bluuebunny/crossref_metadata_2025 huggingface dataset:
European Society for Clinical Nutrition and Metabolism (ESPEN) Malnutrition Criteria for Predicting Major Complications After Hepatectomy and Pancreatectomy
Authors: Fukami Yasuyuki , Saito Takuya , Arikawa Takashi , Osawa Takaaki , Komatsu Shunichiro , Kaneko Kenitiro , Ishida Yuria , Maeda Keisuke , Mori Naoharu , Sano Tsuyoshi
Published: September 2020

Background

Recently, diagnostic criteria for malnutrition have been proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN). This study aimed to investigate the utility of the ESPEN malnutrition criteria as a predictor for major complications following hepatectomy and pancreatectomy.

Methods

Data were reviewed from 176 consecutive patients who underwent hepatectomy (n = 103) or pancreatectomy (n = 73) between November 2017 and December 2019. Patients were divided into two groups according to the ESPEN malnutrition criteria using a prospectively collected database. The clinical data and the surgical outcomes of patients in the malnourished and normal groups were retrospectively analyzed.

Results

Thirty‐five (20%) patients were diagnosed with malnourishment according to ESPEN criteria. The malnourished group had a significantly low preoperative albumin concentration (p = 0.001). After hepatectomy, major complications (Clavien grade ≥ 3a) occurred significantly more frequently in the malnourished group than in the normal group (p = 0.013). Multivariate analysis indicated that operative duration ≥ 300 min (hazard ratio: 22.47, 95% CI: 2.17 to 232.73, p = 0.009) and malnourishment (hazard ratio: 14.56, 95% CI: 2.58 to 82.17, p = 0.002) were independently associated with major complications after hepatectomy. On the other hand, malnutrition was not associated with major complications after pancreatectomy.

Conclusions

The ESPEN malnutrition criteria are a valuable predictor for major complications following hepatectomy.
Can mobile genetic elements rescue genes from extinction?
Authors: van Dijk Bram
Published: September 2020

Bacteria and other prokaryotes evolve primarily through rapid changes in their gene content by quickly losing and gaining genes whenever an ecological opportunity emerges. As gene loss and horizontal gene transfer (HGT) appear to be the most common events across the prokaryotic tree of life, we need to think beyond gradual sequence evolution if we wish to understand the microbial world. Especially genes that reside on mobile genetic elements (MGEs) may spread much more rapidly through a microbial population than genes that reside on the bacterial chromosome. This raises the question: why are some genes associated with MGEs, while others are not? Here, I briefly review a recently proposed class of genes for which we have coined the term “rescuable genes”. The fitness effect of carrying these genes is so small, either constantly or on average, that they are prone to be lost from a microbial population. I argue that HGT, even when costly to the individual cells, may play an important role in maintaining these rescuable genes in microbial communities.
Whole-body MRI versus an FDG-PET/CT-based reference standard for staging of paediatric Hodgkin lymphoma: a prospective multicentre study
Authors: Spijkers Suzanne , Littooij Annemieke S. , Kwee Thomas C. , Tolboom Nelleke , Beishuizen Auke , Bruin Marrie C. A. , Elias Sjoerd G. , van de Brug Tim , Enríquez Goya , Sábado Constantino , Miller Elka , Granata Claudio , de Lange Charlotte , Verzegnassi Federico , Greer Mary-Louise C. , de Keizer Bart , Nievelstein Rutger A. J.
Published: September 2020

Objectives

To assess the concordance of whole-body MRI (WB-MRI) and an FDG-PET/CT-based reference standard for the initial staging in children with Hodgkin lymphoma (HL)

Methods

Children with newly diagnosed HL were included in this prospective, multicentre, international study and underwent WB-MRI and FDG-PET/CT at staging. Two radiologists and a nuclear medicine physician independently evaluated all images. Discrepancies between WB-MRI and FDG-PET/CT were assessed by an expert panel. All FDG-PET/CT errors were corrected to derive the FDG-PET/CT-based reference standard. The expert panel corrected all reader errors in the WB-MRI DWI dataset to form the intrinsic MRI data. Inter-observer agreement for WB-MRI DWI was calculated using overall agreement, specific agreements and kappa statistics. Concordance for correct classification of all disease sites and disease stage between WB-MRI (without DWI, with DWI and intrinsic WB-MRI DWI) and the reference standard was calculated as primary outcome. Secondary outcomes included positive predictive value, negative predictive value and kappa statistics. Clustering within patients was accounted for using a mixed-effect logistic regression model with random intercepts and a multilevel kappa analysis.

Results

Sixty-eight children were included. Inter-observer agreement between WB-MRI DWI readers was good for disease stage (κ = 0.74). WB-MRI DWI agreed with the FDG-PET/CT-based reference standard for determining disease stage in 96% of the patients versus 88% for WB-MRI without DWI. Agreement between WB-MRI DWI and the reference standard was excellent for both nodal (98%) and extra-nodal (100%) staging.

Conclusions

WB-MRI DWI showed excellent agreement with the FDG-PET/CT-based reference standard. The addition of DWI to the WB-MRI protocol improved the staging agreement.

Key Points

• This study showed excellent agreement between WB-MRI DWI and an FDG-PET/CT-based reference standard for staging paediatric HL.

• Diffusion-weighted imaging is a useful addition to WB-MRI in staging paediatric HL.

• Inter-observer agreement for WB-MRI DWI was good for both nodal and extra-nodal staging and determining disease stage.
Cost-effectiveness of stress CTP versus CTA in detecting obstructive CAD or in-stent restenosis in stented patients
Authors: Kim S. H. , Rübenthaler J. , Nörenberg D. , Huber T. , Kunz W. G. , Sommer W. H. , Schoenberg S. O. , Janssen S. , Overhoff D. , Froelich M. F.
Published: September 2020

Objectives

The aim of this retrospective study was to determine cost-effectiveness of stress myocardial CT perfusion (CTP), coronary CT angiography (CTA), and the combination of both in suspected obstructive coronary artery disease (CAD) or in-stent restenosis (ISR) in patients with previous coronary stent implantation.

Methods

A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with CTA, CTP, and CTA + CTP. Model input parameters were obtained from published literature. Probabilistic sensitivity analysis was performed to evaluate overall model uncertainty. A single-variable deterministic sensitivity analysis evaluated the sensitivity of the results to plausible variations in model inputs. Cost-effectiveness was assessed based on a cost-effectiveness threshold of $100,000 per QALY.

Results

In the base-case scenario with willingness to pay of $100,000 per QALY, CTA resulted in total costs of $47,013.87 and an expected effectiveness of 6.84 QALYs, whereas CTP resulted in total costs of $46,758.83 with 6.93 QALYs. CTA + CTP reached costs of $47,455.63 with 6.85 QALYs. Therefore, strategies CTA and CTA + CTP were dominated by CTP in the base-case scenario. Deterministic sensitivity analysis demonstrated robustness of the model to variations of diagnostic efficacy parameters and costs in a broad range. CTP was cost-effective in the majority of iterations in the probabilistic sensitivity analysis as compared with CTA.

Conclusions

CTP is cost-effective for the detection of obstructive CAD or ISR in patients with previous stenting and therefore should be considered a feasible approach in daily clinical practice.

Key Points

• CTP provides added diagnostic value in patients with previous coronary stents.

• CTP is a cost-effective method for the detection of obstructive CAD or ISR in patients with previous stenting.
Ultra-low-dose chest CT imaging of COVID-19 patients using a deep residual neural network
Authors: Shiri Isaac , Akhavanallaf Azadeh , Sanaat Amirhossein , Salimi Yazdan , Askari Dariush , Mansouri Zahra , Shayesteh Sajad P. , Hasanian Mohammad , Rezaei-Kalantari Kiara , Salahshour Ali , Sandoughdaran Saleh , Abdollahi Hamid , Arabi Hossein , Zaidi Habib
Published: September 2020

Objectives

The current study aimed to design an ultra-low-dose CT examination protocol using a deep learning approach suitable for clinical diagnosis of COVID-19 patients.

Methods

In this study, 800, 170, and 171 pairs of ultra-low-dose and full-dose CT images were used as input/output as training, test, and external validation set, respectively, to implement the full-dose prediction technique. A residual convolutional neural network was applied to generate full-dose from ultra-low-dose CT images. The quality of predicted CT images was assessed using root mean square error (RMSE), structural similarity index (SSIM), and peak signal-to-noise ratio (PSNR). Scores ranging from 1 to 5 were assigned reflecting subjective assessment of image quality and related COVID-19 features, including ground glass opacities (GGO), crazy paving (CP), consolidation (CS), nodular infiltrates (NI), bronchovascular thickening (BVT), and pleural effusion (PE).

Results

The radiation dose in terms of CT dose index (CTDIvol) was reduced by up to 89%. The RMSE decreased from 0.16 ± 0.05 to 0.09 ± 0.02 and from 0.16 ± 0.06 to 0.08 ± 0.02 for the predicted compared with ultra-low-dose CT images in the test and external validation set, respectively. The overall scoring assigned by radiologists showed an acceptance rate of 4.72 ± 0.57 out of 5 for reference full-dose CT images, while ultra-low-dose CT images rated 2.78 ± 0.9. The predicted CT images using the deep learning algorithm achieved a score of 4.42 ± 0.8.

Conclusions

The results demonstrated that the deep learning algorithm is capable of predicting standard full-dose CT images with acceptable quality for the clinical diagnosis of COVID-19 positive patients with substantial radiation dose reduction.

Key Points

• Ultra-low-dose CT imaging of COVID-19 patients would result in the loss of critical information about lesion types, which could potentially affect clinical diagnosis.

• Deep learning–based prediction of full-dose from ultra-low-dose CT images for the diagnosis of COVID-19 could reduce the radiation dose by up to 89%.

• Deep learning algorithms failed to recover the correct lesion structure/density for a number of patients considered outliers, and as such, further research and development is warranted to address these limitations.
In situ magnetorheological SANS setup at Institut Laue-Langevin
Authors: Zákutná Dominika , Graef Kevin , Dresen Dominique , Porcar Lionel , Honecker Dirk , Disch Sabrina
Published: September 2020

A magnetorheological sample environment is presented that allows for in situ magnetic field and shear flow during small-angle neutron scattering (SANS) measurements and is now available at the Institut Laue-Langevin (ILL). The setup allows performing simultaneous magnetorheological measurements together with the investigation of structural and magnetic changes on the nanometer length scale underlying the rheological response of ferrofluids. We describe the setup consisting of a commercial rheometer and a custom-made set of Helmholtz coils and show exemplarily data on the field and shear flow alignment of a dispersion of hematite nanospindles in water.
Intraoperative quantification of floating mass transducer coupling quality in active middle ear implants: a multicenter study
Authors: Fröhlich Laura , Rahne Torsten , Plontke Stefan K. , Oberhoffner Tobias , Dahl Rüdiger , Mlynski Robert , Dziemba Oliver , Aristeidou Aristotelis , Gadyuchko Maria , Koscielny Sven , Hoth Sebastian , Kropp Miriam H. , Mir-Salim Parwis , Müller Alexander
Published: September 2020

Purpose

Evaluating the effectiveness of intraoperative auditory brainstem responses (ABRs) to stimulation by the Vibrant Soundbridge (VSB) active middle ear implant for quantifying the implant’s floating mass transducer (FMT) coupling quality.

Methods

In a diagnostic multicentric study, patients (> 18 years) who received a VSB with different coupling modalities were included. Pre- and postoperative bone conduction thresholds, intraoperative VSB-evoked ABR thresholds (VSB-ABR) using a modified audio processor programmed to preoperative bone conduction thresholds, postoperative vibrogram thresholds, and postoperative VSB-ABR thresholds were measured. Coupling quality was calculated from the difference between the pure tone average at 1000, 2000, and 4000 Hz (3PTA) vibrogram and postoperative 3PTA bone conduction thresholds.

Results

Twenty-three patients (13 males, 10 females, mean age 56.6 (± 12.5) years) were included in the study. Intraoperative VSB-ABR response thresholds could be obtained in all except one patient where the threshold was > 30 dB nHL. Postoperatively, an insufficient coupling of 36.7 dB was confirmed in this patient. In a Bland–Altman analysis of the intraoperative VSB-ABRs and coupling quality, the limits of agreement exceeded ± 10 dB, i.e., the maximum allowed difference considered as not clinically important but the variation was within the general precision of auditory brainstem responses to predict behavioral thresholds. Five outliers were identified. In two patients, the postoperative VSB-ABR thresholds were in agreement with the coupling quality, indicating a change of coupling before the postoperative testing.

Conclusion

The response thresholds recorded in this set-up have the potential to predict the VSB coupling quality and optimize postoperative audiological results.
Association of imaging biomarkers and local activation of complement in aqueous humor of patients with early forms of age-related macular degeneration
Authors: Sitnilska Vasilena , Enders Philip , Cursiefen Claus , Fauser Sascha , Altay Lebriz
Published: September 2020

Purpose

To investigate a possible correlation between established imaging biomarkers for age-related macular degeneration and local complement system activation, measured in aqueous humor (AH) of patients with early stages of age-related macular degeneration (AMD) and controls.

Methods

This analysis included prospectively acquired AH samples of 106 eyes (35 with early/intermediate AMD, 71 controls). The levels of complement protein 3 (C3), 4 (C4), 5 (C5); activation products of complement factor 3a (C3a) and Ba, C3b/iC3b; complement factors B, D, H, I (CFB, CFD, CFH, CFI); and total protein concentration were analyzed. Quantitative levels of complement factors were correlated to the presence of reticular pseudodrusen (RPD), the presence of hyperreflective foci (HRF), and total drusen volume (DV) graded on imaging by spectral-domain optical coherence tomography and using Spearman’s rank correlation test.

Results

DV correlated with C3b/iC3b (r = 0.285; P = 0.034), C3a (r = 0.200; P = 0.047), Ba (r = 0.262; P = 0.009), and C5 (r = 430; P = 0.005), and showed a tendency towards correlation with C3a (r = 0.198; P = 0.057). HRF correlated significantly with C5 (r = 0.388; P = 0.011) and RPD showed a tendency towards correlation with CFB (r = 0.196; P = 0.050).

Conclusion

In patients with early AMD, HRF and drusen parameters but not RPD show low to fair levels of correlation with local complement activation in patients’ AH. Better understanding of complement activation could provide some insights into the pathogenesis of AMD. Imaging biomarkers could be useful to identify suitable patients for future clinical trials with complement-modulating therapies.
Molecular mechanisms involved in the positive effects of physical activity on coping with COVID-19
Authors: Nigro Ersilia , Polito Rita , Alfieri Andreina , Mancini Annamaria , Imperlini Esther , Elce Ausilia , Krustrup Peter , Orrù Stefania , Buono Pasqualina , Daniele Aurora
Published: September 2020

Purpose

Physical activity (PA) represents the first line of defence against diseases characterised by increased inflammation status, such as metabolic and infectious diseases. Conversely, a sedentary lifestyle—associated with obesity, type 2 diabetes and cardiovascular disorders—negatively impacts on general health status, including susceptibility to infections. At a time of a pandemic SARS-CoV2 infection, and in the context of the multiorgan crosstalk (widely accepted as a mechanism participating in the pathophysiology of all organs and systems), we examine the complex interplay mediated by skeletal muscle contraction involving the immune system and how this contributes to control health status and to counteract viral infections. In so doing, we review the molecular mechanisms and expression of molecules modulated by PA, able to provide the proper molecular equipment against viral infections such as the current SARS-CoV2.

Methods

A critical review of the literature was performed to elucidate the molecular mechanisms and mediators induced by PA that potentially impact on viral infections such as SARS-CoV2.

Results

We showed the effects mediated by regular moderate PA on viral adverse effects through the regulation of biological processes involving the crosstalk between skeletal muscle, the immune system and adipose tissue. Evidence was provided of the effects mediated by modulation of the expression of inflammation markers.

Conclusion

A tigth association between PA and reduction in inflammation status allows effective counteracting of SARS-CoV2 infection. It is therefore essential to persuade people to keep active.
Role of minimally invasive surgery versus open approach in patients with early-stage uterine carcinosarcomas: a retrospective multicentric study
Authors: Corrado Giacomo , Ciccarone Francesca , Cosentino Francesco , Legge Francesco , Rosati Andrea , Arcieri Martina , Turco Luigi Carlo , Certelli Camilla , Federico Alex , Vizza Enrico , Fanfani Francesco , Scambia Giovanni , Ferrandina Gabriella
Published: September 2020

Objective

The aim of this retrospective study was to compare surgical and survival outcome in only patients with early-stage UCSs managed by laparotomic surgery (LPT) versus minimally invasive surgery (MIS).

Methods

Data were retrospectively collected in four Italian different institutions. Inclusion criteria were UCS diagnosis confirmed by the definitive histological examination, and stage I or II according to the FIGO staging system.

Results

Between August 2000 and March 2019, the data relative to 170 patients bearing UCSs were collected: of these, 95 were defined as early-stage disease (stage I–II) based on the histological report at the primary surgery, and thus were included in this study. Forty-four patients were managed by LPT, and 51 patients were managed by MIS. The operative time was lower in the MIS group versus the LPT group (p value 0.021); the median estimated blood loss was less in the MIS group compared to the median of LPT group (p value < 0.0001). The length of hospital stay days was shorter in the MIS patients (p value < 0.0001). Overall, there were eight (8.4%) post-operative complications; of these, seven were recorded in the LPT group versus one in the MIS group (p value 0.023). There was no difference in the disease-free survival (DFS) and overall survival (OS) between the two groups.

Conclusion

There was no difference of oncologic outcome between the two approaches, in face of a more favourable peri-operative and post-operative profile in the MIS group.
Correction to: The computational framework for continuum-kinematics-inspired peridynamics
Authors: Javili A. , Firooz S. , McBride A. T. , Steinmann P.
Published: September 2020

The article “The computational framework for continuum-kinematics-inspired peridynamics”.
Influence of geographical factors on thermal stress in northern Carpathians
Authors: Krzysztof Błażejczyk , Pavol Nejedlik , Oleh Skrynyk , Agnieszka Halaś , Olesya Skrynyk , Anna Błażejczyk , Katarina Mikulova
Published: September 2020

While general features of mountain climate are well recognised, there is not many research regarded their bioclimatic differentiation. The aim of the present study is to answer the question how different geographical factors: elevation above sea level, physiographical type of area, climate continentality and location of area in relation to the main mountain ridge influence thermal stress in northern Carpathians. To analyse thermal stress in the region, daily meteorological data from 21 stations of national weather networks of Poland, Ukraine and Slovakia for the period 1986–2015 were used. Daily data of air temperature, relative humidity, total cloud cover and wind speed at 10 m above ground for 12 UTC were used because they represent midday hours which are mostly used for any human activity. The Universal Thermal Climate Index (UTCI) was applied as a measure of thermal stress. The results show that (1) cold stress significantly increases and heat stress decreases due to rise of altitude, (2) due to climate continentality and physiographical differences between western and eastern parts of northern Carpathians in their eastern edge, the cold stress is more evident than in western one, (3) at southward slopes of Carpathian, heat stress is significantly more frequent then at northward areas.
Bloodstream infection due to Enterobacter ludwigii, correlating with massive aggregation on the surface of a central venous catheter
Authors: Wagner Lysett , Bloos Frank , Vylkova Slavena
Published: September 2020

We report a case of catheter associated bloodstream infection due to Enterobacter ludwigii with a massive aggregation on the outside surface of a central venous catheter (CVC). The 57 years old patient with a history of spondylodiscitis and Staphylococcus aureus-associated endocarditis was admitted to the intensive care unit for acute cerebral infarction. The patient developed signs of infections and the CVC was removed 11 days after placement. The infectious agent was identified by standard diagnostics to the genus level as belonging to the Enterobacter cloacae complex, and additional molecular testing determined the species as E. ludwigii. The catheter was selected for a study aiming to identify the influence of blood components on the formation of central venous catheter-associated biofilms. In this course a massive biofilm was recognized and is presented here.
Digestive enzymes of fungal origin as a relevant cause of false positive Aspergillus antigen testing in intensive care unit patients
Authors: Schroeder Ines , Dichtl Karl , Liebchen Uwe , Wagener Johannes , Irlbeck Michael , Zoller Michael , Scharf Christina
Published: September 2020

Background

Galactomannan antigen (GM) testing is widely used in the diagnosis of invasive aspergillosis (IA). Digestive enzymes play an important role in enzyme substitution therapy in exocrine pancreatic insufficiency. As digestive enzymes of fungal origin like Nortase contain enzymes from Aspergillus, a false-positive result of the test might be possible because of cross-reacting antigens of the cell wall of the producing fungi. We, therefore, asked whether the administration of fungal enzymes is a relevant cause of false-positive GM antigen test results.

Methods

Patients with a positive GM antigen test between January 2016 and April 2020 were included in the evaluation and divided into two groups: group 1—Nortase-therapy, group 2—no Nortase-therapy. In addition, dissolved Nortase samples were analyzed in vitro for GM and β-1,3-D-glucan. For statistical analysis, the chi-squared and Mann‒Whitney U tests were used.

Results

Sixty-five patients were included in this evaluation (30 patients receiving Nortase and 35 patients not receiving Nortase). The overall false positivity rate of GM testing was 43.1%. Notably, false-positive results were detected significantly more often in the Nortase group (73.3%) than in the control group (17.1%, p < 0.001). While the positive predictive value of GM testing was 0.83 in the control group, there was a dramatic decline to 0.27 in the Nortase group. In vitro analysis proved that the Nortase enzyme preparation was highly positive for the fungal antigens GM and β-1,3-D-glucan.

Conclusions

Our data demonstrate that the administration of digestive enzymes of fungal origin like Nortase leads to a significantly higher rate of false-positive GM test results compared to that in patients without digestive enzyme treatment.
Modeling the Number of Confirmed Cases and Deaths from the COVID-19 Pandemic in the UK and Forecasting from April 15 to May 30, 2020
Authors: Jamshidi Babak , Rezaei Mansour , Kakavandi Mohsen , Jamshidi Zargaran Shahriar
Published: September 2020

Objective:

The UK is one of the epicenters of coronavirus disease (COVID-19) in the world. As of April 14, there have been 93 873 confirmed patients of COVID-19 in the UK and 12 107 deaths with confirmed infection. On April 14, it was reported that COVID-19 was the cause of more than half of the deaths in London.

Methods:

The present paper addresses the modeling and forecasting of the outbreak of COVID-19 in the UK. This modeling must be accomplished through a 2-part time series model to study the number of confirmed cases and deaths. The period we aimed at a forecast was 46 days from April 15 to May 30, 2020. All the computations and simulations were conducted on Matlab R2015b, and the average curves and confidence intervals were calculated based on 100 simulations of the fitted models.

Results:

According to the obtained model, we expect that the cumulative number of confirmed cases will reach 282 000 with an 80% confidence interval (242 000 to 316 500) on May 30, from 93 873 on April 14. In addition, it is expected that, over this period, the number of daily new confirmed cases will fall to the interval 1330 to 6450 with the probability of 0.80 by the point estimation around 3100. Regarding death, our model establishes that the real case fatality rate of the pandemic in the UK approaches 11% (80% confidence interval: 8%–15%). Accordingly, we forecast that the total death in the UK will rise to 35 000 (28 000–50 000 with the probability of 80%).

Conclusions:

The drawback of this study is the shortage of observations. Also, to conduct a more exact study, it is possible to take the number of the tests into account as an explanatory variable besides time.
Costs of ambulatory pediatric healthcare-associated infections: Central-line–associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs)
Authors: Rinke Michael L. , Oyeku Suzette O. , Ford William J. H. , Heo Moonseong , Saiman Lisa , DeLaMora Patricia , Rabin Barbara , Zachariah Philip , Rosenberg Rebecca E. , Mirhaji Parsa , Obaro-Best Oghale , Drasher Michael , Klein Elizabeth , Peshansky Alexandre , Bundy David G.
Published: September 2020

Objective:

Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This study estimated additional costs associated with pediatric ambulatory central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery.

Design:

Retrospective case-control study.

Setting:

Four academic medical centers.

Patients:

Children aged 0–22 years seen between 2010 and 2015 and at risk for HAI as identified by electronic queries.

Methods:

Chart review adjudicated HAIs. Charges were obtained for patients with HAIs and matched controls 30 days before HAI, on the day of, and 30 days after HAI. Charges were converted to costs and 2015 USD. Mixed-effects linear regression was used to estimate the difference-in-differences of HAI case versus control costs in 2 models: unrecorded charge values considered missing and a sensitivity analysis with unrecorded charge considered $0.

Results:

Our search identified 177 patients with ambulatory CLABSIs, 53 with ambulatory CAUTIs, and 26 with SSIs following ambulatory surgery who were matched with 382, 110, and 75 controls, respectively. Additional cost associated with an ambulatory CLABSI was $5,684 (95% confidence interval [CI], $1,005–$10,362) and $6,502 (95% CI, $2,261–$10,744) in the 2 models; cost associated with a CAUTI was $6,660 (95% CI, $1,055, $12,145) and $2,661 (95% CI, −$431 to $5,753); cost associated with an SSI following ambulatory surgery at 1 institution only was $6,370 (95% CI, $4,022–$8,719).

Conclusions:

Ambulatory HAI in pediatric patients are associated with significant additional costs. Further work is needed to reduce ambulatory HAIs.
Nosocomial hepatitis A outbreak among healthcare workers and patients in a community hospital during an ongoing statewide outbreak
Authors: Brennan Julia , Mullins Heather , Tobey Kelley , Jones Cassandra , Kainer Marion A. , Fiscus Michelle , May Stephen , Dunn John R. , Schaffner William , Jones Timothy F.
Published: September 2020

Objective:

The Tennessee Department of Health (TDH) investigated a hepatitis A virus (HAV) outbreak to identify risk factors for infection and make prevention recommendations.

Design:

Case series.

Setting:

Community hospital.

Participants:

Healthcare workers (HCWs) or patients with laboratory-confirmed acute HAV infection during October 1, 2018–January 10, 2019.

Methods:

HCWs with suspected or confirmed hepatitis A infections were interviewed to assess their exposures and activities. Patient medical records and hospital administrative records were reviewed to identify common exposures. We conducted a site investigation to assess knowledge of infection control practices among HCWs. Serum specimens from ill persons were tested for HAV RNA by polymerase chain reaction (PCR) and genotyped.

Results:

We identified 6 HCWs and 2 patients with laboratory-confirmed HAV infection. All cases likely resulted from exposure to a homeless patient with a history of recreational substance use and undiagnosed HAV infection. Breaches in hand hygiene and use of standard precautions were identified. HAV RNA was detected in 7 serum specimens and all belonged to an identical strain of HAV genotype 1b.

Conclusions:

A hepatitis A outbreak among hospital patients and HCWs resulted from exposure to a single patient with undiagnosed HAV infection. Breakdowns in infection control practices contributed to the outbreak. The likelihood of nosocomial transmission can be reduced with proper hand hygiene, standard precautions, and routine disinfection. During community outbreaks, medical providers can better prevent ongoing transmission by including hepatitis A in the differential diagnosis among patients with a history of recreational substance use and homelessness.
Who are we missing with EHR-based smoking cessation treatments? A descriptive study of patients who smoke and do not regularly visit primary care clinics
Authors: Nolan Margaret , Zwaga Deejay , McCarthy Danielle , Kastman Christian , Baker Timothy , Zehner Mark , Smith Stevens , Fiore Michael
Published: September 2020

Introduction

Most tobacco treatment efforts target healthcare settings, because about 75% of smokers in the United States visit a primary care provider annually. Yet, 25% of patients may be missed by such targeting.

Aims

To describe patients who smoke but infrequently visit primary care – their characteristics, rates of successful telephone contact, and acceptance of tobacco treatment.

Methods

Tobacco Cessation Outreach Specialists ‘cold-called’ those without a primary care visit in the past year, offering tobacco dependence treatment. Age, sex, insurance status, race, ethnicity, electronic health record (EHR) patient-portal status and outreach outcomes were reported.

Results

Of 3,407 patients identified as smokers in a health system registry, 565 (16.6%) had not seen any primary care provider in the past year. Among 271 of those called, 143 (53%) were successfully reached and 33 (23%) set a quit date. Those without visits tended to be younger, male, some-day versus every-day smokers (42 vs. 44 years, P = 0.004; 48% vs. 40% female, P = 0.0002, and 21% vs. 27% some-day, P = 0.003), and less active on the EHR patient portal (33% vs. 40%, P = 0.001).

Conclusions

A substantial proportion of patients who smoke are missed by traditional tobacco treatment interventions that require a primary care visit, yet many are receptive to quit smoking treatment offers.
Heritable anisotropy associated with cognitive impairments among patients with schizophrenia and their non-psychotic relatives in multiplex families
Authors: Prasad K. M. , Gertler J. , Tollefson S. , Wood J. A. , Roalf D. , Gur R. C. , Gur R. E. , Almasy L. , Pogue-Geile M. F. , Nimgaonkar V. L.
Published: September 2020

Background

To test the functional implications of impaired white matter (WM) connectivity among patients with schizophrenia and their relatives, we examined the heritability of fractional anisotropy (FA) measured on diffusion tensor imaging data acquired in Pittsburgh and Philadelphia, and its association with cognitive performance in a unique sample of 175 multigenerational non-psychotic relatives of 23 multiplex schizophrenia families and 240 unrelated controls (total = 438).

Methods

We examined polygenic inheritance (h2r) of FA in 24 WM tracts bilaterally, and also pleiotropy to test whether heritability of FA in multiple WM tracts is secondary to genetic correlation among tracts using the Sequential Oligogenic Linkage Analysis Routines. Partial correlation tests examined the correlation of FA with performance on eight cognitive domains on the Penn Computerized Neurocognitive Battery, controlling for age, sex, site and mother's education, followed by multiple comparison corrections.

Results

Significant total additive genetic heritability of FA was observed in all three-categories of WM tracts (association, commissural and projection fibers), in total 33/48 tracts. There were significant genetic correlations in 40% of tracts. Diagnostic group main effects were observed only in tracts with significantly heritable FA. Correlation of FA with neurocognitive impairments was observed mainly in heritable tracts.

Conclusions:

Our data show significant heritability of all three-types of tracts among relatives of schizophrenia. Significant heritability of FA of multiple tracts was not entirely due to genetic correlations among the tracts. Diagnostic group main effect and correlation with neurocognitive performance were mainly restricted to tracts with heritable FA suggesting shared genetic effects on these traits.
Theorizing about faith with Lara Buchak
Authors: HOWARD-SNYDER DANIEL , MCKAUGHAN DANIEL J.
Published: September 2020

What is faith? Lara Buchak has done as much as anyone recently to answer this question in a sensible and instructive fashion. As it turns out, her writings reveal two theories of faith, an early one and a later one – or two versions of the same one if you like. In what follows, we aim to assess those theories with an eye to highlighting both their good- and bad-making features, marking choice points for theorizing about faith along the way, and defending the choices we make. The result is an alternative theory of faith, one that we hope extends our common pursuit of understanding what faith is.
The Symbol of Justice: Bloodguilt in Kant
Authors: Thomason Krista K.
Published: September 2020

One of the more notorious passages in Kant occurs in the Doctrine of Right where he claims that ‘bloodguilt’ will cling to members of a dissolving society if they fail to execute the last murderer (MM, 6: 333). Although this is the most famous, bloodguilt appears in three other passages in Kant’s writings. These have received little attention in Kant scholarship. In this article, I examine these other passages and argue that bloodguilt functions as a symbol for the demandingness of justice. I then offer a sympathetic interpretation of the passage from the Doctrine of Right.
Meta-analysis of controlled trials testing horticultural therapy for the improvement of cognitive function
Authors: Tu Hung-Ming , Chiu Pei-Yu
Published: September 2020

Improving cognitive function is one of the most challenging global issues in cognitive impairment population. Horticultural therapy involves the expertise of a horticultural therapist who establishes a treatment plan for horticultural activities that aim to achieve cognitive changes, and thereby improve health-related quality of life. However, more convincing evidence demonstrating the effect of horticultural therapy on cognitive function is essential. The purpose of this study was to conduct a meta-analysis of controlled trials testing the effect of horticultural therapy on cognitive function and the findings indicate that horticultural therapy programs significantly improved cognitive function. The effect size of the horticultural therapy program was large. Findings of this meta-analysis have important implications for practice and policies. Contemporary healthcare systems should consider horticultural therapy as an important intervention for improving patients’ cognitive function. Governments and policy-makers should consider horticultural therapy as an important tool to prevent the decline of cognitive function in cognitive impairment population.
Author Correction: On the evolution of sexual receptivity in female primates
Authors: Rooker Kelly , Gavrilets Sergey
Published: September 2020

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Intrinsic Laryngeal Muscle Response to a Public Speech Preparation Stressor: Personality and Autonomic Predictors
Authors: Helou Leah B. , Jennings J. Richard , Rosen Clark A. , Wang Wei , Verdolini Abbott Katherine
Published: September 2020

Purpose

Laboratory stressors have been shown to impact the activity of the intrinsic laryngeal muscles (ILMs), which may be part of the final causal pathway in some stress-induced voice disorders. Previous research suggests that personality traits such as stress reaction might increase one's susceptibility to these problems. Also, the autonomic nervous system response is implicated in the pathogenesis of voice disorders putatively involving ILM hyperfunction. The purpose of this study was to investigate personality and autonomic nervous system predictors of ILM responses to stressor exposure.

Method

Thirty-seven physically and vocally healthy female adults completed a personality questionnaire and were subjected to a speech preparation task intended to induce stress. Fine wire electromyography of the ILMs was performed so that the activity of these muscles could be measured prior to and during the stressor. Participants' trait stress reaction was measured as a personality-based predictive variable, as was respiratory-corrected respiratory sinus arrhythmia, a putative measure of vagal outflow to the heart.

Results

The personality measure trait stress reaction uniquely predicted thyroarytenoid, trapezius, and tibialis activity, whereas respiratory sinus arrhythmia uniquely predicted the activity of all muscles studied. Differences were observed in the autonomic predictor variable as a function of whether or not effects of respiration were accounted for in the variable's calculation.

Conclusions

This study explores the potential mediating roles of personality and autonomic function in ILM activity during a stressor. Both variables have value in predicting ILM activity during stressor exposure.
High‐voltage pulse transformer for IOT modulators
Authors: Jalakas Tanel , Janson Kuno , Mõlder Heigo , Roasto Indrek
Published: September 2020

Neutron sources like European Spallation Source consist of linear proton accelerator and beam target. The linear accelerator is supplied by inductive output tubes (IOTs) or klystrons that require high‐voltage DC supply (40 kV). This study describes the design and experimental evaluation of high‐voltage dry‐isolation pulse transformer design evaluation prototype for interleaved IOT supply modules. In order to withstand high‐voltage stress, a modular secondary winding module with multistage voltage field equalisation are designed. Inter‐winding connections are realised in the air as the separate winding outputs are routed together through common high‐voltage isolators. The novelties of the current manuscript are new pulse transformer design and the experimental work. Experiments with full‐scale prototype verified the advantages and revealed, also, some drawbacks of this construction. Proposed transformer design could be used not only in IOT or klystron power supplies but also in high‐voltage DC/DC or AC/AC converters and power electronic transformers, used in the medium‐voltage distribution grids.
Three‐stage RGBD architecture for vehicle and pedestrian detection using convolutional neural networks and stereo vision
Authors: Ferraz Pedro Augusto Pinho , de Oliveira Bernardo Augusto Godinho , Ferreira Flávia Magalhães Freitas , Martins Carlos Augusto Paiva da Silva
Published: September 2020

With the growth of autonomous vehicles and collision‐avoidance systems, several approaches using deep learning and convolutional neural networks (CNNs) continually address accuracy improvement in obstacle detection. The authors introduce a three‐stage architecture that adds side channels as low‐level features to serve as input to existing CNNs. In a case study, the architecture is used to extract depth from stereo cameras, and then compose RGBD inputs to state‐of‐the‐art CNNs to improve their vehicle and pedestrian detection accuracy. This can be achieved by simple modifications on the first layers of any existing CNN with RGB inputs. To validate the architecture, the state‐of‐the‐art matching cost‐CNN, and cascade residual learning, both specialist algorithms to extract depth information combined to the state‐of‐the‐art Faster‐region‐based CNN, MSCNCN, and Subcategory‐aware Convolutional Neural Network (SubCNN) to yield the models to be tested using the KITTI dataset benchmark. In many cases, the accuracy (in terms of average precision) using their proposal outperforms the original scores in various scenarios of detection difficulty, reaching improvements up to +3.96% in the training and +1.50% in the testing KITTI datasets. This proposal also introduces efficient methods to initialise the weights of the depth convolutional filters during transfer learning using net surgery.
Bus scheduling considering trip‐varying travel times, vehicle availability and capacity
Authors: Gkiotsalitis Konstantinos
Published: September 2020

Bus scheduling is a well‐known NP‐hard problem, and it is addressed with the use of heuristic solution methods or graphical approaches. In this study, the author proposes an improved formulation of the bus scheduling problem that considers the vehicle availability, the vehicle capacity and the allowed headway variability among successive trip dispatches. His formulation expands the classic bus scheduling model formulation by including the aforementioned features. In his study, the bus scheduling problem is understood as the problem of setting the optimal dispatching times for a set of pre‐determined daily trips of a particular bus line. His model facilitates the search of solutions that can improve the waiting times of passengers while meeting the operational requirements and avoiding overcrowding. His proposed mathematical program is proved to be non‐convex, and it is solved with heuristic solution methods because numerical optimisation approaches cannot guarantee a globally optimal solution. The performance of his approach is tested in a case study using real operational data from bus line 302 in Singapore. A simulation‐based evaluation demonstrates potential gains of up to 20% on average passenger waiting times and a major reduction in refused passenger boardings because of overcrowding.
Der Lösung ist das Problem egal – Lösungsfokussierte Kurztherapie
Authors: Matuschek Kathrin
Published: September 2020

Müssen Therapeuten die Probleme ihrer Klienten kennen, um sie zu lösen? Im Sinne der Lösungsfokussierten Kurztherapie ist dies nicht notwendig. Hier stehen der Lösungsprozess und die Ressourcen der Klienten ganz klar im Mittelpunkt.
Schmerzen im Ellenbogen reduzieren – Ergotherapie bei lateraler Epicondylopathie
Authors: Abel Theresa
Published: September 2020

Schmerzen sind das Hauptsymptom beim Tennisellenbogen bzw. der lateralen Epicondylopathie. Und nein, man muss kein Tennisspieler sein, oft sind es auch Fehlhaltungen bei der Arbeit, einseitige Belastungen oder schweres Heben, die zu den Beschwerden führen. Ergotherapie kann dabei helfen, Schmerzfreiheit zu erreichen und die Belastbarkeit der Muskeln auf die Alltagsbelastungen anzupassen.
Peri-implantitis Update: Risk Indicators, Diagnosis, and Treatment
Authors: Rokaya Dinesh , Srimaneepong Viritpon , Wisitrasameewon Wichaya , Humagain Manoj , Thunyakitpisal Pasutha
Published: September 2020

Despite the success rates of dental implants, peri-implantitis presents as the most common complication in implant dentistry. This review discusses various factors associated with peri-implantitis and various available treatments, highlighting their advantages and disadvantages. Relevant articles on peri-implantitis published in English were reviewed from August 2010 to April 2020 in MEDLINE/PubMed, Scopus, and ScienceDirect. The identified risk indicators of peri-implant diseases are plaque, smoking, history of periodontitis, surface roughness, residual cement, emergence angle >30 degrees, radiation therapy, keratinized tissue width, and function time of the implant, sex, and diabetes. Peri-implantitis treatments can be divided into nonsurgical (mechanical, antiseptic, and antibiotics), surface decontamination (chemical and laser), and surgical (air powder abrasive, resective, and regenerative). However, mechanical debridement alone may fail to eliminate the causative bacteria, and this treatment should be combined with other treatments (antiseptics and surgical treatment). Surface decontamination using chemical agents may be used as an adjuvant treatment; however, the definitive clinical benefit is yet not proven. Laser treatment may result in a short-term decrease in periodontal pocket depth, while air powder abrasive is effective in cleaning a previously contaminated implant surface. Surgical elimination of a pocket, bone recontouring and plaque control are also effective for treating peri-implantitis. The current evidence indicates that regenerative approaches to treat peri-implant defects are unpredictable.
Reporting and Analyzing Uncertainty
Authors: Swartz Clifford E.
Published: September 2020

When a value is not known precisely, the amount of uncertainty is usually called “error.” This has given the whole business of uncertainty analysis a bad name, because in common usage “error” implies sloppiness, very likely caused by sinfulness. (She saw the error of her ways.)

In the language of technology, this section deals with the analysis of errors—how to judge their magnitude, how to describe them in conventional ways, and how to take them into account in calculating numerical values based on a number of individual measurements. As we shall emphasize, error represents uncertainty and has nothing to do with mistakes or sloppiness. Indeed, reducing the amount of error in a measurement beyond the immediate need is usually a mistake and a sign of poor judgment.
Units and Dimensions
Authors: Swartz Clifford E.
Published: September 2020

Both the technical world and our everyday world are bedeviled with a multitude of units used to measure the same quantity. Length is measured in meters, feet, centimeters, inches, kilometers, yards, miles, furlongs, spans, fathoms, microns, Ångstroms, Fermi’s, millimeters, rods, chains, light-years, parsecs, barleycorns, and probably many others. Some of these units survive as accidents of history, but many are used because they are convenient for some particular trade. It is useful to have a standard unit about the same size as the object being measured.
Geometry
Authors: Swartz Clifford E.
Published: September 2020

One of the greatest advances in mathematics came during the sixteenth century when René Descartes began drawing geometrical figures on graphs. Geometry and algebra were linked. With a simple device of a grid of lines, it is possible to locate any point merely by specifying its distance and direction from a common point called the origin.