bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation of the DCS System for the validation of MM HV Boards and the DCS System of the new BIS78 Chambers for the upgrade of muon system of the ATLAS Experiment
Authors: Drivas-Koulouris Ioannis
Published: November 2021

The ATLAS Muon Spectrometer is going through upgrades on the Phase I in order to achieve higher rates for the upcoming LHC runs. The two main projects of this Phase I upgrade are the New Small Wheels (NSW), which are expected to complement the ATLAS muon spectrometer in the end-cap regions and a smaller size project, known as BIS78 (Barrel Inner Small sectors).

The NSW is expected to replace the Small Wheel (SW) and it will be installed in the ATLAS underground cavern during the summer by the end of the LHC Long Shutdown 2. This new system will be consisted by two prototype detectors, the sTGC (small Thin Gas Chambers) and the resistive Micromegas (MM).

In order to cope with higher LHC luminosities, the installation of NSW will help the reduction of the trigger rate in the forward region. With half of the rate in the barrel-endcap transition region reduced by the existing TGCs, the other half of the fake trigger rate in transition region will be reduced by the new BIS78 stations. The BIS78 subproject foresees the replacement of the existing Monitored Drift Tubes (MDTs), used for the precise position measurement in this area, with muon stations formed by integrated smaller diameter tubes (sMDT) and a new generation of RPCs, capable of withstanding the higher rates and provide a robust standalone muon confirmation. The existing BIS7 and BIS8 MDT Chambers will be replaced by 16 new muon stations of one small (sMDT) chamber and two RPC triplets, and it will be the pilot project for the Phase II BI Upgrade.

This work is divided into two parts. First will be presented the development and the implementation of a Detector Control System (DCS) for the HV system for the MM detectors of NSW and specifically the validation of a new type of HV Boards (A7038AP). Second, the development of the DCS for the monitoring and operation of the new sMDT chambers of the MDT Sub-System will be presented.
Global labor loss due to humid heat exposure underestimated for outdoor workers
Authors: Parsons Luke A , Masuda Yuta J , Kroeger Timm , Shindell Drew , Wolff Nicholas H , Spector June T
Published: November 2021

Humid heat impacts a large portion of the world’s population that works outdoors. Previous studies have quantified humid heat impacts on labor productivity by relying on exposure response functions that are based on uncontrolled experiments under a limited range of heat and humidity. Here we use the latest empirical model, based on a wider range of temperatures and humidity, for studying the impact of humid heat and recent climate change on labor productivity. We show that globally, humid heat may currently be associated with over 650 billion hours of annual lost labor (148 million full time equivalent jobs lost), 400 billion hours more than previous estimates. These differences in labor loss estimates are comparable to losses caused by the COVID-19 pandemic. Globally, annual heat-induced labor productivity losses are estimated at 2.1 trillion in 2017 PPP$, and in several countries are equivalent to more than 10% of gross domestic product. Over the last four decades, global heat-related labor losses increased by at least 9% (>60 billion hours annually using the new empirical model) highlighting that relatively small changes in climate (<0.5 °C) can have large impacts on global labor and the economy.
On the diagonalization of quadratic Hamiltonians
Authors: Härkönen Ville J , Gonoskov Ivan A
Published: November 2021

A new procedure to diagonalize quadratic Hamiltonians is introduced. We show that one can establish the diagonalization of a quadratic Hamiltonian by changing the frame of reference by a unitary transformation. We give a general method to diagonalize an arbitrary quadratic Hamiltonian and derive a few of the simplest special cases in detail.
Local flow assessment of the Japan Bulk Carrier using different turbulence models
Authors: Bekhit A , Popescu F
Published: November 2021

Ship resistance and powering represent the most important aspects in the initial design stage of the ship. Based on their estimation the basic milestone for selecting the main engine and the propulsion system is established. The majority of ships in the international fleet nowadays rely on the screw propeller working in the wake zone behind the ship. The wake flow of the ship has a direct impact on the propeller performance and the propulsion efficiency. Accurate prediction of the nominal and effective wake is crucially important to provide a proper understanding of the flow where the propeller will perform. From this point of view, the wake flow of the Capesize Japan Bulk Carrier (JBC) is assessed using a viscous flow Computational Fluid Dynamics (CFD) method. Numerical simulations are performed to predict the nominal and effective wake of the ship by making use of the viscous flow solver ISIS_CFD of the FINETM/Marine software provided by NUMECA. The solver is based on the finite volume method to build the spatial discretization of the transport equation to resolve the Reynolds-Averaged Navier-Stokes (RANS) equations. Closure to turbulence is achieved using different turbulence models in order to investigate their accuracy in predicting the complex wake flow of the ship. Two-phase flow approach is used to model the air-water interface where the Volume of Fluid method is implemented to capture the free-surface. The results for both nominal and effective wake are assessed against the experimental data provided by the National Maritime Research Institute (NMRI) and Yokohama National University in Japan that were presented in the seventh Workshop on CFD in ship hydrodynamics (Tokyo2015). The results validation showed a reasonable agreement compared to the experimental data for both nominal and effective wake. As it was expected, some turbulence models showed to be more accurate in predicting ship wake, especially the Shear Stress Transport (K-ω SST) and Explicit Algebraic Reynolds Stress (EASM) Models. A special investigation of the flow vortices is also taken into consideration.
Long-term stability analysis and its relationship with the steel structure of gauge blocks from several manufacturers
Authors: Mínguez A , Moreno J , De Vicente J
Published: November 2021

Gauge blocks are one of the most widespread measurement standards (etalons) in dimensional metrology laboratories. Among all its properties, it is worth highlighting the importance of dimensional stability. This property allows to classify these measuring instruments in quality grades. Although the gauge blocks should be dimensionally stable, it can be observed that there is a drift that can be observed when the calibration history is revised. In this document, authors present a statistical method for the estimation of the dimensional stability of gauge blocks using the calibration history of samples from the main manufacturers. In addition, all the samples have been subjected to metallographic analysis to evaluate the structure.
An unsteady analysis of two-phase binding of drug in an asymmetric stenosed vessel
Authors: Biswas Sayantan , Sarifuddin  , Mandal Prashanta Kumar
Published: November 2021

In this paper, we investigate endovascular delivery to get a step ahead of the pharmacological limitations it has due to the complexity of dealing with a patient-specific vessel through a mathematical model. We divide the domain of computation into four sub-domains: the lumen, the lumen-tissue interface, the upper tissue and the lower tissue which are extracted from an asymmetric atherosclerotic image derived by the intravascular ultrasound (IVUS) technique. The injected drug at the luminal inlet is transported with the streaming blood which is considered Newtonian. An irreversible uptake kinetics of the injected drug at the lumen-tissue interface from the luminal side to the tissue domains is assumed. Subsequently, the drug is dispersed within the tissue followed by its retention in the extracellular matrix (ECM) and by receptor-mediated binding. The Marker and Cell (MAC) method has been leveraged to get a quantitative insight into the model considered. The effect of the wall absorption parameter on the concentration of all drug forms (free as well as two-phase bound) has been thoroughly investigated, and some other important factors, such as the averaged concentration, the tissue content, the fractional effect, the concentration variance and the effectiveness of drug have been graphically analyzed to gain a clear understanding of endovascular delivery. The simulated results predict that with increasing values of the absorption parameter, the averaged concentrations of all drug forms do decrease. An early saturation of binding sites takes place for smaller values of the absorption parameter, and also rapid saturation of ECM binding sites occurs as compared to receptor binding sites. Results also predict the influence of surface roughness as well as asymmetry of the domain about the centerline on the distribution and retention of drug. A thorough sensitivity analysis has been carried out to determine the influence of some parameters involved.
Southeast Asian expert perceptions of solar radiation management techniques and carbon dioxide removal approaches: caution, ambivalence, risk precaution, and research directions
Authors: Delina Laurence L
Published: November 2021

As the climate crisis intensifies in its impacts, discussions around the deployment of geoengineering solutions in case other interventions fail or prove insufficient have figured in research and have even been on the agenda of the United Nations. There have been calls for more investigation of geoengineering techniques to address the climate crisis. Yet, this response presents technological unknowns and economic, political, and ethical risks. Producing knowledge on these techniques has been pushed in many research institutes in the global North, especially in the United States, Europe, and Australia. Still, contributions from global South researchers, including those in Southeast Asia, remain scant. This paper describes the responses of seventeen climate and energy experts from southeast Asia on a purposively designed survey that collected expert opinions on two geoengineering techniques: solar radiation modification (SRM) and carbon dioxide removal (CDR), their risks, impacts, and governance as they pertain to their countries and region. Respondents showed ambivalence towards these techniques, with many supporting ‘natural’ CDR research and deployment while being cautious about ‘technological’ SRM and CDR research and deployment. Although respondents would welcome research on these technologies, especially their risks and impacts, they also identified critical barriers in research capacity development and funding availability.
Residual stress, distortion, and porosity analysis of LED heat sink printed by SLM process using machine learning
Authors: Thakur Sumit , Talla Gangadharudu , Verma Prakash
Published: November 2021

In recent years, Light-emitting diodes (LEDs) are dominating the traditional lighting system. Besides mercury-free, they have small size, good break resistance and long life. Although LEDs are cool to touch, they generate a lot of unnecessary heat inside the gadgets. It is important to remove the heat using efficient thermal management component such as heat sink. Instead of using a conventional manufacturing process, selective laser melting (SLM) process is used to manufacture the heat sink. The quick solidification and various thermal regimes of the material during the SLM process lead to the development of residual stresses that cause the part distortion and harm the mechanical properties of the component. The objective of the current study is to find the optimum value of laser power, scanning speed, and hatch spacing to bring down the residual stress and distortion in the SLM process to an acceptable range. Residual stress and distortion values of the heat sink are simulated using MSC Simufact additive and ANSYS Additive software. The conflicting nature between residual stress and porosity was observed. Hence, grey relation analysis was used to convert residual stress & porosity into a single objective. Optimum process parameters obtained were, laser power 80 (W), scanning speed 950 (mm s−1), and hatch spacing of 70

(
μ
m
)

.

The values of residual stress and porosity at optimum parameters were found to be 385.58 MPa and 12.21%. Multiple regressions algorithm of machine learning was used to form a relationship between residual stresses and porosity. It was also observed that the magnitude of residual stress and distortion were low at lower energy densities and high at higher energy densities and the residual stress and porosities were high in the z-direction.
Predicting protein–membrane interfaces of peripheral membrane proteins using ensemble machine learning
Authors: Chatzigoulas Alexios , Cournia Zoe
Published: November 2021

Abnormal protein–membrane attachment is involved in deregulated cellular pathways and in disease. Therefore, the possibility to modulate protein–membrane interactions represents a new promising therapeutic strategy for peripheral membrane proteins that have been considered so far undruggable. A major obstacle in this drug design strategy is that the membrane-binding domains of peripheral membrane proteins are usually unknown. The development of fast and efficient algorithms predicting the protein–membrane interface would shed light into the accessibility of membrane–protein interfaces by drug-like molecules. Herein, we describe an ensemble machine learning methodology and algorithm for predicting membrane-penetrating amino acids. We utilize available experimental data from the literature for training 21 machine learning classifiers and meta-classifiers. Evaluation of the best ensemble classifier model accuracy yields a macro-averaged F1 score = 0.92 and a Matthews correlation coefficient = 0.84 for predicting correctly membrane-penetrating amino acids on unknown proteins of a validation set. The python code for predicting protein–membrane interfaces of peripheral membrane proteins is available at https://github.com/zoecournia/DREAMM.
Effect of minimally invasive mitral valve surgery compared to sternotomy on short- and long-term outcomes: a retrospective multicentre interventional cohort study based on Netherlands Heart Registration
Authors: Olsthoorn Jules R , Heuts Samuel , Houterman Saskia , Maessen Jos G , Sardari Nia Peyman ,   the Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration, Bramer S , van Boven W J P , Vonk A B A , Koene B M J A , Bekkers J A , Hoohenkerk G J F , Markou A L P , Weger A de , Segers P , Porta F , Speekenbrink R G H , Stooker W , Li W W L , Daeter E J , van der Kaaij N P , Vigano G
Published: November 2021

OBJECTIVES

Minimally invasive mitral valve surgery (MIMVS) has been performed increasingly for the past 2 decades; however, large comparative studies on short- and long-term outcomes have been lacking. This study aims to compare short- and long-term outcomes of patients undergoing MIMVS versus median sternotomy (MST) based on real-world data, extracted from the Netherlands Heart Registration.

METHODS

Patients undergoing mitral valve surgery, with or without tricuspid valve, atrial septal closure and/or rhythm surgery between 2013 and 2018 were included. Primary outcomes were short-term morbidity and mortality and long-term survival. Propensity score matching analyses were performed.

RESULTS

In total, 2501 patients were included, 1776 were operated through MST and 725 using an MIMVS approach. After propensity matching, no significant differences in baseline characteristics persisted. There were no between-group differences in 30-day mortality (1.1% vs 0.7%, P = 0.58), 1-year mortality (2.6% vs 2.1%, P = 0.60) or perioperative stroke rate (1.1% vs 0.6%, P = 0.25) between MST and MIMVS, respectively. An increased rate of postoperative arrhythmia was observed in the MST group (31.3% vs 22.4%, P < 0.001). A higher repair rate was found in the MST group (80.9% vs 76.3%, P = 0.04). No difference in 5-year survival was found between the matched groups (95.0% vs 94.3%, P = 0.49). Freedom from mitral reintervention was 97.9% for MST and 96.8% in the MIMVS group (P = 0.01), without a difference in reintervention-free survival (P = 0.30).

CONCLUSIONS

The MIMVS approach is as safe as the sternotomy approach for the surgical treatment of mitral valve disease. However, it comes at a cost of a reduced repair rate and more reinterventions in the long term, in the real-world.
Real-life experience with compassionate use of cefiderocol for difficult-to-treat resistant Pseudomonas aeruginosa (DTR-P) infections
Authors: Meschiari Marianna , Volpi Sara , Faltoni Matteo , Dolci Giovanni , Orlando Gabriella , Franceschini Erica , Menozzi Marianna , Sarti Mario , Del Fabro Giovanni , Fumarola Benedetta , Guarneri Francesco , Lanza Paola , Lorenzotti Silvia , Saccani Barbara , Signorini Liana , Van Hauwermeiren Evelyn , Gatti Milo , Pea Federico , Castelli Francesco , Mussini Cristina
Published: November 2021

Objectives

To describe our real-life experience with cefiderocol in XDR and difficult-to-treat resistant Pseudomonas aeruginosa (DTR-P) infections without any other available treatment options.

Methods

We included patients with a proven infection due to an XDR/DTR-P, who had failed on previous regimens, and were treated with cefiderocol, following them prospectively to day 90 or until hospital discharge or death.

Results

Seventeen patients treated for >72 h with cefiderocol were included: 14 receiving combination regimens (82.4%) and 3 receiving monotherapy (17.6%). Fourteen patients were males (82%) with a median age of 64 years (IQR 58–73). Fifteen patients (88.2%) were admitted to the ICU and five had septic shock (29%). Seven cases (41.2%) were ventilator-associated pneumonia, of which 71% (5/7) occurred in COVID-19 patients. Four were complicated intrabdominal infections, one ecthyma gangrenosum, one nosocomial pneumonia and one empyema, one osteomyelitis, one primary bacteraemia, and one nosocomial external ventricular drainage meningitis. Clinical cure and microbiological cure rates were 70.6% and 76.5%, respectively. There were six deaths (35.3%) after a median of 8 days (IQR 3–10) from the end of treatment, but only two of them (11.7%) were associated with P. aeruginosa infection progression.

Conclusions

Our experience collecting this large case series of DTR-P treated with cefiderocol may help clinicians consider this new option in this hard-to-manage setting. Our results are even more relevant in the current scenario of ceftolozane/tazobactam shortage. Importantly, this is the first study providing real-life data indicating adequate cefiderocol concentrations in CSF.
Development of 3D printed drug-eluting contact lenses
Authors: Mohamdeen Youssra Moustafa Gadelkareem , Tabriz Atabak Ghanizadeh , Tighsazzadeh Mohammad , Nandi Uttom , Khalaj Roxanne , Andreadis Ioannis , Boateng Joshua S , Douroumis Dennis
Published: November 2021

Objectives

The aim of the work was to introduce 3D printing technology for the design and fabrication of drug-eluting contact lenses (DECL) for the treatment of glaucoma. The development of 3D printed lenses can effectively overcome drawbacks of existing approaches by using biocompatible medical grade polymers that provide sustained drug release of timolol maleate for extended periods.

Methods

Hot melt extrusion was coupled with fusion deposition modelling (FDM) to produce printable filaments of ethylene-vinyl acetate copolymer–polylactic acid blends at various ratios loaded with timolol maleate. Physicochemical and mechanical characterisation of the printed filaments was used to optimise the printing of the contact lenses

Key findings

3D printed lenses with an aperture (opening) and specified dimensions could be printed using FDM technology. The lenses presented a smooth surface with good printing resolution while providing sustained release of timolol maleate over 3 days. The findings of this study can be used for the development of personalised DECL in the future.
Systemic BCGosis following intra-renal instillation of BCG: a case report
Authors: Schembri Higgans Jessica , Pace Keith , Sciberras John , Scicluna Warren
Published: November 2021

Bacillus Calmette-Guerin (BCG) immunotherapy is a mainstay of adjunctive therapy for non-muscle-invasive bladder cancer. The instillation of BCG in the upper urinary tract after complete tumour eradication has also been studied and used after kidney-sparing management. It is effective in increasing the length of remission. However, it is also associated with rare but severe local and systemic side effects which may potentially become life-threatening. We present a case report of a 37-year-old gentleman who developed BCGosis following intra-renal instillation of BCG immunotherapy. The patient presented with systemic symptoms of jaundice, fever, myalgia and arthralgia, rather than local symptoms. Mycobacterium bovis infection was confirmed on blood cultures. The patient also developed hepatosplenomegaly, dyspnoea and pancytopaenia. BCGosis following intravesical instillation has been well documented in literature; to the best of our knowledge, this is the first case report documenting BCGosis following intra-renal instillation.
The propagation of strong shocks into planetary and stellar atmospheres with graded density profiles
Authors: Remorov Andrey , Yalinewich Almog
Published: November 2021

Previous works developed an analytic model for the propagation of shock waves into atmospheres with a uniform density. In this work, we generalized this formalism to account for graded density profiles. These waves can occur in a wide range of astrophysical events, such as collisions in planetary and stellar atmospheres, common envelope explosions, and peculiar type Ia supernovae. The behaviour of the shock wave and its evolution can be modelled using type II self-similar solutions. In such solutions, the evolution of the shock wave is determined by boundary conditions at the shock front and a singular point in the shocked region. We show how the evolution can be determined for different equations of state and density profiles, and compare these results to numerical simulations. We also demonstrate how these results can be applied to a wide range of problems in astrophysics.
On the evolution of vortex in locally isothermal self-gravitating discs: a parameter study
Authors: Tarczay-Nehéz D , Rozgonyi K , Regály Zs
Published: November 2021

Gas-rich dusty circumstellar discs observed around young stellar objects are believed to be the birthplace of planets and planetary systems. Recent observations revealed that large-scale horseshoe-like brightness asymmetries are present in dozens of transitional protoplanetary discs. Theoretical studies suggest that these brightness asymmetries bf could be caused by large-scale anticyclonic vortices triggered by the Rossby wave Instability (RWI), which can be excited at the edges of the accretionally inactive region, the dead zone edge. Since vortices may play a key role in planet formation, investigating the conditions of the onset of RWI and the long-term evolution of vortices is inevitable. The aim of our work was to explore the effect of disc geometry (the vertical thickness of the disc), viscosity, the width of the transition region at the dead zone edge, and the disc mass on the onset, lifetime, strength and evolution of vortices formed in the disc. We performed a parametric study assuming different properties for the disc and the viscosity transition by running 1980 2D hydrodynamic simulations in the locally isothermal assumption with disc self-gravity included. Our results revealed that long-lived, large-scale vortex formation favours a shallow surface density slope and low- or moderate-disc masses with Toomre Q ≲ 1 h-1, where h is the geometric aspect ratio of the disc. In general, in low viscosity models, stronger vortices form. However, rapid vortex decay and re-formation is more widespread in these discs.
Radiative transfer of ionizing radiation through gas and dust: grain charging in star-forming regions
Authors: Glatzle Martin , Graziani Luca , Ciardi Benedetta
Published: November 2021

The presence of charged dust grains is known to have a profound impact on the physical evolution of the multiphase interstellar medium (ISM). Despite its importance, this process is still poorly explored in numerical simulations due to its complex physics and the tight dependence on the environment. Here, we introduce a novel implementation of grain charging in the cosmological radiative transfer code crash. We first benchmark the code predictions on a series of idealized dusty H ii regions created by a single star, in order to assess the impact of grain properties on the resulting spatial distribution of charges. Secondly, we perform a realistic radiative transfer simulation of a star-forming region extracted from a dusty galaxy evolving in the Epoch of Reionization. We find that ∼13 per cent of the total dust mass gets negatively charged, mainly silicate and graphite grains of radius 10−3 $\mu$m. A complex spatial distribution of grain charges is also found, primarily depending on the exposure to stellar radiation and strongly varying along different lines of sight, as a result of radiative transfer effects. We finally assess the impact of grain properties (both chemical composition and size) on the resulting charge distribution. The new implementation described here will open up a wide range of possible studies investigating the physical evolution of the dusty ISM, nowadays accessible to observations of high- and low- redshift galaxies.
Structural basis of dimerization and nucleic acid binding of human DBHS proteins NONO and PSPC1
Authors: Knott Gavin J , Chong Yee Seng , Passon Daniel M , Liang Xue-hai , Deplazes Evelyne , Conte Maria R , Marshall Andrew C , Lee Mihwa , Fox Archa H , Bond Charles S
Published: November 2021

The Drosophila behaviour/human splicing (DBHS) proteins are a family of RNA/DNA binding cofactors liable for a range of cellular processes. DBHS proteins include the non-POU domain-containing octamer-binding protein (NONO) and paraspeckle protein component 1 (PSPC1), proteins capable of forming combinatorial dimers. Here, we describe the crystal structures of the human NONO and PSPC1 homodimers, representing uncharacterized DBHS dimerization states. The structures reveal a set of conserved contacts and structural plasticity within the dimerization interface that provide a rationale for dimer selectivity between DBHS paralogues. In addition, solution X-ray scattering and accompanying biochemical experiments describe a mechanism of cooperative RNA recognition by the NONO homodimer. Nucleic acid binding is reliant on RRM1, and appears to be affected by the orientation of RRM1, influenced by a newly identified ‘β-clasp’ structure. Our structures shed light on the molecular determinants for DBHS homo- and heterodimerization and provide a basis for understanding how DBHS proteins cooperatively recognize a broad spectrum of RNA targets.
Heavy particle non-decoupling in flavor-changing gravitational interactions
Authors: Inami Takeo , Kubota Takahiro
Published: November 2021

The flavor-changing gravitational process, d → s + graviton, is evaluated at the one-loop level in the standard electroweak theory with on-shell renormalization. The results that we present in the ’t Hooft–Feynman gauge are valid for on- and off-shell quarks and for all external and internal quark masses. We show that there exist non-decoupling effects of the internal heavy top quark in interactions with gravity. A naive argument taking account of the quark Yukawa coupling suggests that the amplitude of the process d → s + graviton in the large top quark mass limit would possibly acquire an enhancement factor $m_{t}^{2}/M_{W}^{2}$, where mt and MW are the top quark and the W-boson masses, respectively. In practice this leading enhancement is absent in the renormalized amplitude due to cancellation. Thus the non-decoupling of the internal top quark takes place at the ${\cal O}(1)$ level. The flavor-changing two- and three-point functions are shown to satisfy the Ward–Takahashi identity, which is used as a consistency check for the aforementioned cancellation of the ${\cal O}(m_{t}^{2}/M_{W}^{2})$ terms. Among the ${\cal O}(1)$ non-decoupling terms, we sort out those that can be regarded as due to the effective Lagrangian in which quark bilinear forms are coupled to the scalar curvature.
Definition of low disease activity state based on the SLE-DAS: derivation and validation in a multicentre real-life cohort
Authors: Assunção Helena , Jesus Diogo , Larosa Maddalena , Henriques Carla , Matos Ana , Le Guern Véronique , Rubiño Francisco , da Silva José A P , Rua-Figueroa Iñigo , Costedoat-Chalumeau Nathalie , Doria Andrea , Inês Luís S
Published: November 2021

Objectives

To derive and validate a definition of low disease activity (LDA) for SLE based on the SLE Disease Activity Score (SLE-DAS), in a real-life multicentre cohort of SLE patients.

Methods

Derivation was conducted using data from a monocentric cohort of SLE (Portugal), and validation was performed in a multicentre cohort (Italy, France and Spain). The Lupus Low Disease Activity State (LLDAS) was used as comparator. We applied receiver operating characteristics curve analysis against the LLDAS to determine the cut-off of SLE-DAS for LDA using bootstrap methodology. In a second step, we tested a definition of SLE-DAS LDA that included: (i) the statistically derived SLE-DAS upper threshold for LDA and (ii) prednisone dose ≤7.5 mg/day. In the multicentre validation cohort, we assessed the classification performance of this SLE-DAS LDA definition.

Results

We included 774 patients, 300 in the derivation and 474 in the validation cohort. In the derivation cohort, the optimal cut-off to identify patients in LLDAS was SLE-DAS ≤2.48, presenting an area under the curve of 0.965 (95% CI 0.935, 0.994). When applied to the multicentre validation cohort, the SLE-DAS LDA definition showed a sensitivity of 97.1% and a specificity of 97.7% for LLDAS and an almost perfect agreement (Cohen’s Kappa = 0.933; P < 0.001). McNemar’s test found no significant differences between the two definitions (P = 0.092).

Conclusion

The SLE-DAS LDA is a validated, accurate and easy-to-use definition for classifying SLE patients in LDA state.
Exploring differential engagement with mathematics support from an engineering student focus
Authors: Gokhool Farhana , Lawson Duncan , Hodds Mark , Aslam Farzana
Published: November 2021

This paper explores the differential engagement of engineering students with mathematics support at Coventry University. Mathematics support is an additional help in mathematics that is offered to all students at the University, and engagement with such support is voluntary. Attendance records show that, whilst many students do engage with mathematics support, there are others who do not, even though their results indicate that they might benefit from so doing. Previous studies of engagement with mathematics support have either treated the student cohort as a whole or explored the effect of a single demographic factor such as age or gender. This paper investigates the effect of a range of demographic factors on the engagement of engineering students with mathematics support.
Comparison of Clinical Findings in SARS-CoV-2 with Other Respiratory Viruses in Critically Ill Children during the COVID-19 Pandemic
Authors: Perk Oktay , Ozcan Serhan , Emeksiz Serhat , Uyar Emel , Gulhan Belgin
Published: November 2021

Objectives

The aim of this study was to compare the clinical and laboratory findings in SARS-CoV-2 (COVID-19) with those of other respiratory viruses in critically ill children.

Methods

It is a single center retrospective descriptive study conducted in a 32-bed pediatric intensive care unit (PICU). Our study was performed in Ankara City Hospital, Ankara, Turkey, between 1 March 2020, and 1 March 2021. Demographic and clinical characteristics of the patients were collected and we recorded the antibiotic use, antiviral treatments, respiratory and extracorporeal supports, PICU stay and survival rates.

Results

A total of 202 pediatric patients who tested positive for either COVID-19 or for another respiratory virus panel (RVP) were included in the study. Seventy-two patients were COVID-19 positive. The median age of COVID-19 positive patients and RVP positive patients was 97 and 17 months, respectively. Hypoxia was much more common in patients with RVP than in COVID-19 patients. Low oxygen saturation in arterial blood (SaO2), increased oxygen saturation index (OSI) and fraction of inspired oxygen (FiO2) needs were more significant in RVP patients than in COVID-19 patients. Respiratory support therapies, such as high-flow nasal cannula and non-invasive ventilation (NIV), were used more frequently in RVP patients than in COVID-19 patients.

Conclusion

It is important to distinguish between COVID-19 and RVP cases in order to prioritize intensive care needs in these patients. In addition, non-Covid diseases should not be left aside in the pandemic and appropriate care should be provided to them.
Predictors of Dysphagia After Anterior Cervical Discectomy and Fusion
Authors: Nguyen Sarah , Sherrod Brandon A. , Paziuk Taylor M. , Rihn Jeffrey A. , Patel Alpesh A. , Brodke Darrel S. , Bisson Erica F.
Published: November 2021

Study Design.

Multicenter prospective study.

Objective.

Our aim was to evaluate the incidence and predictors of postoperative dysphagia in patients undergoing anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.

Dysphagia is a common complication after ACDF that can have significant effect on patients’ quality of life, but the frequency of occurrence and potential risk factors are not known.

Methods.

A multicenter prospective study was undertaken at three academic sites to evaluate patients undergoing ACDF between September 2018 and September 2020. Included patients were aged 18 to 80 years and were undergoing primary or revision ACDF for a degenerative condition. Dysphagia was assessed using the validated Eating Assessment Tool (EAT-10) questionnaire, with dysphagia defined as EAT-10 ≥ 3.

Results.

A total of 170 patients (53.5% female; mean age at surgery 55.0 yr) were included. At preoperative baseline, 23 patients (13.5%) had dysphagia. Rates of dysphagia increased to 45.3% at 2 weeks postoperatively but gradually decreased to 15.3% at 24weeks. On univariate analysis, patients with dysphagia at 2weeks had longer operations (113.1 ± 58.4 vs. 89.0 ± 39.8 minutes, P 
= 0.003) and higher baseline dysphagia rates (18.2% vs. 6.2%, P 
= 0.018) and were more likely to be female (66.2% vs. 45.7%, P 
= 0.009). Patients with prolonged dysphagia had more levels fused (2.1 ± 1.0 vs. 1.7 ± 0.7, P 
= 0.020), longer operations (131.8 ± 63.1 vs. 89.3 ± 44.3 min-minutes, P 
< 0.001), and higher baseline dysphagia rates (32% vs. 7.1%, P 
< 0.001) and were more likely to be smokers (24% vs. 8%, P 
= 0.021). On multivariate analysis to determine associations with prolonged dysphagia, only smoking status (OR 6.2, 95% CI 1.57–24.5, P 
= 0.009) and baseline dysphagia (OR 5.1, 95% CI 1.47–17.6, P 
= 0.01) remained significant.

Conclusion.

Dysphagia is common immediately after ACDF, but rates of prolonged dysphagia are similar to preoperative baseline rates. We identified dysphagia rates over time and several patient factors associated with development of short- and long-term postoperative dysphagia.

Level of Evidence: 3
Adjunctive Topical Tranexamic Acid for Blood Salvage Does Not Reduce Postoperative Blood Loss Compared with Placebo in Patients Who Undergo Palliative Decompressive Spinal Metastasis Surgery
Authors: Maethungkul Ronnakrit , Atthakomol Pichitchai , Phinyo Phichayut , Phanphaisarn Areerak , Murakami Hideki , Sangsin Apiruk
Published: November 2021

Study Design.

Randomized controlled trial.

Objective.

To evaluate the efficacy of adjunctive topical tranexamic acid (tTXA) in reducing postoperative blood loss and packed red cell (PRC) transfusion in patients who underwent palliative decompressive spinal metastasis surgery for malignant epidural spinal cord compression.

Summary of Background Data.

Palliative decompressive spinal metastasis surgery is associated with massive postoperative blood loss and increased transfusion rate. tTXA reduces blood loss in traumatic or degenerative spinal surgery; however, the role of topical TXA in decompressive spinal metastasis surgery remains controversial.

Method.

A total of 65 patients who underwent palliative decompressive thoracolumbar spinal metastasis surgery were included in this study. In 33 patients, 1 g of tTXA (20 mL) was soaked in an absorbable gelatin sponge and placed lateral to the decompressive site. The remaining 32 patients in the control group received the same procedures with normal saline at the same volume, instead of TXA. All of the patients received standard 1 g intravenous TXA, just before initiating the operation. The primary outcome was postoperative blood loss, and the secondary outcomes were postoperative PRC transfusion and complications.

Results.

No differences were found in postoperative blood loss between tTXA and placebo group (P50 778 mL [IQR 347, 1,122 mL] versus P50 490 mL [IQR 295, 920 mL]; P = 0.238). The number of patients requiring postoperative PRC transfusion were quite similar in tTXA and placebo groups (PRC transfusion in 15 patients [45.45%] versus 16 patients [50%]; P = 0.585). No complications related to TXA and absorbable gelatin sponge were observed.

Conclusion.

We do not recommend tTXA as an adjunctive treatment for patients undergoing decompressive spinal metastasis surgery since it does not provide additional benefit to prophylactic intravenous TXA in postoperative blood loss and transfusion rate.

Level of Evidence: 2
Epidural Fat Tissue Is More Effective for Scar Prevention Than Conventional Subcutaneous Fat Grafting After Laminectomy in a Mouse Model
Authors: Hata Kazuhiro , Kobayakawa Kazu , Saiwai Hirokazu , Tamaru Tetsuya , Lura Hirotaka , Haruta Yohei , Ono Gentarou , Kitade Kazuki , Maeda Takeshi , Nakashima Yasuharu , Okada Seiji
Published: November 2021

Study Design.

Basic science study.

Objective.

The aim of this study was to examine whether epidural fat tissue (EFT) transplantation can prevent epidural adhesion after laminectomy more efficiently than subcutaneous fat tissue (SFT) transplantation.

Summary of Background Data.

Epidural adhesion is almost inevitable after laminectomy. Although many materials have been used to prevent adhesion, none has been widely accepted. As EFT is an ectopic fat tissue located on the dura mater and there is no adhesion between EFT and the dura mater, we focused on the efficacy of EFT for adhesion prevention.

Methods.

We examined the differences in histology and gene expression between EFT and SFT of mice. We performed laminectomy at the 10th thoracic level and immediately transplanted EFT or SFT to the dura mater in mice. At 6 weeks after transplantation, we performed histological and gene expression analyses and evaluated the adhesion tenacity. In addition, we examined the characteristic differences between human EFT and SFT.

Results.

The adipocytes of EFT were significantly smaller than those of SFT in mice and humans. The gene expression of inflammatory cytokine and fibrosis-related factors was significantly higher in SFT than in EFT. At 6 weeks after transplantation, the percentage of the remaining fat area over the dura mater was significantly greater in the EFT group than in SFT group, and the adhesion tenacity score was significantly lower in the EFT group than that in the SFT group. An RNA sequencing analysis revealed 1921 differentially expressed genes (DEGs) between human EFT and SFT, and a Gene Ontology term associated with the inflammatory response was most highly enriched in SFT.

Conclusion.

EFT has different molecular and histological profiles from SFT and EFT grafting is more effective for epidural adhesion prevention than conventional SFT transplantation after laminectomy in a mouse model.

Level of Evidence: N/A
Analysis of Spastic Gait in Patients With Cervical Myelopathy Using the Timed Up and Go Test With a Laser Range Sensor
Authors: Koyama Takafumi , Fujita Koji , Iijima Hirotaka , Norose Mio , Ibara Takuya , Sasaki Toru , Yoshii Toshitaka , Nimura Akimoto , Takahashi Masaki , Okawa Atsushi
Published: November 2021

Study Design.

Cross-sectional study.

Objective.

This study aimed to objectively evaluate spastic gait and reveal its novel characteristics via analysis of gait in patients with cervical myelopathy (CM) using the Timed Up and Go (TUG) test with a laser range sensor.

Summary of Background Data.

Among patients with CM, spastic gait is a common diagnostic symptom; thus, objective assessments of spastic gait would be useful for the diagnosis of CM and recognition of disease status. Although spastic gait has been objectively evaluated in previous studies, the methods employed in those studies are not suitable for clinical settings.

Methods.

In total, 37 and 24 participants were recruited for a control group and CM group, respectively. CM was diagnosed by spine surgeons. We developed a laser TUG test, in which the position and velocity of both the legs were captured. The parameter values for both groups were statistically compared, and odds ratios were calculated using logistic regression analyses.

Results.

The total TUG-test time, time to stand up, time to first step, number of steps, and trajectory error for the CM group were significantly higher than those for the control group, whereas the average velocity and average stride length for the CM group were significantly lower than those for the control group. There was a significant independent association between the total TUG-test time and CM. The optimal cutoff point of the total test time for CM risk was approximately 9 seconds.

Conclusion.

Through the use of the laser TUG test, we were able to identify characteristics of spastic gait, which leads to difficulty in standing and taking the first step, wobbling while walking, and an increased risk of falling. We found that the risk of CM was higher if the individual took longer than 9 seconds to complete the TUG test.

Level of Evidence: 4
NPHP1 Full Deletion Causes Nephronophthisis and a Cone-Rod Dystrophy
Authors: Tauqeer Zujaja , O’Neil Erin C. , Brucker Alexander J. , Aleman Tomas S.
Published: November 2021

Purpose:

To describe in detail the structural and functional phenotype of a patient with cone-rod dystrophy associated with a full deletion of the NPHP1 gene.

Methods:

A 30-year-old male with history of end-stage renal disease (ESRD) presented with progressive vision loss in early adulthood prompting evaluation for retinal disease. Ophthalmic evaluation was performed including, kinetic fields, electroretinography (ERG), spectral domain optical coherence tomography (SD-OCT), fundus auto-fluorescence (FAF), wide-angle fluorescein angiography and near infrared imaging (NIR).

Results:

Visual acuity was 20/60 in each eye. Fundus examination revealed a subtle bull’s-eye maculopathy confirmed with fundus autofluorescence. SD-OCT demonstrated perifoveal loss of the outer retinal layers with structural preservation further peripherally. Testing of retinal function confirmed loss of cone greater than rod sensitivities in a manner that co-localized to structural findings. ERG revealed decreased photopic and scotopic responses. Genetic testing confirmed a homozygous whole gene deletion of the NPHP1 gene.

Conclusion:

NPHP1-associated retinal degeneration may present as a cone-rod dystrophy in addition to the previously reported rod-predominant phenotypes and can notably be associated with systemic abnormalities, including renal disease. Our work further expands upon the growing literature describing retinal disease associated with systemic ciliopathies.
Development of models of care coordination for rare conditions: A qualitative study
Authors: Walton Holly , Simpson Amy , Ramsay Angus I.G. , Hunter Amy , Jones Jennifer , Ng Pei Li , Leeson-Beevers Kerry , Bloom Lara , Kai Joe , Kokocinska Maria , Sutcliffe Alastair G , Morris Stephen , Fulop Naomi J.
Published: November 2021

Introduction

Improving care coordination for people with rare conditions may help to reduce burden on patients and carers and improve the care that patients receive. We recently developed a taxonomy of different ways of coordinating care for rare conditions. It is not yet known which models of care coordination are appropriate in different situations. This study aimed to: i) explore what types of care coordination may be appropriate in different situations, and ii) use these findings to develop hypothetical models of care coordination for rare conditions.

Methods

To explore appropriateness of different types of care coordination, we conducted interviews (n=30), four focus groups (n=22) and two workshops (n=27) with patients, carers, healthcare professionals, commissioners, and charity representatives. Participants were asked about preferences, benefits and challenges, and the factors influencing coordination. Thematic analysis was used to develop hypothetical models of care coordination. Models were refined following feedback from workshop participants.

Results

Stakeholders prefer models of care that: are nationally centralised or a hybrid of national and local care, involve professionals collaborating to deliver care, have clear roles and responsibilities outlined (including administrative, coordinator, clinical and charity roles), provide access to records and offer flexible appointments (in terms of timing and mode). Many factors influenced coordination, including those relating to the patient (e.g., condition complexity, patient’s location and ability to coordinate their own care), the healthcare professional (e.g., knowledge and time), the healthcare environment (e.g., resources) and societal factors (e.g., availability of funding). We developed and refined ten illustrative hypothetical models of care coordination for rare conditions.

Conclusion

Findings underline that different models of care coordination may be appropriate in different situations. It is possible to develop models of care coordination which are tailored to the individual in context. Findings may be used to facilitate planning around which models of care coordination may be appropriate in different services or circumstances. Findings may also be used by key stakeholders (e.g. patient organisations, clinicians and service planners) as a decision-making tool.