bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between nucleos(t)ide analogue therapy for hepatitis B and Sjögren’s syndrome: 15‐year analysis of the national database of Taiwan
Authors: Tung Chien‐Hsueh , Li Chung‐Yi , Chen Yen‐Chun , Chen Yi‐Chun
Published: February 2021

Hepatitis B virus (HBV) infection has been proposed to play a role in the development of Sjögren's syndrome. However, to date, there are no reports on the risk of SS in HBV‐infected patients following nucleos(t)ide analogue therapy. Due to Taiwan has higher prevalence of HBV infection and therapy was well recorded in the Taiwan's single‐payer national health insurance database, we hypothesized that a long‐term retrospective analysis of the risk of Sjögren's syndrome in HBV‐infected patients following nucleotide therapy will increase our understanding of Sjögren's syndrome development following HBV infection. We identified 26,147 adults diagnosed with HBV infection between 1997 and 2012 in claims data. Finally, a total of 3268 HBV‐infected patients who ever received nucleotide therapy (treated cohort) were frequency‐matched on age and sex at 1:4 ratios to select a control group of 13,072 counterparts without therapy (untreated cohort). To identify Sjögren's syndrome risk, competing risk analysis adjusted for all covariates was performed. The risk was significantly lower in the treated cohort (15‐year cumulative incidence, 2.4%; 95% confidence interval [CI], 1.4%–3.7%) than in the untreated cohort (7.1%; 95% CI, 2.5%–15.2%) (p = .015), and the adjusted HR was 0.6 (95% CI, 0.41–0.88; p = .009). Multivariable stratified analysis further verified the consistent associations between nucleoside therapy and risk reduction of Sjögren's syndrome across all strata. Our finding suggests that HBV infection treated with nucleotides is associated with lower risk of Sjögren's syndrome, implying a potential role of HBV infection in the development of Sjögren's syndrome.
Factors associated with clinical interpretation of tracheal wash fluid from dogs with respiratory disease: 281 cases (2012‐2017)
Authors: Graham Amber M. , Tefft Karen M. , Stowe Devorah M. , Jacob Megan E. , Robertson James B. , Hawkins Eleanor C.
Published: February 2021

Background

Clinicians face several dilemmas regarding tracheal washes (TWs) for the diagnosis of respiratory disease, including method and prediction of bacterial growth from cytology results.

Objective

To compare cytology and culture of endotracheal and transtracheal washes and identify factors associated with discordancy and bacterial growth.

Animals

Two hundred forty‐five dogs with respiratory disease.

Methods

Retrospective study. Tracheal wash submissions were included if cellularity was sufficient for cytologic interpretation and aerobic cultures were performed. Collection technique, cytology, bacterial growth, and antibiotic history were analyzed.

Results

Fewer transtracheal specimens (9/144, 6.3%) were excluded for hypocellularity than endotracheal (28/174, 16.1%); otherwise, results were similar and were combined. Of 281 specimens with cellularity sufficient for interpretation, 97 (34.5%) had bacteria on cytology and 191 (68.0%) had bacterial growth. Cytology positive/culture negative discordancy was uncommon (8/97, 8%). Cytology negative/culture positive discordancy was frequent (102/184, 55.4%), but occurred less often (28/184, 14.2%) when only 1+ growth or greater was considered positive. Oropharyngeal contamination was associated with bacterial growth, but not discordancy. No association was found between antibiotic administration and bacterial growth.

Conclusions and Clinical Importance

Endotracheal wash fluid, in particular, should be screened for gross mucus or turbidity to maximize the likelihood of an adequate specimen. Otherwise, endotracheal and transtracheal specimens were similar. Presence of bacteria on cytology was a good predictor of any growth, while their absence was a good predictor of the absence of growth of 1+ or more. Recent antibiotic usage should not discourage TW culture if there is compelling reason to avoid delay.
Dietary pattern and telomere length in preschool children in a middle‐income country
Authors: Meshkani Seyed Elyas , Kooshki Akram , Alahabadi Ahmad , Lari Najafi Moslem , Rad Abolfazl , Riahimanesh Forough , Miri Mohammad
Published: February 2021

Telomere length (TL) has been associated with lifestyle and dietary pattern. However, the available evidence on this association in children is scarce, especially in low‐ and middle‐income countries (LMICs). Therefore, this study aimed to evaluate the association of dietary pattern and leukocyte TL (LTL) in preschool children, Sabzevar, Iran (2017). This cross‐sectional study was based on 187 preschool children (aged 5 to 7) recruited from 27 kindergartens. Nutrition information including amounts of consumed dairy products, meat and processed meat products, nuts and seeds, white bread and refined grains, fruits, vegetables, simple sugars, fats and drinks was obtained through a questionnaire. Linear mixed‐effects models were fitted with polymerase chain reaction (PCR) plate ID and kindergartens as random effects to estimate the association of each food group consumption with LTL, controlled for relevant covariates. Higher consumption of dairy products and sugar was associated with shorter LTL (β= −0.180, 95% confidence interval [CI]: −0.276, −0.085,Pvalue <0.001 andβ= −0.139, 95% CI: −0.193, −0.086,Pvalue <0.001, respectively). An increase in consumption of fish, nuts and seeds, coloured fruits, green leafy vegetables, cruciferous vegetables and olive was significantly associated with the increase in relative LTL. The associations for the consumption of legumes, other fruits, yellow and orange vegetables, red meat, egg, white bread and refined grains, solid and liquid fats, processed meats, potato chips, carbonated drinks, tea (black) and soft drinks groups were not statistically significant. Our findings showed that there was an association between the consumption of certain food groups with LTL.
Shifting State–Business Relations in the Gulf Cooperation Council (GCC) Post‐2014
Authors: Nosova Anastasia
Published: February 2021

This study aims to explore how state–business relations in the Gulf Cooperation Council (GCC) have been developing following the fall in oil prices in 2014 and the subsequent increased pressure to implement economic reforms. The main argument is that due to a combination of factors, the positions of the established business community vis‐à‐vis the ruling powers in those countries have become weaker. The factors are: 1) economic pressure and necessity to reform since the 2014 decline in oil prices; 2) the generational shift and subsequent centralizing tendencies in the ruling circles in some of the states; and 3) increased geopolitical rivalry and antagonism between the GCC members, including intensified competition for foreign investment and external political support. Meanwhile the governments have acquired more control over commercial activities that used to be the realm of the business elite. Although these changes are happening to a varying extent and at a different pace in each GCC country, the trend is recognizable in all six.
The Ins and Outs of Iranian Industrial Resilience under Sanctions
Authors: Batmanghelidj Esfandyar
Published: February 2021

This paper draws on export data from four of Iran’s key trade partners—the European Union, China, the United Arab Emirates (UAE), and Turkey—to examine the robust and positive correlations between the export of parts and machinery to Iran and Iran’s industrial output, as measured by production index data published by the Central Bank of Iran for industrial enterprises with over 100 employees. The period of analysis is 2000 to 2017. It may seem intuitive that the output of Iranian manufacturers depends on the ability of companies to source intermediate goods such as parts and machinery. However, the imposition of sanctions on Iran is shown to have temporarily decoupled the relationship between European industrial exports to Iran and the Iranian industrial production index—the index remained stable even as European exports fell. An analysis of trade data for the other three trade partners included in this study quantitatively substantiates reports noting that in order to sustain the industrial production index, Iran engaged in processes that can be collectively described as “import reflection.” This entails substituting European intermediate inputs with Chinese inputs while also circumventing sanctions pressures on trade by sourcing European inputs via re‐export from the UAE and Turkey. These processes were fundamental to Iran’s economic resilience in the face of multilateral sanctions and have played a central role in Iran’s defense of its industrialized economy and particularly its non‐oil exports as the administration of US President Donald Trump pursues a new unilateral campaign of “maximum pressure” sanctions.
Update on diagnosis, pathophysiology, and management of diabetic kidney disease
Authors: Sugahara Mai , Pak Wai Lun Will , Tanaka Tetsuhiro , Tang Sydney C. W. , Nangaku Masaomi
Published: February 2021

Diabetic kidney disease (DKD) is a chronic complication of diabetes mellitus which may eventually lead to end‐stage kidney disease (ESKD). Despite improvements in glycaemic control and blood pressure management with renin‐angiotensin‐aldosterone system (RAAS) blockade, the current therapy cannot completely halt DKD progression to ESKD in some patients. DKD is a heterogeneous disease entity in terms of its clinical manifestations, histopathology and the rate of progression, which makes it difficult to develop effective therapeutics. It was formerly considered that albuminuria preceded kidney function decline in DKD, but recent epidemiological studies revealed that a distinct group of patients presented kidney dysfunction without developing albuminuria. Other comorbidities, such as hypertension, obesity and gout, also affect the clinical course of DKD. The pathophysiology of DKD is complex and multifactorial, involving both metabolic and haemodynamic factors. These induce activation of intracellular signalling pathways, oxidative stress, hypoxia, dysregulated autophagy and epigenetic changes, which result in kidney inflammation and fibrosis. Recently, two groups of antidiabetic drugs, sodium‐glucose cotransporter 2 (SGLT2) inhibitors and glucagon‐like peptide‐1 (GLP‐1) receptor agonists, were demonstrated to provide renoprotection on top of their glucose‐lowering effects. Several other therapeutic agents are also being developed and evaluated in clinical trials.
Modelling predicts tomatoes can be bigger and sweeter if biophysical factors and transmembrane transports are fine‐tuned during fruit development
Authors: Chen Jinliang , Beauvoit Bertrand , Génard Michel , Colombié Sophie , Moing Annick , Vercambre Gilles , Gomès Eric , Gibon Yves , Dai Zhanwu
Published: February 2021

The trade‐off between yield and quality, a major problem for the production of fleshy fruits, involves fruit expansive growth and sugar metabolism.

Here we developed an integrative model by coupling a biophysical model of fleshy fruit growth processes, including water and carbon fluxes and organ expansion, with an enzyme‐based kinetic model of sugar metabolism to better understand the interactions between these two processes. The integrative model was initially tested on tomato fruit, a model system for fleshy fruit.

The integrative model closely simulated the biomass and major carbon metabolites of tomato fruit developing under optimal or stress conditions. The model also performed robustly when simulating the fruit size and sugar concentrations of different tomato genotypes including wild species. The validated model was used to explore ways of uncoupling the size–sweetness trade‐off in fruit. Model‐based virtual experiments suggested that larger sweeter tomatoes could be obtained by simultaneously manipulating certain biophysical factors and transmembrane transports.

The integrative fleshy fruit model provides a promising tool to facilitate the targeted bioengineering and breeding of tomatoes and other fruits.
Optimized single‐point left ventricular pacing leads to improved resynchronization compared with multipoint pacing
Authors: San Antonio Rodolfo , Guasch Eduard , González‐Ascaso Ana , Jiménez‐Arjona Rafael , Climent Andreu M. , Pujol‐López Margarida , Doltra Adelina , Alarcón Francisco , Garre Paz , Liberos Alejandro , Trotta Omar , Quinto Levio , Borràs Roger , Arbelo Elena , Roca‐Luque Ivo , Atienza Felipe , Brugada Josep , Fernández‐Avilés Francisco , Guillem María S. , Sitges Marta , Tolosana Jose María , Mont Lluís
Published: February 2021

Background

Multipoint pacing (MPP) in cardiac resynchronization therapy (CRT) activates the left ventricle from two locations, thereby shortening the QRS duration and enabling better resynchronization; however, compared with conventional CRT, MPP reduces battery longevity. On the other hand, electrocardiogram‐based optimization using the fusion‐optimized intervals (FOI) method achieves more significant reverse remodeling than nominal CRT programming. Our study aimed to determine whether MPP could attain better resynchronization than single‐point pacing (SPP) optimized by FOI.

Methods

This prospective study included 32 consecutive patients who successfully received CRT devices with MPP capabilities. After implantation, the QRS duration was measured during intrinsic rhythm and with three pacing configurations: MPP, SPP‐FOI, and MPP‐FOI. In 14 patients, biventricular activation times (by electrocardiographic imaging, ECGI) were obtained during intrinsic rhythm and for each pacing configuration to validate the findings. Device battery longevity was estimated at the 45‐day follow‐up.

Results

The SPP‐FOI method achieved greater QRS shortening than MPP (‐56 ± 16 vs. ‐42 ± 17 ms, p < .001). Adding MPP to the best FOI programming did not result in further shortening (MPP‐FOI: ‐58 ± 14 ms, p = .69). Although biventricular activation times did not differ significantly among the three pacing configurations, only the two FOI configurations achieved significant shortening compared with intrinsic rhythm. The estimated battery longevity was longer with SPP than with MPP (8.1 ± 2.3 vs. 6.3 ± 2.0 years, p = .03).

Conclusions

SPP optimized by FOI resulted in better resynchronization and longer battery duration than MPP.
Associative transcriptomics study dissects the genetic architecture of seedling biomass‐related traits in rapeseed (Brassica napus L.)
Authors: Xu Jinsong , Zhan Hui , Xie Yanping , Tian Gang , Xie Lingli , Xu Benbo , Zhao Yongguo , Lu Guangyuan , Zhang Xuekun
Published: February 2021

It was observed that the seedling biomass was correlated with final seed yield in many crops. It is helpful to dissect the genetic architecture of seedling biomass‐related traits for high yield breeding of rapeseed (Brassica napus L.). To date, the genetic architecture of seedling biomass‐related traits is still unclear in B. napus. To identify candidate genes associated with high seedling biomass, a genome‐wide association study of seedling biomass‐related traits under normal growth condition and waterlogging stress was conducted with 156 B. napus accessions. We detected six peaks including 55 single‐nucleotide polymorphisms (SNPs) significantly associated with the above‐mentioned traits in SNP association analysis and 142 UniGenes showed significantly associated with traits in gene expression marker (GEM) association analysis. Candidate genes located within the linkage disequilibrium (LD) blocks were identified, such as ADP GLUCOSE PYROPHOSPHORYLASE LARGE SUBUNIT 1 (BnaC2APL1), PS II OXYGEN‐EVOLVING COMPLEX 1 (BnaC9PSBO1), their ortholog in the Arabidopsis thaliana has been shown to play key roles in starch biosynthesis and photosynthesis. Resequencing of genomic regions revealed the non‐synonymous SNPs in coding regions may be the functional polymorphisms in the two candidate genes. Our results provide insight into the molecular mechanisms underlying the establishment of high‐seedling biomass B. napus and lay a foundation for the characterization of candidate genes aimed at developing high‐seedling B. napus varieties.
Connective appendages in Huberia bradeana (Melastomataceae) affect pollen release during buzz pollination
Authors: Bochorny T. , Bacci L. F. , Dellinger A. S. , Michelangeli F. A. , Goldenberg R. , Brito V. L. G.
Published: February 2021

Floral structures, such as stamen appendages, play crucial roles in pollinator attraction, pollen release dynamics and, ultimately, the reproductive success of plants. The pollen‐rewarding, bee buzz‐pollinated flowers of Melastomataceae often bear conspicuous staminal appendages. Surprisingly, their functional role in the pollination process remains largely unclear. We use Huberia bradeana Bochorny & R. Goldenb. (Melastomataceae) with conspicuously elongated, twisted stamen appendages to investigate their functional role in the pollination process.

We studied the effect of stamen appendages on pollinator behaviour and reproductive success by comparing manipulated flowers (appendages removed) with unmanipulated flowers. To assess bee pollinator behaviour, we measured three properties of buzzes (vibrations) produced by bees on Huberia flowers: frequency, duration and number of buzzes per flower visit. We measured male and female reproductive success by monitoring pollen release and deposition after single bee visits. Finally, we used artificial vibrations and laser vibrometry to assess how flower vibrational properties change with the removal of stamen appendages.

Our results show that the absence of staminal appendages does not modify bee buzzing behaviour. Pollen release was higher in unmanipulated flowers, but stigmatic pollen loads differ only marginally between the two treatments. We also detected lower vibration amplitudes in intact flowers as compared to manipulated flowers in artificial vibration experiments.

The presence of connective appendages are crucial in transmitting vibrations and assuring optimal pollen release. Therefore, we propose that the high diversity of colours, shapes and sizes of connective appendages in buzz‐pollinated flowers may have evolved by selection through male fitness.
Left‐hemispheric predominance on appropriateness evaluation of restructuring during chunk decomposition problem solving
Authors: Zhang Zhonglu , Lei Yi , Xing Qiang , Li Hong
Published: February 2021

Restructuring refers to achieving satisfactory solutions by breaking obstacles or forming novel associations in problem‐solving. One critical question arises regarding how an appropriate solution is processed in our brain during the restructuring of problem representations. This study aims to explore the electrophysiological correlates of appropriateness evaluation of restructuring by employing a chunk decomposition task. During loose or tight chunk decomposition, participants needed to assess whether they could get a valid solution after probe removal from a source character chunk. As reflected by the late positive complex, the processing of appropriateness exhibited the greatest effect (appropriate vs. inappropriate) in left parietal regions for tight chunk decomposition, but exhibited insignificant differences across most brain regions for loose chunk decomposition. This study provides the first primary electrophysiological evidence that both hemispheres contribute to and the left hemisphere plays a predominant role in evaluating the appropriateness of restructuring in problem solving.
Realistic (3D) looming of emotional visual stimuli: Attentional effects at neural and behavioral levels
Authors: Fernández‐Folgueiras Uxía , Méndez‐Bértolo Constantino , Hernández‐Lorca María , Bódalo Cristina , Giménez‐Fernández Tamara , Carretié Luis
Published: February 2021

Previous research shows that endogenous attention (the controlled selection of certain aspects of our environment) is enhanced toward emotional stimuli due to its biological relevance. Although looming affective stimuli such as threat seem even more critical for survival, little is known about their effect on endogenous attention. Here, we recorded neural (event‐related potentials, ERPs) and behavioral responses (errors and reaction times) to explore the combined effect of emotion and looming motion. 3D‐recreated static and moving animals assessed as emotionally positive, negative, and neutral, were presented to participants (n = 71), who performed an indirect categorization task (vertebrate vs. invertebrate). Behavioral results showed better task performance, as reflected by lower number of errors and reaction times, in response to threatening stimuli. Neural indices revealed significant early (P1p, 150 milliseconds), intermediate (P2p, 240), and late (LPP, 450) effects, the latter being more intensely associated with behavior, as revealed by regression analyses. In general, neural indexes of attention to both static and dynamic stimuli showed a positivity offset in early stages and a negativity bias in subsequent phases. However, and importantly, the progressive inclusion of negative stimuli in the attentional focus is produced earlier in the case of dynamic (at P2p latency) than in static versions (at LPP). These results point to an enhancement of attention, particularly in temporal terms, toward stimuli combining motion and biological significance.
Oral health perceptions, behaviors, and barriers among differently abled and healthy children
Authors: Rajput Soni , Kumar Amit , Puranik Manjunath P. , Sowmya KR , Chinam Nivedita
Published: February 2021

Aim

To describe and compare the oral health perceptions, behaviors, and barriers for utilization of dental care among differently abled and healthy children.

Methods

Participants in this cross‐sectional study were differently abled and healthy children belonging to the age group of 7‐15 years. A questionnaire for measuring the children's perceptions, behaviors, and barriers was developed, validated, and applied to this study. Cronbach's α was calculated to test reliability, and test‐retest reliability was assessed by Pearson's correlation test. Chi‐square/Fisher exact test, Mann‐Whitney U test, and factor analysis were also applied. Statistical significant differences were defined as P < 0.05, two‐tailed.

Results

A total number of 300 children in each group participated in the study. The correlations of test and retest for the questionnaire ranged from 0.69 to 0.86 (P < 0.05) with Cronbach's α score of 0.862. More than half in both the groups were aware of the presence of fluoride in their toothpaste, and parents agreed that a child's dental health is satisfactory yet only one‐third of them perceived dental problems as serious. Regarding brushing twice daily, the frequency was better in the study group (26.3% and 17.3%, P = 0.01), most of them changed their toothbrush between 3 and 6 months (67.3% and 82.0%, P < 0.001), and tongue cleaner were regularly used as an oral hygiene aid (62.3% and 88.5%, P = 0.01). Members of the study group appear to have visited the dentist (26.0%) more as compared to the control group (17.7%) (P = 0.01), and most of the respondents (50.0% and 41.5%) consulted the dentist on account of dental caries. In the study group, no priority care (8.82±2.81), difficulty in communicating with the dentist (7.85±1.92), treatment cost (6.90±1.98) and fear of dental instruments (6.90±1.98), respectively, were the barriers with the highest means of scores, whereas in the control group it was related to affordability and fear. Facilities in dental clinics excluding wheelchairs (76.3% and 76.7%) and corridor signs (66.3% and 61.7%) were lacking.

Conclusion

Knowledge and attitude scores were adequate but there was a discrepancy present concerning oral health practices. Dental health was not viewed as a threat, and therefore, not many visited the dentist. Priority care and communication problems were the central issues among differently abled children, while among healthy children, the main factor was cost and fear.
Regulating road rage
Authors: Bjureberg Johan , Gross James J.
Published: February 2021

Road rage has been a problem since the advent of cars. Given the ubiquity of road rage and its potentially devastating consequences, understanding road rage and developing interventions to curb it are important priorities. Emerging theoretical and empirical advances in the study of emotion and emotion regulation have provided new insights into why people develop road rage and how it can be prevented and treated. In the current article, we suggest an integrative conceptual framework for understanding road rage, based upon a psychological analysis of emotion and emotion regulation has been suggested. We begin by defining road rage and other key constructs. We then consider the interplay between road rage generation and road rage regulation. Using an emotion regulation framework, we describe key points at which emotion‐regulation difficulties can lead to road rage, followed by strategies that may alleviate these difficulties have been described. We suggest that this framework usefully organizes existing research on road rage, while exposing key directions for future research.
Long‐term Outcomes of team‐based learning
Authors: Langer Arielle L. , Binder Adam F. , Scigliano Eileen
Published: February 2021

Background

Team‐based learning (TBL) is associated with improved end‐of‐course exam performance, but the impact on long‐term retention is unknown. We compared the impact of three teaching methods: traditional case‐based small group discussion (TSG), TBL or no small group reinforcement on short‐term understanding and long‐term retention after a haematology course.

Methods

Knowledge assessments were conducted prior to, immediately after and 14 months after course completion. Several topics covered by TSG were switched to TBL and could be directly compared.

Results

We recruited 24% of eligible students (n = 70). Of these, 48 completed the final assessment (69% retention). Pre‐course, participants scored 31% correctly, which increased to 78% post‐course with significant differences: TBL 87%; TSG 78%; no small group 76% (p < 0.01 for both comparisons). At long‐term follow‐up, the effect of the teaching method was no longer significant: TBL 75%; TSG 67% (p = 0.14); no small group 70% (p = 0.36). When restricted to topics converted from TSG to TBL, the long‐term benefit was not shown: TSG 59%; TBL 54% (p = 0.47).

Findings and Discussion

We confirm increased understanding gained by using TBL, but this did not lead to better long‐term retention. Improved scores on short‐term testing has value for student well‐being and competitiveness for residency application. TBL may still be of long‐term benefit through modelling team decision making and self‐directed learning that are core features of how clinical medicine is practiced. However, our findings argue against justifying the adoption of TBL on the basis of superior long‐term retention.
Design of an Ankle Rehab Robot With a Compliant Parallel Kinematic Mechanism
Authors: Jalgaonkar Nishant , Kim Adam , Awtar Shorya
Published: February 2021

In this article, we present the design of a novel ankle rehabilitation robot (ARR), called the Flex-ARR, that employs a compliant parallel kinematic mechanism (PKM) with decoupled degrees-of-freedom. While multiple ARRs have been developed and commercialized, their clinical adoption has been limited primarily because they do not emulate the natural motion of the ankle. Based on a review of existing ARRs and their limitations, this article defines functional requirements and design specifications for an optimal ARR. These are then used to develop a design strategy followed by conceptual and detailed design of a novel ARR. The proposed Flex-ARR is designed to collocate the biological center of rotation of the ankle with that of the robot's center of rotation to allow natural ankle motion. The strategic use of a compliant PKM in the Flex-ARR not only absorbs any residual misalignment between these two centers but also helps inherently accommodate variations in user foot sizes with minimal adjustments. Detailed design includes the ARR structure with adjustable features, compliant PKM optimization, sensor and actuator selection, and an alignment tool.
A high frequency, power, and efficiency diaphragm acoustic-to-electric transducer for thermoacoustic engines and refrigerators
Authors: Steiner Thomas W. , Antonelli Keith B. , Archibald Geoffrey D. S. , De Chardon Briac , Gottfried Kristjan T. , Malekian Mohammad , Kostka Peter
Published: February 2021

A high frequency, power, and efficiency diaphragm transducer is described for use with thermoacoustic engines and refrigerators. It uses a tube acting in compression and extension as the primary spring so that the mechanical resonant frequency is around 500 Hz. A high-frequency transducer results in more compact and higher power density thermoacoustic engines, refrigerators, and heat pumps. The tube spring furthermore constitutes a part of the pressure vessel so that the alternator is outside the pressure vessel, thereby simplifying transducer construction and reducing mass. The hermetically sealed transducer operates entirely without wear or lubricants, leading to a long maintenance-free lifetime. We present in situ efficiency measurement results at the full power operating frequency and temperature of the transducer. Despite the high operating frequency, the transducer efficiency is better than that of other transducers previously used in thermoacoustic systems. Accelerated fatigue test results on tube spring coupons justify the long-life claims. The exceptional stiffness of the primary spring in this transducer leads to the unusual need to consider stretch in additional transducer structural components. We present a multi-mass, lumped-element, coupled oscillator model of the transducer and discuss thermoacoustic system design using this model.
Sensitivity and Specificity of a Multimodal Approach for Concussion Assessment in Youth Athletes
Authors: Toong Tiffany , Wilson Katherine E. , Hunt Anne W. , Scratch Shannon , DeMatteo Carol , Reed Nick
Published: February 2021

Context: Current international consensus endorses a multimodal approach to concussion assessment. However, the psychometric evaluation of clinical measures used to identify postconcussion performance deficits once an athlete is asymptomatic remains limited, particularly in the pediatric population. Objective: To describe and compare the sensitivity and specificity of a multimodal assessment battery (balance, cognition, and upper and lower body strength) versus individual clinical measures at discriminating between concussed youth athletes and noninjured controls when asymptomatic. Design: Prospective cohort study. Setting: Hospital laboratory setting. Participants: A total of 32 youth athletes with a concussion and 32 matched (age and sex) noninjured control participants aged 10–18 years. Intervention(s): Participants were administered preinjury (baseline) assessments of cognition (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT]), balance (BioSway), and upper and lower body strength (grip strength and standing long jump). Assessments were readministered when concussed participants reported symptom resolution (asymptomatic time point). Noninjured control participants were reassessed using the same time interval as their concussion matched pair. Sensitivity and specificity were calculated using standardized regression-based methods and receiver operating characteristic curves. Main Outcome Measures: Outcome measures included baseline and postinjury ImPACT, BioSway, grip strength, and standing long jump scores. Results: When asymptomatic, declines in performance on each individual clinical measure were seen in 3% to 22% of the concussion group (sensitivity = 3%–22%) compared with 3% to 13% of the noninjured control group (specificity = 87%–97%) (90% confidence interval). The multimodal battery of all combined clinical measures yielded a sensitivity of 41% and a specificity of 77% (90% confidence interval). Based on discriminative analyses, the multimodal approach was statistically superior compared with an individual measures approach for balance and upper and lower body strength, but not for cognition. Conclusions: Results provide a foundation for understanding which domains of assessment (cognition, balance, and strength) may be sensitive and specific to deficits once symptoms resolve in youth athletes. More work is needed prior to clinical implementation of a preinjury (baseline) to postinjury multimodal approach to assessment following concussion in youth athletes.
High-Dose Micafungin in Neonates and Young Infants with Invasive Candidiasis: Results of a Phase 2 Study
Authors: Auriti Cinzia , Goffredo Bianca M. , Ronchetti Maria P. , Piersigilli Fiammetta , Cairoli Sara , Bersani Iliana , Dotta Andrea , Bagolan Pietro , Pai Manjunath P.
Published: February 2021

Limited data are available on the most appropriate dosing, efficacy, and safety of micafungin in neonates with invasive candidiasis (IC). This study evaluated plasma levels, efficacy, and safety of micafungin at a dose of 8 mg/kg daily for a mean of 13.3 days (±5.2 days) in 35 neonates and young infants with IC.
I’m Infected, Eat Me! Innate Immunity Mediated by Live, Infected Cells Signaling To Be Phagocytosed
Authors: Birkle Tim , Brown G. C.
Published: February 2021

Innate immunity against pathogens is known to be mediated by barriers to pathogen invasion, activation of complement, recruitment of immune cells, immune cell phagocytosis of pathogens, death of infected cells, and activation of the adaptive immunity via antigen presentation. Here, we propose and review evidence for a novel mode of innate immunity whereby live, infected host cells induce phagocytes to phagocytose the infected cell, thereby potentially reducing infection.
Flagellar Perturbations Activate Adhesion through Two Distinct Pathways in
Caulobacter crescentus
Authors: Hershey David M. , Fiebig Aretha , Crosson Sean
Published: February 2021

Understanding how bacteria colonize solid surfaces is of significant clinical, industrial and ecological importance. In this study, we identified genes that are required for
Caulobacter crescentus
to activate surface attachment in response to signals from a macromolecular machine called the flagellum.
Targeting of Mammalian Glycans Enhances Phage Predation in the Gastrointestinal Tract
Authors: Green Sabrina I. , Gu Liu Carmen , Yu Xue , Gibson Shelley , Salmen Wilhem , Rajan Anubama , Carter Hannah E. , Clark Justin R. , Song Xuezheng , Ramig Robert F. , Trautner Barbara W. , Kaplan Heidi B. , Maresso Anthony W.
Published: February 2021

Invasive pathobionts or microbes capable of causing disease can reside deep within the mucosal epithelium of our gastrointestinal tract. Targeted effective antibacterial therapies are needed to combat these disease-causing organisms, many of which may be multidrug resistant.
Manipulation of IRE1-Dependent MAPK Signaling by a Vibrio Agonist-Antagonist Effector Pair
Authors: De Nisco Nicole J. , Casey Amanda K. , Kanchwala Mohammed , Lafrance Alexander E. , Coskun Fatma S. , Kinch Lisa N. , Grishin Nick V. , Xing Chao , Orth Kim
Published: February 2021

Vibrio parahaemolyticus
is a seafood-borne pathogen that encodes two type 3 secretion systems (T3SS). The first system, T3SS1, is thought to be maintained in all strains of
V. parahaemolyticus
to maintain survival in the environment, whereas the second system, T3SS2, is linked to clinical isolates and disease in humans.
Undiagnosed sarcoidosis presenting as acute pancreatitis: a rare presentation of a known disease
Authors: Basnet Nishraj , Aluko Atinuke , Fenando Ardy , Rayamajhi Supratik
Published: February 2021

A 43-year-old African American man presented with right upper quadrant pain and elevated blood pressure. Investigations revealed elevated lipase, hypercalcaemia and elevated creatinine. CT abdomen with contrast revealed extensive intraabdominal lymphadenopathy with an initial suspicion for a lymphoproliferative malignancy. Patient was managed for acute pancreatitis, with further workup of hypercalcaemia revealing an elevated ACE level. Inguinal lymph node biopsy confirmed a non-caseating granuloma leading to the diagnosis of sarcoidosis.
Hepatectomy for liver metastasis from rectal cancer in a patient with mitochondrial disease
Authors: Takei Shogo , Homma Yuki , Matsuyama Ryusei , Endo Itaru
Published: February 2021

We herein report a woman who was suffering from type 1 diabetes and hearing impairment and whose mother had mitochondrial disease. Abdominal ultrasound identified a hepatic tumour, and a further examination led to the diagnosis of rectal cancer with synchronous multiple liver metastases. A genetic test led to the diagnosis of mitochondrial disease with a mitochondrial gene 3243A>G mutation. After neoadjuvant chemotherapy, we performed hepatectomy and low anterior resection in one stage. Hepatic vascular exclusion was not performed in order to prevent damage to hepatocytes due to liver ischaemia, and Ringer’s lactate solution was not used to prevent lactic acidosis. The postoperative course was uneventful. Only one other case involving hepatectomy being performed in a patient with mitochondrial disease has been reported. Considering the extreme rarity of such cases and the importance of perioperative management, we report this case here.
Aortoenteric fistula after endovascular mycotic aortic aneurysm exclusion: lessons learned during the COVID-19 era
Authors: Hassan Ahmed , Khan Aazeb , Huasen Bella , Banihani Mohamed
Published: February 2021

We report a case of aortoenteric fistula 2 years following endovascular aortic aneurysm repair (EVAR) for mycotic aneurysm presenting as upper gastrointestinal bleeding. Initial CT angiogram did not reveal the bleeding or connection to bowel, but endoscopy was suspicious of endograft in the duodenum. Management required a multidisciplinary approach. To stabilise the patient and to control bleeding, a ‘bridging’ endograft extension was performed. This was followed by open surgical removal of the EVAR endograft and lower limb in situ revascularisation. During postoperative recovery, the patient developed atypical, staged multisystemic symptoms (cardiac, pulmonary and neurological). With increasing awareness of the COVID-19 pandemic, the patient was found SARS-CoV-2-positive, which explained the progression of his symptoms. This was also reflected on other case reports in literature later.
Fever in a patient with osteomyelitis: the diagnosis could be serotonin syndrome
Authors: Gould Matthew , Harrison William D , Cahill-Kearns Abbey , Barton Greg
Published: February 2021

Awareness of rare differential diagnoses of common clinical presentations helps promote early detection and prompt management of serious conditions. A 54-year-old man, with an infected non-union following a high tibial osteotomy, presented with an acutely discharging abscess to his proximal tibia. He was generally unwell with aStaphylococcus aureusbacteraemia. The tibia was debrided, CERAMENT G used as dead space management and a spanning external fixator applied. Postoperatively, pregabalin and tapentadol were commenced in addition to amitriptyline and sertraline, which the patient was taking regularly. Overnight, the patient developed hyperthermia, inducible clonus, hyperreflexia, agitation, confusion and rigors. Prompt recognition of the possibility of serotonin syndrome resulted in early cessation of serotonergic medications and a positive outcome. From this case an important message is that fever in a patient taking serotonergic medications should prompt a screening neurological examination. Clinicians should also be wary when patients are commenced on multimodal analgesia, including tapentadol.
ALK-negative primary cutaneous T-cell anaplastic large cell lymphoma, myxoid variant; masquerading as sarcoma: unveiling the diagnostic dilemma
Authors: Misra Medha , Raghuvanshi Shivanjali , Goel Madhu Mati , Verma Shailendra Prasad
Published: February 2021

We present a case of 50-year-old man with history of ulcerative right axillary mass for 6 months. Axillary lymphadenopathy and organomegaly were absent. Microscopic examination showed sheets of pleomorphic cells which were mitotically active. Distinctive myxoid change was seen throughout the tumor. These cells were strongly positive for CD30 and vimentin but were negative for CD3, CD5, CD20, CD15, anaplastic lymphoma kinase protein (ALK), CD56, cytokeratin, melan A, desmin, myogenin, CD68, S100, epithelial membrane antigen and CD34. The final diagnosis of primary cutaneous ALK-negative T-cell anaplastic large cell lymphoma (PCALCL), myxoid variant was made. Work-up revealed no systemic involvement. The patient received eight cycles of cyclophosphamide, doxorubicin, vincristine, prednisone and etoposide chemotherapy with complete resolution of disease. This case report highlights that a high index of suspicion is necessary in patients of PCALCL due to varied clinical presentation, and to discuss in brief the histopathologic and immunophenotypic features of this entity along with its differential diagnosis.
Clinical conundrum: managing iron overload after renal transplantation
Authors: Upadhyay Binayak , Green Steven D , Khanal Nabin , Antony Aśok C
Published: February 2021

Iatrogenic iron overload, which is not uncommon in patients undergoing long-term haemodialysis, arises from a combination of multiple red cell transfusions and parenteral iron infusions that are administered to maintain a haemoglobin concentration of approximately 10 g/dL. Although iron overload due to genetic haemochromatosis is conventionally managed by phlebotomy, patients with haemoglobinopathies and chronic transfusion-induced iron overload are treated with iron-chelation therapy. However, the management of iron overload in our patient who presented with hepatic dysfunction and immunosuppressive drug-induced mild anaemia in the post-renal transplant setting posed unique challenges. We report on the decision-making process used in such a case that led to a successful clinical resolution of hepatic iron overload through the combined use of phlebotomy and erythropoiesis stimulating agents, while avoiding use of iron-chelating agents that could potentially compromise both hepatic and renal function.
Three-dimensional reconstruction model in the diagnosis of Morgagni’s hernia
Authors: Zhang Zhirong , Fu Yili , Hu Bin
Published: February 2021

Morgagni’s hernia (MH) can be diagnosed by different utilities, but all these methods are not always 100% accurate. Three-dimensional (3D) reconstruction model could be helpful in better understanding the important anatomical structures. We report a case of MH who was once misdiagnosed as diaphragmatic eventration at the other institution and we offered laparoscopic repair according to the 3D reconstruction model. Our case highlights that 3D reconstruction model could be a useful supplementary tool in the diagnosis and preoperative assessment for patients with MH especially when it is confused in diagnosis in clinical practice.
Clinician checklist for assessing suitability of machine learning applications in healthcare
Authors: Scott Ian , Carter Stacy , Coiera Enrico
Published: February 2021

Machine learning algorithms are being used to screen and diagnose disease, prognosticate and predict therapeutic responses. Hundreds of new algorithms are being developed, but whether they improve clinical decision making and patient outcomes remains uncertain. If clinicians are to use algorithms, they need to be reassured that key issues relating to their validity, utility, feasibility, safety and ethical use have been addressed. We propose a checklist of 10 questions that clinicians can ask of those advocating for the use of a particular algorithm, but which do not expect clinicians, as non-experts, to demonstrate mastery over what can be highly complex statistical and computational concepts. The questions are: (1) What is the purpose and context of the algorithm? (2) How good were the data used to train the algorithm? (3) Were there sufficient data to train the algorithm? (4) How well does the algorithm perform? (5) Is the algorithm transferable to new clinical settings? (6) Are the outputs of the algorithm clinically intelligible? (7) How will this algorithm fit into and complement current workflows? (8) Has use of the algorithm been shown to improve patient care and outcomes? (9) Could the algorithm cause patient harm? and (10) Does use of the algorithm raise ethical, legal or social concerns? We provide examples where an algorithm may raise concerns and apply the checklist to a recent review of diagnostic imaging applications. This checklist aims to assist clinicians in assessing algorithm readiness for routine care and identify situations where further refinement and evaluation is required prior to large-scale use.
Variation in health service use by veterans with an accepted disability of post-traumatic stress disorder who had a service record post 1975: a cluster analysis
Authors: Roughead Elizabeth Ellen , Ramsay E N , Kalisch Ellett L M , Khoo A , Moffatt A , Pratt N L
Published: February 2021

Background

The use of health services is likely to vary among veterans with an accepted disability of post-traumatic stress disorder (PTSD), however, the extent of variation is not known. We aimed to determine the extent and type of health services used by veterans with an accepted disability of PTSD.

Methods

The cohort included veterans who served post 1975, were eligible for all Australian Government Department of Veterans’ Affairs funded health services, had PTSD as an accepted disability prior to July 2015 and were alive at the 30 June 2016. Veterans were assigned to groups based on their use of health services using K-means cluster analysis.

Results

The cohort comprised five clusters involving 2286 veterans. The largest cluster (43%) were a younger, general practitioner (GP) managed cluster who saw their GP quarterly and the psychiatrist twice a year. The second GP cluster (30%) had higher levels of physical comorbidity. The psychiatrist managed cluster (14%) had a mean of 12 psychiatrist visits and one PTSD hospitalisation in the year. The remaining two clusters involved GP and allied healthcare, but no psychologist care. High levels of antidepressant use occurred in all clusters, ranging from 44% up to 69%. The psychiatrist managed cluster had 47% on antipsychotics and 58% on anxiolytics.

Conclusion

Our study highlights the heterogeneity in health service use. These results identify the significant health utilisation required for up to one-sixth of veterans with PTSD and the significant role of primary care physicians in supporting veterans with PTSD.