bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhanced x-ray emission coinciding with giant radio pulses from the Crab Pulsar
Authors: Enoto Teruaki , Terasawa Toshio , Kisaka Shota , Hu Chin-Ping , Guillot Sebastien , Lewandowska Natalia , Malacaria Christian , Ray Paul S. , Ho Wynn C.G. , Harding Alice K. , Okajima Takashi , Arzoumanian Zaven , Gendreau Keith C. , Wadiasingh Zorawar , Markwardt Craig B. , Soong Yang , Kenyon Steve , Bogdanov Slavko , Majid Walid A. , Güver Tolga , Jaisawal Gaurava K. , Foster Rick , Murata Yasuhiro , Takeuchi Hiroshi , Takefuji Kazuhiro , Sekido Mamoru , Yonekura Yoshinori , Misawa Hiroaki , Tsuchiya Fuminori , Aoki Takahiko , Tokumaru Munetoshi , Honma Mareki , Kameya Osamu , Oyama Tomoaki , Asano Katsuaki , Shibata Shinpei , Tanaka Shuta J.
Published: April 2021

X-rays from giant radio pulses

Pulsars are spinning, magnetized neutron stars that are observed as a regular sequence of radio pulses. Most pulses are of consistent intensity, but occasionally one is brighter by orders of magnitude. The cause of these unpredictable giant radio pulses (GRPs) is unknown. Enoto
et al.
observed the Crab Pulsar simultaneously with x-ray and radio telescopes. They found that x-ray emission during GRPs was slightly brighter than that during normal pulses. Comparing the radio and x-ray enhancements provides constraints on the GRP emission mechanism and the possible connections with other transient radio phenomena.

Science
, this issue p.
187
Response to Comment on “Tumor-initiating cells establish an IL-33–TGF-β niche signaling loop to promote cancer progression”
Authors: Taniguchi Sachiko , Elhance Ajit , Van Duzer Avery , Kumar Sushil , Leitenberger Justin , Oshimori Naoki
Published: April 2021

Kamphuis
et al
. argue that macrophages accumulated in the proximity of tumor-initiating cells do not express the high-affinity immunoglobulin E receptor FcεRIα. Although we cannot exclude the possibility of nonspecific binding of anti-FcεRIα antibody (clone MAR-1), we provide evidence that macrophages in squamous cell carcinomas express FcεRIα and that IL-33 induces FcεRIα expression in bone marrow cell–derived macrophages.
Seeded 2D epitaxy of large-area single-crystal films of the van der Waals semiconductor 2H MoTe
2
Authors: Xu Xiaolong , Pan Yu , Liu Shuai , Han Bo , Gu Pingfan , Li Siheng , Xu Wanjin , Peng Yuxuan , Han Zheng , Chen Ji , Gao Peng , Ye Yu
Published: April 2021

Seeding 2D crystals

Small, single crystals are often used to direct the growth of larger, bulk single crystals. Xu
et al.
modified these methods to grow single-crystal films of a two-dimensional (2D) semiconductor, 2H molybdenum ditelluride (2H MoTe
2
), on an amorphous glass surface. After coating the wafer with a 1T′ MoTe
2
film, a small 2H MoTe
2
crystallite was placed on the wafer. The wafer was capped with an alumina film, except for a small hole above the seed region that allowed entry of additional tellurium during the heating process that drove the phase transition and epitaxial growth of 2H MoTe
2
.

Science
, this issue p.
195
Boron insertion into alkyl ether bonds via zinc/nickel tandem catalysis
Authors: Lyu Hairong , Kevlishvili Ilia , Yu Xuan , Liu Peng , Dong Guangbin
Published: April 2021

Slipping boron into alkyl ethers

The carbon–oxygen bonds that hold alkyl ethers together are relatively inert. Lyu
et al.
report that zinc and nickel can team up to insert boron between the carbon and oxygen using an unusual mechanism. First, a dibromoborane pries open the bond with help from a zinc ion. Next, the nickel stitches together the carbon and boron, and the oxidation of metallic zinc starts the cycle over again. Versatile reactivity at the inserted boron center can then add carbons to the original ether or swap out oxygen for nitrogen.

Science
, this issue p.
175
Rethinking Alexander Graham Bell's legacy
The Invention of Miracles
Katie Booth
Simon and Schuster, 2021. 416 pp.
Authors: Trussell Jessica
Published: April 2021

A new biography confronts the inventor's complicated relationship with the Deaf community
Ovarian vein thrombosis: a potential clinical consequence of ruptured ectopic pregnancy
Authors: Teytelbaum David Elliot , Meade Josh Dean , Swanson Jennifer
Published: April 2021

A healthy 32-year-old G3P3 woman with an unknown last menstrual period presented to the emergency department with intense abdominal pain and pain in the right chest that radiated down the right arm. Further workup showed that she had a ruptured ectopic pregnancy with significant haemoperitoneum. After successful laparoscopic evacuation of the ectopic pregnancy and haemoperitoneum, the patient subsequently developed a right ovarian vein thrombosis 4 weeks after the procedure. She was treated with anticoagulation, and further haematological studies did not show any significant findings. Postpartum ovarian vein thrombosis is extremely rare and can be life- threatening if not accurately diagnosed and treated with anticoagulation or surgical management in a timely manner.
Rare case of adult-onset phalangeal microgeodic syndrome of the feet
Authors: Ellatif Mostafa , Sahu Ajay , Abraham Sonya , Rosenbloom Craig , Chatterjee Robin
Published: April 2021

Phalangeal microgeodic syndrome (PMS) is a rare condition typically affecting children and is characterised by painful digits precipitated by cold temperatures. In medical literature, cases appear to be clustered in Japan. Adult-onset PMS is particularly rare and although imaging features are characteristic, it may go undiagnosed, as it is not commonly encountered. We present, to our knowledge, the fifth reported case in the literature of adult PMS, the second to affect the feet rather than hands, and the first in a Caucasian adult patient. This case report aims to raise awareness of this likely underdiagnosed condition to allow optimal management and avoidance of unnecessary diagnostic procedures.
Clinical outcomes following selective laser trabeculoplasty in Afro-Caribbean patients with glaucoma at high risk for progression
Authors: Realini Tony , Shillingford-Ricketts Hazel , Burt Darra , Balasubramani Goundappa K
Published: April 2021

Aim

To characterise clinical outcomes following selective laser trabeculoplasty (SLT) in eyes of Afro-Caribbean patients with open-angle glaucoma (OAG) at high risk for progression.

Methods

In a prospective interventional case series, patients meeting high-risk criteria (advanced disease, unilateral glaucoma blindness, inadequate intraocular pressure (IOP) on >2 medications, recent progression on medications, inability to administer, afford or tolerate medications) underwent bilateral 360° SLT and managed based on their subsequent clinical course. Patient-specific indications for SLT—IOP reduction (IOP group) or reduced reliance on medical therapy (MED group)—were recorded before treatment. IOP and medication use were recorded every 3–4 months through up to 24 months of follow-up. Outcomes were analysed separately in the IOP and MED groups.

Results

Among 33 right eyes (left eye outcomes were similar) in the IOP group, mean (SD) IOP was significantly reduced from 21.7 (7.5) mm Hg to 16.2–17.1 mm Hg over follow-up (p<0.0177); medication use remained unchanged (p>0.05) at all time points. Among 36 right eyes in the MED group, mean medication use was 1.9 (0.9) at baseline and ranged from 1.2 to 1.4 medications per eye through follow-up (p<0.0033), and mean IOP was significantly reduced at months 1–6 (to 13.1 (2.3) mm Hg, p=0.0013), months 13–18 (to 14.3 (2.8), p=0.0136) and unchanged at other time points. No vision-threatening adverse events occurred.

Conclusions

Afro-Caribbean patients with OAG at risk for progression can achieve clinically and statistically significant reductions in IOP or medications through up to 24 months following a single 360° SLT treatment.

Trial registration number

NCT02375009.
Concussion in para sport: the first position statement of the Concussion in Para Sport (CIPS) Group
Authors: Weiler Richard , Blauwet Cheri , Clarke David , Dalton Kristine , Derman Wayne , Fagher Kristina , Gouttebarge Vincent , Kissick James , Lee Kenneth , Lexell Jan , Van de Vliet Peter , Verhagen Evert , Webborn Nick , Ahmed Osman Hassan
Published: April 2021

Concussion is a frequent injury in many sports and is also common in para athletes. However, there is a paucity of concussion research related to para sport, and prior International Concussion in Sport (CIS) consensus papers have not substantively addressed this population. To remedy this and to improve concussion care provided to para athletes, the concussion in para sport (CIPS) multidisciplinary expert group was created. This group analysed and discussed in-depth para athlete-specific issues within the established key clinical domains of the current (2017) consensus statement on CIS. Due to the onset of the COVID-19 pandemic, the group held all meetings by video conferencing. The existing Sport Concussion Assessment Tool 5 (SCAT5) for the immediate on-field and office-based off-field assessment of concussion was evaluated as part of this process, to identify any para athlete-specific concerns. Regular preparticipation and periodic health examinations are essential to determine a baseline reference point for concussion symptoms but pose additional challenges for the interpreting clinician. Further considerations for concussion management for the para athlete are required within the remove, rest, reconsider and refer consensus statement framework. Considering return to sport (RTS), the 2017 CIS consensus statement has limitations when considering the RTS of the para athlete. Case-by-case decision making related to RTS following concussion is imperative for para athletes. Additional challenges exist for the evaluation and management of concussion in para athletes. There is a need for greater understanding of existing knowledge gaps and attitudes towards concussion among athlete medical staff, coaches and para athletes. Future research should investigate the use and performance of common assessment tools in the para athlete population to better guide their clinical application and inform potential modifications. Concussion prevention strategies and sport-specific rule changes, such as in Para Alpine Skiing and Cerebral Palsy Football, also should be carefully considered to reduce the occurrence of concussion in para athletes.
Knowledge, attitude and psychological status of patients living with hepatitis C in five provinces in China: a cross-sectional survey
Authors: Zhao Tian-Shuo , Jin Cunduo , Wang Yishan , Cui Fuqiang
Published: April 2021

Objective

This study investigated the knowledge, attitudes and psychological status of hepatitis C virus (HCV)-positive patients through a cross-sectional survey to provide scientific strategies for improving their treatment compliance and quality of life.

Setting

The research was conducted in nine hospitals in five provincial administrative regions in China, namely Inner Mongolia, Jilin, Beijing, Hebei and Sichuan.

Participants

A total of 457 patients were recruited for this study and 409 patients were included in the final analysis. The participants were 215 men and 194 women, with an average age of 59 years.

Primary and secondary outcome measures

The primary outcomes were scores on scales assessing knowledge, attitudes and psychological status. The secondary outcomes were transmission of HCV, preference regarding the mode in which information about HCV was provided and factors affecting treatment.

Results

Blood transfusion was the most common route of HCV transmission (42.7%), followed by surgery (15.9%) and blood donation/sale (8.7%). The misunderstanding of HCV and negative attitudes towards other HCV-positive patients were relatively common among HCV-positive patients and were more pronounced among rural and ethnic minority populations. HCV-positive patients were generally categorised as possibly having symptoms of depression. Patients with negative attitudes were more likely to have symptoms of depression (OR=0.6, 95% CI 0.4 to 0.8).

Conclusions

HCV-positive patients had a poor understanding of HCV and a negative attitude towards other HCV-positive patients. It is very important to develop effective health education strategies to improve the knowledge, attitudes and mental health of HCV-positive patients and enhance treatment compliance.
Travel-related control measures to contain the COVID-19 pandemic: an evidence map
Authors: Movsisyan Ani , Burns Jacob , Biallas Renke , Coenen Michaela , Geffert Karin , Horstick Olaf , Klerings Irma , Pfadenhauer Lisa Maria , von Philipsborn Peter , Sell Kerstin , Strahwald Brigitte , Stratil Jan M , Voss Stephan , Rehfuess Eva
Published: April 2021

Objectives

To comprehensively map the existing evidence assessing the impact of travel-related control measures for containment of the SARS-CoV-2/COVID-19 pandemic.

Design

Rapid evidence map.

Data sources

MEDLINE, Embase and Web of Science, and COVID-19 specific databases offered by the US Centers for Disease Control and Prevention and the WHO.

Eligibility criteria

We included studies in human populations susceptible to SARS-CoV-2/COVID-19, SARS-CoV-1/severe acute respiratory syndrome, Middle East respiratory syndrome coronavirus/Middle East respiratory syndrome or influenza. Interventions of interest were travel-related control measures affecting travel across national or subnational borders. Outcomes of interest included infectious disease, screening, other health, economic and social outcomes. We considered all empirical studies that quantitatively evaluate impact available in Armenian, English, French, German, Italian and Russian based on the team’s language capacities.

Data extraction and synthesis

We extracted data from included studies in a standardised manner and mapped them to a priori and (one) post hoc defined categories.

Results

We included 122 studies assessing travel-related control measures. These studies were undertaken across the globe, most in the Western Pacific region (n=71). A large proportion of studies focused on COVID-19 (n=59), but a number of studies also examined SARS, MERS and influenza. We identified studies on border closures (n=3), entry/exit screening (n=31), travel-related quarantine (n=6), travel bans (n=8) and travel restrictions (n=25). Many addressed a bundle of travel-related control measures (n=49). Most studies assessed infectious disease (n=98) and/or screening-related (n=25) outcomes; we found only limited evidence on economic and social outcomes. Studies applied numerous methods, both inferential and descriptive in nature, ranging from simple observational methods to complex modelling techniques.

Conclusions

We identified a heterogeneous and complex evidence base on travel-related control measures. While this map is not sufficient to assess the effectiveness of different measures, it outlines aspects regarding interventions and outcomes, as well as study methodology and reporting that could inform future research and evidence synthesis.
Could social prescribing contribute to type 2 diabetes prevention in people at high risk? Protocol for a realist, multilevel, mixed methods review and evaluation
Authors: Calderón-Larrañaga Sara , Clinch Megan , Greenhalgh Trisha , Finer Sarah
Published: April 2021

Introduction

Social prescribing is an innovation being widely adopted within the UK National Health Service policy as a way of improving the management of people with long-term conditions, such as type 2 diabetes (T2D). It generally involves linking patients in primary care with non-medical community-based interventions. Despite widespread national support, evidence for the effectiveness of social prescribing is both insufficient and contested. In this study, we will investigate whether social prescribing can contribute to T2D prevention and, if so, when, how and in what circumstances it might best be introduced.

Methods and analysis

We will draw on realist evaluation to investigate the complex interpersonal, organisational, social and policy contexts in which social prescribing relevant to T2D prevention is implemented. We will set up a stakeholder group to advise us throughout the study, which will be conducted over three interconnected stages. In stage 1, we will undertake a realist review to synthesise the current evidence base for social prescribing. In stage 2, we will investigate how social prescribing relevant to people at high risk of T2D ‘works’ in a multiethnic, socioeconomically diverse community and any interactions with existing T2D prevention services using qualitative, quantitative and realist methods. In stage 3 and building on previous stages, we will synthesise a ‘transferable framework’ that will guide implementation and evaluation of social prescribing relevant to T2D prevention at scale.

Ethics and dissemination

National Health Service ethics approval has been granted (reference 20/LO/0713). This project will potentially inform the adaptation of social prescribing services to better meet the needs of people at high risk of T2D in socioeconomically deprived areas. Findings may also be transferable to other long-term conditions. Dissemination will be undertaken as a continuous process, supported by the stakeholder group. Tailored outputs will target the following audiences: (1) service providers and commissioners; (2) people at high risk of T2D and community stakeholders; and (3) policy and strategic decision makers.

PROSPERO registration number

CRD42020196259.
Clinical characteristics of hospitalised patients with COVID-19 and the impact on mortality: a single-network, retrospective cohort study from Pennsylvania state
Authors: Gadhiya Kinjal P , Hansrivijit Panupong , Gangireddy Mounika , Goldman John D
Published: April 2021

Objective

COVID-19 is a respiratory disease caused by SARS-CoV-2 with the highest burden in the USA. Data on clinical characteristics of patients with COVID-19 in US population are limited. Thus, we aim to determine the clinical characteristics and risk factors for in-hospital mortality from COVID-19.

Design

Retrospective observational study.

Setting

Single-network hospitals in Pennsylvania state.

Participants

Patients with confirmed SARS-CoV-2 infection who were hospitalised from 1 March to 31 May 2020.

Primary and secondary outcome measures

Primary outcome was in-hospital mortality. Secondary outcomes were complications, such as acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS).

Results

Of 283 patients, 19.4% were non-survivors. The mean age of all patients was 64.1±15.9 years. 56.2% were male and 50.2% were white. Several factors were identified from our adjusted multivariate analyses to be associated with in-hospital mortality: increasing age (per 1-year increment; OR 1.07 (1.045 to 1.105)), hypoxia (oxygen saturation <95%; OR 4.630 (1.934 to 1.111)), opacity/infiltrate on imaging (OR 3.077 (1.276 to 7.407)), leucocytosis (white blood cell >10109/µL; OR 2.732 (1.412 to 5.263)), ferritin >336 ng/mL (OR 4.016 (1.195 to 13.514)), lactate dehydrogenase >200 U/L (OR 7.752 (1.639 to 37.037)), procalcitonin >0.25 ng/mL (OR 2.404 (1.011 to 5.714)), troponin I >0.03 ng/mL (OR 2.242 (1.080 to 4.673)), need for advanced oxygen support other than simple nasal cannula (OR 4.608–13.889 (2.053 to 31.250)), intensive care unit admission/transfer (OR 13.699 (6.135 to 30.303)), renal replacement therapy (OR 21.277 (5.025 to 90.909)), need for vasopressor (OR 22.222 (9.434 to 52.632)), ARDS (OR 23.810 (10.204 to 55.556)), respiratory acidosis (OR 7.042 (2.915 to 16.949)), and AKI (OR 3.571 (1.715 to 7.407)). When critically ill patients were analysed independently, increasing Sequential Organ Failure Assessment score (OR 1.544 (1.168 to 2.039)), AKI (OR 2.128 (1.111 to 6.667)) and ARDS (OR 6.410 (2.237 to 18.182)) were predictive of in-hospital mortality.

Conclusion

We reported the characteristics of ethnically diverse, hospitalised patients with COVID-19 from Pennsylvania state.
Factors associated with mobile phone usage to access maternal and child healthcare among women of urban slums in Dhaka, Bangladesh: a cross-sectional study
Authors: Mistry Sabuj Kanti , Akter Fahmida , Yadav Uday Narayan , Hossain Md Belal , Sichel Amarynth , Labrique Alain B , Storisteanu Daniel M L
Published: April 2021

Introduction

With the acute shortage of human resources and infrastructure, mobile phones can be a critical tool for accessing health services and strengthening health systems in Bangladesh. Yet, there is a scarcity of evidence on the use of mobile phones in this context for accessing health services. In this study, we sought to explore the current use of mobile phones for accessing maternal and child healthcare and its determinants among recently delivered women in urban slums of Bangladesh.

Methods

The data were collected through interviewing 800 recently delivered women from eight slums of Dhaka city of Bangladesh during May and June 2018. The study followed a cross-sectional design and a two-stage cluster random sampling procedure was followed. A pretested structured questionnaire was employed to collect information. Chi square tests were performed for descriptive analyses and a multilevel binary logistic regression model was executed to explore the determinants of mobile phone usage for accessing maternal and childcare among the participants.

Results

Overall, 73.8% of study participants used mobile phones for accessing maternal and child healthcare. After adjusting for potential confounders, participants’ age, husband’s occupation, sex of household head, women’s ownership of mobile phones and household wealth status were found to be significantly associated with higher odds of using mobile phones to access maternal and child healthcare.

Conclusion

The study highlighted the possibility of implementing large-scale mobile health (mHealth) interventions in slum settlements for accessing maternal and child healthcare and is a sustainable mitigation strategy for the acute health worker crisis in Bangladesh. The findings of this study are particularly crucial for policymakers and practitioners while they revise the health policy to incorporate mHealth interventions as highlighted in the recently initiated Digital Health Strategy of Bangladesh.
How COVID-19 has affected general practice consultations and income: general practitioner cross-sectional population survey evidence from Ireland
Authors: Homeniuk Robyn , Collins Claire
Published: April 2021

Objectives

How general practice is delivered in many countries has drastically changed due to the COVID-19 pandemic. This study aimed to answer the question of how general practice has changed in Ireland in response to COVID-19.

Design

The Irish College of General Practitioners surveyed its membership before and after the global pandemic hit Ireland using a cross-sectional online survey instrument.

Setting

This study focuses on primary care, specifically general practice, in Ireland.

Participants

In February 2020 before the global pandemic, 526 general practices across Ireland submitted responses to the survey; 538 general practices responded to the second survey during the pandemic in June 2020. This covers 32% and 33% of practices in Ireland, respectively.

Main outcome measures

The type of consultations by general practitioners (GPs) and practice nurses in both surveys is the main outcome measure reported in this paper. Other changes such as the perceived change in attendance by certain patient groups and practice income are also reported.

Results

Face-to-face consultations significantly (p<0.001) decreased from a median of 26 (IQR 21.3–30) to a median of 8 (IQR 6–13). GP telemedicine consultations increased (p<0.001) from a median of 2.4 (IQR 0–5.3) to a median of 11.3 (IQR 6–19). The majority of practices (80.0%) reported reduced practice profit. Respondents reported a decline in non-COVID-19-related consultations among certain patient cohorts—92.0% for children under 6 years old; 79.5% for patients over 70 years.

Conclusions

It is likely that the way general practice is delivered will not return to as it was before the COVID-19 pandemic and increased telemedicine can be expected. However, it is necessary to assess the impact of this shift on patient health and to assess healthcare provider and patient experience to ensure continued high-quality care and patient safety.
Predicting the risk of drug–drug interactions in psychiatric hospitals: a retrospective longitudinal pharmacovigilance study
Authors: Wolff Jan , Hefner Gudrun , Normann Claus , Kaier Klaus , Binder Harald , Domschke Katharina , Hiemke Christoph , Marschollek Michael , Klimke Ansgar
Published: April 2021

Objectives

The aim was to use routine data available at a patient’s admission to the hospital to predict polypharmacy and drug–drug interactions (DDI) and to evaluate the prediction performance with regard to its usefulness to support the efficient management of benefits and risks of drug prescriptions.

Design

Retrospective, longitudinal study.

Setting

We used data from a large multicentred pharmacovigilance project carried out in eight psychiatric hospitals in Hesse, Germany.

Participants

Inpatient episodes consecutively discharged between 1 October 2017 and 30 September 2018 (year 1) or 1 January 2019 and 31 December 2019 (year 2).

Outcome measures

The proportion of rightly classified hospital episodes.

Methods

We used gradient boosting to predict respective outcomes. We tested the performance of our final models in unseen patients from another calendar year and separated the study sites used for training from the study sites used for performance testing.

Results

A total of 53 909 episodes were included in the study. The models’ performance, as measured by the area under the receiver operating characteristic, was ‘excellent’ (0.83) and ‘acceptable’ (0.72) compared with common benchmarks for the prediction of polypharmacy and DDI, respectively. Both models were substantially better than a naive prediction based solely on basic diagnostic grouping.

Conclusion

This study has shown that polypharmacy and DDI can be predicted from routine data at patient admission. These predictions could support an efficient management of benefits and risks of hospital prescriptions, for instance by including pharmaceutical supervision early after admission for patients at risk before pharmacological treatment is established.
Educational needs in the COVID-19 pandemic: a Delphi study among doctors and nurses in Wuhan, China
Authors: Hou Xun , Hu Wenjie , Russell Lene , Kuang Ming , Konge Lars , Nayahangan Leizl Joy
Published: April 2021

Objective

To identify theoretical and technical aspects regarding treatment, prevention of spread and protection of staff to inform the development of a comprehensive training curriculum on COVID-19 management.

Design

Cross-sectional study.

Setting

Nine hospitals caring for patients with COVID-19 in Wuhan, China.

Participants

134 Chinese healthcare professionals (74 doctors and 60 nurses) who were deployed to Wuhan, China during the COVID-19 epidemic were included. A two-round Delphi process was initiated between March and May 2020. In the first round, the participants identified knowledge, technical and behavioural (ie, non-technical) skills that are needed to treat patients, prevent spread of the virus and protect healthcare workers. In round 2, the participants rated each item according to its importance to be included in a training curriculum on COVID-19. Consensus for inclusion in the final list was set at 80%.

Primary outcome measures

Knowledge, technical and behavioural (ie, non-technical) skills that could form the basis of a training curriculum for COVID-19 management.

Results

In the first round 1398 items were suggested by the doctors and reduced to 67 items after content analysis (treatment of patients: n=47; infection prevention and control: n=20). The nurses suggested 1193 items that were reduced to 70 items (treatment of patients: n=49; infection prevention and control: n=21). In round 2, the response rates were 82% in doctors and 93% in nurses. Fifty-eight items of knowledge, technical and behavioural skills were agreed on by the doctors to include in the final list. For the nurses, 58 items were agreed on.

Conclusions

This needs assessment process resulted in a comprehensive list of knowledge, technical and behavioural skills for COVID-19 management. Educators can use these to guide decisions regarding content of training curricula not only for COVID-19 management but also in preparation for future viral pandemic outbreaks.
Diagnostic accuracy of the HEART Pathway and EDACS-ADP when combined with a 0-hour/1-hour hs-cTnT protocol for assessment of acute chest pain patients
Authors: Nilsson Tsvetelina , Johannesson Erik , Lundager Forberg Jakob , Mokhtari Arash , Ekelund Ulf
Published: April 2021

Background/aim

In ED chest pain patients, a 0-hour/1-hour protocol based on high sensitivity cardiac troponin T (hs-cTnT) tests combined with clinical risk stratification in diagnosing acute coronary syndrome is recommended. Two of the most promising risk stratification tools are the History, ECG, Age, Risk Factors and Troponin (HEART) and Emergency Department Assessment of Chest Pain (EDAC) scores. Few studies have assessed the diagnostic accuracy of the 0-hour/1-hour hs-cTnT protocol when combined with HEART score, and none with EDACS. In ED chest pain patients, we aimed to evaluate the diagnostic accuracy of a 0-hour/1-hour hs-cTnT protocol combined the HEART Pathway, or the EDACS accelerated diagnostic pathway (EDACS-ADP).

Methods

This was a secondary analysis of data from a prospective observational study enrolling 1167 ED chest pain patients who visited the ED at Skåne University Hospital in Lund, Sweden in the period between February 2013 and April 2014. HEART and EDAC scores were assessed together with hs-cTnT at 0 and 1 hour and compared with HEART score alone. Sensitivity, specificity, negative predictive value (NPV) and likelihood ratios were evaluated. The primary outcome was major adverse cardiac events (MACE) including unstable angina within 30 days. The secondary outcome was index visit acute myocardial infarction (AMI).

Results

A total of 939 patients were included in the final analysis. When combined with 0-hour/1-hour hs-cTnT testing, the HEART Pathway and EDACS-ADP identified 49.8% and 49.6% of the patients for rule-out, with NPVs for 30-day MACE of 99.8% and 99.1%, compared with the HEART score alone that identified 53.4% of the patients for rule-out with NPV of 99.2%. The NPV for index visit AMI were 100%, 99.8% and 99.2%, respectively.

Conclusion

The combination of the HEART Pathway or the EDACS-ADP with a 0-hour/1-hour hs-cTnT protocol allows safe and early rule-out in a large proportion of ED chest pain patients.
Predicting endoscopic remission in Crohn’s disease by the modified multiplier SES-CD (MM-SES-CD)
Authors: Narula Neeraj , Wong Emily C L , Colombel Jean-Frederic , Sandborn William J , Marshall John Kenneth , Daperno Marco , Reinisch Walter , Dulai Parambir S
Published: April 2021

Background and aims

The Simple Endoscopic Score for Crohn’s disease (SES-CD) is the primary tool for measurement of mucosal inflammation in clinical trials but lacks prognostic potential. We set to develop and validate a modified multiplier of the SES-CD (MM-SES-CD), which takes into consideration each individual parameter’s prognostic value for achieving endoscopic remission (ER) while on active therapy.

Methods

In this posthoc analysis of three CD clinical trial programmes (n=350 patients, baseline SES-CD ≥ 3 with confirmed ulceration), data were pooled and randomly split into a 70% training and 30% testing cohort. The MM-SES-CD was designed using weights for individual parameters as determined by logistic regression modelling, with 1-year ER (SES-CD < 3) being the dependent variable. A cut point score for low and high probability of ER was determined by using the maximum Youden Index and validated in the testing cohort.

Results

Baseline ulcer size, extent of ulceration and presence of non-passable strictures had the strongest association with 1-year ER as compared with affected surface area, with differential weighting of individual parameters across disease segments being observed during logistic regression. The MM-SES-CD was generated using this weighted regression model and demonstrated strong discrimination for ER in the training dataset (area under the receiver operator curve (AUC) 0.83, 95% CI 0.78 to 0.94) and in the testing dataset (AUC 0.82, 95% CI 0.77 to 0.92). In comparison to the MM-SES-CD scoring model, the original SES-CD score lacks accuracy (AUC 0.60, 95% CI 0.55 to 0.65) for predicting the achievement of ER.

Conclusions

We developed and internally validated the MM-SES-CD as an endoscopic severity assessment tool to predict one-year ER in patients with CD on active therapy.
Retrieving the deleterious mutations before extinction: genome-wide comparison of shared derived mutations in liver cancer and normal population
Authors: Chang Shuai , Li Jian , Li Qun , Yu Chun-peng , Xie Ling-ling , Wang Song
Published: April 2021

Study purpose

Deleterious mutations would be rapidly purged from natural populations along with the extinction of their carriers. The currently observed mutations in existing species are mostly neutral. The inaccessibility of deleterious mutations impedes the functional studies on how these mutations affect the fitness at individual level.

Study design

The connection between the deleterious genotype and the non-adaptive phenotype could be bridged by sequencing the genome before extinction. Although this approach is no longer feasible for evolutionary biologists, it is feasible for cancer biologists by profiling the mutations in tumour samples which are so deleterious that the carriers hardly live.

Results

By comparing the derived mutation profile between normal populations and patients with liver cancer, we found that the shared mutations, which are highly deleterious, are suppressed to low allele frequencies in normal populations and tissues, but show remarkably high frequency in tumours. The density of shared mutations is negatively correlated with gene conservation and expression levels.

Conclusions

Deleterious mutations are suppressed in functionally important genes as well as in normal populations. This work deepened our understanding on how natural selection act on deleterious mutations by analogising the cancer evolution to species evolution, which are essentially the same molecular process but at different time scales.
Structural properties of Na atom under impenetrable spatial confinement
Authors: Mondal Santanu , Sen K.D. , Saha Jayanta K.
Published: April 2021

The structural properties and radial distributions of the valence electron in different excited levels of Na atom (n = 3–5, l = 0–4; n and l being the principal and orbital angular momentum quantum numbers, respectively) under impenetrable spherical confinement have been studied, where the interaction between the frozen core and the valence electron is mimicked by a model potential available in the literature. The effect of the core on the valence electron has been investigated by estimating the structural properties of Na10+ ion under similar confinement. Scaled radial densities at the nucleus and related ratios are presented for a few excited states of the valence electron of Na atom and the corresponding analytic results have been tested numerically.
COVID-19 outbreaks follow narrow paths: A computational phase portrait approach based on nonlinear physics and synergetics
Authors: Frank T. D.
Published: April 2021

From the perspective of mathematical epidemiology, COVID-19 epidemics emerge due to instabilities in epidemiological systems. It is shown that the COVID-19 outbreaks follow highly specified paths in epidemiological state spaces. These paths are described by phase portraits that can be readily computed from epidemiological models defined in terms of nonlinear dynamical systems. The paths are predicted by order parameters and amplitude equations that are well known in nonlinear physics and synergetics to exist at instability points. The approach is illustrated for SIR, SEIR and SEIAR models and epidemic outbreaks in China, Italy and West Africa. Identifying such COVID-19 order parameters may help in forecasting COVID-19 epidemics and predicting the impacts of intervention measures.
Numerical investigation on effect of internal flow on vortex-induced vibration dynamics of a full-scale mining riser
Authors: Duan Jin-Long , Wang Xu , Chen Ke
Published: April 2021

The dynamics of a full-scale pipe conveying fluid inside is investigated based on the finite element method (FEM). During the numerical simulation, the Euler–Bernoulli beam equations are used to model the motion of the full-scale pipe while the effect of internal flow is considered. And the semi-empirical time-domain model is applied to simulate the external hydrodynamic forces exerted on the pipe. Then the typical vortex-induced vibration (VIV) characteristics of the full-scale pipe considering both internal and external flows are analyzed. The results show that with the increase of the internal flow velocity, the natural frequencies of the full-scale pipe decrease and the in-line (IL) and cross-flow (CF) dominating modes are increased. Furthermore, the dominating frequencies in both IL and CF directions are not notably changed. And the IL and CF root-mean-square (RMS) values of amplitudes fluctuate at around the stable values due to the stable external hydrodynamic forces. It should be noticed that the IL and CF RMS strain values of the full-scale pipe are increased, especially for high external and internal flow velocities. The maximal RMS strain values in both IL and CF directions appear next to the pipe top, which could have an influence on the motion of the ship on the sea surface.
Type IV codes over a non-unital ring
Authors: Alahmadi Adel , Altassan Alaa , Basaffar Widyan , Shoaib Hatoon , Bonnecaze Alexis , Solé Patrick
Published: April 2021

There is a special local ring [Formula: see text] of order [Formula: see text] without identity for the multiplication, defined by [Formula: see text] We study the algebraic structure of linear codes over that non-commutative local ring, in particular their residue and torsion codes. We introduce the notion of quasi self-dual codes over [Formula: see text] and Type IV codes, that is quasi self-dual codes whose all codewords have even Hamming weight. We study the weight enumerators of these codes by means of invariant theory, and classify them in short lengths.
A FEATURE SELECTION-BASED ALGORITHM FOR DETECTION OF ATRIAL FIBRILLATION USING SHORT-TERM ECG
Authors: ZHU JUNJIANG , PU YU , HUANG HAO , WANG YUXUAN , LI XIAOLU , YAN TIANHONG
Published: April 2021

In the presence of premature atrial contraction (PAC), premature ventricular contraction (PVC) or other ectopic beats, RR intervals (RRIs) may be disturbed, which results in other types of heart disease being misdiagnosed as atrial fibrillation (AF). In this study, a low-complexity AF detection method based on short ECG is proposed, which includes RRIs modification and feature selection. The extracted RRIs are used to determine whether the potential RRI interference exists and to modify it. Next, based on the modified RRIs, the features are evaluated and selected by the methods of correlation criterion, Fisher criterion, and minimum redundancy maximum relevance criterion. Finally, filtered features are classified by the artificial neural network (ANN). The algorithm is validated in a test set including 2332 AF, 313 normal (NOR), 239 atrioventricular block (IAVB), 81 left bundle branch block (LBBB), 624 right bundle branch block (RBBB), 426 PAC and 564 PVC. Compared with the previous detection method of AF based on the RRIs, the proposed method achieved an overall sensitivity of 94.04% and an overall specificity of 86.74%. The specificity of the test set containing only AF and NOR is up to 99.04%. Meanwhile, the overall false-positive rate (FPR) of PAC and PVC can be reduced by 9.19%. While ensuring accuracy, this method effectively reduces the probability of misdiagnosis of PVC and PAC as AF. It is an automatic detection method of AF suitable for inter-patient clinical short-term ECG.
Periostin promotes arterial calcification through PPARγ-related glucose metabolism reprogramming
Authors: Zhu Yi , Ji Jing-Jing , Wang Xiao-Dong , Sun Xue-Jiao , Li Min , Wei Qin , Ren Li-Qun , Liu Nai-Feng
Published: April 2021

Periostin caused arterial calcification, overactivated glycolysis, and damaged OXPHOS. PPARγ agonists alleviated periostin-promoted arterial calcification and corrected abnormal glycolysis and unbalanced mitochondrial homeostasis. There exists a relationship between periostin and lactate in patients with CAC.
Pharmacological Activation of Nrf2 by Rosolic Acid Attenuates Endoplasmic Reticulum Stress in Endothelial Cells
Authors: Naresh Amin Karan , Rajagru Palanisamy , Sarkar Koustav , Ganesh M. R. , Suzuki Takayoshi , Ali Daoud , Kunka Mohanram Ramkumar
Published: April 2021

Endoplasmic reticulum (ER) plays a key role in the folding, modification, and trafficking of proteins. When the homeostasis of the ER is disturbed, un/misfolded proteins accumulate in the ER which leads to ER stress. Sustained ER stress results in apoptosis, which is associated with various diseases. Nuclear factor erythroid 2‐related factor 2 (Nrf2) is a major transcription factor in redox homeostasis by regulating various genes associated with detoxification and cell‐protective mechanisms. We found that Rosolic acid (RA) treatment dose‐dependently activates Nrf2 in endothelial cells using the enzyme fragment complementation assay. The cytoprotective role of RA against ER stress‐induced endothelial apoptosis and its molecular mechanism was explored in the present study. The Nrf2 and its target genes, as well as ER stress marker expressions, were measured by qPCR in ER stress‐exposed endothelial cells. The contribution of Nrf2 in RA‐mediated defense mechanism in endothelial cells was established by knockout studies using Nrf2‐CRISPR/Cas9. The treatment with RA to ER stress‐induced endothelial cells exhibited activation of Nrf2, as demonstrated by Nrf2 translocation and reduction of ER stress markers. We found that the Nrf2 knockout sensitized the endothelial cells against ER stress, and further, RA failed to mediate its cytoprotective effect. Proteomic studies using LC‐MS/MS revealed that among the 1370 proteins detected, we found 296 differentially regulated proteins in ER stress‐induced endothelial cells, and RA administration ameliorated 71 proteins towards the control levels. Of note, the ER stress in endothelial cells was attenuated by the treatment with the RA, suggesting the role of the Nrf2 activator in the pathological conditions of ER stress‐associated diseases.
The Evaluation of Online Education Course Performance Using Decision Tree Mining Algorithm
Authors: Yang Yongxian
Published: April 2021

With the continuous development of “Internet + Education”, online learning has become a hot topic of concern. Decision tree is an important technique for solving classification problems from a set of random and unordered data sets. Decision tree is not only an effective method to generate classifier from data set, but also an active research field in data mining technology. The decision tree mining algorithm can classify the data, grasp the teaching process of the teacher, and analyze the overall performance of the students, so as to realize the dynamic management of the educational administration and help the educational administration personnel to make the right decision, with more reasonable allocation of resources. This paper evaluates students’ academic performance based on the learning behavior data of online learning, so as to intervene in students’ learning in advance, which is the key problem that needs to be solved at present. Taking students’ learning attitude, completion of homework, and attendance as factors, the paper uses decision tree technology to analyze the factors affecting students’ performance, and evaluates students’ performance. Firstly, this paper collects the high‐dimensional behavioral characteristic data of students’ online learning and conducts correlation analysis after preprocessing the behavioral characteristic data. Then, the decision tree C4.5 algorithm is used to construct a performance evaluation model. Students’ performance is evaluated by the model, and the evaluation accuracy is about 88% compared with actual performance. Finally, through the model analysis, it is concluded that the video task point completion is the most influential in students’ achievement, followed by chapter test completion and chapter test average score, and the course interaction amount and homework average score are the least influential in students’ achievement, which has a practical reference value for effectively serving online learning and teachers’ teaching.
Coronary Vessel Segmentation by Coarse‐to‐Fine Strategy Using U‐nets
Authors: Thuy Le Nhi Lam , Trinh Tan Dat , Anh Le Hoang , Kim Jin Young , Hieu Huynh Trung , Bao Pham The
Published: April 2021

Each level of the coronary artery has different sizes and properties. The primary coronary arteries usually have high contrast to the background, while the secondary coronary arteries have low contrast to the background and thin structures. Furthermore, several small vessels are disconnected or broken up vascular segments. It is a challenging task to use a single model to segment all coronary artery sizes. To overcome this problem, we propose a novel segmenting method for coronary artery extraction from angiograms based on the primary and secondary coronary artery. Our method is a coarse‐to‐fine strategic approach for extracting coronary arteries in many different sizes. We construct the first U‐net model to segment the main coronary artery extraction and build a new algorithm to determine the junctions of the main coronary artery with the secondary coronary artery. Using these junctions, we determine regions of the secondary coronary arteries (rectangular regions) for a secondary coronary artery‐extracted segment with the second U‐net model. The experiment result is 76.40% in terms of Dice coefficient on coronary X‐ray datasets. The proposed approach presents its potential in coronary vessel segmentation.
Isoparametric Element Analysis of Two‐Dimensional Unsaturated Transient Seepage
Authors: Luo Yang , Liu Yuan , Wang Juanjuan
Published: April 2021

A FEM for unsaturated transient seepage is established by using a quadrilateral isoparametric element, considering the fact that the main permeability does not coincide with the axis situation. It creates a function by using the element’s node hydraulic head and shape function instead of the real head in the Richard seepage control equation. With the help of the Galerkin weighted residual method, a FEM equation is given for analyzing 2‐dimensional transient seepage problem. Further, based on the Jacobi matrix and Gauss numerical integral, it determines the elements of stiffness and capacitance matrices. This FEM equation considers not only the anisotropic of soil but also the uncoincidence between permeability and the axis. It is a common form of transient seepage. In the end, two examples illustrate the node accuracy of the quadrilateral element and the correctness of this FEM equation.