bluuebunny/crossref_metadata_2025 huggingface dataset:
Did court dismiss coaching applicant's discrimination suit?
Authors: Lyerly Eric
Published: November 2020

The plaintiff was a Black Lebanese citizen who sued American University for discrimination on the basis of race, ethnicity, and national origin. Specifically, the plaintiff claimed the university discriminated against him when it hired a white candidate — instead of the plaintiff — for the position of head coach of its men's soccer team. The plaintiff claimed the white candidate had significantly inferior qualifications to his own.
Validating the Essen Climate Evaluation Schema modified for people with learning disabilities in a low‐risk secure forensic setting
Authors: Barker Lindsie , McKeown Annette , Small Michelle , Meggs Jenny
Published: November 2020

Background

Research has shown that an empowering and nurturing yet challenging work climate is beneficial for people receiving clinical services as it increases patient satisfaction, motivation, engagement, therapeutic alliance and functional improvement. Therefore, for inpatients, monitoring, encouraging and understanding ward climate holds considerable potential for improving forensic mental health services. To date, the most widely employed tool for ward‐climate, the Essen Climate Evaluation Schema (EssenCES), has been evidenced as useful in medium and high security hospitals, but little tested with people with learning disabilities or in low security services.

Aims

To establish the internal consistency and factor validity of the EssenCES, modified for easier reading, in a low secure hospital unit for people with learning disabilities.

Method

Language in the EssenCES was simplified and picture supplements added to facilitate comprehension. Patients completed the scale as part of their clinical routine, supported by National Health Service (NHS) employed psychology assistants. The research team, entirely independent of NHS staff, extracted data from the electronic records of purposively sampled residents in a low‐secure forensic hospital setting for people with learning disabilities.

Findings

Two hundred and twenty‐seven records (70% men) were acquired. The EssenCES was shown to have good factor validity and retained the original three factor model including the subscales: therapeutic hold, safety and cohesion. One single‐item from the ‘therapeutic hold’ subscale was removed to improve the internal consistency (p < 0.05).

Conclusions

This study adds preliminary support for the use of the EssenCES (with removal of one item) in individuals with learning disabilities within low‐risk secure forensic hospital settings.
Long‐term clinical outcomes after self‐expandable bare nitinol stent implantation for femoropopliteal occlusive disease in hemodialysis patients
Authors: Ito Ryuta , Ishii Hideki , Oshima Satoru , Nakayama Takuya , Takahashi Hiroshi , Sakakibara Takashi , Kakuno Motohiko , Murohara Toyoaki
Published: November 2020

Objectives

To compare the long‐term clinical outcomes after self‐expandable bare nitinol stent (BNS) implantation between hemodialysis (HD) and non‐HD patients with femoropopliteal (FP) disease.

Background

Although a BNS has been commonly used in patients with FP disease, the long‐term efficacy of BNSs in HD patients remains unknown.

Methods

In total, 427 HD patients treated with a BNS for FP disease were enrolled, along with 157 non‐HD patients as a control group. Over the following 5 years, the incidence of target lesion revascularization (TLR), major amputation and mortality was investigated. We also performed propensity‐score matching analysis.

Results

The 5‐year TLR rate (45.2 vs. 32.5%, p = .013) and mortality rate (39.3 vs. 14.0%, p = .0002) were significantly higher in the HD group than in the non‐HD group. The major amputation rate was comparable between the groups (7.2% in the HD group vs. 2.8% in the non‐HD group, p = .16). In the propensity‐score‐matched cohort, the TLR rate, and mortality rate were remained higher in the HD group than in the non‐HD group (48.9 vs. 34.1%, hazard ratio [HR] 2.11, 95% confidence interval [CI] 1.30–3.49, p = .0024, and 47.9 vs. 12.0%, HR 3.38, 95% CI 1.86–6.56, p < .0001, respectively). The adjusted amputation rate was consistently similar between the groups (1.7% in the HD group vs. 2.7% in the non‐HD group, HR 0.90, 95% CI 0.26–2.99, p = .86).

Conclusions

The TLR rate and mortality at 5 years post BNS implantation for FP disease were significantly higher in HD patients than in non‐HD patients, though the limb salvage rate was similar.
Long‐term outcomes after transcatheter aortic valve replacement with minimal contrast in chronic kidney disease
Authors: Rzucidlo Justyna , Jaspan Vita , Paone Darien , Jilaihawi Hasan , Xia Yuhe , Kapitman Anna , Nakashima Makoto , He Yuxin , Ibrahim Homam , Pushkar Illya , Neuburger Peter J. , Saric Muhamed , Bamira Daniel , Paschke Sonja , Kalish Chloe , Staniloae Cezar , Shah Binita , Williams Mathew
Published: November 2020

Background

Patients with renal insufficiency have poor short‐term outcomes after transcatheter aortic valve replacement (TAVR).

Methods

Retrospective chart review identified 575 consecutive patients not on hemodialysis who underwent TAVR between September 2014 and January 2017. Outcomes were defined by VARC‐2 criteria. Primary outcome of all‐cause mortality was evaluated at a median follow‐up of 811 days (interquartile range 125–1,151).

Results

Preprocedural glomerular filtration rate (GFR) was ≥60 ml/min in 51.7%, 30–60 ml/min in 42.1%, and < 30 ml/min in 6.3%. Use of transfemoral access (98.8%) and achieved device success (91.0%) did not differ among groups, but less contrast was used with lower GFR (23 ml [15–33], 24 ml [14–33], 13 ml [8–20]; p < .001). Peri‐procedural stroke (0.7%, 2.1%, 11.1%; p < .001) was higher with lower GFR. Core lab analysis of preprocedural computed tomography scans of patients who developed a peri‐procedural stroke identified potential anatomic substrate for stroke in three out of four patients with GFR 30–60 ml/min and all three with GFR <30 ml/min (severe atheroma was the most common subtype of anatomical substrate present). Compared to GFR ≥60 ml/min, all‐cause mortality was higher with GFR 30–60 ml/min (HR 1.61 [1.00–2.59]; aHR 1.61 [0.91–2.83]) and GFR <30 ml/min (HR 2.41 [1.06–5.48]; aHR 2.34 [0.90–6.09]) but not significant after multivariable adjustment. Follow‐up echocardiographic data, available in 63%, demonstrated no difference in structural heart valve deterioration over time among groups.

Conclusions

Patients with baseline renal insufficiency remain a challenging population with poor long‐term outcomes despite procedural optimization with a transfemoral‐first and an extremely low‐contrast approach.
One‐year clinical and echocardiographic outcomes of direct implantation of a self‐expanding valve
Authors: Benetos Georgios , Karmpalioti Maria , Drakopoulou Maria , Stathogiannis Konstantinos , Xanthopoulou Maria , Latsios George , Synetos Andreas , Bei Evangelia , Voudris Vassilis , Iakovou Ioannis , Katsimagklis Georgios , Moraitis Sotiris , Zeniou Vicki , Danenberg Haim , Halvatsiotis Panagiotis , Vavuranakis Manolis , Tousoulis Dimitris , Toutouzas Konstantinos
Published: November 2020

Objective

To present 1 year clinical and echocardiographic outcomes of the randomized DIRECT (Pre‐dilatation in Transcatheter Aortic Valve Implantation Trial) trial.

Background

Intermediate‐term data from randomized studies investigating the safety and efficacy of direct implantation are lacking.

Methods

DIRECT trial randomized 171 consecutive patients with severe aortic stenosis at four tertiary centers to undergo TAVI with the use of self‐expanding prostheses with (pre‐BAV) or without pre‐dilatation (no‐BAV). The primary endpoint was device success according to the VARC‐2 criteria. All patients underwent a clinical and echocardiographic follow‐up at 1 year. All‐cause and cardiac mortality, stroke, heart failure hospitalization, and new pacemaker implantation were recorded.

Results

At 1 year, four deaths were recorded in pre‐BAV group (4.7%) and three deaths in no‐BAV group (3.5%). There was no difference in Kaplan–Meier plots between the two groups in all‐cause mortality at 1 year (log‐rank p = .72). Similarly, there was no difference in the incidence of permanent pacemaker implantation between the two groups at 1 year (27/67–40.3% in no‐BAV group versus 20/69–29% in pre‐BAV group, log‐rank p = .24). There was no significant difference between pre‐BAV and no BAV group in aortic valve area (1.84 ± 0.39 cm2 vs. 1.85 ± 0.44 cm2, p = .90), mean aortic valve gradient (8.36 ± 5.04 vs. 8.00 ± 4.04 mmHg, p = .65) and moderate or severe paravalvular regurgitation (5–6.6 vs. 4–5.7%, respectively) at 1 year. The same applied independently from the performance of post‐dilatation at baseline.

Conclusions

Direct, without pre‐dilatation, implantation of a self‐expanding valve has no impact on one‐year clinical and echocardiographic outcomes, independently also from the baseline performance of post‐dilatation.
TFE3 activation in a TSC1‐altered malignant PEComa: challenging the dichotomy of the underlying pathogenic mechanisms
Authors: Schmiester Maren , Dolnik Anna , Kornak Uwe , Pfitzner Berit , Hummel Michael , Treue Denise , Hartmann Arndt , Agaimy Abbas , Weyerer Veronika , Lekaj Anja , Brakemeier Susanne , Peters Robert , Öllinger Robert , Märdian Sven , Bullinger Lars , Striefler Jana Käthe , Flörcken Anne
Published: November 2020

Perivascular epithelioid cell tumors (PEComas) form a family of rare mesenchymal neoplasms that typically display myomelanocytic differentiation. Upregulation of mTOR signaling due the inactivation of TSC1/2 (Tuberous Sclerosis 1 and 2) is believed to be a key oncogenic driver in this disease. Recently, a subgroup of PEComas harboring TFE3 (Transcription Factor E3) rearrangements and presenting with a distinctive morphology has been identified. TSC1/2 and TFE3 aberrations are deemed to be mutually exclusive in PEComa, with two different pathogenic mechanisms assumed to lead to tumorigenesis. Here, we challenge this dichotomy by presenting a case of a clinically aggressive TCS1‐mutated PEComa displaying a TFE3‐altered phenotype. FISH analysis was suggestive of a TFE3 inversion; however, RNA and whole genome sequencing was ultimately unable to identify a fusion involving the gene. However, a copy number increase of the chromosomal region encompassing TFE3 was detected and transcriptome analysis confirmed upregulation of TFE3, which was also seen at the protein level. Therefore, we believe that the TSC1/2‐mTOR pathway and TFE3 overexpression can simultaneously contribute to tumorigenesis in PEComa. Our comprehensive genetic analyses add to the understanding of the complex pathogenic mechanisms underlying PEComa and harbor insights for clinical treatment options.
Continuous monitoring of sleep‐disordered breathing with pacemakers: Indexes for risk stratification of atrial fibrillation and risk of stroke
Authors: Mazza Andrea , Bendini Maria Grazia , Leggio Massimo , De Cristofaro Raffaele , Valsecchi Sergio , Boriani Giuseppe
Published: November 2020

Background

Sleep apnea (SA) is a risk factor for atrial fibrillation (AF). Advanced pacemakers are now able to calculate indexes of SA severity.

Hypothesis

We investigated the changes in pacemaker‐measured indexes of SA, we assessed their predictive value for AF occurrence and the associated risk of stroke and death at long‐term.

Methods

We enrolled 439 recipients of a pacemaker endowed with an algorithm for the calculation of a Respiratory Disturbance Index (RDI). The RDI variability was measured over the first 12 months after implantation, as well as its potential association with the occurrence of AF, defined as device‐detected cumulative AF burden ≥6 hoursours in a day.

Results

The individual RDI mean was 30 ± 18 episodes/h, and the RDI maximum was 59 ± 21 episodes/h. RDI ≥30 episodes/h was detected in 351 (80%) patients during at least one night. The proportion of nights with RDI ≥30 episodes/h was 14% (2%‐36%). AF ≥6 hours was detected in 129 (29%) patients during the first 12 months. The risk of AF was higher in patients with RDI maximum ≥63 episodes/h (HR:1.74; 95%CI: 1.22‐2.48; P = .001) and with RDI mean ≥ 46 episodes/h (HR:1.63; 95%CI: 1.03‐2.57; P = .014). The risk of all‐cause death or stroke was higher in patients with AF burden ≥6 hours (HR:1.75; 95%CI: 1.06‐2.86; P = .016). Moreover, among patients with no previous history of AF the risk was higher in those with RDI maximum ≥63 episodes/h (HR:1.96; 95%CI: 1.06‐3.63; P = .031).

Conclusions

Pacemaker‐detected SA showed a considerable variability during follow‐up. We confirmed the association between RDI and higher risk of AF, and we observed an association between higher RDI maximum and all‐cause death or stroke among patients with no previous history of AF.
Consider impact of DOJ regulation restricting reliance on guidance documents
Authors: Masinter Michael R.
Published: November 2020

To comply with civil rights laws, institutions look to the text of those laws, legally binding regulations, court decisions, and often to agency guidance documents. Questions have arisen in recent years about the legal significance of guidance documents — is the failure to follow guidance documents a violation of law? To help answer that question, the Department of Justice published on Oct. 7 a new regulation that severely restricts DOJ attorneys from relying on guidance documents in enforcement actions.
Personalized networks of eating disorder symptoms predicting eating disorder outcomes and remission
Authors: Levinson Cheri A. , Cash Elizabeth , Welch Karla , Epskamp Sacha , Hunt Rowan A. , Williams Brenna M. , Keshishian Ani C. , Spoor Samantha P.
Published: November 2020

Enhanced cognitive–behavioral therapy (CBT‐E) is one of the primary evidence‐based treatments for adults with eating disorders (EDs). However, up to 50% of individuals do not respond to CBT‐E, likely because of the high heterogeneity present even within similar diagnoses. This high heterogeneity, especially in regard to presenting pathology, makes it difficult to develop a treatment based “on averages” and for clinicians to accurately pinpoint which symptoms should be targeted in treatment. As such, new models based at both the group, and individual level, are needed to more accurately refine targets for personalized evidence‐based treatments that can lead to full remission. The current study (Expected N = 120 anorexia nervosa, atypical anorexia nervosa, and bulimia nervosa) will build both group and individual longitudinal models of ED behaviors, cognitions, affect, and physiology. We will collect data for 30 days utilizing a mobile application to assess behaviors, cognition, and affect and a sensor wristband that assesses physiology (heart rate, acceleration). We will also collect outcome data at 1‐ and 6‐month follow‐ups to assess ED outcomes and remission status. These data will allow for identification of “on average” and “individual” targets that maintain ED pathology and test if these targets predict outcomes, including ED remission.
Trophic resource partitioning drives fine‐scale coexistence in cryptic bat species
Authors: Novella‐Fernandez Roberto , Ibañez Carlos , Juste Javier , Clare Elizabeth L. , Doncaster C. Patrick , Razgour Orly
Published: November 2020

Understanding the processes that enable species coexistence has important implications for assessing how ecological systems will respond to global change. Morphology and functional similarity increase the potential for competition, and therefore, co‐occurring morphologically similar but genetically unique species are a good model system for testing coexistence mechanisms. We used DNA metabarcoding and high‐throughput sequencing to characterize for the first time the trophic ecology of two recently described cryptic bat species with parapatric ranges, Myotis escalerai and Myotis crypticus. We collected fecal samples from allopatric and sympatric regions and from syntopic and allotopic locations within the sympatric region to describe the diets both taxonomically and functionally and compare prey consumption with prey availability. The two bat species had highly similar diets characterized by high arthropod diversity, particularly Lepidoptera, Diptera and Araneae, and a high proportion of prey that is not volant at night, which points to extensive use of gleaning. Diet overlap at the prey item level was lower in syntopic populations, supporting trophic shift under fine‐scale co‐occurrence. Furthermore, the diet of M. escalerai had a marginally lower proportion of not nocturnally volant prey in syntopic populations, suggesting that the shift in diet may be driven by a change in foraging mode. Our findings suggest that fine‐scale coexistence mechanisms can have implications for maintaining broad‐scale diversity patterns. This study highlights the importance of including both allopatric and sympatric populations and choosing meaningful spatial scales for detecting ecological patterns. We conclude that a combination of high taxonomic resolution with a functional approach helps identify patterns of niche shift.
Splenic erythroid progenitors decrease TNF‐α production by macrophages and reduce systemic inflammation in a mouse model of T cell‐induced colitis
Authors: Shim Yaein Amy , Weliwitigoda Asanga , Campbell Teresa , Dosanjh Manisha , Johnson Pauline
Published: November 2020

In inflammatory bowel disease (IBD), inflammation can occur beyond the intestine and spread systemically causing complications such as arthritis, cachexia, and anemia. Here, we determine the impact of CD45, a pan‐leukocyte marker and tyrosine phosphatase, on IBD. Using a mouse model of T cell transfer colitis, CD25−CD45RBhighCD4+ T cells were transferred into Rag1‐deficient mice (RAGKO) and CD45‐deficient RAGKO mice (CD45RAGKO). Weight loss and systemic wasting syndrome were delayed in CD45RAGKO mice compared to RAGKO mice, despite equivalent inflammation in the colon. CD45RAGKO mice had reduced serum levels of TNF‐α, and reduced TNF‐α production by splenic myeloid cells. CD45RAGKO mice also had increased numbers of erythroid progenitors in the spleen, which had previously been shown to be immunosuppressive. Adoptive transfer of these erythroid progenitors into RAGKO mice reduced their weight loss and TNF‐α expression by splenic red pulp macrophages. In vitro, erythroid cells suppressed TNF‐α expression in red pulp macrophages in a phagocytosis‐dependent manner. These findings show a novel role for erythroid progenitors in suppressing the pro‐inflammatory function of splenic macrophages and cachexia associated with IBD.
Characterisation of La0.9Ce0.1Ni5 alloy for the development of single‐stage thermally driven sorption hydrogen compressor
Authors: Gupta Sanjay , Sharma Vinod Kumar
Published: November 2020

In this study, La0.9Ce0.1Ni5 alloy is characterised to investigate the performance of a single‐stage thermally driven sorption hydrogen compressor (TDSHC). The pressure‐concentration isotherm (PCI) properties of La0.9Ce0.1Ni5 alloy are measured through Sievert's Apparatus, and the thermodynamic properties are estimated by constructing van't Hoff plots at different temperature ranges between 20°C and 140°C. The effects of an increase in operating temperature on hydrogen storage capacity as well as on thermodynamic properties and the corresponding effects on TDSHC performance are studied. It is observed that the hydrogen storage capacity decreased, whereas reaction enthalpy increased, with an increase in operating temperature. It is also observed that the equilibrium pressure increased dramatically with an operating temperature; therefore, this alloy is employed, in this study, for the development of TDSHC. The proposed TDSHC operates at the supply temperature and pressure of 20°C and 15 bar, respectively, in which the compressed hydrogen is delivered at 40°C, 60°C, 80°C, 100°C, 120°C and 140°C with a maximum pressure output of 270 bar. The measured PCI and thermodynamic data are employed to investigate the thermodynamic performance of TDSHC which results in the maximum compressor work of 10.13 W and the maximum cycle efficiency of 27.57% with an average heat input of 35 ± 3 W. The increase in discharge temperature on system performance are observed to increase in compressor work and efficiency due to the increase in discharge pressure, whereas the effect on heat input is not significant due to the reduction in hydrogen discharge amount. Also, the behaviour of metal hydride (MH) bed is predicted through the finite volume method in terms of variations in MH bed temperature and hydrogen transmission. The numerical investigation is carried out by solving the required energy equations and are validated with experimental data. The numerical investigation results into minimum cycle time of 2700 seconds for the operation of TDSHC. It is also observed that the increase in discharge temperature increases the reaction kinetics and hydrogen mass fraction.
Mathematical and intelligent modeling of stevia (Stevia Rebaudiana) leaves drying in an infrared‐assisted continuous hybrid solar dryer
Authors: Bakhshipour Adel , Zareiforoush Hemad , Bagheri Iraj
Published: November 2020

Drying characteristics of stevia leaves were investigated in an infrared (IR)‐assisted continuous‐flow hybrid solar dryer. Drying experiments were conducted at the inlet air temperatures of 30, 40, and 50°C, air inlet velocities of 7, 8, and 9 m/s, and IR lamp input powers of 0, 150, and 300 W. The results indicated that inlet air temperature and IR lamp input power had significant effect on drying time (p < .05). A comparative study was performed among mathematical, Artificial Neural Networks (ANNs), and Adaptive Neuro‐Fuzzy System (ANFIS) models for predicting the experimental moisture ratio (MR) of stevia leaves during the drying process. The ANN model was the most accurate MR predictor with coefficient of determination (R2), root mean squared error (RMSE), and chi‐squared error (χ2) values of 0.9995, 0.0005, and 0.0056, respectively, on test dataset. These values of the ANFIS model on test dataset were 0.9936, 0.0243, and 0.0202, respectively. Among the mathematical models, the Midilli model was the best‐fitted model to experimental MR values in most of the drying conditions. It was concluded that artificial intelligence modeling is an effective approach for accurate prediction of the drying kinetics of stevia leaves in the continuous‐flow IR‐assisted hybrid solar dryer.
Dementia and the risk of death in elderly patients with COVID‐19 infection: Systematic review and meta‐analysis
Authors: Zuin Marco , Guasti Patrizia , Roncon Loris , Cervellati Carlo , Zuliani Giovanni
Published: November 2020

Objectives

The COVID‐19 infection represents a global public health emergency worldwide. Several risk factors have been associated with a poor prognosis among COVID‐19 patients. We aimed to perform a systemic review and meta‐analysis to evaluate the mortality risk in elderly patients with dementia and COVID‐19 infection.

Methods

Literature search was based on Cochrane Library, Embase, PubMed, and Google Scholar to locate articles published between December 2019 and July 2020, presenting the number of survived versus deceased patients with dementia and COVID‐19 infection.

Results

A total of 233 articles were retrieved: 158 were excluded for not meeting the inclusion criteria, leaving 75 articles to assess for eligibility. After evaluation of the full‐text articles, eight met the inclusion criteria and were thus included into the final analysis (6493 patients – mean age: 69.6 years). Among COVID‐19 patients, the prevalence of dementia was higher in non‐survivors compared with survivors (17.5% vs. 5.4%, p < 0.001). The pooled analysis performed using a random‐effect model showed an increase in the risk of death in COVID‐19 patients with dementia (odds ratio: 3.75; 95% confidence interval: 2.54–5.54, p < 0.0001, I
2 = 49.5%). The Egger's regression test confirmed that there were not statistically evidences of publication bias (t = 0.059; p = 0.954).

Conclusions

Our preliminary results suggest that patients with COVID‐19 infection and dementia have a higher mortality risk in the short‐term period compared with infected non‐demented individuals. Due to their intrinsic frailty, dementia patients may require a more aggressive treatment and prompt isolation to improve their short‐term outcome.
On the subprime crisis and the Latin American financial markets: A regime switching skew‐normal approach
Authors: Ferreira Diego , Palma Andreza A.
Published: November 2020

This article analyses the potential occurrence of financial contagion in Latin American markets from the recent U.S. subprime crisis. Distinctively from the usual empirical approaches for contagion analyses, a regime‐switching skew‐normal model is implemented in order to assess both correlation and coskewness contagion as well as investigate the occurrence of structural breaks in the moments of the mean, variance and skewness. Even though correlation contagion was observed in all selected Latin American markets, coskewness contagion was only detected in Brazil. Variance structural breaks were found in all financial markets while structural breaks in the mean were only detected in Argentinian, Mexican and the U.S. markets. Yet, joint contagion and structural break tests suggested the occurrence of these phenomena in all considered markets.
Self‐phase‐modulated femtosecond laser source at 1603 nm and its application to deep‐brain 3‐photon microscopy in vivo
Authors: Chen Xinlin , Cheng Hui , Deng Xiangquan , Tong Shen , Li Jia , Qiu Ping , Wang Ke
Published: November 2020

3‐photon microscopy (3PM) excited at the 1700 nm window enables deep‐tissue imaging in vivo, especially in brain. PC rod soliton source has previously been exclusively used as the excitation source, which is rather costly and difficult to align. Here we demonstrate a novel nonlinear optical technique to build femtosecond laser source at the 1700 nm window, based on self‐phase modulation (SPM) in a short span of large‐mode‐area fiber. The spectral broadening experienced by the pump pulse leads to the generation of a red‐shifted sidelobe at 1603 nm. After spectral filtering, this sidelobe corresponds to 170‐fs, 167‐nJ pulses at 1603 nm. Using this SPM source, we further demonstrate deep‐brain 3 PM to a depth of 1500 μm below the mouse brain surface in vivo. Our SPM femtosecond laser source thus provides a cost effective and easy‐to‐align alternative excitation source to the PC rod soliton source.
Parasite burden and red blood cell exchange transfusion for babesiosis
Authors: O'Bryan Jane , Gokhale Amit , Hendrickson Jeanne E. , Krause Peter J.
Published: November 2020

Background

The association between parasite burden and end‐organ dysfunction in subjects with Babesia microti infection has not been extensively studied, nor has the optimal role of red blood cell exchange (RCE) transfusion in babesiosis treatment. This retrospective chart review evaluates the associations between parasitemia, end‐organ dysfunction, and outcomes in babesiosis patients treated with antimicrobial agents and RCE compared to those treated with antimicrobial agents alone.

Materials and Methods

We evaluated adults (≥18 years of age) with laboratory‐confirmed babesiosis who were admitted between 2011 and 2017 to Yale New Haven Hospital, located in a Babesia‐endemic region of the Northeastern United States. Patient demographics, parasitemia levels, clinical and laboratory indicators of end‐organ dysfunction, and outcomes were examined.

Results

Ninety‐one subjects (mean age 65.1 years, 69.2% male) were studied. Subjects were stratified according to peak parasitemia: <1% (n = 34), 1‐5% (n = 24), 5‐10% (n = 15), and >10% (n = 18). Laboratory measures indicating degrees of hemolysis, coagulopathy, and pulmonary, renal and hepatic dysfunction differed significantly across peak parasitemia levels. Median length of hospital stay increased with each successive peak parasitemia level (P < .001). These results indicate a strong association between peak parasitemia level and disease severity. Nineteen subjects underwent RCE, all with peak parasitemia ≥9% and some degree of end‐organ dysfunction.

Conclusions

Babesia microti parasitemia is closely associated with disease severity, though not all subjects with end‐organ dysfunction had high‐grade parasitemia. Our data suggest that the use of parasitemia >10%, coupled with clinical status, is a reasonable indicator for RCE in babesiosis patients.
Tail regeneration in a cephalochordate, the Bahamas lancelet,Asymmetron lucayanum
Authors: Holland Nicholas D. , Somorjai Ildiko M. L.
Published: November 2020

Lancelets (Phylum Chordata, subphylum Cephalochordata) readily regenerate a lost tail. Here, we use light microscopy and serial blockface scanning electron microscopy (SBSEM) to describe tail replacement in the Bahamas lancelet,Asymmetron lucayanum. One day after amputation, the monolayered epidermis has migrated over the wound surface. At 4 days, the regenerate is about 3% as long as the tail length removed. The re‐growing nerve cord is a tubular outgrowth of ependymal cells, and the new part of the notochord consists of several degenerating lamellar cells anterior to numerous small vacuolated cells. The cut edges of the mesothelium project into the regenerate as tubular extensions. These tubes anastomose with each other and with midline mesodermal canals beneath the regenerating edges of the dorsal and ventral fins. SBSEM did not reveal a blastema‐like aggregation of undifferentiated cells anywhere in the regenerate. At 6 days, the regenerate (10% of the amputated tail length) includes a notochord in which the small vacuolated cells mentioned above are differentiating into lamellar cells. At 10 days, the regenerate is 22% of the amputated tail length: myocytes have appeared in the walls of the myomeres, and sclerocoels have formed. By 14 days, the regenerate is 35% the length of the amputated tail, and the new tissues resemble smaller versions of those originally lost. The present results forA. lucayanum, a species regenerating quickly and with little inter‐specimen variability, provide the morphological background for future cell‐tracer, molecular genetic, and genomic studies of cephalochordate regeneration.
Malnutrition as a Risk Factor in Cleft Lip and Palate Surgery
Authors: Escher Paul J. , Zavala Hanan , Lee Daniel , Roby Brianne Barnett , Chinnadurai Sivakumar
Published: November 2020

Objectives/Hypothesis

To assess the prevalence of acute and chronic malnutrition at the time of surgery in patients with cleft lip and/or palate (CLP) at our institution, and to quantify nutrition as a risk factor for postsurgical complications following CLP surgery.

Study Design

Retrospective cohort study.

Methods

Retrospective review of 855 children undergoing initial cleft lip or palate surgery, or revision surgery after fistula/dehiscence of initial cleft repair. We measured acute and chronic malnutrition using World Health Organization Z‐scores of weight‐for‐age and height‐for‐age, respectively, and noted any postsurgical fistula or dehiscence.

Results

Among patients with cleft lip, 22.3% were at least moderately chronically malnourished at the time of initial repair, and 17.5% were at least moderately acutely malnourished. Among patients undergoing initial repair of cleft palate, 20.9% were at least moderately chronically malnourished, and 8.1% were at least moderately acutely malnourished. Increasing nutritional status, as measured by height‐for‐age, predicts decreased odds of fistula (OR 0.78,P= .01) after cleft palate surgery.

Conclusions

Chronic malnutrition significantly increases the risk of fistula formation in patient with cleft palate. Preoperative strategies to manage this risk and influence surgical timing can avoid morbid and costly postoperative complications.

Level of Evidence

4Laryngoscope, 131:E2060–E2065, 2021
Prevalence of Multidrug‐Resistant Organisms in Patients Undergoing Free Flap Reconstruction
Authors: Hamill Chelsea S. , Snyder Vusala , Sykes Kevin J. , O'Toole Thomas
Published: November 2020

Objectives/Hypothesis

The purpose of this study is to evaluate the relationship between antibiotic prophylaxis and prevalence of multidrug‐resistant organisms (MDRO) in patients undergoing head and neck cancer reconstruction.

Study Design

Retrospective Chart Review.

Methods

Retrospective review of patients who underwent head and neck free flap reconstruction at our institution between 2009 to 2016.

Results

Of the 145 patients that underwent head and neck tumor removal surgery using free tissue flaps to cover the defect and therafter received antibiotic prophylaxis, 30 (20.7%) developed postoperative surgical site (n = 17, 55.7%) or distant (n = 13, 43.4%) infections. Seven had a multidrug‐resistant infection, the most common with Methicillin‐Resistant Staphylococcus aureus (MRSA). There was no significant relationship between antibiotic spectrum or duration to the development of postoperative infections or MDRO. Pseudomonas and MRSA infections were low overall with only one multidrug‐resistant Pseudomonas infection.

Conclusions

The choice of antibiotic prophylaxis should cover organisms these patients are at highest risk for including anaerobes and Gram‐negative organisms. A shorter duration of antibiotic prophylaxis should be considered given no increased risk of postoperative infection nor MDRO. Finally, one must be aware of the potential threat of multidrug‐resistant Pseudomonas and MRSA amongst this vulnerable population and identity these with culture driven treatment.

Level of Evidence

4 Laryngoscope, 131:E1881–E1887, 2021
Direct Preparation of High Thermal Stable PLA‐Based Nanocomposite via Extra‐Low Loading of In Situ Exfoliated Ultrathin MWW Zeolite Nanosheets
Authors: Zhang Chunna , Wang Sinong , Zhang Hongbin , Liu Peng , Yu Minmin , Zhong Guoxiang , Zhang Huihui , Lu Haiyang , Xu Shuyu , Dong Shuo , Guan Xinyu , Tang Yi
Published: November 2020

Poly(lactic acid) (PLA)‐based nanocomposite incorporated with zeolite MCM‐22 precursor at extra‐low loading of 0.2–0.8 wt% is directly prepared by melt compounding and injection moulding method. The Vicat softening temperature raises up to >155 °C, much higher than that of pure PLA (63 °C), which is very beneficial for its application in many fields such as a container for hot food due to its environmentally friendly property. The high heat resistance property is believed to not be caused by the improvement of crystallinity and glass transition temperature but resulting from the obstruction of PLA polymer chain movement originating from >CO···HOSi hydrogen bonding between PLA molecules and the in situ exfoliated MWW zeolite nanosheets with abundant exposed surface silanol groups. Such a method would pave a new way not only for designing more types of thermal stable polymer composites but also for delaminating multi‐layered zeolite precursors.
Newton‐like and inexact Newton‐like methods for a parameterized generalized inverse eigenvalue problem
Authors: Dalvand Zeynab , Hajarian Masoud
Published: November 2020

In this paper, we establish the Newton‐like and inexact Newton‐like based methods for solving a type of parameterized generalized inverse eigenvalue problem. This type of parameterized generalized inverse eigenvalue problem, including multiplicative and additive inverse eigenvalue problems, appears in many applications. We show that the direction produced by the Newton‐like method does not depend explicitly on the eigenvalues. Also, the inexact version can minimize the oversolving problem of Newton‐like methods and hence improve efficiency. We discuss the convergence properties of the presented methods. Finally, the performance and effectiveness of the algorithms are tested on three numerical examples and compared to the Newton algorithm.
Confined interface vibration for femtoliter droplets generation and manipulation
Authors: Li Dege , Huang Bingfang , Cao Yi , Han Molong , Wu Xinlei , Sun Qiang , Ma Chi , Zhao Lilong , Liu Peng , Zheng Chao , Dong Hang , Wang Xiaolong , Liu Yonghong , Zhang Yanzhen
Published: November 2020

The precise and effective generation and manipulation of micron‐sized droplets is crucial for chemical and biological research and applications. Normally, droplets generation and manipulation are achieved by two separate devices/systems with their respective operation strategies. Pipette, inkjet nozzle, and microfluidic channels equipped with programed syringes are commonly used for droplets generation whereas the subsequent manipulation is normally achieved by leveraging of forces originating either from optical, electric, magnetic or acoustic field and the corresponding complicated devices. Here we report a new paradigm that can realize simultaneous droplets generation and manipulation in an immiscible liquid environment using only the confined interface vibration generated by the ordinary inkjet nozzle. Droplets, ranging from femtoliter to picoliter, can be generated and manipulated without interruption since they are actuated by the same nozzle. Our strategy provides a platform for precise generation and manipulating the micro‐sized droplets that may be valuable for applications requiring simple setups and seamless connection between droplets generation and droplets manipulation.
Harmonic wideband simultaneous dual‐frequency MR Elastography
Authors: Sango Solanas Pilar , Tse Ve Koon Kevin , Ratiney Helene , Millioz Fabien , Caussy Cyrielle , Beuf Olivier
Published: November 2020

Magnetic resonance elastography (MRE) is used to non‐invasively quantify viscoelastic properties of tissues based on the measurement of propagation characteristics of shear waves. Because some of these viscoelastic parameters show a frequency dependence, multifrequency analysis allows us to measure the wave propagation dispersion, leading to a better characterization of tissue properties. Conventionally, motion encoding gradients (MEGs) oscillating at the same frequency as the mechanical excitation encode motion. Hence, multifrequency data is usually obtained by sequentially repeating monochromatic wave excitations experiments at different frequencies. The result is that the total acquisition time is multiplied by a factor corresponding to the number of repetitions of monofrequency experiments, which is a major limitation of multifrequency MRE. In order to make it more accessible, a novel single‐shot harmonic wideband dual‐frequency MRE method is proposed. Two superposed shear waves of different frequencies are simultaneously generated and propagate in a sample. Trapezoidal oscillating MEGs are used to encode mechanical vibrations having frequencies that are an odd multiple of the MEG frequency. The number of phase offsets is optimized to reduce the acquisition time. For this purpose, a sampling method not respecting the Shannon theorem is used to produce a controlled temporal aliasing that allows us to encode both frequencies without any additional examination time. Phantom experiments were run to compare conventional monofrequency MRE with the single‐shot dual‐frequency MRE method and showed excellent agreement between the reconstructed shear storage moduli G′. In addition, dual‐frequency MRE yielded an increased signal‐to‐noise ratio compared with conventional monofrequency MRE acquisitions when encoding the high frequency component. The novel proposed multifrequency MRE method could be applied to simultaneously acquire more than two frequency components, reducing examination time. Further studies are needed to confirm its applicability in preclinical and clinical models.
SERPs: A look at Google's search engine results page
Authors: Talarico Donna
Published: November 2020

Other search engines exist, but Google dominates. How this tech giant displays results on the screen has evolved over the decades, and it continues to change its secret algorithm. As content marketers, we have to do our best to keep up on these trends and, therefore, keep our content up to par.
Support students of color through mental health challenges
Authors: Sutton Halley
Published: November 2020

Black, Indigenous, Pacific Islander, and Latinx populations are three times as likely to die from COVID‐19 as white neighbors, and populations of color are experiencing greater rates of anxiety, depression, and mental health concerns than white peers as well. Those findings come from a report issued by The Steve Fund, a national advocacy organization focused on the mental health of college and university students of color.
Track, trace, treat, and vaccinate to preserve confidence in your college
Authors: Raines Karla , Morris Renea
Published: November 2020

Frequent media reports show that new students are changing their views of your institution's academic plan on a daily basis. Confronted with uncertainty, many students and their parents are questioning your commitment to their best interests. One disgruntled parent's feelings about paying full tuition for an online‐only experience creates a flurry of shared sentiment in a matter of hours. Soon you discover a new Facebook group is gaining members, each with a complaint about your college. Even if your campus is off to a smooth start, your students and families are influenced by the opinions of others.
The importance of the Central Asian region in energy security at the global level: A review
Authors: Alkuwaiti Mubarak Ateeq Sultan
Published: November 2020

Energy security is an important issue locally and globally. Likewise, the most recent technological developments concern the sustainability and environmental impact of nonrenewable energy. Thus, most countries' concern has increased in new and renewable energy sources for generating electricity to reduce the consumption of nonrenewable energy. The central Asian region (CAR) is one of the most regions that contain much more energy. In this way, it is one of the primary exporters of energy for the global market. The Central Asian area contains around 5.5% of the world's hydro potential. Furthermore, over 20% of the world's investigated uranium is in Kazakhstan and Uzbekistan. Natural gas is the most consumed resource in the CAR countries, 75% of which is consumed in Uzbekistan, and the second place, consumed by the CAR countries, goes to coal, where 93% of its stores are consumed in Kazakhstan. The countries that produce most of the oil in Central Asia are Kazakhstan and Uzbekistan. Kazakhstan provides 1.2 billion metric tons of oil and Uzbekistan provides up to 730 million barrels of oil. Kyrgyzstan has great potential for using renewable energy, including, solar energy, hydropower, and biomass. Thus, utilizing renewable energy for Kyrgyzstan must be addressed as a solution for population growth and socioeconomic problems in the future. Finally, the presence of energy is generating interest. However, the construction of pipelines is needed.
Pain in survivors of Ewing sarcoma: Prevalence, associated factors and prediction of recurrence
Authors: Heinemann Melina , Hoffmann Christiane , Hardes Jendrik , Guder Wiebke , Streitbürger Arne , Götte Miriam , Welz Theresa Luisa , Jürgens Heribert , Ranft Andreas , Vieth Volker , Weckesser Matthias , Schäfers Michael , Stegger Lars , Dirksen Uta
Published: November 2020

Background

While the prognosis of patients with Ewing sarcoma (EwS) is improving, little is known about the frequency of pain and its risk factors in survivors of EwS. This study aims to analyse the prevalence and risk factors of pain and its predictive value for recurrence.

Patients and Methods

In patients with remission after treatment of EwS, frequency and characteristics of pain within the first 5 years of follow up were assessed retrospectively.

Results

Of 80 patients, 37 (46%) presented with at least one episode of pain. Chronic pain (>3 months) was observed in 10 patients (13%). Experience of at least one episode of pain was associated with prior combined local treatment (surgery and radiation compared to surgery alone; odds ratio [OR] 5.83, 95% confidence interval [CI] 1.43‐34.9, P = .007). A total of 59 episodes of pain were observed, including 47 acute and 12 chronic episodes. Lower limb pain accounted for 46% (27/59) of all episodes of pain, and was associated with primary tumour of the pelvis or lower extremity (OR 4.29, 95% CI 1.18‐18.21, P = .025), which represented 64% (51/80) of all EwS. The positive predictive value of pain for recurrence was only 12%.

Conclusion

Pain is a common problem in survivors of EwS, which mostly affects the lower extremity, and should be regularly assessed. Interventions to reduce pain may be particularly important in patients with combined local treatment with surgery and radiation, who seem to be at considerably increased risk for pain. Patients presenting with pain should be examined for recurrence.
Effect of cellulose acetate/cellulose triacetate ratio on reverse osmosis blend membrane performance
Authors: Elkony Yasmeen , Mansour El‐Sayed , Elhusseiny Amel , Ebrahim Shaker
Published: November 2020

Surface functionalization and modification including the grafting process are effective approaches to improve and enhance the reverse osmosis (RO) membrane performance. This work is aimed to synthesize grafted/crosslinked cellulose acetate (CA)/cellulose triacetate (CTA) blend RO membranes using N‐isopropylacrylamide (N‐IPAAm) as a monomer and N,N‐methylene bisacrylamide (MBAAm) as a crosslinker. The morphology of these membranes was analyzed by scanning electron microscopy and their surface roughness was characterized by atomic force microscopy. The performance of these membranes was evaluated through measuring two major parameters of salt rejection and water flux using RO unit at variable operating pressures. It was noted that the surface average roughness obviously decreased from 148 nm for the pure CA/CTA blend membrane with 2.5% CTA to 110 nm and 87 nm for the grafted N‐IPAAm and grafted/crosslinked N‐IPAAM/MBAAm/CA/CTA‐RO membranes, respectively. Moreover, the contact angle decreased from 51.98° to 47.6° and 43.8° after the grafting and crosslinking process. The salt rejection of the grafted CA/CTA‐RO membrane by 0.1% N‐IPAAm produced the highest value of 98.12% and the water flux was 3.29 L/m2h at 10 bar.
On the application of hole‐selective MoOx as full‐area rear contact for industrial scale p‐type c‐Si solar cells
Authors: Nasser Hisham , Es Fırat , Zolfaghari Borra Mona , Semiz Emel , Kökbudak Gamze , Orhan Efe , Turan Raşit
Published: November 2020

We present the feasibility of integrating substoichiometric molybdenum oxide (MoOx) as hole‐selective rear contact into the production sequence of industrial scale p‐type crystalline silicon (c‐Si) solar cells. Thin films of MoOx are deposited directly on p‐type c‐Si by thermal evaporation at room temperature. It is found that Ag/MoOx/p‐type c‐Si rear contact structure exhibits low contact resistivity and modest surface recombination current density. The attained peak efficiency (η) of the fabricated solar cells is 17.65% with Voc of 626 mV, Jsc of 36.8 mA/cm2, and fill factor (FF) of 76.63%. Next, a complete loss analysis of a MoOx/p‐type Si heterojunction solar cell is carried out for the first time by using Quokka simulation software that employs characteristics of different layers which constitute the fabricated solar cell. Based on this loss analysis, the dominant loss mechanisms are defined and a roadmap to attain the desired highest possible efficiency from industrial scale p‐type c‐Si solar cells with full‐area MoOx hole‐collecting rear contact is explored.