bluuebunny/crossref_metadata_2025 huggingface dataset:
352 QUALITY OF LIFE OF PATIENTS UNDERGOING SURGERY FOR ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CANCER
Authors: Lidoriki I , Schizas D , Mylonas K , Alexandrou A , Karavokyros I , Liakakos T
Published: September 2020

The assessment of patients’ quality of life is increasingly gaining ground as an effective approach to evaluate treatment efficacy and patients satisfaction in the clinical setting. The aim of this study was to investigate the association between patients’ preoperative nutritional status and quality of life, as well as to examine quality of life changes at six months postoperatively in patients undergoing surgery for esophageal and gastroesophageal junction cancer.

Methods

The study sample consisted of 93 patients with esophageal (n = 14) and gastroesophageal junction cancer (n = 79) who were admitted for surgery in the xxxxx between September 2015 and July 2019. Out of them, 77 patients underwent esophagectomy while 16 patients underwent total gastrectomy. The preoperative evaluation of patients’ nutritional status was based on Patient Generated Subjective Global Assessment (PG-SGA) and Skeletal Muscle Index (SMI) derived from analysis of CT scans, while the assessment of patients’ quality of life (QoL) was based on EORTC QLQ-C30 questionnaire (version 3.0). Patients’ follow-up was done six months postoperatively.

Results

Forty three patients (46.2%) were diagnosed with sarcopenia. The prevalence of malnutrition was 64%. Sarcopenic patients scored lower on Global Health (59.94 ± 19.21 vs 65.68 ± 20.08, p = 0.050), Physical Functioning (77.63 ± 23.08 vs 86.58 ± 15.26, p = 0.003) and higher on Fatigue (35.80 ± 25.19 vs 25.73 ± 22.31, p = 0.008) compared with non-sarcopenic patients. Μalnourished patients exhibited more impaired QoL, except Emotional Functioning, compared to well-nourished patients. Physical Functioning (79.9 ± 18.3 vs 88.2 ± 12.9, p = 0.004) and Social Functioning (67.7 ± 22.6 vs 83.1 ± 20.8, p < 0.001) were lower, while Pain (19.9 ± 19.0 vs 13.9 ± 17.9, p = 0.050), Diarrhea (19.4 ± 22.2 vs 9.7 ± 19.5, p = 0,011) and Financial Difficulties (21.0 ± 21.1 vs 12.9 ± 23.7, p = 0.031) were higher at six months postoperatively compared to the preoperative levels.

Conclusion

Sarcopenia and malnutrition affected several parameters of health related QoL in patients undergoing surgery for esophageal and gastroesophageal junction cancer. Moreover, various components of the QoL significantly declined at six months postoperatively. These results indicate that preoperative nutritional assessment is necessary in order to prevent further deterioration of nutritional and functional status, which, in turn may worsen patients’ QoL.
371 LARGE HIATAL HERNIAS: WATCH AND WAIT, OR SURGICAL REPAIR?
Authors: Giulini L , Razia D , Mittal S
Published: September 2020

Laparoscopic-assisted hiatal hernia (HH) repair has been reported to be safe and feasible. However, uncertainty exists regarding whether asymptomatic large HHs (L-HH) should be treated or if a watch-and-wait strategy should be used. The latter might expose the patient to the risk of progression and gastric incarceration. In this study, we investigated this issue by analyzing perioperative outcomes of patients who underwent HH repair at our high-volume center.

Methods

After obtaining approval from the Institutional Review Board, we queried a prospectively maintained database for data on patients who underwent primary minimally invasive HH repair between August 2016 and December 2019. All procedures were performed by a single surgeon (SKM). Hernias were classified in 4 groups: small (S-HH [sliding]), moderate (M-HH [<50% herniated stomach]), large (L-HH [50%–75% herniated stomach]) and giant (G-HH [≥75% herniated stomach]). Data on preoperative assessment, surgical procedure, and postoperative morbidity were analyzed and compared across groups. Complications were defined according to the Clavien-Dindo (CD) classification.

Results

In total, 170 patients met inclusion criteria. Mean age was 58.5 ± 11, 61.9 ± 11.3, 70.7 ± 10.3, and 72.6 ± 9.7 years for S-HH (n = 46), M-HH (n = 69), L-HH (n = 20), and G-HH (n = 35), respectively (p < 0.001). The mean operative time (minutes) increased by group as the HH size increased (69.6 ± 20.9, 83.5 ± 26.1, 99 ± 29.1, and 98.6 ± 24.9, respectively; p < 0.001). Eight of 35 patients with G-HH (22.9%) were treated urgently due to gastric incarceration. Postoperative complications were significantly more common after L-HH and G-HH repair (Figure 1). CD complications Grade II, IIIb, and IVa were observed only in patients with L-HH or G-HH. There was no mortality.

Conclusion

Patients with L-HH and G-HH are significantly older than those with S-HH or M-HH; this reflects the likely progressive nature of this pathology. Laparoscopic HH repair is associated with higher morbidity in patients with L-HH and G-HH. Furthermore, patients with G-HH are at risk of gastric incarceration, which requires emergency surgery. Our findings suggest that in patients with M-HH (even asymptomatic), a watch-and-wait strategy should be discouraged. Surgical repair, in experienced hands, is preferred.
372 ESOPHAGEAL BODY PERISTALSIS CORRELATES FOR DYSPHAGIA AND REGURGITATION: AN ASSESSMENT BASED ON BARIUM ESOPHAGRAM
Authors: Giulini L , Razia D , Mittal S
Published: September 2020

Because it offers real-time assessment, barium esophagram should be the modality of choice when studying esophageal peristalsis. However, no standard reporting method is available for BE results. Presently, peristaltic disorders are defined according to high-resolution manometry (HRM), but HRM findings do not correlate with clinical symptoms. The aim of this study was to stratify esophageal peristaltic function via standardized evaluation of BE, and to define the association between esophageal peristalsis and dysphagia and regurgitation.

Methods

After IRB approval, a prospectively maintained database was reviewed for patients who underwent both HRM and BE from 08/01/2016 to 12/31/2019. Patients with conditions associated with outflow impairment were excluded. BEs were re-examined in blinded fashion and assigned subjective scores (0, 1, or 2) for dilation grade (DG) and contractility grade (CG). Patients were categorized according to the sum of the DG and CG: Group A = 0, Group B = 1–2, and Group C = 3–4. Mean distal contractile integral (DCI), number of failed contractions on HRM, and number of patients with dysphagia/regurgitation in each group were analyzed and compared.

Results

In all, 124 patients were included. The mean DCI (mmHg*cm*s) was 2539.1 ± 1357.8 in Group A, 884.4 ± 916.9 in Group B, and 77.4 ± 192.3 in Group C (p < 0.001). The mean number of failed contractions were 0.7 ± 1.3, 3.4 ± 3.4, and 8.6 ± 3.2, respectively (p < 0.001). Table 1 shows the distribution of patients with dysphagia or regurgitation across groups. The proportion of patients with dysphagia in Group C was higher than in Groups A or B (OR 3.75, p = 0.02; and OR 2.58, p = 0.07, respectively). Similarly, Group C was significantly more often associated with regurgitation than in Groups A or B (OR 4.69, p = 0.009; and OR 4.42, p = 0.005).

Conclusion

The combined DG and CG allowed us to identify the patients with a grade of peristaltic disfunction that was significantly more associated with dysphagia or regurgitation (Group C). However, in order to achieve a clearer definition of the different peristaltic disfunction levels according to their propensity to cause dysphagia or regurgitation, a more objective assessment of both DG and CG should be provided; therefore, further studies are required.
373 ESOPHAGEAL BODY PERISTALSIS IN PATIENTS WITH NORMAL LOWER ESOPHAGEAL SPHINCTER: ARE VIDEO ESOPHAGOGRAM AND HIGH-RESOLUTION MANOMETRY IN AGREEMENT?
Authors: Razia D , Giulini L , Bremner R , Mittal S
Published: September 2020

Peristaltic disorders of the esophageal body have been categorized according to how they appear on high-resolution manometry. Abnormalities in peristalsis may lead to abnormal esophageal clearance and dysphagia. The aim of our retrospective analysis was to study bolus transit patterns on barium esophagogram in patients with various grades of esophageal body peristalsis as diagnosed by high-resolution manometry.

Methods

After Institutional Review Board approval, we queried an esophageal center database to identify patients with normal lower esophageal sphincter parameters. Patients with jackhammer esophagus, esophageal spasm, previous foregut surgery, hiatal hernia, and fragmented peristalsis were excluded. Remaining patients were divided into 11 groups based on their percentages of normal swallows out of 10 swallows (0%–100% swallows normal, DCI > 450 mmHg.s.cm). All previously obtained video esophagograms were re-evaluated in blinded fashion. Bolus transit time through the esophagus was measured in upright and prone positions, using live time stamps at the entry and exit of the bolus. ANOVA and χ2 were used.

Results

In total, 146 patients were included in the analysis. 73 (50%) were men. Mean age and body mass index were 58.4 ± 14.7 years and 22.8 ± 10.4 kg/m2, respectively. Bolus transit time in prone-position swallows increased in tandem with increases in number of abnormal swallows (11.3 ± 3.7, 22 ± 15.5, 29.5 ± 24.3, 42.7 ± 39.5, 42.4 ± 46.9, 64 ± 70.8, 59.4 ± 34.6, 58.8 ± 37.9, 110 ± 66.6, 83.2 ± 49.6 and 105.6 ± 72.5 seconds, p < 0.0001) but no difference was noted in upright-position bolus transit time (p = 0.317). There was a dropoff in level of significance at Group 5 (60% swallows normal) compared to Group 11 (absent contractility), after which there were no inter-group differences (Fig. 1).

Conclusion

Bolus transit time in prone-position swallows progressively increases as percentage of normal swallows decreases. Further work associated with symptoms to define a cutoff between normal and ineffective peristalsis would be useful.
380 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE—ESOPHAGUS) STUDY: OUTCOME OF VARIOUS LEAKAGE TREATMENTS
Authors: Van Workum F , Verstegen M , Ubels S , Hannink G , Klarenbeek B , Rosman C , Bouwense S
Published: September 2020

Anastomotic leakage (AL) is a common and severe complication after esophagectomy. It is largely unknown which initial treatments are most effective for what type of leak. We aimed to investigate the effectiveness of initial treatments of AL in daily clinical practice.

Methods

The TENTACLE—Esophagus is a multinational retrospective cohort study, in which patients with AL after esophagectomy with gastric tube reconstruction in the period 2011–2019 were included. Detailed data regarding casemix, surgery, leak characteristics (e.g. organ failure, leak circumference, contamination, drains present) and treatment (e.g. hours from diagnosis to treatment, treatment modalities) were collected. Primary outcome was 90-day mortality and secondary outcomes included length of stay and leak healing time. Regression analysis will be used to analyze the effectiveness of primary treatments after correction for patient-, surgery- and leak characteristics. The full study protocol is accessible at www.tentaclestudy.com.

Results

Detailed data of 1407 patients with AL from 70 centers in 20 countries is currently being validated and is awaiting final analysis. Preliminary results showed that AL was diagnosed 0–43 days after surgery and 90-day mortality rate was 11.1%. Primary treatments included re-operation (23.0%), stenting (16.8%), radiological drainage (10.5%), tube placement through the defect in the leak cavity (8.7%) and endoVAC placement (3.4%). Re-operations (n = 323) were drainage only (54.6%), oversewing the leak (15.5%), anastomotic resection and re-anastomosis (5,3%), repair with muscle flap (2.5%), disconnection and esophagostomy (11.8%) and other or unknown procedures (10.3%).

Conclusion

This is the largest study on effectiveness of AL treatments. The final results of initial leak treatments, which will be available for presentation at the ISDE meeting, could provide an evidence based basis that can be used by clinicians to determine the preferred primary treatment strategy in patients with a given type of AL.
405 TUMOR BUDDING AS A PROGNOSTIC MARKER FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Suresh A , Nag A , S R , M A
Published: September 2020

Carcinomas of the esophagus are the sixth most common malignancy worldwide in males. Esophageal cancer occurs in two histological types: SCC and adenocarcinoma, 90% is SCC in developing countries.

The presence of tumor budding (TB) at the tumor–host interface of gastrointestinal cancers has been recognized as a hallmark of unfavorable disease biology. TB is defined as the presence of isolated malignant cells or small clusters of up to five cells at the tumor invasive front.

Methods

The study done by taking formalin fixed paraffin blocks of 13 esophagectomy specimens from the year 2014-2019. TB score was calculated at the invasive front of the tumor in 200x magnification. 10 fileds were screened and a hotspot was found.

<5 buds were taken as a low grade budding.

≥5 buds were taken as a high grade budding.

Results

The study showed that 53.85% were found to be males & 46.15% were females. In pT staging, T3 was the most common.

61.5% of the cases showed high grade budding while low grade budding was seen in only 38.5%. This tells us 69.2% fell under T3 stage of which 88.89% had high grade TB while only 11.11% had low grade budding.

Of the 4 present cases of LVI, 75% had high grade TB & 25% had low grade budding.

Of the 3 margin involved cases, 67% had high grade TB while 33% had low grade budding.

Conclusion

To conclude, TB is a valuable prognostic factor and indicator of aggressive diseases. Presence of TB correlates to unfavorable clinico-pathological features. It also provides an important value of risk stratification.

1. Risk stratification

2. High grade TB benefit from esophagectomy.
Stochastic Gain and Loss of Novel Transcribed Open Reading Frames in the Human Lineage
Authors: Dowling Daniel , Schmitz Jonathan F , Bornberg-Bauer Erich
Published: September 2020

In addition to known genes, much of the human genome is transcribed into RNA. Chance formation of novel open reading frames (ORFs) can lead to the translation of myriad new proteins. Some of these ORFs may yield advantageous adaptive de novo proteins. However, widespread translation of noncoding DNA can also produce hazardous protein molecules, which can misfold and/or form toxic aggregates. The dynamics of how de novo proteins emerge from potentially toxic raw materials and what influences their long-term survival are unknown. Here, using transcriptomic data from human and five other primates, we generate a set of transcribed human ORFs at six conservation levels to investigate which properties influence the early emergence and long-term retention of these expressed ORFs. As these taxa diverged from each other relatively recently, we present a fine scale view of the evolution of novel sequences over recent evolutionary time. We find that novel human-restricted ORFs are preferentially located on GC-rich gene-dense chromosomes, suggesting their retention is linked to pre-existing genes. Sequence properties such as intrinsic structural disorder and aggregation propensity—which have been proposed to play a role in survival of de novo genes—remain unchanged over time. Even very young sequences code for proteins with low aggregation propensities, suggesting that genomic regions with many novel transcribed ORFs are concomitantly less likely to produce ORFs which code for harmful toxic proteins. Our data indicate that the survival of these novel ORFs is largely stochastic rather than shaped by selection.
How Self-Employed Older Adults Differ by Age: Evidence and Implications From the Health and Retirement Study
Authors: Halvorsen Cal J
Published: September 2020

Background and Objectives

There has been increased attention in recent years on self-employment in later life, with about 1 in 5 workers past of the age of 50 working for themselves. This study aims to build upon previous documentation of the characteristics of self-employed older adults by estimating how these characteristics vary by age.

Research Design and Methods

Using 7 waves of the Health and Retirement Study with a sample of more than 16,000 working older adults, this study considers how the association between self-employment and sociodemographic characteristics; indicators of human, social, and financial capital; and risk tolerance differ between adults aged 50–61 and 62 years and older. Binary logistic regression and seemingly unrelated estimation are used to estimate and compare the characteristics by age group.

Results

Compared to wage-and-salary work and controlling for all other factors in the models, the oldest self-employed group was more likely to identify as Black, report lower health, and receive health insurance from several sources than the younger group. Further, the older group reported lower individual earnings from work yet higher total household income (less individual earnings) and was also less likely to formally volunteer at the highest commitment levels.

Discussion and Implications

With some exceptions, these results indicate that the diversity of self-employed older adults within traditional retirement age is greater than among those before this age. Implications regarding how access to key safety net programs, such as Social Security retirement benefits and Medicare, may lead to this finding are discussed.
Advocate General advises CJEU on copyright liability of online sharing platforms
Authors: Smith Graham
Published: September 2020

Opinion of Advocate General Saugmandsgaard Øe in Joined Cases C-682/18 Peterson v Google LLC, YouTube LLC, YouTube Inc and Google Germany GmbH and C-683/18 Elsevier Inc v Cyando AG, EU:C:2020:586, 16 July 2020
Characterization of genomic alterations in Chinese colorectal cancer patients
Authors: Huang Wei , Li Hui , Shi Xiaoliang , Lin Minglin , Liao Cun , Zhang Shuirong , Shi Weiwei , Zhang Lin , Zhang Xiaolong , Gan Jialiang
Published: September 2020

Objective

Colorectal cancer is one of the most prevalent types of cancer worldwide. Right-sided and left-sided colorectal cancer (RCC and LCC) patients respond differently to treatment. We aimed to identify the different mutational profile between RCC and LCC and provided evidence for future precision therapy.

Methods

A total of 630 Chinese colorectal cancer patients, including 467 (74.1%) LCC and 163 (25.9%) RCC, were enrolled in this cohort. Both formalin-fixed paraffin-embedded tumor tissues and matching blood samples were collected and deep sequenced targeting 450 cancer genes for genomic alteration analysis. Tumor mutational burden was measured by an algorithm developed in-house. Correlation analysis was performed by Fisher’s exact test.

Results

The most common mutated genes were TP53 (77.0%), APC (71.7%), KRAS (50.0%), SMAD4 (19.8%), PIK3CA (18.3%), FBXW7 (17.5%), TCF7L2 (12.5%), SOX9 (11.3%), LRP1B (10.8%), ARID1A (10.3%) and FAT4 (10.3%). The mutation frequencies of TP53 and APC in LCC were significantly higher than that of RCC, while the mutation frequency of PIK3CA was lower than that of RCC. Six gene fusions were specifically detected in RCC patients. Colorectal cancer sites were associated with gender (P = 4.15 × 10−5) and tumor differentiation (P = 0.059). In LCC, the gender-associated genes were FAT4, EP300, FAT1, LRP1, ARID1B, AR, FYN and TAF1, while in RCC, they were ARID1A, SMARCA4, LRP1 and GRIN2A. The mutations of 18 genes were associated with tumor differentiation (8 for LCC and 10 for RCC). High tumor mutational burden was more common in RCC. Our results implied more potential targeted drug therapy opportunities for RCC.

Conclusion

We describe the different molecular characteristics of LCC and RCC. Our result supported a better prognosis of RCC than LCC in Chinese colorectal cancer patients.
Long-Term Prognostication for 20 114 Women With Small and Node-Negative Breast Cancer
(T1abN0)
Authors: Jaraj David , Höijer Jonas , Widman Linnea , Ahlgren Johan , Arnesson Lars-Gunnar , Einbeigi Zakaria , Klintman Marie , Vikhe Patil Eva , Sund Malin , Fredriksson Irma , Bergh Jonas , Andreas Pettersson
Published: September 2020

Background

Although small, node-negative breast cancer (ie, T1abN0) constitutes 20% of all newly diagnosed breast cancers, data on prognosis and prognostic factors are limited.

Methods

We conducted a population-based cohort study including 20 114 Swedish women treated for T1abN0 breast cancer from 1977 onward. Patient and tumor data were collected from Swedish breast cancer registries. Cohort subjects were followed through linkage to the Cause of Death Register. We calculated the cumulative incidence of breast cancer–specific and overall death and used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

During a median follow-up of 9.1 years (range = 0-38), 915 women died of breast cancer and 5416 of any cause. The 10-, 20-, and 30-year cumulative incidences of breast cancer death were 3.4% (95% CI = 3.1% to 3.7%), 7.6% (95% CI = 7.1% to 8.2%), and 10.5% (95% CI = 9.6% to 11.4%), respectively. The multivariable hazard ratios and 95% confidence intervals of breast cancer death were 0.92 (95% CI = 0.88 to 0.97) for each additional calendar year of diagnosis, 4.38 (95% CI = 2.79 to 6.87) for grade 3 vs grade 1 tumors, 0.43 (95% CI = 0.31 to 0.62) for progesterone receptor–positive vs progesterone receptor–negative disease, and 2.01 (95% CI = 0.99 to 4.07) for HER2-positive vs HER2-negative disease. Women with grade 3 vs grade 1 tumors had a 56% increased risk of death from any cause (HR = 1.56, 95% CI = 1.30 to 1.88).

Conclusions

The risk of breast cancer death in T1abN0 disease continues to increase steadily beyond 10 years after diagnosis, has improved over time, and varies substantially by tumor characteristics.
Plant phenols contents and their changes with nitrogen availability in peatlands of northeastern China
Authors: Wu Di , Wang Xian-Wei , Xu Shi-Qi , Chen Chong-Juan , Mao Rong , Liu Xue-Yan
Published: September 2020

Aims

Climate warming and increasing nitrogen (N) deposition have influenced plant nutrient status and thus plant carbon (C) fixation and vegetation composition in boreal peatlands. Phenols, which are secondary metabolites in plants for defense and adaptation, also play important roles in regulating peatland C dynamics due to their anti-decomposition properties. However, how the phenolic levels of different functional types of plants vary depending on nutrient availability remain unclear in boreal peatlands.

Methods

Here, we investigated total phenols contents (TPC) and total tannins contents in leaves of 11 plant species in 18 peatlands of the Great Hing’an Mountains area in northeastern China, and examined their variations with leaf N and phosphorus (P) and underlying mechanisms.

Important Findings

Shrubs had higher TPC than graminoids, indicating less C allocation to defense and less uptake of organic N in faster-growing and nonmycorrhizal graminoids than in slower-growing and mycorrhizal shrubs. For shrubs, leaf TPC decreased with increasing N contents but was not influenced by changing leaf phosphorus (P) contents, which suggested that shrubs would reduce the C investment for defense with increasing N availability. Differently, leaf TPC of graminoids increased with leaf N contents and decreased with leaf P contents. As graminoids are more N-limited and less P-limited, we inferred that graminoids would increase the defensive C investment under increased nutrient availability. We concluded that shrubs would invest more C in growth than in defense with increasing N availability, but it was just opposite for graminoids, which might be an important mechanism to explain the resource competition and encroachment of shrubs in boreal peatlands in the context of climate warming and ever-increasing N deposition.
Biochar and alternate partial root-zone irrigation greatly enhance the effectiveness of mulberry in remediating lead-contaminated soils
Authors: Wang Lei , Dang Qing-Lai , Tedla Binyam
Published: September 2020

Aims

Soil lead contamination has become increasingly serious and phytoremediation can provide an effective way to reclaim the contaminated soils. This study aims to examine the growth, lead resistance and lead accumulation of mulberry (Morus alba L.) seedlings at four levels of soil lead contamination with or without biochar addition under normal or alternative partial root-zone irrigation (APRI).

Methods

We conducted a three-factor greenhouse experiment with biochar (with vs. without biochar addition), irrigation method (APRI vs. normal irrigation) and four levels of soil lead (0, 50, 200 and 800 mg·kg−1). The performance of the seedlings under different treatments was evaluated by measuring growth traits, osmotic substances, antioxidant enzymes and lead accumulation and translocation.

Important Findings

The results reveal that mulberry had a strong ability to acclimate to soil lead contamination, and that biochar and APRI synergistically increased the biomass and surface area of absorption root across all levels of soil lead. The seedlings were able to resist the severe soil lead contamination (800 mg·kg−1 Pb) by adjusting glutathione metabolism, and enhancing the osmotic and oxidative regulating capacity via increasing proline content and the peroxidase activity. Lead ions in the seedlings were primarily concentrated in roots and exhibited a dose–effect associated with the lead concentration in the soil. Pb, biochar and ARPI interactively affected Pb concentrations in leaves and roots, translocation factor and bioconcentration. Our results suggest that planting mulberry trees in combination with biochar addition and APRI can be used to effectively remediate lead-contaminated soils.
The Needle in the Haystack: Identifying Credible Mobile Health Apps for Pediatric Populations during a Pandemic and beyond
Authors: Psihogios Alexandra M , Stiles-Shields Colleen , Neary Martha
Published: September 2020

Background

The COVID-19 pandemic has ignited wider clinical adoption of digital health tools, including mobile health apps (mHealth apps), to address mental and behavioral health concerns at a distance. While mHealth apps offer many compelling benefits, identifying effective apps in the crowded and largely unregulated marketplace is laborious. Consumer demand and industry productivity are increasing, although research is slower, making it challenging for providers to determine the most credible and safe apps for patients in need.

Objectives/Methods

This commentary offers a practical, empirically guided framework and associated resources for selecting appropriate mHealth apps for pediatric populations during the pandemic and beyond.

Results

In the first stage, Narrow the target problem, end user, and contender apps. Beginning the search with continuously updated websites that contain expert app ratings can help expedite this process (e.g., Psyberguide). Second, Explore each contender app’s: (a) scientific and theoretical support (e.g., are app components consistent with health behavior change theories?), (b) privacy policies, and (c) user experience (e.g., through crowdsourcing feedback about app usability and appeal via social media). Third, use clinical expertise and stakeholder feedback to Contextualize whether the selected app is a good fit for a particular patient and/or caregiver (e.g., by considering age, race/ethnicity, ability, gender, sexual orientation, technology access), including conducting a brief self-pilot of the app.

Conclusion

Youth are increasingly turning to technology for support, especially during the pandemic, and pediatric psychologists must be primed to recommend the most credible tools. We offer additional recommendations for rapidly disseminating evidence-based apps to the public.
‘Not one action but many’: institutional work by commissioners of children's mental health services in the English NHS
Authors: Passey Andrew
Published: September 2020

This article enhances our understanding of institutional work, through a study of professional health commissioners in the English National Health Service. Using a case study of mental health policy implementation, commissioners are conceptualized as institutional agents involved in shaping the organizational field and its boundary. Health service commissioners face a series of challenges as institutional agents. Commissioning is a relatively new health profession. It lacks a strong professional association and has predominantly been externally professionalized. Commissioners have limited direct organizational strategic management control. In the case study, commissioners were charged with leading implementation of the policy, which required them to address fragmentation in the field. Using existing typologies as an analytical frame, activities by commissioners in the case study are identified and explored as different modes of institutional work. Commissioners created a new normative network and instigated specific processes to embed and routinize cross-organization working. They undertook boundary-spanning cognitive institutional work, creating new knowledge by commissioning education of school staff in the basics of children’s mental health. Their institutional work involved challenging existing working practices, both in the health field and in the contiguous education field. The article elucidates connections between different modes of institutional work and attends to boundary work by commissioners in parallel with institutional work in the field. It also outlines how a profession seemingly lacking many of the ingredients of institutional power might pursue its own professional project through institutional work. Findings have resonance in other geographical and policy areas and fields.
Reversible regulation of conjugation of Bacillus subtilis plasmid pLS20 by the quorum sensing peptide responsive anti-repressor RappLS20
Authors: Singh Praveen K , Serrano Ester , Ramachandran Gayetri , Miguel-Arribas Andrés , Gago-Cordoba César , Val-Calvo Jorge , López-Pérez Arancha , Alfonso Carlos , Wu Ling Juan , Luque-Ortega Juan R , Meijer Wilfried J J
Published: September 2020

Quorum sensing plays crucial roles in bacterial communication including in the process of conjugation, which has large economical and health-related impacts by spreading antibiotic resistance. The conjugative Bacillus subtilis plasmid pLS20 uses quorum sensing to determine when to activate the conjugation genes. The main conjugation promoter, Pc, is by default repressed by a regulator RcopLS20 involving DNA looping. A plasmid-encoded signalling peptide, Phr*pLS20, inactivates the anti-repressor of RcopLS20, named RappLS20, which belongs to the large group of RRNPP family of regulatory proteins. Here we show that DNA looping occurs through interactions between two RcopLS20 tetramers, each bound to an operator site. We determined the relative promoter strengths for all the promoters involved in synthesizing the regulatory proteins of the conjugation genes, and constructed an in vivo system uncoupling these regulatory genes to show that RappLS20 is sufficient for activating conjugation in vivo. We also show that RappLS20 actively detaches RcopLS20 from DNA by preferentially acting on the RcopLS20 molecules involved in DNA looping, resulting in sequestration but not inactivation of RcopLS20. Finally, results presented here in combination with our previous results show that activation of conjugation inhibits competence and competence development inhibits conjugation, indicating that both processes are mutually exclusive.
A Major Regional Measles Outbreak: Description of Hospitalized Cases in 2017–2018 at Bordeaux University Hospital, France
Authors: Barthod Laure , Fourgeaud Jacques , Puges Mathilde , Rogues Anne-Marie , Coppry Maïder , Sarlangue Jean , Boyer Alexandre , Neau Didier , Vabret Astrid , Dina Julia , Lafon Marie-Edith , Cazanave Charles
Published: September 2020

Background

Measles remains endemic worldwide, despite current vaccination recommendations, and is associated with high morbidity and mortality rates. We describe all cases hospitalized in Bordeaux University Hospital (BUH), the starting point of a national significant measles outbreak in 2017–2018.

Methods

In this retrospective study, we included all patients hospitalized in BUH from September 1, 2017, to May 31, 2018. Inclusion criteria were age >1 year, clinical symptoms, and biological confirmation by measles immunoglobulin M or measles reverse transcription polymerase chain reaction positivity.

Results

We included 171 patients. Most patients were immunocompetent; only 19% had preexisting medical histories. Most patients had rash and fever (97%), but some cases were atypical and difficult to diagnose. Köplik’s spots were reported in 66 cases (38%). The most frequent biological markers were blood inflammation markers (96%) and lymphopenia (81%). Unexpectedly, we found hyponatremia (<135 mmol/L) in 40% of patients. We identified peaks in January and March, corresponding to 76 D8 genotypes and 28 B3 strains. The following complications were reported in 65 patients (38%): pneumonia, hepatitis, and keratitis; 10 had neurological symptoms. One patient had Guillain-Barré syndrome, and a young immunocompromised patient died from measles inclusion-body encephalitis. Most of the patients (80%) had not been correctly vaccinated, including 28 health care workers. Some patients (n = 43, 25%) developed measles despite having plasma IgG. These included 12 possible vaccination failure cases.

Conclusions

During the BUH outbreak, measles was often complicated and sometimes atypical. Vaccination coverage was dramatically insufficient. We also describe vaccination failure cases that must be better investigated.
Incidence of Health Care–Associated COVID-19 During Universal Testing of Medical and Surgical Admissions in a Large US Health System
Authors: Long Dustin R , O’Reilly-Shah Vikas , Rustagi Alison S , Bryson-Cahn Chloe , Jerome Keith R , Weiss Noel S , Sunshine Jacob E
Published: September 2020

Concerns about severe acute respiratory syndrome coronavirus 2 exposure in health care settings may cause patients to delay care. Among 2992 patients testing negative on admission to an academic, 3-hospital system, 8 tested positive during hospitalization or within 14 days postdischarge. Following adjudication of each instance, health care–associated infection incidence ranged from 0.8 to 5.0 cases per 10 000 patient-days.
Small sleepers, big data: leveraging big data to explore sleep-disordered breathing in infants and young children
Authors: Ehsan Zarmina , Glynn Earl F , Hoffman Mark A , Ingram David G , Al-Shawwa Baha
Published: September 2020

Study Objectives

Infants represent an understudied minority in sleep-disordered breathing (SDB) research and yet the disease can have a significant impact on health over the formative years of neurocognitive development that follow. Herein we report data on SDB in this population using a big data approach.

Methods

Data were abstracted using the Cerner Health Facts database. Demographics, sleep diagnoses, comorbid medication conditions, healthcare utilization, and economic outcomes are reported.

Results

In a cohort of 68.7 million unique patients, over a 9-year period, there were 9,773 infants and young children with a diagnosis of SDB (obstructive sleep apnea [OSA], nonobstructive sleep apnea, and “other” sleep apnea) who met inclusion criteria, encompassing 17,574 encounters, and a total of 27,290 diagnoses across 62 U.S. health systems, 172 facilities, and 3 patient encounter types (inpatient, clinic, and outpatient). Thirty-nine percent were female. Thirty-nine percent were ≤1 year of age (6,429 infants), 50% were 1–2 years of age, and 11% were 2 years of age. The most common comorbid diagnoses were micrognathia, congenital airway abnormalities, gastroesophageal reflux, chronic tonsillitis/adenoiditis, and anomalies of the respiratory system. Payor mix was dominated by government-funded entities.

Conclusions

We have used a novel resource, large-scale aggregate, de-identified EHR data, to examine SDB. In this population, SDB is multifactorial, closely linked to comorbid medical conditions and may contribute to a significant burden of healthcare costs. Further research focusing on infants at highest risk for SDB can help target resources and facilitate personalized management.
Melanopsin-dependent phototransduction is impaired in delayed sleep–wake phase disorder and sighted non–24-hour sleep–wake rhythm disorder
Authors: Abbott Sabra M , Choi Jin , Wilson John , Zee Phyllis C
Published: September 2020

Study Objectives

The circadian system must perform daily adjustments to align sleep–wake and other physiologic rhythms with the environmental light–dark cycle: This is mediated primarily through melanopsin containing intrinsically photosensitive retinal ganglion cells. Individuals with delayed sleep–wake phase disorder (DSWPD) exhibit a delay in sleep–wake timing relative to the average population, while those with sighted non–24-hour sleep–wake rhythm disorder (N24SWD) exhibit progressive delays. An inability to maintain appropriate entrainment is a characteristic of both disorders. In this study, we test the hypothesis that individuals with DSWPD exhibit alteration in melanopsin-dependent retinal photo-transduction as measured with the postillumination pupil response (PIPR).

Methods

Twenty-one control and 29 participants with DSWPD were recruited from the community and clinic. Of the 29 DSWPD participants, 17 reported a history of N24SWD. A pupillometer was used to measure the PIPR in response to a bright 30-second blue or red-light stimulus. The PIPR was calculated as the difference in average pupil diameter at baseline and 10–40 seconds after light stimulus offset.

Results

The PIPR was significantly reduced in the DSWPD group when compared with the control group (1.26 ± 1.11 mm vs 2.05 ± 1.04 mm, p < 0.05, t-test). The PIPR was significantly reduced in the sighted N24SWD subgroup when compared with individuals with the history of only DSWPD (0.88 ± 0.58 mm vs 1.82 ± 1.44 mm, p < 0.05, analysis of variance [ANOVA]) or controls (0.88 ± 0.58 mm vs 2.05 ± 1.04 mm, p < 0.01, ANOVA).

Conclusions

These results indicate that reduced melanopsin-dependent retinal photo-transduction may be a novel mechanism involved in the development of DSWPD and sighted N24SWD.
Use of a Support Surface Standard to Test the Effects of a Turning and Positioning Device Versus Low-Air-Loss Therapy on Temperature and Humidity
Authors: Call Evan , Oberg Craig , Rappl Laurie M.
Published: September 2020

BACKGROUND

Turning and repositioning devices (TRDs) help to reduce strain on caregivers, but clinicians question their effects on humidity and temperature (microclimate) at the skin surface that may increase risk of pressure ulcers.

OBJECTIVE

To pilot the use of a standard test for support surfaces to compare microclimate at the skin surface in three scenarios: (1) on a low-air-loss (LAL) surface, (2) on a representative TRD with a basic underpad (TRDU) placed on a LAL surface, and (3) on a negative control with full occlusion. The results are designed to inform clinical decision-making in using a TRD on a LAL surface and the viability of using this test to study TRDs.

DESIGN

Measuring humidity and temperature at the device-surface interface using a heated moisture-exuding bronze thermodynamic human model in a laboratory setting.

MAIN OUTCOME MEASURE

Humidity and temperature levels across 3 hours 15 minutes of continuous loading with a 45-second complete unloading to simulate a position change at 3 hours.

MAIN RESULTS

Relative humidity on the TRDU was below that on the LAL surface for the first 110 minutes and was markedly lower than the negative control for the remainder of humidity testing. Temperature on the TRDU was well below the negative control and negligibly higher than the surface alone throughout testing. The position change enhanced the effects of the TRDU.

CONCLUSIONS

The support surface standard test appears useful in evaluating TRDs. This TRD along with the basic underpad is more comparable to a LAL surface than to full occlusion in managing the microclimate of the skin and pressure ulcer risk.
Wireless power transfer-based eddy current non-destructive testing using a flexible printed coil array
Authors: Daura Lawal Umar , Tian GuiYun , Yi Qiuji , Sophian Ali
Published: September 2020

Eddy current testing (ECT) has been employed as a traditional non-destructive testing and evaluation (NDT&E) tool for many years. It has developed from single frequency to multiple frequencies, and eventually to pulsed and swept-frequency excitation. Recent progression of wireless power transfer (WPT) and flexible printed devices open opportunities to address challenges of defect detection and reconstruction under complex geometric situations. In this paper, a transmitter–receiver (Tx–Rx) flexible printed coil (FPC) array that uses the WPT approach featuring dual resonance responses for the first time has been proposed. The dual resonance responses can provide multiple parameters of samples, such as defect characteristics, lift-offs and material properties, while the flexible coil array allows area mapping of complex structures. To validate the proposed approach, experimental investigations of a single excitation coil with multiple receiving coils using the WPT principle were conducted on a curved pipe surface with a natural dent defect. The FPC array has one single excitation coil and 16 receiving (Rx) coils, which are used to measure the dent by using 21 C-scan points on the dedicated dent sample. The experimental data were then used for training and evaluation of dual resonance responses in terms of multiple feature extraction, selection and fusion for quantitative NDE. Four features, which include resonant magnitudes and principal components of the two resonant areas, were investigated for mapping and reconstructing the defective dent through correlation analysis for feature selection and feature fusion by deep learning. It shows that deep learning-based multiple feature fusion has outstanding performance for 3D defect reconstruction of WPT-based FPC-ECT.

This article is part of the theme issue ‘Advanced electromagnetic non-destructive evaluation and smart monitoring’.
Machine learning at the interface of structural health monitoring and non-destructive evaluation
Authors: Gardner P. , Fuentes R. , Dervilis N. , Mineo C. , Pierce S.G. , Cross E.J. , Worden K.
Published: September 2020

While both non-destructive evaluation (NDE) and structural health monitoring (SHM) share the objective of damage detection and identification in structures, they are distinct in many respects. This paper will discuss the differences and commonalities and consider ultrasonic/guided-wave inspection as a technology at the interface of the two methodologies. It will discuss how data-based/machine learning analysis provides a powerful approach to ultrasonic NDE/SHM in terms of the available algorithms, and more generally, how different techniques can accommodate the very substantial quantities of data that are provided by modern monitoring campaigns. Several machine learning methods will be illustrated using case studies of composite structure monitoring and will consider the challenges of high-dimensional feature data available from sensing technologies like autonomous robotic ultrasonic inspection.

This article is part of the theme issue ‘Advanced electromagnetic non-destructive evaluation and smart monitoring’.
Analysis of electromagnetic non-destructive evaluation modelling using Stratton-Chu formulation-based fast algorithm
Authors: Bao Yang , Song Jiming
Published: September 2020

The eddy current non-destructive evaluation (NDE) modelling using Stratton-Chu formulation-based fast algorithm is analysed. Stratton-Chu formulations, which have no low frequency breakdown issue, are selected for modelling electromagnetic NDE problems with low frequency and high conductivity approximations. As the main contribution of this article, the robustness and efficiency of the approximations, which result in big savings in both memory and CPU time, are validated and analysed using examples from practical EC testing. The boundary element method (BEM) is used to discretize the integral equations into a linear system of equations: the first order Rao-Wilton-Glisson (RWG) vector basis functions with the flat triangle meshes of the object and pulse basis functions are selected to expand the equivalent surface currents and the normal component of magnetic fields, respectively. Then the multilevel adaptive cross approximation (MLACA) algorithm is applied to accelerate the iterative solution process. The performance and efficiency of adaptively applying a multi-stage (level) algorithm based on the criteria concluded for the operators are shown.

This article is part of the theme issue ‘Advanced electromagnetic non-destructive evaluation and smart monitoring’.
Hierarchical low-rank and sparse tensor micro defects decomposition by electromagnetic thermography imaging system
Authors: Wu Tongle , Gao Bin , Woo Wai Lok
Published: September 2020

With the advancement of electromagnetic induction thermography and imaging technology in non-destructive testing field, this system has significantly benefitted modern industries in fast and contactless defects detection. However, due to the limitations of front-end hardware experimental equipment and the complicated test pieces, these have brought forth new challenges to the detection process. Making use of the spatio-temporal video data captured by the thermal imaging device and linking it with advanced video processing algorithm to defects detection has become a necessary alternative way to solve these detection challenges. The extremely weak and sparse defect signal is buried in complex background with the presence of strong noise in the real experimental scene has prevented progress to be made in defects detection. In this paper, we propose a novel hierarchical low-rank and sparse tensor decomposition method to mine anomalous patterns in the induction thermography stream for defects detection. The proposed algorithm offers advantages not only in suppressing the interference of strong background and sharpens the visual features of defects, but also overcoming the problems of over- and under-sparseness suffered by similar state-of-the-art algorithms. Real-time natural defect detection experiments have been conducted to verify that the proposed algorithm is more efficient and accurate than existing algorithms in terms of visual presentations and evaluation criteria.

This article is part of the theme issue ‘Advanced electromagnetic non-destructive evaluation and smart monitoring’.
Study on the characteristics of magneto acoustic emission for mild steel fatigue
Authors: Shen Gongtian , Shen Yongna
Published: September 2020

Fatigue life of materials or structures can be classified into three stages: fatigue hardening or softening, crack initiation and crack propagation, which includes two stages. Current mature non-destructive testing (NDT) methods can only detect macro or visible cracks in stage II crack propagation. In order to detect and evaluate the fatigue damage occurring before stage II crack propagation quickly and effectively, magneto acoustic emission (MAE) measurement was carried out on laboratory specimens with different numbers of fatigue cycles. With the accumulation of fatigue damage, the RMS of MAE decrease steadily on the whole, making MAE a promising non-destructive method for evaluating fatigue damage. To make MAE applicable in noisy environments, square waveform voltage were selected to excite magnetic fields, and ‘T' type MAE signals with higher amplitude were produced. The variation of MAE with number of fatigue cycles at different excitation intensity indicated that the defects associated with fatigue damage have greater effects on the creation and annihilation of domain walls. The point where the MAE amplitude begins to increase instead of decrease with fatigue can be an indicator for the onset of stage II crack propagation.

This article is part of the theme issue ‘Advanced electromagnetic non-destructive evaluation and smart monitoring'.