bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasible approaches and implementation challenges to atrial fibrillation screening: a qualitative study of stakeholder views in 11 European countries
Authors: Engler Daniel , Hanson Coral L , Desteghe Lien , Boriani Giuseppe , Diederichsen Søren Zöga , Freedman Ben , Palà Elena , Potpara Tatjana S , Witt Henning , Heidbuchel Hein , Neubeck Lis , Schnabel Renate B
Published: June 2022

Objectives

Atrial fibrillation (AF) screening may increase early detection and reduce complications of AF. European, Australian and World Heart Federation guidelines recommend opportunistic screening, despite a current lack of clear evidence supporting a net benefit for systematic screening. Where screening is implemented, the most appropriate approaches are unknown. We explored the views of European stakeholders about opportunities and challenges of implementing four AF screening scenarios.

Design

Telephone-based semi-structured interviews with results reported using Consolidated criteria for Reporting Qualitative research guidelines. Data were thematically analysed using the framework approach.

Setting

AF screening stakeholders in 11 European countries.

Participants

Healthcare professionals and regulators (n=24) potentially involved in AF screening implementation.

Intervention

Four AF screening scenarios: single time point opportunistic, opportunistic prolonged, systematic single time point/prolonged and patient-led screening.

Primary outcome measures

Stakeholder views about the challenges and feasibility of implementing the screening scenarios in the respective national/regional healthcare system.

Results

Three themes developed. (1) Current screening approaches: there are no national AF screening programmes, with most AF detected in symptomatic patients. Patient-led screening exists via personal devices, creating screening inequity. (2) Feasibility of screening: single time point opportunistic screening in primary care using single-lead ECG devices was considered the most feasible. Software algorithms may aid identification of suitable patients and telehealth services have potential to support diagnosis. (3) Implementation requirements: sufficient evidence of benefit is required. National screening processes are required due to different payment mechanisms and health service regulations. Concerns about data security, and inclusivity for those without primary care access or personal devices must be addressed.

Conclusions

There is an overall awareness of AF screening. Opportunistic screening appears the most feasible across Europe. Challenges are health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit and a tailored approach adapted to national realities.
To what extent is socioeconomic status associated with not taking up and dropout from cardiac rehabilitation: a population-based follow-up study
Authors: Svendsen Marie Louise , Gadager Birgitte Bitsch , Stapelfeldt Christina M , Ravn Maiken Bay , Palner Sanne Moeller , Maribo Thomas
Published: June 2022

Objectives

High socioeconomic status (SES) has been linked to high referral for cardiac rehabilitation (CR). However, the impact of SES on CR utilisation from enrolment to completion is unclear. The objective of this study was to examine whether indicators of SES are associated with not taking up and dropout from CR.

Design

A population-based, follow-up study.

Setting

Hospitals and primary healthcare centres in the Central Denmark Region.

Participant

Patients diagnosed with ischaemic heart disease (IHD) in the hospital and referred for rehabilitation in the primary healthcare setting from 1 September 2017 to 31 August 2018 (n=2018).

Variables

Four SES indicators (education, disposable family income, occupation and cohabitant status) were selected because of their established association with cardiovascular health and CR utilisation. Patients were followed up regarding no uptake of or dropout from CR in the primary healthcare setting.

Statistical methods

The associations between the four SES indicators and either no uptake or dropout from CR were analysed using logistic regression with adjustment for age, sex, nationality and comorbidity.

Results

Overall, 25% (n=507) of the referred patients did not take up CR and 24% (n=377) of the participators dropped out the CR. All adjusted ORs, except one (education/dropout) demonstrated that low SES compared with high are statistically significantly associated with higher odds of not taking up CR and dropout from CR. The ORs ranged from 1.52, 95% CI 1.13 to 2.04 (education/no uptake) to 2.36, 95% CI 1.60 to 3.46 (occupation/dropout).

Conclusions

This study highlights that indicators of SES are important markers of CR utilisation following hospitalisation for IHD.
Exploring the most important factors related to self-perceived health among older men in Sweden: a cross-sectional study using machine learning
Authors: Olsson Max , Currow David C , Ekström Magnus Per
Published: June 2022

Objective

To evaluate which factors are the most strongly related to self-perceived health among older men and describe the shape of the association between the related factors and self-perceived health using machine learning.

Design and setting

This is a cross-sectional study within the population-based VAScular and Chronic Obstructive Lung disease study (VASCOL) conducted in southern Sweden in 2019.

Participants

A total of 475 older men aged 73 years from the VASCOL dataset.

Measures

Self-perceived health was measured using the first item of the Short Form 12. An extreme gradient-boosting model was trained to classify self-perceived health as better (rated: excellent or very good) or worse (rated: fair or poor) using self-reported data on 19 prevalent physician-diagnosed health conditions, intensity of 9 symptoms and 9 demographic and lifestyle factors. Importance of factors was measured in SHapley Additive exPlanations absolute mean and higher scores correspond to greater importance.

Results

The most important factors for classifying self-perceived health were: pain (0.629), sleep quality (0.595), breathlessness (0.549), fatigue (0.542) and depression (0.526). Health conditions ranked well below symptoms and lifestyle variables. Low levels of symptoms, good sleep quality, regular exercise, alcohol consumption and a body mass index between 22 and 28 were associated with better self-perceived health.

Conclusions

Symptoms are more strongly related to self-perceived health than health conditions, which suggests that the impacts of health conditions are mediated through symptoms, which could be important targets to improve self-perceived health. Machine learning offers a new way to assess composite constructs such as well-being or quality of life.
Prevalence of hypertension in Shenzhen, China: a population-based, cross-sectional study
Authors: Cai Weicong , Wang Yirong , Peng Ke , Zhao Rencheng , Liu Fangjiang , Lin Kaihao , Xie Fengzhu , Lei Lin , Peng Ji
Published: June 2022

Objective

Hypertension (HTN) is an important public health issue worldwide, associated with the rapid economic development and urbanisation over the last decades. This is especially the case in Shenzhen, which has benefited greatly from the reform and opening-up policies. However, there is limited information on the epidemiology of HTN in this region. This study was designed to investigate the prevalence, awareness, treatment and control of HTN and the associated factors among adult residents in Shenzhen, China.

Design

Population-based, cross-sectional study.

Participants

Through the multistage stratified random sampling method, a representative sample of 10 043 urban population aged ≥18 years were selected. Three consecutive blood pressure (BP) readings were measured after resting for a 5 min seat by trained staff and HTN was defined as mean systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or self-reported current use of antihypertensive drugs. Participants were interviewed using a structured questionnaire. Anthropometric details, BP, blood and urine samples were also collected.

Primary outcome measure

Prevalence of HTN.

Results

Overall, the weighted prevalence of HTN among residents in Shenzhen was 19.2% (95% CI 18.5 to 20.0). Among patients with HTN, 55.0% (95% CI 52.9 to 57.1) were aware of their condition and 44.9% (95% CI 42.8 to 47.1) were taking antihypertensive medications, but only 21.7% (95% CI 20.0 to 23.5) achieved BP control. Among those who knew their HTN, 81.7% (95% CI 79.3 to 83.8) were under treatment and 48.3% (95% CI 45.1 to 51.5) were controlled among those with treated HTN. Male, older age, lower educational level, overweight and obesity, family history of HTN, tobacco smoking, alcohol intake, diabetes mellitus, dyslipidaemia and high uric acid were associated with HTN.

Conclusions

HTN is a major public health concern in Shenzhen, which has low awareness, treatment and control rates, and is associated with several risk factors. Effective multifaceted implementation strategies are highly needed to combat the emerging burden of HTN.
Implications of the availability and distribution of birth weight on addressing neonatal mortality: population-based assessment from Bihar state of India
Authors: Kumar G Anil , George Sibin , Akbar Md , Bhattacharya Debarshi , Nanda Priya , Dandona Lalit , Dandona Rakhi
Published: June 2022

Objective

A large proportion of neonatal deaths in India are attributable to low birth weight (LBW). We report population-based distribution and determinants of birth weight in Bihar state, and on the perceptions about birth weight among carers.

Design

A cross-sectional household survey in a state representative sample of 6007 live births born in 2018–2019. Mothers provided detailed interviews on sociodemographic characteristics and birth weight, and their perceptions on LBW (birth weight <2500 g). We report on birth weight availability, LBW prevalence, neonatal mortality rate (NMR) by birth weight and perceptions of mothers on LBW implications.

Setting

Bihar state, India.

Participants

Women with live birth between October 2018 and September 2019.

Results

A total of 5021 (83.5%) live births participated, and 3939 (78.4%) were weighed at birth. LBW prevalence among those with available birth weight was 18.4% (95% CI 17.1 to 19.7). Majority (87.5%) of the live births born at home were not weighed at birth. LBW prevalence decreased and birth weight ≥2500 g increased significantly with increasing wealth index quartile. NMR was significantly higher in live births weighing <1500 g (11.3%; 95% CI 5.1 to 23.1) and 1500–1999 g (8.0%; 95% CI 4.6 to 13.6) than those weighing ≥2500 g (1.3%, 95% CI 0.9 to 1.7). Assuming proportional correspondence of LBW and NMR in live births with and without birth weight, the estimated LBW among those without birth weight was 35.5% (95% CI 33.0 to 38.0) and among all live births irrespective of birth weight availability was 23.0% (95% CI 21.9 to 24.2). 70% of mothers considered LBW to be a sign of sickness, 59.5% perceived it as a risk of developing other illnesses and 8.6% as having an increased probability of death.

Conclusions

Missing birth weight is substantially compromising the planning of interventions to address LBW at the population-level. Variations of LBW by place of delivery and sociodemographic indicators, and the perceptions of carers about LBW can facilitate appropriate actions to address LBW and the associated neonatal mortality.
Effectiveness of a guideline implementation tool for supporting management of mental health complications after mild traumatic brain injury in primary care: protocol for a randomised controlled trial
Authors: Silverberg Noah D , Otamendi Thalia , Brasher Penelope MA , Brubacher Jeffrey R , Li Linda C , Lizotte Pierre-Paul , Panenka William J , Scheuermeyer Frank X , Archambault Patrick
Published: June 2022

Introduction

Mental health problems frequently interfere with recovery from mild traumatic brain injury (mTBI) but are under-recognised and undertreated. Consistent implementation of clinical practice guidelines for proactive detection and treatment of mental health complications after mTBI will require evidence-based knowledge translation strategies. This study aims to determine if a guideline implementation tool can reduce the risk of mental health complications following mTBI. If effective, our guideline implementation tool could be readily scaled up and/or adapted to other healthcare settings.

Methods and analysis

We will conduct a triple-blind cluster randomised trial to evaluate a clinical practice guideline implementation tool designed to support proactive management of mental health complications after mTBI in primary care. We will recruit 535 adults (aged 18–69 years) with mTBI from six emergency departments and two urgent care centres in the Greater Vancouver Area, Canada. Upon enrolment at 2 weeks post-injury, they will complete mental health symptom screening tools and designate a general practitioner (GP) or primary care clinic where they plan to seek follow-up care. Primary care clinics will be randomised into one of two arms. In the guideline implementation tool arm, GPs will receive actionable mental health screening test results tailored to their patient and their patients will receive written education about mental health problems after mTBI and treatment options. In the usual care control arm, GPs and their patients will receive generic information about mTBI. Patient participants will complete outcome measures remotely at 2, 12 and 26 weeks post-injury. The primary outcome is rate of new or worsened mood, anxiety or trauma-related disorder on the Mini International Neuropsychiatric Interview at 26 weeks.

Ethics and dissemination

Study procedures were approved by the University of British Columbia’s research ethics board (H20-00562). The primary report for the trial results will be published in a peer-reviewed journal. Our knowledge user team members (patients, GPs, policymakers) will co-create a plan for public dissemination.

Trial registration number

ClinicalTrials.gov Registry (NCT04704037).
Optic disc area frequency distribution in a large sample of retinographic images
Authors: Gonzalez-Hernandez Marta , Gonzalez-Hernandez Daniel , Perez-Barbudo Daniel , Gonzalez de la Rosa Manuel
Published: June 2022

Objective

To describe a new method to estimate the frequency distribution of optic nerve disc area, using digital retinographic images.

Methods and analysis

We analysed 492 023 fundus images obtained with seven fundus cameras, mainly in Caucasian subjects. They were grouped by resolution and zoom. They were automatically segmented by identifying the inner edge of the Elschnig scleral ring. For this purpose, a neural network trained by deep learning previously described was used. The number of pixels contained within the segmentation and their frequency distribution were calculated. The results of each camera, using different number of images, were compared with the global results using the Kolmogorov-Smirnov test to confront frequency distributions.

Results

The frequency distribution was non-Gaussian, more limited in small sizes than in large ones. If the median is assigned a theoretical value of 1.95 mm2, the 1th, 5th, 25th, 50th, 75th, 95th and 99th percentiles would correspond to 1.29, 1.46, 1.73, 1.95, 2.20, 2.64 and 3.03 mm2in all the dataset. The overall differences were significant for the smaller series, but for each percentile their mean value was only 0.01 mm2and the maximum 0.10 mm2, so they can be considered similar for practical purposes in all cameras.

Conclusion

By automatically segmenting the edges of the optic nerve and observing the frequency distribution of the number of pixels it delimits, it is possible to estimate the frequency distribution of the disc area in the population as a whole and that of each individual case.
Cognitive impairment and frailty screening in older surgical patients: a rural tertiary care centre experience
Authors: Andrew Caroline D , Fleischer Christina , Charette Kristin , Goodrum Debra , Chow Vinca , Abess Alexander , Briggs Alexandra , Deiner Stacie
Published: June 2022

Introduction

Despite a clear association between cognitive impairment and physical frailty and poor postoperative outcomes in older adults, preoperative rates are rarely assessed. We sought to implement a preoperative cognitive impairment and frailty screening programme to meet the unique needs of our rural academic centre.

Methods

Through stakeholder interviews, we identified five primary drivers underlying screening implementation: staff education, technology infrastructure, workload impact, screening value and patient–provider communication. Based on these findings, we implemented cognitive dysfunction (AD8, Mini-Cog) and frailty (Clinical Frailty Scale) screening in our preoperative care clinic and select surgical clinics.

Results

In the preoperative care clinic, many of our patients scored positive for clinical frailty (428 of 1231, 35%) and for cognitive impairment (264 of 1781, 14.8%). In our surgical clinics, 27% (35 of 131) and 9% (12 of 131) scored positive for clinical frailty and cognitive impairment, respectively. Compliance to screening improved from 48% to 86% 1 year later.

Conclusion

We qualitatively analysed stakeholder feedback to drive the successful implementation of a preoperative cognitive impairment and frailty screening programme in our rural tertiary care centre. Preliminary data suggest that a clinically significant proportion of older adults screen positive for preoperative cognitive impairment and frailty and would benefit from tailored inpatient care.
Childhood ‘bronchitis’ and respiratory outcomes in middle-age: a prospective cohort study from age 7 to 53 years
Authors: Perret Jennifer L , Wurzel Danielle , Walters E Haydn , Lowe Adrian J , Lodge Caroline J , Bui Dinh S , Erbas Bircan , Bowatte Gayan , Russell Melissa A , Thompson Bruce R , Gurrin Lyle , Thomas Paul S , Hamilton Garun , Hopper John L , Abramson Michael J , Chang Anne B , Dharmage Shyamali C
Published: June 2022

Background

Chronic bronchitis in childhood is associated with a diagnosis of asthma and/or bronchiectasis a few years later, however, consequences into middle-age are unknown.

Objective

To investigate the relationship between childhood bronchitis and respiratory-related health outcomes in middle-age.

Design

Cohort study from age 7 to 53 years.

Setting

General population of European descent from Tasmania, Australia.

Participants

3202 participants of the age 53-year follow-up (mean age 53, range 51–55) of the Tasmanian Longitudinal Health Study cohort who were born in 1961 and first investigated at age 7 were included in our analysis.

Statistical methods

Multivariable linear and logistic regression. The association between parent reported childhood bronchitis up to age 7 and age 53-year lung conditions (n=3202) and lung function (n=2379) were investigated.

Results

Among 3202 participants, 47.5% had one or more episodes of childhood bronchitis, classified according to severity based on the number of episodes and duration as: ‘non-recurrent bronchitis’ (28.1%); ‘recurrent non-protracted bronchitis’ (18.1%) and ‘recurrent-protracted bronchitis’ (1.3%). Age 53 prevalence of doctor-diagnosed asthma and pneumonia (p-trend <0.001) and chronic bronchitis (p-trend=0.07) increased in accordance with childhood bronchitis severities. At age 53, ‘recurrent-protracted bronchitis’ (the most severe subgroup in childhood) was associated with doctor-diagnosed current asthma (OR 4.54, 95% CI 2.31 to 8.91) doctor-diagnosed pneumonia (OR=2.18 (95% CI 1.00 to 4.74)) and, paradoxically, increased transfer factor for carbon monoxide (z-score +0.51 SD (0.15–0.88)), when compared with no childhood bronchitis.

Conclusion

In this cohort born in 1961, one or more episodes of childhood bronchitis was a frequent occurrence. ‘Recurrent-protracted bronchitis’, while uncommon, was especially linked to multiple respiratory outcomes almost five decades later, including asthma, pneumonia and raised lung gas transfer. These findings provide insights into the natural history of childhood ‘bronchitis’ into middle-age.
Assessment and monitoring of Achilles tendinopathy in clinical practice: a qualitative descriptive exploration of the barriers clinicians face
Authors: Murphy Myles Calder , Debenham James , Bulsara Caroline , Chivers Paola , Rio Ebonie Kendra , Docking Sean , Travers Mervyn , Gibson William
Published: June 2022

Our primary objective was to explore the barriers preventing clinicians from implementing what they think is ideal practice as it relates to using tools to aid diagnosis and monitor progress in mid-portion Achilles tendinopathy. Our secondary objectives were to describe the assessments employed by clinicians in their own practice to aid with (a) diagnosis and (b) monitoring progress in Achilles tendinopathy and explore the outcome measure domains clinicians believe to be the most and least important when managing patients with Achilles tendinopathy. We employed a qualitative descriptive study design. Thirteen participants (eight female, five male) from across Australia, consisting of two junior physiotherapists, five senior physiotherapists working in private practice, four senior physiotherapists working within elite sports organisations and two sport and exercise medicine doctors, were included and one-on-one interviews were performed. Audio was transcribed then entered into NVivo for coding and analysis. Four main themes were perceived as barriers to implementing ideal practice of assessment and monitoring in people with Achilles tendinopathy: financial constraints, time constraints, access to equipment and patient symptom severity. Assessments related to function, pain on loading, pain over a specified time frame and palpation are commonly used to assist diagnosis. Assessments related to disability, pain on loading, pain over a specified time frame and physical function capacity are used to monitor progress over time. Furthermore, pain on loading and pain over a specified time frame were considered the most important outcome measure domains for assisting diagnosis whereas pain on loading, patient rating of the condition and physical function capacity were the most important outcome measure domains for monitoring progress. A number of barriers exist that prevent clinicians from implementing what they view as ideal assessment and monitoring for Achilles tendinopathy. These barriers should be considered when developing new assessments and in clinical practice recommendations.
Acute and delayed psychiatric sequelae among patients hospitalised with COVID-19: a cohort study using LIFE study data
Authors: Murata Fumiko , Maeda Megumi , Ishiguro Chieko , Fukuda Haruhisa
Published: June 2022

Background

Characterising the psychiatric sequelae of coronavirus disease 2019 (COVID-19) can inform the development of long-term treatment strategies. However, few studies have examined these sequelae at different time points after COVID-19 infection.

Aims

The study aimed to investigate the incidences and risks of acute and delayed psychiatric sequelae in patients hospitalised with COVID-19 in Japan.

Methods

This retrospective cohort study was conducted using a database comprising healthcare claims data from public health insurance enrollees residing in a Japanese city. We analysed a primary cohort comprising patients hospitalised with COVID-19 between March 2020 and July 2021 and two control cohorts comprising patients hospitalised with influenza or other respiratory tract infections (RTI) during the same period. We calculated the incidences of acute (1–3 months after infection) and delayed (4–6 months after infection) psychiatric sequelae. These sequelae were identified using diagnosis codes and categorised as mood/anxiety/psychotic disorder, mood disorder, anxiety disorder, psychotic disorder or insomnia. Multivariable logistic regression models were used to estimate the odds ratios (ORs) of psychiatric sequelae occurrence after COVID-19 infection compared with influenza and other RTI.

Results

The study population with acute psychiatric sequela consisted of 662 patients with COVID-19, 644 patients with influenza, and 7369 patients with RTI who could be followed for 3 months; the study population with delayed psychiatric sequelae consisted of 371 patients with COVID-19, 546 patients with influenza, and 5397 patients with RTI who could be followed for 6 months. In the analysis of acute psychiatric sequelae, COVID-19 had significantly higher odds of mood/anxiety/psychotic disorder (OR: 1.39, p=0.026), psychotic disorder (OR: 2.13, p<0.001), and insomnia (OR: 2.59, p<0.001) than influenza, and significantly higher odds of insomnia (OR: 1.44, p=0.002) and significantly lower odds of anxiety disorder (OR: 0.56, p<0.001) than other RTI. In the analysis of delayed psychiatric sequelae, COVID-19 had significantly higher odds of psychotic disorder (OR: 2.25, p=0.007) than influenza, but significantly lower odds of anxiety disorder (OR: 0.55, p=0.011) than other RTI.

Conclusions

COVID-19 was generally associated with an increased risk of psychiatric sequelae occurring within 3 months after infection, but had a lower risk of new psychiatric sequelae developing 4–6 months after infection.
High-Risk Human Papillomavirus Infection in Pregnant Women: A Descriptive Analysis of Cohorts from Two Centers
Authors: Liu Jing , Li Yuhong , Bo Di , Wang Jiandong , Wang Yudong
Published: June 2022

The aim was to descriptively analyze the clinical characteristics, cytopathology, and outcomes of pregnant patients with high-risk human papillomavirus (HPV) infection. Clinical data of 151,516 female patients with high-risk HPV infection were retrospectively collected. Baseline data, cervical cytology results, histopathology, HPV types, delivery mode, and follow-up outcomes were recorded for descriptive analysis. A total of 157 patients were identified as positive for high-risk HPV. There were 32 (24.2%), 6 (4.5%), and 107 (81.1%) cases of HPV-16, HPV-18, and other types, respectively. Additionally, 12 patients showed combined infection with HPV-18 or HPV-16 and other types. Cytopathological examinations showed that the most common type was low-grade squamous intraepithelial lesion (LSIL; 104 cases, 78.8%), followed by high-grade squamous intraepithelial lesion (HSIL; 17 cases, 12.8%), atypical squamous cells of undetermined significance (10 cases, 9.6%), and cervical cancer (1 case, 0.7%). Thirty-seven patients underwent colposcopic biopsy, of whom 9 (24.3%) showed normal results, while 12 (32.4%) and 13 (35.1%) patients had LSIL and HSIL, respectively. χ2 tests demonstrated that different delivery modes did not show significant difference in patients’ cervical cytopathology (p>0.05). However, therapeutic methods were statistically different among patients with different cytopathological types (p<0.05). Cervical alterations in pregnancy mostly go along with high-risk HPV infection. High-risk HPV infection in pregnancy with abnormal cervical cytology should be followed closely during the pregnancy and postpartum period.
Antibody-based redirection of universal Fabrack-CAR T cells selectively kill antigen bearing tumor cells
Authors: Kuo Yi-Chiu , Kuo Cheng-Fu , Jenkins Kurt , Hung Alfur Fu-Hsin , Chang Wen-Chung , Park Miso , Aguilar Brenda , Starr Renate , Hibbard Jonathan , Brown Christine , Williams John C
Published: June 2022

Background

Chimeric antigen receptor (CAR) T cells engineered to recognize and target tumor associated antigens have made a profound impact on the quality of life for many patients with cancer. However, tumor heterogeneity and intratumoral immune suppression reduce the efficacy of this approach, allowing for tumor cells devoid of the target antigen to seed disease recurrence. Here, we address the complexity of tumor heterogeneity by developing a universal CAR.

Method

We constructed a universal Fabrack-CAR with an extracellular domain composed of the non-tumor targeted, cyclic, twelve residue meditope peptide that binds specifically to an engineered binding pocket within the Fab arm of monoclonal antibodies (mAbs). As this site is readily grafted onto therapeutic mAbs, the antigen specificity of these universal Fabrack-CAR T cells is simply conferred by administering mAbs with specificity to the heterogeneous tumor.

Results

Using in vitro and in vivo studies with multiple meditope-engineered mAbs, we show the feasibility, specificity, and robustness of this approach. These studies demonstrate antigen- and antibody-specific T cell activation, proliferation, and IFNγ production, selective killing of target cells in a mixed population, and tumor regression in animal models.

Conclusion

Collectively, these findings support the feasibility of this universal Fabrack-CAR T cell approach and provide the rationale for future clinical use in cancer immunotherapy.
Resistance to systemic immune checkpoint inhibition in the peritoneal niche
Authors: Chia Daryl Kai Ann , Gwee Yong Xiang , Sundar Raghav
Published: June 2022

Immune checkpoint inhibition (ICI) is an established therapeutic option for patients with deficient mismatch repair or high levels of microsatellite instability tumors. Yet, response to ICI among this group is varied, with nearly one-third of patients exhibiting primary resistance. Initial efforts in studying mechanisms of resistance to ICI have focused on intrinsic tumor factors. Host factors such as metastatic niches have unique biological properties that may mediate resistance to ICI but have been less studied date. Patients with metastatic d-MMR/MSI-H gastrointestinal cancers and peritoneal metastases (PM) who had concurrent ascites have been recently shown to have worse outcomes with ICI therapy compared with patients with PM without ascites and patients with non-PM metastases. The juxtaposition of tumors with an intrinsic sensitivity to ICI failing to respond by virtue of the presence of ascites within the peritoneum, brings to the forefront the critical role of the metastatic niche. In this commentary, we discuss mechanisms for ICI resistance that may arise from the immunoprivileged state of the peritoneal cavity, paracrine factors within malignant ascites or tumor-peritoneum interactions. An improved understanding of the peritoneal microenvironment and the use of peritoneal-directed therapies may ameliorate the modest benefit of ICIs in this unique clinical entity.
Randomized comparison between perineural dexamethasone and combined perineural dexamethasone-dexmedetomidine for ultrasound-guided infraclavicular block
Authors: Aliste Julián , Layera Sebastián , Bravo Daniela , Aguilera Germán , Erpel Hans , García Armando , Lizama Marcelo , Finlayson Roderick J , Tran De Q
Published: June 2022

Background

This randomized trial compared perineural dexamethasone with combined perineural dexamethasone-dexmedetomidine for ultrasound-guided infraclavicular block. We hypothesized that the combination of perineural adjuvants would result in a longer motor block.

Methods

Fifty patients undergoing upper limb surgery with ultrasound-guided infraclavicular block (using 35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 µg/mL) were randomly allocated to receive perineural dexamethasone (2 mg) or combined perineural dexamethasone (2 mg)-dexmedetomidine (50 µg). After the performance of the block, a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min), the onset time (defined as the time required to reach a minimal composite score of 14 points) as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental blocks, intravenous opioids or general anesthesia).

Postoperatively, the blinded observer contacted patients with successful blocks to inquire about the duration of motor block, sensory block and postoperative analgesia.

Results

No intergroup differences were observed in terms of success rate, onset time and surgical anesthesia. Compared with dexamethasone alone, combined dexamethasone-dexmedetomidine provided longer durations of motor block (21.5 (2.7) vs 17.0 (3.9) hours; p<0.001; 95% CI 2.6 to 6.4), sensory block (21.6 (3.6) vs 17.2 (3.6) hours; p<0.001; 95% CI 2.2 to 6.5), and postoperative analgesia (25.5 (9.4) vs 23.5 (5.6) hours; p=0.038; 95% CI 1.0 to 7.7).

Conclusion

Compared with perineural dexamethasone (2 mg) alone, combined perineural dexamethasone (2 mg)-dexmedetomidine (50 µg) results in longer durations of sensorimotor block and analgesia. Further studies are required to determine the optimal dosing combination for dexamethasone-dexmedetomidine.

Trial registration number

ClinicalTrials.gov identifier:NCT04875039.
Massive gauge particles versus Goldstone bosons in non-Hermitian non-Abelian gauge theory
Authors: Fring Andreas , Taira Takano
Published: June 2022

We investigate the Englert–Brout–Higgs–Guralnik–Hagen–Kibble mechanism for non-Hermitian field theories with local non-Abelian gauge symmetry in different regions of their parameter spaces. We demonstrate that the two aspects of the mechanism, that is giving mass to gauge vector bosons and at the same time preventing the existence of massless Goldstone bosons, remain to be synchronized in all regimes characterized by a modified CPT symmetry. In the domain of parameter space where the “would be Goldstone bosons” can be identified the gauge vector bosons become massive and the Goldstone bosons cease to exist. The mechanism is also in tact at the standard exceptional points. However, at the zero exceptional points, that is when the eigenvalues of the mass squared matrix vanish irrespective of the symmetry breaking, the mechanism breaks down as the Goldstone bosons cannot be identified and the gauge vector bosons remain massless. This breakdown coincides with the vanishing of the CPT inner product of symmetry breaking vacua defined on the eigenvector space of mass squared matrix. We verify this behaviour for a theory with SU(2) symmetry in which the complex scalar fields are taken in the fundamental as well as in the adjoint representation.
Effects of Lorentz symmetry violation by a constant vector field subject to Cornell-type potential on relativistic quantum oscillator
Authors: Ahmed Faizuddin
Published: June 2022

In this paper, we analyze a relativistic quantum oscillator model under a Lorentz symmetry violation (LSV) environment defined by an arbitrary constant vector field [Formula: see text] subject to Cornell-type scalar potential. We first introduce the Cornell-type scalar potential by modifying the mass term via [Formula: see text], and then momentum vector [Formula: see text] in the wave equation. We solve the Klein–Gordon oscillator analytically for different vector field configurations and obtained the bound-states energy profiles and the wave function. We discuss the influences of a vector field on the energy eigenvalues and the wave function of these oscillators.
A FRACTAL MODEL FOR THE MICRO–MACRO INTERACTIONS ON TUNNEL LEAKAGE
Authors: YE DAYU , LIU GUANNAN , TIAN YUHE , SUN ZIZHENG , YU BOMING
Published: June 2022

The complex microstructure of the surrounding porous rock of a tunnel has a significant influence on tunnel leakage. However, traditional tunnel leakage models are rarely able to quantify the interactions between the microstructure and macroscopic parameters of the surrounding porous rock of a tunnel, and the influence of the microstructure evolution on tunnel leakage. In order to quantify the contribution of the surrounding rock microstructure to leakage, a model capable of investigating the interaction between the evolution of microstructure and tunnel leakage behavior under the action of multi-physical fields is established based on fractal theory. The model couples the evolution of microstructure with the stress effect, adsorption–desorption effect, water pressure effect and surrounding rock deformation during tunnel leakage. The accuracy of the model is verified against experimental results, and the contribution of the surrounding porous rock pore size and pore distribution to tunnel water leakage is investigated. This study provides a theoretical basis and technical guidance for a reasonably accurate study of the tunnel leakage mechanism.
A NOVEL FRACTAL MODEL FOR GAS DIFFUSION COEFFICIENT IN DRY POROUS MEDIA EMBEDDED WITH A DAMAGED TREE-LIKE BRANCHING NETWORK
Authors: XIAO BOQI , WANG PEILONG , WU JINSUI , ZHU HUAIZHI , LIU MINGXING , LIU YONGHUI , LONG GONGBO
Published: June 2022

A novel gas diffusivity model for dry porous media with a damaged tree-like branching network is proposed by using the fractal theory in this study. We systematically investigated the effects of the number of damaged channels and the other structural parameters on the dimensionless gas diffusivity (DGD) and concentration drop. As the number of damaged channels increases, the DGD presents a decreasing trend, while the ratio of concentration drop shows a rising tendency. Meanwhile, the DGD is negatively correlated to the length exponent, the total number of branching levels, and the branching angle, respectively. On the other hand, the DGD is positively correlated with the diameter exponent. Besides, the ratio of concentration drop is negatively correlated with the length exponent and the total number of branching levels. However, it is positively associated with the diameter exponent and branching levels. In addition, during the calculation of the value of concentration drop, the total concentration drop can be disassembled into two equal-ratio sequences. And the scale factors in sequences are constants that are independent of the number of damaged channels. The reliability of the model predictions was verified by a comparison with the experimental data available in the literature. The physical mechanism of gas diffusion in the damaged network may be well explained by the proposed model.
APPROXIMATION WITH FRACTAL FUNCTIONS BY FRACTAL DIMENSION
Authors: LIANG Y. S.
Published: June 2022

On the basis of previous studies, we explore the approximation of continuous functions with fractal structure. We first give the calculation of fractal dimension of the linear combination of continuous functions with different Hausdorff dimension. Fractal dimension estimation of the linear combination of continuous functions with the same Hausdorff dimension has also been discussed elementary. Then, based on Weierstrass Theorem and the related results of Weierstrass function, we give the conclusion that the linear combination of polynomials with the same Hausdorff dimension approximates the objective function. The corresponding results with noninteger and integer Hausdorff dimensions have been investigated. We also give the preliminary applications of the theory in the last section.
On random matrices arising in deep neural networks: General I.I.D. case
Authors: Pastur Leonid , Slavin Victor
Published: June 2022

We study the eigenvalue distribution of random matrices pertinent to the analysis of deep neural networks. The matrices resemble the product of the sample covariance matrices, however, an important difference is that the analog of the population covariance matrix is now a function of random data matrices (synaptic weight matrices in the deep neural network terminology). The problem has been treated in recent work [J. Pennington, S. Schoenholz and S. Ganguli, The emergence of spectral universality in deep networks, Proc. Mach. Learn. Res. 84 (2018) 1924–1932, arXiv:1802.09979] by using the techniques of free probability theory. Since, however, free probability theory deals with population covariance matrices which are independent of the data matrices, its applicability in this case has to be justified. The justification has been given in [L. Pastur, On random matrices arising in deep neural networks: Gaussian case, Pure Appl. Funct. Anal. (2020), in press, arXiv:2001.06188] for Gaussian data matrices with independent entries, a standard analytical model of free probability, by using a version of the techniques of random matrix theory. In this paper, we use another version of the techniques to extend the results of [L. Pastur, On random matrices arising in deep neural networks: Gaussian case, Pure Appl. Funct. Anal. (2020), in press, arXiv:2001.06188] to the case where the entries of the data matrices are just independent identically distributed random variables with zero mean and finite fourth moment. This, in particular, justifies the mean field approximation in the infinite width limit for the deep untrained neural networks and the property of the macroscopic universality of random matrix theory in this case.
Interventionism, Decoupling, and Reshuffle: New Developments in Global Supply Chain Management
Authors: Wang Zhongmei
Published: June 2022

Developed countries, led by the United States and the European Union, have stepped up security review of supply chains and adopted a series of restrictive policies and protectionist measures to reshape a more secure, sustainable, and risk-controllable supply chain. A key objective of the West’s supply chain strategy is to wean their economies off Chinese influence by resorting to discriminatory policies. Supply chain interventionism on national security grounds violates market rules on which the global supply chain is based, and also runs counter to the principles of nondiscrimination and liberalization embedded in the multilateral trade governance architecture. Global supply chain reshuffles will take time and incur huge costs, leaving ample room for Beijing to make necessary adjustments and bolster its position in global supply networks.
Language models
Authors: Li Hang
Published: June 2022

A language modeling overview, highlighting basic concepts, intuitive explanations, technical achievements, and fundamental challenges.
The dynamics of remembering and forgetting
Authors: Baquero Carlos , Cabecinhas Rosa
Published: June 2022

The
Communications
website, http://cacm.acm.org, features more than a dozen bloggers in the BLOG@CACM community. In each issue of
Communications
, we'll publish selected posts or excerpts.

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Carlos Baquero and Rosa Cabecinhas consider how we make assumptions about authors' roles and relative contributions when reading papers.
On sampled metrics for item recommendation
Authors: Krichene Walid , Rendle Steffen
Published: June 2022

Recommender systems personalize content by recommending items to users. Item recommendation algorithms are evaluated by metrics that compare the positions of truly relevant items among the recommended items. To speed up the computation of metrics, recent work often uses sampled metrics where only a smaller set of random items and the relevant items are ranked. This paper investigates such sampled metrics in more detail and shows that they are inconsistent with their exact counterpart, in the sense that they do not persist relative statements, for example,
recommender A is better than B
, not even in expectation. Moreover, the smaller the sample size, the less difference there is between metrics, and for very small sample size, all metrics collapse to the AUC metric. We show that it is possible to improve the quality of the sampled metrics by applying a correction, obtained by minimizing different criteria. We conclude with an empirical evaluation of the naive sampled metrics and their corrected variants. To summarize, our work suggests that sampling should be avoided for metric calculation, however if an experimental study needs to sample, the proposed corrections can improve the quality of the estimate.
Streaming Overlay Architecture for Lightweight LSTM Computation on FPGA SoCs
Authors: Ioannou Lenos , Fahmy Suhaib A.
Published: June 2022

Long-Short Term Memory (LSTM)
networks, and
Recurrent Neural Networks (RNNs)
in general, have demonstrated their suitability in many time series data applications, especially in
Natural Language Processing (NLP)
. Computationally, LSTMs introduce dependencies on previous outputs in each layer that complicate their computation and the design of custom computing architectures, compared to traditional feed-forward networks. Most neural network acceleration work has focused on optimising the core matrix-vector operations on highly capable FPGAs in server environments. Research that considers the embedded domain has often been unsuitable for streaming inference, relying heavily on batch processing to achieve high throughput. Moreover, many existing accelerator architectures have not focused on fully exploiting the underlying FPGA architecture, resulting in designs that achieve lower operating frequencies than the theoretical maximum. This paper presents a flexible overlay architecture for LSTMs on FPGA SoCs that is built around a streaming dataflow arrangement, uses DSP block capabilities directly, and is tailored to keep parameters within the architecture while moving input data serially to mitigate external memory access overheads. The architecture is designed as an overlay that can be configured to implement alternative models or update model parameters at runtime. It achieves higher operating frequency and demonstrates higher performance than other lightweight LSTM accelerators, as demonstrated in an FPGA SoC implementation.
FENCE: Feasible Evasion Attacks on Neural Networks in Constrained Environments
Authors: Chernikova Alesia , Oprea Alina
Published: June 2022

As advances in
Deep Neural Networks (DNNs)
demonstrate unprecedented levels of performance in many critical applications, their vulnerability to attacks is still an open question. We consider evasion attacks at testing time against Deep Learning in constrained environments, in which dependencies between features need to be satisfied. These situations may arise naturally in tabular data or may be the result of feature engineering in specific application domains, such as threat detection in cyber security. We propose a general iterative gradient-based framework called FENCE for crafting evasion attacks that take into consideration the specifics of constrained domains and application requirements. We apply it against Feed-Forward Neural Networks trained for two cyber security applications: network traffic botnet classification and malicious domain classification, to generate feasible adversarial examples. We extensively evaluate the success rate and performance of our attacks, compare their improvement over several baselines, and analyze factors that impact the attack success rate, including the optimization objective and the data imbalance. We show that with minimal effort (e.g., generating 12 additional network connections), an attacker can change the model’s prediction from the Malicious class to Benign and evade the classifier. We show that models trained on datasets with higher imbalance are more vulnerable to our FENCE attacks. Finally, we demonstrate the potential of performing adversarial training in constrained domains to increase the model resilience against these evasion attacks.