bluuebunny/crossref_metadata_2025 huggingface dataset:
Internal lithospheric rotation at the initiation of intra-oceanic rift-drift: An example of proto-transform tectonics from the Vourinos Ophiolite, Greece
Authors: Rassios* Anne Ewing , Ghikas* Dina , Batsi* Anna , Koutsovitis* Petros , Tzamos* Evangelos , Dilek* Yildirim
Published: August 2021

The “petrological Moho” recognized in the Jurassic Vourinos Ophiolite (northern Greece) was the first “crust-mantle” boundary described within a fossil oceanic lithosphere. Early observations suggested a Cenozoic brittle-field block rotation of the petrological Moho transition area resulting in an oblique clockwise rotation of ~100°, but a brittle fault system responsible for the mechanism of this rotation was never located. A modern interpretation of research dating from the 1960s to the present documents the occurrence of a diverse set of ductile structures overprinting this primary intra-oceanic feature.

The following observations from our original “Moho” studies in the Vourinos complex are still pertinent: the contact between the upper mantle units and the magmatic crustal sequence is in situ and intrusional in nature; high-temperature intragranular ductile deformation (mantle creep at temperatures from around 1200 °C down to ~900 °C) fabrics terminate at the crust-mantle boundary; the overlying oceanic crustal rocks display geochemical fractionation patterns analogous to crustal rocks in the in situ oceanic lithosphere. Since these original studies, however, understanding the mechanisms of ductile deformation and ridge crest processes have advanced, and hence we can now interpret the older data and recent observations in a new paradigm of oceanic lithosphere formation.

Our major interpretational breakthrough includes the following phenomena: lower temperature, intergranular deformation of ~900 °C to 700 °C extends from the upper mantle tectonites up into the lower crustal cumulate section; the origin of mineral lineations within adcumulate crustal rocks as remnants of ductile deformation during early phases of magmatic crystallization; syn-magmatic folding and rotation of the cumulate section; the tectonic significance of flaser gabbro and late gabbroic intrusions in the crustal sequence; and the relevance and significance of a cumulate troctolite unit within the crustal sequence. These observations collectively point to an important process of a ductile-field, syn-magmatic rotation of the Moho transition area. The most plausible mechanism explaining such a rotation is proto-transform faulting deformation near the ridge crest. By recognizing and distinguishing structures that resulted from such initial rotational deformation in the upper mantle peridotites of ophiolites, future field-based structural, petrographic, and petrological studies can better document the mode of the initiation of oceanic transform faults.
Numerical models of Cretaceous continental collision and slab breakoff dynamics in western Canada
Authors: Zhang Wenbo , Johnston* Stephen T. , Currie Claire A.
Published: August 2021

The North American Cordillera is generally interpreted as a result of the long-lived, east-dipping subduction at the western margin of the North American plate. However, the east-dipping subduction seems problematic for explaining some of the geological features in the Cordillera such as large volume back-arc magmatism. Recent studies suggested that westward subduction of a now-consumed oceanic plate during the Cretaceous could explain these debated geological features. The evidence includes petrological and geochemical variations in magmatism, the presence of ophiolite that indicates tectonic sutures between the Cordillera and Craton, and seismic tomography images showing high-velocity bodies within the underlying convecting mantle that are interpreted as slab remnants from the westward subduction. Here we use 2-D upper mantle-scale numerical models to investigate the dynamics associated with westward subduction and Cordillera-Craton collision. The models demonstrate the controls on slab breakoff (remnant) following collision including: (1) oceanic and continental mantle lithosphere strength, (2) variations in density (eclogitization of continental lower crust and cratonic mantle lithosphere density), and (3) convergence rate. Our preferred model has a relatively weak mantle lithosphere, eclogitization of the lower continental crust, cratonic mantle lithosphere density of 3250 kg/m3, and a convergence rate of 5 cm/yr. It shows that collision and slab breakoff result in an ~2 km increase in surface elevation of the Cordilleran region west of the suture as the dense oceanic plate detaches. The surface also shows a foreland geometry that extends >1000 km east of the suture with ~4 km of subsidence relative to the adjacent Cordillera.
Gravitational sliding or tectonic thrusting?: Examples and field recognition in the Miura-Boso subduction zone prism
Authors: Ogawa* Yujiro , Mori* Shin’ichi
Published: August 2021

Discrimination between gravity slides and tectonic fold-and-thrust belts in the geologic record has long been a challenge, as both have similar layer shortening structures resulting from single bed duplication by thrust faults of outcrop to map scales. Outcrops on uplifted benches within the Miocene to Pliocene Misaki accretionary unit of Miura-Boso accretionary prism, Miura Peninsula, central Japan, preserve good examples of various types of bedding duplication and duplex structures with multiple styles of folds. These provide a foundation for discussion of the processes, mechanisms, and tectonic implications of structure formation in shallow parts of accretionary prisms. Careful observation of 2-D or 3-D and time dimensions of attitudes allows discrimination between formative processes. The structures of gravitational slide origin develop under semi-lithified conditions existing before the sediments are incorporated into the prism at the shallow surfaces of the outward, or on the inward slopes of the trench. They are constrained within the intraformational horizons above bedding-parallel detachment faults and are unconformably covered with the superjacent beds, or are intruded by diapiric, sedimentary sill or dike intrusions associated with liquefaction or fluidization under ductile conditions. The directions of vergence are variable. On the other hand, layer shortening structure formed by tectonic deformation within the accretionary prism are characterized by more constant styles and attitudes, and by strong shear features with cataclastic textures. In these structures, the fault surfaces are oblique to the bedding, and the beds are systematically duplicated (i.e., lacking random styles of slump folds), and they are commonly associated with fault-propagation folds. Gravitational slide bodies may be further deformed at deeper levels in the prism by tectonism. Such deformed rocks with both processes constitute the whole accretionary prism at depth, and later may be deformed, exhumed to shallow levels, and exposed at the surface of the trench slope, where they may experience further deformation. These observations are not only applicable in time and space to large-scale thrust-and-fold belts of accretionary prism orogens, but to small-scale examples. If we know the total 3-D geometry of geologic bodies, including the time and scale of deformational stages, we can discriminate between gravitational slide and tectonic formation of each fold-and-thrust belt at the various scales of occurrence.
Subduction and exhumation slip accommodation at depths of 10–80 km inferred from field geology of exhumed rocks: Evidence for temporal-spatial localization of slip
Authors: Wakabayashi John
Published: August 2021

Field relationships in the Franciscan Complex of California suggest localization of subduction slip in narrow zones (≤300 m thick) at the depths of ~10–80 km. Accretionary and non-accretionary subduction slip over the ca. 150 Ma of Franciscan history was accommodated across the structural thickness of the complex (maximum of ~30 km). During accretion of a specific unit (<5 Ma), subduction slip (accretionary subduction slip) deformed the full thickness of the accreting unit (≤5 km), primarily on discrete faults of <20 m in thickness, with the remainder accommodated by penetrative deformation. Some faults accommodating accretionary subduction slip formed anastomosing zones ≤200 m thick that resulted in block-in-matrix (tectonic mélange) relationships but did not emplace exotic blocks.

Mélange horizons with exotic blocks range in thickness from 0.5 m to 1 km. These apparently formed by sedimentary processes as part of the trench fill prior to subsequent deformation during subduction-accretion. Accretionary subduction slip was localized within some of these mélanges in zones ≤300 m thick. Such deformation obscured primary sedimentary textures. Non-accretionary subduction faults separate units accreted at different times, but these <100-m-thick fault zones capture a small fraction of associated subduction slip because of footwall subduction and likely removal of hanging wall by subduction erosion. Most exhumation was accommodated by discrete faults ≤30 m thick. Structural, geochronologic, and plate motion data suggest that of the ~13,000 km of subduction during the ca. 150 Ma assembly of the Franciscan Complex, ~2000 km was associated with accretion.
Latest Quaternary slip rates of the San Bernardino strand of the San Andreas fault, southern California, from Cajon Creek to Badger Canyon
Authors: McGill Sally F. , Owen Lewis A. , Weldon Ray J. , Kendrick Katherine J. , Burgette Reed J.
Published: August 2021

Four new latest Pleistocene slip rates from two sites along the northwestern half of the San Bernardino strand of the San Andreas fault suggest the slip rate decreases southeastward as slip transfers from the Mojave section of the San Andreas fault onto the northern San Jacinto fault zone. At Badger Canyon, offsets coupled with radiocarbon and optically stimulated luminescence (OSL) ages provide three independent slip rates (with 95% confidence intervals): (1) the apex of the oldest dated alluvial fan (ca. 30–28 ka) is right-laterally offset ~300–400 m yielding a slip rate of 13.5 +2.2/−2.5 mm/yr; (2) a terrace riser incised into the northwestern side of this alluvial fan is offset ~280–290 m and was abandoned ca. 23 ka, yielding a slip rate of 11.9 +0.9/−1.2 mm/yr; and (3) a younger alluvial fan (13–15 ka) has been offset 120–200 m from the same source canyon, yielding a slip rate of 11.8 +4.2/−3.5 mm/yr. These rates are all consistent and result in a preferred, time-averaged rate for the past ~28 k.y. of 12.8 +5.3/−4.7 mm/yr (95% confidence interval), with an 84% confidence interval of 10–16 mm/yr. At Matthews Ranch, in Pitman Canyon, ~13 km northwest of Badger Canyon, a landslide offset ~650 m with a 10Be age of ca. 47 ka yields a slip rate of 14.5 +9.9/−6.2 mm/yr (95% confidence interval). All of these slip rates for the San Bernardino strand are significantly slower than a previously published rate of 24.5 ± 3.5 mm/yr at the southern end of the Mojave section of the San Andreas fault (Weldon and Sieh, 1985), suggesting that ~12 mm/yr of slip transfers from the Mojave section of the San Andreas fault to the northern San Jacinto fault zone (and other faults) between Lone Pine Canyon and Badger Canyon, with most (if not all) of this slip transfer happening near Cajon Creek. This has been a consistent behavior of the fault for at least the past ~47 k.y.
Supplemental Material: Metallogenic fingerprint of a metasomatized lithospheric mantle feeding gold endowment in the western Mediterranean basin
Authors: Schettino Erwin , al. et
Published: August 2021

Appendix 1: Petrogenesis of Tallante mantle xenoliths; Appendix 2: Analytical methods; Table S1: Major element compositions of rock-forming minerals in Tallante xenoliths; Table S2: Major element compositions of base-metal sulfides (in wt%); Table S3: trace elements abundances (ppm) of clinopyroxene grains in Tallante xenoliths; Table S4: concentrations (ppm) of chalcophile and siderophile elements in base-metal sulfides.
Learning lessons from the paediatric critical care response to the SARS-CoV-2 pandemic in England and Wales: a qualitative study
Authors: Roche Emma , Lim Chun , Sayma Meelad , Navaratnam Annakan , Davis Peter J , Ramnarayan Padmanabhan , Fraser James , Kenny Simon
Published: August 2021

Objectives

To explore the experiences of clinical leads in paediatric critical care units (PCCUs) in England and Wales during the reorganisation of services in the initial surge of the SARS-CoV-2 pandemic and to learn lessons for future surges and service planning.

Methods

A qualitative study design using semistructured interviews via virtual conferencing was conducted with consultant clinical leads and lead nurses covering 21 PCCUs. Interviews were conducted over a period of 2 weeks, 2 months after the initial SARS-CoV-2 surge. Interview notes underwent thematic analysis.

Results

Thematic analysis revealed six themes: leadership, management and planning; communication; workforce development and training; innovation; workforce experience; and infection prevention and control. Leadership was facilitated through clinician-led local autonomy for decision-making and services were better delivered when the workforce was empowered to be flexible in their response. Communication was preferred through collaborative management structures. Further lessons include recognising workforce competencies in surge preparations, the use of virtual technology in facilitating training and meetings, the importance of supporting the well-being of the workforce and the secondary consequences of personal protective equipment use.

Conclusions

During the 2020 SARS-CoV-2 pandemic, an agile response to a rapidly changing situation was enabled through effective clinical leadership and an adaptive workforce. Open systems of communication across senior clinical and management teams facilitated service planning. Support for all members of the workforce through implementation of appropriate and innovative education and well-being solutions was vital in sustaining resilience. This learning supports planning for future surge capacity across paediatric critical care locally and nationally.
Fifteen-minute consultation: Guide to the young person with menorrhagia and dysmenorrhoea
Authors: Griffiths Angharad Siân , Hall Dani
Published: August 2021

Adolescents who menstruate commonly present to acute paediatric services.
Functional reconstructions using only ulnar nerve and ulnar nerve-innervated muscles for traumatic musculocutaneous, median and radial nerve palsies
Authors: Motomiya Makoto , Watanabe Naoya , Kawamura Daisuke , Iwasaki Norimasa
Published: August 2021

A 20-year-old right-handed fisherman experienced a severe injury in a high-energy traffic accident. These injuries included a shaft fracture of the right humerus, open comminuted fracture of the right forearm and multiple peripheral nerve palsies involving the musculocutaneous, median and radial nerves. Six months after the initial treatment, the patient was referred to our hand surgeons for further treatment. Several operations for functional reconstruction using only the ulnar nerve and ulnar nerve-innervated muscles were performed: the main procedures included a partial ulnar nerve transfer for elbow flexion, flexor carpi ulnaris transfer for reconstruction of wrist and finger extension and opponensplasty using the abductor digiti minimi. Three years after the initial injury, the patient had relatively good function including elbow flexion and stable side pinch and grasp. Functional reconstruction using a combination of the ulnar nerve and ulnar nerve-innervated muscles may be useful in specific cases involving multiple peripheral nerve injuries.
Challenging case of chronic Q fever endocarditis: usefulness of 18F-FDG PET/CT in the diagnosis and follow-up
Authors: Markowich Anna Hermine , Romani Lorenza , Leccisotti Lucia , De Luca Maia
Published: August 2021

Diagnosis of infective endocarditis can be challenging for clinicians, especially when involving prosthetic valves. Recent data suggest that18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) could be a useful diagnostic tool in this setting. Here, we report a case of a patient with an aortic biological prosthesis who presented with a history of fever and fatigue. Echocardiograms were negative for vegetations. The18F-FDG PET/CT revealed an infective process of the valve and serological tests were positive for chronicCoxiella burnetiiinfection. Specific treatment for chronic Q fever endocarditis was, therefore, started and the response was monitored using18F-FDG PET/CT. This case highlights the challenges and pitfalls clinicians face when confronted with prosthetic valve endocarditis and the use of18F-FDG PET/CT for diagnosis and follow-up.
First recurrence of small cell lung cancer presenting as subacute monoarticular arthritis
Authors: McCormick John Peter , Trueick Robert , Connaughton John , McDonnell Niamh
Published: August 2021

We describe a case of recurrent small cell lung cancer presenting as an acute monoarticular arthritis. This patient had recently undergone comprehensive review and surveillance imaging under a local oncology unit, 18 months after undergoing chemoradiotherapy for limited disease small cell lung cancer. He had presented to the emergency department on multiple occasions and been managed as an outpatient for a provisional diagnosis of spontaneous haemarthrosis in the setting of rivaroxaban therapy. Subsequent investigation revealed occult fracture of the distal femur with joint effusion, secondary to isolated metastatic disease from recurrent small cell lung cancer. This case demonstrates the importance of reconsidering differential diagnoses when a patient’s symptoms do not respond to appropriate treatment as expected. It also highlights the limitations of surveillance protocols and the influence that recent specialist input can have on diagnostic processes.
Severe Ludwig’s angina caused by an unknown insect bite
Authors: Almadhi Gihad , Alkathlan Mohammed , Alharbi Othman , Almeman Ahmad
Published: August 2021

Hereby, we report a case of a 75-year-old man who presented with a 3-day history of facial swelling and choking sensation. The only history of note was an insect bite on the left parotid gland area 3 days prior. The patient was later diagnosed with insect-bite-induced Ludwig’s angina.Enterococcus faecaliswas detected on blood cultures and was presumed the source of infection. Intravenous antibiotics and corticosteroids were initiated. The patient was intubated and was subsequently made to undergo a tracheostomy insertion to establish a definitive airway. He was admitted to the intensive care unit and when his condition improved, he was transferred to the ward for full recovery. The patient spent a total of 66 days in hospital before being discharged. This case suggests that Ludwig’s angina can be caused by insect bites. However, further similar cases are needed to be documented to explore this theory.
Ipilimumab and nivolumab induced immune-related adverse events in metastatic mucosal melanoma
Authors: Cao Yenong , Afzal Muhammad Zubair , Shirai Keisuke
Published: August 2021

Mucosal melanoma is a rare subtype of melanoma and represents a unique diagnosis and treatment challenge. Immune-checkpoint inhibitors (ICIs) have revolutionised metastatic melanoma treatment, and one of the leading regimens is the combination of ipilimumab (anti-cytotoxic T lymphocyte-associated antigen 4: CTLA4) and nivolumab (anti-programmed cell death protein 1: PD1). We report a case of a patient with metastatic mucosal melanoma treated with ipilimumab and nivolumab who developed multiple immune-related adverse events (irAEs) including uveitis, type I diabetes complicated by diabetic ketoacidosis, destructive thyroiditis, hepatitis and vitiligo. Endocrinopathies including type 1 diabetes and hypothyroidism were treated with insulin and levothyroxine. Hepatitis was responsive to steroids. She had sustained complete response 12 months after discontinuation of the combination therapy. With the wide usage of ICIs in multiple types of malignancies, it is important for general practioners to recognise common and serious irAEs due to ICIs.
Immune-mediated Coombs negative intravascular haemolysis in systemic lupus erythematosus (SLE)
Authors: Magendiran Bhoobalan , Jose Augustine , Kolar Vishwanath Vinod , Bammigatti Chanaveerappa
Published: August 2021

A 27-year-old woman presented with a history of excessive hair loss, loss of appetite, loss of weight, amenorrhoea and loss of axillary and pubic hair for 6 months followed by fever and vomiting for 5 months and abdominal pain for 1 month. During the course of her illness, the patient developed intravascular haemolysis as evidenced by a drop in haemoglobin, indirect hyperbilirubinaemia, raised lactate dehydrogenase (LDH) and haemoglobinuria. Examination revealed severe pallor, mild icterus, elevated jugular venous pressure, generalised lymphadenopathy and hyperpigmentation. Investigations revealed severe anaemia, indirect hyperbilirubinaemia, raised LDH and negative Coombs test. Antinuclear antibody and anti-dsDNA, anti-Sm and anti-SS-A/Ro antibodies were positive and complement C3 was low. The patient was diagnosed to have systemic lupus erythematosus and immune-mediated intravascular haemolysis and was treated with prednisolone and hydroxychloroquine. Haemolysis resolved following steroid therapy, and during follow-up, there were no further episodes of haemolysis.
Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study
Authors: Chung Hannah , He Siyi , Nasreen Sharifa , Sundaram Maria E , Buchan Sarah A , Wilson Sarah E , Chen Branson , Calzavara Andrew , Fell Deshayne B , Austin Peter C , Wilson Kumanan , Schwartz Kevin L , Brown Kevin A , Gubbay Jonathan B , Basta Nicole E , Mahmud Salaheddin M , Righolt Christiaan H , Svenson Lawrence W , MacDonald Shannon E , Janjua Naveed Z , Tadrous Mina , Kwong Jeffrey C
Published: August 2021

Objective

To estimate the effectiveness of mRNA covid-19 vaccines against symptomatic infection and severe outcomes (hospital admission or death).

Design

Test negative design study.

Setting

Ontario, Canada between 14 December 2020 and 19 April 2021.

Participants

324 033 community dwelling people aged ≥16 years who had symptoms of covid-19 and were tested for SARS-CoV-2.

Interventions

BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine.

Main outcome measures

Laboratory confirmed SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) and hospital admissions and deaths associated with SARS-CoV-2 infection. Multivariable logistic regression was adjusted for personal and clinical characteristics associated with SARS-CoV-2 and vaccine receipt to estimate vaccine effectiveness against symptomatic infection and severe outcomes.

Results

Of 324 033 people with symptoms, 53 270 (16.4%) were positive for SARS-CoV-2 and 21 272 (6.6%) received at least one dose of vaccine. Among participants who tested positive, 2479 (4.7%) were admitted to hospital or died. Vaccine effectiveness against symptomatic infection observed ≥14 days after one dose was 60% (95% confidence interval 57% to 64%), increasing from 48% (41% to 54%) at 14-20 days after one dose to 71% (63% to 78%) at 35-41 days. Vaccine effectiveness observed ≥7 days after two doses was 91% (89% to 93%). Vaccine effectiveness against hospital admission or death observed ≥14 days after one dose was 70% (60% to 77%), increasing from 62% (44% to 75%) at 14-20 days to 91% (73% to 97%) at ≥35 days, whereas vaccine effectiveness observed ≥7 days after two doses was 98% (88% to 100%). For adults aged ≥70 years, vaccine effectiveness estimates were observed to be lower for intervals shortly after one dose but were comparable to those for younger people for all intervals after 28 days. After two doses, high vaccine effectiveness was observed against variants with the E484K mutation.

Conclusions

Two doses of mRNA covid-19 vaccines were observed to be highly effective against symptomatic infection and severe outcomes. Vaccine effectiveness of one dose was observed to be lower, particularly for older adults shortly after the first dose.
Abortion-related morbidity in six Latin American and Caribbean countries: findings of the WHO/HRP multi-country survey on abortion (MCS-A)
Authors: Romero Mariana , Gomez Ponce de Leon Rodolfo , Baccaro Luiz Francisco , Carroli Berenise , Mehrtash Hedieh , Randolino Jimena , Menjivar Elisa , Estevez Saint-Hilaire Erika , Huatuco Maria del Pilar , Hernandez Muñoz Rosalinda , Garcia Camacho Gabriela , Thwin Soe Soe , Campodonico Liana , Abalos Edgardo , Giordano Daniel , Gamerro Hugo , Kim Caron Rahn , Ganatra Bela , Gülmezoglu Metin , Tuncalp Özge , Carroli Guillermo
Published: August 2021

Introduction

Abortion-related complications are a significant cause of morbidity and mortality among women in many Latin American and Caribbean (LAC) countries. The objective of this study was to characterise abortion-related complication severity, describe the management of these complications and report women’s experiences with abortion care in selected countries of the Americas region.

Methods

This is a cross-sectional study of 70 health facilities across six countries in the region. We collected data on women’s characteristics including socio-demographics, obstetric history, clinical information, management procedures and using Audio Computer-Assisted Self-Interviewing (ACASI) survey the experience of abortion care. Descriptive bivariate analysis was performed for women’s characteristics, management of complications and reported experiences of abortion care by severity of complications, organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Generalised linear estimation models were used to assess the association between women’s characteristics and severity of complications.

Results

We collected data on 7983 women with abortion-related complications. Complications were classified as mild (46.3%), moderate (49.5%), potentially life-threatening (3.1%), near-miss cases (1.1%) and deaths (0.2%). Being single, having a gestational age of ≥13 weeks and having expelled products of conception before arrival at the facility were significantly associated with experiencing severe maternal outcomes compared with mild complications.

Management of abortion-related complications included both uterotonics and uterine evacuation for two-thirds of the women while one-third received uterine evacuation only. Surgical uterine evacuation was performed in 93.2% (7437/7983) of women, being vacuum aspiration the most common one (5007/7437, 67.4%).

Of the 327 women who completed the ACASI survey, 16.5% reported having an induced abortion, 12.5% of the women stated that they were not given explanations regarding their care nor were able to ask questions during their examination and treatment with percentages increasing with the severity of morbidity.

Conclusions

This is one of the first studies using a standardised methodology to measure severity of abortion-related complications and women’s experiences with abortion care in LAC. Results aim to inform policies and programmes addressing sexual and reproductive rights and health in the region.
Scaling up kangaroo mother care in the Philippines using policy, regulatory and systems reform to drive changes in birth practices
Authors: Calibo Anthony Pascual , De Leon Mendoza Socorro , Silvestre Maria Asuncion , Murray John Charles Scott , Li Zhao , Mannava Priya , Kitong Jacqueline , Quiazon Mark Benjamin , Sobel Howard Lawrence
Published: August 2021

The WHO recommends kangaroo mother care (KMC) for stable preterm and low birthweight babies because it has been demonstrated to reduce mortality by up to half compared with conventional incubator-based care. Uptake of KMC in low/middle-income countries has been limited, despite its suitability for low-resource environments. This paper reviews factors that contributed to the adoption and expansion of KMC in the Philippines. Early introduction began in 1999 but national scale-up was slow until 2014 after which a significant improvement in national adoption was observed. The proportion of target hospitals implementing KMC rose from 3% to 43% between 2014 and 2019, with 53% of preterm and low birthweight babies receiving KMC by the end of this period. Expansion was led by the government which committed resources and formed partnerships with development partners and non-governmental organisations. Scale-up of KMC was built on the introduction of evidence-based newborn care practices around birth. Practice changes were promoted and supported by consensus-based policy, protocol, regulatory and health insurance changes led by multidisciplinary teams. A new approach to changing and sustaining clinical practice used hospital teams to conduct on-the-job clinical coaching and use local data to make environmental changes to support practices. Institutionalisation of early skin-to-skin contact, non-separation of mother and newborn and early initiation of exclusive breast feeding, with increased responsibility given to mothers, drove a cultural change among staff and families which allowed greater acceptance and uptake of KMC. Financial and programmatic support must be sustained and expanded to address ongoing challenges including staffing gaps, available space for KMC, willingness of some staff to adopt new practices and lack of resources for clinical coaching and follow-up.
Association of body mass index with morbidity in patients hospitalised with COVID-19
Authors: Plataki Maria , Pan Di , Goyal Parag , Hoffman Katherine , Choi Jacky Man Kwan , Huang Hao , Safford Monika M , Schenck Edward J
Published: August 2021

Purpose

To evaluate the association between body mass index (BMI) and clinical outcomes other than death in patients hospitalised and intubated with COVID-19.

Methods

This is a single-centre cohort study of adults with COVID-19 admitted to New York Presbyterian Hospital-Weill Cornell Medicine from 3 March 2020 through 15 May 2020. Baseline and outcome variables, as well as lab and ventilatory parameters, were generated for the admitted and intubated cohorts after stratifying by BMI category. Linear regression models were used for continuous, and logistic regression models were used for categorical outcomes.

Results

The study included 1337 admitted patients with a subset of 407 intubated patients. Among admitted patients, hospital length of stay (LOS) and home discharge was not significantly different across BMI categories independent of demographic characteristics and comorbidities. In the intubated cohort, there was no difference in in-hospital events and treatments, including renal replacement therapy, neuromuscular blockade and prone positioning. Ventilatory ratio was higher with increasing BMI on days 1, 3 and 7. There was no significant difference in ventilator free days (VFD) at 28 or 60 days, need for tracheostomy, hospital LOS, and discharge disposition based on BMI in the intubated cohort after adjustment.

Conclusions

In our COVID-19 population, there was no association between obesity and morbidity outcomes, such as hospital LOS, home discharge or VFD. Further research is needed to clarify the mechanisms underlying the reported effects of BMI on outcomes, which may be population dependent.
Dietary fibres and IBS: translating functional characteristics to clinical value in the era of personalised medicine
Authors: So Daniel , Gibson Peter R , Muir Jane G , Yao Chu K
Published: August 2021

Clinical guidelines in the use of fibre supplementation for patients with IBS provide one-size-fits-all advice, which has limited value. This narrative review addresses data and concepts around the functional characteristics of fibre and subsequent physiological responses induced in patients with IBS with a view to exploring the application of such knowledge to the precision use of fibre supplements. The key findings are that first, individual fibres elicit highly distinct physiological responses that are associated with their functional characteristics rather than solubility. Second, the current evidence has focused on the use of fibres as a monotherapy for IBS symptoms overall without attempting to exploit these functional characteristics to elicit specific, symptom-targeted effects, or to use fibre types as adjunctive therapies. Personalisation of fibre therapies can therefore target several therapeutic goals. Proposed goals include achieving normalisation of bowel habit, modulation of gut microbiota function towards health and correction of microbial effects of other dietary therapies. To put into perspective, bulking fibres that are minimally fermented can offer utility in modulating indices of bowel habit; slowly fermented fibres may enhance the activities of the gut microbiota; and the combination of both fibres may potentially offer both benefits while optimising the activities of the microbiota throughout the different regions of the colon. In conclusion, understanding the GI responses to specific fibres, particularly in relation to the physiology of the individual, will be the future for personalising fibre therapy for enhancing the personalised management of patients with IBS.
Clarifying the anatomy of the superior sinus venosus defect
Authors: Relan Jay , Gupta Saurabh Kumar , Rajagopal Rengarajan , Ramakrishnan Sivasubramanian , Gulati Gurpreet Singh , Kothari Shyam S , Saxena Anita , Sharma Sanjiv , Rajashekar Palleti , Anderson Robert H
Published: August 2021

Objectives

We sought to clarify the variations in the anatomy of the superior cavoatrial junction and anomalously connected pulmonary veins in patients with superior sinus venosus defects using computed tomographic (CT) angiography.

Methods

CT angiograms of 96 consecutive patients known to have superior sinus venosus defects were analysed.

Results

The median age of the patients was 34.5 years. In seven (7%) patients, the defect showed significant caudal extension, having a supero-inferior dimension greater than 25 mm. All patients had anomalous connection of the right superior pulmonary vein. The right middle and right inferior pulmonary vein were also connected anomalously in 88 (92%) and 17 (18%) patients, respectively. Anomalous connection of the right inferior pulmonary vein was more common in those with significant caudal extension of the defect (57% vs 15%, p=0.005). Among anomalously connected pulmonary veins, the right superior, middle, and inferior pulmonary veins were committed to the left atrium in 6, 17, and 11 patients, respectively. The superior caval vein over-rode the interatrial septum in 67 (70%) patients, with greater than 50% over-ride in 3 patients.

Conclusion

Anomalous connection of the right-sided pulmonary veins is universal, but is not limited to the right upper lobe. Not all individuals have over-riding of superior caval vein. In a minority of patients, the defect has significant caudal extension, and anomalously connected pulmonary veins are committed to the left atrium. These findings have significant clinical and therapeutic implications.
Repetitive and forceful movements of the hand as predictors of treatment for pain in the distal upper extremities
Authors: Aavang Petersen Jonathan , Brauer Charlotte , Thygesen Lau Caspar , Flachs Esben Meulengracht , Lund Christina Bach , Thomsen Jane Frølund
Published: August 2021

Objective

To investigate repetitive movements and the use of hand force as causes of treatment for distal upper extremities musculoskeletal disorders

Methods

A cohort of 202 747 workers in a pension health scheme from 2005 to 2017 in one of 17 jobs (eg, office work, carpentry, cleaning) was formed. Representative electro-goniometric measurements of wrist angular velocity as a measure for repetition and expert-rated use of hand force were used in a job exposure matrix (JEM). Job titles were retrieved from the Danish registers. Outcome was first treatment in the distal upper extremities. In a Poisson regression model, incidence rate ratios (IRRs) of treatment were adjusted for age, calendar-year, diagnosis of rheumatoid arthritis and arm fractures. In further analyses, wrist velocity or hand force was added.

Results

In men, wrist velocity had an IRR of 1.48 (95% CI 1.15 to 1.91) when the highest exposure level was compared with the lowest but with no clear exposure-response pattern. The effect became insignificant when adjusted for hand force. Hand force had an IRR of 2.65 (95% CI 2.13 to 3.29) for the highest versus the lowest exposure with an exposure-response pattern, which remained after adjustment for wrist velocity. Among women, no increased risk was found for hand force, while wrist velocity showed a significantly protective association with treatment.

Conclusions

In men, occupational exposure to hand force more than doubled the risk of seeking treatment. The results for exposure to repetition were less clear. In women, we could not find any indications of an increased risk neither for force nor for repetition.
Comparison of continuous intravenous lidocaine versus transversus abdominis plane block for kidney transplant surgery: a randomized, non-inferiority trial
Authors: Hanson Neil A , Strunk Joseph , Saunders Genna , Cowan Nick G , Brandenberger Jared , Kuhr Christian S , Oryhan Christine , Warren Daniel T , Slee April E , Strodtbeck Wyndam
Published: August 2021

Background and objectives

Transversus abdominis plane (TAP) blocks are associated with an improvement in postoperative analgesia following kidney transplant surgery. However, these blocks carry inherent risk and require a degree of expertise to perform successfully. Continuous intravenous lidocaine may be an effective alternative. In this randomized, non-inferiority study, we hypothesized that a continuous lidocaine infusion provides similar postoperative analgesia to a TAP block.

Methods

Subjects presenting for kidney transplant surgery were randomized in a 1:1 ratio to either an ultrasound-guided unilateral, single-injection TAP block (TAP group) or a continuous infusion of lidocaine (Lido group). The primary outcome of this non-inferiority study was opioid consumption within the first 24 hours following surgery. Secondary outcomes included pain scores, patient satisfaction, opioid-related adverse events, time to regular diet, and persistent opioid use.

Results

One hundred and twenty subjects, 59 from the TAP group and 61 from the Lido group, completed the study per protocol. Analysis of the primary outcome showed a cumulative geometric mean intravenous morphine equivalent difference between the TAP (14.6±3.2 mg) and Lido (15.9±2.4 mg) groups of 1.27 mg (95% CI −4.25 to 6.79; p<0.001), demonstrating non-inferiority of the continuous lidocaine infusion. No secondary outcomes showed clinically meaningful differences between groups.

Conclusions

This study demonstrates that a continuous infusion of lidocaine offers non-inferior postoperative analgesia compared with an ultrasound-guided unilateral, single-injection TAP block in the first 24 hours following kidney transplant surgery.

Trial registration number

NCT03843879.
Diagnostic value of 3D-FLAIR MRI in children with sudden deafness caused by inner ear hemorrhage
Authors: Gao Fu Sheng , Jia Xuan , Ma XiaoHui , Bi Jing , Shu Qiang
Published: August 2021

Objective

To investigate the diagnostic value of three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) MRI in children with sudden deafness caused by inner ear hemorrhage.

Methods

The diagnostic efficacies of three different MRI sequences in the examination of the inner ear for 32 children with sudden deafness were compared. Hearing examination results and 3-month follow-up outcomes were analyzed.

Results

The age of 32 children with sudden deafness ranged from 5 to 18 years. MRI was performed from 1 to 18 days after onset. Six cases of sudden deafness caused by inner ear hemorrhage were finally diagnosed clinically. For different MRI sequences, the 3D-FLAIR sequence detected five positive cases; the conventional T1-weighted image sequence also detected five positive cases; but the conventional T2-weighted image sequence only detected three positive cases. The sensitivity and specificity of the 3D-FLAIR sequence in the diagnosis of inner ear hemorrhage were 83.3% (5/6) and 96.2% (25/26), respectively, and the area under the curve value of the receiver operating characteristic curve was 0.897. In the hemorrhage group, all six cases had extremely severe sensorineural hearing loss, and the hearing recovery was ineffective after 3 months of follow-up. The degree of hearing impairment, 3-month short-term treatment efficacy, and 3D-FLAIR MRI in the diagnosis of inner ear hemorrhage between hemorrhage group and non-hemorrhage group were statistically significant (p=0.043, p=0.000, p=0.000).

Conclusions

3D-FLAIR MRI is helpful for the diagnosis of inner ear hemorrhage in children with sudden deafness. Besides, short-term treatment indicates poor effects on children with severe hearing impairment.
Dispersion-theoretical analysis of the electromagnetic form factors of the nucleon: Past, present and future
Authors: Lin Yong-Hui , Hammer Hans-Werner , Meißner Ulf-G.
Published: August 2021

We review the dispersion-theoretical analysis of the electromagnetic form factors of the nucleon. We emphasize in particular the role of unitarity and analyticity in the construction of the isoscalar and isovector spectral functions. We present new results on the extraction of the nucleon radii, the electric and magnetic form factors and the extraction of$$\omega $$ω-meson couplings. All this is supplemented by a detailed calculation of the theoretical uncertainties, using bootstrap and Bayesian methods to pin down the statistical errors, while systematic errors are determined from variations of the spectral functions. We also discuss the physics of the time-like form factors and point out further issues to be addressed in this framework.
Forced apart: a microtubule-based mechanism for equidistant positioning of multiple nuclei in single cells
Authors: Teapal Juliane , Schuitman Leander J. , Mulder Bela M. , Janson Marcel E.
Published: August 2021

Cells can position multiple copies of components like carboxysomes, nucleoids, and nuclei at regular intervals. By controlling positions, cells, for example, ensure equal partitioning of organelles over daughter cells and, in the case of nuclei, control cell sizes during cellularization. Mechanisms that generate regular patterns are as yet poorly understood. We used fission yeast cell cycle mutants to investigate the dispersion of multiple nuclei by microtubule-generated forces in single cells. After removing internuclear attractive forces by microtubule-based molecular motors, we observed the establishment of regular patterns of nuclei. Based on live-cell imaging, we hypothesized that microtubule growth within internuclear spaces pushes neighbouring nuclei apart. In the proposed mechanism, which was validated by stochastic simulations, the repulsive force weakens with increasing separation because stochastic shortening events limit the extent over which microtubules generate forces. Our results, therefore, demonstrate how cells can exploit the dynamics of microtubule growth for the equidistant positioning of organelles.
Characterization of medieval-like glass alteration layers by laser spectroscopy and nonlinear optical microscopy
Authors: Oujja Mohamed , Palomar Teresa , Martínez-Weinbaum Marina , Martínez-Ramírez Sagrario , Castillejo Marta
Published: August 2021

Historical glass-based objects undergo, since the time of their manufacture, different degradation phenomena that are related to their composition and to the environment to which they were exposed. Three-dimensional (3D) structural and chemical characterization of the degradation layers is important to select the most adequate conservation strategies for glass objects. Optical microscopy (OM) is the most frequently used non-destructive method to examine the surface of historical glasses; however, the 3D structural assessment of alteration layers requires applying the destructive modality of this technique to conduct a cross-sectional study. In this work, a different approach for structural and compositional characterization of alteration layers on model medieval-like glasses is presented, based on the combination of the laser spectroscopies of laser-induced breakdown spectroscopy (LIBS), laser-induced fluorescence (LIF) and FT-Raman, and the emerging, cutting edge technique of nonlinear optical microscopy (NLOM) in the modality of multiphoton excitation fluorescence (MPEF). The results obtained through this multi-analytical photonic approach were compared with those retrieved by examination of the surface and cross sections of the samples by OM and scanning electron microscopy–energy-dispersive X-ray spectroscopy (SEM–EDS). While the combination of LIBS, LIF and FT-Raman served to assess the composition of the various alteration layers, the use of MPEF microscopy allowed the non-destructive determination of the thicknesses of these layers, showing for both thickness and composition a good agreement with the OM and SEM–EDS results. Thus, the proposed approach, which avoids sample preparation, illustrates the capability of non-destructive, or micro-destructive in the case of LIBS, laser spectroscopies and microscopies for the in situ study of glass objects of historic or/and artistic value.

Graphic Abstract
AGGLOMERATION TAXES IN THE INDIAN STATES DUE TO WIDER ECONOMIC BENEFITS: AN EMPIRICAL ASSESSMENT
Authors: BHUTANI SALONI , MISHRA ALOK KUMAR
Published: August 2021

This paper carries out an empirical study to examine the contribution of urban areas in generating tax revenue and growth at 28 Indian state levels. The study is based on the hypothesis that the productivity and agglomeration externality effects present in cities, known as “wider economic benefits”, lead to enhanced tax bases of State Governments. The cross-sectional estimation has confirmed that urbanization and state gross domestic product per capita significantly contribute to the tax bases of State Governments, such as sales tax, stamps, registration duty and motor vehicle tax. These three agglomeration taxes (including goods and services tax) are recommended for sharing with urban local bodies.
GLOBAL EXISTENCE OF TIMOSHENKO SYSTEM WITH RESPECT TO FRACTIONAL MEMORY OPERATOR, SPATIAL FRACTIONAL THERMAL EFFECT AND DISTRIBUTED DELAY
Authors: CHOUCHA ABDELBAKI , BOULAARAS SALAH , OUCHENANE DJAMEL , ALHARBI ASMA , ABDALLA MOHAMED
Published: August 2021

In this paper, the Timoshenko system with distributed delay term, fractional operator in the memory and spatial fractional thermal effect is considered, we will prove under some assumptions the global existence of a weak solution. Furthermore, we show some results about the stability of system by the semigroup method.
RESULT OF LOCAL EXISTENCE OF SOLUTIONS OF NONLOCAL VISCOELASTIC SYSTEM WITH RESPECT TO THE NONLINEARITY OF SOURCE TERMS
Authors: BOULAARAS SALAH , CHOUCHA ABDELBAKI , OUCHENANE DJAMEL , ALHARBI ASMA , ABDALLA MOHAMED
Published: August 2021

This work deals with the proof of local existence theorem of solutions for coupled nonlocal singular viscoelastic system with respect to the nonlinearity of source terms by using the Faedo–Galerkin method together with energy methods. This work makes a new contribution, since most of the previous works did not address the proof of the theorem of the local existence of solutions. It is also a completed study of Boulaaras et al. [Adv. Differ. Equ. 2020 (2020) 310].