bluuebunny/crossref_metadata_2025 huggingface dataset:
Materials‐in‐Action: Pedagogical Ergonomics of a French‐as‐a‐Foreign‐Language Classroom
Authors: GUERRETTAZ ANNE MARIE
Published: March 2021

Materials use is a critical yet poorly understood dynamic of language classrooms. This study examines ‘materials‐in‐action,’ meaning how materials shape classroom interaction and activity, in a beginning‐level French‐as‐a‐foreign‐language classroom. The conceptual framework, ‘pedagogical ergonomics,’ similarly centers on materials‐in‐action, and more specifically on ‘intra‐action.’ This refers to actions, influences, engagements, and exchanges among (a) materials, and (b) the students and teacher. Polysemiotic analyses and action analyses of classroom activity were triangulated with interviews and focus groups. Findings first expound the pedagogical ergonomics framework as comprising intra‐actions among human and material ‘actants’ that are co‐substantiated with sociocultural and physical space. This involves the concept of ‘classroomscape.’ Then—drawing on pedagogical ergonomics—macro‐level analyses of materials‐in‐action reveal 4 genres of materials use, each of which influenced classroom activity and interaction differently. Additionally, micro‐level analysis reveals 3 polysemiotic patterns of materials‐in‐action: (a) cloze worksheet prompts that ‘mapped’ onto the students, (b) learners’ ‘snowball languaging’ in French—involving extended meaning‐focused descriptions of images—and (c) a physically dynamic information gap where students unexpectedly avoided using French. Additionally, this article hones the definition of ‘materials use,’ substantively focusing on activity and interaction. Theory and practice converge in pedagogical ergonomics, with implications for both.
Ultrasonographically guided percutaneous transhepatic liver biopsy after pediatric liver transplantation
Authors: Sanada Yukihiro , Sakuma Yasunaru , Onishi Yasuharu , Okada Noriki , Yamada Naoya , Hirata Yuta , Miyahara Go , Katano Takumi , Horiuchi Toshio , Omameuda Takahiko , Ogaki Keiko , Otomo Shinya , Lefor Alan Kawarai , Sata Naohiro
Published: March 2021

Background

Complications associated with ultrasonographically guided percutaneous transhepatic liver biopsy (PTLB) after liver transplantation (LT) have been rarely reported, and there is no consensus about its safety. We retrospectively reviewed the safety and outcomes of PTLB after pediatric LT.

Methods

Between January 2008 and December 2019, 8/1122 (0.71%) pediatric patients who underwent ultrasonographically guided PTLB after LT developed complications. The median age at PTLB was 7.8 years (range 0.1–17.9). Grafts included left lobe/left lateral segment in 1050 patients and others in 72. PTLB was performed using local anesthesia±sedation in 1028 patients and general anesthesia in 94.

Results

Complications after PTLB included acute cholangitis in 3 patients, sepsis in 2, respiratory failure due to over‐sedation in 1, subcapsular hematoma in 1, and intrahepatic arterioportal fistula in 1. The incidence of complications of PTLB in patients with biopsy alone and those with simultaneous interventions was 0.49% and 3.19%, respectively (p = .023). Patients who developed acute cholangitis, respiratory failure, subcapsular hematoma, and arterioportal fistula improved with non‐operative management. Of two patients with sepsis, one underwent PTLB and percutaneous transhepatic portal vein balloon dilatation and developed fever and seizures the following day. Sepsis was treated with antibiotic therapy. Another patient who underwent PTLB and exchange of percutaneous transhepatic biliary drainage catheter developed fever and impaired consciousness immediately. Sepsis was treated with antibiotic therapy, mechanical ventilation, and continuous hemofiltration.

Conclusions

Percutaneous transhepatic liver biopsy after pediatric LT is safe. However, combining liver biopsy with simultaneous procedures for vascular and biliary complications is associated with an increased risk of complications.
Agency, Causation, and Empiricism
Authors: Beni Majid D.
Published: March 2021

Price claims that the agency theory of causation could be understood as a sophisticated form of either realism or empiricism (but not a simple‐minded form of any of them). In this paper, I argue that the agency theory could find a more congenial ally in constructive empiricism (rather than realism) and show that this new alliance would be profitable to both constructive empiricism and the agency theory of causation.
Evaluation of equine corneal disease using ultrasound biomicroscopy
Authors: Keenan Alessandra V. , Townsend Wendy M.
Published: March 2021

Objective

To describe the clinical use of ultrasound biomicroscopy (UBM) to evaluate equine corneal disease.

Methods

Images were obtained using a 50‐MHz probe ultrasound biomicroscopy system (Quantel Aviso) and Clear Scan® probe cover. Six horses with corneal disease were evaluated via UBM for lesion size, lesion depth, and continuity of Descemet's membrane. Horses were sedated and received auriculopalpebral nerve blocks and application of topical anesthetic prior to UBM.

Results

Ultrasound biomicroscopy was easily performed in all cases. UBM evaluation of three cases of corneo‐limbal squamous cell carcinoma yielded information regarding lesion depth for planning of keratectomies using fixed‐depth keratomes and subsequent β‐radiation therapy. Corneal depth and continuity of Descemet's membrane were determined in two horses with stromal abscesses and allowed for planning of therapeutic options. In one horse with a corneal foreign body, UBM contributed to accurate assessment of the foreign body's stromal depth, which could not be assessed during ophthalmic examination due to extensive corneal cellular infiltrate. The information regarding corneal depth allowed for more accurate pre‐surgical planning in patients with opaque corneal lesions.

Conclusions

Ultrasound biomicroscopy was easily performed and provided useful information regarding lesion depth and continuity of Descemet's membrane for patients with corneo‐limbal squamous cell carcinoma, stromal abscesses, and a corneal foreign body, allowing for increased precision in pre‐surgical planning and development of therapeutic protocols.
On the Collapse of a Hemispherical Cavity Seated on a Surface
Authors: Oza Hasmukh P.
Published: March 2021

From a study of cavitation, the author has worked out the independent theory outlined in the paper. An idealized problem is demonstrated, in which a small hemispherical cavity, with vacuum inside, in a semi-infinite mass of homogeneous incompressible fluid acted upon by no body forces, the pressure at infinity being supposed constant, is seated at rest on a solid infinite plane surface: To investigate the motion.
Problems in the Mechanical Design of Gas Turbines
Authors: Smith Ronald B.
Published: March 2021

High temperatures involved in the operation of the gas turbine have introduced many new problems in the properties of the metals with which the designer has to work. This paper outlines some of these and offers a line of approach taken successfully by the author’s company in solving them.
The Optical Investigation of Fluid Flow
Authors: Weller R.
Published: March 2021

This paper points out that the methods of photoelastic stress analysis can be carried over to the study of the flow of fluids by making use of the double refraction developed in viscous shear. The effect is referred to as the “photoviscous effect.” Suitable liquids are tabulated, the method of calibration is described, and qualitative results are shown for a few simple conditions obtained in an experimental liquid tunnel.
Combined-Stress Tests on 24S-T Aluminum-Alloy Tubes
Authors: Osgood W. R.
Published: March 2021

Combined-stress tests were made on five 24S-T aluminum-alloy tubes, 1 3/4 in. ID × 0.05 in. thick. The ratios of circumferential (hoop) stress to axial stress were 0, 1/2, 1, 2, and ∞. The tubes were tested to failure and sufficient measurements of circumferential strain and axial strain were taken to plot stress-strain curves almost up to rupture. The results are presented in the form of two sets of stress-strain curves for each ratio of stresses, namely, maximum shearing stress plotted against maximum shearing strain, and octahedral shearing stress plotted against octahedral shearing strain. In each plot the maximum deviation of the curves is about ± 5 per cent. A method of evaluating small octahedral shearing strains from the data is given which does not assume Poisson’s ratio to be 1/2.
The Calculated Performance of Dynamically Loaded Sleeve Bearings
Authors: Burwell J. T.
Published: March 2021

The general equations for the film pressure and load capacity of a dynamically loaded sleeve bearing which have been derived by Harrison (1) and Swift (2) are discussed. Conclusions about the performance of the bearing under constant load, constant rotating load, and periodic alternating load of various frequencies as well as cases where the shaft is not rotating are drawn. A method is developed, based upon these equations, for analyzing any dynamically loaded bearing whose polar load diagram is known, and the method is applied to two actual bearings as examples, namely, a Diesel-engine connecting-rod bearing, and a radial-aircraft-engine master-rod bearing. It is shown that the results of these calculations can be simply generalized to apply to bearings under all other operating conditions, provided only that the shape of the load-versus-time curve remains unchanged.
A Concentrated Force Problem of Plane Strain or Plane Stress
Authors: Green A. E.
Published: March 2021

The problem in plane strain or plane stress of a large plate containing an elliptical hole, which is loaded by line forces at the ends of the minor axis of the ellipse, is solved in closed form by using complex variable analysis.
A Numerical Solution for the Torsion of Hollow Sections
Authors: Colin E. C. , Newmark N. M.
Published: March 2021

This paper describes a numerical method for solving directly the problem of the torsion of a bar of constant cross section having one or more internal longitudinal holes. The method involves the use of finite differences and can be used with either the iteration procedure due to Liebmann (1), or the relaxation procedure attributed to Southwell (2). The method avoids the necessity of combining a number of separate solutions since it establishes the necessary conditions around the hole by a special condition which amounts in general to treating the entire hole as a single point in a network, and determining the elevation of this point (i.e., the elevation of the stress function for torsion at the boundary of the hole) by a relation similar in form to that used for regular points of the network. The calculations by this method appear to converge at least as rapidly as for a section without a hole.
A Circle Intersection Method for Bi-Objective Optimization
Authors: Zhou Jianhua , Li Mian , Fu Xiaojin
Published: March 2021

Multi-objective optimization (MOO) problems are encountered in many applications, of which bi-objective problems are frequently met. Despite the computational efforts, the quality of the Pareto front is also a considerable issue. An evenly distributed Pareto front is desirable in certain cases when a continuous representation of the Pareto front is needed. In this paper, a new approach called circle intersection (CI) is proposed. First, the anchor points are computed. Then in the normalized objective space, a circle with a proper radius of r centering at one of the anchor points or the latest obtained Pareto point is drawn. Interestingly, the intersection of the circle and the feasible boundary can be determined whether it is a Pareto point or not. For a convex or concave feasible boundary, the intersection is exactly the Pareto point, while for other cases, the intersection can provide useful information for searching the true Pareto point even if it is not a Pareto point. A novel MOO formulation is proposed for CI correspondingly. Sixteen examples are used to demonstrate the applicability of the proposed method and results are compared to those of normalized normal constraint (NNC), multi-objective grasshopper optimization algorithm (MOGOA), and non-dominated sorting genetic algorithm (NSGA-II). Computational results show that the proposed CI method is able to obtain a well-distributed Pareto front with a better quality or with less computational cost.
An Energy-Based Framework for Nonlinear Kinetostatic Modeling of Compliant Mechanisms Utilizing Beam Flexures
Authors: Chen Guimin , Ma Fulei , Bai Ruiyu , Zhu Weidong , Magleby Spencer P. , Howell Larry L.
Published: March 2021

Although energy-based methods have advantages over the Newtonian methods for kinetostatic modeling, the geometric nonlinearities inherent in deflections of compliant mechanisms preclude most of the energy-based theorems. Castigliano’s first theorem and the Crotti–Engesser theorem, which do not require the problem being solved to be linear, are selected to construct the energy-based kinetostatic modeling framework for compliant mechanisms in this work. Utilization of these two theorems requires explicitly formulating the strain energy in terms of deflections and the complementary strain energy in terms of loads, which are derived based on the beam constraint model. The kinetostatic modeling of two compliant mechanisms are provided to demonstrate the effectiveness of the explicit formulations in this framework derived from Castigliano’s first theorem and the Crotti–Engesser theorem.
Stress Corrections After Necking Using a Two-Parameter Equation for the Radius of Curvature
Authors: Lu Feng , Mánik Tomáš , Holmedal Bjørn
Published: March 2021

Uniaxial tensile tests were conducted at room temperature, 100 °C and 150 °C, for obtaining necking-corrected stress–strain curves until fracture. The necking correction is based on specimen contours estimated from images recorded during testing. Axisymmetric tensile specimens of an AA6082 alloy artificially aged at different times were tested. The radius of the minimal cross-section area and the necking-curvature radius R were experimentally obtained. For all cases, a/R as a function of the strain after the onset of necking ɛ − ɛu shows a characteristic nonlinear transition into a linear asymptotic relationship. Based on the tests, a new two-parameter curve was proposed for the a/R relationship. The slope of the linear part of the new model equals 1.1, as in the Le Roy model. An additional parameter is introduced, which controls the part of the curve with the nonlinear transition. This region increases at increased testing temperature and varies for different aging times. The proposed equation and the necking corrections were verified by finite element modeling analysis.
Electrical-Driven Delamination of Flexible Piezoelectric System and Its Applications in Surface Energy Testing
Authors: Qi Luqiao , Shi Yan , Hunag Cheng , Li Zhi , Gao Cun-Fa
Published: March 2021

In the present work, a novel experiment for the flexible piezoelectric system was introduced. The flexible piezoelectric film was spontaneously in contact with the soft substrate conformably. After driven by the pure electrical load, the delamination between the film substrate systems can be observed visually. By thoroughly analyzing and eliminating the influence of gravity, the “force” that prevents the delamination points to the effect of surface energy. Apparently, the deformation of the flexible film is quite small, and a linear constitutive model still dominates the mechanics of the system in this scenario. Moreover, different from the traditional piezoelectric system, the Maxwell stress cannot be neglected in the current experiment. A simple mechanics model is derived in this study to reveal the mechanism behind the experiment.
Mobility of Alpha-Actinin Along Growing Actin Filaments Might Affect the Cellular Chirality
Authors: Li Xi , Chen Bin
Published: March 2021

Chirality is a widespread feature existing in nature and can be critical in the proper functions of some organisms. In our previous work, a rotational clutch-filament model for a radial fiber was built to reveal the critical role of α-actinin in the cellular chiral swirling. Here, we assume two mobility modes of α-actinin along actin filaments. In Mode A, where α-actinin concomitantly moves together with a growing filament, our model analysis suggests that cells cannot swirl clockwise; in Mode B, where α-actinin is fixed along the axial direction of the radial fiber instead, our model analysis suggests that both counter-clockwise and clockwise chiral swirling occur, consistent with experiments. Thus, our studies suggest that how α-actinin moves along growing filaments within a radial fiber would strongly affect cellular swirling. In addition, the previous rotational clutch-model has been improved by considering the elastic response of a radial fiber to a torque and distributed biomechanical properties of varied cell phenotype.
Down-Hole Directional Drilling Dynamics Modeling Based on a Hybrid Modeling Method With Model Order Reduction
Authors: Ke Chong , Song Xingyong
Published: March 2021

This paper presents a dynamics model for the down-hole directional drilling system based on a hybrid modeling method with model order reduction. Due to the long dimension of the drill string, a drilling model purely based on numerical methods such as the finite element method (FEM) may require a large number of meshes, which induces high computational intensity. By using a hybrid method combining FEM and the transfer matrix method (TMM), the order of the model can be significantly reduced. To further reduce the modeling order, a proper orthogonal decomposition (POD)-Galerkin projection-based approach is applied, and a set of linear normal modes (LNMs) are identified to create a reduced-order projection subspace. To this end, simulation results are presented to prove that the method can effectively capture the dominant modes of the drilling dynamics, and a computationally efficient and high fidelity reduced-order hybrid model can be reached for real-time state estimation and control design.
In-School, Out-of-School, and Weekend Physical Activity Levels Vary Across Sociodemographic Subgroups of US Adolescents
Authors: Johnson Ashleigh M. , Gabriel Kelley Pettee , Ranjit Nalini , Kohl Harold W. , Springer Andrew E.
Published: March 2021

Background: In response to conflicting findings for activity levels across sociodemographic groups, this study examined differences in adolescents’ in-school, out-of-school, and weekend physical activity (PA) by sociodemographic subgroups using representative US data. Methods: Data were obtained from the Family Life, Activity, Sun, Health, and Eating study. Multiple regression models compared in-school, out-of-school, and weekend PA by gender and race/ethnicity, and examined potential modification of associations by grade (middle vs high school) and socioeconomic status (lower vs higher). Results: Final analytic sample was 1413 adolescents (Mean age = 14.5 y, 51.3% female, 64.5% white). Compared with whites, in-school PA was significantly higher among blacks and those classified as other race/ethnicity for middle school (69.8 and 71.0, respectively, vs 66.4 min/d), and among Hispanics for high school (52.7 vs 48.4 min/d). Hispanics’ (vs whites’) out-of-school PA was significantly lower for middle school (63.7 vs 66.6 min/d), but higher for high school (54.0 vs 51.8 min/d). In-school PA was significantly higher among adolescents of lower (vs higher) socioeconomic status among males and Hispanics (all Ps < .05). Conclusions: The relation of race/ethnicity with PA varies by grade and time of day/week. Socioeconomic status findings contradict previously reported findings. Efforts to increase PA based on sociodemographic disparities should consider potential interaction effects.
Ownership in European Soccer, Financial Fair Play, and Performance in UEFA’s 2006–2018 Champions League Tournaments
Authors: Jakar Gidon , Gerretsen Stephanie
Published: March 2021

European soccer clubs have different ownership models, some of which are still dependent on or controlled by the public sector. The authors investigate club performance in the 2006–2018 Union of European Football Associations’ Champions League seasons, using a random-effects and ordered logistic model, to identify how different ownerships are associated with performance and what other factors, such as Financial Fair Play, determine the likelihood of European soccer clubs progressing through the tournament and increasing their revenues. The private ownership structure is statistically significant and positively associated with the probability of qualifying for later rounds in the Champions League and consequently leading to increased revenues. These results, however, vary before and after Financial Fair Play was implemented. It is apparent that the objective to implement a policy designed to increase competitiveness requires a more in-depth approach than Financial Fair Play as wealthier clubs, despite their ownership model, are more likely to be more successful and widen the gap.
A Primer on Content Knowledge in Physical Education Research
Authors: Hastie Peter A.
Published: March 2021

This paper presents a summary of the research on teacher (and preservice teacher) content knowledge within physical education teaching and teacher education. It is organized around the key terms that are predominant in the literature of this field, namely, content knowledge, common content knowledge, and specialized content knowledge. Each of the studies and their key findings are presented within tables. The result is a document that serves as a primer, allowing readers a good understanding of the vocabulary of the field, as well as knowledge of the topics that have been researched to date.
Magnet tests kick off bid for net fusion energy
Authors: Clery Daniel
Published: March 2021

High-temperature superconductors are key to companies' planned compact reactors.
A call to arms
Authors: Service Robert F.
Published: March 2021

Researchers are testing an arsenal of weapons against the pandemic coronavirus.
Globally observed trends in mean and extreme river flow attributed to climate change
Authors: Gudmundsson Lukas , Boulange Julien , Do Hong X. , Gosling Simon N. , Grillakis Manolis G. , Koutroulis Aristeidis G. , Leonard Michael , Liu Junguo , Müller Schmied Hannes , Papadimitriou Lamprini , Pokhrel Yadu , Seneviratne Sonia I. , Satoh Yusuke , Thiery Wim , Westra Seth , Zhang Xuebin , Zhao Fang
Published: March 2021

Change of flow

Anthropogenic influence on climate has changed temperatures, precipitation, atmospheric circulation, and many other related physical processes, but has it changed river flow as well? Gudmundsson
et al.
analyzed thousands of time series of river flows and hydrological extremes across the globe and compared them with model simulations of the terrestrial water cycle (see the Perspective by Hall and Perdigão). They found that the observed trends can only be explained if the effects of climate change are included. Their analysis shows that human influence on climate has affected the magnitude of low, mean, and high river flows on a global scale.

Science
, this issue p.
1159
; see also p.
1096
Temperature controls carbon cycling and biological evolution in the ocean twilight zone
Authors: Boscolo-Galazzo Flavia , Crichton Katherine A. , Ridgwell Andy , Mawbey Elaine M. , Wade Bridget S. , Pearson Paul N.
Published: March 2021

Getting more pumped

It is thought that the ocean's biological carbon pump, the process that transfers organic matter from the surface to the deep ocean, should be sensitive to climate change because temperature controls photosynthesis and respiration rates. Boscolo-Galazzo
et al.
show that the efficiency of the biological carbon pump increased over the past 15 million years as the oceans cooled because of a reduction in the rate of the breakdown of sinking organic matter (see the Perspective by Bopp). The resulting redistribution of nutrients at depth could have affected plankton evolution and expanded the mesopelagic “twilight zone” ecosystem.

Science
, this issue p.
1148
; see also p.
1099
Chiral-induced spin selectivity enables a room-temperature spin light-emitting diode
Authors: Kim Young-Hoon , Zhai Yaxin , Lu Haipeng , Pan Xin , Xiao Chuanxiao , Gaulding E. Ashley , Harvey Steven P. , Berry Joseph J. , Vardeny Zeev Valy , Luther Joseph M. , Beard Matthew C.
Published: March 2021

Spin injection sans magnetism

Light-emitting diodes (LEDs) that emit circularly polarized light (spin-LEDs) have potential applications in in three-dimensional displays, bioencoding, and tomography. The requisite spin polarization of the charge carriers is usually achieved with ferromagnetic contacts and applied magnetic fields, but Kim
et al.
report on a room-temperature spin-LED that relies instead on a chiral-induced spin selectivity organic layer. This layer selectively injected spin-polarized holes into metal halide perovskite nanocrystals, where they radiatively recombined with unpolarized electrons with an efficiency of 2.6%.

Science
, this issue p.
1129
Recurrent deletions in the SARS-CoV-2 spike glycoprotein drive antibody escape
Authors: McCarthy Kevin R. , Rennick Linda J. , Nambulli Sham , Robinson-McCarthy Lindsey R. , Bain William G. , Haidar Ghady , Duprex W. Paul
Published: March 2021

Eluding detection

Influenza viruses evade immunity initiated by previous infection, which explains recurrent influenza pandemics. Unlike the error-prone RNA-dependent RNA polymerase of influenza, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and related viruses contain polymerases with proofreading activity. However, proofreading cannot correct deletions, which during a long-term persistent infection could result in the generation of viruses showing alteration of entire stretches of amino acids and the structures they form. McCarthy
et al.
identified an evolutionary signature defined by prevalent and recurrent deletions in the spike protein of SARS-CoV-2 at four antigenic sites. Deletion variants show human-to-human transmission of viruses with altered antigenicity.

Science
, this issue p.
1139
Synthesis of borophane polymorphs through hydrogenation of borophene
Authors: Li Qiucheng , Kolluru Venkata Surya Chaitanya , Rahn Matthew S. , Schwenker Eric , Li Shaowei , Hennig Richard G. , Darancet Pierre , Chan Maria K. Y. , Hersam Mark C.
Published: March 2021

Hydrogenating borophene

The two-dimensional material borophene, which is formed on silver surfaces, has a diverse polymorphism and is predicted to have unusual materials and electronic properties. However, it is highly unstable outside of ultrahigh vacuum conditions and oxidizes readily, which hampers exploration of its properties. Li
et al.
hydrogenated these materials with atomic hydrogen and showed that borophane has a lower local work function. This material is stable for days in air, and borophene can be recovered simply by thermally driving off the hydrogen.

Science
, this issue p.
1143
Deep Structure of the Lithosphere in the Central Tien Shan along the Son-Kul Magnetotelluric Sounding Profile
Authors: Rybin A. K. , Bataleva E. A. , Matiukov V. E. , Morozov Yu. A. , Nepeina K. S.
Published: March 2021

New results of a detailed study of the deep structure of the Central Tien Shan along the Son-Kul magnetotelluric (MT) profile crossing the Son-Kul Lake are reported. Based on the results of magnetotelluric data modeling, the regional and local geoelectric anomalies in the lithosphere are studied and their quantitative characteristics are given. Geological interpretation of the geoelectric cross-section was carried out, which supported the existing ideas about the block–hierarchical structure of the upper part of the Earth’s crust. This corresponds to the tectonophysical concepts of the sequential inserted subordination of large and smaller elements of the zone–block structure consisting of stable blocks and limiting mobile zones, which are distinguished by the high dislocation of the geological substrate. The integral pattern of the distribution and morphology of zones of high electrical conductivity in this segment of the Central Tien Shan crust may reflect discretely localized palm tree–type structures associated with the evolution of transgressive suture zones of localized deformation during the Hercynian and Alpine tectogenesis.
Two-year add-on effect of using low concentration atropine in poor responders of orthokeratology in myopic children
Authors: Chen Zhi , Zhou Jiaqi , Xue Feng , Qu Xiaomei , Zhou Xingtao
Published: March 2021

Methods

Axial elongation in 73 eyes of 73 subjects who completed 3 years of orthokeratology (ortho-k) treatment was retrospectively reviewed. During their first year of ortho-k treatment (phase 1), they all demonstrated an axial elongation of 0.30 mm or greater. They were then divided into two groups: orthokeratology and atropine (OKA) group (n=37) being treated with nightly 0.01% atropine in addition to ortho-k treatment for another 2 years and orthokeratology (OK) group (n=36) continued to be treated with ortho-k without atropine (phase 2). Axial elongation over time and between groups was compared.

Results

Baseline biometrics was similar between the two groups in phase 1 (all p>0.05). The mean axial elongation was 0.47±0.15, 0.21±0.15, 0.23±0.13 mm for the OKA group and 0.41±0.09, 0.30±0.11, 0.20±0.13 mm for the OK group during the first, second and third year, respectively. The cumulative axial elongation over 3 years was 0.91±0.30 mm for the OKA group and 0.91±0.24 mm for the OK group. The overall AL change was not significantly different between the two groups (p=0.262). Baseline myopic refractive error had a significant impact on axial elongation over 3 years of treatment (p<0.001). None of baseline age (p=0.129), lens design (p=0.890) or treatment modality (p=0.579) had a significant impact on axial elongation.

Conclusions

For fast myopia progressors and poor responders of ortho-k, combining 0.01% nightly atropine did not significantly change the3-year axial elongation outcome as compared to ortho-k mono-therapy.
Home-based exercise in patients with refractory fatigue associated with primary biliary cholangitis: a protocol for the EXerCise Intervention in cholesTatic LivEr Disease (EXCITED) feasibility trial
Authors: Freer Alice , Williams Felicity , Durman Simon , Hayden Jennifer , Trivedi Palak J , Armstrong Matthew J
Published: March 2021

Introduction

Fatigue is the most commonly reported symptom of the liver disease primary biliary cholangitis (PBC). It affects 40%–80% of patients, has no effective treatment and is associated with heightened mortality risk. The pathogenesis is unknown, but muscle bioenergetic abnormalities have been proposed to contribute. Directly observed exercise has been shown to attenuate symptoms in small groups; however, due to the rare nature of the disease, home-based interventions need to be evaluated for feasibility, safety and efficacy.

Methods and analysis

This is a phase 1/pilot, single-arm, open-label clinical trial evaluating a novel home-based exercise programme in patients with PBC with severe fatigue. Forty patients with moderate-severe fatigue (PBC40 fatigue domain score >33; other causes of fatigue excluded) will be selected using a convenience sampling method. A 12-week home-based exercise programme, consisting of individualised resistance, aerobic exercises and telephone health calls (first 6 weeks only), will be delivered. Measures of fatigue (PBC40 fatigue domain; fatigue impact scale), quality of life, sleep (Epworth Sleep Score), physical activity, anxiety and depression, aerobic exercise capacity (incremental shuttle walk test; Duke Activity Status Index) and functional capacity (short physical performance battery) will be assessed at baseline and at 6 and 12 weeks following the intervention.

Ethics and dissemination

The protocol is approved by the National Research Ethics Service Committee London (IRAS 253115). Recruitment commenced in April 2019 and ended in March 2020. Participant follow-up is due to finish by December 2020. Findings will be disseminated through peer-reviewed publication, conference presentation and social media.

Trial registration number

NCT04265235.
Implementation of a nutrition screening tool to improve nutritional status of children with cancer in Singapore’s largest paediatric hospital
Authors: Han Wee Meng , Koo Jasly YS , Lim Yan Yin , Iyer Prasad , Ong Chengsi , Tong Jasper WK , Chan Mei Yoke
Published: March 2021

Poor nutritional status in children with cancer can impact treatment outcomes and mortality. Nutrition screening is a simple yet effective approach to identify malnutrition risk for early intervention. We aim to improve the identification of children with cancer at high risk of malnutrition, so that nutritional intervention and rehabilitation can commence early for these children. Our multidisciplinary team conducted a root cause analysis and concluded that the generic screening tool did not differentiate malnutrition risk for different cancer types, stage and intensity of treatment. Hence, a screening tool that considered the identified factors was tested for reliability and validity first. Subsequently, we used the Plan, Do, Study, Act model with two improvement cycles to put in place a systematic process to facilitate the implementation. The interventions included (1) instituting the tool in the electronic medical records and (2) direct referral to dietitian based on screening score.

We compared pre- and post-implementation cohorts and demonstrated better identification of nutritionally at-risk patients (36.4%–85.7%, p<0.001) with the new tool as well as improved timeliness of nutritional intervention (3 days to 1 day from admission, p=0.010). A lower malnutrition rate (17.4%–6.5%, p<0.001) in the postimplementation cohort was also demonstrated. Nutritional intervention within 48 hours of admission led to an overall positive weight change at 3 months (+2.68%, IQR: −1.14 to 9.09 vs −0.43%, −6.60 to 2.29; p=0.036) in the malnourished patients from both cohorts. Further studies will be conducted to evaluate the scale of the effectiveness of early intervention and close nutritional monitoring, in improving the nutritional status of children with cancer. The collaborative partnership among the doctors, nurses and dietitians has helped to streamline and simplify nutrition screening, making it an efficient and sustainable system in our hospital.
Large decrease in paediatric hospitalisations during the COVID-19 outbreak in Japan
Authors: Sano Kazuaki , Nakamura Masaki , Ninomiya Hideki , Kobayashi Yasuki , Miyawaki Atsushi
Published: March 2021

We evaluated the nationwide trends in paediatric hospitalisations including non-emergency hospitalisations during the COVID-19 pandemic in Japan. Using inpatient data from 272 acute-care hospitals covering 12.4% of total hospitalisations of all ages, we analysed the number of hospitalisations of children (aged 1–17 years) for weeks 9–21 of 2020 (during the outbreak) versus 2017–2019. Hospitalisation decreased during the outbreak by 38.4% (adjusted incidence rate ratio, 0.60; 95% CI, 0.53 to 0.69). There were reductions in communicable diseases and trauma, possibly through non-pharmaceutical interventions, but not in appendicitis. This study highlights the potential importance of reallocating paediatric care resources during the pandemic.
Lower medial hamstring activity after ACL reconstruction during running: a cross-sectional study
Authors: Einarsson Einar , Thomson Athol , Sas Bart , Hansen CLint , Gislason Magnus , Whiteley Rodney
Published: March 2021

Objective

Anterior cruciate ligament reconstruction (ACLR) predisposes footballers for subsequent ACL and hamstring (HS) injury. This case series examines HS muscle activation patterns during the running in ACLR patients (bone-patellar tendon-bone (BTB) and (HS) graft) after completion of functional criteria allowing return to training.

Methods

Electromyography (EMG) recorded from medial and lateral HS bilaterally during treadmill running (12, 14 and 16 km/hour) from 21 male ACLR patients on average 7 months from surgery (5-9) that underwent (HS) (n=12) or BTB reconstruction (n=9) were compared with 19 healthy runners. Main outcome measures: EMG signal was normalised to peak during the running. Pairwise comparisons were made for each muscle group examining stance and swing activation for mean and peak EMG for each patient group and leg.

Results

Significantly lower relative peak activation in stance (not swing) phase for medial HS was seen for all conditions with effect sizes ranging from −0.63 (controls, BTB non-injured leg) to −1.09 (HS injured). For lateral HS only BTB injured were significantly lower in stance phase (−1.05)

Conclusion

ACLR patients show neuromuscular alterations during different phases of running. The finding of reduced medial HS activity in stance phase might have implications for knee instability and HS muscle injury on resumption of sport.
Incidence, predictors and mortality risk of new heart failure in patients hospitalised with atrial fibrillation
Authors: Weber Courtney , Hung Joseph , Hickling Siobhan , Nedkoff Lee , Murray Kevin , Li Ian , Briffa Tom G
Published: March 2021

Objective

To determine the incidence, risk predictors and relative mortality risk of incident heart failure (HF) in patients following atrial fibrillation (AF) hospitalisation.

Methods

The Western Australian Hospitalisation Morbidity Data Collection was used to identify patients aged 25–94 years with index (first-in-period) AF hospitalisation, but without a prior HF admission, between 2000 and 2013. We evaluated the risk of incident HF hospitalisation within 3 years after AF admission, and the impact of HF hospitalisation on all-cause mortality.

Results

The cohort comprised 52 447 patients, 57.5% men, with a median age of 73.1 (IQR 63.2-80.8) years. At 3 years after AF discharge, the cumulative incidence of HF (n=6153) was 11.7% (95% CI 11.5% to 12.0%) and all-cause death (n=9702) was 18.5% (95% CI 18.2% to 18.8%). Independent predictors of incident HF included advancing age, any history of myocardial infarction (MI), peripheral vascular disease, valvular heart disease, chronic kidney disease, chronic obstructive pulmonary disease, hypertension, diabetes, obesity and excessive alcohol use (all p<0.001). Patients hospitalised for first-ever HF compared with those without HF hospitalisation had an adjusted HR of 3.3 (95% CI 3.1 to 3.4) for all-cause mortality (p<0.001). Independent predictors of HF were also shared with those for mortality, with the exception of hypertension.

Conclusion

Hospitalisation for new HF is common in patients with AF and independently associated with a 3-fold hazard for death. The clinical predictors of incident HF emphasise the importance of integrated management of common comorbid conditions and lifestyle risk factors in patients with AF to reduce their morbidity and mortality.
Letter to the editor: Hypoxia kinetics and histology in combined radiotherapy and oxidative phosphorylation inhibition effects on antitumor immunity
Authors: Boreel Daan F , Span Paul N , Bussink Johan
Published: March 2021

In response to the recent paper by Chen et al investigating the triple combination of oxidative phosphorylation inhibition, immunotherapy and radiotherapy, we would like to stress that after irradiation, a strong reduction in hypoxia (within 24 hours) can be followed by a strong increase (several days). This is especially the case with larger fraction sizes of radiation therapy, which are often applied in combination with immunotherapy, and is likely to be tumor dependent. All together this may strongly affect the synergistic effect of such a triple combination therapy.
Host response to immune checkpoint inhibitors contributes to tumor aggressiveness
Authors: Khononov Irina , Jacob Eyal , Fremder Ella , Dahan Nili , Harel Michal , Raviv Ziv , Krastev Boris , Shaked Yuval
Published: March 2021

Background

Immune checkpoint inhibitors (ICIs) have made a paradigm shift in clinical oncology due to unprecedented long-term remissions. However, only a small proportion of patients respond to ICI therapy. It is, therefore, essential to understand the mechanisms driving therapy resistance and to develop strategies for increasing response rates. We previously demonstrated that in response to various cancer treatment modalities, the host activates a range of biological processes that promote tumor regrowth and metastasis. Here, we characterize the host-mediated response to ICI therapy, and investigate its contribution to therapy resistance.

Methods

Tumor cell migration, invasion and motility were assessed in the presence of plasma from ICI-treated mice and patients. Immune cell composition in peripheral blood and tumors of ICI-treated mice was assessed by flow and mass cytometry. Plasma host factors driving tumor aggressiveness were identified by proteomic profiling, followed by bioinformatic analysis. The therapeutic effect of inhibiting host-mediated processes in ICI-treated mice was assessed in a tumor model.

Results

Tumor cells exhibit enhanced migratory and invasive properties in vitro on exposure to plasma from anti-PD1-treated mice. Moreover, mice intravenously injected with plasma-exposed tumor cells display increased metastatic burden and mortality rate in comparison to control arms. Furthermore, tumors from anti-PD1-treated mice as well as Matrigel plugs containing plasma from anti-PD1-treated mice are highly infiltrated with immune cell types associated with both antitumor and protumor activity. These collective findings suggest that anti-PD1 treatment induces a systemic host response that potentially counteracts the drug’s therapeutic activity. Proteomic profiling of plasma from anti-PD1-treated mice reveals an activation of multiple biological pathways associated with tumor aggressiveness. Consequently, blocking IL-6, one of the key drivers of the identified biological pathways, counteracts ICI-induced metastatic properties in vitro and improves ICI treatment efficacy in vivo. Lastly, plasma samples from ICI-treated non-small cell lung cancer patients differentially affect tumor cell aggressiveness in vitro, with enhanced tumor cell motility correlating with a worse clinical outcome.

Conclusions

ICI therapy induces host-mediated processes that contribute to therapy resistance. Identification and analysis of such processes may lead to the discovery of biomarkers for clinical response and strategies for overcoming therapy resistance.
Interrogation of the cellular immunome of cancer patients with regard to the COVID-19 pandemic
Authors: Donahue Renee N , Marté Jennifer L , Goswami Meghali , Toney Nicole J , Tsai Yo-Ting , Gulley James L , Schlom Jeffrey
Published: March 2021

While vaccines directed against the SARS-CoV-2 spike protein will have varying degrees of effectiveness in preventing SARS-CoV-2 infections, the severity of infection will be determined by multiple host factors including the ability of immune cells to lyse virus-infected cells. This review will discuss the complexity of both adaptive and innate immunomes and how a flow-based assay can detect up to 158 distinct cell subsets in the periphery. This assay has been employed to show the effect of age on differences in specific immune cell subsets, and the differences in the immunome between healthy donors and age-matched cancer patients. Also reviewed are the numerous soluble factors, in addition to cytokines, that may vary in the pathogenesis of SARS-CoV-2 infections and may also be employed to help define the effectiveness of a given vaccine or other antiviral agents. Various steroids have been employed in the management of autoimmune adverse events in cancer patients receiving immunotherapeutics and may be employed in the management of SARS-CoV-2 infections. The influence of steroids on multiple immune cells subsets will also be discussed.
Canadian perspective on ageism and selective lockdown: a response to Savulescu and Cameron
Authors: Nix Hayden P
Published: March 2021

In a recent article, ‘Why lockdown of the elderly is not ageist and why levelling down equality is wrong’, Savulescu and Cameron argue that a selective lockdown of older people is not ageist because it would treat people unequally based on morally relevant differences. This response argues that a selective lockdown of older people living in long-term care homes would be unjust because it would allow the expansive liberties of the general public to undermine the basic liberties of older people, and because it would discriminate on the basis of extrinsic disadvantages.
Prevalence of heated tobacco product use in Japan: the 2020 JASTIS study
Authors: Odani Satomi , Tabuchi Takahiro
Published: March 2021

Background

Japan is the leading market for heated tobacco products (HTPs). We assessed the latest prevalence of HTP use including novel products (Ploom S, glo sens, and Pulze).

Methods

Data were obtained from an internet-based, self-reported survey conducted during February-March 2020 with individuals aged 15–74 years in Japan(n=9044). Prevalence of current (past 30-day) HTP use and cigarette smoking was computed. Poison regression analysis was conducted to examine predictors of HTP use among current cigarette smokers (n=1478). All analyses were weighted to account for selection bias in the internet survey using a nationally representative sample of Japanese population.

Results

In 2020, prevalence of current HTP use and cigarette smoking was 10.9% and 25.9% in Japan, respectively. The most commonly used HTP brand was IQOS (5.7%) followed by Ploom TECH/Ploom TECH+ (5.4%) and glo (2.6%). Use of Ploom S, glo sens and Pulze was 1.6%, 0.8% and 0.6%, respectively. Among current cigarette smokers, 34.9% of those who were interested in quitting smoking and 30.5% of those who were not interested in quitting reported concurrent use of HTP, respectively (difference not significant). Cigarette smokers who reported having multiple chronic conditions (aPR=2.31), alcohol consumption (aPR=2.07), and e-cigarette use (aPR=1.88) were more likely to use an HTP compared to those who did not report such characteristics.

Conclusions

HTP use remained prevalent in Japan. One in three current cigarette smokers used HTPs regardless of whether they were interested inquitting smoking. Continuedsurveillance is important to inform national and global tobaccocontrol strategies.