bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital delivery of non-pharmacological intervention programmes for people living with dementia during the COVID-19 pandemic
Authors: Quail Zara , Bolton Laura , Massey Karina
Published: June 2021

The COVID-19 pandemic significantly impeded face-to-face health and social care delivery for people living with dementia and their carers. Interruption of meaningful activity engagement along with increased social isolation is known to be associated with loss of skills, increased loneliness, physical deterioration and decline in cognition and mood in people with dementia. To ensure continuity of care for people living with dementia, for whom multimodal, non-pharmacological intervention programmes were being provided, there was an urgent need to adopt a remote delivery model. Guidance on digitally delivered assessment and care specific to non-pharmacological interventions for dementia is lacking. Adoption of technology-enabled care for people with dementia requires overcoming barriers to technology use, adaptation of therapeutic guidelines, adaptation of communication methods and carer support. Despite these challenges, therapists successfully transitioned from in-person to digital delivery of therapeutic interventions with associated benefits of continued meaningful activity engagement discussed.
Unilateral diaphragm paralysis with COVID-19 infection
Authors: FitzMaurice Thomas Simon , McCann Caroline , Walshaw Martin , Greenwood James
Published: June 2021

Neurological complications are well described in SARS-CoV-2, but for the first time we report a case of unilateral diaphragm paralysis occurring early in mechanical ventilation for respiratory failure due to such an infection. The patient subsequently required tracheostomy and ventilator support for 37 days, and had increased breathlessness and an elevated diaphragm at clinic review 9 months later. Dynamic chest radiography demonstrated persistent diaphragm paralysis with an accompanying postural change in lung volumes, and he subsequently underwent surgical plication. This case demonstrates that although persistent dyspnoea is a common feature following SARS-CoV-2 infection and is usually due to deconditioning or persistent parenchymal involvement, it can be due to other causes and needs to be investigated appropriately.
Impact of smoking on COVID-19 outcomes: a HOPE Registry subanalysis
Authors: Espejo-Paeres Carolina , Núñez-Gil Iván J , Estrada Vicente , Fernández-Pérez Cristina , Uribe-Heredia Giovanna , Cabré-Verdiell Clara , Uribarri Aitor , Romero Rodolfo , García-Aguado Marcos , Fernández-Rozas Inmaculada , Becerra-Muñoz Victor , Pepe Martino , Cerrato Enrico , Raposeiras-Roubín Sergio , Barrionuevo-Ramos María , Aveiga-Ligua Freddy , Aguilar-Andrea Carolina , Alfonso-Rodríguez Emilio , Ugo Fabrizio , García-Prieto Juan Fortunato , Feltes Gisela , Akin Ibrahim , Huang Jia , Jativa Jorge , Fernández-Ortiz Antonio , Macaya Carlos , Carrero-Fernández Ana , Signes-Costa Jaime
Published: June 2021

Background

Smoking has been associated with poorer outcomes in relation to COVID-19. Smokers have higher risk of mortality and have a more severe clinical course. There is paucity of data available on this issue, and a definitive link between smoking and COVID-19 prognosis has yet to be established.

Methods

We included 5224 patients with COVID-19 with an available smoking history in a multicentre international registry Health Outcome Predictive Evaluation for COVID-19 (NCT04334291). Patients were included following an in-hospital admission with a COVID-19 diagnosis. We analysed the outcomes of patients with a current or prior history of smoking compared with the non-smoking group. The primary endpoint was all-cause in-hospital death.

Results

Finally, 5224 patients with COVID-19 with available smoking status were analysed. A total of 3983 (67.9%) patients were non-smokers, 934 (15.9%) were former smokers and 307 (5.2%) were active smokers. The median age was 66 years (IQR 52.0–77.0) and 58.6% were male. The most frequent comorbidities were hypertension (48.5%) and dyslipidaemia (33.0%). A relevant lung disease was present in 19.4%. In-hospital complications such sepsis (23.6%) and embolic events (4.3%) occurred more frequently in the smoker group (p<0.001 for both). All cause-death was higher among smokers (active or former smokers) compared with non-smokers (27.6 vs 18.4%, p<0.001). Following a multivariate analysis, current smoking was considered as an independent predictor of mortality (OR 1.77, 95% CI 1.11 to 2.82, p=0.017) and a combined endpoint of severe disease (OR 1.68, 95% CI 1.16 to 2.43, p=0.006).

Conclusion

Smoking has a negative prognostic impact on patients hospitalised with COVID-19.
Diabetes and associated dietary intake among urban adults: COPEN (Colombian Nutritional Profiles)—a cross-sectional study
Authors: Mendivil Carlos O , Gutiérrez Romero Sebastián A , Peláez-Jaramillo María J , Nieves-Barreto Luz D , Montaño-Rodríguez Angélica , Betancourt-Villamizar Eddy
Published: June 2021

Objectives

Diabetes is increasing rapidly in low-income and middle-income countries. We aimed to estimate the prevalence of diabetes, describe its correlates and its associated dietary intake in urban adults from Colombia.

Setting

The Colombian Study of Nutritional Profiles was a population-based, cross-sectional, multi-stage probabilistic sampling survey designed to represent the five main Colombian cities.

Participants

Between June and November 2018, we studied 736 non-pregnant participants aged 18 or older. Diabetes was defined as a random plasma glucose ≥200 mg/dL, self-reported prior diagnosis of diabetes or use of any oral or injectable antidiabetic medication(s). Participants also fulfilled a detailed 157-item food-frequency questionnaire.

Primary and secondary outcome measures

Prevalence of diabetes, dietary intake of key nutrients, achievement of dietary goals among individuals with diabetes.

Results

The overall estimated prevalence of diabetes was 10.1%, with no difference by sex (9.6% in women, 10.8% in men, p=0.43). The association between diabetes and education level depended on sex, diabetes was more prevalent among more educated men and less educated women. Abdominal obesity was associated with a 65% increase in diabetes prevalence among men, and a 163% increase in women. Individuals with diabetes reported lower mean consumption of all nutrients, but after adjustment by sex, age, socioeconomic level (SEL) and body mass index, only their lower sodium consumption remained significant (p=0.013). The proportion of non-achievement of dietary intake goals among participants with diabetes was 94.4% for saturated fats, 86.7% for sodium, 84.4% for fibre and 80% for trans fats. In multivariate logistic regression models, age was the strongest independent correlate of diabetes.

Conclusions

Diabetes by self-report, random plasma glucose or medication use was highly prevalent among Colombian adults. There were large differences by abdominal obesity status, region of residence, SEL and educational level. The proportion of individuals with diabetes meeting dietary recommendations was alarmingly low.
Social capital and pneumococcal vaccination (PPSV23) in community-dwelling older Japanese: a JAGES multilevel cross-sectional study
Authors: Iwai-Saito Kousuke , Shobugawa Yugo , Kondo Katsunori
Published: June 2021

Objective

Inequalities exist between the 23-valent pneumococcal polysaccharide vaccination (PPSV23) rate in each municipality among Japanese older adults. Exploring individual-level and community-level intervenable factors is necessary to improve the vaccination rates. We examined the associations between community-level and individual-level social capital and the PPSV23 vaccination among older Japanese adults using multilevel Poisson regression analyses.

Design

Cross-sectional study.

Setting

We used data from the Japan Gerontological Evaluation Study, conducted between 3 October 2016 and 10 January 2017 in 631 districts, 39 municipalities and 18 prefectures.

Participants

The target population comprised persons aged 65 years or older who are physically and cognitively independent (that is, not certified as needing long-term care). Further, 180 021 older adults from 39 Japanese municipalities were enrolled.

Primary outcome measure

The primary outcome was the PPSV23 vaccination among the Japanese older adults aged 65 years or older who did not have physical or cognitive disabilities.

Results

After adjusting for municipality-, community-, individual-levels effects with multiple imputation, 137 075 individuals who participated in one/more of the civic participation (participation of social groups), social cohesion (social tie), or reciprocity (mutual exchange of social support) were significantly associated with more vaccinations than those without the three social capitals among the 137 075 older adults (13.0% (95% CI 11.0% to 14.9%), 5.0% (95% CI 2.4% to 7.6%) or 33.9% (95% CI23.6% to 44.2%) increase, respectively, p>0.001 for all). The rich (≥+1 SD) community-level civic participation was significantly associated with 3.4% increase [95% CI 0.02% to 6.78%, p<0.05] of the PPSV23 vaccination among the older adults compared to those with the poor or standard one.

Conclusions

Older adults with one/more of the three social capitals at the both levels received more PPSV23 vaccinations than those without those social capitals. Therefore, fostering of those social capitals may improve the inequality of the PPSV23 vaccination rate among older adults in each municipality.
Population-based cross-sectional prevalence survey of diabetes and diabetic retinopathy in Sohag—Egypt, 2019
Authors: AlSawahli Heba , Mpyet Caleb D , Ezzelarab Gamal , Hassanin Ibrahim , Shalaby Mohammad , Safa Omar , Almansour Ahmed
Published: June 2021

Objectives

To determine the prevalence of diabetes mellitus (DM), prevalence of diabetic retinopathy (DR) and sight-threatening conditions among persons with DM aged 50 years and older in Sohag governorate in Upper Egypt.

Design

Population-based, cross-sectional survey using the standardised Rapid Assessment of Avoidable Blindness with the addition of the Diabetic Retinopathy module methodology.

Settings

Sohag governorate in Egypt where 68 clusters were selected using probability proportional to population size. Households were selected using the compact segment technique.

Participants

4078 people aged 50 years and older in 68 clusters were enrolled, of which 4033 participants had their random blood sugar checked and 843 examined for features of DR.

Primary and secondary outcomes

The prevalence of DM and DR; secondary outcome was the coverage with diabetic eye care.

Results

The prevalence of DM was 20.9% (95% CI 19.3% to 22.5%). The prevalence in females (23.8%; 95% CI 21.4% to 26.3%) was significantly higher than in males (18.9%; 95% CI 17.1% to 20.7%) (p=0.0001). Only 38.8% of persons diagnosed with diabetes had good control of DM. The prevalence of DR in the sample was 17.9% (95% CI 14.7% to 21.1%). The prevalence in females was higher (18.9%; 95% CI 14.0% to 23.8%) than in males (17.1%; 95% CI 13.0% to 21.2%). Up to 85.3% of study participants have never had eye examination. Sight-threatening DR (R4 and/or M2) was detected in 5.2% (95% CI 3.4% to 7.0%) with only 2.3% having had laser treatment.

Conclusion

The prevalence of uncontrolled DM in Sohag governorate in Egypt is higher than the national prevalence. There is a high prevalence of sight-threatening retinopathy and/or maculopathy with few people having access to diabetic eye care. A public health approach is needed for health promotion, early detection and management of DR.
Copper and zinc concentrations in the breast milk of mothers undergoing treatment for Wilson’s disease: a prospective study
Authors: Kodama Hiroko , Anan Yasumi , Izumi Yoichi , Sato Yasuhiro , Ogra Yasumitsu
Published: June 2021

Objective

To evaluate the concentrations of copper and zinc in the breast milk of mothers undergoing treatment for Wilson’s disease (WD) and clarify whether they can safely breast feed their infants.

Design

This was an observational and prospective study in an individual-based case series.

Setting

Breast milk samples were collected from participants across Japan from 2007 to 2018 at the Department of Pediatrics, Teikyo University in Tokyo. This was a primary-care level study. Clinical data were collected from the participants’ physicians.

Patients

Eighteen Japanese mothers with WD who were treated with trientine, penicillamine or zinc, and 25 healthy mothers as controls, were enrolled.

Main outcome measures

Whey exacted from the milk was used to evaluate the distribution of copper by high-performance liquid chromatography-inductively coupled plasma mass spectrometry. Copper and zinc concentrations in the breast milk samples were analysed by atomic absorption spectrometry.

Results

Copper distribution was normal in the breast milk of mothers with WD treated with trientine, penicillamine or zinc. No peak was detected for trientine-bound or penicillamine-bound copper. The mean copper concentrations in the mature breast milk of patients treated with trientine, penicillamine and zinc were 29.6, 26 and 38 µg/dL, respectively, and were within the normal range compared with the value in healthy controls (33 µg/dL). Likewise, mean zinc concentrations were normal in the mature breast milk of patients treated with trientine and penicillamine (153 and 134 µg/dL, respectively vs 160 µg/dL in healthy controls). Zinc concentrations in the breast milk of mothers treated with zinc were significantly higher than those in control milk. All infants were born normally, breast fed by mothers undergoing treatment and exhibited normal development.

Conclusions

Our results suggest that mothers with WD can safely breast feed their infants, even if they are receiving treatment for WD.
Teach-back of discharge instructions in the emergency department: a pre–post pilot evaluation
Authors: Hesselink Gijs , Sir Özcan , Koster Nadia , Tolsma Carolien , Munsterman Maartje , Olde Rikkert Marcel , Schoon Yvonne
Published: June 2021

Objectives

With the 'teach-back' method, patients or carers repeat back what they understand, so that professionals can confirm comprehension and correct misunderstandings. The effectiveness of teach-back has been underexamined, particularly for older patients discharged from the emergency department (ED). We aimed to determine whether teach-back would reduce ED revisits and whether it would increase patients’ retention of discharge instructions, improve self-management at home and increase satisfaction with the provision of instructions.

Methods

A nonrandomised pre–post pilot evaluation in the ED of one Dutch academic hospital including patients discharged from the ED receiving standard discharge care (pre) and teach-back (post). Primary outcomes were ED-revisits within 7 days and within 8–30 days postdischarge. Secondary outcomes for a subsample of older adults were retention of instructions, self-management 72 hours after discharge and satisfaction with the provision of discharge instructions.

Results

A total of 648 patients were included, 154 were older adults. ED revisits within 7 days and within 8–30 days were lower in the teach-back group compared with those receiving standard discharge care: adjusted odds ratios (AORs) of 0.23 (95% CI 0.05 to 1.07) and 0.42 (95% CI 0.14 to 1.33), respectively. Participants in the teach-back group had an increased likelihood of full knowledge retention on information related to their ED diagnosis and treatment (AOR 2.19; 95% CI 1.01 to 4.75; p=0.048), medication (AOR 14.89; 95% CI 4.12 to 53.85; p>0.001) and follow-up appointments (AOR 3.86; 95% CI 1.33 to 10.19; p=0.012). Use of teach-back was not significantly associated with improved self-management and higher satisfaction with discharge instructions. Discharge conversations were generally shorter for participants receiving teach-back.

Conclusions

Discharging patients from the ED with a relatively simple and feasible teach-back method can contribute to safer and better transitional care from the ED to home.
Massive PD-L1 and CD8 double positive TILs characterize an immunosuppressive microenvironment with high mutational burden in lung cancer
Authors: Zhang Libin , Chen Yanhui , Wang Han , Xu Zheyuan , Wang Yang , Li Sixing , Liu Jun , Chen Yun , Luo Hongli , Wu Lijia , Yang Ying , Zhang Henghui , Peng Hao
Published: June 2021

Background

Programmed cell death ligand 1 (PD-L1) expressed on tumor and immune cells are both associated with the response to programmed cell death 1 (PD-1) pathway blockade therapy. Here, we examine the role of CD8+PD-L1+ tumor-infiltrating lymphocyte (Tils) in the tumor microenvironment of non-small cell lung cancer (NSCLC).

Methods

Tumor tissue samples of a total of 378 patients from two NSCLC cohorts were collected retrospectively. Tumor genetic variations were measured by targeted next-generation sequencing of 543 oncogenes. Tils were assessed by multiplex immunohistochemistry assay. Correlations among Tils, tumor genetic variations, and clinicopathological characteristics were analyzed.

Results

The levels of CD8+PD-L1+ Tils varied in NSCLC tumor tissues. Tumor samples with high CD8+PD-L1+ Tils had higher levels of CD8+ Tils, CD68+ macrophages, PD-L1+ tumor cells, PD-1+ Tils, and CD163+ M2-type macrophages, and also had a higher tumor mutation burden, all of which collectively constituted a typically hot but immunosuppressive tumor microenvironment. Therefore, in a non-immunotherapy cohort, we observed that the higher the CD8+PD-L1+ Tils level in the tumor tissue, the worse the prognosis (progression-free survival; cohort A, stage I–II tumor; p=0.005). Contrarily, in an immunotherapy cohort, where the immune suppression was blocked by anti-PD-1 treatment, the higher the CD8+PD-L1+ Tils level, the better the response to the anti-PD-1 treatment (complete response/partial response vs stable disease/progressive disease; cohort B; p=0.0337).

Conclusions

CD8+PD-L1+ Tils may be an indicator of the hot but immunosuppressive tumor microenvironment which is related to a high tumor mutation burden. PD-1 pathway blockade therapy can help to mitigate this immunosuppression and obtain better curative effects.
IL-6 contributes to metastatic switch via the differentiation of monocytic-dendritic progenitors into prometastatic immune cells
Authors: Magidey-Klein Ksenia , Cooper Tim J , Kveler Ksenya , Normand Rachelly , Zhang Tongwu , Timaner Michael , Raviv Ziv , James Brian P. , Gazit Roi , Ronai Ze'ev A. , Shen-Orr Shai , Shaked Yuval
Published: June 2021

Background

Metastasis is the major cause of death in patients with cancer. Myeloid skewing of hematopoietic cells is a prominent promoter of metastasis. However, the reservoir of these cells in the bone marrow (BM) compartment and their differentiation pattern from hematopoietic stem and progenitor cells (HSPCs) have not been explored.

Methods

We used a unique model system consisting of tumor cell clones with low metastatic potential or high metastatic potential (met-low and met-high, respectively) to investigate the fate of HSPC differentiation using murine melanoma and breast carcinoma. Single-cell RNA sequencing (scRNA-seq) analysis was performed on HSPC obtained from the BM of met-low and met-high tumors. A proteomic screen of tumor-conditioned medium integrated with the scRNA-seq data analysis was performed to analyze the potential cross talk between cancer cells and HSPCs. Adoptive transfer of tumor-educated HSPC subsets obtained from green fluorescent protein (GFP)+ tagged mice was then carried out to identify the contribution of committed HSPCs to tumor spread. Peripheral mononuclear cells obtained from patients with breast and lung cancer were analyzed for HSPC subsets.

Results

Mice bearing met-high tumors exhibited a significant increase in the percentage of HSPCs in the BM in comparison with tumor-free mice or mice bearing met-low tumors. ScRNA-seq analysis of these HSPCs revealed that met-high tumors enriched the monocyte-dendritic progenitors (MDPs) but not granulocyte-monocyte progenitors (GMPs). A proteomic screen of tumor- conditioned medium integrated with the scRNA-seq data analysis revealed that the interleukin 6 (IL-6)–IL-6 receptor axis is highly active in HSPC-derived MDP cells. Consequently, loss of function and gain of function of IL-6 in tumor cells resulted in decreased and increased metastasis and corresponding MDP levels, respectively. Importantly, IL-6-educated MDPs induce metastasis within mice bearing met-low tumors—through further differentiation into immunosuppressive macrophages and not dendritic cells. Consistently, MDP but not GMP levels in peripheral blood of breast and lung cancer patients are correlated with tumor aggressiveness.

Conclusions

Our study reveals a new role for tumor-derived IL-6 in hijacking the HSPC differentiation program toward prometastatic MDPs that functionally differentiate into immunosuppressive monocytes to support the metastatic switch.
Identifying leadership in medical trainees: evaluation of a competency-based approach
Authors: Jones Samantha K. , Chan Ka Hong , Bourdage Joshua S. , Bharwani Aleem
Published: June 2021

Background

As medical professional roles diversify, it is essential to understand what makes effective medical leaders. This study develops and validates a medical leadership competency framework that can be used to develop and evaluate leaders across all levels of medical organisations.

Method

In Phase One, the authors derived desired leadership traits and behaviours in the medical context from a panel of subject matter experts (SMEs). Traits and behaviours were then combined into multifaceted competencies which were ranked and further refined through evaluation with additional SMEs. In Phase Two, the final seven competencies were evaluated with 181 medical trainees and 167 supervisors between 2017 and 2018 to determine the validity of rapid-form and long-form leadership assessments of medical trainees. Self and supervisor reports of the seven competencies were compared with validated trait and leadership behaviour measures as well as clinical performance evaluations.

Results

The final seven leadership competencies were: Ethical and Social Responsibility, Civility, Self-Leadership, Team Management, Vision and Strategy, Creativity and Innovation, and Communication and Interpersonal Influence. Results demonstrate initial validity for rapid-form and long-form leadership evaluations; however, perceptions of good leadership may differ between trainees and supervisors. Further, negative leadership behaviours (eg, incivility) are generally not punished by supervisors and some positive leadership behaviours (eg, ethical leadership) were associated with poor leadership and clinical performance evaluations by supervisors. Supervisor perceptions of leadership were significantly driven by trainee scores on social boldness (a facet of extraversion).

Conclusions

A multicompetency framework effectively evaluates leadership in medicine. To more effectively reinforcepositive leadership behaviours and discourage negative leadership behaviours in medical students and resident physicians, we recommend that medical educators:: (1) Use validated frameworks to build leadership curriculum and evaluations. (2) Use short-term and long-term assessment tools. (3) Teach assessors how to evaluate leaders and encourage positive leadership behaviours early in training.
Patients with symptomatic permanent atrial fibrillation show quantitative signs of pain sensitisation
Authors: Jackson Adam , Frobert Ole , Boye Larsen Dennis , Arendt-Nielsen Lars , Björkenheim Anna
Published: June 2021

Objective

Most patients with atrial fibrillation (AF) report symptoms, while one-third are asymptomatic. We hypothesised that sensory processing, in particular pain, differs in patients with symptomatic and asymptomatic AF.

Methods

Thirty individuals with permanent AF (15 symptomatic and 15 asymptomatic) completed the Atrial Fibrillation 6 (AF6) and short form 36 Health Survey questionnaires and underwent quantitative pain sensitisation testing using pressure algometry at the sternum (referred pain area) and the tibialis anterior muscle (generalised pain area). The primary objective was to assess differences in pressure pain thresholds (PPT), temporal summation of pain (TSP) and conditioned pain modulation (CPM) in the two groups. The secondary objective was to determine association of demographic and clinical parameters to measures of pain sensitisation.

Results

The symptomatic group had lower PPTs at both tibialis (p=0.004) and sternum (p=0.01), and impaired CPM (p=0.025) and facilitated TSP (p=0.008) at the tibialis but not sternum, compared with the asymptomatic group. The AF6 sum score was negatively correlated to PPT on both tibialis (r=−0.50, p=0.005) and sternum (r=−0.42, p=0.02) and positively correlated to TSP on both tibialis (r=0.57, p=0.001) and sternum (r=0.45, p=0.01), but not to CPM. The physical component summary score was positively correlated to the PPT on both tibialis (r=0.52, p=0.003) and sternum (r=0.40, p=0.03) and negatively to TSP on the tibialis (r=−0.53, p=0.003) but not sternum.

Conclusions

Patients with symptomatic AF exhibit lower pain tolerance than patients with asymptomatic AF, as well as impaired pain inhibitory control and facilitated summation of pain, indicating that pain sensitisation may be of importance in symptomatic AF.

Trial registration number

NCT04649437.
Is it a matter of time? The effect of transfer time on femur fracture outcomes
Authors: Larson Leah E , Harry Melissa L , Kosmatka Paul K , Colling Kristin P
Published: June 2021

Background

Trauma systems in rural areas often require longdistance transfers for definitive care. Delays in care, such as delayed femurfracture repair have been reported to be associated with poorer outcomes, butlittle is known about how transfer time affects time to repair or outcomesafter femur fractures.

Methods

We conducted a retrospective review of all trauma patients transferred to our level 1 rural trauma center between May 1, 2016-April 30, 2019. Patient demographics and outcomes were abstracted from chart and trauma registry review. All patients with femur fractures were identified. Transfer time was defined as the time from admission at the initial hospital to admission at the trauma center, and time to repair was defined as time from admission to the trauma center until operative start time. Our outcome variables were mortality, in-hospital complications, and hospital length of stay (LOS).

Results

Over the study period1,887 patients were transferred to our level 1 trauma center and 398 had afemur fracture. Compared to the entire transfer cohort, femur fracture patientswere older (71 versus 57 years), and more likely to be female (62% versus 43%).The majority (74%) of patients underwent fracture repair within 24hours. Delay in fracture fixation >24 hours wasassociated with increased length of stay (5 days versus 4 days; p<0.001),higher complication rates (23% versus 12%; p=0.01), and decreased dischargehome (19% vs. 32%, pp=0.02), but was not associated with mortality (6% versus5%; p=0.75). Transfer time and time at the initial hospital were not associatedwith mortality, complication rate, or time to femur fixation.

Discussion

Fixation delay greater than 24 hours associated with increased likelihood of in-hospital complications, longer length of stay, and decreased likelihood of dischargehome. Transfer time not related to patient outcomes or time to femur fixation.

Level of evidence

Level III; therapeutic/care management.
Contractility of permeabilized rat vastus intermedius muscle fibres following high-fat, high-sucrose diet consumption
Authors: Smith Ian C. , Ostertag Curtis , O’Reilly Jennifer J. , Rios Jaqueline L. , Klancic Teja , MacDonald Graham Z. , Collins Kelsey H. , Reimer Raylene A. , Herzog Walter
Published: June 2021

Obesity is a worldwide health concern associated with impaired physical function. It is not clear if contractile protein dysfunction contributes to the impairment of muscle function observed with obesity. The purpose of this study was to examine if diet-induced obesity affects contractile function of chemically permeabilized vastus intermedius fibres of male Sprague–Dawley rats expressing fast myosin heavy chain (MHC) IIa or slow MHC I. Rats consumed either a high-fat, high sucrose (HFHS) diet or a standard (CHOW) diet beginning as either weanlings (7-week duration: WEAN7 cohort, or 14-week duration: WEAN14 cohort) or young adults (12-week duration: ADULT12 cohort, 24-week duration: ADULT24 cohort). HFHS-fed rats had higher (P < 0.05) whole-body adiposity (derived from dual-energy X-ray absorptiometry) than CHOW-fed rats in all cohorts. Relative to CHOW diet groups, the HFHS diet was associated with impaired force production in (a) MHC I fibres in the ADULT24 cohort; and (b) MHC IIa fibres in the ADULT12 and ADULT24 cohorts combined. However, the HFHS diet did not significantly affect the Ca2+-sensitivity of force production, unloaded shortening velocity, or ratio of active force to active stiffness in any cohort. We conclude that diet-induced obesity can impair force output of permeabilized muscle fibres of adult rats.

Novelty: We assessed contractile function of permeabilized skeletal muscle fibres in a rat model of diet-induced obesity. The high-fat, high-sucrose diet was associated with impaired force output of fibres expressing MHC I or MHC IIa in some cohorts of rats. Other measures of contractile function were not significantly affected by diet.
Remotely sensed trends in vegetation productivity and phenology during population decline of the Bathurst caribou (Rangifer tarandus groenlandicus) herd
Authors: Dearborn Katherine D. , Danby Ryan K.
Published: June 2021

The Bathurst caribou (Rangifer tarandus groenlandicus (Borowski, 1780)) herd declined from ∼349 000 animals in 1996 to ∼8200 in 2018. Climate-driven changes to tundra and boreal vegetation is one hypothesis for the decline. We modelled and mapped annual productivity and phenology across the herd’s range using enhanced vegetation index (EVI) data derived from a Moderate Resolution Imaging Spectroradiometer (MODIS) time series spanning 2000–2017. Maximum annual EVI, growing season length, and time-integrated EVI increased significantly on 16%, 18%, and 49% of the core annual range, respectively. Trends toward longer growing seasons were driven entirely by earlier spring green-up and, along with time-integrated EVI, were most prevalent in tundra regions. Trends in forested regions were overwhelmingly related to the influence of forest fires, which burned more than half of the range below the forest–tundra ecotone since 1965. These trends suggest that climate-driven changes in production and phenology have occurred in the tundra and forest–tundra portions of the range and could have contributed to the recent herd decline. However, the trends may also be a result of herd decline itself, given the loss of this large herbivore from the landscape. Elucidating cause and effect will require comprehensive analysis of interactions between climatic variables, herd dynamics, and vegetation change, complemented by targeted field investigations.
Divergent reactivities of 2-pyridyl sulfonate esters. Exceptionally mild access to alkyl bromides and 2-substituted pyridines
Authors: Dumas Adrien , Li Da , Pinet Sonia , Corona-Becerril David , Hanessian Stephen
Published: June 2021

A series of 2- and 3-pyridyl sulfonate and tosylate esters of primary and secondary alcohols were synthesized and evaluated in the bromination reaction with MgBr2·Et2O. The greater coordinating ability of the 2-pyridyl sulfonate esters accounted for its observed superior reactivity and selectivity. Reaction of neopentyl and phenyl 2-pyridyl sulfonates with a variety of aryl and heteroaryl Li reagents led to 2-substituted pyridines at temperatures as low as −78 °C via an SNAr process. Mechanistic considerations are discussed.
Renormalization of the topological charge density in QCD with dimensional regularization
Authors: Lüscher Martin , Weisz Peter
Published: June 2021

To all orders of perturbation theory, the renormalization of the topological charge density in dimensionally regularized QCD is shown to require no more than an additive renormalization proportional to the divergence of the flavour-singlet axial current. The proof is based on the standard BRS analysis of the QCD vertex functional in the background gauge and exploits the special algebraic properties of the charge density through the Stora–Zumino chain of descent equations.
Bandgap tuning in ZnO thin films and enhanced n-type properties through Mn doping synthesized by a simple spray pyrolysis
Authors: Khorshed Alam Md. , Sharmin Mehnaz , Podder Jiban
Published: June 2021

Undoped and manganese (Mn)-doped zinc oxide (ZnO) thin films have been deposited onto glass substrates at 300[Formula: see text]C using a low cost spray pyrolysis technique. Structural, optical and electrical properties of the as-deposited films have been investigated. Scanning electron microscopy images show the existence of clusters with well-defined nucleation centers consisting of highly dense ganglia-like fibers over a large area around the nucleation center. Chemical compositions of the ZnO and Mn-doped ZnO thin films are studied by using energy dispersive X-ray (EDX) analysis. X-ray diffraction spectra depict that the films have polycrystalline wurtzite structure. The average crystallite sizes are calculated in the range of 8–16 nm by Williamson–Hall method and found in good agreement with Scherer method. Optical transmittance of the films is about 80% in the visible region. Bandgap energy is tuned to 2.83 eV from 3.10 eV with increasing Mn doping. Electrical resistivity at room-temperature decreases significantly with increasing Mn doping as well as increasing temperature from 300–440 K. The activation energies in the temperature ranges 300–350 K and 350–440 K are found to be in the range of 0.25–0.16 eV and 0.35–0.59 eV, respectively. Hall Effect measurements show that the thin films have negative Hall co-efficient indicating [Formula: see text]-type conductivity at room-temperature. Carrier concentration is found to be of the order of 10[Formula: see text] cm[Formula: see text].
Splittings in varieties of logic
Authors: Davey Brian A. , Kowalski Tomasz , Taylor Christopher J.
Published: June 2021

We study splittings or lack of them, in lattices of subvarieties of some logic-related varieties. We present a general lemma, the non-splitting lemma, which when combined with some variety-specific constructions, yields each of our negative results: the variety of commutative integral residuated lattices contains no splitting algebras, and in the varieties of double Heyting algebras, dually pseudocomplemented Heyting algebras and regular double [Formula: see text]-algebras the only splitting algebras are the two-element and three-element chains.
More on Prime, Maximal and Principal Soft Ideals of Soft Rings
Authors: Atagün Akín Osman , Sezgi̇n Aslihan
Published: June 2021

In this paper, we aim to extend the studies [M. R. Alimoradi, R. Rezaei and M. Rahimi, Some notes on ideals in soft rings, Journal Australian Journal of Basic and Applied Sciences 6(3) (2012) 717–721; F. Koyuncu and B. Tanay, Some soft algebraic structures, Journal of New Results Science 10(2016) 38–51] as regards maximal, prime and principal soft ideal of soft rings, characterize soft rings with these soft ideals and also provide some more relations between maximal, prime and principal soft ideals of soft rings. The notions of maximality and primeness points of soft ideals of a soft rings are defined, maximal and prime idealistic soft rings as well as maximal, prime and principal soft ideal of soft rings and their basic properties are more investigated under certain conditions, especially by means of homomorphism and epimorphism of rings. We apply some of the basic results about maximal ideals and prime ideals in classical abstract algebra to maximal, prime and principal idealistic soft rings and we give some of their interrelations between each others.
Application of the C-N fractal model, factor analysis and geochemical mineralization probability index (GMPI) for delineating geochemical anomalies related to a Mn-Fe deposit and associated Cu mineralization in west-central Sinai, Egypt
Authors: Helba Hossam A. , El-Makky Ahmed M. , Khalil Khalil I.
Published: June 2021

The west-central Sinai area includes one of the most productive manganese deposits in Egypt (Um Bogma Mn-Fe ore). The explored area is covered by a Carboniferous and Cambro-Ordovician sedimentary succession overlying Precambrian basement rocks. The purpose of this study is to delineate geochemical anomalies of ore and related elements and track their dispersion trains, which may lead to the discovery of unknown ore deposits. For this purpose, 143 stream sediment samples were analysed and the data were interpreted using the concentration–number (C-N) fractal model, factor analysis and the geochemical mineralization probability index (GMPI). Geochemical thresholds obtained from the C-N fractal model, factor scores and GMPI were used for constructing geochemical anomaly maps and delineating probable anomalous sites. The spatial distribution of Mn, Cu, Co, Pb and Zn anomalies was correlated to Mn and Cu mineralization sites whereas those of Fe and Cr were consistent with mafic rock distributions. Factor analysis revealed significant element associations for mineralization (Cu, Co, Mn, Zn, Pb), country rock composition (Fe, Cr) and element mobility (Cd, Zn). The spatial distribution of ore elements (Mn, Cu) delineated by the factor score and GMPI distribution maps was confirmed and more accurately interpreted using geochemical anomaly maps constructed based on the fractal-derived thresholds. Based on the current study, recent Cu and Mn mineralization sites may be suggested. Cobalt, Zn, Pb and Cd are suggested as efficient pathfinder elements for marine Mn deposits. A dispersion sequence of Cd>Mn>Co>Pb>Zn>Cu>Cr>Fe was proposed based on the threshold distribution patterns of these elements.

Supplementary material:
Tables S1–S3 and Figures S1 and S2 are available at
https://doi.org/10.6084/m9.figshare.c.5463511
Perspectives on the active volcanoes of China
Authors: Xu Jiandong , Oppenheimer Clive , Hammond James O. S. , Wei Haiquan
Published: June 2021

China has a rich record of Holocene volcanism that is relatively little known outside the country. It is encountered in large stratovolcanoes in the NE, linked to subduction of the Pacific plate (e.g. Changbaishan), in smaller volcanoes on the Tibetan margin, associated with the collision of India and Eurasia (e.g. Tengchong, Ashishan), and in more isolated centres, possibly resulting from mantle upwelling (e.g. volcanoes in Hainan island). This makes China a natural laboratory for studies of intraplate volcanism, and significant progress in understanding its nature and origins has been made over the past quarter century. Here, we introduce the first publication in English to provide a comprehensive survey of the state of knowledge and research highlights. Accordingly, we provide an overview of the dynamics, geology, geochemistry, volcanic histories and geophysical studies of 14 volcanic areas associated with the Holocene documented thus far. The special publication represents a benchmark reference on the topic but, as importantly, we hope that it will stimulate new, international collaborations aimed at deepening our understanding of the origins, history, hazards and associated risks of China's volcanoes.
Review of Blown to Bits
Authors: Gasarch William
Published: June 2021

I reviewed the first edition of this book in 2009. Here is a link to the entire column which includes reviews of other books as well: https://www.cs.umd.edu/users/gasarch/bookrev/40-1.pdf If you are reading this as an online pdf you can probably click on the above line and get to my old review. (Is that illegal on your part? On my part? I have no idea.) Some of this review will overlap with some of that review.

I begin with the first paragraph of my old review just to show how one issue seems to have been solved.
Hilbert's Tenth Problem
Authors: Gasarch William
Published: June 2021

This column is a short version of a long version of an article based on a blog. What? I give the complete history.
Packet Scheduling
Authors: Veselý Pavel
Published: June 2021

Online packet scheduling with deadlines is one of the fundamental models in buffer management. Recently, the author together with Chrobak, Jez, and Sgall (SODA 2019) designed an optimal ϕ-competitive algorithm for this problem, where ϕ ≈1.618 is the golden ratio. In this column, we sketch ideas that led us to the development of this algorithm and outline the concepts in its analysis. We also highlight open questions in packet scheduling.
Teaching Nondeterminism
Authors: Richards Dana
Published: June 2021

Nondeterminism is an important topic that is difficult to teach. We give a plan that starts with a new abstraction of nondeterminism. We present language models rst and foremost. The use of pseudo-code augmented by a new construct makes it easier to follow.
Distributed Computing Column 82
Distributed Computability
Authors: Alistarh Dan
Published: June 2021

Overview. In this edition of the column, we have a very useful and interesting piece from Michel Raynal (IRISA Rennes & Hong Kong Polytechnic), whose goal is to provide a systematic view of the computability results in distributed computing which should be well-understood by any Masters-level student with an interest in our area. Michel's motivation for the column is that, given the intense proliferation of computational models, tasks, and correctness and progress conditions in recent years, for instance, in the context of Blockchain technology, it may be hard for newcomers to the field to understand the boundary between what is essentially possible and what is impossible in a distributed system.
Directional Recoil Detection
Authors: Vahsen Sven E. , O'Hare Ciaran A.J. , Loomba Dinesh
Published: June 2021

Searches for dark matter–induced recoils have made impressive advances in the last few years. Yet the field is confronted by several outstanding problems. First, the inevitable background of solar neutrinos will soon inhibit the conclusive identification of many dark matter models. Second, and more fundamentally, current experiments have no practical way of confirming a detected signal's Galactic origin. The concept of directional detection addresses both of these issues while offering opportunities to study novel dark matter– and neutrino-related physics. The concept remains experimentally challenging, but gas time projection chambers are an increasingly attractive option and, when properly configured, would allow directional measurements of both nuclear and electron recoils. In this review, we reassess the required detector performance and survey relevant technologies. Fortuitously, the highly segmented detectors required to achieve good directionality also enable several fundamental and applied physics measurements. We comment on near-term challenges and how the field could be advanced.
Effects of Evolution, Ecology, and Economy on Human Diet: Insights from Hunter-Gatherers and Other Small-Scale Societies
Authors: Pontzer Herman , Wood Brian M.
Published: June 2021

We review the evolutionary origins of the human diet and the effects of ecology economy on the dietary proportion of plants and animals. Humans eat more meat than other apes, a consequence of hunting and gathering, which arose ∼2.5 Mya with the genus Homo. Paleolithic diets likely included a balance of plant and animal foods and would have been remarkably variable across time and space. A plant/animal food balance of 50/50% prevails among contemporary warm-climate hunter-gatherers, but these proportions vary widely. Societies in cold climates, and those that depend more on fishing or pastoralism, tend to eat more meat. Warm-climate foragers, and groups that engage in some farming, tend to eat more plants. We present a case study of the wild food diet of the Hadza, a community of hunter-gatherers in northern Tanzania, whose diet is high in fiber, adequate in protein, and remarkably variable over monthly timescales.
A homological approach to a mathematical definition of pulmonary fibrosis and emphysema on computed tomography
Authors: Tanabe Naoya , Kaji Shizuo , Sato Susumu , Yokoyama Tomoo , Oguma Tsuyoshi , Tanizawa Kiminobu , Handa Tomohiro , Sakajo Takashi , Hirai Toyohiro
Published: June 2021

This study proposes a homological approach to mathematically define a three-dimensional texture feature of emphysema and fibrosis on chest computed tomography using persistent homology. The proposed definition enabled accurate segmentation with comparable quality to deep learning while offering higher interpretability than deep learning-based methods.
Enhanced Visualization of Retinal Microvasculature via Deep Learning on OCTA Image Quality
Authors: Xu Yishuang , Su Yu , Hua Dihao , Heiduschka Peter , Zhang Wenliang , Cao Tianyue , Liu Jingcheng , Ji Zhenyu , Eter Nicole
Published: June 2021

Purpose. To investigate the impact of denoising on the qualitative and quantitative parameters of optical coherence tomography angiography (OCTA) images of the optic nerve and macular area. Methods. OCTA images of the optic nerve and macular area were obtained using a Canon-HS100 OCT device for 48 participants (48 eyes). Multiple image averaging (MIA) and denoising techniques were used to improve the quality of the OCTA images. The peak signal-to-noise ratio (PSNR) as an image quality parameter and vessel density (VD) as a quantitative parameter were obtained from single-scan, MIA, and denoised OCTA images. The parameters were compared, and the correlation was analyzed between different imaging protocols. Results. In the optic nerve area, there were significant differences in the PSNR and VD in all measured regions between the three groups (

P
<
0.0001

). The PSNR of the denoised group was significantly higher than that of the other two groups (

P
<
0.0001

). The VD in the denoised group was significantly lower than that in the single-scan group in all measured regions (

P
<
0.0001

). In the macular area, there were significant differences in the PSNR and VD in all measured regions among the three groups. The PSNR of the denoised group was significantly higher than that of the other two groups (

P
<
0.0001

). The VD in the denoised group was significantly lower than that in the single-scan group in all measured regions. The VD around the optic nerve in the denoised group was correlated with that in the single-scan group (

R
=
0.9403

,

P
<
0.0001

), but the VD in the MIA group was not correlated with that in the single-scan group (

R
=
0.2505

,

P
=
0.2076

). The VD around the fovea in the denoised and MIA images was correlated with that in the single-scan group (

R
=
0.7377

,

P
<
0.0001

;

R
=
0.7005

,

P
=
0.0004

, respectively). Conclusion. Denoising could provide an easy and quick way to improve image quality parameters, such as PSNR. It shows great potential in improving the sensitivity of OCTA images as retinal disease markers.