bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of early biliary complications on survival rates after pediatric liver transplantation—A positive outlook
Authors: Berchtold Valeria , Messner Franka , Weissenbacher Annemarie , Oberhuber Rupert , Entenmann Andreas , Aldrian Denise , Vogel Georg , Margreiter Christian , Ulmer Hanno , Krapf Johanna , Cardini Benno , Schlitt Hans J. , Margreiter Raimund , Öfner Dietmar , Müller Thomas , Schneeberger Stefan
Published: June 2021

Background

Early biliary complications (EBC) constitute a burden after pediatric liver transplantation frequently requiring immediate therapy. We aimed to assess the impact of EBC on short‐ and long‐term patient and graft survival as well as post‐transplant morbidity.

Methods

We analyzed 121 pediatric liver transplantations performed between 1984 and 2019 at the Medical University of Innsbruck for the occurrence of early (<90 days) biliary complications and investigated the influence of EBC on patient and graft survival.

Results

Early biliary complications occurred in 30 (24.8%) out of the 121 pediatric liver transplant recipients. Patient survival at 15 years (89.2% vs. 84.2%, p = .65) and all‐cause (82.5% vs. 74.0%) and death‐censored graft survival (82.5% vs. 75.1%, p = .71) at 10 years were similar between the EBC and the non‐EBC group. The EBC group had a significantly longer ICU (25 vs. 16 days, p < .001) and initial hospital stay (64 vs. 42 days, p = .002). Livers of patients with EBC were characterized by multiple bile ducts (33.3% vs. 13.2%, p = .027), and patients with EBC had a higher risk to develop late biliary complications (OR 2.821 [95% CI 1.049–7.587], p = .044) and bowel obstruction/perforation (OR 4.388 [95% CI 1.503–12.812], p = .007).

Conclusion

Early biliary complications after pediatric liver transplantation is frequent. The occurrence of EBC significantly increased post‐transplant morbidity without affecting mortality. Multiple bile ducts were the only risk factor for the development of EBC in our cohort.
Platform Information Transparency and Effects on Third‐Party Suppliers and Offline Retailers
Authors: Tsunoda Yushi , Zennyo Yusuke
Published: June 2021

We examine a model in which a supplier sells products through an online platform and an offline retailer under conditions of demand uncertainty. The actual demand potential can be observed (or predicted accurately using rich sales data) by the platform and retailer, but not by the supplier. The model addresses the following issues. First, the supplier optimizes its multi‐channel strategy, including a selling format choice in the online channel and optimal pricing. Specifically, although a traditional wholesale model is used offline, both wholesale and agency models are prepared online. Given a commission rate set by the platform for the agency model, the supplier chooses one selling format from the two models. The second one is related to the platform's information‐sharing policy. The platform can commit to sharing its demand information with the supplier. This study elucidates how the platform's information sharing alters the supplier's multi‐channel management and subsequently affects the retailer eventually. Results show that the platform charges its commission rate so that the supplier chooses the agency model, unless the consumer demand is sufficiently uncertain. We also demonstrate that the platform's information sharing capability makes the agency model more likely to be adopted. However, information transparency arising from the platform's voluntary information disclosure can be unfavorable to the retailer. Finally, we demonstrate that, with information sharing, a shift from wholesale to agency models can be desirable not only for the platform and supplier, but also for the retailer (i.e., Pareto‐improving).
Policy Consultation in	Malaysia Public Service
Authors: Mat	Arifin Fazni , Othman Nooraini
Published: June 2021

The aim of this article is to discuss the process of public policymaking and how the policy consultation helps to elaborate the processes involved in enhancing cooperation among government agencies. Existing literature indicates that there has never been any research that studies in detail on the consultative process of the process of policymaking in the country’s public service. The only available guidance is in the National Policy on the Development and Implementation of Regulations to improve the decision-making process for policy implementation. Therefore, a further reference has been done to a qualitative study on the policymaking process of the proposed National Halal Policy. The study indicates that an effective consultative approach must be able to act as either a vehicle of communication or stakeholder management in the policy process. The framework of negotiation-based policy consultative informs clearly on what types of consultative process practiced by the country and how does it operate in promoting wider participation in the policy process.
Psychological Capital as a Thrust to	Innovative Personality: A Focus on	Education
Authors: Othman Nooraini
Published: June 2021

This paper aims to describe the importance of psychological capital and innovative personality development for the creation of a sustainable educational ecosystem. References are made to some relevant Malaysian education policies. In principle, psychological capital and innovative personality are intertwined and inseparable, and the context of educational development in Malaysia is no exception. Numerous policies have been developed by the Ministry of Education in Malaysia. What is profoundly important after every policy development is its effective implementation. Policy analysis is another initiative. This paper aims to investigate psychological capital as a component of holistic human capital that needs to be developed. The innovative personality profile is briefly described. The role of the education sector, and the progress towards the development of a sustainable education ecosystem, finally conclude the paper. The main emphasis is on training and policy enlightenment.
The Impact of Religion and Culture on Leadership Styles of Women Policy-Makers in the Education Industry
Authors: Mohamad Saleh Baqutayan Shadiya , Raji Fauziah
Published: June 2021

This qualitative study is purposive in sampling and explored a small number of women leaders in the education industry who are policymakers of Malay Muslim origin of their experiences in leadership positions. Policymaking here involved policies at the micro-level, which related more to their institutions and organizations. The researcher examined the women's leadership styles and the factors that influenced how they lead explicitly. Likewise, the researcher focused on how gender, culture, and religion may relate to women's experiences. Basic interpretive and descriptive qualitative research methods were employed. Data were collected through in-depth individual interviews. Participants interviewed included nine women leaders in the public and private sector who were either teachers/lecturers or administrators in the education industry. These women held positions within the top echelon of their organization or institution. The finding of this research indicated that gender, religion, and culture play an important role in women's leadership experiences, therefore, themes emerged around influences on the women's approaches to leadership, with particular emphasis on the role of the larger environment in impacting women's leadership behaviors. To further focus on the impact of culture and religion on women's leadership styles, the researcher conducted a focused discussion group on the second group of Malay Muslim women leaders. This group of women leaders compromised mainly of women leaders who are department and section heads but still involved in policymaking decisions albeit within their department or sections. This study can provide insight into the landscape of women‘s leadership roles and how to support these leaders.
Kemahiran Bertutur Bahasa Melayu oleh Murid Cina: Teori Analisis Kontrastif
Authors: Rosli Nor Zulaiqha , Mohd Rusli Nur Farahkhanna , Abdul Jobar Norfaizah , Zakaria Norazimah
Published: June 2021

The acquisition of Malay as a second language, either verbally or non verbally among the non-Malay students, is still in question. It is observed that the problems of pronunciation is still prevalent among the non-Malay students. Hence, the objectives of this study are twofold; (i) to identify the level of proficiency of the speaking skill of Malay language among Chinese students, and (ii) to analyse the errors made in the speaking skill of Malay language by Chinese students based on contrastive analysis theory. The respondents were 27 Chinese Form 1 students in SMK Ampang Pecah, Kuala Kubu Baharu, Selangor. The initial design of the study was spurred by library research and observation. The instruments used in data collection included notebooks, questionnaire, recorder and texts for speech test. The data were analyzed by contrastive analysis theory by Robert Lado (1957). The findings showed that there were four aspects of pronunciation errors related consonants produced by the respondents. They were (i) sound replacement, (ii) sound addition, (iii) sound abortion, (iv) and grammatical errors. This study also shows that the pronunciation errors were due to the influence of their native language, which is Mandarin language, and the interlingual factors of the respondents that have caused them to be weak in the mastery of Malay language. In terms of implication, this study provides some understanding on the importance of mastering oral speech in Malay language through appropriate grammatical usage and pronunciation , especially among the second language speakers of Malay.
Tourism-related Coronaneologisms
Authors: Orel Frank Tina
Published: June 2021

In linguistic research, there have been numerous recent attempts to extract and analyse covidneologisms, yet the field of languages for specific purposes is to the date left unresearched. Coronaneologisms are neologisms in the neologistic phase of the word life cycle at the time of the recent catastrophic COVID -19 outbreak, which was particularly devastating in the tourism sector. The paper is therefore concerned with the emergence of new tourism-related coronaneologisms. It extracts them by analysing previous academic research on the subject, by observing tourism-related sources on the Internet and by conducting interviews with academic professionals in the field of tourism at The Faculty of Tourism Studies - Turistica in Slovenia as an active tourism discourse community. The list of tourism-related coronaneologisms contributes to the understanding of current languages for specific purposes in general and examines the new lexis from the perspective of the current socio-cultural challenges tourism is facing.
Teaching Literature among Pre-Service Teachers: Challenges and Solutions
Authors: Harun Ain Suraya , Abdul Samat Norhanim
Published: June 2021

Teacher trainees should be prepared to teach and exposed to the approaches, models, and techniques of literature teaching. Being ready can also boost their confidence to teach literature so that the lessons can be delivered smoothly.  These teachers are so new to teaching that they might face difficulties when teaching English, specifically literature. There are teaching techniques, strategies and approaches that those pre-service teachers can investigate to understand better how to apply in their teaching. Additionally, their lack of exposure towards literature teaching can also affect the performance of teaching. This paper seeks to investigate pre-service teachers’ readiness to teach literature in schools and the challenges faced by them while teaching literature. It also attempts to offer suggestions to improve better literature teaching. This mixed method research study used questionnaires distributed to 22 TESL pre-service teachers from a public university in Johor. Additionally, semi-structured interviews were conducted with two lecturers who have vast experiences in supervising pre-service teachers at schools. Results show that a majority of fourth year TESL students are ready to teach literature with the training and courses provided by the university. Also, among the challenges that they faced are time management and their students’ feelings on the subject. This study hopes to provide insights to training teachers on literature teaching.
Forced Turbulent Convection Along Heated and Cooled Walls With Variable Fluid Properties
Authors: Sufrà Lorenzo , Steiner Helfried
Published: June 2021

The effect of temperature depending material properties on heat and momentum transfer along heated/cooled walls in turbulent pipe flow was investigated using direct numerical simulations (DNS). For the considered thermal wall conditions, always associated with a molecular Prandtl number well over unity Prw = 10, the significantly dampened/enhanced turbulent motion caused by the increase/decrease of the viscosity with distance to the heated/cooled wall turned out to clearly dominate over the opposite trend of the enthalpy fluctuations. The Nusselt number and, quantitatively less pronounced, the wall friction coefficient are accordingly decreased/increased for the heated/cooled case. A comparison against a well-established Nu-correlation unveils the limits of the generally applied approach, which is essentially based on uniform bulk flow conditions and subsequently modified accounting for material property variation, when applied to heated and cooled conditions. An enhanced disparity of the turbulent normal stresses is observed inside the inertial subrange for the heated case, indicating a stronger deviation from isotropic turbulence, which possibly challenges mostly isotropic standard turbulence models.
Experimental Investigation on Cavity Pressure Inside Sheet Cavitation
Authors: Kobayashi Keisuke , Katayama Yusuke , Watanabe Satoshi , Tsuda Shin-ichi
Published: June 2021

The gas content is one of the important factors in cavitation, which may increase the pressure inside the cavity through the diffusive mass transfer of the dissolved gas into the cavity. In the present study, we try to directly measure the cavity pressure inside the sheet cavity at the throat of a converging-diverging nozzle. Then the influences of the flow velocity and the gas content (amount of dissolved oxygen) on the gas partial pressure are investigated. It is found that, even in low gas content level, the cavity pressure is slightly but apparently higher than the saturated vapor pressure, indicating the presence of gas partial pressure. It is observed that the gas partial pressure in significantly developed cavitation is almost constant regardless of the flow velocity but slightly increases against the increase of the saturation level of dissolved gas. It is also found that the gas partial pressure inside cavity depends on the degree of cavitation development; the gas partial pressure decreases with the development of cavitation.
Model of Human Actions Recognition Based on 2D Kernel
Authors: Radulescu Bogdan Alexandru , Radulescu Victorita
Published: June 2021

Action Recognition is a domain that gains interest along with the development of specific motion capture equipment, hardware and power of processing. Its many applications in domains such as national security and behavior analysis make it even more popular among the scientific community, especially considering the ascending trend of machine learning methods. Nowadays approaches necessary to solve real life problems through human actions recognition became more interesting. To solve this problem are mainly two approaches when attempting to build a classifier, either using RGB images or sensor data, or where possible a combination of these two. Both methods have advantages and disadvantages and domains of utilization in real life problems, solvable through actions recognition. Using RGB input makes it possible to adopt a classifier on almost any infrastructure without specialized equipment, whereas combining video with sensor data provides a higher accuracy, albeit at a higher cost. Neural networks and especially convolutional neural networks are the starting point for human action recognition. By their nature, they can recognize very well spatial and temporal features, making them ideal for RGB images or sequences of RGB images. In the present paper is proposed the convolutional neural network architecture based on 2D kernels. Its structure, along with metrics measuring the performance, advantages and disadvantages are here illustrated. This solution based on 2D convolutions is fast, but has lower performance compared to other known solutions. The main problem when dealing with videos is the context extraction from a sequence of frames. Video classification using 2D Convolutional Layers is realized either by the most significant frame or by frame to frame, applying a probability distribution over the partial classes to obtain the final prediction. To classify actions, especially when differences between them are subtle, and consists of only a small part of the overall image is difficult. When classifying via the key frames, the total accuracy obtained is around 10%. The other approach, classifying each frame individually, proved to be too computationally expensive with negligible gains.
Vision-Based Motion Planning of Cable-Driven Parallel Robots in the Presence of Moving Obstacle Using Sampling-Based Method
Authors: Xu Jiajun , Park Kyoung-Su
Published: June 2021

In the past decades, cable-driven parallel robots (CDPRs) have been proven the extraordinary performance for various applications. However, the multiple cables lead the robot easy to interfere with environments. Especially the large workspace of CDPR may introduce unknown moving obstacles. In this study, a sampling-based path planning method is presented for a CDPR to find the collision-free path in the presence of the moving obstacle. The suggested method is based on rapidly exploring random tree (RRT) algorithm which gives CDPRs advantages to handle complex constraints such as cable collision and dynamic feasible workspace (DFW). Moreover, we conduct the forward simulation to check the feasibility in a closed-loop system. The moving parts of both CDPRs and the moving obstacle are assumed as convex bodies, so that Gilbert-Johnson-Keerthi (GJK) algorithm is adopted to detect collision in real-time. Finally, the related simulation is carried out to illustrate the algorithm. The experiment is also presented using the drone as a moving obstacle and YOLO vision algorithm to detect the drone. The experiment results demonstrate the reliability of the suggested method.
A New Approach to Enhance Artificial Intelligence for Robot Picking System Using Auto Picking Point Annotation
Authors: Tsai Cheng-Han (Lance) , Chang Jen-Yuan (James)
Published: June 2021

Artificial Intelligence (AI) has been widely used in different domains such as self-driving, automated optical inspection, and detection of object locations for the robotic pick and place operations. Although the current results of using AI in the mentioned fields are good, the biggest bottleneck for AI is the need for a vast amount of data and labeling of the corresponding answers for a sufficient training. Evidentially, these efforts still require significant manpower. If the quality of the labelling is unstable, the trained AI model becomes unstable and as consequence, so do the results. To resolve this issue, the auto annotation system is proposed in this paper with methods including (1) highly realistic model generation with real texture, (2) domain randomization algorithm in the simulator to automatically generate abundant and diverse images, and (3) visibility tracking algorithm to calculate the occlusion effect objects cause on each other for different picking strategy labels. From our experiments, we will show 10,000 images can be generated per hour, each having multiple objects and each object being labelled in different classes based on their visibility. Instance segmentation AI models can also be trained with these methods to verify the gaps between performance synthetic data for training and real data for testing, indicating that even at mAP 70 the mean average precision can reach 70%!
Convolutional Neural Network Design for Improvement of Machining Quality Monitoring
Authors: Chang Ting-Yu , Chang Jen-Yuan (James)
Published: June 2021

Automatically monitoring finishing quality by computers can achieve efficient product quality management and can improve overall production efficiency. To be able to offer quantitative measures and to achieve this goal, this paper discusses and suggests the utilization of artificial intelligence (AI) technology to predict product finishing quality by use of signals such as vibrations captured by accelerometers generated during manufacturing. To reduce the cost of inspecting products one by one, a deep one-dimensional convolutional neural network (CNN) is proposed to predict machined surface quality. In this method, dense residual skip-connections are used to improve the complexity of the model to improve the accuracy of predicted values. With the adaptation of the pooling layer in the proposed model, it is observed that the number of parameters used in the model is greatly reduced. Not only the predicted accuracy is optimized with the proposed model, the parameters that need to be stored and the computation resource that is consumed in the inference stage are significantly reduced as well. Compared with methods reported in the literature, through calibrated experimental verifications, the proposed model used in this work can improve the prediction accuracy by 10 percent, without any additional signal preprocessing efforts. The work presented in this paper is thought to have engineering implications in quantifying machining quality in the machine tools industry.
Calculation of Electromagnetic Forces for EDS Type Maglev Using 3-D Finite Element Model
Authors: Lim Seonbin , Yoo Junsun , Park No-Cheol
Published: June 2021

Electrodynamic (EDS) type suspension is appropriate for a high-speed maglev train as control is not essential to levitate a train. However, the trains might oscillate large in the vertical direction since there is no control for the EDS type maglev train. Linear Synchronous Motor (LSM) is used to propel trains as it can generate large propulsion force with high efficiency. LSM generate periodic, not uniform, Electromagnetic (EM) force and it cause vertical and lateral vibration. Therefore, EM forces acting on a maglev vehicle should be investigated to determine the vibration characteristics of a high-speed maglev train.

An excitation force on bogies is nonlinearly changed by air gap between ground coils and magnets on bogies. Therefore, relative position of guide and a bogie could be defined to contracting time variant excitation force. The study focuses on verifying vertical and lateral vibration due to LSM that makes repeating propulsion force to a maglev vehicle. We made a transient 3-D EM analysis model that could simulate levitation and guidance force of a maglev vehicle. The model was constructed based on straight rail of the conventional maglev system, L0 series in Japan. We compared the simulation results, levitation, and guidance forces on single ground coil, with another study results. Also, total EM forces on a bogie in simulation results was compared with real track experimental results of another study. We could evaluate ride comport and running stability using our transient EM force by coupling with rigid body simulation.
FPGA-Based Implementation of Torque Controller for 6-DOF Articulated Robots
Authors: Tan-Phat Phan , Chao Paul C.-P. , Zih-Wei Huang
Published: June 2021

This paper aims to design an impedance position-based proportional-integral-derivative (PID) controller based on forward and inverse kinematics of HIWIN RA605 articulated robot, and Field-Programmable Gate Array (FPGA) implementation for a PID torque controller. In order to control the robot, the FPGA needs to output commands to communicate with the AC servo motor drivers. An FPGA-based controller for a 6-degree-of-freedom (DOF) articulated robot that implements several tasks such as hardware implementation, encoder counters, noise cancellation algorithm, analog generators, PID controller, and communication are included, the processing time of the FPGA is 16 μs. Meanwhile, the whole process of the system only takes 82 μs to complete.
Design of a 2 DOF Shape Memory Alloy Actuator Using SMA Springs
Authors: Ali Hussein F. M. , Kim Youngshik
Published: June 2021

In this paper, we developed two degree of freedom shape memory alloy (SMA) actuator using SMA springs. This module can be applied easily to various applications: device holder, artificial finger, grippes, fish robot, and many other biologically inspired applications, where small size and small wight of the actuator are very critical. This actuator is composed of two sets of SMA springs: one set is for the rotation around the X axis (roll angle) and the other set is for the rotation around the Y axis (pitch angle). Each set contains two elements: one SMA spring and one antagonistic SMA spring. We used an inertia sensor (IMU) and two potentiometers for angles feedback.

The SMA actuator system is modeled mathematically and then tested experimentally in open-loop and closed-loop control. We designed and experimentally tuned a proportional integrator derivative (PID) controller to follow the set points and to track the desired trajectories. The main goal of the presented controller is to control roll and pitch angles simultaneously in order to satisfy set points and trajectories within the work space. The experimental results show that the two degree of freedom SMA actuator system follows the desired setpoints with acceptable rise time and overshoot.
Identification of Factors Affecting Disk Drive’s Performance in Data Server by Use of Decision Tree Learning Method
Authors: Liao Yi-Ju , Chang Jen-Yuan (James)
Published: June 2021

To identify factors affecting magnetic disk drive’s data recording performance in data server, decision tree learning method is proposed and validated in this paper. Aiming at improving classification efficiency of various causes of HDD performance degradation, the ID3 algorithm of decision tree was first used showing the training set model would be able to achieve 100% accuracy. The maximum information entropy and information gain theory of ID3 algorithm were then adopted, from which accuracy range of 0.5–0.6 can be further achieved. The proposed method was validated to be effective for leveraging the data sever into Industry 4.0 ready smart machine.
Portable Ophthalmic Device for Remote Slit-Lamp Examinations and Visual Acuity Screening
Authors: Phan Alex , Truong Buu , Suen Benjamin , Melles Gerrit , Talke Frank E.
Published: June 2021

A multi-functional self-examination ophthalmic device for remote eye examinations has been studied in this paper. The device integrates two standard ophthalmic examinations: slit-lamp and visual acuity. Testing of the device has been performed in a preliminary clinical study. The results show good and comparable images to those of conventional instruments routinely used in ophthalmic clinics. The device can be used in a myriad of remote settings including home monitoring.
Optical phase contrast imaging for absolute, quantitative measurements of ultrasonic fields with frequencies up to 20 MHz
Authors: Goldfain Aaron M. , Yung Christopher S. , Briggman Kimberly A. , Hwang Jeeseong
Published: June 2021

The technique of phase contrast imaging, combined with tomographic reconstructions, can rapidly measure ultrasonic fields propagating in water, including ultrasonic fields with complex wavefront shapes, which are difficult to characterize with standard hydrophone measurements. Furthermore, the technique can measure the absolute pressure amplitudes of ultrasonic fields without requiring a pressure calibration. Absolute pressure measurements have been previously demonstrated using optical imaging methods for ultrasonic frequencies below 2.5 MHz. The present work demonstrates that phase contrast imaging can accurately measure ultrasonic fields with frequencies up to 20 MHz and pressure amplitudes near 10 kPa. Accurate measurements at high ultrasonic frequencies are performed by tailoring the measurement conditions to limit optical diffraction as guided by a simple dimensionless parameter. In some situations, differences between high frequency measurements made with the phase contrast method and a calibrated hydrophone become apparent, and the reasons for these differences are discussed. Extending optical imaging measurements to high ultrasonic frequencies could facilitate quantitative applications of ultrasound measurements in nondestructive testing and medical therapeutics and diagnostics such as photoacoustic imaging.
The Use of a Nonrefundable Tax Credit to Increase Children’s Participation in Physical Activity in Alberta, Canada
Authors: Stearns Jodie A. , Veugelers Paul J. , McHugh Tara-Leigh , Sprysak Chris , Spence John C.
Published: June 2021

Background: Potential income disparities were examined in the (1) awareness and uptake of the Children’s Fitness Tax Credit (CFTC), and (2) physical activity (PA) of children from families who did and did not claim the credit in Alberta, Canada in 2012 and 2014. Methods: Secondary analyses of 3 cross-sectional data sets of grade 5 students (10–11 y) were performed, including Alberta Project Promoting healthy Living for Everyone Schools 2012 (N = 1037), and Raising healthy Eating and Active Living Kids Alberta 2012 (N = 2676), and 2014 (N = 3125). Parents reported whether they claimed the CFTC in the previous year, their education and household income, and their child’s gender and PA. Children self-reported their PA from the previous 7 days. In Alberta Project Promoting healthy Living for Everyone Schools, children also wore pedometers. Analyses adjusted for clustering within schools and demographic factors. Results: Higher income families (≥$50,000/y) were more likely to be aware of and to have claimed the CFTC compared with low-income families (<$50,000/y). The CFTC was associated with organized PA with larger associations for higher-income families (odds ratio = 9.03–9.32, Ps < .001) compared with lower-income families (odds ratio = 3.27–4.05, Ps < .01). No associations existed for overall PA or pedometer steps with the CFTC. Conclusions: Income disparities exist in the awareness, uptake, and potential impact of the CFTC. Tax credits are not effective in promoting overall PA.
Diversity and Within-Host Evolution of Leishmania donovani from Visceral Leishmaniasis Patients with and without HIV Coinfection in Northern Ethiopia
Authors: Franssen Susanne U. , Takele Yegnasew , Adem Emebet , Sanders Mandy J. , Müller Ingrid , Kropf Pascale , Cotton James A.
Published: June 2021

Visceral leishmaniasis (VL) is the second largest cause of deaths due to parasite infections and a growing problem in East Africa. In Ethiopia, it is particularly associated with migrant workers moving from regions of nonendemicity for seasonal agricultural work and is frequently found as a coinfection with HIV, which leads to frequent VL relapse following treatment.
Genomic and Phenotypic Evolution of Achromobacter xylosoxidans during Chronic Airway Infections of Patients with Cystic Fibrosis
Authors: Khademi S. M. Hossein , Gabrielaite Migle , Paulsson Magnus , Knulst Mattis , Touriki Eleni , Marvig Rasmus L. , Påhlman Lisa I.
Published: June 2021

A thorough understanding of bacterial pathogen adaptation is essential for the treatment of chronic bacterial infections. One unique challenge in the analysis and interpretation of genomics data is identifying the function impact of mutations accumulated in the bacterial genome during colonization in the human host.
Mosaic Ends Tagmentation (METa) Assembly for Highly Efficient Construction of Functional Metagenomic Libraries
Authors: Crofts Terence S. , McFarland Alexander G. , Hartmann Erica M.
Published: June 2021

Medically and industrially important genes can be recovered from microbial communities by high-throughput sequencing, but precise annotation is often limited to characterized genes and their relatives. Cloning a metagenome
en masse
into an expression host to produce a functional metagenomic library, directly connecting genes to functions, is a sequence-naive and cultivation-independent method to discover novel genes.
Diagnosis of an adenocarcinoma of Müllerian origin made as a result of its metastasis in the mouth floor
Authors: Gandolfo Mariana Silva , Denninghoff Valeria , Avagnina Alejandra , Adler Lidia Isabel
Published: June 2021

Metastases derived from primary tumours distant to the oral and maxillofacial region account for only 1% of all malignancies at that location, usually with a poor prognosis. In women, the primary tumours that most frequently metastasise to the oral cavity are breast adenocarcinomas affecting the jawbones and soft tissues (41% and 24%, respectively), followed by adrenal glands and female genital organs to the jawbones (8%), and female genital organs to the soft tissues (15%). Metastatic tumours of the mouth are a challenging diagnosis because of their exceptional occurrence. We report on the case of an 83-year-old woman who consulted for a bleeding ulcerated tumour on the floor of the mouth. A biopsy-confirmed metastasis of an adenocarcinoma of Müllerian origin. The oral lesion was the first sign of undetected cancer. The patient agreed to surgical resection and was further referred to palliative care for her symptoms.
Unexpected presentation of acute porphyria
Authors: Kiew Chiun Khang , Lam Adeline Serena Ee Ling
Published: June 2021

Acute porphyrias are rarely reported in Southeast Asia. They may be underdiagnosed due to their clinical mimicry and lack of awareness among physicians. There is a common cognitive bias to gravitate towards common conditions. In this case report, a 28-year-old woman, who presented with seizures, rhabdomyolysis hyponatraemia and altered mental state, was initially diagnosed as amphetamine overdose. She had presented 3 days prior with abdominal pain, treated for acute cystitis and discharged. On readmission for seizures a day later, she was extensively worked up for altered mental state. Despite normalisation of serum sodium concentration and control of her seizures, she remained unwell. Further investigations later confirmed a diagnosis of acute porphyria. The aim of this case report is to highlight the non-specific nature of presentation of acute porphyria and the importance of considering it as a differential diagnosis in cases of abdominal pain with neuropsychiatric features.
Cardiac involvement in a child post COVID-19: a case from Lebanon
Authors: Abi Nassif Tania H , Daou Karim N , Tannoury Theresia , Majdalani Marianne
Published: June 2021

We report on an 8-year-old boy, who presented to the emergency department at our institution with fever, generalised oedema and hypotension. Investigations revealed anaemia, thrombocytopenia in addition to elevated serum inflammatory markers, a negative COVID-19 PCR test and a positive COVID-19 IgG. His echocardiography was consistent with carditis in otherwise morphologically normal heart with depressed cardiac function, moderate-to-severe mitral valve regurgitation, moderate tricuspid regurgitation with an estimated right ventricular systolic pressure half systemic, trace aortic regurgitation, bilateral small pleural effusions, distended inferior vena cava and normal coronaries. He was started on inotropic support, intravenous immunoglobulin and methylprednisolone, and was transferred to the paediatric intensive care unit. To the best of our knowledge, this was the first case of multisystem inflammatory syndrome in children encountered in Lebanon. The presentation and management were thoroughly described in this article aiming to share our experience and to contribute to the rapidly emerging literature on this syndrome.
Cancer Aging Research Group (CARG) score in older adults undergoing curative intent chemotherapy: a prospective cohort study
Authors: Ostwal Vikas , Ramaswamy Anant , Bhargava Prabhat , Hatkhambkar Tejaswee , Swami Rohit , Rastogi Sameer , Mandavkar Sarika , Ghosh Jaya , Bajpai Jyoti , Gulia Seema , Srinivas Sujay , Rath Sushmita , Gupta Sudeep
Published: June 2021

Importance

The Cancer Aging Research Group (CARG) toxicity score is used to assess toxicity risk in geriatric patients receiving chemotherapy.

Objective

The primary aim was to validate the CARG score in geriatric patients treated with curative intent chemotherapy in predicting grade 3–5 toxicities.

Design

This was a longitudinal prospective observational study.

Setting

Tata Memorial Hospital, Mumbai, India, a tertiary cancer care referral centre.

Participants

Patients, aged ≥65 years, with gastrointestinal, breast or gynaecological stage I–III cancers being planned for curative intent chemotherapy. A total of 270 patients were required for accrual in the study.

Exposure(s)

Total risk score ranged from 0 (lowest toxicity risk) to 19 (highest toxicity risk).

Main outcome(s) and measure(s)

The primary endpoint of the study was to evaluate whether the CARG risk score predicted for grade 3–5 toxicities.

Results

The study cohort of 270 patients had a mean age of 69 (65–83) years, with the most common cancers being gastrointestinal (79%). Fifty-two per cent of patients had atleast one grade 3–5 toxicity. The risk of toxicity was increased with an increasing risk score (42% low risk, 51% medium risk and 79% high risk; p<0.001). There was no association between either Eastern Cooperative Oncology Group (ECOG) performance status (p=0.69) or age-adjusted Charlson Comorbidity Index (p=0.79) risk categories and grade 3–5 chemotherapy toxicities.

Conclusions and relevance

This study validates the CARG risk score in predicting for grade 3–5 toxicities in geriatric oncology patients receiving curative intent chemotherapy and can be considered as the standard of care before planning chemotherapy in every elderly patient.

Trial registration number

CTRI/2016/10/007357; Results.
Mixed-methods study protocol for an evaluation of the mental health transition navigator model in child and adolescent mental health services: the Navigator Evaluation Advancing Transitions (NEAT) study
Authors: Cleverley Kristin , Stevens Katye , Davies Julia , McCann Emma , Ashley Tracy , Brathwaite Daneisha , Gebreyohannes Mana , Nasir Saba , O"Reilly Katelyn , Bennett Kathryn J , Brennenstuhl Sarah , Charach Alice , Henderson Joanna , Jeffs Lianne , Korczak Daphne J , Monga Suneeta , de Oliveira Claire , Szatmari Peter
Published: June 2021

Introduction

Transition from child and adolescent mental health services (CAMHS) to community or adult mental health services (AMHS) is a highly problematic health systems hurdle, especially for transition-aged youth. A planned and purposeful transition process is often non-existent or experienced negatively by youth and their caregivers. Stakeholders, including youth and their caregivers, have demanded interventions to support more effective transitions, such a transition navigator. The transition navigator model uses a navigator to facilitate complex transitions from acute care CAMHS to community or AMHS. However, despite the widespread implementation of this model, there has been no evaluation of the programme, hindering its scalability. This paper describes the study protocol of the Navigator Evaluation Advancing Transitions study that aims to collaborate with patients, caregivers and clinicians in the evaluation of the navigator model.

Methods and analysis

A pre and post mixed-method study will be conducted, using the Triple Aim Framework, to evaluate the navigator model. We will recruit participants from one large tertiary and two community hospitals in Toronto, Canada. For the quantitative portion of the study, we will recruit a sample of 45 youth (15 at each site), aged 16–18, and their caregivers at baseline (referral to navigator) (T1) and 6 months (T2). Youth and caregiver participants will complete a set of standardised measures to assess mental health, service utilisation, and satisfaction outcomes. For the qualitative portion of the study, semistructured interviews will be conducted at 6 months (T2) with youth, their caregivers and clinicians to better understand their experience and satisfaction with the model.

Ethics and dissemination

Research Ethics Board (REB) approval has been obtained from the lead research sites, the University of Toronto and the Hospital for Sick Children. The results of the study will be reported in peer-reviewed publications, webinars and conferences and to all relevant stakeholders.
Palliative home care and emergency department visits in the last 30 and 90 days of life: a retrospective cohort study of patients with cancer
Authors: Mracek Jennifer , Earp Madalene , Sinnarajah Aynharan
Published: June 2021

Objectives

Evaluate the association of specialist palliative home care (HC) on emergency department (ED) visits in the 30 and 90 days prior to death.

Methods

This retrospective cohort study using administrative data identified 6976 adults deceased from cancer between 2008 and 2015, living ≥180 days after diagnosis of cancer, and residing in the urban Calgary Zone of Alberta Health Services. All palliative HC and generalist HC services were examined. Regression analyses examined the relationships of HC type to ED visits in the last 30 or 90 days of life.

Results

In the last 30 days of life, compared with patients receiving palliative HC, patients receiving only generalist HC, or no HC, were more likely to visit the ED (OR)generalist-HC1.19; 95% CI 1.06 to 1.34; ORno-HC1.54; 95% CI 1.31 to 1.82). In the last 90 days of life, compared with patients receiving palliative HC, those receiving generalist HC (OR 1.48; 95% CI 1.32 to 1.67) and no HC (OR 1.66; 95% CI 1.39 to 1.99) had increased odds of visiting the ED.

Conclusions

Receiving generalist HC and no HC was associated with increased odds of visiting the ED in the last 30 and 90 days of life, when compared with patients receiving palliative HC. Improving access to palliative HC for patients at high risk of visiting the ED may reduce ED visits and acute care costs and improve quality of life in the last 90 days of life.
Association of emergency department boarding times on hospital length of stay for patients with psychiatric illness
Authors: Lane Daniel J , Roberts Lauren , Currie Shawn , Grimminck Rachel , Lang Eddy
Published: June 2021

Background

Extended periods awaiting an inpatient bed in the emergency department (ED) may exacerbate the state of patients with acute psychiatric illness, increasing the time it takes to stabilise their acute problem in hospital. Therefore, we assessed the association between boarding time and hospital length of stay for psychiatric patients.

Methods

ED clinical records were linked to inpatient administrative records for all patients with a primary psychiatric diagnosis admitted to a Calgary, Alberta hospital between April 2014 and March 2018. The primary exposure was boarding time (admission decision to inpatient bed transfer), and primary outcome was inpatient length of stay. Confounders for this relationship, including indicators of illness severity, were selected a priori then the association was assessed using hierarchical Bayesian Poisson regression, which accounts for repeat observations of the same patient and differences between hospital sites. Changes in length of stay were measured using a rate ratio (ie, expected change in length of stay for each 1 hour increase in boarding time).

Results

A total of 19 212 admissions (14 261 unique patients) were included in the analysis. The average boarding time was 14 hours (range: 0–186 hours). Patients who were boarded for greater than 14 hours more frequently required a high-observation bed (14% vs 3.5%), received an antipsychotic (44% vs 14%) or received sedation (55% vs 33%) while in the ED. The probability that boarding time increased hospital length of stay (rate ratio: >1) was 92%, with a median increase for a patient boarded for 24 hours of 0.01 days.

Conclusion

Boarding in the ED was associated with a high probability of increasing the hospital length of stay for psychiatric patients; however, the absolute increase is minimal. Although slight, this signal for longer length of stay may be a sign of increased morbidity for psychiatric patients held in the ED.
Identification of the source events for aerosol generation during oesophago-gastro-duodenoscopy
Authors: Gregson Florence K A , Shrimpton Andrew J , Hamilton Fergus , Cook Tim M , Reid Jonathan P , Pickering Anthony E , Pournaras Dimitri J , Bzdek Bryan R , Brown Jules
Published: June 2021

Objective

To determine if oesophago-gastro-duodenoscopy (OGD) generates increased levels of aerosol in conscious patients and identify the source events.

Design

A prospective, environmental aerosol monitoring study, undertaken in an ultraclean environment, on patients undergoing OGD. Sampling was performed 20 cm away from the patient’s mouth using an optical particle sizer. Aerosol levels during OGD were compared with tidal breathing and voluntary coughs within subject.

Results

Patients undergoing bariatric surgical assessment were recruited (mean body mass index 44 and mean age 40 years, n=15). A low background particle concentration in theatres (3 L−1) enabled detection of aerosol generation by tidal breathing (mean particle concentration 118 L−1). Aerosol recording during OGD showed an average particle number concentration of 595 L−1with a wide range (3–4320 L−1). Bioaerosol-generating events, namely, coughing or burping, were common. Coughing was evoked in 60% of the endoscopies, with a greater peak concentration and a greater total number of sampled particles than the patient’s reference voluntary coughs (11 710 vs 2320 L−1and 780 vs 191 particles, n=9 and p=0.008). Endoscopies with coughs generated a higher level of aerosol than tidal breathing, whereas those without coughs were not different to the background. Burps also generated increased aerosol concentration, similar to those recorded during voluntary coughs. The insertion and removal of the endoscope were not aerosol generating unless a cough was triggered.

Conclusion

Coughing evoked during OGD is the main source of the increased aerosol levels, and therefore, OGD should be regarded as a procedure with high risk of producing respiratory aerosols. OGD should be conducted with airborne personal protective equipment and appropriate precautions in those patients who are at risk of having COVID-19 or other respiratory pathogens.