bluuebunny/crossref_metadata_2025 huggingface dataset:
Pseudomonas aeruginosa Stimulates Inflammation and Enhances Kaposi’s Sarcoma Herpesvirus-Induced Cell Proliferation and Cellular Transformation through both Lipopolysaccharide and Flagellin
Authors: Markazi Ashley , Bracci Paige M. , McGrath Michael , Gao Shou-Jiang
Published: November 2020

Kaposi’s sarcoma (KS), caused by infection with Kaposi’s sarcoma-associated herpesvirus (KSHV), is one of the most common cancers in AIDS patients. KS is a highly inflammatory tumor, but how KSHV infection induces inflammation remains unclear. We have previously shown that KSHV infection upregulates Toll-like receptor 4 (TLR4), sensitizing cells to lipopolysaccharide (LPS) andEscherichia coli. In the current study, we examined the role ofPseudomonas aeruginosa, an opportunistic bacterium that can affect AIDS patients, in inflammation and cell proliferation of KSHV-transformed cells.P. aeruginosastimulation increased cell proliferation, inflammatory cytokines, and activation of growth and survival pathways in KSHV-transformed cells through two pathogen-associated molecular patterns, LPS and flagellin. Because AIDS-KS patients are susceptible toP. aeruginosainfection, our work highlights the preventive and therapeutic potential of targetingP. aeruginosainfection in these patients.
Genome-Scale Mapping Reveals Complex Regulatory Activities of RpoN in Yersinia pseudotuberculosis
Authors: Mahmud A. K. M. Firoj , Nilsson Kristina , Fahlgren Anna , Navais Roberto , Choudhury Rajdeep , Avican Kemal , Fällman Maria
Published: November 2020

The alternative sigma factor RpoN (σ
54
), which is widely distributed in eubacteria, has been implicated in controlling gene expression of importance for numerous functions including virulence. Proper responses to host environments are crucial for bacteria to establish infection, and regulatory mechanisms involved are therefore of high interest for development of future therapeutics. Little is known about the function of RpoN in the intestinal pathogen
Y. pseudotuberculosis
, and we therefore investigated its regulatory role in this pathogen. This regulator was indeed found to be critical for establishment of infection in mice, likely involving its requirement for motility and biofilm formation. The RpoN regulon involved both activating and suppressive effects on gene expression which could be confirmed with mutagenesis of identified binding sites. This is the first study of its kind of RpoN in
Y. pseudotuberculosis
, revealing complex regulation of gene expression involving both productive and silent effects of its binding to DNA, providing important information about RpoN regulation in enterobacteria.
Lung injury from e-cigarette use: a foul and pestilent congregation of vapours
Authors: Chapman Robert , Tweed Conor D , Moonsie Ian
Published: November 2020

A 62-year-old man presented with worsening dyspnoea, haemoptysis and reduced exercise tolerance. He was found to be hypoxaemic with bilateral basal opacification on chest imaging, but inflammatory markers, respiratory virus PCR and sputum culture demonstrated no signs of infection. The patient reported having initially mild, yet progressive, symptoms since he started vaping 14 months previously. He was treated with oxygen therapy, supportive care and cessation of vaping. Chest imaging at discharge showed marked improvement of previous bilateral opacification and the patient returned to baseline exercise tolerance, with no oxygen requirement. Vaping is becoming more common in the UK and this case demonstrates the importance of considering electronic vaping-associated lung injury in cases of non-infective lung injury.
Secondary sclerosing cholangitis in critically ill patients: a rare disease precipitated by severe SARS-CoV-2 infection
Authors: Edwards Kate , Allison Miles , Ghuman Sekina
Published: November 2020

A previously well 59-year-old man required a prolonged intensive care unit stay due to severe COVID-19 symptoms. During the admission, he developed a cytokine storm, also known as secondary haemophagocytic lymphohistocytosis, and multiorgan failure. Despite recovering from his other organ failures, his liver function continued to deteriorate. Magnetic resonance cholangiopancreatography and subsequent endoscopic retrograde cholangiopancreatography revealed extensive intrahepatic duct dilatation with ‘beading’ but common bile duct sparing. Given the patient had no primary liver disease prior to admission, we considered secondary causes of cholestatic liver injury; this led us to an unusual diagnosis of secondary sclerosing cholangitis in critically ill patients. This case demonstrates a rare disease that has developed specifically in the context of SARS-CoV-2 infection. A review of current literature and the underlying pathophysiology for this rare disease are discussed, particularly in relation to COVID-19.
Association of body temperature with in-hospital mortality among paediatric trauma patients: an analysis of a nationwide observational trauma database in Japan
Authors: Okada Asami , Okada Yohei , Narumiya Hiromichi , Ishii Wataru , Kitamura Tetsuhisa , Osamura Toshio , Iiduka Ryoji
Published: November 2020

Objectives

To examine the association between body temperature (BT) on hospital arrival and in-hospital mortality among paediatric trauma patients.

Design

A retrospective cohort study.

Setting

Japan Trauma Data Bank (JTDB, which is a nationwide, prospective, observational trauma registry with data from 235 hospitals).

Participants

Paediatric trauma patients <16 years old who were transferred directly from the scene of injury to the hospital and registered in the JTDB from January 2004 to December 2017 were included. We excluded patients >16 years old and those who developed cardiac arrest before or on hospital arrival.

Primary outcome

The association between BT on hospital arrival and in-hospital mortality. We conducted multivariate logistic regression analyses to calculate the adjusted ORs, with their 95% CIs, of the association between BT and in-hospital mortality.

Results

A total of 9012 patients were included (median age: 9 years (IQR, 6.0–13.0 years), mortality: 2.5% (mortality number was 226 in total 9012 patients)). In the multivariate logistic regression analysis, the corresponding adjusted ORs of BT <36.0°C and BT ≥37.0°C, relative to a BT of 36°C–36.9°C, for in-hospital mortality were 2.83 (95% CI: 1.85 to 4.33) and 0.93 (95% CI: 0.53 to 1.63), respectively.

Conclusions

In paediatric patients with hypothermia (BT <36.0°C) on hospital arrival, a clear association with in-hospital mortality was observed; no such association was observed between higher BT values (≥37.0°C) and outcomes.
Implementation of a comprehensive surveillance system for recording suicides and attempted suicides in rural India
Authors: Vijayakumar Lakshmi , Pathare Soumitra , Jain Nikhil , Nardodkar Renuka , Pandit Deepa , Krishnamoorthy Sadhvi , Kalha Jasmine , Shields-Zeeman Laura
Published: November 2020

Introduction

WHO reports that 78 of the 140 low-income and middle-income countries (LMICs) do not have a registration system for suicides and attempted suicides. Absence of data on suicide and attempted suicide in LMICs, which account for 79% of suicides worldwide, is a major impediment in understanding the magnitude of the problem and formulating prevention strategies to reduce suicide and self-harm. A comprehensive surveillance system has the potential to address this data gap. The objective of this study is to describe the development of a comprehensive surveillance system in rural India by adding a community based component and reflect on its added value in obtaining data on suicide and attempted suicide compared with relying only on hospital and police records.

Method

The comprehensive system consists of three components. Community surveillance involved collecting information on suicides and attempted suicides from third party key informants such as village heads, teachers, priests, shopkeepers, private physicians, private hospitals and community health workers. The second component consisted of data from public health facilities. The final component consisted of suicide data from police records. Information was collected for a period of 12 months from August 2018 to July 2019 from 116 villages (population 377 276) in Gujarat, India.

Results

An average of 710 community informants were interviewed each month (mean: 6.72 informants per village). The community surveillance system identified 67 cases of suicide compared with 30 cases by hospital and police records (Cochran’s Q test 67.9 p<0.01) and 70 attempted suicides compared with 51 from the hospital and police records (Cochran’s Q test 66.6 p<0.01).

Discussion

This is the first report of implementing a large-scale comprehensive surveillance system for suicide and attempted suicide in a LMIC. The combination of community surveillance system and official data from hospital and police records addresses the problem of under-reporting of suicide and suicide attempts in India and other LMIC.
The Copenhagen test and treat hepatitis C in a mobile clinic study: a protocol for an intervention study to enhance the HCV cascade of care for people who inject drugs (T’N’T HepC)
Authors: Lazarus Jeffrey Victor , Øvrehus Anne , Demant Jonas , Krohn-Dehli Louise , Weis Nina
Published: November 2020

Introduction

Injecting drug use is the primary driver of hepatitis C virus (HCV) infection in Europe. Despite the need for more engagement with care, people who inject drugs (PWID) are hard to reach with HCV testing and treatment. We initiated a study to evaluate the efficacy for testing and linkage to care among PWID consulting peer-based testing at a mobile clinic in Copenhagen, Denmark.

Methods and analysis

In this intervention study, we will recruit participants at a single community-based, peer-run mobile clinic. In a single visit, we will first offer participants a point-of-care HCV antibody test, and if they test positive, then they will receive an HCV RNA test. If they are HCV-RNA+, we will administer facilitated referrals to designated ‘fast-track’ clinics at a hospital or an addiction centre for treatment. The primary outcomes for this study are the number of tested and treated individuals. Secondary outcomes include individuals lost at each step in the care cascade.

Ethics and dissemination

The results of this study could provide a model for targeting PWID for HCV testing and treatment in Demark and other settings, which could help achieve WHO HCV elimination targets. The Health Research Ethics Committee of Denmark and the Danish Data Protection Agency confirmed (December 2018/January 2019) that this study did not require their approval. Study findings will be disseminated through peer-reviewed publications, conference presentations and social media.
Dance for people with chronic breathlessness: a transdisciplinary approach to intervention development
Authors: Harrison Samantha , Bierski Krzysztof , Burn Naomi , Mclusky Sarah , McFaull Victoria , Russell Andrew , Williams Gaynor , Williams Siân , Macnaughton Jane
Published: November 2020

Objectives

A transdisciplinary research approach was used to develop a holistic understanding of the physical and psychosocial benefits of dance as an intervention for people living with chronic breathlessness.

Methods

The dance programme was developed in collaboration with British Lung Foundation Breathe Easy members in NE England (Darlington) and London (Haringey). Members of the Darlington group were invited to participate in the programme. An exercise instructor, trained and mentored by a dance facilitator delivered 60–90 min dance classes for 10 consecutive weeks. Exercise capacity, mobility, quadriceps strength, health status, mood and interoceptive awareness were assessed at baseline and after the 10-week programme. Second-to-second heart rate (HR) monitoring was conducted during one of the classes.

Results

Ten individuals were enrolled (n=8 women). Mean (SD) age was 70 (24); Body Mass Index 29.7 (8.1) kg/m2; one participant used oxygen and one a walking aid. Seven completed the dance programme. Improvements in all outcome measures were detected, with the exception of the Multidimensional Assessment of Interoceptive Awareness, which individuals found hard to comprehend. Eight participants wore HR monitors during one dance class and spent on average 43.5 (21.8) min with HR corresponding to at least moderate intensity physical activity (≥64% HRmax). People found the dance classes enjoyable and those with relevant past experiences who are optimistic, committed to staying well and playful readily adopted the programme.

Conclusion

A dance programme bringing both physical and psychosocial benefits for people with chronic breathlessness is acceptable when coproduced and evaluated through a transdisciplinary approach.
Harmonising palliative care: a national survey to evaluate the knowledge and attitude of emergency physicians towards palliative care in Kuwait
Authors: Al-Ansari Ameena , Suroor Saleem , AboSerea Sobhi , Abd-El-Gawad Wafaa Mostafa
Published: November 2020

Background and aim

Although the challenges of integrating palliative care practices across care settings are real and well recognised, to date little is known about palliative care practices of emergency physicians (EPs) in Kuwait. Therefore, this study aims to explore the attitude and knowledge of EPs in providing palliative care in all general hospitals in Kuwait.

Method

A cross-sectional survey was performed in the emergency rooms of all general hospitals in Kuwait using the Palliative Care Attitude and Knowledge Questionnaire.

Results

Of the total number of physicians working in emergency rooms (n=156), 104 (66.67%) had completed the survey. 76.9% (n=80) of the EPs had an uncertain attitude towards palliative care. Most of the EPs (n=73, 70.28%) did not discuss the patients’ need for palliative care either with the patients or with their families. Only 16 (15.4%) of the EPs responded correctly to most of the questions while nearly half of the EPs (n=51, 49%) had poor knowledge. Experience ≥11 years and better knowledge scores were independent predictors of positive attitude after adjustment of age, sex, qualifications, specialty, position and nationality (OR: 5.747 (CI 1.031 to 25.00), 1.458(CI 1.148 to 1.851); p values: 0.021, 0.002, respectively).

Conclusions

Despite recognising palliative care as an important competence, the majority of the EPs in Kuwait had uncertain attitude and poor knowledge towards palliative care. Efforts should be made to enhance physician training and provide palliative care resources to improve the quality of care given to patients visiting emergency departments.
Using chatbots to screen for heritable cancer syndromes in patients undergoing routine colonoscopy
Authors: Heald Brandie , Keel Emma , Marquard Jessica , Burke Carol A , Kalady Matthew F , Church James M , Liska David , Mankaney Gautam , Hurley Karen , Eng Charis
Published: November 2020

Background

Hereditary colorectal cancer (HCRC) syndromes account for 10% of colorectal cancers but remain underdiagnosed. This feasibility project tested the utility of an artificial intelligence-based chatbot deployed to patients scheduled for colonoscopy to identify HCRC risk factors, educate participants about HCRC and obtain consent to genetic testing as an extension of genetic counselling of appropriate subjects. Genetic counsellor (GC) and genetic counselling assistant (GCA) time spent per subject was also measured.

Methods

Patients scheduled for colonoscopy at Cleveland Clinic were invited via electronic medical record patient portal or letter prior to colonoscopy with a link to a chatbot administering the Colon Cancer Risk Assessment Tool (CCRAT) to screen for HCRC syndromes. Those with ≥1 positive response to a CCRAT question received chatbot-deployed genetic education and the option to receive genetic testing. An order for a 55-gene pan-cancer panel was placed for those consenting, and the subject had blood drawn on the day of colonoscopy. Results were disclosed by a GC or GCA by telephone. Subject demographics, progression through the chat, responses to CCRAT, personal and family history, genetic test results and communication with the subject were recorded. Descriptive statistics and two-tailed unpaired t-test and Fisher’s exact test were used.

Results

506/4254 (11.9%) initiated and 487 (96.2%) completed the chat with the chatbot. 215 (44.1%) answered ‘yes’ to ≥1 CCRAT question and all completed pretest education. 129/181 (71.3%) subjects who consented completed testing, and 12 (9.3%) were found to have a germline pathogenic variant. Per subject, the GC spent a mean of 14.3 (SD 7.3) and the GCA a mean of 19.2 (SD 9.8) minutes.

Conclusion

The use of a chatbot in this setting was a novel and feasible method, with the potential of increasing genetic screening and testing in individuals at risk of HCRC syndromes.
Factors associated with delays in discharge for trauma patients at an urban county hospital
Authors: Cai Christopher , Lindquist Karla , Bongiovanni Tasce
Published: November 2020

Background

Discharge delays for non-medical reasons put patients at unnecessary risk for hospital-acquired infections, lead to loss of revenue for hospitals and reduce hospital capacity to treat other patients. The objective of this study was to determine prevalence of, and patient characteristics associated with, delays in discharge at an urban county trauma service.

Methods

We performed a retrospective cohort study with data from Zuckerberg San Francisco General Hospital (ZSFGH), a level-1 trauma center and safety net hospital in San Francisco, California. The study included 1720 patients from the trauma surgery service at ZSFGH. A ‘delay in discharge’ was defined as days in the hospital, including an initial overnight stay, after all medical needs had been met. We used logistic and zero-inflated negative binomial regression models to test whether the following factors were associated with prolonged, non-medical length of stay: age, gender, race/ethnicity, housing, disposition location, type of insurance, having a primary care provider, primary language and zip code.

Results

Of the 1720 patients, 15% experienced a delay in discharge, for a total of 1147 days (median 1.5 days/patient). The following were statistically significant (p<0.05) predictors of delays in discharge in a multivariable logistic regression model: older age, unhoused status or disposition to home health or postacute care (compared with home discharge) were associated with increased likelihood of delays. Having private insurance or Medicare (compared with public insurance) and discharge against medical advice or absent without leave (compared with home discharge) were associated with reduced likelihood of delays in discharge after all medical needs were met.

Discussion

These results suggest that policymakers interested in reducing non-medical hospital stays should focus on addressing structural determinants of health, such as lack of housing, bottlenecks at postacute care disposition destinations and lack of adequate insurance.

Level of evidence

Epidemiological, Level III
Challenges for water quality protection in the greater metropolitan area of Addis Ababa and the upper Awash basin, Ethiopia – time to take stock
Authors: Getachew Melaku , Mulat Worku Legesse , Mereta Seid Tiku , Gebrie Geremew Sahilu , Kelly-Quinn Mary
Published: November 2020

Ethiopia, the second-most populous country in Africa after Nigeria, has more than one hundred million people and is one of the world’s fastest-growing countries in terms of economy. It has 12 major river basins with an annual renewable flow of 122 billion m3. The country is facing increasing pressures on water resources both in terms of quantity and quality. Many researchers have highlighted that water pollution is severe and increasing particularly in the environs of Addis Ababa because of complex anthropogenic factors. The objective of this review was to synthesize the key results of research to date on the water quality in the environs of Addis Ababa and use that information to highlight management gaps, challenges, and future research needs. According to the studies reviewed, water pollution pressures result from rapid urbanization and industrial expansion without adequate solid waste management and wastewater treatment facilities, and agricultural activities. The problems are compounded by law enforcement difficulties. Trace metal contamination of rivers, streams, reservoirs, and their bioaccumulation in vegetables highlight the urgency of addressing water pollution in the upper Awash catchment. Most studies agreed that water from reservoirs, rivers, and streams in the environs of Addis Ababa is unfit for human consumption as it contains a wide range of pollutants that could affect community health. Hence effective pollution detection, mitigation measures, and monitoring including the development of bioassessment tools, together with cost-effective management measures are urgently required to reverse the decline in water quality in Ethiopia in general and in the greater metropolitan area of Addis Ababa and the upper Awash basin in particular.
Linear Software Models: An Occam’s Razor Set of Algebraic Connectors Integrates Modules into a Whole Software System
Authors: Exman Iaakov , Wallach Harel
Published: November 2020

Well-designed software systems, with providers only modules, have been rigorously obtained by algebraic procedures from the software Laplacian Matrices or their respective Modularity Matrices. However, a complete view of the whole software system should display, besides provider relationships, also consumer relationships. Consumers may have two different roles in a system: either internal or external to modules. Composite modules, including both providers and internal consumers, are obtained from the joint providers and consumers Laplacian matrix, by the same spectral method which obtained providers only modules. The composite modules are integrated into a whole Software System by algebraic connectors. These algebraic connectors are a minimal Occam’s razor set of consumers external to composite modules, revealed through iterative splitting of the Laplacian matrix by Fiedler eigenvectors. The composite modules, of the respective standard Modularity Matrix for the whole software system, also obey linear independence of their constituent vectors, and display block-diagonality. The spectral method leading to composite modules and their algebraic connectors is illustrated by case studies. The essential novelty of this work resides in the minimal Occam’s razor set of algebraic connectors — another facet of Brooks’ Propriety principle leading to Conceptual Integrity of the whole Software System — within Linear Software Models, the unified algebraic theory of software modularity.
Method for Predicting Mobile Service Evolution from User Reviews and Update Logs
Authors: Song Jiafei , Wang Zhongjie , Tu Zhiying , Xu Xiaofei
Published: November 2020

Because of rapid growth in mobile application markets, competition between companies that provide similar applications has become fierce. To improve user satisfaction for keeping existing users and attracting new users, application developers need to quickly respond to customer feedback regarding functionality and performance defects. In software engineering, specifying an accurate evolution plan according to user feedback is useful but quite difficult. Hence, we propose an approach for predicting and recommending evolution plans to application developers that includes: (1) when a new version of an App should be released; (2) which features should be updated in the next version and (3) if a new version is released, to what degree users would like or dislike it. This approach is based on an elaborate text analysis of massive numbers of user reviews and App update histories. A collocation-based mRAKE method is presented to extract requested and updated features from user reviews and update logs, and the intensity and sentiment scores of each feature are calculated to quantitatively represent time-series histories of App updates and user requests. Machine learning algorithms including linear support vector, Gaussian naïve Bayes and logistic regression are employed to discover the underlying correlation between user opinions embedded in their reviews and the App update behaviors of developers, and rich experiments were conducted on real data to validate the effectiveness of the proposed approach. Overall, our approach can achieve an average accuracy of 72.8% and 93.7% in release time recommendation and content updates of successive versions, respectively, and it can predict user reactions to a planned version with an average accuracy of above 89.0%.
Cooperative Game with Agreements Implemented by a Third Party
Authors: Chen Jeanpantz
Published: November 2020

In the literature of cooperative game theory, it is often assumed that there is only one coalition composed of all the players other than the dummies in a cooperative game of complete information, although the coalition formation is examined and the equilibrium process of coalition formation (EPCF) was defined in a repeated cooperative game of incomplete information. On the other hand, the blocking approach only provided several possible ranges of the distribution scheme of the cooperative payoff of a coalition in a cooperative game with agreements implemented by a third party, and the single point solutions provided are usually collectivistic.

This paper examines the coalition formation in a cooperative game with agreements implemented by a third party, and provides the existence proof and an algorithm of the coalition equilibrium; moreover, this paper analyzes the equilibrium of the bargaining game on the distribution of the cooperative payoff of a coalition under the coalition equilibrium, and examines the distribution scheme of cooperative payoff of a coalition.
Interfacial Fatigue and Discrete Interfacial Damage in a Finite Strain Thermomechanical Framework
Authors: Chen Pinlei , Wijaya Ignasius P. A. , Masud Arif
Published: November 2020

We present a stabilized finite element method for thermomechanical problems in the class of materials with discrete microstructural interfaces that undergo interfacial fatigue and dominant interfacial damage. This formulation is applicable to polycrystalline solids, fibrous composites, filled elastomers, and additively manufactured layered materials. A finite strain formulation for monolithically coupled thermomechanical fields is presented where interfacial kinematic models for low-cycle fatigue and for strong interfacial discontinuities are variationally embedded at the interfaces. Formulation is written in the spatial configuration to account for large local strains and finite rotations of the interfaces. The method is implemented employing the family of low-order 3D Lagrange elements comprised of linear hexahedra and linear tetrahedra. A set of benchmark problems is presented to show the mathematical and algorithmic attributes of the method.
Stability and bifurcation for a stochastic differential algebraic Holling-II predator–prey model with nonlinear harvesting and delay
Authors: Luo Yantao , Zhang Long , Teng Zhidong , Zheng Tingting
Published: November 2020

In this paper, a stochastic delayed differential algebraic predator–prey model with Michaelis–Menten-type prey harvesting is proposed. Due to the influence of gestation delay and stochastic fluctuations, the proposed model displays a complex dynamics. Criteria on the local stability of the interior equilibrium are established, and the effect of gestation delay on the model dynamics is discussed. Taking the gestation delay and economic profit as bifurcation parameters, Hopf bifurcation and singularity induced bifurcation can occur as they cross through some critical values, respectively. Moreover, the solution of the model will blow up in a limited time when delay [Formula: see text]. Then, we calculate the fluctuation intensity of the stochastic fluctuations by Fourier transform method, which is the key to illustrate the effect of stochastic fluctuations. Finally, we demonstrate our theoretical results by numerical simulations.
THE EFFECTS OF GOLD, STOCK MARKETS AND GEOPOLITICAL UNCERTAINTY ON BITCOIN PRICES AND VOLATILITY
Authors: KYRIAZIS NIKOLAOS A.
Published: November 2020

This paper investigates the nexus between Bitcoin, gold and highly innovative uncertainty indices by employing alternative Autoregressive Conditional Heteroskedasticity (ARCH) and Generalized ARCH (GARCH) specifications. The period examined covers from March 2012 up to March 2020. Econometric outcomes indicate that Bitcoin returns and volatility are positively influenced by gold returns and the S&P500 volatility index (VIX). Nevertheless, it is revealed that the innovative Geopolitical Risk Index by Caldara and Iacoviello ( 2019 ) exerts negative impacts on Bitcoin markets. Evidence indicates that the Simple Asymmetric ARCH methodology provides the best fit for the purposes of estimations. Our findings cast light on the important aspects of Bitcoin behavior and provide guidance for decision-making about portfolios that contain Bitcoin and gold. This enables economic agents to ameliorate their risk–return trade-off depending on the fluctuations in stock markets and geopolitical uncertainty.
“So if Mr Blue Head here clicks the link...” Risk Thinking in Cyber Security Decision Making
Authors: Shreeve Benjamin , Hallett Joseph , Edwards Matthew , Anthonysamy Pauline , Frey Sylvain , Rashid Awais
Published: November 2020

Cyber security decision making is inherently complicated, with nearly every decision having knock-on consequences for an organisation’s vulnerability and exposure. This is further compounded by the fact that decision-making actors are rarely security experts and may have an incomplete understanding of the security that the organisation currently has in place. They must contend with a multitude of possible security options that they may only partially understand. This challenge is met by decision makers’
risk thinking
—their strategies for identifying risks, assessing their severity, and prioritising responses. We study the risk thinking strategies employed by teams of participants in an existing dataset derived from a tabletop cyber-physical systems security game.  Our analysis identifies four
structural patterns
of risk thinking and two
reasoning
strategies:
risk-first
and
opportunity-first
. Our work highlights that risk-first approaches (as prescribed by the likes of NIST-800-53 and ISO 27001) are followed neither substantially nor exclusively when it comes to decision making. Instead, our analysis finds that decision making is affected by the plasticity of teams—that is, the ability to readily switch between ideas and practising both risk-first and opportunity-first reasoning.
Paths of Real Roots for Odd-Degree Polynomials with Parameters
Authors: Xu Junxiang
Published: November 2020

In this paper, we construct a connected path of real roots of odd-degree real polynomials depending on parameters continuously, which joins with all parameters. Moreover, most of the points on the path are odd-multiple real roots except for at most countable even-multiple real roots. Furthermore, some geometrical features of the path can be seen easily from the construction.
MRI-Based 3-Dimensional Visualization Workflow for the Preoperative Planning of Nephron-Sparing Surgery in Wilms’ Tumor Surgery: A Pilot Study
Authors: Fitski Matthijs , Meulstee Jene W. , Littooij Annemieke S. , van de Ven Cornelis P. , van der Steeg Alida F. W. , Wijnen Marc H. W. A.
Published: November 2020

Purpose. Due to the size and localization of Wilms’ tumor (WT), nephron-sparing surgery (NSS) is only possible in a limited number of cases. When NSS is considered, the surgeon preoperatively requires a thorough understanding of the patient-specific anatomy to prevent positive surgical margins and other complications. Through a collaboration between the radiology and pediatric surgery departments and 3D imaging specialists, a 3D visualization workflow was developed to improve preoperative planning of NSS for WT patients. Methods. The 3D visualization workflow combines a MRA sequence, a segmentation protocol, and augmented reality (AR) visualization, additional to in-house 3D printing. A noncontrast-enhanced MRA scan was added to the MRI protocol. MRI sequences were segmented with a segmentation protocol in an open-source software package. The resulting 3D models were visualized in AR with a HoloLens and 3D print. Results. In a pilot study, five WT patients eligible for NSS were preoperatively planned through the 3D visualization workflow. AR visualization software was fast and free to use and allowed adequate handling of the 3D holograms. The 3D printed models were considered convenient and practical for intraoperative orientation. The patient-friendly, fast, and low-cost 3D visualization workflow was easily implemented and appeared to be valuable for the preparation of NSS. Conclusion. This pilot study demonstrates how a strong collaboration between the pediatric surgery and radiology departments and 3D imaging specialists will help to shape the future of pediatric oncological surgery. This 3D visualization workflow aims to prepare pediatric oncological surgeons for nephron-sparing surgery in patients with Wilms’ tumors.
A Recurrence‐Specific Gene‐Based Prognosis Prediction Model for Lung Adenocarcinoma through Machine Learning Algorithm
Authors: Xu Shaohua , Zhou Jie , Liu Kai , Chen Zhoumiao , He Zhengfu
Published: November 2020

Background. After curative surgical resection, about 30‐75% lung adenocarcinoma (LUAD) patients suffer from recurrence with dismal survival outcomes. Identification of patients with high risk of recurrence to impose intense therapy is urgently needed. Materials and Methods. Gene expression data of LUAD were obtained from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. Differentially expressed genes (DEGs) were calculated by comparing the recurrent and primary tissues. Prognostic genes associated with the recurrence‐free survival (RFS) of LUAD patients were identified using univariate analysis. LASSO Cox regression and multivariate Cox analysis were applied to extract key genes and establish the prediction model. Results. We detected 37 DEGs between primary and recurrent LUAD tumors. Using univariate analysis, 31 DEGs were found to be significantly associated with RFS. We established the RFS prediction model including thirteen genes using the LASSO Cox regression. In the training cohort, we classified patients into high‐ and low‐risk groups and found that patients in the high‐risk group suffered from worse RFS compared to those in the low‐risk group (P < 0.01). Concordant results were confirmed in the internal and external validation cohort. The efficiency of the prediction model was also confirmed under different clinical subgroups. The high‐risk group was significantly identified as the risk factor of recurrence in LUAD by the multivariate Cox analysis (HR = 13.37, P = 0.01). Compared to clinicopathological features, our prediction model possessed higher accuracy to identify patients with high risk of recurrence (AUC = 96.3%). Finally, we found that the G2M checkpoint pathway was enriched both in recurrent tumors and primary tumors of high‐risk patients. Conclusions. Our recurrence‐specific gene‐based prognostic prediction model provides extra information about the risk of recurrence in LUAD, which is conducive for clinicians to conduct individualized therapy in clinic.
A Rare Case of Mixed Infectious Keratitis Caused by Pseudomonas koreensis and Aspergillus fumigatus
Authors: Khoo Lin Wei , Srinivasan Sathish S. , Henriquez Fiona L. , Bal Abhijit M.
Published: November 2020

We report the clinical and microbiological features of contact lens-related mixed infectious keratitis caused by a spore-forming filamentous fungus and a rare gram-negative bacterial infection. A 66-year-old Caucasian female presented with right eye (OD) pain after sleeping in her 2-weekly contact lenses for 3 days. On presentation, corrected distance visual acuity was 0.46 LogMAR OD and 0.20 in the left eye. Slit lamp biomicroscopy revealed a 1.9 mm by 1.9 mm area of dense stromal infiltrate with epithelial defect. Corneal scrapes grew Aspergillus fumigatus and Pseudomonas koreensis, and culture-directed microbial therapy with oral and topical voriconazole and topical fortified gentamicin along with regular debridement resulted in slow resolution of the infection, leaving a dense stromal scar in the visual axis requiring penetrating keratoplasty. Mixed infectious keratitis caused by filamentous fungi and gram-negative bacteria is rare. Pseudomonas koreensis infection has not been previously reported as a cause of infectious keratitis in humans. In our experience, these mixed infections require prolonged systemic and topical therapy and the secondary scarring may require surgical intervention for vision rehabilitation.
Open Fetal Surgical Outcomes for Myelomeningocele Closure Stratified by Maternal Body Mass Index in a Large Single-Center Cohort
Authors: Moldenhauer Julie S. , Soni Shelly , Jatres Jillian , Gebb Juliana , Khalek Nahla , Paidas Teefey Christina , Johnson Mark P. , Flake Alan W. , Hedrick Holly L. , Peranteau William H. , Heuer Gregory G. , Adzick N. Scott
Published: November 2020

Background: Open maternal-fetal surgery for in utero closure of myelomeningocele (MMC) has become an accepted treatment option for prenatally diagnosed open neural tube defects. Historically, this option has been limited to women with BMI < 35 due to concern for increasing complications in patients with obesity. Objective: The aim of this study was to evaluate maternal, obstetric, and fetal/neonatal outcomes stratified by maternal BMI classification in women who undergo open maternal-fetal surgery for fetal myelomeningocele (fMMC) closure. Methods: A single-center fMMC closure registry was queried for maternal demographics, preoperative factors, fetal surgery outcomes, delivery outcomes, and neonatal outcomes. Data were stratified based on maternal BMI: <30, 30–34.99, and ≥35–40, corresponding to normal weight/overweight, obesity class I, and obesity class II. Statistical analysis was performed using statistical software SAS v.9.4 (SAS Institute Inc., Cary, NC, USA). Results: A total of 264 patients were analyzed, including 196 (74.2%) with BMI <30, 54 (20.5%) with BMI 30–34.99, and 14 (5.3%) with BMI ≥ 35–40. Maternal demographics and preoperative characteristics were similar among the groups. Operative time increased with increasing BMI; otherwise, perioperative outcomes were similar among the groups. Obstetric and neonatal outcomes were similar among the groups. Conclusion: Increasing maternal BMI did not result in a negative impact on maternal, obstetric, and fetal/neonatal outcomes in a large cohort of patients undergoing open maternal-fetal surgery for fMMC closure. Further study is warranted to determine the generalizability of these results.
Abstract 121: A Pre-Clinical Randomized Blinded Trial of Inhaled Nitric Oxide During Pediatric Cardiopulmonary Resuscitation
Authors: Morgan Ryan W , Sutton Robert M , Himebauch Adam S , Roberts Anna L , Landis William P , Hefti Marco , Nadkarni Vinay M , Berg Robert A , Kilbaugh Todd J
Published: November 2020

Introduction:
Inhaled nitric oxide (iNO) may result in higher systemic BP during CPR and may have a neuroprotective role post-arrest, but its effects on cerebral perfusion pressure (CePP), cerebral blood flow (CBF), and mitochondrial function when administered during CPR are unknown.

Hypotheses:
We hypothesized that administration of iNO during CPR would lead to higher CePP, higher CBF, and less brain injury as measured by cerebral mitochondrial function, neuronal apoptosis, and microglial activation.

Methods:
In 1-month-old swine (n=20), lipopolysaccharide was intravenously infused to induce a shock state, followed by induction of VF and treatment with hemodynamic-directed CPR (HD-CPR). Animals were randomized to blinded treatment with either: 1) HD-CPR with iNO (beginning 1 minute into CPR), or 2) HD-CPR without iNO. Defibrillation attempts began at 10 minutes with a maximum CPR duration of 20 minutes. Among animals surviving 1-hour post-arrest, cerebral tissue underwent high-resolution respirometry to evaluate the mitochondrial electron transport system and quantification of neuronal apoptosis and microglial activation. Chi-square test, Fisher’s exact test, Student’s t-test, Wilcoxon rank-sum test, and a generalized estimating equation regression model compared the two groups.

Results:
During CPR, the iNO group had higher mean aortic pressure (41.6±2.0 vs. 36.0±1.4 mmHg; p=0.005); diastolic BP (32.4±2.4 vs. 27.1±1.7 mmHg; p=0.03); CePP (25.0±2.6 vs. 19.1±1.8 mmHg; p=0.02); and CBF relative to pre-CPR baseline (243.2±54.1 vs. 115.5±37.2%; p=0.02). Among the 8/10 survivors in each group, the iNO group had higher mitochondrial Complex I oxidative phosphorylation in the cerebral cortex (3.60 [3.56, 3.99] vs. 3.23 [2.44, 3.46] pmol O
2
/s*mg; p=0.01) and hippocampus (4.79 [4.35, 5.18] vs. 3.17 [2.75, 4.58] pmol O
2
/s*mg; p=0.02). There were no other differences in mitochondrial respiration or brain injury between groups.

Conclusions:
Blinded treatment with iNO during CPR in a model of pediatric shock-associated cardiac arrest resulted in superior CePP, CBF, and cerebral mitochondrial Complex I respiration. These data suggest that iNO treatment during CPR may lead to improved neurologic outcomes from pediatric cardiac arrest.
Abstract 131: Chest Molding in Extended Cardiopulmonary Resuscitation
Authors: Russell James K , Gonzalez-Otero Digna , Daya Mohamud R , Ruiz De Gauna Sofia , Ruiz Jesus
Published: November 2020

Introduction:
Cardiopulmonary resuscitation (CPR) is a forceful procedure that may change characteristics of the subject. Little clinical data has been published relating applied forces and depth responses, particularly in increasingly prevalent extended sessions of CPR. We analyzed synchronous force and depth records to investigate how chests mold during the course of extended CPR.

Hypothesis:
Chest molding, characterized as decrease in stiffness from its initial value, will increase as CPR proceeds.

Methods:
Force and acceleration signals were extracted from CPR monitors used in adult cases of continuous compression CPR in out-of-hospital resuscitations attended by a single EMS agency (TVFR, Tigard, Oregon) during 2013 through 2017. We computed depth and velocity from acceleration, and identified chest compressions automatically where downward velocity crossed 25mm/s and force subsequently exceeded 5 kg-f. Series were defined as sequences without pauses exceeding 2 minutes. We analyzed initial series lasting at least 10 minutes. We calculated stiffness as force/depth at peak compression velocity. We calculated molding in 5 minute blocks of CPR as 100*(1- stiffnessblock/stiffnessminute 1), using medians as stiffness was not normally distributed. Dependence of molding on CPR duration was analyzed with Kruskal-Wallis ANOVA.

Results and Conclusions:
Of 616 available cases, 478 had initial CPR series >= 10 minutes duration, including 997,254 compressions. Initial CPR series duration were >= 30 minutes in 152 cases, and >= 40 minutes in 48 cases. The longest initial series was 61 minutes. Chest molding increased steadily through the first 25 minutes of CPR, and plateaued thereafter (p < 0.001). Median molding at >= 25 minutes was 20%. The implications of declining stiffness warrant further investigation.
Abstract 144: Role of Iron Metabolism on Outcomes after Cardiac Arrest and Resuscitation in Mice
Authors: Miyazaki Yusuke , Hayashida Kei , Ikeda Takamitsu , Marutani Eizo , Bagchi Aranya , Ichinose Fumito
Published: November 2020

Introduction:
Ischemia and reperfusion (I/R) induces hepcidin in neurons and macrophages. Hepcidin downregulates ferroportin, the only known iron exporter, thereby inhibiting iron efflux and increases iron in ferroportin rich cells while decreasing serum iron. Increased intracellular iron after I/R induces ferroptosis, a regulated cell death characterized by iron-dependent lipid peroxidation. We hypothesized that hepcidin-induced sequestration of iron in neurons and macrophages, both of which express ferroportin, worsens post-cardiac arrest (CA) brain injury.

Methods:
Levels of hepcidin, iron, and a lipid peroxidation product, malondialdehyde; and expression of HAMP that encodes hepcidin, transferrin receptor 1, and markers of ferroptosis, PTGS2 and CHAC1, were measured in naïve and post-CA wild-type (WT) mice. To examine the effects of hepcidin on CA outcomes, hepcidin-deficient and WT mice were subjected to potassium-induced 8 min of CA followed by cardiopulmonary resuscitation (CPR). To determine the role of increased intracellular iron after CA/CPR, we administered iron-dextran (300 mg/kg IP) or vehicle to WT mice 24h before CA. The effect of liproxstatin-1, a ferroptosis inhibitor, on cell viability was assessed in murine primary cortical neurons after oxygen-glucose deprivation/reperfusion (OGD/R) with iron-loading.

Results:
Post-CA WT mice exhibited increased systemic HAMP expression, intracellular iron in spleen, and ferroptosis in brain. Hepcidin deficiency that decreases intracellular iron improved survival and neurological function after CA/CPR, whereas pre-arrest iron-loading that increases intracellular iron worsened survival and neurological function after CA/CPR (Fig. 1). Liproxstatin-1 improved neuron viability after OGD/R with iron-loading.

Conclusions:
Our data suggest that inhibiting hepcidin improves post-CA neurological outcomes by reducing intracellular iron and ferroptosis-induced neuronal death.
Abstract 149: Annual and Lifetime Economic Productivity Loss Due to Adult Out-of-hospital Cardiac Arrest in the United States
Authors: Coute Ryan A , Nathanson Brian , Mader Timothy J , McNally Bryan F , Kurz Michael C
Published: November 2020

Objective:
To estimate the annual and lifetime economic productivity loss due to adult out-of-hospital cardiac arrest (OHCA) in the United States (U.S.) over a 5-year study period between 2013-2018.

Methods:
All adult (age≥ 18 years) non-traumatic EMS-treated OHCA with complete data for age, sex, race, and survival outcomes from the CARES database for the most recently available 5-year period were included. Annual and lifetime labor productivity values, based on age and gender, were obtained from previously published national economic data. Productivity losses for OHCA events were calculated by year. Productivity losses for survivors were assigned by cerebral performance category score (CPC): CPC 1 and 2 = 0% productivity loss; CPC 3-5 = 100% productivity loss. Sensitivity analyses were performed assigning CPC 2 varying productivity losses (0-100%). Lifetime productivity values assumed 1% annual growth and 3% discount rate. Productivity data are presented in U.S. dollars and adjusted for inflation based on 2016 values. Results were extrapolated to the annual U.S. population.

Results:
A total of 338,492 (96.5%) cases met inclusion criteria. The mean annual and lifetime productivity losses per OHCA in 2018 were $48,224 and $638,947 respectively. Total annual and lifetime productivity losses for the study population in 2018 were $3.8 billion and $50.6 billion, respectively. Sensitivity analyses assigning CPC 2 varying productivity losses yielded similar findings. Males had a much larger lifetime productivity loss to approximately age 65 years compared to females (FIGURE 1). For the U.S. population in 2018, the total annual and lifetime productivity losses due to OHCA were $11.3 billion and $150.2 billion, respectively.

Conclusion:
Adult non-traumatic OHCA events are associated with significant annual and lifetime economic productivity losses and should be the focus of public health resources to improve preventative measures and survival outcomes.