bluuebunny/crossref_metadata_2025 huggingface dataset:
Method for detecting the pollution degree of naturally contaminated insulator based on hyperspectral characteristics
Authors: Yin Chengfeng , Xiao Zhang , Guo Yujun , Shi Chaoqun , Zhang Xueqin , Wu Guangning
Published: March 2021

Insulator pollution degree detection is of great significance for preventing a flashover. Equivalent salt deposit density, leakage current, and surface pollution layer conductivity are commonly used to describe insulator pollution degree; however, all these parameters have limitations in field application and real‐time monitoring. Non‐contact detection methods, such as infrared thermal imaging and ultraviolet imaging, only image insulators in a specific band, which makes the extracted features limited. Hyperspectral technology is the new comprehensive image data technology based on imaging spectroscopy that has the advantages of multiband high resolution. Therefore, a method based on hyperspectral image and spectral characteristics is proposed to fully characterize natural pollution information and accurately detect the pollution degree of insulators. The hyperspectral spectral line characteristics, image texture, and colour characteristic data of insulators were extracted and fused and then used to establish the pollution degree detection model on the basis of integrated learning classification algorithms. The results show that the model based on fusion data has an accuracy rate of 95.0%, which is more accurate than the model based on spectral line features only. Consequently, hyperspectral technology can realize the non‐contact detection of pollution degree and provide some guidance for cleaning the contamination of external insulation.
Review of flash sintering with strong electric field
Authors: Zhou Hongyang , Li Xiang , Zhu Yuchen , Liu Jieming , Wu Angxuan , Ma Guoming , Wang Xilin , Jia Zhidong , Wang Liming
Published: March 2021

Flash sintering is a novel field‐assisted sintering technology for ceramics that allows a dramatic reduction in processing time and temperature. Since 2010, when flash sintering was first reported, it has been a focus of research interest in the field of materials science. Recent study results have confirmed that the sintering temperature decreases with the strength of the applied electric field; for some ceramics, the sintering temperature can be lowered even to room temperature. This represents an innovative breakthrough for ceramic sintering at ultra‐low temperatures. However, once the electric field strength in flash sintering is increased, new questions and challenges arise, such as whether or not partial discharge occurs in the green body if under electro‐thermal coupling stress, how to quantitatively analyse the impact of discharge on sintering, and, moreover, whether the sintering mechanism under a strong electric field is consistent with that under a weak electric field. These research questions require knowledge of partial discharge detection, dielectric theory, and other topics that are beyond the scope of materials science. To address this need, this review summarises the work carried out in flash sintering with a strong electric field from the perspective of high voltage and insulation technology. First, the flash sintering process and mechanism are briefly introduced. Then, the published literature on flash sintering with a strong electric field for various ceramic materials is summarised in depth. In addition, experimental phenomena that are observed in flash sintering with a strong electric field, such as flash and blackening, are discussed. Finally, some suggestions for future work are presented. It is anticipated that the knowledge gap between different areas of study can be filled by this review.
Classification of partial discharge severities of ceramic insulators based on texture analysis of UV pulses
Authors: Ma Danrui , Jin Lijun , He Jianming , Gao Kai
Published: March 2021

Inspection of partial discharge before contamination flashover is of great importance for preventing exterior insulation accidents. In this study, a new method for identification of discharge severities is proposed. Specifically, a low‐cost ultraviolet (UV) sensor detection system was combined with time–frequency method, texture analysis and support vector machine (SVM) classifier to classify partial discharge severities for ceramic insulators. The visible images and the root‐mean‐square value of leakage currents detected simultaneously are used to classify the UV signals into different discharge faults. The frequency and amplitude integration of UV pulses are minimum in corona discharge and larger in arc discharge. The images of UV signal spectrograms differ significantly at different discharge stages. The density and brightness of image textures are minimal in corona discharge and larger in arc discharge. Valid and reliable features selected by two texture feature extraction methods with SVM classifier have a reliable classification accuracy of 90.6% for ceramic insulators, and outperform a single time feature or other texture features. SVM outperforms k‐Nearest Neighbour, Naive Bayes and Decision Tree. Our new method with computational effectiveness and high practicality can solve the problem of high randomness and low accuracy of UV sensor detection. It can be further applied to the deterioration diagnosis of power facilities.
Effects of drying methods on compositional characterization and functional characteristics of Blighia sapida aril oil
Authors: Oluba Olarewaju M. , Mbamara Divine-Favour O. , Akpor Oghenerobor B. , Adebiyi Feyikemi D. , Alabi Olayinka O. , Shoyombo Ayoola , Osemwegie Omorefosa O.
Published: March 2021

The composition of Blighia sapida fruits is reported to differ based on its origin, variety, and preservation technique. In this study, the effect of drying method on the composition as well as the antioxidant activity of oven-dried and sun-dried B. sapida aril flour and oil were examined using standard procedures. Sun-dried B. sapida aril flour had significantly higher protein and fat content compared to the oven-dried flour. In addition, sun-dried B. sapida aril flour contained a more diverse phytochemical profile compared to the oven-dried flour. However, oven-dried B. sapida aril oil (ODAO) showed a higher percentage of unsaturated fatty acids compared to oil from the sun-dried B. sapida flour (SDAO). On the other hand, SDAO showed significantly higher DPPH scavenging and nitric oxide inhibitory activities compared to ODAO. Based on these findings, sun-drying is recommended for both nutritional purposes and other health-promoting usage such as antioxidant, over oven-drying.
Analysis of EU legume value chains from the H2020 LegValue project: What insights for organic value chains?
Authors: Smadja Tiana , Muel Frédéric
Published: March 2021

This paper presents the results of a legume-based value chain analysis based on twenty-seven case studies in the H2020 LegValue project and discusses those relating to organic legume-based value chains. The analysis aims to illustrate the diversity of legume-based value chains and to discuss the conditions by which they can successfully meet the growing demand for legumes in the EU. The research is based on a qualitative survey of the value chain stakeholders in the case studies. Regarding organic legume-based value chains, the analysis reveals two types that depend on the stakeholder type at the launch of the value chain, the stakeholder’s primary objective in the chain, and the organic legume species involved. The first value chain type is launched by extension services with an aim of developing the organic production of a single legume species. The second type is launched by a stakeholder (processor or collector) acting further downstream in response to market demand for several legume species. A key success factor for these value chains is the ability of the launcher to ensure close coordination along the chain. To achieve this, several means and tools have been identified: the setting-up of a value chain development project, the implementation of contracting practices, production support programmes (technical assistance, financial support), and market support programmes (information sharing, regulation, facilitators).
Imaging of Gastric Carcinoma. Part Two: Lymph node mapping in Gastric Carcinoma
Authors: Maru Pulkit , Roy Bipradas , Sen Saugata , Chatterjee Argha
Published: March 2021

Accurate preoperative nodal staging is critical in determining the appropriate therapy and prognosis for stomach cancer. A staging computed tomography should inform the treating surgeon about the nodal burden to decide the appropriate surgical plan or perioperative chemotherapy. Nodal staging is also a powerful predictor of the outcome of surgery and overall survival. Imaging of nodes is also important in the assessment of response following the chemotherapy. In this article, we will discuss lymphatic drainage of stomach and different nodal stations, identification of nodal stations on cross sectional imaging, and different types of surgical nodal clearance for gastric cancer.
A Rare Case of Thrombus Aspiration Device Stuck in the Stent
Authors: Gupta Himanshu , Rajan Palanivel , Singh Harkant , Agstam Sourabh , Revaiah Pruthvi C.
Published: March 2021

Hardware loss and entrapment during percutaneous coronary intervention is one of the important complications, which an interventionist should anticipate in his practice. Basic knowledge about various extraction methods is essential to bail out in such situations. We describe a 74-year-old male, in whom a used thrombuster device got stuck in struts of an already deployed stent in the right coronary artery. The device could not be retrieved via various percutaneous maneuvers, necessitating an emergency surgical device retrieval and concomitant coronary bypass.
Unplanned Postoperative Reintubation in Children with Bronchial Asthma
Authors: Winch Peter D. , Mpody Christian , Murray-Torres Teresa M. , Rudolph Shannon , Tobias Joseph D. , Nafiu Olubukola O.
Published: March 2021

Unplanned postoperative reintubation is a serious complication that may increase postsurgical hospital length of stay and mortality. Although asthma is a risk factor for perioperative adverse respiratory events, its association with unplanned postoperative reintubation in children has not been comprehensively examined. Our aim was to determine the association between a preoperative comorbid asthma diagnosis and the incidence of unplanned postoperative reintubation in children. This was a retrospective cohort study comprising of 194,470 children who underwent inpatient surgery at institutions participating in the National Surgical Quality Improvement Program–Pediatric. The primary outcome was the association of preoperative asthma diagnosis with early, unplanned postoperative reintubation (within the first 72 hours following surgery). We also evaluated the association between bronchial asthma and prolonged hospital length of stay (longer than the 75th percentile for the cohort). The incidence of unplanned postoperative reintubation in the study cohort was 0.5% in patients with a history of asthma compared with 0.2% in patients without the diagnosis (odds ratio [OR]: 2.23, 95% confidence interval [CI]: 1.71–2.89). This association remained significant after controlling for several clinical characteristics (OR: 1.54, 95% CI: 1.17–2.20). Additionally, asthmatic children were more likely to require a hospital length of stay longer than the 75th percentile for the study cohort (adjusted OR: 1.05, 95% CI: 1.01–1.10). Children with preoperative comorbid asthma diagnosis have an increased incidence of early, unplanned postoperative reintubation and prolonged postoperative hospitalization following inpatient surgery. By identifying these patients as having higher perioperative risks, it may be possible to institute strategies to improve their outcomes.
Role of Imaging in Bariatric Surgery: A Review of the Various Surgical Techniques and Their Complications
Authors: Girishekar Bhavana , Rawat Sudarshan , Ananthasivan Rupa , Reddy Pramesh , Patil Pooja , Kaushik Kavya
Published: March 2021

According to the World Health Organization, obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese. Bariatric surgery is being increasingly used as a form of treatment, particularly in those patients where lifestyle modifications are deemed insufficient. With the role of radiologists transitioning from a medical to a surgical evaluation in obesity, it is becoming increasingly important to familiarize oneself with the various imaging techniques used in the preoperative and postsurgical evaluation in such cases. This article aims to review the various surgeries performed, their normal imaging appearance, and the various complications that could be encountered.
Bioengineering the neurovascular niche to study the interaction of neural stem cells and endothelial cells
Authors: Winkelman Max A. , Koppes Abigail N. , Koppes Ryan A. , Dai Guohao
Published: March 2021

The ability of mammalian neural stem cells (NSCs) to self-renew and differentiate throughout adulthood has made them ideal to study neurogenesis and attractive candidates for neurodegenerative disease therapies. In the adult mammalian brain, NSCs are maintained in the neurovascular niche (NVN) where they are found near the specialized blood vessels, suggesting that brain endothelial cells (BECs) are prominent orchestrators of NSC fate. However, most of the current knowledge of the mammalian NVN has been deduced from nonhuman studies. To circumvent the challenges of in vivo studies, in vitro models have been developed to better understand the reciprocal cellular mechanisms of human NSCs and BECs. This review will cover the current understanding of mammalian NVN biology, the effects of endothelial cell-derived signals on NSC fate, and the in vitro models developed to study the interactions between NSCs and BECs.
Integrated photon-pair sources with nonlinear optics
Authors: Wang Yuchen , Jöns Klaus D. , Sun Zhipei
Published: March 2021

Assisted by the rapid development of photonic integrated circuits, scalable and versatile chip-based quantum light sources with nonlinear optics are increasingly tangible for real-world applications. In this review, we introduce the basic concepts behind parametric photon pair sources and discuss the current state-of-the-art photon pair generation in detail but also highlight future perspectives in hybrid integration, novel waveguide structures, and on-chip multiplexing. The advances in near-deterministic integrated photon pair sources are deemed to pave the way for the realization of large-scale quantum photonic integrated circuits for applications, including quantum telecommunication, quantum sensing, quantum metrology, and photonic quantum computing.
Uncovering the Critical
Authors: Marro Joaquin , Torres Joaquin J.
Published: March 2021

The evolution of physics and related fields over the last little more than a century, leading to the formidable technological development of which we are witnesses, has confirmed that accurate and verifiable observation is the unsurpassed method for optimizing the generation of knowledge and progress. An objective of this essay is to show how, through a similar process, comparable advances are now emerging in the brain sciences that are on the verge of leading us to amazing applications in medicine and technology. There is no doubt regarding the extensiveness and importance of this process, since the improvement and popularization of techniques and devices capable of increasingly precise descriptions of the brain and its functions are constantly and decisively propelling forward this domain of knowledge. From this perspective and following on from cursory comments in previous chapters, we now initiate a more systematic account of empirical evidence. Our main goal is now to show that the brain can certainly be seen today as a complex system determined to grow and function under conditions such as those described in Chapter 2 for a critical point. Unable to address a complete account of everything that is already known and intuited in this regard, we begin in this chapter with what at the end will be a coherent and strong description according to the declared purposes of this essay.
By Completing a Bestiary
Authors: Marro Joaquin , Torres Joaquin J.
Published: March 2021

The Byzantine Empire—center through a millennium for commerce, culture, and data in the world—was a fertile setup in which bestiaries spread [Kalof and Resl, A Cultural History of Animals in the Medieval Age (1000–1400) (Berg Publishers, Oxford, 2007)]. These are literary images of animals and plants that, together with a variety of fantastic beings, appeared in compendia and beautifully illustrated books, paintings, and bas-reliefs. Often having a moralizing purpose, they meant admitting a symbolic language of nature, and each element had its specific characteristics and function. With a more scientific intent, thus serving the purposes of this book, we now perfect our bestiary, a compendium of phenomena concerning the thing. We thus come to examine further “creatures” of those that have attributes of complexity and criticality together with an intentional irregular dynamics—beasts that, incidentally, may also merit addition to a medieval album. Actually, a contemporary bestiary should include, for example, cellular metabolism; the action of genetic networks; various mechanisms underlying memory, intelligence, and consciousness; the rise, spread, and dissipation of epidemics; the dynamics of the immune system and social revolutions, bird flocks, and fish banks; and the occurrence of large fluctuations such as huge crashes in financial markets and massive failures of power grids. We have already addressed in this book guidelines to explain such a wide and intricate bestiary, aspiring to help to draw “moralizing” conclusions. New phenomena and their interpretations are next reviewed within this context to clarify, as this essay has proposed to do, the essence of the thing.
Pd/SAPO-34 passive NO
x
adsorbers: Stable Pd ion adsorption sites in six-member rings
Authors: Zhang Nana , Xin Yin , Li Ruirui , Han Dongxu , Jia Junxiu , Li Qian , Wang Jin , Zhang Zhaoliang
Published: March 2021

Pd/zeolites with chabazite (CHA) topology are effective passive NO
x
adsorbers (PNAs), which are promising for the removal of NO
x
from diesel exhausts during cold start to meet increasingly stringent emission regulations. In this work, Pd/SAPO-34 zeolites with different preparation methods and Pd contents were developed and exhibited high NO adsorption performance. Three Pd species in Pd/SAPO-34, including well-dispersed PdO
x
clusters, Pd ions in the eight- and six-member rings (8MRs and 6MRs) of zeolites, are NO adsorption sites in the absence of H2O in the feed, demonstrated by a good linear relationship between the total Pd contents and NO
x
desorption amounts. However, in the presence of H2O, only Pd ions in 6MRs are stable NO adsorption sites and provide the continuous NO adsorption, due to the limited mobility of the Pd ions in 6 MRs with small pore size. This new finding points out a definite direction for the rational design of high-performance PNAs to eliminate NO
x
during the cold start of diesel vehicles.
Gender pay gap is a confidence gap, claims new study
Authors: Allen Michael
Published: March 2021

The gender pay gap in computer science and engineering is driven by differences in self-confidence. That is according to an analysis of surveys of US graduates
Neutrino pioneer Masatoshi Koshiba dies aged 94
Authors: Banks Michael
Published: March 2021

The Japanese physicist Masatoshi Koshiba, who shared the 2002 Nobel Prize for Physics for the detection of cosmic neutrinos, died on 12 November
Simulating the redox potentials of unexplored phenazine derivatives as electron mediators for biofuel cells
Authors: Nakagawa Ryo , Nishina Yuta
Published: March 2021

In this research, we aimed to establish a guideline for designing electron mediators suitable for biofuel cells. A redox potential simulator was fabricated by combining density functional theory calculation and experiment, allowing us to select molecules with appropriate redox potentials efficiently. Previously, mediators have been developed depending on the trials and errors; thus, our strategy will speed up the development of biofuel cells with outstanding performances.
Toward self-powered real-time health monitoring of body fluid components based on improved enzymatic biofuel cells
Authors: Shitanda Isao , Tsujimura Seiya
Published: March 2021

This topical review focuses on self-powered electrochemical sensor devices that use wearable biofuel cells (BFCs) that generate electricity from body fluid components, such as glucose in urine and lactate in sweat. The advantages of using BFCs as power sources for wearable health monitoring devices are discussed herein. Recently developed porous carbon materials with controlled interfaces and spaces are also explored for enhancing the output power and stability of BFCs. We describe a printed wearable high-power BFC that uses body fluids as a fuel. This topical review also explains several challenges existing in the development of self-driving health monitoring devices, such as their power output and stability.
The Clinical Characteristics and Treatment Outcomes of Concomitant Eosinophilic Esophagitis and Inflammatory Bowel Disease
Authors: Urquhart Siri A , Quinn Kevin P , Ravi Karthik , Loftus Edward V
Published: March 2021

Background

The clinical characteristics and treatment outcomes in patients with eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) have not been extensively investigated.

Methods

We determined treatment outcomes and frequencies of disease-related complications in patients with EoE and IBD.

Results

Among 69 patients who met inclusion criteria, 39 (56.5%) had a diagnosis of Crohn disease. Clinical and histologic response rates to proton pump inhibitors and topical steroids were 25.9% and 24.4%, respectively.

Conclusions

Lower than expected clinical and histologic response rates for EoE suggest the combination of EoE and IBD is a medically refractory phenotype with more difficult to treat EoE.
Replication studies in the clinical decision support literature–frequency, fidelity, and impact
Authors: Coiera Enrico , Tong Huong Ly
Published: March 2021

Objective

To assess the frequency, fidelity, and impact of replication studies in the clinical decision support system (CDSS) literature.

Materials and Methods

A PRISMA-compliant review identified CDSS replications across 28 health and biomedical informatics journals. Included articles were assessed for fidelity to the original study using 5 categories: Identical, Substitutable, In-class, Augmented, and Out-of-class; and 7 IMPISCO domains: Investigators (I), Method (M), Population (P), Intervention (I), Setting (S), Comparator (C), and Outcome (O). A fidelity score and heat map were generated using the ratings.

Results

From 4063 publications matching search criteria for CDSS research, only 12/4063 (0.3%) were ultimately identified as replications. Six articles replicated but could not reproduce the results of the Han et al (2005) CPOE study showing mortality increase and, over time, changed from truth testing to generalizing this result. Other replications successfully tested variants of CDSS technology (2/12) or validated measurement instruments (4/12).

Discussion

A replication rate of 3 in a thousand studies is low even by the low rates in other disciplines. Several new reporting methods were developed for this study, including the IMPISCO framework, fidelity scores, and fidelity heat maps. A reporting structure for clearly identifying replication research is also proposed.

Conclusion

There is an urgent need to better characterize which core CDSS principles require replication, identify past replication data, and conduct missing replication studies. Attention to replication should improve the efficiency and effectiveness of CDSS research and avoiding potentially harmful trial and error technology deployment.
Professionals Inflation Forecasts: The Two Dimensions Of Forecaster Inattentiveness
Authors: Easaw Joshy , Golinelli Roberto
Published: March 2021

This article explores professionals’ inflation forecasts, specifically the structure of their forecast error. Recent papers considering professionals’ inflation forecast have focused on the role of forecaster inattentiveness. We consider a new additional dimension of inattentiveness which is observed when forecasters form multi-period forecasts, and implicitly their perceived momentum of inflation. The present analysis introduces a novel model that is investigated empirically using survey-based data for the US. It establishes a new structure for the professionals’ forecast error accounting for both dimensions of inattentiveness, which relates respectively to forecast updating and multi-period forecasting in each period.
Optical spectroscopic monitoring of the symbiotic star MWC 560 before and after the 2018 unpredicted brightening
Authors: Ando Kazuko , Fukuda Naoya , Akazawa Hidehiko , Sato Bunei , Hasegawa Ryo , Koizumi Yohei , Omiya Masashi , Harakawa Hiroki , Kambe Eiji , Maehara Hiroyuki , Izumiura Hideyuki
Published: March 2021

MWC 560 (V694 Mon) is classified as a symbiotic binary consisting of a white dwarf and an M5III red giant. In this object, a very- high-speed component, thought to be a jet, has been reported in the hydrogen Balmer line. We have been conducting long-term spectroscopic monitoring since the brightening in 2016 February. An irregular rebrightening was reported by Goranskij et al. (2018, Astronomer’s Telegram, 12227), who also showed that the high-velocity absorption component was not seen on 2018 November 16. Our low-resolution spectroscopic observations showed no high-velocity absorption component on 2018 November 14, and wide emission lines in Balmer line region (Hα, Hβ). However, high-resolution spectroscopy revealed the presence of slow, weak absorbing components and an emission wing on 2018 December 25. MWC 560 began to brighten in 2018 November, and it is gradually brightening as of 2020 April 14. For the absorption component, we propose a shell expansion of a classical symbiotic nova that occurred in 2016. During the 2018 brightening a new emission wing with vFWHM ≈ 700 km s−1 was confirmed, which could be triggered by disk instability like a dwarf nova. This paper summarizes the results of long-term monitoring observations and the recent changes in MWC 560.
“I Can't Breathe”: Biopower in the Time of COVID-19
Authors: Espina Christine R. , Narruhn Robin A.
Published: March 2021

In this article, we apply Agamben's theory of biopower and other related concepts to the COVID-19 pandemic in the United States. We explore the similarities between the COVID-19 pandemic and the pandemic of racism. Concepts such as bios, zoe, homo sacer, and states of exception can be applied to understand inequities among marginalized communities in the COVID-19 pandemic. We recommend that nurses and health care workers use critical conscientization and structural competency to increase awareness and develop interventions to undo the injustices related to biopower faced by many in the COVID-19 pandemic.
Effectiveness and Safety of Magseed Localization for Excision of Breast Lesions
Authors: Singh Puneet , Scoggins Marion E. , Sahin Aysegul A. , Hwang Rosa F. , Kuerer Henry M. , Caudle Abigail S. , Mittendorf Elizabeth A. , Thompson Alastair M. , Bedrosian Isabelle , Teshome Mediget , DeSnyder Sarah M. , Meric-Bernstam Funda , Hunt Kelly K.
Published: March 2021

Objective:

A prospective, phase IV study was conducted to assess the effectiveness of Magseed to localize breast lesions requiring surgical excision.

Background:

Since Food and Drug Administration approval in 2016, Magseed has been increasingly used to localize nonpalpable lesions due to advantages over wires or radioactive seeds. This is the first prospective, postmarketing trial of Magseed.

Methods:

From January 2017 to February 2018, 107 women with lesions requiring localization were enrolled at a single institution. Primary endpoint was Magseed retrieval rate. Secondary endpoints were adverse events, accuracy of placement, surgery duration, and positive margin rate. Clinicians were surveyed for ease of use using a Likert scale. Descriptive statistics and Fisher exact test were performed to assess univariable associations with positive margins.

Results:

There were 124 Magseeds placed including 1 marker in 93 subjects, 2 markers in 11, and 3 markers in 3. The majority of lesions were masses (63%) followed by calcifications (24%). All 124 Magseeds were placed within 10 mm of the target lesion and surgically retrieved with median operative time of 15 minutes (range, 4–47). No device-related adverse events occurred. Of the 98 malignant lesions, 9 had positive margins and 7 of them underwent a second surgery for additional margins. On univariable analysis, age ≤50 (25.0% vs 6.4%, P = 0.04), lesion histology (P = 0.03), and pathologic T stage (P = 0.04) were significantly associated with positive margins. Clinicians rated the Magseed very or fairly easy to use in most cases.

Conclusions:

The Magseed system for localization of nonpalpable lesions was effective and safe; all markers were successfully retrieved with margin-negative resections in 91%. This study supports use of Magseed for localization of breast lesions.
Expert consensus on peri-operative myocardial injury screening in noncardiac surgery
Authors: Puelacher Christian , Bollen Pinto Bernardo , Mills Nicholas L. , Duceppe Emmanuelle , Popova Ekaterine , Duma Andreas , Nagele Peter , Omland Torbjørn , Hammerer-Lercher Angelika , Lurati Buse Giovanna
Published: March 2021

Peri-operative myocardial injury, detected by dynamic and elevated cardiac troponin (cTn) concentrations, is a common complication of noncardiac surgery that is strongly associated with 30-day mortality. Although active screening for peri-operative myocardial injury has been suggested in recent guidelines, clinical implementation remains tentative due to a lack of examples on how to tackle such an interdisciplinary project at a local level. Moreover, consensus on which assay and cTn cut-off values should be used has not yet been reached, and guidance on whom to screen is lacking. In this article, we aim to summarise local examples of successfully implemented cTn screening practices and review the current literature in order to provide information and suggestions for patient selection, organisation of a screening programme, caveats and a potential management pathway.
Using Population Pharmacokinetic Modeling to Estimate Exposure to Δ9-Tetrahydrocannabinol in an Observational Study of Cannabis Smokers in Colorado
Authors: Sempio Cristina , Bidwell L. Cinnamon , Hutchison Kent , Huestis Marilyn A. , Klawitter Jost , Christians Uwe , Henthorn Thomas K.
Published: March 2021

Background:

Self-report questionnaires, weighing products consumed, and Δ9-tetrahydrocannabinol (THC) biomarkers are established techniques for estimating cannabis exposure. Population pharmacokinetic modeling of plasma THC and metabolite concentrations by incorporating self-reported and weighed products as covariates could improve estimates of THC exposure in regular cannabis users.

Methods:

In this naturalistic study, blood samples were obtained from 36 regular smokers of cannabis for analysis of THC and its 2 metabolites at 4 time points: recruitment and during an experimental mobile laboratory assessment that included 3 time points: before, immediately after, and 1 hour after ad libitum legal market flower use. These data were analyzed using an established model of population pharmacokinetics developed from laboratory-controlled cannabis administration data. Elimination and metabolite production clearances were estimated for each subject as well as their daily THC doses and the dose consumed during the ad libitum event.

Results:

A statistically significant correlation existed between the daily THC dose estimated by self-report questionnaire and population pharmacokinetic modeling (correlation coefficient = 0.79, P < 0.05) between the weighed cannabis smoked ad libitum and that estimated by population pharmacokinetic modeling (correlation coefficient = 0.71, P < 0.05).

Conclusion:

Inclusion of self-reported questionnaire data of THC consumption improved pharmacokinetic model–derived estimates based on measured THC and metabolite concentrations. In addition, the pharmacokinetic-derived dose estimates for the ad libitum smoking event underestimated the THC consumption compared with the weighed amount smoked. Thus, the subjects in this study, who smoked ad libitum and used cannabis products with high concentrations of THC, were less efficient (lower bioavailability) compared with computer-paced smokers of low potency, NIDA cannabis in a laboratory setting.
Cardiovascular outcomes in patients at high cardiovascular risk with previous myocardial infarction or stroke
Authors: Böhm Michael , Schumacher Helmut , Teo Koon K. , Lonn Eva M. , Lauder Lucas , Mancia Giuseppe , Redon Josep , Schmieder Roland E. , Sliwa Karen , Marx Nikolaus , Weber Michael A. , Williams Bryan , Yusuf Salim , Mann Johannes F.E. , Mahfoud Felix
Published: March 2021

Background:

Guidelines recommend to start blood pressure (BP)-lowering drugs also according to cardiovascular risk including history of cardiovascular events. We hypothesized that in patients with a history of myocardial infarction (MI), stroke, both or none of those, the index events predict the next event and have different SBP risk associations to different cardiovascular outcomes.

Design and measurements:

In this pooled posthoc, nonprespecified analysis, we assessed outcome data from high-risk patients aged 55 years or older with a history of cardiovascular events or proven cardiovascular disease, randomized to the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and to Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease Trial investigating telmisartan, ramipril and their combination with a median follow-up of 56 months. Standardized office BP was measured every 6 months. Associations of mean achieved BP on treatment were investigated on MI, stroke and cardiovascular death. We identified patients with previous MI (N = 13 487), stroke (N = 4985), both (N = 1509) or none (N = 10 956) of these index events. Analyses were done by Cox regression, analysis of variance and Chi2-test. 30 937 patients with complete data were enrolled between 1 December 2001 and 31 July 2003, and followed until 31 July 2008. Data of both trials were pooled as the outcomes were similar.

Results:

Patients with MI as index event had a higher risk to experience a second MI [hazard ratio 1.42 (confidence interval (CI) 1.20–1.69), P < 0.0001] compared with patients with no events but no increased risk for a stroke as a next event [hazard ratio 0.95 (CI 0.73–1.23), n.s.]. The risk was roughly doubled when they had both, MI and stroke before [hazard ratio 2.07 (CI 1.58–2.71), P < 0.0001]. Patients with a stroke history had a roughly three-fold higher likelihood to experience a second stroke [hazard ratio 2.89 (CI 2.37–3.53) P < 0.0001] but not MI [hazard ratio 1.07 (CI 0.88–1.32), n.s.]. Both types of index events increased roughly three-fold the risk of a second stroke compared with no previous events. The SBP-risk relationship was not meaningfully altered by the event history. After MI and stroke the risk for subsequent events and cardiovascular death was increased over the whole SBP spectrum. A J-shape relationship between BP and outcome was only observed for cardiovascular death.

Conclusion:

Previous MI and previous stroke are associated with increased risk for the same event in the future, independent of achieved SBP. Thus, secondary prevention may also be chosen according to the event history of patients.

Clinical trial registration:

http://clinicaltrials.gov. Unique identifier: NCT00153101.
Psychosocial and Functional Predictors of Depression and Anxiety Symptoms in Veterans and Service Members With TBI: A VA TBI Model Systems Study
Authors: Benavides Angela M. , Finn Jacob A. , Tang Xinyu , Ropacki Susan , Brown Racine M. , Smith Austin N. , Stevens Lillian Flores , Rabinowitz Amanda R. , Juengst Shannon B. , Johnson-Greene Doug , Hart Tessa
Published: March 2021

Objective:

To identify psychosocial and functional predictors of self-reported depression and anxiety symptoms at year 2 following traumatic brain injury (TBI).

Setting:

Five Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs) within the TBI Model Systems (TBIMS).

Participants:

A total of 319 service members/veterans enrolled in VA TBIMS who were eligible for and completed both 1- and 2-year follow-up evaluations.

Design:

Secondary analysis from multicenter prospective longitudinal study.

Main Measures:

Demographic, injury-related, military, mental health, and substance use variables. Questionnaires included the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Neurobehavioral Symptom Inventory. Rating scales included the Participation Assessment with Recombined Tools–Objective and Disability Rating Scale.

Results:

The final sample was largely male (96%) and predominantly White (65%), with a median age of 27 years. In unadjusted analyses, pre-TBI mental health treatment history and year 1 employment status, community activity, sleep difficulties, and self-reported depression and anxiety symptoms were associated with year 2 PHQ-9 scores; pre-TBI mental health treatment history and year 1 community activity, social contact, problematic substance use, sleep difficulties, and self-reported depression and anxiety symptoms were associated with year 2 GAD-7 scores. In multivariable analyses, only year 1 community activity and depression symptoms uniquely predicted year 2 PHQ-9 scores, and only year 1 employment status, community activity, problematic substance use, and anxiety symptoms uniquely predicted year 2 GAD-7 scores.

Conclusion:

Anxiety and depression commonly occur after TBI and are important treatment targets. Some predictors (eg, participation and substance use) are modifiable and amenable to treatment as well. Early identification of anxiety and depression symptoms is key.
Cognitive Recovery During Inpatient Rehabilitation Following Pediatric Traumatic Brain Injury: A Pediatric Brain Injury Consortium Study
Authors: Watson William D. , Suskauer Stacy J. , Askin Gulce , Nowak Sophie , Baum Katherine T. , Gerber Linda M. , Blackwell Laura S. , Koterba Christine H. , Hoskinson Kristen R. , Kurowski Brad G. , Mclaughlin Matthew J. , Tlustos Sarah J. , Zimmerman Kanecia O. , Shah Sudhin A.
Published: March 2021

Objectives:

To characterize the demographics, clinical course, and predictors of cognitive recovery among children and young adults receiving inpatient rehabilitation following pediatric traumatic brain injury (TBI).

Design:

Retrospective observational, multicenter study.

Setting:

Eight acute pediatric inpatient rehabilitation facilities in the United States with specialized programs for treating patients with TBI.

Participants:

Children and young adults (0-21 years) with TBI (n = 234) receiving inpatient rehabilitation.

Interventions:

Not applicable.

Main Outcome Measures:

Admission and discharge status assessed by the WeeFIM Cognitive Developmental Functional Quotient (DFQ) and Cognitive and Linguistic Scale (CALS).

Results:

Patients admitted to pediatric inpatient rehabilitation are diverse in cognitive functioning. While the majority of patients make improvements, cognitive recovery is constrained for those admitted with the most severe cognitive impairments. Age, time since injury to rehabilitation admission, and admission WeeFIM Cognitive DFQ are significant predictors of cognitive functioning at discharge from inpatient rehabilitation.

Conclusions:

This work establishes a multicenter Pediatric Brain Injury Consortium and characterized the demographics and clinical course of cognitive recovery during inpatient rehabilitation of pediatric patients with TBI to aid in prospective study design.
Vestibular, Oculomotor, and Balance Functions in Children With and Without Concussion
Authors: Cochrane Graham D. , Christy Jennifer B. , Almutairi Anwar , Busettini Claudio , van Heyningen Hendrik K. Kits , Weise Katherine K. , Swanson Mark W. , Gould Sara J.
Published: March 2021

Objective:

The main objective of this study was to assess whether objective vestibular, oculomotor, and balance functions were impaired in children with a current diagnosis of concussion with vestibular and/or ocular symptoms.

Setting:

Data were collected in a vestibular/ocular clinical laboratory. Patient participants were recruited from a concussion clinic in a children's hospital.

Participants:

Thirty-three children aged 8 to 17 years with a current diagnosis of concussion and vestibular and/or ocular symptoms and 30 children without concussion.

Design:

Cross-sectional single-visit study.

Main Outcome Measures:

Eye-tracking rotary chair oculomotor and vestibular measures, vestibular evoked potentials, and static posturography.

Results:

There were no statistically significant differences on any clinical measure between children with concussion and children without concussion. Younger children without concussion performed significantly worse on several rotary chair and balance measures compared with older children without concussion.

Conclusions:

No vestibular, oculomotor, or balance measures were significantly different between children with concussion and children without concussion, suggesting these measures may not be useful in the evaluation of a child with concussion and vestibular and/or oculomotor symptoms. Future research should investigate age effects and other vestibular and oculomotor tests to identify objective findings that better relate to vestibular and/or ocular symptoms in children with concussion.
Multidimensional Psychoeducative and Counseling Intervention (SAAM) for Symptomatic Patients With Mild Traumatic Brain Injury: A Pilot Randomized Controlled Trial
Authors: Audrit Hélène , Beauchamp Miriam H. , Tinawi Simon , Laguë-Beauvais Maude , Saluja Rajeet , de Guise Elaine
Published: March 2021

Objective:

To estimate feasibility and explore the treatment effect of a psychoeducative and counseling intervention program targeting 4 postconcussion symptoms (SAAM: Sleep/fatigue, Attention, Anxiety/mood, Memory).

Setting:

Level 1 trauma center.

Participants:

Twenty-five patients with postconcussion symptoms enrolled 1 to 3 months post-accident.

Design:

Parallel-group (experimental and wait-list control), randomized controlled trial, with masked outcome assessment the week following the last intervention session. The Experimental group received the SAAM intervention (1 session/week during 4 weeks); care as usual was maintained for both groups.

Main Measure:

Rivermead Post-concussion Symptoms Questionnaire (RPQ).

Secondary Measures:

Hospital Anxiety and Depression Scale (HADS-A/-D); Pittsburgh Sleep Quality Index (PSQI); Multidimensional Fatigue Inventory (MFI); attention and memory neuropsychological battery; Community Integration Questionnaire (CIQ).

Tolerability Measure:

A 10-item satisfaction questionnaire for the experimental group.

Results:

15.67% of the participants evaluated for eligibility were randomized and completed the evaluation at T0. High rates of satisfaction regarding the SAAM intervention were found in the experimental group (n = 10). One participant (experimental group) withdrew after T0. Exploratory results showed that the group × time interaction was not significant, but had a large effect size for the RPQ (P = .051, η2 = .16) and HADS-D (P = .052, η2 = 0.17), and a significant interaction was found with a large effect size for the PSQI (P = .017, η2 = .24) and MFI (P = .041, η2 = .18). Post-hoc analyses revealed a significant reduction of these variables post-intervention. No significant group × time interaction was observed for cognitive measures and CIQ.

Conclusion:

The pilot study demonstrates the feasibility and tolerability of the SAAM intervention. Preliminary data suggest that SAAM intervention delivered post-acutely might reduce postconcussion symptoms, depression symptoms, fatigue, and sleep difficulties. A larger scale randomized control trial is warranted to confirm these promising results.
Primary Language and Participation Outcomes in Hispanics With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study
Authors: Sander Angelle M. , Ketchum Jessica M. , Lequerica Anthony H. , Pappadis Monique R. , Bushnik Tamara , Hammond Flora M. , Sevigny Mitch
Published: March 2021

Objective:

To examine the relationship between primary language and participation outcomes in English- and Spanish-speaking persons with complicated mild to severe traumatic brain injury (TBI) at 1 year post-injury.

Setting:

Community following discharge from inpatient rehabilitation.

Participants:

A total of 998 Hispanic participants with outcomes available at year 1 follow-up; 492 (49%) indicated English as their primary language and 506 (51%) indicated Spanish as their primary language.

Design:

Prospective, multicenter, cross-sectional, observational cohort study.

Main Measures:

Community participation at 1 year post-injury was assessed by 3 domains of the Participation Assessment with Recombined Tools-Objective (PART-O): Out and About, Productivity, and Social Relations.

Results:

Unadjusted group comparisons showed better participation outcomes for English versus Spanish speakers for all PART-O domains and for the Balanced Total score. After controlling for relevant covariates, English-speaking participants had significantly better PART-O Balanced Total scores and better scores on the Social Relations domain, although effect sizes were small.

Conclusions:

Hispanic persons with TBI whose primary language is Spanish may require greater assistance integrating socially back into their communities after TBI. However, potential cultural differences in value placed on various social activities must be considered. Potential cultural bias inherent in existing measures of participation should be investigated in future studies.