bluuebunny/crossref_metadata_2025 huggingface dataset:
Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report
Authors: Demir Gokhan , Hommos Rama , Al-Sirhan Sally Sami , Serhan Hashem Abu , Haddadin Muhannad , Bin Rashid Umar , Chawa Yamane
Published: May 2023

Background

SARS-CoV-19 infection is associated with an increased risk of thrombotic events. We present a case of acute middle cerebral artery ischemic stroke in a patient with SARS-CoV-19 infection despite being on warfarin with supratherapeutic INR (International Normalized Ratio).

Case presentation

A 68-year-old Caucasian female with multiple comorbidities was admitted to the hospital with symptoms of upper respiratory tract infection. A rapid antigen test confirmed the diagnosis of COVID-19 pneumonia, and intravenous remdesivir was initiated. On the fifth day of admission, the patient experienced sudden onset confusion, slurred speech, left-sided hemiplegia, right-sided eye deviation, and left-sided facial droop. Imaging studies revealed an occlusion of the distal anterior M2 segment of the right middle cerebral artery, and an MRI of the brain confirmed an acute right MCA infarction. Notably, the patient was receiving warfarin therapy with a supratherapeutic INR of 3.2.

Conclusions

This case report highlights the potential for thromboembolic events, including stroke, in patients with COVID-19 infection, even when receiving therapeutic anticoagulation therapy. Healthcare providers should be vigilant for signs of thrombosis in COVID-19 patients, particularly those with pre-existing risk factors. Further research is necessary to understand the pathophysiology and optimal management of thrombotic complications in COVID-19 patients.
NPM3 as a novel oncogenic factor and poor prognostic marker contributes to cell proliferation and migration in lung adenocarcinoma
Authors: Wei Shan , Xing Jing , Lu Kaining , Wang Kai , Yu Wanjun
Published: May 2023

Background

Lung cancer is the leading cause of cancer-related deaths worldwide, and despite recent advances in targeted therapies and immunotherapies, the clinical benefit remains limited. Therefore, there is an urgent need to further investigate the molecular mechanisms underlying lung cancer. The aim of this study was to investigate the expression and function of NPM3 in the tumor microenvironment of lung adenocarcinoma (LUAD).

Methods

We utilized bioinformatics tools and databases, including UALCAN, GEPIA2, HPA, and Sangerbox, to analyze NPM3 expression in LUAD samples and its association with prognosis and mutational landscape. NPM3 expression in various cell types was assessed at the single cell level using the TISCH database. We also used algorithms such as TIMER and EPIC to explore the crosstalk between NPM3 expression and immune features. KEGG enrichment analysis was performed to identify potential signaling pathways of NPM3. Finally, we employed siRNA knockdown strategy to investigate the effect of NPM3 on LUAD cell proliferation and migration in vitro.

Results

NPM3 was significantly upregulated in LUAD tissues and was strongly associated with poor prognosis and TP53 gene mutations. Single-cell sequencing analysis revealed that NPM3 was expressed in immune cells (dendritic cells and monocytes/macrophages) in the tumor microenvironment. Moreover, NPM3 expression was negatively associated with immune B cell and CD4 T cell infiltration, as well as with several immune-related genes (including CCL22, CXCR2, CX3CR1, CCR6, HLA-DOA, HLA-DQA2). KEGG enrichment analysis indicated that NPM3 expression was associated with cell cycle, CAMs, and NSCLC pathway genes. Finally, in vitro experiments showed that NPM3 knockdown inhibited LUAD cell proliferation and migration in NCI-H1299 and SPC-A1 cells, and suppressed the expression of CCNA2 and MAD2L1.

Conclusion

Elevated NPM3 expression predicts poor clinical outcome and an immunosuppressive microenvironment in LUAD tissues. NPM3 promotes LUAD progression by promoting cell proliferation and migration, and targeting NPM3 may represent a novel therapeutic strategy for LUAD.

Graphical Abstract
Patient and public involvement in rheumatic and musculoskeletal research: an idea whose time has firmly come
Authors: Botto-van Bemden Angie , Adebajo Adewale O. , Fitzpatrick Ciarán Martin
Published: May 2023

Patient and public involvement is an idea whose time has firmly come. It is the views of these Guest Editors that it is the right thing to do morally and improves research quality and applicability.
Impact of Newborn Screening on Adult Height in Patients With Congenital Adrenal Hyperplasia (CAH)
Authors: Hoyer-Kuhn Heike , Eckert Alexander J , Binder Gerhard , Bonfig Walter , Dübbers Angelika , Riedl Stefan , Woelfle Joachim , Dörr Helmuth G , Holl Reinhard W
Published: May 2023

Context

Treatment of children with classical congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is challenging. Linear growth and adult height are compromised according to recent publications. However, most of these data were obtained in the era before CAH newborn screening.

Design

Body height of patients with classical CAH diagnosed before and after the establishment of newborn screening were analyzed retrospectively.

Patients and Methods

We identified 600 patients with classical CAH (227 male) with data on near-adult height (NAH), target height (TH), and information on newborn screening from the electronic German CAH registry (German Society for Paediatric Endocrinology and Diabetology). Newborn screening was performed in 101 (16.8%) patients. All patients received hydrocortisone with or without fludrocortisone.

To assess the effects of newborn screening, a linear regression model adjusted/stratified for sex and phenotype was used (SAS 9.4).

Results

TH corrected NAH (mean; 95% confidence interval) was closer to 0 in patients with CAH and newborn screening [−0.25 standard deviation score (SDS); −0.44 to −0.06] than in patients without newborn screening (−0.44 SDS; −0.52 to −0.36) (P = .069). Screening had no effect on NAH in female patients. In male patients, NAH was significantly better (P = .033) with screening than without screening. After stratifying for CAH phenotype, screening did not affect the NAH of patients with salt-wasting CAH. Patients with simple-virilizing CAH had a significantly better cNAH (P = .034) with screening (0.15 SDS; −0.28-0.59) than without screening (−0.35 SDS; −0.52 to −0.18).

Conclusions

Our data suggest that newborn screening might be associated with improved NAH in male CAH patients and in patients with simple-virilizing CAH.
A Pedagogy of Living
Authors: Gordon Eva Sage
Published: May 2023

This essay discusses the usefulness of empathetic, relational pedagogy while teaching at CUNY in the time of COVID-19 and reflects on experiences with three students early in the author's career that led her to this pedagogical approach. A terminally ill student, a student who had been shot in Tahrir Square during the Arab Spring, and a student who became paralyzed in a motorbike accident led the author to reconsider the idea of the classroom as apart from the outside world. Embracing the sometimes frightening events happening beyond the classroom walls can lead to a deeper engagement with course texts as well as to a more meaningful student-teacher relationship and a sense of the course as personally significant. By constructing classrooms as places for listening and by striving to practice antiracist pedagogy, linguistically and culturally diverse students find themselves supported, even when the world outside becomes unstable and difficult to navigate.
The Walking Class of India and English after COVID-19
Authors: Chandran K. Narayana
Published: May 2023

While students discovered that the elite civic conscience served to render the Indian “migrant workers” invisible, they felt that a discursive correctness of terms called for debate. This article records their overwhelming sense of ethical quandary as others and othering gained traction in classrooms where English at once endorsed and condemned such usages.
Predictors of Progression-Free Survival in Patients With Spinal Intramedullary Ependymoma: A Multicenter Retrospective Study by the Neurospinal Society of Japan
Authors: Naito Kentaro , Umebayashi Daisuke , Kurokawa Ryu , Endo Toshiki , Mizuno Masaki , Hoshimaru Minoru , Kim Phyo , Hida Kazutoshi , Takami Toshihiro
Published: May 2023

BACKGROUND AND OBJECTIVES:

Ependymoma is the most common spinal intramedullary tumor. Although clinical outcomes have been described in the literature, most of the reports were based on limited numbers of cases or been confined to institutional experience. The objective of this study was to analyze more detailed characteristics of spinal intramedullary ependymoma (SIE) and provide clinical factors associated with progression-free survival (PFS).

METHODS:

This retrospective observational multicenter study included consecutive patients with SIE in the cervical or thoracic spine treated surgically at a total of 58 institutions between 2009 and 2020. The results of pathological diagnosis at each institute were confirmed, and patients with myxopapillary ependymoma, subependymoma, or unverified histopathology were strictly excluded from this study. Outcome measures included surgical data, surgery-related complications, postoperative systemic adverse events, postoperative adjuvant treatment, postoperative functional condition, and presence of recurrence.

RESULTS:

This study included 324 cases of World Health Organization grade II (96.4%) and 12 cases of World Health Organization grade III (3.6%). Gross total resection (GTR) was achieved in 76.5% of cases. Radiation therapy (RT) was applied after surgery in 16 cases (4.8%), all of which received local RT and 5 of which underwent chemotherapy in combination. Functional outcomes were significantly affected by preoperative neurological symptoms, tumor location, extent of tumor resection, and recurrence. Multivariate regression analysis suggested that limited extent of tumor resection or recurrence resulted in poor functional outcomes. Multiple comparisons among the groups undergoing GTR, subtotal resection and biopsy, or partial resection of the tumor showed that the probability of PFS differed significantly between GTR and other extents of resection.

CONCLUSION:

When GTR can be safely obtained in the surgery for SIE, functional maintenance and longer PFS can be expected.
Comparison of the Retrosigmoid Suprameatal and Anterior Subtemporal Transpetrosal Approaches After Full Exposure of the Internal Acoustic Meatus
Authors: Yüncü Mustafa Eren , Karadag Ali , Polat Sarper , Camlar Mahmut , Bilgin Berra , Quiñones-Hinojosa Alfredo , Middlebrooks Erik H. , Özer Fusun , Tanriover Necmettin
Published: May 2023

BACKGROUND AND OBJECTIVES:

Surgical approaches to the ventral brainstem and petroclival regions are complex, and standard retrosigmoid and subtemporal approaches are often inadequate. Retrosigmoid suprameatal tubercle (RSMTA) and anterior subtemporal transpetrosal (ASTA) approaches may provide extended surgical exposure with less brain retraction. The objective of this study was to evaluate advantages and disadvantages of RSMTA vs ASTA, and illustrate the surgical corridors and 3-dimensional microsurgical anatomy of the related structures.

METHODS:

Four silicone-injected adult cadaver heads (8 sides) were dissected to evaluate the accessibility of lesions located at the petrous apex, ventral brainstem, and pontomedullary region using ASTA and RSTMA.

RESULTS:

Both ASTA and RSMTA provide access from the petrous apex to the ventral lower pons and pontomedullary junction. A greater extent of safely resected bone was found in ASTA vs RSMTA. ASTA provides a larger surgical view to the ventrolateral midpons, peritrigeminal region, superior neurovascular complex, pontomesencephalic junction, and posterior cavernous sinus. Meanwhile, through cranial nerve V mobilization, RSMTA provides a larger surgical view to the lower half part of the pons, ventrolateral part of the pontomedullary junction, and middle and lower neurovascular structures.

CONCLUSION:

The choice of surgical approach is determined by considering the area where the lesion originates, lesion size, the anatomic structures to which it extends, and evaluation of the area that can be surgically exposed. Our study highlights the differences between these approaches and important surgical anatomic considerations.
Dynamic Lateral Semisitting Position for Supracerebellar Approaches: Technical Note and Case Series
Authors: Durmuş Yunus Emre , Kaval Barış , Demirgil Bülent Timur , Gökalp Elif , Gurses Muhammet Enes , Varol Eyüp , Gonzalez-Lopez Pablo , Cohen-Gadol Aaron , Gungor Abuzer
Published: May 2023

BACKGROUND:

It has always been a matter of debate which position is ideal for the supracerebellar approach. The risk of venous air embolism (VAE) is the major deterrent for surgeons and anesthesiologists, despite the fact that sitting and semisitting positions are commonly used in these operations.

OBJECTIVE:

To demonstrate a reduction on the risk of VAE and tension pneumocephalus throughout the operation period while taking advantages of the semisitting position.

METHODS:

In this study, 11 patients with various diagnoses were operated in our department using the supracerebellar approach in the dynamic lateral semisitting position. We used end-tidal carbon dioxide and arterial blood pressure monitoring to detect venous air embolism.

RESULTS:

None of the patients had clinically significant VAE in this study. No tension pneumocephalus or major complications were observed. All the patients were extubated safely after surgery.

CONCLUSION:

The ideal position, with which to apply the supracerebellar approach, is still a challenge. In our study, we presented an alternative position that has advantages of the sitting and semisitting positions with a lower risk of venous air embolism.
Presidential Address: Does Monetary Policy Matter? The Narrative Approach after 35 Years
Authors: Romer Christina D. , Romer David H.
Published: May 2023

The narrative approach to macroeconomic identification uses qualitative sources, such as newspapers or government records, to provide information that can help establish causal relationships. This paper discusses the requirements for rigorous narrative analysis using fresh research on the impact of monetary policy as the focal application. We read the historical Minutes and Transcripts of Federal Reserve policymaking meetings to identify significant contractionary and expansionary changes in monetary policy not taken in response to current or prospective developments in real activity for the period 1946 to 2016. We find that such monetary shocks have large and significant effects on unemployment, output, and inflation in the expected directions. Analysis of available policy records suggests that a contractionary monetary shock likely occurred in 2022. Based on the empirical estimates of the effect of previous shocks, one would expect substantial negative impacts on real GDP and inflation in 2023 and 2024. (JEL E31, E52, E58, E65, N12)
The Birth of a Nation:Media and Racial Hate
Authors: Ang Desmond
Published: May 2023

This paper documents the impact of popular media on racial hate by examining the first American blockbuster: 1915’s The Birth of a Nation, a fictional portrayal of the KKK’s founding rife with racist stereotypes. Exploiting the film’s five-year “road show,” I find a sharp spike in lynchings and race riots coinciding with its arrival in a county. Instrumenting for road show destinations using the location of theaters prior to the movie’s release, I show that the film significantly increased local Klan support in the 1920s. Road show counties continue to experience higher rates of hate crimes and hate groups a century later. (JEL J15, K42, L82, N31, N32, N41, Z13)
Reconciliation Narratives:The Birth of a Nationafter the US Civil War
Authors: Esposito Elena , Rotesi Tiziano , Saia Alessandro , Thoenig Mathias
Published: May 2023

We study how the spread of the Lost Cause narrative—a revisionist and racist retelling of the US Civil War—shifted opinions and behaviors toward national reunification and racial discrimination against African Americans. Looking at screenings of The Birth of a Nation, a blockbuster movie that greatly popularized the Lost Cause after 1915, we find that the film shifted the public discourse toward a more patriotic and less divisive language, increased military enlistment, and fostered cultural convergence between former enemies. We document how the racist content of the narrative connects to reconciliation through a “common-enemy” type of argument. (JEL J15, L82, N31, N32, N41, Z13)
Δημογραφική μελέτη της νοσηλευτικής κίνησης των κέντρων υγείας Κέρκυρας
Authors: Μπόικου Ουρανία
Published: May 2023

Στα πλαίσια της διδακτορικής μου έρευνας επικεντρώθηκα στη μελέτη της νοσηλευτικής κίνησης των Κέντρων Υγείας Κέρκυρας, όπως αυτή αποτυπώθηκε μέσα από το παράδειγμα παροχής Πρωτοβάθμιας Φροντίδας Υγείας από το Κέντρο Υγείας Αγίου Αθανασίου-Αγρού. Στόχος της μελέτης είναι να προσδιορίσει και να συσχετίσει δημογραφικούς παράγοντες που επηρεάζουν την προσφορά των Υπηρεσιών Υγείας του συγκεκριμένου Κέντρου Υγείας προς τους πολίτες, που αρχικά διαμένουν μόνιμα ή προσωρινά στην περιοχή δικαιοδοσίας του Κέντρου Υγείας, είτε γενικότερα στην ευρύτερη περιοχή του νησιού. Τα δεδομένα της έρευνας βασίζονται σε πρωτογενείς πληροφορίες από τα βιβλία μητρώων καταγραφής περιστατικών του Κέντρου Υγείας και αφορούν τα έτη 1990-2019. Τα αποτελέσματα της έρευνας καταδεικνύουν τη συσχέτιση των δημογραφικών παραγόντων στη διαμόρφωση προσφοράς των Υπηρεσιών Υγείας στην Πρωτοβάθμια Φροντίδα από το Κέντρο Υγείας Αγίου Αθανασίου-Αγρού Κέρκυρας.
The genome sequence of the Brown House-moth, Hofmannophila pseudospretella (Stainton, 1849)
Authors: Boyes Douglas , Holland Peter W.H. ,   University of Oxford and Wytham Woods Genome Acquisition Lab,   Darwin Tree of Life Barcoding collective,   Wellcome Sanger Institute Tree of Life programme,   Wellcome Sanger Institute Scientific Operations: DNA Pipelines collective,   Tree of Life Core Informatics collective,   Darwin Tree of Life Consortium
Published: May 2023

We present a genome assembly from an individual male Hofmannophila pseudospretella (the Brown House-moth; Arthropoda; Insecta; Lepidoptera; Oecophoridae). The genome sequence is 406.2 megabases in span. Most of the assembly is scaffolded into 28 chromosomal pseudomolecules, including the Z sex chromosome. The mitochondrial genome has also been assembled and is 15.5 kilobases in length.
Etnicidad y salud. Una reconceptualización necesaria
Authors: Cortés-García Claudia Margarita
Published: May 2023

¿Qué significa lo étnico y la etnicidad, la diferencia y la diversidad en el discurso de la salud? ¿Qué significa la salud con enfoque étnico? Estas preguntas logran un lugar central cuando se consigna que la región de las Américas es heterogénea y que, en este sentido, los grupos tienen necesidades distintas. En lo relacionado con la salud, se plantea que este reconocimiento implica enfoques socioculturales diferenciados para mejorar las condiciones de vida de las personas, tanto en una dimensión individual como en una colectiva. Debe mencionarse también que no es nuevo el trabajo desde dicho reconocimiento, y tampoco, tácito.
Smart Natural Disaster Relief: Assisting Victims with Artificial Intelligence in Lending
Authors: Liu Yidi , Li Xin , Zheng Zhiqiang (Eric)
Published: May 2023

Natural disasters can have devastating economic and financial consequences for those affected. This research note explores the potential of artificial intelligence (AI) in disaster relief through lending services. By collaborating with a credit-scoring company, we investigate how AI-empowered lenders can effectively reduce delinquency rates for borrowers in the aftermath of disasters. Our findings reveal that borrowers applying to lenders that utilize AI in their loan assessment process experience improved outcomes in terms of delinquency reduction, particularly for borrowers with lower credit scores. This research underscores the positive impact of AI in the lending context, benefiting both lenders and borrowers. Furthermore, we highlight that AI indirectly supports disaster relief efforts through financing, providing a compelling use case for AI fairness in lending. Our findings have significant implications for leveraging AI as a valuable tool in mitigating the financial impact of disasters and promoting fairness in lending practices.
Does Social Interaction Spread Fear Among Institutional Investors? Evidence from Coronavirus Disease 2019
Authors: Au Shiu-Yik , Dong Ming , Zhou Xinyao
Published: May 2023

We study how social connectedness affected active mutual fund manager trading behavior in the first half of 2020. In the first quarter during which the coronavirus disease 2019 (COVID-19) outbreak occurred, fund managers located in or socially connected to COVID-19 hotspots sold more stock holdings compared with a control group of unconnected managers. The economic impact of social connectedness on stock holdings was comparable with that of COVID-19 hotspots and was elevated among “epicenter” stocks most susceptible to the pandemic shock. In the second quarter, social interaction had an overall negative effect on fund performance, but this effect depended on manager skill; unskilled managers who were connected to the hotspots underperformed, whereas skillful managers suffered no deleterious effect. Our evidence suggests that social connections can intensify salience bias for all but the most skilled institutional investors, and policy makers should be wary of the destabilizing role of social networks during market downturns.

This paper was accepted by Gustavo Manso, finance.

Funding: This work was supported by the Social Science and Humanities Research Council of Canada.

Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2023.4814 .
Competitive Bundling and Offer Design in a Symmetric Bertrand Duopoly
Authors: Roels Guillaume , Khodabakhshian Araz , Karmarkar Uday S.
Published: May 2023

How should digital service firms design and bundle their offering to capture a large market while seeking differentiation from competition? To answer this question, we consider the most generic model of competition, namely, two symmetric firms competing on price with regard to two (independent or complementary) components with an arbitrary distribution of valuations, without restrictions on their product offering. We show that three outcomes emerge in equilibrium, namely, a full-mixed bundling monopoly, a full-mixed bundling competitive duopoly leading to a price war, and a pure or partial-mixed bundling differentiated duopoly yielding positive profits for both firms. The latter equilibrium is the most plausible because it is the only one that is both trembling-hand perfect and not payoff dominated. We demonstrate the benefits of bundling under competition, thereby explaining the online platforms’ motivation for and success in expanding their offering horizontally. Yet not all products may be offered in equilibrium to avoid direct or indirect competition; hence, competition may lead to a narrower range of products available than a monopoly. Is bundling anticompetitive? It is a double-edged sword. On the one hand, it softens price competition by allowing firms to differentiate their offering. On the other hand, it stimulates competition by creating some product overlap.
Levodopa-induced pseudopheochromocytoma
Authors: Cardoso Joana Bernardino , Silveira Ana , Duarte Sara , Fortes Ruth , Botelho Ahmed , Simas Ana , Suzano Rui
Published: May 2023

Pseudopheochromocytoma is a pathological condition presenting with paroxysmal hypertension with normal or moderate elevation in catecholamines and metanephrine levels, but no evidence of a tumoural cause. Imaging studies and I-123 metaiodobenzylguanidine scintigraphy are essential for exclusion of pheocromocytoma. We describe a case of pseudopheochromocytoma related to levodopa in a patient with paroxysmal hypertension, headache, sweating, palpitations and increased plasmatic and urinary metanephrine levels, without adrenal or extra-adrenal tumour. The beginning of the patient´s clinical symptoms coincided with the initiation of the levodopa treatment and the complete resolution of the symptoms occurred after the discontinuation of levodopa.
Diagnosis, management and training in perineal trauma: a national survey of UK midwives
Authors: Roper Joanna C , Thakar Ranee , Hurt K. Joseph , Sultan Abdul H
Published: May 2023

Background/Aims

Midwives are often the only professionals to examine a women after a vaginal birth. Therefore, it is important that they are trained in the detection and management of obstetric perineal trauma. This study's aim was to establish midwives' current knowledge and training in post-birth perineal trauma, including obstetric anal sphincter injuries, in the UK.

Methods

An online national validated survey was distributed to UK midwives. There were 58 questions to assess midwives' knowledge and training. Univariable and multivariable analyses were conducted.

Results

A total of 149 midwives participated. Only 50.3% had received training in obstetric tears. Midwives were better at classifying 3a (98.0% and 87.9% respectively) than 3b tears (79.2%, 85.9% and 84.6%) from images and descriptive text. Those who had training (P=0.02) and were a higher banding (P=0.003) were better at identifying tears.

Conclusions

Although midwives' knowledge of obstetric tears was good, there was room for improvement and midwives stated that they would like more training.
Maternal intrapartum fluids and neonatal weight loss in the breastfed infant
Authors: Rich Melody , Dowling Sally , Bray Isabelle
Published: May 2023

Background/Aims

Significant weight loss during early life can be of serious concern and assessing weight is key in decisions regarding supplementation. However, supplementation is a significant risk factor for early breastfeeding cessation. Recognising differential causes of weight loss supports identification of genuinely unwell infants and targets practices that support exclusive breastfeeding appropriately. This study's aim was to identify whether maternal fluid balance/load is associated with neonatal weight loss.

Methods

The databases CINAHL, MEDLINE, EMBASE, EMCARE were searched for relevant literature. Data were extracted using a structured form based on the Cochrane handbook. Meta-analysis was not possible because of the heterogeneity of all aspects of study design and outcome definitions.

Results

Eight studies presented original data. Four reported an association between maternal intravenous fluid intake and neonatal weight loss, and four did not. No two studies collected the same outcome data at the same time, using the same comparator or intervention.

Conclusions

Further research is required to clarify the relationship between maternal fluid intake and neonatal weight loss in a clinically useful way.
The history of industrial action in the NHS
Authors: Baldwin AJ
Published: May 2023

How often have strikes occurred throughout the NHS' history?
The RCS England/McKinsey fellowship: lessons from a world-leading management consultancy firm
Authors: Allan A , Ha J , Pathiraja A , Muirhead W , Downham C
Published: May 2023

A look at the RCS England/McKinsey fellowship and how developing leadership and management skills help surgeons in their careers.
Wasted costs award against an expert – again
Authors: Todd NV
Published: May 2023

In 2021, a wasted costs order of £50,543.85 was made against a dental expert. He was found to have reported on a subject where he had no expertise (among many other criticisms). In addition, he was found to have shown a flagrant and reckless disregard for his duties to the court. This is only the second time that a wasted costs order has been made against a medicolegal expert. This paper discusses the case and the tests for the award of a wasted costs order, emphasising the duties to the court of all medicolegal experts.
A review of deaths in surgery using the structured judgement case note review process
Authors: Gallegos CRR , Gregg-Smith SJ , Ashworth C , Courtney E
Published: May 2023

Introduction

In December 2016, the Care Quality Commission published a review of how National Health Service trusts investigate patient deaths. Provider organisations and commissioners must work together to review and improve their local approach following the death of people receiving care from their services.

Methods

The Royal College of Physicians led the National Mortality Case Record Review programme based on the qualitative approach developed by Professor Hutchinson and colleagues at the Yorkshire and Humber Academic Health Science Network. The structured case note review (SCNR) is divided into six phases followed by an overall judgement of the quality of care and of the medical records. We have modified the SCNR to include a section for returns to theatre. The process also includes an assessment of whether any shortcomings in the quality of care contributed to death.

Results

This paper reports the results of the first 172 SCNRs undertaken in surgery at the Royal United Hospital in Bath. The vast majority (97%) of patients were admitted as emergencies. Overall care was graded as poor in four cases, with problems identified in three cases that were likely to have contributed to death. Two of the recurring themes for learning were failure to escalate a deterioration in the National Early Warning Score and delays in recognising deterioration due to acute surgical problems on medical wards.

Conclusions

Learning from mistakes is fundamental. The SCNR offers a process to identify both good and poor practice as well as bringing to light previously unrecognised care delivery problems.
The Future of Surgery Innovation Hub: who, why and what next?
Authors: Dobbs Tom
Published: May 2023

The Technologist interviews the founders of the Future of Surgery Innovation Hub, and what their aims for the future of the I-Hub are
Impact of the band upgrade sequence on the capacity and capital expenditure of multi-band optical networks
Authors: Guo Ningning , Zhang Kai , Li Yongcheng , Deng Ning , Bose Sanjay K. , Shen Gangxiang
Published: May 2023

Multi-band transmission over existing fibers would be a key strategy for ongoing capacity expansion even though upgrading from the conventional C band to multi-band, such as the C+L-band transmission being deployed by operators, would be a slow and complex process. After the C+L band, which band should be upgraded first in the next stage is an open question. We try to answer this by proposing three different band upgrade strategies, including near-to-far, far-to-near, and performance-prediction strategies, and comparing the potential capacity increase and the investment cost to upgrade different bands. We introduce an optical signal-to-noise ratio (OSNR) estimation model comprehensively covering various impairments to evaluate the quality of transmission of an optical channel and develop what we believe to be a novel method to find optimal launch powers for optical channels. Along with routing and spectrum assignment, an OSNR-aware traffic grooming algorithm is also developed to evaluate the capacity that can be achieved after upgrading different bands in an optical network. Our study shows that the performance-prediction strategy always outperforms the other two strategies. When capacity is considered a key performance metric, the E band should be the first to be upgraded next since it both expands the transmission capacity significantly using only a few additional amplifiers and the band upgrade sequence should be E, O, S, and U. For the performance-prediction strategy, we also evaluate the impact of the upgraded band on the performance of other bands. It is found that the upgraded band always has a significant impact on adjacent bands, with the upgrade of high-frequency bands improving the performance of existing low-frequency bands and the upgrade of low-frequency bands degrading the performance of existing high-frequency bands. In addition, the “C+L+E+O+S+U” scenario can achieve 3 times the capacity of the “C+L” scenario when all the bands are upgraded.
Improving beam quality of tapered laser diodes by integrated metalens
Authors: Gong Kai , Wang Yufei , Zhou Xuyan , Zhang Jianxin , Dong Fengxin , Zhang Yu , Zhang Run , Jia Xiaoqin , Zheng Wanhua
Published: May 2023

High-power and high-beam-quality laser sources are required in numerous applications. Here, we theoretically investigate a tapered laser diode with integrated metalens, which can improve the lateral beam quality. By carefully designing the slot length and width at different lateral positions behind the front facet, the mode mismatch between the ridged cavity and the tapered cavity is overcome while ensuring high transmittance (>96%). The beam quality is greatly improved, and the lateral far-field divergence is reduced. The simulation results show that the lateral far-field divergence (second-moment level) decreases from 7.2° to 5.9°, and the M2 (second-moment level) decreases from 2.3 to 1.2. The proposed structure shows a good thermal stability in the simulation.
Optical cascaded reservoir computing for realization of dual-channel high-speed OTDM chaotic secure communication via four optically pumped VCSEL
Authors: Zhong Dongzhou , Zhang Jinbo , Deng Wanan , Hou Peng , Wu Qingfan , Chen Yujun , Wang Tiankai , Hu Yalan , Deng Fuqin
Published: May 2023

In this work, we propose a chaotic secure communication system with optical time division multiplexing (OTDM), using two cascaded reservoir computing systems based on multi beams of chaotic polarization components emitted by four optically pumped VCSELs. Here, each level of reservoir layer includes four parallel reservoirs, and each parallel reservoir contains two sub-reservoirs. When the reservoirs in the first-level reservoir layer are well trained and the training errors are far less than 0.1, each group of chaotic masking signals can be effectively separated. When the reservoirs in the second reservoir layer are effectively trained and the training errors are far less than 0.1, the output for each reservoir can be well synchronized with the corresponding original delay chaotic carrier-wave. Here, the synchronization quality between them can be characterized by the correlation coefficients of more than 0.97 in different parameter spaces of the system. Under these high-quality synchronization conditions, we further discuss the performances of dual-channel OTDM with a rate of 4×60 Gb/s. By observing the eye diagram, bit error rate and time-waveform of each decoded message in detail, we find that there is a large eye-openings in the eye diagrams, low bit error rate and higher quality time-waveform for each decoded message. Except that the bit error rate of one decoded message is lower than 7 × 10−3 in different parameter spaces, and those of the other decoded messages are close to 0, indicating that high-quality data transmissions are expected to be realized in the system. The research results show that the multi-cascaded reservoir computing systems based on multiple optically pumped VCSELs provide an effective method for the realization of multi-channel OTDM chaotic secure communications with high-speed.
High-accuracy measurement system for rotor-stator axial clearance in narrow spaces based on all-fiber microwave photonic mixing
Authors: Yu Zhenxin , Liu Wenzheng , Duan Fajie , Fu Xiao , Bao Ruijia , Guo Guanghui
Published: May 2023

In this paper, a high-accuracy measurement method for rotor-stator axial clearance in narrow spaces is proposed. The optical path structure based on all-fiber microwave photonic mixing is established. To improve the accuracy and expand the measurement range, the total coupling efficiency over the entire measurement range at different working distances of fiber probe was evaluated by Zemax analysis tool and theoretical model. The performance of the system was verified by experiments. The experimental results show that the measurement accuracy of axial clearance is better than 10.5 um within the range of 0.5–20.5 mm. The measurement accuracy has been effectively improved compared to previous methods. Additionally, the probe size is reduced to a mere diameter of 2.78 mm, which is more suitable for axial clearance measurement in narrow spaces inside rotating machines.
Multi working mode SPR chip laboratory for high refractive index detection
Authors: Ren Zhuo , Liu Chunlan , Wei Yong , Liu Chunbiao , Shi Chen , Wang Xingkai , Tang Yixiong , Wang Rui , Liu Zhihai
Published: May 2023

The Fiber SPR chip laboratory has become a popular choice in biochemical detection. To meet the needs of different kinds of analytes for the detection range and number of channels of the chip, we proposed a multi-mode SPR chip laboratory based on microstructure fiber in this paper. The chip laboratory was integrated with microfluidic devices made from PDMS and detection units made of bias three-core fiber and dumbbell fiber. By injecting light into different cores of a bias three-core fiber, different detection areas of dumbbell fiber can be selected, enabling the chip laboratory to enter high refractive index detection, multi-channel detection and other working modes. In the high refractive index detection mode, the chip can detect liquid samples with a refractive index range of 1.571-1.595. In multi-channel detection mode, the chip can achieve dual parameter detection of glucose and GHK-Cu, with sensitivities of 4.16 nm/(mg/mL) and 9.729 nm/(mg/mL), respectively. Additionally, the chip can switch to temperature compensation mode. The proposed multi working mode SPR chip laboratory, based on micro structured fiber, offers a new approach for the development of portable testing equipment that can detect multiple analytes and meet multiple requirements.
Dual-band achromatic metalens-assisted grating couplers for wavelength demultiplexing
Authors: Qu Yu , Lei Lei , Yu Yu , Zhang Xinliang , Xu Ping , Qian Zhengfang
Published: May 2023

The design of grating couplers (GCs) that can (de)multiplex and couple arbitrarily defined spatial light into photonic devices is crucial for miniaturized integrated chips. However, traditional GCs have a limited optical bandwidth due to their wavelength’s dependency on the coupling angle. In this paper, we propose a device that addresses this limitation by combining a dual-broadband achromatic metalens (ML) with two focusing GCs. By controlling the frequency dispersion, the waveguide-mode-based ML achieves excellent dual-broadband achromatic convergence and separates broadband spatial light into opposing directions at normal incidence. The focused and separated light field matches the grating diffractive mode field and is then coupled into two waveguides by the GCs. This ML-assisted GCs device exhibits a good broadband property with −3 dB bandwidths of 80 nm at 1.31 µm (CE ∼ −6 dB) and 85 nm at 1.51 µm (CE ∼ −5 dB), which almost covers the entire designed working bands, representing an improvement over traditional spatial light-GC coupling. This device can be integrated into optical transceivers and dual-band photodetectors to enhance the bandwidth of wavelength (de)multiplexing.
Standard sine motion video-based virtual traceability method for monocular vision low-frequency vibration measurements
Authors: Yang Ming , Mo Sifan , Cai Chenguang , Liu Zhihua , Wang Deguang , Wang Ying
Published: May 2023

The low-frequency vibration exists in building structures, mechanical devices, instrument manufacturing, and other fields, and is the key to modal analysis, steady-state control, and precision machining. At present, the monocular vision (MV) method has gradually become the primary choice to measure the low-frequency vibration because of its distinctive advantages in efficiency, non-contact, simplicity, flexibility, low cost, etc. Although many literature reports have demonstrated that this method has the capability to reach high measurement repeatability and resolution, its metrological traceability and uncertainty evaluation are difficult to be unified. In this study, a novel, to the best of our knowledge, virtual traceability method is presented to evaluate the measurement performance of the MV method for the low-frequency vibration. This presented method achieves traceability by adopting the standard sine motion videos and the precise position error correction model. Simulations and experiments confirm that the presented method can evaluate the amplitude and phase measurement accuracy of the MV-based low-frequency vibration in the frequency range from 0.01 to 20 Hz.
Experimental demonstration of an optics-based 4-PSK half-adder using nonlinear wave mixing
Authors: Song Hao , Zou Kaiheng , Zhou Huibin , Karapetyan Narek , Minoofar Amir , Su Xinzhou , Almaiman Ahmed , Habif Jonathan L. , Tur Moshe , Willner Alan E.
Published: May 2023

We experimentally demonstrate an optics-based half-adder of two 4-phase-shift-keying (4-PSK) data channels using nonlinear wave mixing. The optics-based half-adder has two 4-ary phase-encoded inputs (i.e., S
A
and S
B
) and two phase-encoded outputs (i.e., Sum and Carry). The input quaternary base numbers {0,1,2,3} are represented by 4-PSK signals A and B with four phase levels. Along with the original signals A and B, the phase-conjugate signal copies A* and B*and phase-doubled signal copies A2 and B2 are also generated to form two signal groups S
A
(A, A*, A2) and S
B
(B, B*, B2). All of the above signals in the same signal group are (a) prepared in the electrical domain with a frequency spacing of Δf and (b) generated optically in the same IQ modulator. When combined with a pump laser, group S
A
mixes with group S
B
in a periodically poled lithium niobate nonlinear (PPLN) device. At the output of the PPLN device, both the Sum (A2B2) and the Carry (AB + A*B*) are simultaneously generated with four phase levels and two phase levels, respectively. In our experiment, the symbol rates can be varied between 5 Gbaud and 10 Gbaud. The experimental results show that (i) the measured conversion efficiency of two 5-Gbaud outputs is approximately −24 dB for Sum and approximately −20 dB for Carry, and (ii) the measured optical signal-to-noise ratio (OSNR) penalty of the 10-Gbaud Sum and Carry channels is <10 dB and <5 dB, compared with that of the 5-Gbaud channels at the BER of 3.8 × 10−3.
Dimethyl itaconate ameliorates the deficits of goal-directed behavior in Toxoplasma gondii infected mice
Authors: Wu Yongshuai , Xu Daxiang , He Yan , Yan Ziyi , Liu Rundong , Liu Zhuanzhuan , He Cheng , Liu Xiaomei , Yu Yinghua , Yang Xiaoying , Pan Wei
Published: May 2023

Background

The neurotrophic parasiteToxoplasma gondii(T.gondii) has been implicated as a risk factor for neurodegenerative diseases. However, there is only limited information concerning its underlying mechanism and therapeutic strategy. Here, we investigated the effects ofT.gondiichronic infection on the goal-directed cognitive behavior in mice. Moreover, we evaluated the preventive and therapeutic effect of dimethyl itaconate on the behavior deficits induced by the parasite.

Methods

The infection model was established by orally infecting the cysts ofT.gondii. Dimethyl itaconate was intraperitoneally administered before or after the infection. Y-maze and temporal order memory (TOM) tests were used to evaluate the prefrontal cortex-dependent behavior performance. Golgi staining, transmission electron microscopy, indirect immunofluorescence, western blot, and RNA sequencing were utilized to determine the pathological changes in the prefrontal cortex of mice.

Results

We showed thatT.gondiiinfection impaired the prefrontal cortex-dependent goal-directed behavior. The infection significantly downregulated the expression of the genes associated with synaptic transmission, plasticity, and cognitive behavior in the prefrontal cortex of mice. On the contrary, the infection robustly upregulated the expression of activation makers of microglia and astrocytes. In addition, the metabolic phenotype of the prefrontal cortex post infection was characterized by the enhancement of glycolysis and fatty acid oxidation, the blockage of the Krebs cycle, and the disorder of aconitate decarboxylase 1 (ACOD1)-itaconate axis. Notably, the administration of dimethyl itaconate significantly prevented and treated the cognitive impairment induced byT.gondii, which was evidenced by the improvement of behavioral deficits, synaptic ultrastructure lesion and neuroinflammation.

Conclusion

The present study demonstrates thatT.gondiiinfection induces the deficits of the goal-directed behavior, which is associated with neuroinflammation, the impairment of synaptic ultrastructure, and the metabolic shifts in the prefrontal cortex of mice. Moreover, we report that dimethyl itaconate has the potential to prevent and treat the behavior deficits.
Adapted “Break the Cycle for Avant Garde” intervention to reduce injection assisting and promoting behaviours in people who inject drugs in Tallinn, Estonia: A pre- post trial
Authors: Uusküla Anneli , Raag Mait , Barnes David M. , Tross Susan , Ave Talu , Des Jarlais Don C.
Published: May 2023

In the context of established and emerging injection drug use epidemics, there is a need to prevent and avert injection drug use. We tested the hypothesis that an individual motivation and skills building counselling, adapted and enhanced from Hunt’s Break the Cycle intervention targeting persons currently injecting drugs would lead to reduction in injection initiation-related behaviours among PWID in Tallinn, Estonia. For this quasi-experimental study, pre-post outcome measures included self-reported promoting behaviours (speaking positively about injecting to non-injectors, injecting in front of non-injectors, offering to give a first injection) and injection initiation behaviours (assisting with or giving a first injection) during the previous 6 months. Of 214 PWID recruited, 189 were retained (88.3%) for the follow-up at 6 months. The proportion of those who had injected in front of non-PWID significantly declined from 15.9% to 8.5%, and reporting assisting with 1st injection from 6.4% to 1.06%. Of the current injectors retained in the study, 17.5% reported not injecting drugs at the follow up. The intervention adapted for the use in the setting of high prevalence of HIV and relatively low prevalence of injection assisting, tested proved to be effective and safe.