bluuebunny/crossref_metadata_2025 huggingface dataset:
Paralleled multi-GaN MIS–HEMTs integrated cascode switch for power electronic applications
Authors: Elangovan Surya , Cheng Stone , Jang Wen-Yea , Chang Edward Yi , Kuo Hao-Chung
Published: May 2023

A cascode gallium nitride (GaN) switch integrating four paralleled GaN depletion-mode metal–insulator–semiconductor–high-electron-mobility transistors (MIS–HEMT) and a silicon MOSFET (Si-MOSFET) is presented. Each GaN chip is wire-bonded into a multi-chip power module to scale up the power rating. An optimized symmetric configuration and wire bonding of an integral package are used in the cascode switch. By utilizing an optimized packaging approach, the performance of the multi-GaN-chip cascode switch was evaluated through both static and dynamic characterizations. The constructed cascode switch provides a low-static on-state resistance of 72 mΩ and an off-state blocking capability of 400 V with a positive threshold voltage of 2 V. Analysis of dynamic switching characteristics are discussed and demonstrates stable dynamic on-state resistance (R
DS-ON) in inductive load circuits with switching dependencies of voltage, frequency, time, and temperature. The extended defects from buffer caused a minimal decrease in dynamic and static R
DS-ON with respect to hard switching conditions. However, there was no noticeable degradation in R
DS-ON under harsh switching conditions. This study provides a complete analysis of the multi-GaN-chip cascode switch, including MIS–HEMT manufacturing, cascode packaging and static and dynamic characterizations.
Study on the characteristics of grating structure sensing based on off-Γ bound states in the continuum
Authors: Wang Zhan , Xue Qi , Wang PengFei , Yang He , Sun XiaoHong
Published: May 2023

Due to the polarization dependence, there are two kinds of off-Γ bound states in the continuum (BIC) modes (TM-like mode and TE-like mode) for C2 symmetric grating structure. Compared to symmetrical protection BIC, off-Γ BIC is more susceptible to environmental changes, resulting in high refractive index sensitivity. In this paper, the influence of grating structure parameters on refractive index sensitivity of off-Γ BICs is studied, and the responses of two BIC modes to environmental refractive index are summarized. The refractive index sensitivities of TM-like mode and TE-like mode have different responses to grating structure parameters. The maximum sensitivity and figure of merit (FOM) of TM-like mode are 476 nm RIU−1 and 15866 RIU−1, while these of TE-like mode are 720 nm RIU−1 and 1440 RIU−1 respectively. These conclusions provide insights for the assembly and research of grating optical sensors based on off-Γ BICs.
Laser-free method for creation of two-mode squeezed state and beam-splitter transformation with trapped ions
Authors: Nikolova Bogomila S , Ivanov Peter A
Published: May 2023

We propose a laser-free method for creation of a phonon two-mode squeezed state and a beam-splitter transformation, using time-varying electric fields and non-linear couplings between the normal modes in a linear ion crystal. Such non-linear Coulomb-mediated interactions between the collective vibrational modes arise under specific trap-frequency conditions in an ion trap. We study the quantum metrological capability for parameter estimation of the two quantum states and show that a Heisenberg limit of precision can be achieved when the initial state with n phonons evolves under the action of the beam-splitter transformation. Furthermore, we show that the phonon non-linearity and the spin-dependent force can be used for creation of a three-qubit Fredkin gate.
Unsteady detonation with thermodynamic nonequilibrium effect based on the kinetic theory
Authors: Su Xianli , Lin Chuandong
Published: May 2023

In this paper, unsteady detonation is simulated and investigated from the viewpoint of kinetic theory. The deviations of the velocity distribution function from the equilibrium state are studied in the evolution of detonation. It has been discovered that the characteristics of the deviation around the detonation wave are significantly different from those in the post-wave region. Besides, the kinetic moments of the reaction term have been simulated, verified and analyzed in detail. In addition, the reaction manifestation is defined to describe the global effects of kinetic moments due to chemical reactions. It is interesting to find that there are three types of periodic oscillations of the reaction manifestation during the evolution of the unsteady detonation. Via the fast Fourier transform, it can be seen that the reaction manifestation is mainly composed of several signal frequencies. Moreover, the impact of rate constants of the two-step reaction scheme on the reaction manifestation is studied, and the influence of chemical heat is investigated as well.
Excitation-damping quantum channels
Authors: Lonigro Davide , Chruściński Dariusz
Published: May 2023

We study a class of quantum channels describing a quantum system, split into the direct sum of an excited and a ground sector, undergoing a one-way transfer of population from the former to the latter; this construction, which provides a generalization of the amplitude-damping qubit channel, can be regarded as a way to upgrade a trace non-increasing quantum operation, defined on the excited sector, to a possibly trace preserving operation on a larger Hilbert space. We provide necessary and sufficient conditions for the complete positivity of such channels, and we also show that complete positivity can be equivalent to simple positivity when the ground sector is one-dimensional. Finally, we examine the time-dependent scenario and characterize all CP-divisible channels and Markovian semigroups belonging to this class, thus providing a general recipe, beyond the Markovian scenario, to promote a given decay process to a legitimate quantum process on a larger space.
Exhaled breath condensate profiles of U.S. Navy divers following prolonged hyperbaric oxygen (HBO) and nitrogen-oxygen (Nitrox) chamber exposures
Authors: Fothergill David M , Borras Eva , McCartney Mitchell M , Schelegle Edward S , Davis Cristina E
Published: May 2023

Prolonged exposure to hyperbaric hyperoxia can lead to pulmonary oxygen toxicity (PO2tox). PO2tox is a mission limiting factor for special operations forces divers using closed-circuit rebreathing apparatus and a potential side effect for patients undergoing hyperbaric oxygen (HBO) treatment. In this study, we aim to determine if there is a specific breath profile of compounds in exhaled breath condensate (EBC) that is indicative of the early stages of pulmonary hyperoxic stress/PO2tox. Using a double-blind, randomized ‘sham’ controlled, cross-over design 14 U.S. Navy trained diver volunteers breathed two different gas mixtures at an ambient pressure of 2 ATA (33 fsw, 10 msw) for 6.5 h. One test gas consisted of 100% O2 (HBO) and the other was a gas mixture containing 30.6% O2 with the balance N2 (Nitrox). The high O2 stress dive (HBO) and low O2 stress dive (Nitrox) were separated by at least seven days and were conducted dry and at rest inside a hyperbaric chamber. EBC samples were taken immediately before and after each dive and subsequently underwent a targeted and untargeted metabolomics analysis using liquid chromatography coupled to mass spectrometry (LC-MS). Following the HBO dive, 10 out of 14 subjects reported symptoms of the early stages of PO2tox and one subject terminated the dive early due to severe symptoms of PO2tox. No symptoms of PO2tox were reported following the nitrox dive. A partial least-squares discriminant analysis of the normalized (relative to pre-dive) untargeted data gave good classification abilities between the HBO and nitrox EBC with an AUC of 0.99 (±2%) and sensitivity and specificity of 0.93 (±10%) and 0.94 (±10%), respectively. The resulting classifications identified specific biomarkers that included human metabolites and lipids and their derivatives from different metabolic pathways that may explain metabolomic changes resulting from prolonged HBO exposure.
Single photon detection performance of highly disordered NbTiN thin films
Authors: Ma Ruoyan , Shu Rui , Zhang Xingyu , Yu Aobo , Huang Jia , Xiao You , Yu Huiqin , Liu Xiaoyu , Li Hao , Eklund Per , Zhang Xiaofu , You Lixing
Published: May 2023

We experimentally investigated the detection performance of highly disordered

Nb

x

Ti

1
−
x

N

based superconducting nanowire single photon detectors (SNSPDs). The dependence on the composition of the transition temperature

T

c

for

Nb

x

Ti

1
−
x

N

films show a dome-like behavior on the Nb content, with a maximal

T

c

at

x

Nb

∼
0.65
,

and the

Nb

0.65

Ti

0.35

N

films also combine relatively large sheet resistance and intermediate residual resistivity ratio. Moreover, 60-nm-wide and 7-nm-thick

Nb

0.65

Ti

0.35

N

nanowires show a switching current as high as 14.5 μA, and saturated intrinsic detection efficiency with a plateau of more than 2 μA at 2.4 K. Finally, the corresponding SNSPDs on an alternative SiO2/Ta2O5 dielectric mirror showed a system detection efficiency of approximately 92% for 1550 nm photons, and the timing jitter is around 26 ps. Our results demonstrate that the highly disordered

Nb

x

Ti

1
−
x

N

films are promising for fabricating SNSPDs for near- and middle-infrared single photons with high detection efficiency and low timing jitter.
Renormalized phonon spectrum in the Su–Schrieffer–Heeger model
Authors: Fomichev Stepan , Berciu Mona
Published: May 2023

Motivated to understand phonon spectrum renormalization in the ground state of the half-filled Su–Schrieffer–Heeger model, we use the Born–Oppenheimer approximation together with the harmonic approximation to evaluate semi-analytically the all-to-all real-space ionic force constants generated through both linear and quadratic electron-phonon coupling. We then compute the renormalized phonon spectrum and the corresponding lattice zero-point energy (ZPE) as a function of the lattice dimerization. Crucially, the latter is included in the system’s total energy, and thus has a direct effect on the equilibrium dimerization. We find that inclusion of a small quadratic coupling leads to very significant changes in the predicted equilibrium dimerization, calling into question the use of the linear approximation for this model. We also argue that inclusion of the ZPE is key for systems with comparable lattice and electronic energies, and/or for finite size chains. Our method can be straightforwardly generalized to study similar problems in higher dimensions.
Permutation entropy of indexed ensembles: quantifying thermalization dynamics
Authors: Aragoneses Andrés , Kapulkin Arie , Pattanayak Arjendu K
Published: May 2023

We introduce ‘PI-Entropy’

Π
(

ρ
˜

)

(the Permutation entropy of an Indexed ensemble) to quantify mixing due to complex dynamics for an ensemble ρ of different initial states evolving under identical dynamics. We find that

Π
(

ρ
˜

)

acts as an excellent proxy for the thermodynamic entropy

S
(
ρ
)

but is much more computationally efficient. We study 1-D and 2D iterative maps and find that

Π
(

ρ
˜

)

dynamics distinguish a variety of system time scales and track global loss of information as the ensemble relaxes to equilibrium. There is a universal S-shaped relaxation to equilibrium for generally chaotic systems, and this relaxation is characterized by a shuffling timescale that correlates with the system’s Lyapunov exponent. For the Chirikov Standard Map, a system with a mixed phase space where the chaos grows with nonlinear kick strength K, we find that for high K,

Π
(

ρ
˜

)

behaves like the uniformly hyperbolic 2D Cat Map. For low K we see periodic behavior with a relaxation envelope resembling those of the chaotic regime, but with frequencies that depend on the size and location of the initial ensemble in the mixed phase space as well as K. We discuss how

Π
(

ρ
˜

)

adapts to experimental work and its general utility in quantifying how complex systems change from a low entropy to a high entropy state.
Large parametric amplification in kinetic inductance dominant resonators based on 3 nm-thick epitaxial superconductors
Authors: Chien Wei-Chen , Chang Yu-Han , Lu Cheng Xin , Ting Yen-Yu , Wu Cen-Shawn , Lin Sheng-Di , Kuo Watson
Published: May 2023

Ultra-thin superconducting aluminum films of 3-nm grown on sapphire by molecule-beam epitaxy show excellent superconductivity and large kinetic inductance. This results in a record high Kerr non-linearity of 33 kHz and 3.62 MHz per photon in notch-type and transmission-type resonators, respectively. 4-wave mixing leverages this non-linearity to achieve 12 dB parametric amplification in transmission type resonator, making the ultra-thin film ideal for photon detection and amplification applications.
Proteomic and Clinicopathologic Assessment of Penile Amyloidosis: A Single Institutional Review of 12 Cases
Authors: Tekin Burak , Gilani Sarwat I , Dasari Surendra , Theis Jason D , Rech Karen L , Dao Linda N , Cubilla Antonio L , Herrera Hernandez Loren P , Jimenez Rafael E , Cheville John C , Dispenzieri Angela , Howard Matthew T , McPhail Ellen D , Erickson Lori A , Guo Ruifeng , Gupta Sounak
Published: May 2023

Objectives

There is a paucity of data on penile amyloidosis. We aimed to assess the frequency of different amyloid types in surgical specimens from the penis involved by amyloidosis and correlate relevant clinicopathologic parameters with proteomic findings.

Methods

Since 2008, our reference laboratory has performed liquid chromatography/tandem mass spectrometry (LC-MS/MS) for amyloid typing. The institutional pathology archive and reference laboratory database were queried to retrospectively identify all penile surgical pathology specimens with LC-MS/MS results between January 1, 2008, and November 23, 2022. Archived H&E-stained and Congo red–stained sections were re-reviewed.

Results

Twelve cases of penile amyloidosis were identified, which represented 0.35% (n = 3,456) of penile surgical specimens. AL-type amyloid was most frequent (n = 7), followed by keratin-type amyloid (n = 3) and ATTR (transthyretin)–type amyloid (n = 2). AL-type amyloid cases often showed diffuse dermal/lamina propria deposition, whereas all keratin-type amyloid cases were localized to the superficial dermis. Two cases with keratin-type amyloid had concomitant cutaneous findings (penile intraepithelial neoplasia and condyloma).

Conclusions

This series, the largest to date, demonstrates that penile amyloidosis has a heterogeneous proteomic landscape. To the best of our knowledge, this is the first study describing ATTR (transthyretin)–type penile amyloid.
Size-selective harvesting impacts learning and decision-making in zebrafish, Danio rerio
Authors: Roy Tamal , Rohr Tabea , Arlinghaus Robert
Published: May 2023

Size-selective harvesting common to fisheries is known to evolutionarily alter life history and behavioral traits in exploited fish populations. Changes in these traits may, in turn, modify learning and decision-making abilities through energetic trade-offs with brain investment that can vary across development or via correlations with personality traits. We examined the hypothesis of size-selection induced alteration of learning performance in three selection lines of zebrafish (Danio rerio) generated through intensive harvesting for large, small and random body-size for five generations followed by no further selection for ten generations that allowed examining evolutionarily fixed outcomes. We tested associative learning ability throughout ontogeny in fish groups using a color-discrimination paradigm with a food reward, and the propensity to make group decisions in an associative task. All selection lines showed significant associative abilities that improved across ontogeny. The large-harvested line fish showed a significantly slower associative learning speed as subadults and adults than the controls. We found no evidence of memory decay as a function of size-selection. Decision-making speed did not vary across lines, but the large-harvested line made faster decisions during the probe trial. Collectively, our results show that large size-selective harvesting evolutionarily alters associative and decision-making abilities in zebrafish, which could affect resource acquisition and survival in exploited fish populations.
MetaMOPE: a web service for mobile phase determination and fast chromatography peaks evaluation for metabolomics
Authors: Tsai Dong-Ming , Chang Ching-Yao , Lin Shih-Ming , Kuo Tien-Chueh , Wang San-Yuan , Chen Guan-Yuan , Kuo Ching-Hua , Tseng Yufeng Jane
Published: May 2023

Motivation

Liquid chromatography coupled with mass spectrometry (LC-MS) is widely used in metabolomics studies, while HILIC LC-MS is particularly suited for polar metabolites. Determining an optimized mobile phase and developing a proper liquid chromatography method tend to be laborious, time-consuming and empirical.

Results

We developed a containerized web tool providing a workflow to quickly determine the optimized mobile phase by batch-evaluating chromatography peaks for metabolomics LC-MS studies. A mass chromatographic quality value, an asymmetric factor, and the local maximum intensity of the extracted ion chromatogram were calculated to determine the number of peaks and peak retention time. The optimal mobile phase can be quickly determined by selecting the mobile phase that produces the largest number of resolved peaks. Moreover, the workflow enables one to automatically process the repeats by evaluating chromatography peaks and determining the retention time of large standards. This workflow was validated with 20 chemical standards and successfully constructed a reference library of 571 metabolites for the HILIC LC-MS platform.

Availability and implementation

MetaMOPE is freely available at https://metamope.cmdm.tw. Source code and installation instructions are available on GitHub: https://github.com/CMDM-Lab/MetaMOPE.

Supplementary information

Supplementary data are available at Bioinformatics Advances online.
tiny-count: a counting tool for hierarchical classification and quantification of small RNA-seq reads with single-nucleotide precision
Authors: Tate Alex J , Brown Kristen C , Montgomery Taiowa A
Published: May 2023

tiny-count is a highly flexible counting tool that allows for hierarchical classification and quantification of small RNA reads from high-throughput sequencing data. Selection rules can be used to filter reads by 5′ nucleotide, length, position of alignments in relation to reference features, and by the number of mismatches to reference sequences. tiny-count can quantify reads aligned to a genome or directly to small RNA or transcript sequences. With tiny-count, users can quantify a single class of small RNAs or multiple classes in parallel. tiny-count can resolve distinct classes of small RNAs, for example, piRNAs and siRNAs, produced from the same locus. It can distinguish small RNA variants, such as miRNAs and isomiRs, with single-nucleotide precision. tRNA, rRNA, and other RNA fragments can also be quantified. tiny-count can be run alone or as part of tinyRNA, a workflow that provides a basic all-in-one command line-based solution for small RNA-seq data analysis, with documentation and statistics generated at each step for accurate and reproducible results.

Availability and implementation

tiny-count and other tinyRNA tools are implemented in Python, C++, Cython, and R, and the workflow is coordinated with CWL. tiny-count and tinyRNA are free and open-source software distributed under the GPLv3 license. tiny-count can be installed via Bioconda (https://anaconda.org/bioconda/tiny-count) and both tiny-count and tinyRNA documentation and software downloads are available at https://github.com/MontgomeryLab/tinyRNA. Reference data, including genome and feature information, for certain species can be found at https://www.MontgomeryLab.org.
Laparoscopic lavage for Hinchey III perforated diverticulitis: factors for treatment failure in two randomized clinical trials
Authors: Azhar Najia , Lambrichts Daniël , Lange Johan , Yaqub Sheraz , Øresland Tom , Schultz Johannes , Bemelman Willem , Buchwald Pamela
Published: May 2023

Background

The Scandinavian Diverticulitis (SCANDIV) trial and the LOLA arm of the LADIES trial randomized patients with Hinchey III perforated diverticulitis to laparoscopic peritoneal lavage or sigmoid resection. The aim of this analysis was to identify risk factors for treatment failure in patients with Hinchey III perforated diverticulitis.

Methods

This was a post hoc analysis of the SCANDIV trial and LOLA arm. Treatment failure was defined as morbidity requiring general anaesthesia (Clavien–Dindo grade IIIb or higher) within 90 days. Age, sex, BMI, ASA fitness grade, smoking status, previous episodes of diverticulitis, previous abdominal surgery, time to surgery, and surgical competence were all tested in univariable and multivariable logistic regression analyses using an interaction variable.

Results

The pooled analysis included 222 patients randomized to laparoscopic lavage and primary resection (116 and 106 patients respectively). Univariable analysis found ASA grade to be associated with advanced morbidity in both groups, and the following factors in the laparoscopic lavage group: smoking, corticosteroid use, and BMI. Significant factors for laparoscopic lavage morbidity in multivariable analysis were smoking (OR 7.05, 95 per cent c.i. 2.07 to 23.98; P = 0.002) and corticosteroid use (OR 6.02, 1.54 to 23.51; P = 0.010).

Conclusion

Active smoking status and corticosteroid use were risk factors for laparoscopic lavage treatment failure (advanced morbidity) in patients with perforated diverticulitis.
Pericardial effusions: perspective of the acute cardiac care physician
Authors: Jain C Charles , Reddy Yogesh N V
Published: May 2023

Pericardial effusions can result in acute haemodynamic compromise and require rapid intervention. Understanding pericardial restraint is essential to determine the approach to newly identified pericardial effusions in the intensive care unit. As pericardial effusions stretch the pericardium, the pericardial compliance reserve is eventually exhausted, with an exponential rise in compressive pericardial pressure. The severity of pericardial pressure increase depends on both the rapidity and volume of pericardial fluid accumulation. This increase in pericardial pressure is reflected in an increase in measured left- and right-sided ‘filling’ pressures, but paradoxically left ventricular end-diastolic volume (the true left ventricular preload) is decreased. This uncoupling of filling pressures and preload is the hallmark of pericardial restraint. When this occurs acutely from a pericardial effusion, rapid recognition and pericardiocentesis can be lifesaving. In this review, we will discuss the haemodynamics and pathophysiology of acute pericardial effusions, provide a physiological guide to determine the need for pericardiocentesis in acute care, and discuss important caveats to management.
Can Acta Jure Gestionis Be Attributable to the State? A Restrictive Doctrine of State Responsibility
Authors: Okada Yohei
Published: May 2023

The distinction between acta jure imperii and jure gestionis, while playing a pivotal role in the law of state immunity, appears alien to the law of state responsibility. However, recent practice has shown conceptual overlaps between these different areas of international law. The sovereign/commercial dichotomy has informed the attribution of parastatal entities’ conduct to a state under Article 5 of the International Law Commission’s Articles on Responsibility of States for Internationally Wrongful Acts (ARSIWA). More precisely, acta jure gestionis have been excluded from the scope of attributable conduct. Against this backdrop, this study investigates whether, and to what extent, the distinction between acta jure imperii and jure gestionis dictates the interpretation and application of Article 5 of ARSIWA. We conclude that the distinction does have relevance in this context, although Article 5 was not designed to preclude the attributability of commercial acts. However, its obscure wording has allowed subsequent practice to overly narrow the scope of attributable conduct. This study, critically analysing a restrictive doctrine of state responsibility, aims to provide a more accurate and desirable conception of the rule and a clear and detailed guideline on when the commercial act of parastatal entities can be attributable to the state.
Aridity modulates biogeographic distribution and community assembly of cyanobacterial morphotypes in drylands
Authors: Guo Xiaoyu , Li Hua , Huo Da , Hu Chunxiang , Li Renhui , Zhang Silong , Song Lirong
Published: May 2023

The patterns of biogeographic distribution and assembly processes of microbiota are of vital importance for understanding ecological adaptation and functioning maintenance. However, the role of morphological characteristics in microbial assembly is still poorly ascertained. Here, by integrating high-throughput sequencing and robust extrapolation of traits, we investigated taxonomic and phylogenetic turnovers of various cyanobacterial morphotypes in biocrusts to evaluate the contributions of deterministic and stochastic processes across a large scale of drylands in northwestern China. The results showed that the non-heterocystous filamentous category dominated biocrusts in the arid ecosystem and exhibited strong tolerance against environmental fluctuations. Despite the significant distance-decay relationship of β-diversity detected in all categories, both species composition and phylogenetic turnover rates of coccoid cyanobacteria were higher than non-heterocystous filamentous and heterocystous morphotypes. Moreover, the assembly of cyanobacteria was driven by different ecological processes that the entire community and non-heterocystous filamentous morphotype were governed by deterministic processes, while stochasticity prevailed in heterocystous and coccoid cyanobacteria. Nonetheless, aridity can modulate the balance between determinism and stochasticity and prompt a shifting threshold among morphotypes. Our findings provide a unique perspective to understanding the critical role of microbial morphology in community assembly and facilitate the prediction of biodiversity loss under climate change.
A case of Budd–Chiari syndrome combined with drainage of the inferior vena cava into the left atrium
Authors: Shen Yue , Wu Qingsong , Xiao Jun , Chen Liangwan
Published: May 2023

Abnormal drainage of the inferior vena cava to the left atrium and Budd–Chiari syndrome are different congenital malformations. The combination of these 2 disorders is very rare. We report a case of a 35-year-old woman with anomalous inferior vena cava drainage into the left atrium resulting in delayed hypoxic symptoms after interventional therapy for Budd–Chiari syndrome 17 years ago. We speculate that an abnormality of the Eustachian valve is the cause of these 2 disorders. After surgical treatment, the patient's oxygen saturation returned to normal.
Optimized preoperative planning of double outlet right ventricle patients by 3D printing and virtual reality: a pilot study
Authors: Peek Jette J , Bakhuis Wouter , Sadeghi Amir H , Veen Kevin M , Roest Arno A W , Bruining Nico , van Walsum Theo , Hazekamp Mark G , Bogers Ad J J C
Published: May 2023

OBJECTIVES

In complex double outlet right ventricle (DORV) patients, the optimal surgical approach may be difficult to assess based on conventional 2-dimensional (2D) ultrasound (US) and computed tomography (CT) imaging. The aim of this study is to assess the added value of 3-dimensional (3D) printed and 3D virtual reality (3D-VR) models of the heart used for surgical planning in DORV patients, supplementary to the gold standard 2D imaging modalities.

METHODS

Five patients with different DORV subtypes and high-quality CT scans were selected retrospectively. 3D prints and 3D-VR models were created. Twelve congenital cardiac surgeons and paediatric cardiologists, from 3 different hospitals, were shown 2D-CT first, after which they assessed the 3D print and 3D-VR models in random order. After each imaging method, a questionnaire was filled in on the visibility of essential structures and the surgical plan.

RESULTS

Spatial relationships were generally better visualized using 3D methods (3D printing/3D-VR) than in 2D. The feasibility of ventricular septum defect patch closure could be determined best using 3D-VR reconstructions (3D-VR 92%, 3D print 66% and US/CT 46%, P < 0.01). The percentage of proposed surgical plans corresponding to the performed surgical approach was 66% for plans based on US/CT, 78% for plans based on 3D printing and 80% for plans based on 3D-VR visualization.

CONCLUSIONS

This study shows that both 3D printing and 3D-VR have additional value for cardiac surgeons and cardiologists over 2D imaging, because of better visualization of spatial relationships. As a result, the proposed surgical plans based on the 3D visualizations matched the actual performed surgery to a greater extent.
Key considerations for designing, conducting and analysing a cluster randomized trial
Authors: Hemming Karla , Taljaard Monica
Published: May 2023

Not only do cluster randomized trials require a larger sample size than individually randomized trials, they also face many additional complexities. The potential for contamination is the most commonly used justification for using cluster randomization, but the risk of contamination should be carefully weighed against the more serious problem of questionable scientific validity in settings with post-randomization identification or recruitment of participants unblinded to the treatment allocation. In this paper we provide some simple guidelines to help researchers conduct cluster trials in a way that minimizes potential biases and maximizes statistical efficiency. The overarching theme of this guidance is that methods that apply to individually randomized trials rarely apply to cluster randomized trials. We recommend that cluster randomization be only used when necessary—balancing the benefits of cluster randomization with its increased risks of bias and increased sample size. Researchers should also randomize at the lowest possible level—balancing the risks of contamination with ensuring an adequate number of randomization units—as well as exploring other options for statistically efficient designs. Clustering should always be allowed for in the sample size calculation; and the use of restricted randomization (and adjustment in the analysis for covariates used in the randomization) should be considered. Where possible, participants should be recruited before randomizing clusters and, when recruiting (or identifying) participants post-randomization, recruiters should be masked to the allocation. In the analysis, the target of inference should align with the research question, and adjustment for clustering and small sample corrections should be used when the trial includes less than about 40 clusters.
Citrobacter freundii resistant to novel β-lactamase inhibitor combinations and cefiderocol, co-producing class A, B and D carbapenemases encoded by transferable plasmids
Authors: Riccobono Eleonora , Salvetti Sara , Coppi Marco , Montenora Iolanda , Di Pilato Vincenzo , Rossolini Gian Maria
Published: May 2023

Objectives

To characterize a carbapenem-resistant Citrobacter freundii (Cf-Emp) co-producing class A, B and D carbapenemases, resistant to novel β-lactamase inhibitor combinations (BLICs) and cefiderocol.

Methods

Carbapenemase production was tested by an immunochromatography assay. Antibiotic susceptibility testing (AST) was performed by broth microdilution. WGS was performed using short- and long-read sequencing. Transfer of carbapenemase-encoding plasmids was assessed by conjugation experiments.

Results

Cf-Emp was isolated on selective medium for carbapenem-resistant Enterobacterales from the surveillance rectal swab taken at hospital admission from a patient of Moroccan origin. Cf-Emp produced three different carbapenemases, including KPC-2, OXA-181 and VIM-1, and was resistant to all β-lactams including carbapenems, novel BLICs (ceftazidime/avibactam, meropenem/vaborbactam and imipenem/relebactam) and cefiderocol. MIC of aztreonam/avibactam was 0.25 mg/L. The strain belonged to ST22, one of the C. freundii lineages of global diffusion, known to be associated with carbapenemase production. Each carbapenemase gene was located aboard a different plasmid (named pCf-KPC, pCf-OXA and pCf-VIM, respectively), which also carried other clinically relevant resistance genes, such as armA (pCf-KPC), blaSHV-12 (pCf-VIM) and qnrS1 (pCf-OXA). Transferability to Escherichia coli J53 by conjugation was observed for all plasmids.

Conclusions

The finding of enterobacterial strains carrying multiple carbapenemase genes on transferable plasmids is alarming, because similar strains could provide an important reservoir for disseminating these clinically relevant resistance determinants.
A Review of Current Practices and Future Trends in Body Fluid Testing
Authors: Cotten Steven W , Block Darci R
Published: May 2023

Background

Body fluid testing in the clinical chemistry laboratory is a cornerstone in the diagnostic workup of pathological effusions. Laboratorians may not be aware of the preanalytical workflows used in the collection of body fluids though the value is evident whenever processes change or issues arise. The analytical validation requirements can vary depending on the regulations dictated by the laboratories’ jurisdiction and accreditor requirements. Much of analytical validation hinges on how useful testing is to clinical care. Usefulness of testing varies with how well established and incorporated the tests and interpretation are in practice guidelines.

Content

Body fluid collections are depicted and described so clinical laboratorians have a basic appreciation of what specimens are submitted to the laboratory for testing. A review of validation requirements by major laboratory accreditation entities is presented. A review of the usefulness and proposed decision limits for common body fluid chemistry analytes is presented. Body fluid tests that show promise and those that are losing (or lost long ago) value are also reviewed.

The total testing process from collection to result interpretation can be complicated and easily overlooked by the clinical laboratory. This review aims to improve the understanding and awareness of collections, validation, result interpretation, and provide an update on recent trends.
Pediatric Reference Value Profiling of Essential Trace and Toxic Elements in Healthy Children and Adolescents Using High-Resolution and Triple Quadrupole Inductively Coupled Plasma Mass Spectrometry
Authors: Bohn Mary Kathryn , Nichols Matthew , Yang Liju , Bhayana Vipin , Macri Joseph , Adeli Khosrow
Published: May 2023

Background

Assessment of trace and toxic element status is important for the diagnosis and monitoring of several pediatric conditions. Elemental deficiency and toxicity have serious implications, particularly in pediatrics wherein risk is higher. Pediatric reference intervals (RIs) for trace elements and normal exposure limits for toxic elements are lacking on modern analytical systems. Herein, reference values were established for 13 plasma and 22 whole blood trace elements in the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort of healthy children and adolescents.

Methods

Approximately 320 healthy children and adolescents were recruited with informed consent. Trace elements were measured in whole blood and plasma samples using 2 technologies: (a) triple quadrupole inductively coupled plasma tandem mass spectrometry (ICP-MS/MS) (n = 172) and (b) high-resolution sector field ICPMS (HR-SF-ICPMS) (n =161). RIs and normal exposure limits were then established according to Clinical and Laboratory Standards Institute guidelines.

Results

Of all elements assessed, none required sex partitioning and 8 required age partitioning (e.g., copper, manganese, and cadmium). Reference value distributions determined via ICP-MS/MS and HR-SF-ICPMS demonstrated excellent concordance, with few exceptions (e.g., molybdenum, cobalt, and nickel).

Conclusions

These data represent the first study wherein pediatric RIs and normal exposure limits were derived simultaneously on 2 different clinically validated MS platforms which provide urgently needed data to inform clinical decision-making for trace elements in pediatrics. Study findings suggest some trace elements require age-specific consideration for appropriate interpretation. Highly concordant observations across the 2 analytical methods also demonstrate the comparability and reliability of results obtained on both platforms.
Automated identification of eviction status from electronic health record notes
Authors: Yao Zonghai , Tsai Jack , Liu Weisong , Levy David A , Druhl Emily , Reisman Joel I , Yu Hong
Published: May 2023

Objective

Evictions are important social and behavioral determinants of health. Evictions are associated with a cascade of negative events that can lead to unemployment, housing insecurity/homelessness, long-term poverty, and mental health problems. In this study, we developed a natural language processing system to automatically detect eviction status from electronic health record (EHR) notes.

Materials and Methods

We first defined eviction status (eviction presence and eviction period) and then annotated eviction status in 5000 EHR notes from the Veterans Health Administration (VHA). We developed a novel model, KIRESH, that has shown to substantially outperform other state-of-the-art models such as fine-tuning pretrained language models like BioBERT and Bio_ClinicalBERT. Moreover, we designed a novel prompt to further improve the model performance by using the intrinsic connection between the 2 subtasks of eviction presence and period prediction. Finally, we used the Temperature Scaling-based Calibration on our KIRESH-Prompt method to avoid overconfidence issues arising from the imbalance dataset.

Results

KIRESH-Prompt substantially outperformed strong baseline models including fine-tuning the Bio_ClinicalBERT model to achieve 0.74672 MCC, 0.71153 Macro-F1, and 0.83396 Micro-F1 in predicting eviction period and 0.66827 MCC, 0.62734 Macro-F1, and 0.7863 Micro-F1 in predicting eviction presence. We also conducted additional experiments on a benchmark social determinants of health (SBDH) dataset to demonstrate the generalizability of our methods.

Conclusion and Future Work

KIRESH-Prompt has substantially improved eviction status classification. We plan to deploy KIRESH-Prompt to the VHA EHRs as an eviction surveillance system to help address the US Veterans’ housing insecurity.
A New Ex Vivo Human Skin Burn Model
Authors: Labouchère Ania , Haselbach Daniel , Michetti Murielle , Pythoud Catherine , Raffoul Wassim , Applegate Lee Ann , Hirt-Burri Nathalie , de Buys Roessingh Anthony
Published: May 2023

Currently, most burn models for preclinical testing are on animals. For obvious ethical, anatomical, and physiological reasons, these models could be replaced with optimized ex vivo systems. The creation of a burn model on human skin using a pulsed dye laser could represent a relevant model for preclinical research. Six samples of excess human abdominal skin were obtained within one hour after surgery. Burn injuries were induced on small samples of cleaned skin using a pulsed dye laser on skin samples, at varying fluences, pulse numbers and illumination duration. In total, 70 burn injuries were performed on skin ex vivo before being histologically and dermato-pathologically analyzed. Irradiated burned skin samples were classified with a specified code representing burn degrees. Then, a selection of samples was inspected after 14 and 21 days to assess their capacity to heal spontaneously and re-epithelize. We determined the parameters of a pulsed dye laser inducing first, second, and third degree burns on human skin and with fixed parameters, especially superficial and deep second degree burns. After 21 days with the ex vivo model, neo-epidermis was formed. Our results showed that this simple, rapid, user-independent process creates reproducible and uniform burns of different, predictable degrees that are close to clinical reality. Human skin ex vivo models can be an alternative to and complete animal experimentation, particularly for preclinical large screening. This model could be used to foster the testing of new treatments on standardized degrees of burn injuries and thus improve therapeutic strategies.
Changes in cancer mortality after Medicaid expansion and the role of stage at diagnosis
Authors: Barnes Justin M , Johnson Kimberly J , Osazuwa-Peters Nosayaba , Yabroff K Robin , Chino Fumiko
Published: May 2023

Background

Medicaid expansion is associated with improved survival following cancer diagnosis. However, little research has assessed how changes in cancer stage may mediate improved cancer mortality or how expansion may have decreased population-level cancer mortality rates.

Methods

Nationwide state-level cancer data from 2001 to 2019 for individuals ages 20-64 years were obtained from the combined Surveillance, Epidemiology, and End Results National Program of Cancer Registries (incidence) and the National Center for Health Statistics (mortality) databases. We estimated changes in distant stage cancer incidence and cancer mortality rates from pre- to post-2014 in expansion vs nonexpansion states using generalized estimating equations with robust standard errors. Mediation analyses were used to assess whether distant stage cancer incidence mediated changes in cancer mortality.

Results

There were 17 370 state-level observations. For all cancers combined, there were Medicaid expansion–associated decreases in distant stage cancer incidence (adjusted odds ratio = 0.967, 95% confidence interval  = 0.943 to 0.992; P = .01) and cancer mortality (adjusted odds ratio = 0.965, 95% confidence interval = 0.936 to 0.995; P = .022). This translates to 2591 averted distant stage cancer diagnoses and 1616 averted cancer deaths in the Medicaid expansion states. Distant stage cancer incidence mediated 58.4% of expansion-associated changes in cancer mortality overall (P = .008). By cancer site subgroups, there were expansion-associated decreases in breast, cervix, and liver cancer mortality.

Conclusions

Medicaid expansion was associated with decreased distant stage cancer incidence and cancer mortality. Approximately 60% of the expansion-associated changes in cancer mortality overall were mediated by distant stage diagnoses.
Whole Stand Variable Density Yield Equations for Oak-Gum-Cypress Bottomland Hardwood Forests
Authors: Aryal Suchana , McConnell T Eric , Poudel Krishna , Polinko Adam
Published: May 2023

Variable density yield equations were constructed using fuzzy linear regression for bottomland oak-gum-cypress forests along the US Gulf Coast and lower Mississippi River Delta region. The USDA Forest Service (Forest Service)’s Forest Inventory and Analysis program provided plot data (n = 526). Predictors included stand age, growing stock basal area per acre, sweetgum site index (base age 50 years), and US Environmental Protection Agency ecoregion dummy variables located in Alabama, Arkansas, Louisiana, Mississippi, Tennessee, and Texas. Dependent variables were per acre growing stock cubic foot yield (GSV) and Doyle board foot sawlog yield (SLV). Plots averaged 58 years, 90 ft2/ac basal area, 79 ft site index, 2,556 ft3/ac GSV, and 11,183 Doyle bf/ac SLV. Adjusted R2 were 0.98 (GSV) and 0.77 (SLV). Basal area possessed fuzziness in the GSV model, whereas the SLV model’s intercept was fuzzy. Six ecoregions possessed fuzziness in each model, but these were not identical across models.
(054) Correlation between Libido and Testosterone: Estradiol Ratio in Men with Sexual Dysfunction
Authors: Pedrenho Neto R , Chiesa Gouveia Nascimento B , Dos Santos Sobreira Nunes R , Pedro Gismondi J , De Bessa Junior J , Carlos Nahas W , Hallak J
Published: May 2023

Introduction

Sexual desire drives men to seek sexual activity and have a positive effect on cognitive function, emotional, affective state and affecting the quality of life. This dynamic process is impacted by several factors including the cognitive, neurophysiological and affective spheres. Hormonal balance, including Testosterone (T) and Estradiol (E), is a is also one of the knownwell- known associated factors affecting to sexual desire.libido.

Objective

Our aim was to evaluate the correlation between libido reduction and hormonal profile (HP), including the Testosterone(T):Estradiol(E) ratio.

Methods

Retrospective analysis of medical records of sexual medicine consultations in a tertiary care center was performed. Patients were systematically questioned if they perceived their libido decreased using the following question (“Do you believe your libido or sexual desire has decreased in the last few months?”), and all had morning HP checked (Total and free testosterone, SHBG, E2, LH, FSH). HP was categorized into the following groups: Low T (T 100 and Low T:E ratio 35ng/dl) were excluded. Comparison of HP between men who referred decreased libido and those who did not was performed, and the relationship between the different parameters and sexual desire were studied by univariate and multivariate analysis.

Results

Data from 273 patients were available for analysis evaluated, with amean age of 61 y (± 10) y. From them, 264 (97%) reported being heterosexual and 210 (77%) had a steady partner. From this sample, 25% had low T levels. The percentage of patients referring decreased libido was 30%. In the Low T group, 42% reported decrease of Libido (OR 1,9; 95% IC: 1,08- 3,73; p=0,01) and 52% of the Low T:E ratio group reported decrease of Libido (OR 3,47; 95% IC: 1,79-6,46; p=0,001). In multivariate analysis, after adjusting for age, we found the T:E ratio was associated with decreased of libido, irrespective of T status.

Conclusions

In this study, our sample of men seeking treatment for sexual dysfunction, low T and low T:E ratio was significantly correlated with perceived decreased libido. Recognizing the imbalance of T:E ratio can help clinicians to identify men with low sexual desire and their best management. Further studies are necessary to confirm this data, and understand how treatment affects those parameters and if this should be addressed in clinical practice.

Disclosure

No