren O , Warusaviturane J , Windsor A
Published: September 2021

Background

The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20–41 per cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe. Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection, management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide a clear benchmark of care for the preoperative assessment and perioperative optimization of patients undergoing AWR.

Methods

The Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirty-two hernia surgeons from recognized hernia societies globally took part. The process included two rounds of anonymous web-based voting with response analysis and formal feedback, concluding with a live round of voting followed by discussion at an international conference. Consensus for a strong recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per cent agreement.

Results

Consensus was obtained on 52 statements including surgical assessment, preoperative assessment, perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment. Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement.

Conclusion

Clear consensus recommendations from a global group of experts in the AWR field are presented in this study. These should be used as a baseline for surgeons and centres managing abdominal wall hernias and performing complex AWR.
Role of delay and antibiotics on PERForation rate while waiting appendicECTomy (PERFECT): a protocol for a randomized non-inferiority trial
Authors: Jalava K , Sallinen V , Lampela H , Malmi H , Leppäniemi A , Mentula P
Published: September 2021

Background

Longer duration from symptom onset is associated with increased risk of perforation in appendicitis. In previous studies, in-hospital delay to surgery has had conflicting effects on perforation rates. Although preoperative antibiotics have been shown to reduce postoperative infections, there are no data showing that administration of antibiotics while waiting for surgery has any benefits. The aims of this study are to evaluate the role of both in-hospital delay to surgery and antibiotic treatment while waiting for surgery on the rate of appendiceal perforation.

Methods

This prospective, open-label, randomized, controlled non-inferiority trial compares the in-hospital delay to surgery of less than 8 hours versus less than 24 hours in adult patients with predicted uncomplicated acute appendicitis. Additionally, participants are randomized either to receive or not to receive antibiotics while waiting for surgery. The primary study endpoint is the rate of perforated appendicitis discovered during appendicectomy. The aim is to randomize 1800 patients, that is estimated to give a power of 90 per cent (χ2) for the non-inferiority margin of 5 percentage points for both layers (urgency and preoperative antibiotic). Secondary endpoints include length of hospital stay, 30-day complications graded using Clavien–Dindo classification, preoperative pain, conversion rate, histopathological diagnosis and Sunshine Appendicitis Grading System classification.

Discussion

There are no previous randomized controlled studies for either in-hospital delay or preoperative antibiotic treatment. The trial will yield new level 1 evidence.

EU Clinical Trials Register, EudraCT Number: 2019–002348-26; registration number: NCT04378868 (http://www.clinicaltrials.gov)
Interventional treatments for prolapsing haemorrhoids: network meta-analysis
Authors: Jin J Z , Bhat S , Lee K -T , Xia W , Hill A G
Published: September 2021

Background

Multiple treatments for early–moderate grade symptomatic haemorrhoids currently exist, each associated with their respective efficacy, complications, and risks. The aim of this study was to compare the relative clinical outcomes and effectiveness of interventional treatments for grade II–III haemorrhoids.

Methods

A systematic review was conducted according to PRISMA criteria for all the RCTs published between 1980 and 2020; manuscripts were identified using the MEDLINE, Embase, and CENTRAL databases. Inclusion criteria were RCTs comparing procedural interventions for grade II–III haemorrhoids. Primary outcomes of interest were: symptom recurrence at a minimum follow-up of 6 weeks, postprocedural pain measured on a visual analogue scale (VAS) on day 1, and postprocedural complications (bleeding, urinary retention, and bowel incontinence). After bias assessment and heterogeneity analysis, a Bayesian network meta-analysis was performed.

Results

Seventy-nine RCTs were identified, including 9232 patients. Fourteen different treatments were analysed in the network meta-analysis. Overall, there were 59 RCTs (73 per cent) judged as being at high risk of bias, and the greatest risk was in the domain measurement of outcome. Variable amounts of heterogeneity were detected in direct treatment comparisons, in particular for symptom recurrence and postprocedural pain. Recurrence of haemorrhoidal symptoms was reported by 54 studies, involving 7026 patients and 14 treatments. Closed haemorrhoidectomy had the lowest recurrence risk, followed by open haemorrhoidectomy, suture ligation with mucopexy, stapled haemorrhoidopexy, and Doppler-guided haemorrhoid artery ligation (DG-HAL) with mucopexy. Pain was reported in 34 studies involving 3812 patients and 11 treatments. Direct current electrotherapy, DG-HAL with mucopexy, and infrared coagulation yielded the lowest pain scores. Postprocedural bleeding was recorded in 46 studies involving 5696 patients and 14 treatments. Open haemorrhoidectomy had the greatest risk of postprocedural bleeding, followed by stapled haemorrhoidopexy and closed haemorrhoidectomy. Urinary retention was reported in 30 studies comparing 10 treatments involving 3116 participants. Open haemorrhoidectomy and stapled haemorrhoidopexy had significantly higher odds of urinary retention than rubber band ligation and DG-HAL with mucopexy. Nine studies reported bowel incontinence comparing five treatments involving 1269 participants. Open haemorrhoidectomy and stapled haemorrhoidopexy had the highest probability of bowel incontinence.

Conclusion

Open and closed haemorrhoidectomy, and stapled haemorrhoidopexy were associated with worse pain, and more postprocedural bleeding, urinary retention, and bowel incontinence, but had the lowest rates of symptom recurrence. The risks and benefits of each treatment should be discussed with patients before a decision is made.
Clinical outcomes and cost of robotic ventral hernia repair: systematic review
Authors: Ye Linda , Childers Christopher P , de Virgilio Michael , Shenoy Rivfka , Mederos Michael A , Mak Selene S , Begashaw Meron M , Booth Marika S , Shekelle Paul G , Wilson Mark , Gunnar William , Girgis Mark D , Maggard-Gibbons Melinda
Published: September 2021

Background

Robotic ventral hernia repair (VHR) has seen rapid adoption, but with limited data assessing clinical outcome or cost. This systematic review compared robotic VHR with laparoscopic and open approaches.

Methods

This systematic review was undertaken in accordance with PRISMA guidelines. PubMed, MEDLINE, Embase, and Cochrane databases were searched for articles with terms relating to ‘robot-assisted’, ‘cost effectiveness’, and ‘ventral hernia’ or ‘incisional hernia’ from 1 January 2010 to 10 November 2020. Intraoperative and postoperative outcomes, pain, recurrence, and cost data were extracted for narrative analysis.

Results

Of 25 studies that met the inclusion criteria, three were RCTs and 22 observational studies. Robotic VHR was associated with a longer duration of operation than open and laparoscopic repairs, but with fewer transfusions, shorter hospital stay, and lower complication rates than open repair. Robotic VHR was more expensive than laparoscopic repair, but not significantly different from open surgery in terms of cost. There were no significant differences in rates of intraoperative complication, conversion to open surgery, surgical-site infection, readmission, mortality, pain, or recurrence between the three approaches.

Conclusion

Robotic VHR was associated with a longer duration of operation, fewer transfusions, a shorter hospital stay, and fewer complications compared with open surgery. Robotic VHR had higher costs and a longer operating time than laparoscopic repair. Randomized or matched data with standardized reporting, long-term outcomes, and cost-effectiveness analyses are still required to weigh the clinical benefits against the cost of robotic VHR.
Incidence, detection and outcome of differentiated thyroid cancer in Western Sweden
Authors: Dahlberg J , Adok C , Bümming P , Demir A , Hedbäck G , Nilsson B , Nilsson M , Jansson S
Published: September 2021

Background

It is unclear whether the increasing incidence of thyroid cancer (TC) due to increased diagnosis of small and indolent tumours might mask a real increase of clinically significant cancers. The aim of this study was to correlate surgery, pathology and outcome data of individual patients to the mode of primary detection (palpation, by imaging or incidental) to assess if TC incidence has increased.

Methods

The Swedish Cancer Registry identified all patients with TC in Västra Götaland County representing approximately 1.6 million inhabitants. Clinical information was retrieved from medical records of patient cohorts from three study intervals (2001–2002, 2006–2007 and 2011–2014) comprising 60 per cent of all TC patients. Data were also obtained from the NORDCAN registry to compare of TC incidence with other Nordic countries.

Results

Between 2001 and 2014, the annualized standard incidence rate/100 000 population (ASR) of TC increased from 3.14 to 10.71 in women and from 1.12 to 3.77 in men. This was higher than the mean incidence for Sweden but similar to that in Norway and Finland. Differentiated TC (DTC) increased more than threefold. The majority of tumours (64 per cent) were detected by palpation. Larger tumours (10–20, 21–40 and greater than 40 mm) increased as much as microcarcinomas (less than 10 mm). Only 5 per cent of the tumours were detected by imaging. All disease-specific deaths (8.5 per cent of DTC in the first two cohorts) and most patients with recurrent or persistent disease (6.6 per cent of DTC cases) were diagnosed due to tumour-related symptoms.

Conclusion

DTC in Western Sweden gradually increased between 2001 and 2014. The majority of tumours were detected by palpation suggesting a real increase in the incidence of clinically significant thyroid malignancies.
Membrane scaffolds for matrix-induced autologous chondrocyte implantation in the knee: a systematic review
Authors: Migliorini Filippo , Eschweiler Jörg , Goetze Christian , Tingart Markus , Maffulli Nicola
Published: September 2021

Introduction

Chondral defects of the knee are common and their management is challenging.

Source of data

Current scientific literature published in PubMed, Google scholar, Embase and Scopus.

Areas of agreement

Membrane-induced autologous chondrocyte implantation (mACI) has been used to manage chondral defects of the knee.

Areas of controversy

Hyaluronic acid membrane provides better outcomes than a collagenic membrane for mACI in the knee at midterm follow-up is controversial.

Growing points

To investigate whether hyaluronic acid membrane may provide comparable clinical outcomes than collagenic membranes for mACI in focal defects of the knee.

Areas timely for developing research

Hyaluronic acid membrane yields a lower rate of failures and revision surgeries for mACI in the management of focal articular cartilage defects of the knee compared with collagenic scaffolds at midterm follow-up. No difference was found in patient reported outcome measures (PROMs). Further comparative studies are required to validate these results in a clinical setting.
Seed shape supports phylogenetic relationships and adaptive radiation in the genusPinguicula(Lentibulariaceae)
Authors: Shimai Hiro
Published: September 2021

Recent phylogenetic analyses call into question the morphology-based classification of Pinguicula. Although considerable floral morphological diversity among taxa in the genus is present within a geographical region, the phylogenetic analyses suggest that in many cases the taxa in any such region form a monophyletic group. Floral morphology may well have masked phylogenetic relationships and further evidence is required to clarify the issue. In this study, seed shape and size in Pinguicula from Mexico and higher latitudes of the Northern Hemisphere (Northern) belonging to subgenera Isoloba and Pinguicula, a total of 38 taxa, were compared. Results showed that the seed of Mexican taxa was significantly narrower than that of the Northern taxa. The study suggests that the morphology-based subgeneric division was not supported by statistical analyses of seed characters, whereas the geographical division was supported. The Northern and Mexican taxa can, therefore, be separated by their seed shape and size, and consequently the adaptive radiation inferred by the phylogenetic analyses was strongly supported by seed shape, in addition to life-form and basic chromosome number. The shape of seed remains similar within a lineage in each region with relation to the evolutionary history of the genus.
Curcumin preconditioning enhances the efficacy of adipose-derived mesenchymal stem cells to accelerate healing of burn wounds
Authors: Azam Maryam , Ghufran Hafiz , Butt Hira , Mehmood Azra , Ashfaq Ramla , Ilyas Asad M , Ahmad Muhammad R , Riazuddin Sheikh
Published: September 2021

Background

Following recent findings from our group that curcumin preconditioning augments the therapeutic efficacy of adipose-derived stem cells in the healing of diabetic wounds in rats, we aimed to investigate the regenerative effects of curcumin preconditioned adipose-derived mesenchymal stem cells (ASCs) for better recovery of acid inflicted burns in this study.

Methods

ASCs were preconditioned with 5 μM curcumin for 24 hours and assessed for proliferation, migration, paracrine release potential and gene expression comparative to naïve ASCs. Subsequently, the healing capacity of curcumin preconditioned ASCs (Cur-ASCs) versus naïve ASCs was examined using acidic wounds in rats. For this, acid inflicted burns of 20 mm in diameter were made on the back of male Wistar rats. Then, 2 × 106 cells of Cur-ASCs and naïve ASCs were intradermally injected in the wound periphery (n = 6) for comparison with an untreated saline control. Post-transplantation, wounds were macroscopically analysed and photographed to evaluate the percentage of wound closure and period of re-epithelization. Healed wound biopsies were excised and used for histological evaluation and expression analysis of wound healing markers at molecular level by quantitative PCR and western blotting.

Results

We found that Cur-ASCs exhibited greater proliferation, migration and paracrine potential in vitro. Further, Cur-ASCs showed more effective recovery than naïve ASCs as exhibited by gross morphology, faster wound closure and earlier re-epithelialization. Masson’s trichrome and hematoxylin and eosin staining demonstrated the improved architecture of the healing burns, as evidenced by reduced infiltration of inflammatory cells, compact collagen and marked granulation in Cur-ASC treated rats. Corroborating these findings, molecular assessment showed significantly reduced expressions of pro-inflammatory factors (interleukin-1 beta, interleukin-6, tumor necrosis factor alpha) a with striking upsurge of an oxidative marker (superoxide dismutase 1), pro-angiogenic factors (vascular endothelial growth factor, hepatocyte growth factor, hypoxia-inducible factor-1 alpha) and collagen markers (transforming growth factor beta 1, fibroblast growth factor-2, collagen type 1 alpha 1), verifying that Cur-ASCs modulate the regulation of pro-inflammatory and healing markers at burn sites.

Conclusions

Treatment with Cur-ASCs resulted in faster re-epithelization of acid inflicted burns compared to the treatment with naïve ASCs. Based on observed findings, we suggest the transplantation of Cur-ASCs is a valuable therapy for the potent clinical management of acidic burns.
Doing it Like a Tomboy on Post-2010 Chinese TV
Authors: Zhao Jamie J
Published: September 2021

Using examples drawn from post-2010 TV in mainland China, I explore tomboyish images as a sign that potentially subverts both traditional feminine ideals and heteronormative expectations for women. I show that contemporary mainland Chinese TV representations of tomboyism have often softened its subversive edge in a hetero-patriarchal-structured society with growing knowledge in feminist and queer cultures. Thus, while adult women’s embodiment of female masculinity might have been tolerated and even commercialized in post-2010 Chinese society and entertainment, there exists an uncomfortable disjuncture between the tomboyism on TV and certain T identities in the off-screen world.
Unmasking the Strongblackwoman in Mentoring
Authors: Durham Aisha
Published: September 2021

The strongBlackwoman (SBW; Morgan, 1999) is a hip hop generation cultural script strategically performed by Black women to project authority, competency, and togetherness. It acts as psychic armor to shield against the deadly daily dagger of White heteropatriarchy in the academy. The author recites two indelible moments when she engages as mentor to narratively stage unmasking. Each moment provides a pedagogical opportunity to reimagine so-called failed performances as reclamations of her humanness. In doing so, the author demonstrates how unmasking engages a Black feminist ethic of empathy and exemplifies a Black feminist praxis to engender relatable, compassionate, and life-affirming mentoring.
Variations in Commissural Input Processing Across Different Types of Cortical Projection Neurons
Authors: Yi Jee Hyun , Choe Seo Yeon , Jung Min Whan
Published: September 2021

To understand how incoming cortical inputs are processed by different types of cortical projection neurons in the medial prefrontal cortex, we compared intrinsic physiological properties of and commissural excitatory/inhibitory influences on layer 5 intratelencephalic (IT), layer 5 pyramidal tract (PT), and layers 2/3 IT projection neurons. We found that intrinsic physiological properties and commissural synaptic transmission varied across the three types of projection neurons. The rank order of intrinsic excitability was layer 5 PT > layer 5 IT > layers 2/3 IT neurons. Commissural connectivity was higher in layers 2/3 than layer 5 projection neurons, but commissural excitatory influence was stronger on layer 5 than layers 2/3 pyramidal neurons. Paired-pulse ratio was also greater in PT than IT neurons. These results indicate that commissural inputs activate deep layer PT neurons most preferentially and superficial layer IT neurons least preferentially. Deep layer PT neurons might faithfully transmit cortical input signals to downstream subcortical structures for reliable control of behavior, whereas superficial layer IT neurons might integrate cortical input signals from diverse sources in support of higher-order cognitive functions.
Determination of BTEX Compounds in Contaminated Water Using the Novel Vacuum-Assisted-Total Vaporization SPME Method and GO-APTES Fiber
Authors: Beiranvand Mohammad
Published: September 2021

A novel and reliable microextraction technique was used for the fast determination of benzene, toluene, ethylbenzene and xylenes (BTEX) from contaminated water without any extra steps for the preparation or extraction of the aqueous sample. Vacuum-assisted-total vaporization-solid-phase microextraction (SPME) eliminated one of the partitioning steps in conventional headspace SPME and caused an increase in the sensitivity and speed of the method. A home-made graphene oxide/3-aminopropyl-triethoxysilane nanocomposite SPME fiber was synthesized and used as the extraction phase for efficient extraction. Several crucial parameters were optimized, such as the vaporization time and temperature, extraction time and desorption conditions. At the optimum experimental conditions, a linear wide range calibration curve over a wide range of 1–5,000 ng mL−1 and a relative standard deviation (n = 6) of 6.6–7.3% were obtained. The result of the determination of BTEX as a human health risk from real samples, using the proposed method, revealed an acceptable agreement with a valid method.
Mortality, Length of Stay, and Healthcare Costs Associated With Multidrug-Resistant Bacterial Infections Among Elderly Hospitalized Patients in the United States
Authors: Nelson Richard E , Hyun David , Jezek Amanda , Samore Matthew H
Published: September 2021

Background

This study reports estimates of the healthcare costs, length of stay, and mortality associated with infections due to multidrug-resistant bacteria among elderly individuals in the United States.

Methods

We conducted a retrospective cohort analysis of patients aged ≥65 admitted for inpatient stays in the Department of Veterans Affairs healthcare system between 1/2007–12/2018. We identified those with positive cultures for multidrug-resistant bacteria and matched each infected patient to ≤10 control patients. We then performed multivariable regression models to estimate the attributable cost and mortality due to the infection. We also constructed multistate models to estimate the attributable length of stay due to the infection. Finally, we multiplied these pathogen-specific attributable cost, length of stay, and mortality estimates by national case counts from hospitalized patients in 2017.

Results

Our cohort consisted of 87 509 patients with infections and 835 048 matched controls. Costs were higher for hospital-onset invasive infections, with attributable costs ranging from $22 293 (95% confidence interval: $19 101–$24 485) for methicillin-resistant Staphylococcus aureus (MRSA) to $57 390 ($34 070–$80 710) for carbapenem-resistant (CR) Acinetobacter. Similarly, for hospital-onset invasive infections, attributable mortality estimates ranged from 14.2% (12.2–16.2%) for MRSA to 24.1% (12.1–36.0%) for CR Acinetobacter. The aggregate cost of these infections was an estimated $1.9 billion ($1.3 billion–$2.5 billion) with 11 852 (8719–14 985) deaths and 448 224 (354 513–541 934) inpatient days in 2017.

Conclusions

Efforts to prevent these infections due to multidrug-resistant bacteria could save a significant number of lives and healthcare resources.
Urgent, Comprehensive Federal Action Needed To Stem Mortality and Medicare Costs Associated With Antimicrobial Resistance
Authors: Fowler Vance G , Jezek Amanda , Spivak Emily S , Talkington Kathy
Published: September 2021

This paper is a call to action for the policies necessary to reduce the burden of antimicrobial resistance, including federal investments in antibiotic stewardship, antibiotic innovation, surveillance, research, diagnostics, infection prevention, the infectious diseases workforce, and global coordination.
The Political Logic of Status Competition: Leaders, Status Tradeoffs, and Beijing’s Vietnam Policy, 1949–1965
Authors: Wang Ziyuan
Published: September 2021

Students of status politics among nations could hardly evade two broad questions: how do status aspirations drive state foreign policy? And when do leaders consider international conflict a vehicle for status assertion? Conventional wisdom holds that humiliating international events could sensitize leaders to great-power status, increase their propensity for geopolitical competition, and fuel domestic agitation for provocative policies abroad. This assertion is empirically and theoretically flawed. In response, my argument underscores the fact that leaders often have to reconcile their status claims with the imperatives of national security and political survival. Two hypotheses follow. First, in the aftermath of humiliating international events, leaders tend to abstain from provocative policies. That is because such policies risk escalation of conflicts abroad which could jeopardize leaders’ interests in national security and domestic political survival. However, should the moderate approach either encourage the rival power to threaten leaders’ ties with a client state or stir a domestic backlash, leaders may pursue a provocative policy (a second hypothesis). Beijing’s Vietnam policy in 1949–1965 provides crucial evidence for these hypotheses, which carry implications for theory and current events.
Digital Microfluidic Hemagglutination Assays for Blood Typing, Donor Compatibility Testing, and Hematocrit Analysis
Authors: Sklavounos Alexandros A , Lamanna Julian , Modi Dimpy , Gupta Sidharth , Mariakakis Alex , Callum Jeannie , Wheeler Aaron R
Published: September 2021

Background

Blood typing, donor compatibility testing, and hematocrit analysis are common tests that are important in many clinical applications, including those found in high-stakes settings such as the trauma center. These tests are typically performed in centralized laboratories with sample batching; the minutes that are lost in this mode can lead to adverse outcomes, especially for critical-care patients. As a step toward providing rapid results at the bedside, we developed a point-of-care hemagglutination system relying on digital microfluidics (DMF) and a unique, automated readout tool, droplet agglutination assessment using digital microfluidics (DAAD).

Methods

ABO and Rhesus blood grouping, donor crossmatching, and hematocrit assays were developed on a portable DMF platform that allowed for automated sample processing. The result of each assay could be determined by eye or automatically with the DAAD imaging tool.

Results

DMF-DAAD was applied to 109 samples collected from different sources (including commercial samples, pinpricks from volunteers, and a hospital blood bank), with perfect fidelity to gold-standard results. Some of these tests were carried out by a nonexpert in a hospital trauma center. Proof-of-concept results were also collected from smaller sample sets for donor compatibility testing and hematocrit analysis.

Conclusion

DMF-DAAD shows promise for delivering rapid, reliable results in a format well suited for a trauma center and other settings where every minute counts.
Benchmark for Discriminating Power of Edge Centrality Metrics
Authors: Bao Qi , Xu Wanyue , Zhang Zhongzhi
Published: September 2021

Edge centrality has found wide applications in various aspects. Many edge centrality metrics have been proposed, but the crucial issue that how good the discriminating power of a metric is, with respect to other measures, is still open. In this paper, we address the question about the benchmark of the discriminating power of edge centrality metrics. We first use the automorphism concept to define equivalent edges, based on which we introduce a benchmark for the discriminating power of edge centrality measures and develop a fast approach to compare the discriminating power of different measures. According to the benchmark, for a desirable measure, equivalent edges have identical metric scores, while inequivalent edges possess different scores. However, we show that even in a toy graph, inequivalent edges cannot be discriminated by three existing edge centrality metrics. We then present a novel edge centrality metric called forest centrality (FC). Extensive experiments on real-world networks and model networks indicate that FC has better discriminating power than three existing edge centrality metrics.
Minimal Rare Pattern-Based Outlier Detection Approach For Uncertain Data Streams Under Monotonic Constraints
Authors: Cai Saihua , Chen Jinfu , Chen Haibo , Zhang Chi , Li Qian , Shi Dengzhou , Lin Wei
Published: September 2021

Existing association-based outlier detection approaches were proposed to seek for potential outliers from huge full set of uncertain data streams ($UDS$), but could not effectively process the small scale of $UDS$ that satisfies preset constraints; thus, they were time consuming. To solve this problem, this paper proposes a novel minimal rare pattern-based outlier detection approach, namely Constrained Minimal Rare Pattern-based Outlier Detection (CMRP-OD), to discover outliers from small sets of $UDS$ that satisfy the user-preset succinct or convertible monotonic constraints. First, two concepts of ‘maximal probability’ and ‘support cap’ are proposed to compress the scale of extensible patterns, and then the matrix is designed to store the information of each valid pattern to reduce the scanning times of $UDS$, thus decreasing the time consumption. Second, more factors that can influence the determination of outlier are considered in the design of deviation indices, thus increasing the detection accuracy. Extensive experiments show that compared with the state-of-the-art approaches, CMRP-OD approach has at least 10% improvement on detection accuracy, and its time cost is also almost reduced half.
Efficient sampling of complex interdependent and multiplex networks
Authors: Subasi Omer , Chatterjee Samrat
Published: September 2021

Efficient sampling of interdependent and multiplex infrastructure networks is critical for effectively applying failure and recovery algorithms in real-world settings, as well as to generate property-preserving reduced-order graph-based ensembles that address topological uncertainties. In this article, we first explore the performance, that is, the success in preserving graph properties, of graph sampling algorithms for interdependent and multiplex networks with synthetic and real-world graphs. We simulate sampling algorithms under different parameter settings. These settings include probabilistic graph generators, coupling patterns and various performance metrics. Our results show that while Random Node and Random Walk sampling algorithms perform best for interdependent networks, Random Edge and Forest Fire sampling algorithms perform best for multiplex networks. Second, we propose and implement a novel similarity-based sampling algorithm for multiplex networks that samples only ${\it log}(N)$ number of layers of an $N$-layer multiplex network while yielding computational savings with performance guarantees. Experimental results show that similarity-based sampling outperforms complete sampling of all layers while decreasing performance costs from a linear scale to a logarithmic one. Our results also indicate that similarity-based sampling outperforms complete sampling and random selection in nearly all scenarios when tested with real-world data.
Shakespeare’s suppliants: the ‘rotten custom’ of ancient asylum seeking inCoriolanus
Authors: Wald Christina
Published: September 2021

Looking back to the early modern period from the current immigration crisis, this article reads Shakespeare’s tragedy Coriolanus as a tragedy of displacement and asylum seeking. It argues that just like theatrical productions today, Shakespeare might have harked back to ancient Greek tragedy as a cultural resource for coming to terms with the challenges of immigration. It traces the possible migrations between the ritual of asylum seeking that was reflected in a number of Greek tragedies including Aeschylus’s Hiketides, the earliest surviving play about refugees from the fifth century BCE, and Shakespeare’s Coriolanus. In this respect, this article is part of the current critical re-evaluation of the relations between Shakespeare’s work and ancient Greek tragedy. It places Coriolanus into the intertextual and intermedial hiketeia rhizome, in which one transmission line from Greek tragedy via Dionysius of Halicarnassus, Plutarch, Amyot, and North to Shakespeare can be corroborated by evidence, while other lines are more uncertain. Asking whether hiketeia, the ancient verbal and gestural repertoire of a stranger pleading for protection and integration into the polis, is only present as ‘rotten custom’ in Shakespeare’s tragedy, as a trace of cultural history without any considerable force in the new context, the article explores the paradoxical negotiation of displacement in Coriolanus, where both the exiled and the exiler become suppliants. It proposes that Shakespeare’s transformative reactivation of hiketeia as a theatrically, affectively, and politically potent form created an opportunity to negotiate the immigration crisis in Jacobean England.
Cardiovascular comorbidities, inflammation, and cerebral small vessel disease
Authors: Evans Lowri E , Taylor Jade L , Smith Craig J , Pritchard Harry A T , Greenstein Adam S , Allan Stuart M
Published: September 2021

Cerebral small vessel disease (cSVD) is the most common cause of vascular cognitive impairment and affects all levels of the brain’s vasculature. Features include diverse structural and functional changes affecting small arteries and capillaries that lead to a decline in cerebral perfusion. Due to an ageing population, incidence of cSVD is continually rising. Despite its prevalence and its ability to cause multiple debilitating illnesses, such as stroke and dementia, there are currently no therapeutic strategies for the treatment of cSVD. In the healthy brain, interactions between neuronal, vascular, and inflammatory cells are required for normal functioning. When these interactions are disturbed, chronic pathological inflammation can ensue. The interplay between cSVD and inflammation has attracted much recent interest, and this review discusses chronic cardiovascular diseases, particularly hypertension, and explores how the associated inflammation may impact on the structure and function of the small arteries of the brain in cSVD. Molecular approaches in animal studies are linked to clinical outcomes in patients, and novel hypotheses regarding inflammation and cSVD are proposed that will hopefully stimulate further discussion and study in this important area.
Chromosome-level genome assembly of Gynostemma pentaphyllum provides insights into gypenoside biosynthesis
Authors: Huang Ding , Ming Ruhong , Xu Shiqiang , Wang Jihua , Yao Shaochang , Li Liangbo , Huang Rongshao , Tan Yong
Published: September 2021

Gynostemma pentaphyllum (Thunb.) Makino is an economically valuable medicinal plant belonging to the Cucurbitaceae family that produces the bioactive compound gypenoside. Despite several transcriptomes having been generated for G. pentaphyllum, a reference genome is still unavailable, which has limited the understanding of the gypenoside biosynthesis and regulatory mechanism. Here, we report a high-quality G. pentaphyllum genome with a total length of 582 Mb comprising 1,232 contigs and a scaffold N50 of 50.78 Mb. The G. pentaphyllum genome comprised 59.14% repetitive sequences and 25,285 protein-coding genes. Comparative genome analysis revealed that G. pentaphyllum was related to Siraitia grosvenorii, with an estimated divergence time dating to the Paleogene (∼48 million years ago). By combining transcriptome data from seven tissues, we reconstructed the gypenoside biosynthetic pathway and potential regulatory network using tissue-specific gene co-expression network analysis. Four UDP-glucuronosyltransferases (UGTs), belonging to the UGT85 subfamily and forming a gene cluster, were involved in catalyzing glycosylation in leaf-specific gypenoside biosynthesis. Furthermore, candidate biosynthetic genes and transcription factors involved in the gypenoside regulatory network were identified. The genetic information obtained in this study provides insights into gypenoside biosynthesis and lays the foundation for further exploration of the gypenoside regulatory mechanism.
Potential of Ultrasound to Control Sesamia cretica (Lepidoptera: Noctuidae)
Authors: Agah-Manesh Hamzeh , Rajabpour Ali , Yarahmadi Fatemeh , Farsi Afrooz
Published: September 2021

The pink stalk borer, Sesamia cretica Led. (Lepidoptera: Noctuidae), is one of the most important sugarcane pests in many regions of the world, causing severe damage to sugarcane every year. This insect has a specialized form of the auditory organ called the tympanal organ, and ultrasound can be employed as a potential tactic employed in physical control strategy against the pest. The present study evaluates the efficacy of ultrasound in controlling the pest in laboratory conditions. For this purpose, the repellent properties of various ultrasonic frequencies ranging from 21 to 100 kHz with 0.5 kHz intervals and wave shapes, including Sin(x), Cos(x) square, and sawtooth, were studied in choice experiments on the moths. The repellent effects of ultrasonic waves at frequencies 39.5 and 37.5 kHz were more significant than other frequencies in male and female moths, respectively. Furthermore, there was no significant difference between the repellent properties of different wave shapes. In non-choice experiments, the effects of the most repellent ultrasonic treatment, at frequency 37.5 kHz, on biological characteristics of various life stages and distribution patterns of the moths were investigated. The results showed that the ultrasonic treatment causes substantial reductions in many biological parameters of the immature life stages of pests, including longevity, weight, survival rate, and fecundity. Moreover, the pattern indicated that the moths tended to escape from the ultrasound. The findings of this study can be employed for manufacturing the ultrasonic repeller to be used in sugarcane fields.