bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the accuracy of co-registered ionoacoustic and ultrasound images in pulsed proton beams
Authors: Lascaud Julie , Dash Pratik , Wieser Hans-Peter , Kalunga Ronaldo , Würl Matthias , Assmann Walter , Parodi Katia
Published: August 2021

The sharp spatial and temporal dose gradients of pulsed ion beams result in an acoustic emission (ionoacoustics), which can be used to reconstruct the dose distribution from measurements at different positions. The accuracy of range verification from ionoacoustic images measured with an ultrasound linear array configuration is investigated both theoretically and experimentally for monoenergetic proton beams at energies relevant for pre-clinical studies (20 and 22 MeV). The influence of the linear sensor array arrangement (length up to 4 cm and number of elements from 5 to 200) and medium properties on the range estimation accuracy are assessed using time-reversal reconstruction. We show that for an ideal homogeneous case, the ionoacoustic images enable a range verification with a relative error lower than 0.1%, however, with limited lateral dose accuracy. Similar results were obtained experimentally by irradiating a water phantom and taking into account the spatial impulse response (geometry) of the acoustic detector during the reconstruction of pressures obtained by moving laterally a single-element transducer to mimic a linear array configuration. Finally, co-registered ionoacoustic and ultrasound images were investigated using silicone inserts immersed in the water phantom across the proton beam axis. By accounting for the sensor response and speed of sound variations (deduced from co-registration with ultrasound images) the accuracy is improved to a few tens of micrometers (relative error less than to 0.5%), confirming the promise of ongoing developments for ionoacoustic range verification in pre-clinical and clinical proton therapy applications.
Copper oxide phases probed via plasmonic light emission in the STM
Authors: Gloystein Alexander , Nilius Niklas
Published: August 2021

Luminescence spectroscopy with a scanning tunnelling microscope (STM) is employed to differentiate bulk-type Cu2O from a Cu3O2 surface oxide at the nanometre scale. Although plasmonic modes in the tunnelling gap are responsible for the emission response in both cases, the luminescence cross-section shows a characteristic dependence on bias voltage for the two oxide phases. On the Cu3O2 surface oxide, the emission yield peaks at the 1st field emission resonance of the STM junction, when particularly high inelastic tunnelling rates are realized between tip and sample. On Cu2O(111) patches, on the other hand, direct and defect-mediated electron recombination from the oxide conduction to the valence band is responsible for plasmon excitations in the STM cavity. Given the different excitation mechanisms, Cu2O and Cu3O2 oxide regions become distinguishable in bias-dependent STM luminescence maps with nanometre precision. We expect this optical contrast scheme to be applicable whenever blends of dielectric materials with different band gaps coexist on the surface.
Design of Commercial Building by Considering Various Structural Orientations
Authors: Reddy Marri Srinivasa , Gnana Kumar S. , Reddy Tallapureddy Subba
Published: August 2021

Building introduction is a critical structure thought, mostly concerning based on the wind and radiation from the sun. In transcendently hot humidity based locations like Malaysia where the sunlight is existing overall year which gets daylight all year around, structures of the buildings have to be situated to limit sunlight based gain and amplify regular ventilation. This paper represents an investigate on the impact of building introduction based on the absorption of sun radiation at outside divider, shifter zone proportion at the coated window and regular ventilation during the working in humidity locations. The Raman building is located in AEC Campus, Penang which is a mechanical business building, constructed in the form of east west ways. For the contextual investigation the both east and west bearing rooms were considered. By utilizing the lumberjack BABUC/M, the contrast among the “in” and “out” speed and temperature of the air in both of the rooms were calculated which information’s have been dissected and researched. The outcome of this study demonstrated that the indoor temperature is expanded based on the impact of the east window which is better than west window. The west window is identified as suitable for the ventilated or unventilated rooms.
Cultural heritage adaptation is sustainable!
Authors: Sedova A
Published: August 2021

Sustainable development is a well-known term. Sustainable development includes development of cities and communities, industry and infrastructure, innovation and other areas, where no achievement would be possible without caring about the past – our cultural heritage. This paper explains the four-pillar principle of sustainable development of cultural heritage, where each pillar is an amalgamation of various domains. The need to pursue sustainable development of cultural heritage was pointed out in many reports by United Nations Educational, Scientific and Cultural Organization (UNESCO), International Council on Monuments and Sites (ICOMOS), Council of Europe, and others. These important organisations stress the need to preserve heritage, and adaptation is considered an effective means for it. This paper dwells on how and at which stage of cultural heritage life cycle the decision of adaptation should be taken, and what stages it should be preceded and followed by in order to ensure the said shift to sustainable development. The decision of adaptation is seen as a key milestone in the cyclical life of a heritage building, which needs to be set to guarantee the continuation of the building’s sustainable development.
An Experimental Study on heave and Uplift Behaviour of Granular Pile Anchor Foundation System
Authors: Khan Haroon Ali , Gaddam Kalpana
Published: August 2021

Several innovative ground improvement techniques were presented by various researchers throughout the globe for modification of the existing poor soils. Granular Pile-Anchors (GPA) were found to be more promising in resisting the heave behavior of the expansive soils in recent times. The engineering behavior of the soil can be improved by this technique apart from resting the swell. This technique is a modification on the existing granular pile technique with an anchor plate beneath the granular pile that is connected to the foundation by means of an anchor rod or cable. Numerous scale model tests were discussed in this paper to understand the heave and pull-out behavior of Granular Pile-Anchor Foundation (GPAF) system. The effect of spacing was studied by using two granular piles at varied spacing. It was observed that the swell potential was reduced to about 68.09% for 50mm dia GPA, compared to the virgin expansive soil. The swell potential was found to be further reduced at twice the diameter of the pile spacing. The pull-out capacity was found to be increased by about 393% by providing a 50mm diameter GPA in the expansive soil.
Inhibitory effects of luteolin and its derivatives on osteoclast differentiation and differences in luteolin production by Capsicum annuum varieties
Authors: Onishi Shintaro , Tebayashi Shinichi , Hikichi Yasufumi , Sawada Hiromasa , Ishii Yukiko , Kim Chul-Sa
Published: August 2021

Luteolin, an abundant flavonoid in the leaves of Capsicum annuum, has antioxidant activity and is, thus, a key chemical for promoting plant residue utilization, especially for the development of healthcare products. We assessed the inhibitory effect of luteolin and its glycosides on osteoclastic differentiation in human cells and found that the differentiation was effectively inhibited at noncytotoxic concentrations. We also screened 47 varieties of C. annuum for the accumulation of luteolin and apigenin to determine the prevalence of luteolin in diverse cultivars and identify varieties with high and/or selective luteolin production. The glycosides of luteolin and apigenin were found in all the tested varieties, with luteolin predominant over apigenin in most varieties. The identification and characterization of highly productive varieties of C. annuum is expected to be beneficial for the effective development of useful luteolin-based products from plant residues.
ANMCO POSITION PAPER: cardio-oncology in the COVID era (CO and CO)
Authors: Bisceglia Irma , Gabrielli Domenico , Canale Maria Laura , Gallucci Giuseppina , Parrini Iris , Turazza Fabio Maria , Russo Giulia , Maurea Nicola , Quagliariello Vincenzo , Lestuzzi Chiara , Oliva Stefano , Di Fusco Stefania Angela , Lucà Fabiana , Tarantini Luigi , Trambaiolo Paolo , Gulizia Michele Massimo , Colivicchi Furio
Published: August 2021

The COVID-19 pandemic and its impact on patients with cancer and cardiovascular disease have confirmed the particular vulnerability of these populations. Indeed, not only a higher risk of contracting the infection has been reported but also an increased occurrence of a more severe course and unfavourable outcome. Beyond the direct consequences of COVID-19 infection, the pandemic has an enormous impact on global health systems. Screening programmes and non-urgent tests have been postponed; clinical trials have suffered a setback. Similarly, in the area of cardiology care, a significant decline in STEMI accesses and an increase in cases of late presenting heart attacks with increased mortality and complication rates have been reported. Health care systems must therefore get ready to tackle the ‘rebound effect’ that will likely show a relative increase in the short- and medium-term incidence of diseases such as heart failure, myocardial infarction, arrhythmias, and cardio- and cerebrovascular complications. Scientific societies are taking action to provide general guidance and recommendations aimed at mitigating the unfavourable outcomes of this pandemic emergency. Cardio-oncology, as an emerging discipline, is more flexible in modulating care pathways and represents a beacon of innovation in the development of multi-specialty patient management. In the era of the COVID-19 pandemic, cardio-oncology has rapidly modified its clinical care pathways and implemented flexible monitoring protocols that include targeted use of cardiac imaging, increased use of biomarkers, and telemedicine systems. The goal of these strategic adjustments is to minimize the risk of infection for providers and patients while maintaining standards of care for the treatment of oncologic and cardiovascular diseases. The aim of this document is to evaluate the impact of the pandemic on the management of cardio-oncologic patients with the-state-of-the-art knowledge about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease (COVID-19) in order to optimize medical strategies during and after the pandemic.
ANMCO POSITION PAPER: Timing of coronary angiography in non-ST-segment elevation acute coronary syndromes
Authors: Murrone Adriano , di Uccio Fortunato Scotto , Amodeo Vincenzo , Aspromonte Nadia , Caldarola Pasquale , Casella Gianni , Cipriani Manlio , De Luca Leonardo , Di Lenarda Andrea , Domenicucci Stefano , Francese Giuseppina Maura , Imazio Massimo , Roncon Loris , Urbinati Stefano , Valente Serafina , Di Pasquale Giuseppe , Gulizia Michele Massimo , Colivicchi Furio , Gabrielli Domenico
Published: August 2021

The European Society of Cardiology guidelines on non-ST-elevation acute coronary syndromes suggest different temporal strategies for the angiographic study depending on the risk profile. The scientific evidence underlying the guideline recommendations and the critical issues currently existing in Italy, that often do not allow either an extended strategy of revascularization within 24 h or the application of the principle of the same day transfer from a spoke to a hub centre, are analysed. The position paper focuses, in particular, on the subgroup of patients with a defined diagnosis of non-ST-elevation myocardial infarction by proposing a timing of coronary angiography/revascularization that takes into account the available scientific evidence and the organizational possibilities of a considerable part of national cardiology services.
ANMCO POSITION PAPER: Role of intra-aortic balloon pump in patients with acute advanced heart failure and cardiogenic shock
Authors: Rossini Roberta , Valente Serafina , Colivicchi Furio , Baldi Cesare , Caldarola Pasquale , Chiappetta Daniela , Cipriani Manlio , Ferlini Marco , Gasparetto Nicola , Gilardi Rossella , Giubilato Simona , Imazio Massimo , Marini Marco , Roncon Loris , Scotto di Uccio Fortunato , Somaschini Alberto , Sorini Dini Carlotta , Trambaiolo Paolo , Usmiani Tullio , Gulizia Michele Massimo , Gabrielli Domenico
Published: August 2021

The treatment of patients with advanced acute heart failure is still challenging. Intra-aortic balloon pump (IABP) has widely been used in the management of patients with cardiogenic shock. However, according to international guidelines, its routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian Association of Hospital Cardiologists, reviews the available data derived from clinical studies. It also provides practical recommendations for the optimal use of IABP in the treatment of cardiogenic shock and advanced acute heart failure.
Aging in Place Among Older Adults With Histories of Traumatic Experiences: A Scoping Review
Authors: Danielson Ramona A , Ray-Degges Susan
Published: August 2021

Background and Objectives

Adverse childhood and adult experiences can have far-reaching impacts and, when coupled with typical aging-related changes, may impede the achievement of a suitable person–environment fit for aging adults. The objective of our study was to determine whether extant literature connects older adults with trauma history to successfully aging in place.

Research Design and Methods

We proposed a conceptual model regarding trauma history, adaptive capacity of aging adults, and trauma-informed supports for aging in place. We conducted a scoping review using 6 databases (keywords: older adult(s), aging in place, housing, trauma), with a full review of 32 articles.

Results

Insights included: (a) Aging in place does not have to mean living in the same house over time. (b) The uncertainty of the aging process can be traumatic and can be exacerbated by previous traumatic experiences. (c) Environmental sensitivities can result from previous traumatic experiences and cause further trauma. (d) Housing precarity is a traumatic experience. (e) Permanent supportive housing is an important resource for people in crisis. (f) Community supports are critical to aging in place.

Discussion and Implications

Our review revealed insights about aging in place and trauma, but did not connect the vulnerabilities specific to aging adults with personal trauma histories to aging in place. Research is needed that confirms the relationship between history of traumatic experiences and difficulties with aging in place as well as trauma-informed approaches that can mitigate housing-related stressors and foster community-living environments that provide equitable access to aging in place.
Inhaled Corticosteroids Increase Risk of Nontuberculous Mycobacterial Lung Disease: A Nested Case-Control Study and Meta-analysis
Authors: Shu Chin-Chung , Wei Yu-Feng , Chen Kuang-Hung , Chuang Shulin , Wang Ya-Hui , Wang Cheng-Yi , Wang Hao-Chien
Published: August 2021

Studies on use of inhaled corticosteroids (ICS) and the risk of nontuberculous mycobacterial lung disease (NTM-LD) are limited and have some conflicting results. We recruited 1235 NTM-LD patients and found that ICS use within 1 year was associated with increased NTM-LD, and the risk increased with elevated ICS dose and cumulative duration. Discontinuation of ICS use for more than 120 days could reduce the risk of NTM-LD to an insignificant level. For NTM species, the development of NTM-LD by ICS was highest for Mycobacterium kansasii lung disease. The pooled results of the meta-analysis showed that ICS use might increase the risk of NTM-LD with dose response in medium and high dose of daily ICS. In addition, budesonide had a smaller impact on the risk of NTM-LD than other ICS medications. The present study and meta-analysis provide evidence for ICS adjustment, including dose, discontinuation effect, and medications to possibly reduce the risk of NTM-LD.
Failing Is Not an Option, It Is the Only Option: Critical Politics as a Time of Contradiction and Failure
Authors: Fisher Kathryn M , McIntosh Christopher
Published: August 2021

Questions regarding the political significance of international relations (IR) and how scholarly practice relates to/constitutes a political practice appear newly resonant, but are longstanding concerns. This article utilizes the growing literature on temporality within international politics to analyze the political potential of these intellectual interventions and generate new ways of framing scholarly practice. We observe two trends within the field. First, IR as a discipline remains largely—although not exclusively—imagined as an English-language discipline generated by scholars in the Global North. Each area's political discourse is currently dominated by fears surrounding foundational political and institutional change due to the rise of racialized authoritarianism within these self-imagined democratic societies. Despite these purportedly dramatic developments, there has not been a similarly dramatic shift in the scholarly relationship with politics. Scholars continue to successfully intervene in their collective presents, but scholarship itself remains oriented toward enduring claims that accumulate knowledge and resist the possibility of “failure.” This paper theorizes the temporality of critical intervention to better relate positively to the bodies that co-constitute our political present. Ultimately, this paper concludes by arguing for a reconsideration of contradiction and failure as frames for thinking scholarly practice in time.
Limited lumbopelvic mobility does not influence short-term outcomes after primary hip arthroscopy: a propensity-matched controlled study
Authors: Jimenez Andrew E , Fox James D , Miecznikowski Kara , Maldonado David R , Saks Benjamin R , Ankem Hari K , Sabetian Payam W , Lall Ajay C , Domb Benjamin G
Published: August 2021

There is a paucity of literature investigating the effect of lumbopelvic mobility on patient-reported outcome scores (PROs) after primary hip arthroscopy. The purpose of this study was (i) to report minimum 1-year PROs in patients with limited lumbopelvic mobility (LM) who underwent primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and (ii) to compare clinical results with a propensity-matched control group of patients with normal lumbopelvic mobility (NM). Data were reviewed for surgeries performed between November 2019 and March 2020. Patients were considered eligible if they received a primary hip arthroscopy for FAIS in the setting of LM (seated to standing change in sacral slope ≤ 10°). LM patients were propensity-matched to a control group of patients with normal lumbopelvic motion (seated to standing change in sacral slope > 10°) for comparison. A total of 17 LM and 34 propensity-matched NM patients were included in the study. LM patients showed significant improvement in all outcome measures and achieved the minimum clinically important difference (MCID) and patient acceptable symptomatic state (PASS) at high rates for modified Harris Hip Score (MCID: 94% and PASS: 82%) and International Hip Outcome Tool-12 (iHOT-12; MCID: 94% and iHOT-12: 76%). When LM patients were compared to a propensity-matched control group of NM patients, they demonstrated similar postoperative PROs and rates of achieving MCID/PASS. LM patients who undergo primary hip arthroscopy may expect favorable short-term PROs at minimum 1-year follow-up. These results were comparable to a control group of NM patients.
Is there enough evidence to support hip capsular reconstruction? A systematic review of biomechanical studies
Authors: Ankem Hari K , Ouyang Vivian W , Saks Benjamin R , Jimenez Andrew E , Sabetian Payam W , Maldonado David R , Lall Ajay C , Domb Benjamin G
Published: August 2021

The aim of this study was to review and summarize the available biomechanical data on hip capsular reconstruction to guide clinical decision-making. A literature search was completed in December 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify biomechanical cadaver studies on hip capsular reconstruction, hip capsulectomy or hip capsular defect. The investigated parameters included maximum distraction force, capsular state affecting range of motion (ROM), rotation and translation. Four studies met al. the inclusion–exclusion criteria. The median effective force for resisting maximum distraction for the reconstruction state, capsular defect state and the intact state was 171, 111 and 206 N, respectively. The defect capsule force was significantly lower (P = 0.00438) than the intact capsule force. The reconstruction state had a higher distraction force than that of the capsular defect, but due to heterogeneity, the overall effect size was not statistically significant. The capsular reconstruction state reduced excess motion and the degree of instability compared to the capsular defect state but restored the hip close to its native capsular state in the cadaveric model. When compared to capsulectomy/defect state, hip capsular reconstruction significantly improved the rotational stability and effective force at maximum distraction and minimized translation. However, no conclusions can be made regarding the most effective protocol due to the high heterogeneity between the four studies. Further biomechanical studies are needed to test various types of grafts under the same protocol.
Associations between screen time and cognitive development in preschoolers
Authors: Zhang Zhiguang , Adamo Kristi B , Ogden Nancy , Goldfield Gary S , Okely Anthony D , Kuzik Nicholas , Crozier Mitchell , Hunter Stephen , Predy Madison , Carson Valerie
Published: August 2021

Objectives

To examine the cross-sectional associations between screen time and cognitive development in preschoolers.

Methods

Participants were 97 preschoolers (36 to 60 months) in Alberta and Ontario, Canada in the supporting Healthy physical AcTive Childcare setting (HATCH) study. The time that children spent watching television, videos or DVDs (television time) or playing video or computer games (video game time) on a television, computer, or portable device was assessed using a parental questionnaire. Television time and video game time were summed to calculate total screen time. Adherence to the screen time recommendation (≤1 hour/day) of the Canadian 24-Hour Movement Guidelines was calculated. Expressive vocabulary and working memory were assessed using the Early Years Toolbox. Due to the distribution of working memory, it was categorized as a binary variable based on the median score. The associations between screen time and cognitive development were examined using mixed models (expressive vocabulary) or generalized mixed models (working memory).

Results

Screen time was not associated with expressive vocabulary. Preschoolers who had higher total screen time were less likely to have better working memory (OR=0.52; 95%CI:0.31, 0.88), despite the null associations for television time (P=0.155) and video game time (P=0.079). Preschoolers who met the screen time recommendation were more likely to have higher working memory capacity (OR=3.48; 95%CI:1.06, 11.47), compared to those who did not meet the recommendation.

Conclusion

Limiting total screen time to no more than one hour per day may facilitate working memory development in preschoolers. Screen time may be unrelated to expressive language development in this age group.
The impact of education inequality on rheumatoid arthritis risk is mediated by smoking and body mass index: Mendelian randomization study
Authors: Zhao Sizheng Steven , Holmes Michael V , Zheng Jie , Sanderson Eleanor , Carter Alice R
Published: August 2021

Objective

To estimate the causal relationship between educational attainment—as a proxy for socioeconomic inequality—and risk of RA, and quantify the roles of smoking and BMI as potential mediators.

Methods

Using the largest genome-wide association studies (GWAS), we performed a two-sample Mendelian randomization (MR) study of genetically predicted educational attainment (instrumented using 1265 variants from 766 345 individuals) and RA (14 361 cases, 43 923 controls). We used two-step MR to quantify the proportion of education’s effect on RA mediated by smoking exposure (as a composite index capturing duration, heaviness and cessation, using 124 variants from 462 690 individuals) and BMI (517 variants, 681 275 individuals), and multivariable MR to estimate proportion mediated by both factors combined.

Results

Each s.d. increase in educational attainment (4.2 years of schooling) was protective of RA (odds ratio 0.37; 95% CI: 0.31, 0.44). Higher educational attainment was also protective for smoking exposure (β = −0.25 s.d.; 95% CI: −0.26, −0.23) and BMI [β = −0.27 s.d. (∼1.3 kg/m2); 95% CI: −0.31, −0.24]. Smoking mediated 24% (95% CI: 13%, 35%) and BMI 17% (95% CI: 11%, 23%) of the total effect of education on RA. Combined, the two risk factors explained 47% (95% CI: 11%, 82%) of the total effect.

Conclusion

Higher educational attainment has a protective effect on RA risk. Interventions to reduce smoking and excess adiposity at a population level may reduce this risk, but a large proportion of education’s effect on RA remains unexplained. Further research into other risk factors that act as potentially modifiable mediators are required.
The Need for Greater Awareness of Sex Chromosome Variations
Authors: Torres Erin
Published: August 2021

Health care providers remain ill prepared to recognize these conditions and support patients and their families.
Supporting Frontline Staff During the COVID-19 Pandemic
Authors: Clements Charlotte , Barsamian Jennifer , Burnham Nicolette , Cruz Claire , Darcy Ann Marie Grillo , Duphiney Lindsay , FitzGerald Jacqueline , Holland Susan , Joyce Christine , DeSanto-Madeya Susan
Published: August 2021

The coronavirus disease 2019 (COVID-19) pandemic that emerged in early 2020 put unprecedented physical, mental, and emotional strain on the staff of health care organizations, who have been caring for a critically ill patient population for more than a year and a half. Amid the ongoing pandemic, health care workers have struggled to keep up with new information about the disease, while also coping with the anxiety associated with caring for affected patients. It has also been a continual challenge for nurse leaders to provide adequate support for staff members and keep them informed about frequently changing practices and protocols. In this article, nursing leaders at an academic medical center in Boston reflect on the initial COVID-19 patient surge, which occurred from March to June 2020, and identify key actions taken to provide clinical and emotional support to frontline staff who cared for these patients. Lessons learned in this period provide insight into the management of redeployed staff, use of emotional support and debriefing, and relationship between access to information and staff morale. The knowledge gained through these initial experiences has been a vital resource as health care workers continue to face challenges associated with the ongoing pandemic.
The association of actigraphy-assessed sleep duration with sleep blood pressure, nocturnal hypertension, and nondipping blood pressure: the coronary artery risk development in young adults (CARDIA) study
Authors: Abdalla Marwah , Sakhuja Swati , Akinyelure Oluwasegun P. , Thomas S. Justin , Schwartz Joseph E. , Lewis Cora E. , Shikany James M. , Lloyd-Jones Donald , Booth John N. , Shimbo Daichi , Hall Martica H. , Muntner Paul
Published: August 2021

Objective:

Nocturnal hypertension and nondipping systolic blood pressure (SBP) are associated with increased cardiovascular disease (CVD) risk. Short and long sleep duration (SSD and LSD) are also associated with increased CVD risk and may be risk factors for nocturnal hypertension and nondipping SBP. We examined the association between SSD and LSD with sleep BP, nocturnal hypertension, and nondipping SBP among 647 white and African American Coronary Artery Risk Development in Young Adults (CARDIA) study participants who completed 24-h ambulatory BP monitoring, wrist actigraphy, and sleep diaries in 2015–2016.

Methods:

The times when participants were asleep and awake were determined from actigraphy complemented by sleep diaries. Nocturnal hypertension was defined as sleep BP ≥120/70 mmHg and nondipping SBP as mean sleep-to-awake SBP ratio >0.90. Sleep duration was categorized as SSD (<6 h), normal sleep duration (NSD: 6–8.9 h), and LSD (≥9 h).

Results:

The prevalence of SSD and LSD were 13.9 and 21.1%, respectively. Compared to participants with NSD, participants with LSD had higher mean sleep SBP (2.1 mmHg, 95% confidence interval [CI] 0.2, 4.1 mmHg) and diastolic BP (1.7 mmHg, 95% CI 0.5, 3.0 mmHg). Participants with LSD had a higher prevalence of nocturnal hypertension (prevalence ratio [PR]: 1.26, 95% CI 1.03–1.54) and nondipping SBP (PR 1.33, 95% CI 1.03–1.72) compared to participants with NSD. There was no evidence of an association between SSD and sleep SBP or DBP, nocturnal hypertension, or nondipping SBP.

Conclusions:

These findings suggest that LSD may be associated with nocturnal hypertension and nondipping SBP.
Elevated blood pressure positively associates with alpha-1 microglobulin in prepubescent children: the ExAMIN Youth SA study
Authors: Craig Ashleigh , Gafane-Matemane Lebo , Smith Wayne , Mels Carina , Uys Lisa , Breet Yolandi , Brits Sanette , Mokwatsi Gonste , Hanssen Henner , Kruger Ruan
Published: August 2021

Objectives and methods:

Hypertension is a growing health concern in childhood populations and individuals of African descent. As the kidneys play a significant role in blood pressure regulation, we compared alpha-1 microglobulin (A1M) as a marker of proximal tubular function between young healthy black and white children (n = 957; aged: 5–9 years) and explored its association with blood pressure.

Results:

The black children had higher levels of A1M (P < 0.001) and higher DBP (P < 0.001) when compared with their white counterparts. In multiple regression analysis, SBP (adj. R
2 = 0.173, β = 0.151; P < 0.001) and DBP (adj. R
2 = 0.110, β = 0.179; P < 0.001) associated positively with A1M in the black children. In binary logistic regression, each standard deviation increase in A1M increased the odds of having elevated blood pressure by 28% (P = 0.002) in the black group, independent of age, sex, BMI z-score and body height. No significance was reached in the white children.

Conclusion:

Our findings highlight the importance of a marker of proximal tubular function, especially in children of black ethnicity, in the setting of elevated blood pressure. Early childhood screening for elevated blood pressure remains essential in order to promote primary prevention of hypertension and early onset kidney damage in children.
Central versus ambulatory blood pressure for predicting mortality and cardiovascular events in hemodialysis patients: a multicenter cohort study
Authors: Liu Wenjin , Ye Yinyin , Wang Lulu , Gao Chaoqing , Bai Youwei , Chu Hong , Fan Wei , Sun Zhuxing , Wang Liang , Li Xiurong , Yang Junwei
Published: August 2021

Objective:

Studies in the general population suggest that central blood pressure (BP) may be superior to peripheral BP in risk assessment. Although ambulatory brachial BP is recognized as the most reliable BP measurement in the dialysis population, there is no comparison of office central BP with ambulatory BP regarding risk stratification in these patients.

Methods:

In a multicenter prospective study of dialysis patients, central BP was measured noninvasively on a midweek nondialysis day, with interdialytic ambulatory BP and predialysis BP also collected. The primary outcomes were a composite of major adverse cardiovascular events (MACE) and all-cause mortality. Agreement between central and ambulatory BP was assessed using Cohen's Kappa index and Bland--Altman plot. Linear and nonlinear Cox regression models were used to determine the association of BP parameters with outcomes.

Results:

A total of 368 patients were recruited and 366 underwent central BP measurement. Central BP had a moderate agreement with ambulatory BP in defining hypertension (κ = 0.42) with wide limits of agreement in Bland--Altman analysis. After a median follow-up of 51.5 months, central pulse pressure, ambulatory SBP and ambulatory pulse pressure were associated with all-cause mortality, whereas all BP parameters, except for predialysis DBP, were significant predictors of MACE. However, whenever evaluated in a stepwise variable selection Cox model, only ambulatory pulse pressure, but not any central BP, was determined as the best candidate for prediction of both all-cause mortality and MACE. Nonlinear Cox models revealed no significant nonlinear trend of the association between central BP and outcomes.

Conclusion:

Central BP is predictive of all-cause mortality and cardiovascular events in dialysis patients but its prognostic value does not outperform ambulatory peripheral BP. Our data support the superiority of ambulatory BP in the dialysis population.
Maternal blood pressure trajectories and associations with gestational age at birth: a functional data analytic approach
Authors: Horsley Kristin J. , Ramsay James O. , Ditto Blaine , Da Costa Deborah
Published: August 2021

Background:

Research has revealed group-level differences in maternal blood pressure trajectories across pregnancy. These trajectories are typically constructed using clinical blood pressure data and multivariate statistical methods that are prone to bias and ignore the functional, dynamic process underlying a single blood pressure observation. The aim of this study was to use functional data analysis to explore blood pressure variation across pregnancy, and multivariate methods to examine whether trajectories are related to gestational age at birth.

Methods:

Clinical blood pressure observations were available from 370 women who participated in a longitudinal pregnancy cohort study conducted in Montreal, Quebec, Canada. Functional data analysis was used to smooth blood pressure data and then to conduct a functional principal component analysis to examine predominant modes of variation.

Results:

Three eigenfunctions explained greater than 95% of the total variance in blood pressure. The first accounted for approximately 80% of the variance and was characterized by a prolonged-decrease trajectory in blood pressure; the second explained 10% of the variance and captured a late-increase trajectory; and the third accounted for approximately 7% of the variance and captured a mid-decrease trajectory. The prolonged-decrease trajectory of blood pressure was associated with older, and late-increase with younger gestational age at birth.

Conclusion:

Functional data analysis is a useful method to model repeated maternal blood pressure observations and many other time-related cardiovascular processes. Results add to previous research investigating blood pressure trajectories across pregnancy through identification of additional, potentially clinically important modes of variation that are associated with gestational age at birth.
Suture–needle snare for scleral fixation
Authors: Weinlander Eric , Nakatsuka Austin , Lin Amy
Published: August 2021

Current scleral suture fixation techniques pose challenges for highly complex eyes. A scleral suture fixation technique using a snare that is fashioned out of a 27-gauge needle and 8-0 nylon suture is described. This technique is well-suited for scleral suture fixation in complex eyes because it reduces risk factors for intraoperative and postoperative complications, simplifies intraocular maneuvers, minimizes surgical trauma, and does not require specialized microinstrumentation.
Transmembrane protein TMEM184B is necessary for interleukin-31–induced itch
Authors: Larsen Erik G. , Cho Tiffany S. , McBride Matthew L. , Feng Jing , Manivannan Bhagyashree , Madura Cynthia , Klein Nathaniel E. , Wright Elizabeth B. , Wickstead Edward S. , Garcia-Verdugo Hector D. , Jarvis Chelsea , Khanna Rajesh , Hu Hongzhen , Largent-Milnes Tally M. , Bhattacharya Martha R.C.
Published: August 2021

Nociceptive and pruriceptive neurons in the dorsal root ganglia (DRG) convey sensations of pain and itch to the spinal cord, respectively. One subtype of mature DRG neurons, comprising 6% to 8% of neurons in the ganglia, is responsible for sensing mediators of acute itch and atopic dermatitis, including the cytokine IL-31. How itch-sensitive (pruriceptive) neurons are specified is unclear. Here, we show that transmembrane protein 184B (TMEM184B), a protein with roles in axon degeneration and nerve terminal maintenance, is required for the expression of a large cohort of itch receptors, including those for interleukin 31 (IL-31), leukotriene C4, and histamine. Male and female mice lacking TMEM184B show reduced responses to IL-31 but maintain normal responses to pain and mechanical force, indicating a specific behavioral defect in IL-31–induced pruriception. Calcium imaging experiments indicate that a reduction in IL-31–induced calcium entry is a likely contributor to this phenotype. We identified an early failure of proper Wnt-dependent transcriptional signatures and signaling components in Tmem184b mutant mice that may explain the improper DRG neuronal subtype specification. Accordingly, lentiviral re-expression of TMEM184B in mutant embryonic neurons restores Wnt signatures. Together, these data demonstrate that TMEM184B promotes adult somatosensation through developmental Wnt signaling and promotion of proper pruriceptive gene expression. Our data illuminate a new key regulatory step in the processes controlling the establishment of diversity in the somatosensory system.
Psychosocial and cardiometabolic predictors of chronic pain onset in Native Americans: serial mediation analyses of 2-year prospective data from the Oklahoma Study of Native American Pain Risk
Authors: Rhudy Jamie L. , Huber Felicitas A. , Toledo Tyler A. , Kell Parker A. , Street Erin N. , Shadlow Joanna O.
Published: August 2021

Chronic pain results in considerable suffering, as well as significant economic and societal costs. Previous evidence suggests that Native Americans (NAs) have higher rates of chronic pain than other U.S. racial or ethnic groups, but the mechanisms contributing to this pain disparity are poorly understood. The Oklahoma Study of Native American Pain Risk was developed to address this issue and recruited healthy, pain-free NAs and non-Hispanic Whites. Cross-sectional analyses identified several measures of adversity (eg, trauma and discrimination), cognitive-affective factors (perceived stress and pain-related anxiety/catastrophizing), and cardiometabolic factors (eg, body mass index, blood pressure, and heart rate variability) that were associated with pronociceptive processes (eg, central sensitization, descending inhibition, and hyperalgesia). Every 6-months after enrollment, eligible participants (N = 277) were recontacted and assessed for the onset of chronic pain. This study examines predictors of chronic pain onset in the 222 participants (80%) who responded over the first 2 years. The results show that NAs developed chronic pain at a higher rate than non-Hispanic Whites (OR = 2.902, P < 0.05), even after controlling for age, sex, income, and education. Moreover, serial mediation models identified several potential pathways to chronic pain onset within the NA group. These paths included perceived discrimination, psychological stress, pain-related anxiety, a composite measure of cardiometabolic risk, and impaired descending inhibition of spinal nociception (assessed from conditioned pain modulation of the nociceptive flexion reflex). These results provide the first prospective evidence for a pain disparity in NAs that seems to be promoted by psychosocial, cardiometabolic, and pronociceptive mechanisms.
Enhancing U.S. Local, State, and Federal Preparedness Through Simulated Interactive Tabletop Exercises of a Mock Antibiotic-Resistant Gonorrhea Outbreak, 2018–2019
Authors: Schlanger Karen , Black Jamie M. , Smith Marguerite , Ridpath Alison , Crause Candi , Holderman Justin L. , Henderson Kyle , Hardrick Harold , Pham Cau D. , Howard George , Kirkcaldy Robert D.
Published: August 2021

Background

Responding effectively to outbreaks of antibiotic-resistant gonorrhea (ARGC) in the future will likely prove challenging. Tabletop exercises (TTXs) may assist local, state, and federal public health officials evaluate existing ARGC outbreak response plans, strengthen preparedness and response effectiveness, and identify critical gaps to address before an outbreak.

Methods

In 2018 to 2019, Centers for Disease Control and Prevention (CDC) collaborated with state partners to develop and implement TTXs to simulate a public health emergency involving an ARGC outbreak. Before the TTXs, 2 state-local health department pairs developed ARGC outbreak response plans. During each 1-day exercise (in Indiana and Illinois), participants discussed roles, clinical management, public health response, and communication based on predeveloped response plans. Observers identified outbreak response strengths and gaps, and participants completed feedback forms.

Results

Forty-one (Illinois) and 48 people (Indiana) participated in each TTX, including sexually transmitted disease clinical staff, laboratorians, public health infectious disease program staff, and CDC observers. Strengths and gaps varied by jurisdiction, but identified gaps included: (1) local access to gonorrhea culture and timely antimicrobial susceptibility testing, (2) protocols for clinical management of suspected treatment failures, (3) communication plans, and (4) clarity regarding state and local responsibilities. The CDC observers identified opportunities to provide national-level technical assistance, foster local antimicrobial susceptibility testing, and develop further response guidance. Tabletop exercises summary reports were used to guide modifications to local response plans to address gaps.

Conclusions

The TTXs allowed participants to practice responding to a simulated public health emergency and may have enhanced local response capacity. Centers for Disease Control and Prevention made TTX implementation materials publicly available.
Test of Cure Return Rate and Test Positivity, Strengthening the US Response to Resistant Gonorrhea, United States, 2018–2019
Authors: Schlanger Karen , Mauk Kerry , Learner Emily R. , Schillinger Julia A. , Nishiyama Masayo , Kohn Robert , Thibault Christina , Hermus Helen , Dewater Joey , Pabon Vonda , Black Jamie , St. Cyr Sancta , Pham Cau R. , Kirkcaldy Robert D. ,   for the SURRG Working Group
Published: August 2021

Background

Reduced antibiotic susceptibility (RS) in Neisseria gonorrhoeae (GC) may increase treatment failure. Conducting tests of cure (TOC) for patients with RS-GC may facilitate identification of treatment failures.

Methods

We examined 2018 to 2019 data from 8 jurisdictions participating in the US Centers for Disease Control and Prevention's Strengthening US Response to Resistant Gonorrhea project. Jurisdictions collected GC isolates and epidemiological data from patients and performed antimicrobial susceptibility testing. Minimum inhibitory concentrations of ceftriaxone, 0.125 μg/mL or greater; cefixime, 0.250 μg/mL or greater; or azithromycin, 2.0 μg/mL or greater were defined as RS. Patients with RS infections were asked to return for a TOC 8 to 10 days posttreatment. We calculated a weighted TOC return rate and described time to TOC and suspected reasons for any positive TOC results.

Results

Overall, 1165 patients were diagnosed with RS infections. Over half returned for TOC (weighted TOC, 61%; 95% confidence interval, 50.1%–72.6%; range by jurisdiction, 32%–80%). Test of cure rates were higher among asymptomatic (68%) than symptomatic patients (53%, P = 0.001), and men who have sex with men (62%) compared with men who have sex with women (50%; P < 0.001). Median time between treatment and TOC was 12 days (interquartile range, 9–16). Of the 31 (4.5%) TOC patients with positive results, 13 (42%) were suspected because of reinfection and 11 (36%) because of false-positive results. There were no treatment failures suspected to be due to RS-GC.

Conclusions

Most patients with a RS infection returned for a TOC, though return rates varied by jurisdiction and patient characteristics. Test of cure can identify and facilitate treatment of reinfections, but false-positive TOC results may complicate interpretation and clinical management.
Impact of Anatomic Site, Specimen Collection Timing, and Patient Symptom Status on Neisseria gonorrhoeae Culture Recovery
Authors: Nash Evelyn E. , Pham Cau D. , Raphael Brian , Learner Emily R. , Mauk Kerry , Weiner Josh , Mettenbrink Christie , Thibault Christina S. , Fukuda Acasia , Dobre-Buonya Oana , Black Jamie M. , Johnson Kimberly , Sellers Kevin , Schlanger Karen ,   for the SURRG Working Group
Published: August 2021

Background

Neisseria gonorrhoeae culture is required for antimicrobial susceptibility testing, but recovering isolates from clinical specimens is challenging. Although many variables influence culture recovery, studies evaluating the impact of culture specimen collection timing and patient symptom status are limited. This study analyzed urogenital and extragenital culture recovery data from Centers for Disease Control and Prevention's Strengthening the US Response to Resistant Gonorrhea (SURRG) program, a multisite project, which enhances local N. gonorrhoeae culture and antimicrobial susceptibility testing capacity.

Methods

Eight SURRG jurisdictions collected gonococcal cultures from patients with N. gonorrhoeae–positive nucleic acid amplification test (NAAT) results attending sexually transmitted disease and community clinics. Matched NAAT and culture specimens from the same anatomic site were collected, and culture recovery was assessed. Time between NAAT and culture specimen collection was categorized as same day, 1 to 7 days, 8 to 14 days, or ≥15 days, and patient symptoms were matched to the anatomic site where culture specimens were collected.

Results

From 2018 to 2019, among persons with N. gonorrhoeae–positive NAAT, urethral infections resulted in the highest culture recovery (5927 of 6515 [91.0%]), followed by endocervical (222 of 363 [61.2%]), vaginal (63 of 133 [47.4%]), rectal (1117 of 2805 [39.8%]), and pharyngeal (1019 of 3678 [27.7%]) infections. Culture recovery was highest when specimens were collected on the same day as NAAT specimens and significantly decreased after 7 days. Symptoms were significantly associated with culture recovery at urethral (P = <0.0001) and rectal (P = <0.0001) sites of infection but not endocervical, vaginal, or pharyngeal sites.

Conclusions

Culture specimen collection timing and patient symptomatic status can impact culture recovery. These findings can guide decisions about culture collection protocols to maximize culture recovery and strengthen detection of antimicrobial-resistant infections.