bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-cleaning filtration with magnetically controlled particles
Authors: Shorstkii I A
Published: March 2022

In this work, a new concept of dynamic granular bed was proposed based on magnetically controlled particles. Compared with conventional moving granular bed, a rotating granular layer was formed on dynamic granular bed, which can capture solid particulates. The dust cake can be kept at a certain amount of thickness even after long-term operation. Self-cleaning function of dynamic granular bed installation provides a long-term operation. Hence, the backwash process is not required in self-cleaning installation. Rotating magnetic field was used for granular bed formation with a predetermined porosity in this work. Mechanism of a dynamic granular bed formation described using experimental and visual surface layer data. Periodic working moving granular bed is then changed to continuous and steady working dynamic granular bed. Numerical data of the main filtration process showed a good agreement with experiment. The experimental results show that there exist optimal parameters of filtration superficial velocity and mass flow rate of filter granules for dynamic granular bed. Best efficiency obtained at a filtration superficial velocity of 0.03 m/s and a mass flow rate of 10 l/h for dynamic granular bed in the experiments.
Bandwidth of a 4.7 THz beam multiplexer based on Fourier grating
Authors: Gan Y , Mirzaei B , Silva J R G , Laauwen W , van der Tak F F S , Gao J R
Published: March 2022

We present an analysis of the bandwidth of an asymmetric 8-beam Fourier grating as the beam multiplexer for a 4.7 THz local oscillator used in a heterodyne receiver. We take the grating designed for NASA GUSTO balloon observatory as an example to address the bandwidth question although it does not need to operate over a wide frequency range. By illuminating the grating at different frequencies from 4.445 to 5.045 THz, we simulated the changes of its performance in three aspects using COMSOL Multiphysics: diffraction efficiency, power uniformity, and the angular distribution of the output beams. These parameters can affect the coupling efficiency between the output beams of the grating and the beams of a mixer array. The bandwidth of the grating is found to be 230 GHz, corresponding to 4.9% of the operating frequency, which is sufficient for many applications.
On-chip learning of a domain-wall-synapse-crossbar-array-based convolutional neural network
Authors: Desai Varun Bhavin , Kaushik Divya , Sharda Janak , Bhowmik Debanjan
Published: March 2022

Domain-wall-synapse-based crossbar arrays have been shown to be very efficient, in terms of speed and energy consumption, while implementing fully connected neural network algorithms for simple data-classification tasks, both in inference and on-chip-learning modes. But for more complex and realistic data-classification tasks, convolutional neural networks (CNN) need to be trained through such crossbar arrays. In this paper, we carry out device–circuit–system co-design and co-simulation of on-chip learning of a CNN using a domain-wall-synapse-based crossbar array. For this purpose, we use a combination of micromagnetic-physics-based synapse-device modeling, SPICE simulation of a crossbar-array circuit using such synapse devices, and system-level-coding using a high-level language. In our design, each synaptic weight of the convolutional kernel is considered to be of 15 bits; one domain-wall-synapse crossbar array is dedicated to the five least significant bits (LSBs), and two crossbar arrays are dedicated to the other bits. The crossbar arrays accelerate the matrix vector multiplication operation involved in the forward computation of the CNN. The synaptic weights of the LSB crossbar are updated after forward computation on every training sample, while the weights of the other crossbars are updated after forward computation on ten samples, to achieve on-chip learning. We report high classification-accuracy numbers for different machine-learning data sets using our method. We also carry out a study of how the classification accuracy of our designed CNN is affected by device-to-device variations, cycle-to-cycle variations, bit precision of the synaptic weights, and the frequency of weight updates.
Noggin proteins are multifunctional extracellular regulators of cell signaling
Authors: Karunaraj Prashath , Tidswell Olivia , Duncan Elizabeth J , Lovegrove Mackenzie R , Jefferies Grace , Johnson Travis K , Beck Caroline W , Dearden Peter K
Published: March 2022

Noggin is an extracellular cysteine knot protein that plays a crucial role in vertebrate dorsoventral patterning. Noggin binds and inhibits the activity of bone morphogenetic proteins via a conserved N-terminal clip domain. Noncanonical orthologs of Noggin that lack a clip domain (“Noggin-like” proteins) are encoded in many arthropod genomes and are thought to have evolved into receptor tyrosine kinase ligands that promote Torso/receptor tyrosine kinase signaling rather than inhibiting bone morphogenic protein signaling. Here, we examined the molecular function of noggin/noggin-like genes (ApNL1 and ApNL2) from the arthropod pea aphid using the dorso-ventral patterning of Xenopus and the terminal patterning system of Drosophila to identify whether these proteins function as bone morphogenic protein or receptor tyrosine kinase signaling regulators. Our findings reveal that ApNL1 from the pea aphid can regulate both bone morphogenic protein and receptor tyrosine kinase signaling pathways, and unexpectedly, that the clip domain is not essential for its antagonism of bone morphogenic protein signaling. Our findings indicate that ancestral noggin/noggin-like genes were multifunctional regulators of signaling that have specialized to regulate multiple cell signaling pathways during the evolution of animals.
Within-person Variation In Emotional Exhaustion Among Caregivers For Older Adults
Authors: Wakui Tomoko
Published: March 2022

Caregiving is everyday life for family members of older adults. Care recipients’ care requirements, service usage, and caregivers’ physical and emotional conditions differ day by day. Little is known how the differences and variances relate to informal caregivers’ mental health. This study aimed to examine informal caregivers’ day-to-day fluctuation in emotional exhaustion and discuss the within-person effects on mental health among informal caregivers. We developed the Caregiving Visualization Project toolkit (Care VIP), a software program for tracking on daily basis components of care experiences such as care task of Activity of Daily Living (ADL) and Instrumental Activity of Daily Living, service usages, and caregiving burden, as well as eight items of caregivers’ emotional exhaustion. We recruited study participants between May 2018 to March 2019 who provided instrumental help to community-dwelling older adults. A total of 75 participants, who accessed the Care VIP every day by using tablets or computers and completed a one-month study, were analyzed in this study. Females comprised 80.0%, and the average age of caregivers was 52.7 years (SD=9.1). The majority were those who provided care to parents (69.3%), and those who provided to parents-in-law and spouses were 16.0% and 5.3%, respectively. The average score of the eight items on the emotional exhaustion scale, with a 4-point Likert scale, was 23.4 (SD=4.9); however, each question showed different variations. Within-person effects on mental health among informal caregivers will be discussed.
Prolonged complete atrioventricular block due to neostigmine and amiodarone interaction in an amyloidosis patient with left main dissection and postoperative intestinal pseudo-obstruction
Authors: Kalogerakos Paris-Dimitrios , Lasithiotakis Konstantinos , Vernardos Michail , Lazopoulos Lambros , Koutsopoulos Anastasios , Lazopoulos George
Published: March 2022

Cardiac amyloidosis has been strongly associated with postoperative intractable circulatory failure, and intestinal amyloidosis could lead to intestinal pseudo-obstruction. The latter can be treated with neostigmine, which is notorious for its brief bradyarrhythmic complications. The amyloidosis patient presented herein, suffered an iatrogenic left main dissection, failure of bailout stenting and finally underwent urgent surgery. Meticulous fluid and drug management was key to keeping this patient stable. Postoperative atrial fibrillation was treated with amiodarone. The postoperative course was complicated with intestinal pseudo-obstruction, which was ultimately resolved with neostigmine. This short-lived cholinesterase inhibitor interacted with amiodarone and caused a previously undocumented prolonged complete atrioventricular block that resolved 48 hours after both drugs’ discontinuation. The neostigmine amiodarone interaction warrants clinical vigilance and is speculated to be due to their partially shared second messenger pathway involving cyclic adenosine monophosphate. Patients with cardiac amyloidosis could maintain hemodynamic stability perioperatively.
Characterization of the Level and Type of Resistance of Potato Varieties to Late Blight (Phytophthora infestans)
Authors: Abuley I. K. , Hansen J. G.
Published: March 2022

Understanding the level and type of resistance in potato varieties is relevant for integrating varietal resistance into the management of potato late blight. Accordingly, 54 potato varieties were tested for their level and type of resistance to late blight in 2019 and 2020 in Denmark. Spreader rows were artificially inoculated to ensure an even inoculum distribution in the trial. Disease severity was assessed once or twice per week. Cluster analysis (CA) was done based on the weighted mean absolute rate (WMAR), the relative area under the disease progress curve, the onset of disease (Xo), the severity of disease in the middle of the season, the time to reach 1% disease severity, the time to reach final disease severity, and the maximum disease severity. The resistance types were determined by comparing the tested varieties to Bintje (susceptible reference) for Xo and WMAR. The CA ranked the varieties as susceptible, moderately resistant, resistant, and very resistant based on their level of resistance. Except for a few varieties, the expressed resistance levels varied between the years. Several varieties that were susceptible in 2019 were moderately resistant in 2020. Also, the types of resistance that the varieties exhibited varied from year to year. In 2020, most varieties exhibited race-specific resistance, while in 2019 they mostly showed susceptible characteristics. The variation between years for the level and types of resistance of the varieties highlights the importance of regularly monitoring varietal resistance across time and space.
Symbiotic Fungi of an Ambrosia Beetle Alter the Volatile Bouquet of Cork Oak Seedlings
Authors: Nones Stefano , Sousa Edmundo , Holighaus Gerrit
Published: March 2022

In Portugal, fungal symbionts of the ambrosia beetle Platypus cylindrus affect tree vigor of cork oak (Quercus suber) and are linked with the cork oak decline process. Fungal symbionts play crucial roles in the life history of bark and ambrosia beetles and recent work indicates complex interactions on the fungal and plant metabolic level. Colonized trees may respond with an array of currently unknown volatile metabolites being indicative of such interactions, acting as infochemicals with their environment. In this study, we examined volatile organic compounds (VOCs) of cork oak seedlings wound inoculated with strains of three fungal associates of P. cylindrus (Raffaelea montetyi, R. quercina, and Ceratocystiopsis sp. nov.) over a 45-day period by means of thermodesorption gas chromatography-mass spectrometry techniques. Fungal strains induced largely quantitative but species-specific changes among the 58 VOCs characterized. Overall, monoterpenes—the major volatiles of cork oak foliage—were significantly reduced, possibly a result of fungal biotransformation. Acetophenone, sulcatone, and nonanal—volatiles known for mediating ambrosia beetle behavior—increased in response to fungal inoculation. Qualitative VOC profiles of excised tissue of wood lesions (21 VOCs) and pure fungal cultures (60 VOCs) showed little overlap with seedling VOCs, indicating their plant-derived but fungal-induced origin. This chemoecological study expands on the limited knowledge of VOCs as infochemicals emitted from oak trees threatened by oak decline in relation to beetle-vectored ophiostomatoid fungi. It opens new avenues of research to clarify mutualistic or pathogenic aspects of these complex symbiotic interactions and develop new control strategies for P. cylindrus, including its mycobiota.
Rising prevalence of renal calculi
Authors: Coffman Tammie J. , Boothe Amy , Watson Jeff
Published: March 2022

Severe pain and urinary tract obstruction are hallmarks of renal calculi often requiring hospitalization and treatment. Renal damage can occur without proper intervention. This article discusses the role of nurses in caring for patients with renal calculi, current treatment approaches, and prevention strategies.
How to identify predatory journals in a search
Authors: Oermann Marilyn H. , Nicoll Leslie H. , Carter-Templeton Heather , Owens Jacqueline K. , Wrigley Jordan , Ledbetter Leila S. , Chinn Peggy L.
Published: March 2022

Nursing journals offer important content on new practices and approaches to care. Unfortunately, predatory journals that use unsavory publication practices have emerged. This article shares guidance to help nurses effectively appraise information and their sources, distinguish predatory from legitimate journals, and conduct due diligence.
Study Level Meta-Analysis of Transcatheter Aortic Valve Implantation With the ACURATE neo Self-Expanding Transcatheter Heart Valve
Authors: Koliastasis Leonidas , Doundoulakis Ioannis , Kokkinidis Damianos G. , Milkas Anastasios , Kostopoulos Georgios , Drakopoulou Maria , Latsios Georgios , Synetos Andreas , Benetos Georgios , Lampropoulos Konstantinos , Economou Fotios , Tsioufis Konstantinos , Toutouzas Konstantinos
Published: March 2022

The ACURATE neo transcatheter aortic valve is a self-expanding device. Several studies have investigated safety and efficacy, but meta-analysis and pooled data are lacking. We aimed to provide a comprehensive systematic review and meta-analysis on the clinical outcomes of transcatheter aortic valve implantation with the ACURATE neo valve. A systematic literature search for eligible records was conducted. The primary endpoint was device success as designated by Valve Academic Research Consortium-2 criteria. The secondary endpoints (time frame: 30 days) were all-cause mortality, stroke, myocardial infarction, need for new permanent pacemaker, major vascular complications, major bleeding, acute kidney injury stage II or III, and paravalvular regurgitation grade moderate or severe (II or III). Our search yielded a total of 355 records, 20 of those (n = 5858 ACURATE neo receivers) were included in our meta-analysis. Device success was achieved in 94.5% (95% confidence interval [CI], 91.4–96.5%) of the patients. The 30-day all-cause mortality incidence proportion was 1.8% (95% CI, 1.3–2.4%). New pacemaker implantation was required in 7.7% (95% CI, 6.4–9.2%) of the patients, stroke occurred in 1.9% (95% CI, 1.6–2.3%), myocardial infarction in 0.5% (95% CI, 0.3–0.7%), major bleeding in 5.0% (95% CI, 3.9–6.5%), major vascular complication in 5.6% (95% CI, 4.0–7.8%), acute kidney injury stage ≥2 in 2.5% (95% CI, 1.8–3.4%), and paravalvular leak grade ≥moderate was observed in 4.3% (95% CI, 3.0–6.2%). Balloon predilatation and postdilatation incidence was 93.9% (95% CI, 87.0–97.3%) and 43.2% (95% CI, 37.9–48.6%), respectively. ACURATE neo appears to be safe and effective in our analysis with high device success incidence, low mortality, and low new pacemaker implantations.
Effect of a weekly functional independence measure scale on the recovery of patient with acute stroke
Authors: Kawamura Kenta , Murayama Kumi , Takamura Jumpei , Minegishi Shinobu
Published: March 2022

Excessive assistance may decrease stroke patients’ physical activity and make them more dependent on assistance. We have structured a system that provides an ADL (activities of daily living) educational program that focuses on stroke patients’ toileting in our daily clinical practice. Here, we investigated the effect of a functional independence measure (FIM) scale on the recovery of patients with acute stroke.

We retrospectively collected the data of 407 stroke patients from the medical record system of our emergency hospital in Tsukuba, Japan. The enrolled stroke patients (n = 373) were divided into FIM and control groups. Both groups received the standard treatment, but for the FIM group, ward and rehabilitation staff calculated the toilet FIM score for patients 1 ×/wk. The FIM scale measures the amount of assistance a patient needs to perform activities of daily living and is often used in rehabilitation settings. The rehabilitation staff then instructed the ward staff about better assistance methods based on each patient’s physical function and executive dysfunction. We evaluated the usefulness of the FIM scale was based on the patients’ FIM scores at discharge and improvements in their scores.

The recoveries of the total, motor, and cognitive FIM scores recovery at discharge were significantly greater in the FIM group compared with the control group (68.0 vs 45.0, P = .004; 41.0 vs 24.0, P = .005; and 24.0 vs 20.0, P = .007, respectively). The use of the FIM scale contributes to the patients’ recovery of physical function and cognitive function.

The FIM scale can contribute to stroke patients’ recovery of activities of daily living.
Extensive skull ossification after decompressive craniectomy in an elderly patient
Authors: Yang Huanhuan , Liang Man , Su Lijian
Published: March 2022

Rationale:

After severe traumatic brain injury, patients often present with signs of increased intracranial hypertension and partially require decompressive craniectomies. Artificial materials are usually required to repair skull defects and spontaneous skull ossification is rarely observed in adults.

Patient concerns:

This study reported a 64-year-old man was admitted to the hospital with a coma due to a traffic accident.

Diagnosis:

Emergency computed tomography (CT) examination upon admission showed a left temporo-occipital epidural hematoma with a cerebral hernia and skull fracture.

Interventions:

The patient underwent urgent craniotomy for hematoma removal and decompression under general anesthesia. The patient was discharged after 1 month of treatment.

Outcomes:

The patient returned to the hospital for skull repair 145 days after the craniotomy. Pre-operative CT showed island skull regeneration in the skull defect area; therefore, skull repair was postponed after clinical evaluation. Regular follow-up is required. Twenty-three months after surgery, head CT showed that the new skull had completely covered the defect area.

Lesson:

We collected other 11 similar cases of spontaneous human skull regeneration in a literature search to analyze the possible factors impacting skull regeneration. The analysis of the cases indicated that maintaining the integrity of the periosteum, dura, and blood vessels during craniotomy may play an important role in skull regeneration. Skull regeneration predominantly occurs in young patients with rapid growth and development; therefore, an appropriate postponement of the cranioplasty time under close monitoring could be considered for young patients with skull defects.
Development and external validation of a nomogram with inflammatory markers for predicting invasiveness of intraductal papillary mucinous neoplasm of pancreas
Authors: Yoon So Jeong , Kim Hongbeom , Lee Okjoo , Jung Ji Hye , Lim Chang-Sup , Shin Yong Chan , Kwon Wooil , Jang Jin-Young , Shin Sang Hyun , Heo Jin Seok , Han In Woong
Published: March 2022

Recent studies have reported that inflammatory markers, such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and advanced lung cancer inflammation index, are associated with invasiveness of intraductal papillary mucinous neoplasm (IPMN). This study aimed to develop and validate a new nomogram that includes inflammatory markers for predicting the invasiveness of IPMN.

The data of 365 patients who underwent surgical resection for IPMN at 4 centers between 1995 and 2016 were retrospectively reviewed to develop a new nomogram. For external validation, a separate patient cohort was used. The predictive ability of the nomogram was evaluated using the area under the receiver operating characteristic curve.

The new nomogram was developed using the following variables which were identified as risk factors for invasive IPMN: body mass index, preoperative serum bilirubin level, carbohydrate antigen 19-9, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, advanced lung cancer inflammation index, main duct type, presence of solid portion, and tumor size. After external validation, the area under the curve value was 0.649 (95% CI: 0.578-0.720, P < .001).

To the best of our knowledge, this study is the first to predict and externally validate the invasiveness in IPMN using inflammatory markers. Further research is necessary to improve predictability of the model for selecting patients for surgical resection.
Effect of Pei Yuan Tong Nao capsules on cerebral infarction
Authors: Chen Wangkun , Yu Junchi , Li Suting
Published: March 2022

Background:

Pei Yuan Tong Nao (PYTN) capsules has been widely used for the treatment of cerebrovascular disease, including cerebral infarction. However, the mechanisms of action of PYTN capsule on cerebral infarction are ambiguous and unclear. We conducted a protocol for systematic review and meta-analysis to evaluate the efficacy and safety of PYTN capsules for the treatment of cerebral infarction.

Methods:

A comprehensive search of several databases from 1966 to February 2022 will be conducted. The databases includes Ovid Medline In-Process & Other NonIndexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Two authors independently performed the literature searching, data extraction, and quality evaluation. The risk of bias in each included study will be assessed utilizing the Cochrane Collaboration’s risk of bias tool. The Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) will be used to analyze the data.

Result:

A synthesis of current evidence of PYTN capsules for cerebral infarction will be provided in this protocol.

Conclusion:

This review will provide more reliable references to help clinicians make decisions when dealing with cerebral infarction.
Late-onset posttransplant Epstein-Barr virusrelated lymphoproliferative disease after cord blood transplantation for chronic active Epstein Barr virus infection
Authors: Yamamoto Masayo , Shindo Motohiro , Funayama Takuya , Sumi Chihiro , Saito Takeshi , Toki Yasumichi , Hatayama Mayumi , Imadome Ken-Ichi , Mizukami Yusuke , Okumura Toshikatsu
Published: March 2022

Introduction:

Posttransplant lymphoproliferative disease (PTLD) is a critical complication of hematopoietic stem cell transplantation (HSCT). PTLD is classified into early and late-onset PTLDs. In post-HSCT patients, late-onset PTLD is rare, particularly PTLD after HSCT for Epstein-Barr virus (EBV)-related lymphoproliferative disease. Here, we report the case of a patient diagnosed with late-onset EBV-related hemophagocytic lymphohistiocytosis (HLH), that of PTLD, after HSCT for chronic active EBV infection (CAEBV), that of EBV related lymphoproliferative disease, probably because of EBV reactivation.

Patient concerns and diagnosis:

A 22-year-old woman with abdominal fullness visited our hospital. Blood examination showed pancytopenia with atypical lymphocytes, liver dysfunction, and elevated lactate dehydrogenase level. In contrast, bone marrow aspiration showed slight hemophagocytosis with increased natural-killer cells (NK cells). As serum antibodies against EBV were atypical, we calculated the EBV-DNA level in peripheral blood and this level was significantly high. EBV was infected with NK cells, and EBV's monoclonality in NK cells was confirmed. Thus, the patient was diagnosed with CAEBV

Interventions and outcomes:

The patient received chemotherapy and cord blood cell transplantation (CBT); CAEBV was well controlled. Approximately 6years from CBT for CAEBV, she visited our hospital because of fever. Blood examination revealed pancytopenia with atypical lymphocytes, liver dysfunction, and elevated lactate dehydrogenase level. In contrast, bone marrow aspiration showed hemophagocytosis with increased B and T cell counts without increased NK cell count. Additionally, serum antibody titers against EBV were atypical, and the EBV-DNA level in the peripheral blood was high. EBV was infected with only B cells, and EBV's monoclonality was confirmed. A more detailed analysis indicated that EBV-specific cytotoxic T lymphocytes were inactive. Therefore, she was diagnosed with late-onset EBV-related HLH. She received extensive treatment, but EBV-related HLH did not improve. Finally, she died about 3 weeks after diagnosis.

Conclusion:

PTLD, including HLH, is a life-threatening complication after transplantation, including HSCT. To our knowledge, this is the first case of late-onset EBV-related HLH after CBT for CAEBV. Late-onset PTLD has an indolent clinical course, but our patient's disease course was extremely aggressive. Therefore, late-onset EBV-related PTLD may be life-threatening.
Evaluation of clinical safety and efficacy of left bundle branch area pacing in comparison with right ventricular septal pacing
Authors: Liu Xing , Li Wenbin , Zeng Jianping , Huang He , Wang Lei , Tian Shaohua , Wu Mingxing
Published: March 2022

Left bundle branch area pacing (LBBaP) has recently emerged as a new physiological pacing strategy. The purpose of this study is to compare LBBaP with right ventricular sepal pacing (RVSP) in terms of their clinical safety and efficacy.

From February 2019 to May 2020, consecutive pacing-indicated patients were prospectively enrolled and divided into 2 groups. Ventricular synchrony indexes such as QRS duration (QRSd), interventricular mechanical delay and septal-posterior wall motion delay, left ventricular function such as left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF), pacing parameters, and complications were evaluated in the perioperative period and during follow-up.

LBBaP was successful in 45 patients (88.2%), and finally 46 patients underwent RVSP. With LBBaP, ventricular electricalmechanical synchrony were similar to those of native-conduction system (P = .78). However, the ventricular electrical synchrony (QRSd, 108.47±7.64 vs 130.63±13.63ms, P < .001) and mechanical synchrony (interventricular mechanical delay, 27.68±4.33 vs 39.88±5.83, P < .001; septal-posterior wall motion delay, 40.39±23.21 vs 96.36±11.55, P < .001) in the LBBaP group were significantly better than those in the RVSP group. No significant differences in LVEDD (46 [44-48.5] vs 47 [44-52] mm, P = .49) and LVEF% (66 [62.5-70] vs 64 [61-68], P = .76) was observed between 2 groups at last follow-up. But, in the subgroup analysis, LVEDD was shorter (46 [44-49] vs 50 [47-58] mm, P = .03) and the LVEF% was higher (65 [62-68] vs 63 [58-65], P = .02) in the LBBaP-H (high ventricular pacing ratio >40%) group compared with RVSP-H group at last follow-up. There were lower capture thresholds (0.59±0.18V vs 0.71 ± 0.26 V, P = 0.01) at implantation in the LBBaP group than those in the RVSP group, with R-wave amplitudes and pacing impedances showing no significant difference between 2 groups. No serious complications were found in both 2 groups at implantation and follow-ups.

This study confirms the clinical safety and efficacy of LBBaP, and it produces better ventricular electrical-mechanical synchrony than RVSP. The event of pacing-induced left ventricular dysfunction is lower in the LBBaP-H group than RVSP-H group.
How to manage falls in hospitalized patients
Authors: Cioce Marco , Lohmeyer Franziska Michaela , Botti Stefano , Rostagno Elena , Orlando Laura , Vetrugno Giuseppe , Oppedisano Paolo , Zega Maurizio , Sica Simona , Valerio De Stefano , Bacigalupo Andrea , Fiore Alberto
Published: March 2022

In allogeneic hematopoietic stem cell transplantation (AHSCT), falls can lead to immediate and late consequences and in some cases to death. We analyzed risks and causes of falls with root cause analysis (RCA) based on which improvement interventions were implemented.

A retrospective observational study was conducted to analyze with RCA data of incidence reports and medical records of patients admitted; an expert panel identified actions to prevent falls, which were collected in a checklist.

Between December 2017 and November 2019, 214 patients were admitted to ordinary hospital stays for AHSCT or AHSCTrelated complications. In this period, 15 falls, involving 11 patients, occurred resulting in a 2.32 d/patient incidence. In 66.67% of cases minor head trauma occurred. Diuretic drugs (93.33%), induced hyper-diuresis in nonbladder catheter patients (93.33%) and antihypertensive drugs (93.33%) were reported as most common cause in our incident reports. The most frequent fall time slot was between 10 PM and 7 AM (60%). We determined with RCA diuretics and consequent induced hyper-diuresis (80%), self-insufficiency (40%), antihypertensive (33.3%) and noncompliance (33.3%) as the most common cause of falls. Finally, 16 actions, collected in a “safe comfort” checklist, were identified to prevent falls.

Diuretic drugs inducing hyper-diuresis, self-insufficiency, poor patient compliance, orthostatic hypotension, fever, night-time and obstacles within inpatient units are the most common contributing factors. Therefore, administration of diuretic and antihypertensive drugs should be rescheduled and a multidimensional risk assessment scale integrated with a preventive action plan, such as the safe comfort checklist, should be implemented to reduce falls.
Spontaneous Uterine Vessel Rupture During Pregnancy or in the Puerperium: A Review of the Literature
Authors: Mercier Ann Marie , Caldwell Madison G. , Rabie Nader Z. , Pagan Megan , Ramseyer Abigail M. , Magann Everett F.
Published: March 2022

Importance

Spontaneous perinatal rupture of a uterine vessel is a rare occurrence that may lead to severe hemorrhage and requires prompt identification and management.

Objective

The aim of this study was to examine the etiologies, locations, diagnostic tools, treatment options, and risks in subsequent pregnancies when spontaneous rupture of a uterine vessel occurs in pregnancy.

Evidence Acquisition

A literature search was performed by university research librarians using the PubMed, CINAHL, and Web of Science search engines. Identified were 78 cases of perinatal spontaneous uterine vessel rupture and formed the basis for this review.

Results

Increased uterine blood flow during pregnancy may alter the integrity of pelvic vessels leading to increased risk of spontaneous rupture. The uterine artery is the most common site of vessel rupture; the second most common site is the uterine-ovarian plexus. The most common presentation is abdominal or pelvic pain, maternal vital sign abnormalities, and an absence of vaginal bleeding. Exploratory laparotomy and embolization (interventional radiology) have been reported as management options.

Conclusions

Spontaneous rupture of uterine vessels is a rare but potentially life-threatening complication of pregnancy that should be included in the differential diagnosis of pregnant patients presenting with an acute abdomen.

Relevance

Our aim is to increase the awareness of spontaneous vessel rupture during pregnancy to improve detection, management, and perinatal outcomes.

Target Audience

Obstetrician-gynecologists, radiologists, family medicine physicians

Learning Objectives

After completing this CME activity, participants should be better able to describe spontaneous uterine vessel rupture; identify its risk factors and presenting symptoms; and explain preferred diagnostic imaging modalities, management options, and possible complications in future pregnancies.
Antipsychotic prescription patterns and associated factors among the elderly with psychiatric illnesses
Authors: Cheng Shu-Wen , Lu Chao-Wei , Chan Hung-Yu , Chen Jiahn-Jyh , Hsu Chun-Chi
Published: March 2022

Prescribing rate of antipsychotics in elderly patients with psychiatric illnesses has been increasing all over the world. However, there is a lack of research examining the use of antipsychotics at psychiatric hospitals. We aim to find out long-term trends in antipsychotic prescriptions and factors associated with the use of antipsychotics in the elderly population. All outpatient visits with patients aged over 65 years between 2006 and 2015 in a psychiatric hospital were included in the analysis. Demographic and clinical data, including patient age, sex, National Health Insurance status, psychiatric diagnosis and antipsychotic prescription, were retrieved through the electronic medical information system. In this study, we found that prescribing rate of antipsychotics has increased around 5.07% through the study period (from 57.25% in 2006 to 60.15% in 2015, P < 0.001). Among all antipsychotics, there was an increase in the use of second-generation antipsychotics with a simultaneous decline in the use of first-generation antipsychotics. Logistic regression analysis showed advanced age, female gender and certification for catastrophic illnesses were positively associated with the use of antipsychotics. Furthermore, patients most likely to be prescribed an antipsychotic were those with psychotic disorders, followed by dementia, and then affective or neurotic disorders. The results of this study were consistent with the worldwide trend of increasing prescriptions of second-generation antipsychotics among elderly patients with psychiatric illnesses. Despite the potential benefits of these medications on certain psychiatric symptoms, clinicians need to exercise due caution as they may also cause potentially serious side effects among the elderly population.
Differences in transcriptional response underlie why prior vaccination exceeds prior infection in eliciting robust immune responses in Omicron infected outpatients
Authors: Lee Hye Kyung , Knabl Ludwig , Walter Mary , Knabl Ludwig , Dai Yuhai , Füßl Magdalena , Caf Yasemin , Jeller Claudia , Knabl Philipp , Obermoser Martina , Baurecht Christof , Kaiser Norbert , Zabernigg August , Wurdinger Gernot M. , Furth Priscilla A. , Hennighausen Lothar
Published: March 2022

Antibody response following Omicron infection is reported to be less robust than that to other variants. Here we investigated how prior vaccination and/or prior infection modulates that response. Disease severity, antibody responses and immune transcriptomes were characterized in four groups of Omicron-infected outpatients (n=83): unvaccinated/no prior infection, vaccinated/no prior infection, unvaccinated/prior infection and vaccinated/prior infection. The percentage of patients with asymptomatic or mild disease was highest in the vaccinated/no prior infection group (87%) and lowest in the unvaccinated/no prior infection group (47%). Significant anti-Omicron spike antibody levels and neutralizing activity were detected in the vaccinated group immediately after infection but were not present in the unvaccinated/no prior infection group. Within two weeks, antibody levels against Omicron, increased. Omicron neutralizing activity in the vaccinated group exceeded that of the prior infection group. No increase in neutralizing activity in the unvaccinated/no prior infection group was seen. The unvaccinated/prior infection group showed an intermediate response. We then investigated the early transcriptomic response following Omicron infection in these outpatient populations and compared it to that found in unvaccinated hospitalized patients with Alpha infection. Omicron infected patients showed a gradient of transcriptional response dependent upon prior vaccination and infection status that correlated with disease severity. Vaccinated patients showed a significantly blunted interferon response as compared to both unvaccinated Omicron infected outpatients and unvaccinated Alpha infected hospitalized patients typified by the response of specific gene classes such as OAS and IFIT that control anti-viral responses and IFI27, a predictor of disease outcome.
Persistent health issues, adverse events of significant concern, and effectiveness of COVID-19 vaccination- findings from a real-world cohort study of healthcare workers in north India
Authors: Kaur Upinder , Bala Sapna , Joshi Aditi , Srija Reddy Noti Taruni , Chetan  , Chauhan Mayank , Pedapanga Nikitha , Kumar Shubham , Mukherjee Anurup , Mishra Vaibhav , Talda Dolly , Singh Rohit , Gupta Rohit Kumar , Yadav Ashish Kumar , Rana Poonam Jyoti , Srivastava Jyoti , Bhat K Shobha , Singh Anup , PG Naveen Kumar , Pandey Manoj , Patwardhan Kishor , Kansal Sangeeta , Chakrabarti Sankha Shubhra
Published: March 2022

Background

There is paucity of real-world data on COVID-19 vaccine effectiveness and safety from cohort designs. The current study aimed to evaluate vaccine performance during second wave in India. It also aimed to determine adverse events of significant concern (AESCs), and to ascertain the effect of vaccination on persistent health issues in individuals post COVID-19.

Methods

A cohort study was conducted from July-2021 to December-2021 in a tertiary hospital of north India. The primary outcome was vaccine-effectiveness against COVID-19. Secondary outcomes were AESCs, and persistent health issues in those receiving vaccine. Regression analyses were performed to determine risk factors.

Results

In 2760 healthcare workers (HCWs) included, 1033 COVID-19 events were reported. Around 6-17% vaccine effectiveness was observed against COVID-19 occurrence. One dose-recipients were at 1.6-times increased risk of COVID-19. Prior SARS-CoV-2 infection was a strong independent protective factor against COVID-19 (aOR 0.66). Full vaccination reduced moderate-severe COVID-19 by 57%. Those with lung disease were at 2.5-times increased risk of moderate-severe COVID-19. AESCs were observed in 1.3% including one case each of myocarditis and severe hypersensitivity. Individuals with hypothyroidism were at 5-times and those receiving vaccine after recovery from COVID-19 were at 3-times higher risk of persistent health issues.

Conclusion

COVID-19 vaccination reduced COVID-19 severity but offered marginal protection against occurrence. Relationship of asthma and hypothyroidism with COVID-19 outcomes necessitates focused research. Independent protection of prior SARS-CoV-2 infection was high and persistent health issues were common in individuals receiving vaccine post COVID-19. Recommendations of vaccinating those recovered from COVID-19 need further studies.
Mechanistic models of Rift Valley fever virus transmission dynamics: A systematic review
Authors: Cecilia Hélène , Drouin Alex , Métras Raphaëlle , Balenghien Thomas , Durand Benoit , Chevalier Véronique , Ezanno Pauline
Published: March 2022

Rift Valley fever (RVF) is a zoonotic arbovirosis which has been reported across Africa including the northernmost edge, South West Indian Ocean islands, and the Arabian Peninsula. The virus is responsible for high abortion rates and mortality in young ruminants, with economic impacts in affected countries. To this day, RVF epidemiological mechanisms are not fully understood, due to the multiplicity of implicated vertebrate hosts, vectors and ecosystems. In this context, mathematical models are useful tools to develop our understanding of complex systems, and mechanistic models are particularly suited to data-scarce settings. In this work, we performed a systematic review of mechanistic models studying RVF, to explore their diversity and their contribution to the understanding of this disease epidemiology. Researching Pubmed and Scopus databases (October 2021), we eventually selected 48 papers, which needed to provide a clear description of a mechanistic model with numerical application to RVF. We categorized models as theoretical, applied or grey, according to their will to represent a specific geographical context and their use of data to fulfill this intention. We discussed their contributions to the understanding of RVF epidemiology, and highlighted that theoretical and applied models can use different tools to meet common objectives. Through the examination of model features, we identified research questions left unexplored across scales, along with a substantial lack of justification when choosing a functional form for the force of infection. Overall, we showed a great diversity in RVF models, leading to substantial progress in our comprehension of epidemiological mechanisms. To go further, data gaps must be fulfilled, and modelers need to go the extra mile regarding transparency.

Authors summary

Rift Valley fever (RVF) affects humans and livestock across Africa, South West Indian Ocean islands, and in the Arabian Peninsula. This disease is one of the World Health Organization priorities, and is caused by a virus transmitted by Aedes and Culex spp. mosquitoes, but also directly from livestock to humans. Mathematical models have been used in the last 20 years to disentangle RVF virus transmission dynamics. These models can further our understanding of processes driving outbreaks, test the efficiency of control strategies, or even anticipate possible emergence. Provided with detailed datasets, models can tailor their conclusions to specific geographical contexts and aid in decision-making in the field. This review provides a general overview of mathematical models developed to study RVF virus transmission dynamics. We describe their main results and methodological choices, and identify hurdles to be lifted. To offer innovative animal and public health value, we recommend that future models focus on the relative contribution of host species to transmission, and the role of animal mobility.
Unravelling the link between sleep and mental health during the COVID-19 pandemic
Authors: González-Hijón Juan , Kähler Anna K. , Frans Emma M. , Valdimarsdóttir Unnur A. , Sullivan Patrick F. , Fang Fang , Lovik Anikó
Published: March 2022

Background

The emergence of COVID-19 brought unparalleled changes in people’s lifestyle, including sleep. We aimed to assess the bidirectional association between sleep quality and mental health and describe how sleep and mental health were affected in Sweden during the COVID-19 pandemic (between June 2020 and September 2021).

Methods

Data were obtained from the Omtanke2020 study. Participants who completed the baseline survey and 8 monthly follow-up surveys were included (N=9035). We described the distribution of sleep and mental health in the different Swedish regions using maps and over the study period with longitudinal graphs adjusting for sex, age, recruitment type (self-recruitment or invitation), and COVID-19 status. The inner relationships between mental health, sleep and covid infection were described through relative importance networks. Finally, we modelled how mental health affects sleep and vice versa using generalized estimating equations with different adjustments.

Results

Seasonal and north-south regional variations were found in sleep and mental health outcomes at baseline and attenuated over time. The seasonal variation of sleep and mental health correlated moderately with the incidence rate of COVID-19 in the sample. Networks indicate that the relationship between COVID-19 incidence and mental health varies over time. We observed a bidirectional relationship between sleep quality and quantity at baseline and mental health at follow-up and vice versa.

Conclusion

Sleep quality and quantity at baseline was associated with adverse symptom trajectories of mental health at follow-up, and vice versa, during the COVID-19 pandemic. There is also a weak relationship between COVID-19 incidence, sleep, and mental health.
SARS-CoV-2 spike-binding antibody longevity and protection from re-infection with antigenically similar SARS-CoV-2 variants
Authors: Kubale John , Gleason Charles , Carreño Juan Manuel , Srivastava Komal ,   PARIS Study Team, Gordon Aubree , Krammer Florian , Simon Viviana
Published: March 2022

Abstract

The PARIS (Protection Associated with Rapid Immunity to SARS-CoV-2) cohort follows health care workers with and without documented coronavirus disease 2019 (COVID-19) since April 2020. We report our findings regarding SARS-CoV-2 spike binding antibody stability and protection from infection in the pre-variant era. We analyzed data from 400 healthcare workers (150 seropositive and 250 seronegative at enrollment) for a median of 84 days. The SARS-CoV-2 spike binding antibody titers were highly variable with antibody levels decreasing over the first three months, followed by a relative stabilization. We found that both more advanced age (>40 years) and female sex were associated with higher antibody levels (1.6-fold and 1.4-fold increases, respectively). Only six percent of the initially seropositive participants “seroreverted”. We documented a total of 11 new SARS-CoV-2 infections (ten naïve participants, one previously infected participant without detectable antibodies, p<0.01) indicating that spike antibodies limit the risk of re-infection. These observations, however, only apply to SARS-CoV-2 variants antigenically similar to the ancestral SARS-CoV-2 ones. In conclusion, SARS-CoV-2 antibody titers mounted upon infection are stable over several months in most people and provide protection from infection with antigenically similar viruses.

summary

The levels of SARS-CoV-2 spike binding antibodies mounted upon infection with ancestral SARS-CoV-2 variants are highly variable, stabilize at an individual level after three months and provide protection from infection with homologous virus.
HIV co-infection is associated with lower tuberculosis bacterial burden independent of time to diagnosis in Botswana, a setting with widespread ART use
Authors: Chalfin Juliana S. , Baker Chelsea R. , Kizito Balladiah , Otukile Dimpho , Ogopotse Matsiri T. , Shin Sanghyuk S. , Modongo Chawangwa
Published: March 2022

HIV co-infection has been shown to be associated with lower tuberculosis (TB) bacterial load in studies conducted prior to widespread availability of antiretroviral therapy (ART). We investigated associations between HIV co-infection and TB bacterial load, accounting for differences in time to TB diagnosis, in a high prevalence setting with widespread ART use. In Gaborone, Botswana, 268 sputum samples from people with newly diagnosed TB were tested with Xpert MTB/RIF Ultra (Xpert). TB bacterial load and time to TB diagnosis were estimated using mean Xpert cycle threshold (CT) and symptom duration, respectively. Multiple linear regression models and causal mediation analysis were used to determine the associations between HIV and Xpert CT and assess the mediating effect of symptom duration. Mean CT values were higher in people living with HIV compared to people without HIV (22.7 vs 20.3, p < 0.001). Among those living with HIV, there was a negative relationship between CD4 count and mean CT value (Spearman’s rho -0.20, p = 0.06). After controlling for gender, age, and symptom duration, HIV status remained associated with CT value, with an average increase of 1.6 cycles (p = 0.009) among people with HIV and CD4 count > 200 cells/mm3and 2.1 cycles (p = 0.002) in those with a CD4 count ≤ 200 cells/mm3compared to individuals without HIV. Symptom duration was also found to be associated with CT value (p < 0.05). We found an indirect effect of HIV status on Xpert CT through the mediator, symptom duration (β = 0.33, p = 0.048), accounting for 13.5% of the relationship. Our findings suggest that time to TB diagnosis partially mediates the relationship between HIV status and CT value, but differences in pathophysiology between people with and without HIV likely play a dominant role in affecting TB bacterial burden.