bluuebunny/crossref_metadata_2025 huggingface dataset:
Increasing adherence to plotting e-partograph: a quality improvement project in a rural maternity hospital in India
Authors: Jain Shuchi , Kumar Pramod , Jain Manish , Bathla Megha , Joshi Shiv , Srivastava Sushil , Singh Mahtab , Sudke Ajit , Datta Vikram , Shivkumar Poonam
Published: August 2021

Abnormal prolonged labour and its effects are important contributors to maternal and perinatal mortality and morbidity worldwide. E-partograph is a modern tool for real-time computerised recording of labour data which improves maternal and neonatal outcome. The aim was to improve the rates of e-partograph plotting in all eligible women in the labour room from existing 30% to achieve 90% in 6 months through a quality improvement (QI) process.

A team of nurses, obstetricians, postgraduates and a data entry operator did a root cause analysis to identify the possible reasons for the drop in e-partograph plotting to 30%. The team used process flow mapping and fish bone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles to address the issues identified.

The interventions included training labour room staff, identification of eligible women and providing an additional computer and internet facility for plotting and assigning responsibility of plotting e-partographs. We implemented these interventions in five PDSA cycles and observed outcomes by using control charts. A set of process, output and outcome indicators were used to track if the changes made were leading to improvement.

The rate of e-partograph plotting increased from 30% to 93% over the study period of 6 months from August 2018 to January 2019. The result has been sustained since the last PDSA cycle. The maternal outcome included a decrease in obstructed and prolonged labour with its associated complications from 6.2% to 2.4%. The neonatal outcomes included a decrease in admissions in the neonatal intensive care unit for birth asphyxia from 8% to 3.4%. It can thus be concluded that a QI approach can help in improving adherence to e-partography plotting resulting in improved maternal health services in a rural maternity hospital in India.
Checklist to aid young physicians managing obstetric emergencies in rural India: a quality improvement initiative
Authors: Puntambekar Varad , Sharma Aparna K , Yadav Kapil , Kumar Rakesh
Published: August 2021

Background

The decision to admit or refer a patient presenting with an obstetric emergency is extremely crucial. In rural India, such decisions are usually made by young physicians who are less experienced and often miss relevant data points required for appropriate decision making. In our setting, before the quality improvement (QI) initiative, this information was recorded on loose blank sheets (first information sheets (FIS)) where an initial clinical history, physical examination and investigations were recorded. The mean FIS completeness, at baseline, was 73.95% (1–5 January 2020) with none of the FIS being fully complete. Our objective was to increase the FIS completeness to >90% and to increase the number of FIS that were fully complete over a 9-month period.

Methods

With the help of a prioritisation matrix, the QI team decided to tackle the problem of incomplete FIS. The team then used fishbone analysis and identified that the main causes of incomplete FIS were that the interns did not know what to document and would often forget some data points. Change ideas to improve FIS completeness were implemented using Plan-Do-Study-Act (PDSA) cycles, and ultimately, a checklist (referred to as antenatal care (ANC) checklist) was implemented. The study was divided into six phases, and after every phase, a few FIS were conveniently sampled for completeness.

Results

FIS completeness improved to 86.34% (p<0.001) in the post implementation phase (1 Feb to 31 August 2020), and in this phase, 69.72% of the FIS were documented using the ANC checklist. The data points that saw the maximum improvement were relating to the physical examination.

Conclusion

The use of ANC checklist increased FIS completeness. Interns with no prior clinical and QI experience can effectively lead and participate in QI initiatives. The ANC checklist is a scalable concept across similar healthcare settings in rural India.
Implementing a three-hourly feeding schedule in stable preterm infants to decrease maternal fatigue
Authors: Aradhya Abhishek S , Kaur Inderjot , Gupta Rima , Kaur Sonaljot , Shrimanth Yamasandi Siddegowda , Masih Parveen Darshan , Kumar Praveen
Published: August 2021

Background

A three-hourly feeding schedule has been shown to be as safe as a two-hourly schedule in preterm neonates. It saves nursing time and may be less tiring for the mothers. However, tradition and apprehensions have prevented its wider acceptance. We used a quality improvement approach to implement a three-hourly feeding schedule in stable preterm infants >32 weeks postmenstrual age (PMA) in our unit through a series of plan–do–study–act (PDSA) cycles.

Methods

All preterm neonates >32 weeks PMA, who were on full enteral feeds and without any respiratory support were eligible. The key quantitative outcome was maternal fatigue score. Safety was assessed in terms of episodes of hypoglycaemia and feed intolerance. Qualitative experiences from nursing staff were captured. The volume of expressed breastmilk and requirement of formula feeds were also recorded. After recording baseline data on a two-hourly feeding schedule, four PDSA cycles were sequentially completed over 21 weeks. The results of each PDSA cycle informed the change strategy for the next cycle.

Results

In the baseline phase, five neonates on a two-hourly schedule were studied. In PDSA cycles I, II, III and IV, a cumulative of 122 neonates were studied on a three-hourly schedule. There was a significant decrease in median maternal fatigue score (13 (IQR 8–23) to 3 (IQR 1–6); p=0.01)). Only one neonate had feed intolerance, while two had mild asymptomatic transient hypoglycaemia. Six (5%) neonates were shifted to two-hourly feeds temporarily due to transient reasons. Nursing staff felt mothers could devote more time to Kangaroo mother care. The volume of expressed breastmilk and requirement of formula feeds were not different from the three-hourly schedule.

Conclusions

It was possible to change the traditional two-hourly feeding schedule to three-hourly in stable preterm infants using a quality improvement approach, while objectively documenting its safety and benefits.
Advancing emergency airway management by reducing intubation time at a high-volume academic emergency department
Authors: Gopinath Bharath , Sachdeva Seema , Kumar Akshay , Kumar Gaurav
Published: August 2021

Background

Airway management is a life-saving procedure in the emergency department (ED). Hypoxia during rapid sequence intubation (RSI) is associated with high morbidity and mortality.

Aim

To decrease the median time of intubation (time from administration of paralytic agent to the successful passage of endotracheal tube) by 40% from baseline 300 s in patients undergoing RSI in the ED.

Methods

A multidisciplinary quality improvement team worked to improve the airway management. The bottle necks identified using process mapping and fish bone analysis were lack of formal training of residents and nursing officers, and communication gap between residents and nursing officers. Change ideas focused on training residents in laryngoscopy and intubation and nursing officers in facilitating airway management by preparation of drugs and equipment; on-site awareness of logistical issues to the residents and nursing officers, introducing airway drug checklist and ensuring availability of difficult airway equipment.

Results

After implementation of change ideas there was a significant reduction in intubation time. At the end of first Plan-Do-Study-Act (PDSA) cycle median intubation time was 165 s (IQR 125 s). By the end of last PDSA cycle, median intubation time reduced to 157 s (IQR 66 s). A shift was obtained on the run chart with a new median time of 141.5 s from mid-PDSA 1. The 8-week data after the end of PDSA 3 showed sustainability with median time of 126 s (IQR 42 s).

Conclusion

A well organised team effort, simple change ideas such as structured training of residents and nursing officers, introduction of airway drug checklist and improved communication can decrease the intubation time in a chaotic ED.
Development of a framework of intervention strategies for point of care quality improvement at different levels of healthcare delivery system in India: initial lessons
Authors: Datta Vikram , Srivastava Sushil , Garde Rahul , Mehta Rajesh , Livesley Nigel , Sawleshwarkar Kedar , Pemde Harish , Patnaik Suprabha K , Sooden Ankur , Singh Mahtab , John Susy Sarah , Pradeep Jeena , Vig Anupa , Kumar Achala , Singh Vivek , Bhatia Vandana , Garg Bishan Singh , Baswal Dinesh
Published: August 2021

Background

Inadequate quality of care has been identified as one of the most significant challenges to achieving universal health coverage in low-income and middle-income countries. To address this WHO-SEARO, the point of care quality improvement (POCQI) method has been developed. This paper describes developing a dynamic framework for the implementation of POCQI across India from 2015 to 2020.

Methods

A total of 10 intervention strategies were designed as per the needs of the local health settings. These strategies were implemented across 10 states of India, using a modification of the ‘translating research in practice’ framework. Healthcare professionals and administrators were trained in POCQI using a combination of onsite and online training methods followed by coaching and mentoring support. The implementation strategy changed to a fully digital community of practice platform during the active phase of the COVID-19 pandemic. Dashboard process, outcome indicators and crude cost of implementation were collected and analysed across the implementation sites.

Results

Three implementation frameworks were evolved over the study period. The combined population benefitting from these interventions was 103 million. A pool of QI teams from 131 facilities successfully undertook 165 QI projects supported by a pool of 240 mentors over the study period. A total of 21 QI resources and 6 publications in peer-reviewed journals were also developed. The average cost of implementing POCQI initiatives for a target population of one million was US$ 3219. A total of 100 online activities were conducted over 6 months by the digital community of practice. The framework has recently extended digitally across the South-East Asian region.

Conclusion

The development of an implementation framework for POCQI is an essential requirement for the initiative’s successful country-wide scale. The implementation plan should be flexible to the healthcare system’s needs, target population and the implementing agency’s capacity and amenable to multiple iterative changes.
Quality improvement initiative approach to decrease the unindicated usage of antibiotics in a neonatal intensive care unit of a tertiary care teaching hospital in Hyderabad, India
Authors: Konda Kalyan Chakravarthy , Singh Himabindu , Madireddy Alimelu , Poodari Megha Mala Rao
Published: August 2021

Antimicrobial resistance is an emerging global problem concerned with patient safety. It is even more challenging in developing countries like India. Antibiotic stewardship initiative is the best arrow in the quiver to prevent and control this antimicrobial resistance. We observed 61% of the neonates admitted to neonatal intensive care unit of Niloufer hospital, Hyderabad, India were receiving improper antibiotics with respect to choice of drug or dosage or duration. Subsequently, an antibiotic stewardship team was formed to address the antibiotic misuse. Team consisted of neonatology faculty, residents, staff nurses, infection control nurses and microbiologist. We identified problems related to staff awareness, policy issues like lack of display of the antibiotic policy and lack of antibiotic lock, process issues like low rate of documentation of indication for initiation or escalation of antibiotic and a lack of dynamic review plan regarding continuation or de-escalation. We used the Plan-Do-Study-Act cycles to test and adapt solutions to these problems. Within 10 weeks of starting our quality improvement (QI) project, the proportion of unindicated antibiotic usage decreased from 61% to 27%. Timely de-escalation of antibiotic is a neglected intervention in neonates, and yielded the maximum result in our study. We conclude that QI projects are simple, doable yet powerful effective tools to address the burning problems like antibiotic misuse. This result was very satisfying and encouraging boosting our team’s faith in the effectiveness of QI approach.
Pain induced by investigations and procedures commonly administered to older adults in the emergency department: a prospective cohort study
Authors: Baril Laurence , Nguyen Elisabeth , Dufresne-Santerre Lauralee , Émond Virginie , Émond Marcel , Berthelot Simon , Gagnon Ann-Pier , Nadeau Alexandra , Carmichael Pierre-Hugues , Mercier Eric
Published: August 2021

Background

This study aimed to assess the level of pain induced by common interventions performed in older adults consulting to the ED.

Methods

We conducted a prospective multicentre observational cohort study in two academic EDs (Quebec City, Canada) between June 2018 and December 2019. A convenience sample of well-oriented and haemodynamically stable older adults (≥65 years old) who underwent at least two interventions during their ED stay was recruited. The level of pain was assessed using an 11-point Numerous Rating Scale (NRS) and is presented using median and IQR or categorised as no pain (0), mild (1–3), moderate (4–6) or severe pain (7–10).

Results

A total of 318 patients were included. The mean age was 77.8±8.0 years old and 54.4% were female . The number of pain assessments per intervention ranged between 22 (urinary catheterisation) and 240 (intravenous catheter). All imaging investigations (X-rays, CT and bedside ultrasound) were associated with a median level of pain of 0. The median level of pain for other interventions was as follows: blood samplings (n=231, NRS 1 (IQR 0–3)), intravenous catheters (n=240, NRS 2 (IQR 0–4)), urinary catheterisations (n=22, NRS 4.5 (IQR 2–6)), cervical collars (n=50, NRS 5 (IQR 0–8)) and immobilisation mattresses (n=34, NRS 5 (IQR 0–8)). Urinary catheterisations (63.8%), cervical collars (56.0%) and immobilisation mattresses (52.9%) frequently induced moderate or severe pain.

Conclusions

Most interventions administered to older adults in the ED are associated with no or low pain intensity. However, urinary catheterisation and spinal motion restriction devices are frequently associated with moderate or severe pain.
Curriculum review : investigation and management of dysphagia
Authors: Nigam Gaurav B , Vasant Dipesh Harshvadan , Dhar Anjan
Published: August 2021

Dysphagia is a common presentation in gastroenterology practice and the diagnosis and management requires a comprehensive knowledge of diverse range of aetiologies, with a systematic approach for assessment of symptoms, selection of investigations and appropriate treatment to relieve symptoms. In this curriculum review, the suggested diagnostic approach highlights the importance of thorough clinical assessment in order to guide the selection of investigations. This article discusses the utility of endoscopic, histopathology, fluoroscopic and motility investigations for dysphagia, and their interpretation, in order to guide targeted treatments ranging from dietary, pharmacological, endoscopic and surgical interventions.
Suppressor CD4+T cells expressing HLA-G are expanded in the peripheral blood from patients with acute decompensation of cirrhosis
Authors: Khamri Wafa , Gudd Cathrin , Liu Tong , Nathwani Rooshi , Krasniqi Marigona , Azam Sofia , Barbera Thomas , Trovato Francesca M , Possamai Lucia , Triantafyllou Evangelos , Seoane Rocio Castro , Lebosse Fanny , Singanayagam Arjuna , Kumar Naveenta , Bernsmeier Christine , Mukherjee Sujit , McPhail Mark , Weston Chris J , Antoniades Charalambos Gustav , Thursz Mark R
Published: August 2021

Objective

Identifying components of immuneparesis, a hallmark of chronic liver failure, is crucial for our understanding of complications in cirrhosis. Various suppressor CD4+T cells have been established as potent inhibitors of systemic immune activation. Here, we establish the presence, regulation and mechanism of action of a suppressive CD4+T cell subset expressing human leucocyte antigen G (HLA-G) in patients with acute decompensation of cirrhosis (AD).

Design

Flow cytometry was used to determine the proportion and immunophenotype of CD4+HLA-G+T cells from peripheral blood of 20 healthy controls (HCs) and 98 patients with cirrhosis (28 with stable cirrhosis (SC), 20 with chronic decompensated cirrhosis (CD) and 50 with AD). Transcriptional and functional signatures of cell-sorted CD4+HLA-G+cells were delineated by NanoString technology and suppression assays, respectively. The role of immunosuppressive cytokine interleukin (IL)-35 in inducing this population was investigated through in vitro blockade experiments. Immunohistochemistry (IHC) and cultures of primary human Kupffer cells (KCs) were performed to assess cellular sources of IL-35. HLA-G-mediated T cell suppression was explored using neutralising antibodies targeting co-inhibitory pathways.

Results

Patients with AD were distinguished by an expansion of a CD4+HLA-G+CTLA-4+IL-35+immunosuppressive population associated with disease severity, clinical course of AD, infectious complications and poor outcome. Transcriptomic analyses excluded the possibility that these were thymic-derived regulatory T cells. IHC analyses and in vitro cultures demonstrate that KCs represent a potent source of IL-35 which can induce the observed HLA-G+phenotype. These exert cytotoxic T lymphocyte antigen-4-mediated impaired responses in T cells paralleled by an HLA-G-driven downregulation of T helper 17-related cytokines.

Conclusion

We have identified a cytokine-driven peripherally derived suppressive population that may contribute to immuneparesis in AD.
Characteristics of infective endocarditis in a cancer population
Authors: Grable Cullen , Yusuf Syed W , Song Juhee , Viola George M , Ulhaq Owais , Banchs Jose , Jensen Corey T , Goel Harsh , Hassan Saamir A
Published: August 2021

Background

Infective endocarditis (IE) is more common in patients with cancer as compared with the general population. Due to an immunocompromised state, the need for invasive procedures, hypercoagulability and the presence of indwelling catheters, patients with cancer are particularly predisposed to the development of IE.

Objectives

Limited information exists about IE in patients with cancer. We aimed to evaluate the characteristics of patients with cancer and IE at our tertiary care centre, including a comparison of the microorganisms implicated and their association with mortality.

Methods

A retrospective chart review of patients with cancer who had echocardiography for suspicion of endocarditis was conducted. A total of 56 patients with a confirmed diagnosis of cancer and endocarditis, based on the modified Duke criteria, were included in the study. Baseline demographics, risk factors for developing IE, echocardiography findings, microbiology and mortality data were analysed.

Results

Following the findings of vegetations by echocardiography, the median survival time was 8.5 months.Staphylococcus aureuswas the most common organism identified as causing endocarditis. The mitral and aortic valves were the most commonly involved sites of endocarditis. Patients withS. aureusendocarditis (SAE) had a significantly poorer survival when compared with patients without SAE (p=0.0217) over the 12-month period from diagnosis of endocarditis.

Conclusions

Overall survival of patients with cancer and endocarditis is poor, with a worse outcome in patients with SAE.
Review of Irish patients meeting ST elevation criteria during the COVID-19 pandemic
Authors: Byrne Luke , Gardiner Roisin , Devitt Patrick , Powell Caleb , Armstrong Richard , Teehan Sinead , O’Connor Stephen
Published: August 2021

Introduction

The COVID-19 pandemic has seen the introduction of important public health measures to minimise the spread of the virus. We aim to identify the impact government restrictions and hospital-based infection control procedures on ST elevation myocardial infarction (STEMI) care during the COVID-19 pandemic.

Methods

Patients meeting ST elevation criteria and undergoing primary percutaneous coronary intervention from 27 March 2020, the day initial national lockdown measures were announced in Ireland, were included in the study. Patients presenting after the lockdown period, from 18 May to 31 June 2020, were also examined. Time from symptom onset to first medical contact (FMC), transfer time and time of wire cross was noted. Additionally, patient characteristics, left ventricular ejection fraction, mortality and biochemical parameters were documented. Outcomes and characteristics were compared against a control group of patients meeting ST elevation criteria during the month of January.

Results

A total of 42 patients presented with STEMI during the lockdown period. A significant increase in total ischaemic time (TIT) was noted versus controls (8.81 hours (±16.4) vs 2.99 hours (±1.39), p=0.03), with increases driven largely by delays in seeking FMC (7.13 hours (±16.4) vs 1.98 hours (±1.46), p=0.049). TIT remained significantly elevated during the postlockdown period (6.1 hours (±5.3), p=0.05), however, an improvement in patient delays was seen versus the control group (3.99 hours (±4.5), p=0.06). There was no difference seen in transfer times and door to wire cross time during lockdown, however, a significant increase in transfer times was seen postlockdown versus controls (1.81 hours (±1.0) vs 1.1 hours (±0.87), p=0.004).

Conclusion

A significant increase in TIT was seen during the lockdown period driven mainly by patient factors highlighting the significance of public health messages on public perception. Additionally, a significant delay in transfer times to our centre was seen postlockdown.
Prominent juxtacortical white matter lesion hallmarksNOTCH3-related intracerebral haemorrhage
Authors: Chen Chih-Hao , Hsu Hao-Chia , Cheng Yu-Wen , Chen Ya-Fang , Tang Sung-Chun , Jeng Jiann-Shing
Published: August 2021

Background and purpose

NOTCH3p.R544C mutation accounts for 5% of spontaneous intracerebral haemorrhage (ICH) in East Asian patients. We investigated whether certain CT features are associated withNOTCH3-related ICH.

Methods

Patients with spontaneous ICH from a prospective stroke registry were screened forNOTCH3p.R544C mutation. The neuroimaging features on the initial non-contrast CT scans selected to predictNOTCH3p.R544C mutation, including burden of white matter lesion (WML), degree of brain atrophy, number of lacunes, prominent juxtacortical WML and prominent lobar lacunes, were analysed by neuroradiologists blinded to the mutation status.

Results

Of 299 patients with spontaneous ICH (mean age, 61 years; male, 68%; ICH volumes, 14.1±17.8 mL), 13 patients (4.3%) carriedNOTCH3p.R544C mutation. The clinical features, haematoma size and location were similar betweenNOTCH3p.R544C mutation carriers and non-carriers. The CT scan revealed that patients withNOTCH3p.R544C mutation had more severe WML and more frequently had prominent juxtacortical WML (69.2% vs 17.8%, p<0.001), and the effects were not driven by ageing as seen in patients without mutation. Prominent juxtacortical WML (area under receiver operating characteristic curve=0.76) outperformed the total WML score and prominent lobar lacunes and significantly predictedNOTCH3p.R544C mutation in a multivariable-adjusted model (OR, 20.9; 95% CI 4.94 to 88.6).

Conclusion

In patients with spontaneous ICH, the severity and topographic distribution of WML can help in identifying potentialNOTCH3mutation-related ICH.
Modeling earthmoving operations in real time using hybrid fuzzy simulation
Authors: Gerami Seresht Nima , Fayek Aminah Robinson
Published: August 2021

Predicting and optimizing performance in earthmoving operations is critical, because they are essential to many construction projects. The complexity of modeling earthmoving operations remains challenging, even with several modeling techniques available, including simulation. This paper advances the state-of-the-art of modeling earthmoving operations by introducing a hybrid fuzzy system dynamics–discrete event simulation framework with the capacity to: capture the dynamism of performance in earthmoving operations; capture subjective uncertainty of several factors affecting them; model their sequential nature and resource constraints; and determine actual travel time, in real time, using online navigation systems. Findings from this research confirm the proposed framework (i) extends the application of simulation techniques for modeling construction processes involving dynamic input variables and subjective uncertainty, through its ability to capture the non-probabilistic uncertainty of construction systems, and (ii) when combined with the use of online navigation systems to assess trucks’ travel time, improves the accuracy of earthmoving operation models.
Opportunities to reduce nitrous oxide emissions from horticultural production systems in Canada
Authors: Chahal Inderjot , Baral Khagendra R. , Congreves Kate A. , Van Eerd Laura L. , Wagner-Riddle Claudia
Published: August 2021

Horticultural systems, specifically vegetable production systems, are considered intensive agricultural systems as they are characterized by high nitrogen (N) fertilizer application rate, frequent tillage, and irrigation operations. Accordingly, horticultural production in temperate climates is prone to N losses — mainly during post-harvest (during fall and winter) or pre-plant (spring) periods — such as N2O emissions and nitrate leaching. The risk for N losses is linked to low crop N use efficiency (NUE) combined with a narrow C:N and high N content of crop residues. Here we reviewed the studies conducted in Canada and similar climates to better understand the risk of N2O emission and potential agronomic management strategies to reduce N2O emissions from horticultural systems. Current knowledge on N2O emissions from horticultural systems indicate that increasing crop NUE, modifying the amount, type, time, and rate of N fertilizer inputs, and adopting cover crops in crop rotations are some of the effective approaches to decrease N2O emissions. However, there is uncertainty related to the efficiency of the existing N2O mitigation strategies due to the complex interactions between the factors (soil characteristics, type of plant species, climatic conditions, and soil microbial activity) responsible for N2O production from soil. Little research on N2O emissions from Canadian horticultural systems limits our ability to understand and manage the soil N2O production processes to mitigate the risk of N2O emissions. Thus, continuing to expand this line of research will help to advance the sustainability of Canadian horticultural cropping systems.
Invariance principles in the theory and computation of transport coefficients
Authors: Grasselli Federico , Baroni Stefano
Published: August 2021

In this work, we elaborate on two recently discovered invariance principles, according to which transport coefficients are, to a large extent, independent of the microscopic definition of the densities and currents of the conserved quantities being transported (energy, momentum, mass, charge). The first such principle,gauge invariance, allows one to define a quantum adiabatic energy current from density-functional theory, from which the heat conductivity can be uniquely defined and computed using equilibrium ab initio molecular dynamics. When combined with a novel topological definition ofatomic oxidation states, gauge invariance also sheds new light onto the mechanisms of charge transport in ionic conductors. The second principle,convective invariance, allows one to extend the analysis to multi-component systems. These invariance principles can be combined with new spectral analysis methods for the current time series to be fed into the Green–Kubo formula to obtain accurate estimates of transport coefficients from relatively short molecular dynamics simulations.

Graphic abstract
Courant bracket twisted both by a 2-form B and by a bi-vector $$\theta $$
Authors: Davidović Ljubica , Ivanišević Ilija , Sazdović Branislav
Published: August 2021

We obtain the Courant bracket twisted simultaneously by a 2-form B and a bi-vector $$\theta $$
θ
by calculating the Poisson bracket algebra of the symmetry generator in the basis obtained acting with the relevant twisting matrix. It is the extension of the Courant bracket that contains well known Schouten–Nijenhuis and Koszul bracket, as well as some new star brackets. We give interpretation to the star brackets as projections on isotropic subspaces.
A novel determination of non-perturbative contributions to Bjorken sum rule
Authors: Yu Qing , Wu Xing-Gang , Zhou Hua , Huang Xu-Dong
Published: August 2021

Based on the operator product expansion, the perturbative and nonperturbative contributions to the polarized Bjorken sum rule (BSR) can be separated conveniently, and the nonperturbative one can be fitted via a proper comparison with the experimental data. In the paper, we first give a detailed study on the pQCD corrections to the leading-twist part of BSR. Basing on the accurate pQCD prediction of BSR, we then give a novel fit of the non-perturbative high-twist contributions by comparing with JLab data. Previous pQCD corrections to the leading-twist part derived under conventional scale-setting approach still show strong renormalization scale dependence. The principle of maximum conformality (PMC) provides a systematic and strict way to eliminate conventional renormalization scale-setting ambiguity by determining the accurate $$\alpha _s$$

α
s

-running behavior of the process with the help of renormalization group equation. Our calculation confirms the PMC prediction satisfies the standard renormalization group invariance, e.g. its fixed-order prediction does scheme-and-scale independent. In low $$Q^2$$

Q
2

-region, the effective momentum of the process is small and in order to derive a reliable prediction, we adopt four low-energy $$\alpha _s$$

α
s

models to do the analysis, i.e. the model based on the analytic perturbative theory (APT), the Webber model (WEB), the massive pQCD model (MPT) and the model under continuum QCD theory (CON). Our predictions show that even though the high-twist terms are generally power suppressed in high $$Q^2$$

Q
2

-region, they shall have sizable contributions in low and intermediate $$Q^2$$

Q
2

domain. Based on the more accurate scheme-and-scale independent pQCD prediction, our newly fitted results for the high-twist corrections at $$Q^2=1\;\mathrm{GeV}^2$$

Q
2

=
1

GeV

2

are, $$f_2^{p-n}|_{\mathrm{APT}}=-0.120\pm 0.013$$

f
2

p
-
n

|

APT

=
-
0.120
±
0.013

, $$f_2^{p-n}|_\mathrm{WEB}=-0.081\pm 0.013$$

f
2

p
-
n

|

WEB

=
-
0.081
±
0.013

, $$f_2^{p-n}|_{\mathrm{MPT}}=-0.128\pm 0.013$$

f
2

p
-
n

|

MPT

=
-
0.128
±
0.013

and $$f_2^{p-n}|_{\mathrm{CON}}=-0.139\pm 0.013$$

f
2

p
-
n

|

CON

=
-
0.139
±
0.013

; $$\mu _6|_\mathrm{APT}=0.003\pm 0.000$$

μ
6

|

APT

=
0.003
±
0.000

, $$\mu _6|_{\mathrm{WEB}}=0.001\pm 0.000$$

μ
6

|

WEB

=
0.001
±
0.000

, $$\mu _6|_\mathrm{MPT}=0.003\pm 0.000$$

μ
6

|

MPT

=
0.003
±
0.000

and $$\mu _6|_{\mathrm{CON}}=0.002\pm 0.000$$

μ
6

|

CON

=
0.002
±
0.000

, respectively, where the errors are squared averages of those from the statistical and systematic errors from the measured data.
Quantitative Control for Stoichiometric Protein Synthesis
Authors: Taggart James C. , Lalanne Jean-Benoît , Li Gene-Wei
Published: August 2021

Bacterial protein synthesis rates have evolved to maintain preferred stoichiometries at striking precision, from the components of protein complexes to constituents of entire pathways. Setting relative protein production rates to be well within a factor of two requires concerted tuning of transcription, RNA turnover, and translation, allowing many potential regulatory strategies to achieve the preferred output. The last decade has seen a greatly expanded capacity for precise interrogation of each step of the central dogma genome-wide. Here, we summarize how these technologies have shaped the current understanding of diverse bacterial regulatory architectures underpinning stoichiometric protein synthesis. We focus on the emerging expanded view of bacterial operons, which encode diverse primary and secondary mRNA structures for tuning protein stoichiometry. Emphasis is placed on how quantitative tuning is achieved. We discuss the challenges and open questions in the application of quantitative, genome-wide methodologies to the problem of precise protein production.
Subdivision Collocation Method for One-Dimensional Bratu’s Problem
Authors: Mustafa Ghulam , Ejaz Syeda Tehmina , Kouser Sabila , Ali Shafqat , Aslam Muhammad
Published: August 2021

The purpose of this article is to employ the subdivision collocation method to resolve Bratu’s boundary value problem by using approximating subdivision scheme. The main purpose of this researcher is to explore the application of subdivision schemes in the field of physical sciences. Our approach converts the problem into a set of algebraic equations. Numerical approximations of the solution of the problem and absolute errors are compared with existing methods. The comparison shows that the proposed method gives a more accurate solution than the existing methods.
Study on the Correlation among Sleep Quality, Cognitive Function, and Self-Management Ability in Hospitalized Elderly Patients with Coronary Heart Disease
Authors: Shen Zhoumin , Chen Huali , Cai Yimin , Zhou Bifang , Chen Hongjiao , Xie Nian
Published: August 2021

Background. Coronary heart disease (CHD) is the leading cause of death worldwide. The incidence of cardiovascular disease is especially common in low-level and middle-income countries. With the increase in the number of patients with CHD and the complexity of treatment on patients with CHD, many hospitals are devoted to developing new models of care and management for patients with CHD. Understanding the unique characteristics of the patient’s condition, including factors related to self-management, cognitive function, and sleep quality, will lead to a substantial reduction in cardiovascular disease and related mortality. Objective. To investigate the correlation among sleep quality, cognitive function, and self-management ability in hospitalized elderly patients with coronary heart disease (CHD). Methods. 120 hospitalized elderly patients with coronary heart disease (CHD) were investigated by using a self-designed general data questionnaire, Pittsburgh Sleep Quality Index (PSQI), Montreal Cognitive Function Assessment (MoCA) scale, and Coronary Heart Disease Self-management Behavior Scale (CSMS). Results. The Spearman analysis showed that sleep quality was positively correlated with cognitive function in hospitalized elderly CHD patients (

P
<
0.05

). Sleep quality was positively correlated with self-management ability in CHD patients (

P
<
0.05

). Conclusion. Improving the cognitive function and self-management ability of elderly patients with coronary heart disease can improve their sleep quality.
A Case Series of Thromboelastography-Guided Anticoagulation in COVID-19 Patients with Inherited and Acquired Hypercoagulable States
Authors: Thomas Anthony V. , Lin Kevin P. , Stillson John E. , Bunch Connor M. , Speybroeck Jacob , Wiarda Grant , Al-Fadhl Hamid , Gillespie Laura , Zamlut Mahmud , Fulkerson Daniel H. , Khan Rashid Z. , Kwaan Hau C. , Walsh Mark M.
Published: August 2021

One of the complications of the novel coronavirus disease 2019 (COVID-19) is hypercoagulability. For this reason, patients presenting with COVID-19 are often put on therapeutic or intermediate anticoagulation upon hospitalization. A common issue of this anticoagulation is the progression to hypocoagulability resulting in hemorrhage. Therefore, monitoring the hemostatic integrity of critically ill COVID-19 patients is of utmost importance. In this case series, we present the cases of three coagulopathic COVID-19 patients whose anticoagulation was guided by thromboelastography (TEG). In each case, TEG permitted the clinical team to simultaneously prevent thrombotic and hemorrhagic events, a difficult task for COVID-19 patients admitted to the intensive care unit. The first two cases illustrate the utility of TEG to guide anticoagulant dosing for COVID-19 patients when the activated partial thromboplastin time (aPTT) is inaccurate. The first case was a severely ill COVID-19 patient with end-stage renal disease and a falsely elevated aPTT secondary to hypertriglyceridemia. The second case was a severely ill COVID-19 patient with chronic pulmonary disease who demonstrated a falsely elevated aPTT due to polycythemia and hemoconcentration. In both cases, TEG was sensitive to the hypercoagulability caused by the metabolic derangements which enabled the goal-directed titration of anticoagulants. The last case depicts a severely ill COVID-19 patient with an inherited factor V Leiden mutation who required abnormally high dosing to achieve therapeutic anticoagulation, guided by TEG. Hypercoagulopathic COVID-19 patients are difficult to anticoagulate without development of hypocoagulopathy. Treatment of these patients demands goal-directed therapy by diligent laboratory monitoring. This can be accomplished by the use of TEG coupled with aPTT to guide anticoagulation. This case series illustrates the necessity for active hemostatic monitoring of critically ill COVID-19 patients.
Novel Mutation in CACNA1A Associated with Activity-Induced Dystonia, Cervical Dystonia, and Mild Ataxia
Authors: Stampfl Benjamin , Fee Dominic
Published: August 2021

CACNA1A encodes the pore-forming α1 subunit of the neuronal voltage-gated Cav2.1 (P/Q-type) channels, which are predominantly localized at the presynaptic terminals of the brain and cerebellar neurons and play an important role in controlling neurotransmitter release. Mutations in CACNA1A have been associated with several autosomal dominant neurologic disorders, including familial hemiplegic migraine type 1, episodic ataxia type 2 (EA2), and spinocerebellar ataxia type 6. A 37-year-old woman presented with a history of slowly progressive, activity-induced stiffness, and pain in her right leg since age 15 and cervical dystonia since age 20. She denied any right leg stiffness or pain at rest, but when she began to walk, her right foot turned in and her right leg stiffened up. She also had neck pain, stiffness, and spams. There was no family history of similar symptoms. On physical exam, her strength, tone, and reflexes were normal in all extremities at rest. There was mild head titubation and very mild past pointing on finger-to-nose testing. MRI of the brain and spinal cord was unremarkable. This patient’s clinical picture was felt to be most consistent with paroxysmal kinesigenic dyskinesia, as she has attacks of dystonia that are triggered by voluntary movement, last from a few seconds to a minute, and are relieved with rest. She was trialed on carbidopa/levodopa without improvement. A dystonia panel showed two potentially pathologic mutations, one in CACNA1A and the other in PNKP, along with a variant of unknown significance in ATP7B. The mutation in CACNA1A is C2324 G < A. It is heterozygous, autosomal dominant, and computer modeling suggests pathogenicity. This mutation has not been reported previously and is likely the cause of her paroxysmal dystonia; dystonia is sometimes seen during episodes of ataxia in EA2, and CACNA1A knockout mice exhibit dystonia and cerebellar atrophy. After receiving her genetic diagnosis, the patient was trialed on acetazolamide without improvement in her dystonia symptoms. This is the second case report of a patient with cervical dystonia and cerebellar ataxia associated with a mutation in CACNA1A.
Experimental Study on the Deformation and Failure Characteristics of Anchor under Graded Loading and Corrosion
Authors: Sun Guanglin , Hu Jiangchun , Wang Hongfang , Li Pengfei
Published: August 2021

During the entire life cycle of rock and soil anchors, owing to the influence of adverse factors such as the working environment, load change, and anchor performance degradation, the working load of the anchor will continue to increase and the mechanical properties will continue to deteriorate, which significantly affects the safety and stability of rock and soil anchors. Therefore, this study focuses on the deformation and failure characteristics of anchors under loading and corrosion conditions by means of indoor simulation tests under laboratory conditions. The results indicate the following. (1) There are obvious cracks on the surfaces of specimens 2# and 10#. In the two groups of specimens, the corroded bolt surface exhibited a corrosion phenomenon. This indicates that the corrosion environment conditions cause a certain degree of damage to the anchored rock mass. (2) Under the same gradient load condition, three observable cracks were found in the 10# anchorage specimens and one observable crack was found in the 2# anchorage specimens. Therefore, it is clear that the damage degree of the anchor increases with an increase in the corrosion time. (3) Under the condition of corrosion environment, the strain in the lower part of the specimen is generally greater than that in the upper part of the specimen, and the failure of this group of specimens in the loading process is mostly splitting failure, which is basically generated along the trend of the strain nephogram, and shear failure occurs with the extension and diffusion of cracks.
Research on Monitoring Method of Remote Deformation and System Application Based on Image
Authors: Zhang Yu , Zhong Ruofei , Li Yongrong , Sun Haili
Published: August 2021

The development of information technology and computer science has put forward higher requirements on the intelligence of deformation monitoring. We study a method based on image deformation analysis, which uses Scale‐Invariant Feature Transform (SIFT) to extract image feature points after preprocessing the acquired images, applies All‐Pixels Matching (APM) method to the sequence images to do further high‐precision matching to achieve the accuracy of subpixels, and finally solves the deformation variables according to the relationship of the real size of the reference target and its pixel. Wavelet analysis and least squares are used to improve the image quality and matching accuracy. Based on this method, we design and develop a new remotely automated deformation monitoring system. In this paper, we introduce the algorithm principle of deformation analysis, the integration of the system, and the engineering application example of the monitoring system. The monitoring accuracy of the system satisfying 0.1 mm within 10 m and 0.8 mm within 60 m is verified in the simultaneous comparison observation according to the high‐precision total station, which illustrates the effectiveness of the present deformation analysis method and monitoring system and also has the characteristics of low monitoring cost and high degree of automation.
Extreme Learning Machine Denoising Algorithm Based Analysis of Transvaginal 3-Dimensional Ultrasonic Image for the Diagnostic Effect of Intrauterine Adhesion
Authors: Wu Jing , Zhang Zhikun
Published: August 2021

The aim was to analyze the application values and diagnostic effects of transvaginal 3-dimensional (3D) ultrasonic image based on extreme learning machine denoising algorithm (ELMDA) in the diagnosis of intrauterine adhesions (IUA). The speckle noise in the 3D ultrasound image was removed with the ELMDA. Its peak signal-to-noise ratio (PSNR) and the mean square error (MSE) were compared with those of the median filter algorithm (MFA) with the anisotropic diffusion algorithm (ADA) and wavelet threshold. The ELMDA was used in the diagnosis of 3D ultrasound images to compare the accuracy of hysteroscopy with transvaginal 3D ultrasound and two-dimensional (2D) ultrasound in the diagnosis of IUA. The results showed that the MSE of ELMDA was dramatically smaller than those of ADA and WT-MFA and its PSNR was higher than those of the other two algorithms (

P

 < 0.05) when the noise variance was constant. The diagnostic accuracy of mild and moderate adhesions by 2D ultrasound was statistically different (

P

 < 0.05) compared with hysteroscopy. But the diagnosis results of severe adhesions were consistent, and the diagnosed cases were both 6 (11.11%) with no statistical difference (

P

 > 0.05). In addition, there was no statistically great difference in the diagnostic accuracy of IUA by transvaginal 3D ultrasound and hysteroscopy (

P

 > 0.05), and the diagnosis results of moderate and severe adhesions were consistent (both 20 cases (37.04%) and 6 cases (11.11%), respectively) with no statistical difference (

P

 > 0.05). The diagnostic accuracy of 3D ultrasound was 96.30%, while that of 2D ultrasound was 90.74%, showing a statistical difference (

P

 < 0.05). In conclusion, ELMDA had a good effect of denoising, and there was a high accuracy of the application of 3D transvaginal ultrasound to diagnose IUA, which had reliable clinical application value.
Evaluating Community Engagement Strategies to Manage Stigma in Two African Genomics Studies Involving People Living with Schizophrenia or Rheumatic Heart Disease
Authors: Campbell Megan M. , Matshabane Olivia P. , Mqulwana Sibonile , Mndini Michael , Nagdee Mohamed , Stein Dan J. , De Vries Jantina
Published: August 2021

In global health research and genomics research specifically, community engagement has gained prominence in enhancing ethical conduct, particularly in managing the risk of stigmatization, but there is minimal scientific evidence on how to do this effectively. This article reports on community engagement evaluation strategies in two African genomics studies: the Stigma in African Genomics Research study and the Genomics of Schizophrenia in South African Xhosa People (SAX) study. Within the Stigma in African Genomics Research study, a self-report rating scale and open-ended questions were used to track participant responses to an experiential theatre workshop. The workshop focused on participant experiences of living with schizophrenia or rheumatic heart disease (RHD). While the schizophrenia group reported more alienation and less stigma resistance than the RHD group, both groups demonstrated increased stigma resistance over time, after participating in the workshops. Hearing from others living with and managing the same illness normalised participants’ own experiences and encouraged them. Within the SAX study, a short rating scale and qualitative feedback methods were used to evaluate a Mental Health Literacy Day targeting mental health stigma. Information talks about (i) the symptoms of schizophrenia and treatment options and (ii) the illness experiences of a patient in recovery were rated as the most helpful on the day. Audience members reported that these talks challenged negative perceptions about severe mental illness. Three important learnings emerged from these evaluations: firstly, integration of evaluation strategies at the research study planning phase is likely to promote more effective community engagement. Secondly, a combination of quantitative and qualitative methods that draw on simple descriptive statistics and thematic analysis can provide nuanced perspectives about the value of community engagement. Thirdly, such evidence is necessary in establishing and promoting the science of community engagement in genomics research and health research more broadly.