bluuebunny/crossref_metadata_2025 huggingface dataset:
Political (Over)Representation of Public Sector Employees and the Double-Motive Hypothesis: Evidence from Norwegian Register Data (2007–2019)
Authors: Geys Benny , Murdoch Zuzana , Sørensen Rune J
Published: September 2021

Countries have widely diverging regulations regarding the eligibility of public sector employees for political office, and the stringency of such regulations remains fiercely debated. Building on a demand and supply model of political selection, this article contributes to such debates by studying whether and how the incentives of public employees as both consumers and producers of public services (their “double motive”) affects their descriptive political representation. Our analysis employs population-wide individual-level register data covering four Norwegian local elections between 2007 and 2019 (N > 13 million observations). Using predominantly individual-level panel regression models, we find that public employees are strongly overrepresented on election lists and have a higher probability of election (conditional on running). Looking at underlying mechanisms, we provide evidence consistent with the “double motive” of public employees inducing their self-selection into standing for elected office (at higher-ranked ballot positions). Demand-side effects deriving from party and voter selection receive more limited empirical support. We discuss ensuing concerns about the potential substantive representation of policy self-interests by elected public employees.
Quiescent galaxies in a virialized cluster at redshift 2: evidence for accelerated size growth
Authors: Noordeh E , Canning R E A , Willis J P , Allen S W , Mantz A , Stanford S A , Brammer G
Published: September 2021

We present an analysis of the galaxy population in XLSSC 122, an X-ray-selected, virialized cluster at redshift z = 1.98. We utilize Hubble Space Telescope (HST)Wide Field Camera 3 (WFC3) photometry to characterize the activity and morphology of spectroscopically confirmed cluster members. The quiescent fraction is found to be $88^{+4}_{-20}$ per cent within 0.5r500, significantly enhanced over the field value of $20^{+2}_{-2}$ per cent at z ∼ 2. We find an excess of ‘bulge-like’ quiescent cluster members with Sérsic index n > 2 relative to the field. These galaxies are found to be larger than their field counterparts at 99.6 per cent confidence, being on average $63^{+31}_{-24}$ per cent larger at a fixed mass of $M_\star = 5\times 10^{10} \, \mathrm{M}_\odot$. This suggests that these cluster member galaxies have experienced an accelerated size evolution relative to the field at z > 2. We discuss minor mergers as a possible mechanism underlying this disproportionate size growth.
Radiation GRMHD simulations of M87: funnel properties and prospects for gap acceleration
Authors: Yao Philippe Z , Dexter Jason , Chen Alexander Y , Ryan Benjamin R , Wong George N
Published: September 2021

We use the public code ebhlight to carry out 3D radiative general relativistic magnetohydrodynamics (GRMHD) simulations of accretion on to the supermassive black hole in M87. The simulations self-consistently evolve a frequency-dependent Monte Carlo description of the radiation field produced by the accretion flow. We explore two limits of accumulated magnetic flux at the black hole (SANE and MAD), each coupled to several subgrid prescriptions for electron heating that are motivated by models of turbulence and magnetic reconnection. We present convergence studies for the radiation field and study its properties. We find that the near-horizon photon energy density is an order of magnitude higher than is predicted by simple isotropic estimates from the observed luminosity. The radially dependent photon momentum distribution is anisotropic and can be modeled by a set of point-sources near the equatorial plane. We draw properties of the radiation and magnetic field from the simulation and feed them into an analytic model of gap acceleration to estimate the very high energy (VHE) γ-ray luminosity from the magnetized jet funnel, assuming that a gap is able to form. We find luminosities of $\rm \sim 10^{41} \, erg \, s^{-1}$ for MAD models and $\rm \sim 2\times 10^{40} \, erg \, s^{-1}$ for SANE models, which are comparable to measurements of M87’s VHE flares. The time-dependence seen in our calculations is insufficient to explain the flaring behaviour. Our results provide a step towards bridging theoretical models of near-horizon properties seen in black hole images with the VHE activity of M87.
Cosmography using strong-lensing systems and cosmic chronometers
Authors: Lizardo Andrés , Amante Mario H , García-Aspeitia Miguel A , Magaña Juan , Motta V
Published: September 2021

Using a new sub-sample of observed strong gravitational lens systems, for the first time, we present the equation for the angular diameter distance in the y-redshift scenario for cosmography and use it to test the cosmographic parameters. In addition, we also use the observational Hubble data from cosmic chronometers and a joint analysis of both data are performed. Among the most important conclusions are that this new analysis for cosmography using strong-lensing systems (SLSs) is equally competitive to constrain the cosmographic parameters as others presented in literature. Additionally, we present the reconstruction of the effective equation of state inferred from our samples, showing that at z = 0 those reconstructions from SLSs and joint analysis are in concordance with the standard model of cosmology.
General relativistic MHD simulations of non-thermal flaring in Sagittarius A*
Authors: Chatterjee K , Markoff S , Neilsen J , Younsi Z , Witzel G , Tchekhovskoy A , Yoon D , Ingram A , van der Klis M , Boyce H , Do T , Haggard D , Nowak M A
Published: September 2021

Sgr A* exhibits regular variability in its multiwavelength emission, including daily X-ray flares and roughly continuous near-infrared (NIR) flickering. The origin of this variability is still ambiguous since both inverse Compton and synchrotron emission are possible radiative mechanisms. The underlying particle distributions are also not well constrained, particularly the non-thermal contribution. In this work, we employ the GPU-accelerated general relativistic magnetohydrodynamics code H-AMR to perform a study of flare flux distributions, including the effect of particle acceleration for the first time in high-resolution 3D simulations of Sgr A*. For the particle acceleration, we use the general relativistic ray-tracing code bhoss to perform the radiative transfer, assuming a hybrid thermal+non-thermal electron energy distribution. We extract ∼60 h light curves in the sub-millimetre, NIR and X-ray wavebands, and compare the power spectra and the cumulative flux distributions of the light curves to statistical descriptions for Sgr A* flares. Our results indicate that non-thermal populations of electrons arising from turbulence-driven reconnection in weakly magnetized accretion flows lead to moderate NIR and X-ray flares and reasonably describe the X-ray flux distribution while fulfilling multiwavelength flux constraints. These models exhibit high rms per cent amplitudes, $\gtrsim 150{{\ \rm per\ cent}}$ both in the NIR and the X-rays, with changes in the accretion rate driving the 230 GHz flux variability, in agreement with Sgr A* observations.
Cluster assembly times as a cosmological test
Authors: Amoura Yuba , Drakos Nicole E , Berrouet Anael , Taylor James E
Published: September 2021

The abundance of galaxy clusters in the low-redshift Universe provides an important cosmological test, constraining a product of the initial amplitude of fluctuations and the amount by which they have grown since early times. The degeneracy of the test with respect to these two factors remains a limitation of abundance studies. Clusters will have different mean assembly times, however, depending on the relative importance of initial fluctuation amplitude and subsequent growth. Thus, structural probes of cluster age such as concentration, shape, or substructure may provide a new cosmological test that breaks the main degeneracy in number counts. We review analytical predictions for how mean assembly time should depend on cosmological parameters, and test these predictions using cosmological simulations. Given the overall sensitivity expected, we estimate the cosmological parameter constraints that could be derived from the cluster catalogues of forthcoming surveys such as Euclid, the Nancy Grace Roman Space Telescope, eROSITA, or CMB-S4. We show that by considering the structural properties of their cluster samples, such surveys could easily achieve errors of Δσ8 = 0.01 or better.
Timing observations of three Galactic millisecond pulsars
Authors: Lorimer D R , Kawash A M , Freire P C C , Smith D A , Kerr M , McLaughlin M A , Mickaliger M B , Spiewak R , Bailes M , Barr E , Burgay M , Cameron A D , Camilo F , Johnston S , Jankowski F , Keane E F , Keith M , Kramer M , Possenti A
Published: September 2021

We report observed and derived timing parameters for three millisecond pulsars (MSPs) from observations collected with the Parkes 64-m telescope, Murriyang. The pulsars were found during reprocessing of archival survey data by Mickaliger et al. One of the new pulsars (PSR J1546–5925) has a spin period P = 7.8 ms and is isolated. The other two (PSR J0921–5202 with P = 9.7 ms and PSR J1146–6610 with P = 3.7 ms) are in binary systems around low-mass (${\gt}0.2\, {\rm M}_{\odot }$) companions. Their respective orbital periods are 38.2 and 62.8 d. While PSR J0921–5202 has a low orbital eccentricity e = 1.3 × 10−5, in keeping with many other Galactic MSPs, PSR J1146–6610 has a significantly larger eccentricity, e = 7.4 × 10−3. This makes it a likely member of a group of eccentric MSP–helium white dwarf binary systems in the Galactic disc whose formation is poorly understood. Two of the pulsars are co-located with previously unidentified point sources discovered with the Fermi satellite’s Large Area Telescope, but no γ-ray pulsations have been detected, likely due to their low spin-down powers. We also show that, particularly in terms of orbital diversity, the current sample of MSPs is far from complete and is subject to a number of selection biases.
Combined lensed estimator to probe the post-reionization H i power spectrum
Authors: Arora Urvashi , Dutta Prasun
Published: September 2021

In the post-reionization era, the baryons assembled into the protogalaxies and eventually the present population of the galaxies evolved through merger and evolution. In this work, we discuss a possible probe of the statistical distribution and evolution of the H i density in the post-reionization era. We introduce an estimator of the H i power spectrum from the post-reionization Universe by observing it through the strong gravitational lenses by the nearby galaxy cluster. We also analytically calculate the uncertainties associated with the estimates of the post-EoR power spectrum for the discussed estimator. We access the efficacy of this estimator in the context of 19 galaxy clusters for which the lensing potential has been estimated earlier by various authors. We find that by combining the lensed power spectrum through eight of these cluster lenses, it is possible to estimate the post-reionization H i power spectrum at five-sigma significance for angular multipoles <4000 for a uGMRT observation of 16 MHz bandwidth from redshifts of 1.25, 1.5 with a total of 400 h of observation. With the same setup, for a redshift of 3.0, we need 200 h of total observation time. The estimator also suppresses the diffused galactic foreground, though, the latter is still a dominant contributor to the overall signal and hence need to be estimated and mitigated. We discuss the merits and demerits of the estimator.
Turbulence and its connection to episodic accretion in binary YSOs
Authors: Riaz R , Schleicher D R G , Vanaverbeke S , Klessen Ralf S
Published: September 2021

We report signatures of episodic accretion in young stellar objects (YSOs) that emerge in protobinary configurations in a gravoturbulent gas collapse. We find in most of these protobinary systems strong accretion bursts between the two companions with a recurrence time-scale of about 1 kyr. The accretion rate on to the secondary star typically exceeds that on to the primary with a peak value of 2 × 10−2 M⊙ yr−1 for the former and 6 × 10−3 M⊙ yr−1 for the latter. We propose that the secondary companion, which remains more active in its episodes of accretion bursts, especially for the gas cores with subsonic velocity dispersion, may provide observational opportunities to find traces of episodic accretion in the surrounding gas of the embedded YSOs that are in a binary configuration. Also, protostars evolving as single objects in the same environment show fewer accretion bursts and all together a more steady mass growth history. The prestellar cores with subsonic velocity dispersion exhibit an order of magnitude more intense accretion bursts than in the case of cores with supersonic velocity dispersions. The latter shows the formation of some of the protobinaries in which the primary acts as a more actively accreting companion. This can support these binaries to become systems of extreme mass ratio. Moreover, the YSOs in binary configurations with small semimajor axis a ≈ 50 au and high mass ratio q > 0.7 support phases of intense episodic accretion. The eccentricity, however, seems to play no significant role in the occurrence of accretion bursts.
Laplace surface dynamics, revisited: satellites, exoplanets, and debris with distant, eccentric companions
Authors: Farhat Mohammad A , Touma Jihad R
Published: September 2021

To date, studies of Laplace surface dynamics have concerned themselves with test particle orbits of fixed shape and orientation in the combined field of an oblate central body (to which the particle is bound) and a distant, inclined companion, which is captured to quadrupolar order. While amply sufficient for satellites around planets on near-circular orbits, the quadrupolar approximation fails to capture essential dynamical features induced by a wide binary companion (be it a star, a planet, or a black hole) on a fairly eccentric orbit. With similar astronomical settings in mind, we extend the classical Laplace framework to higher multipoles and map out the backbone of stationary orbits, now made complex by the broken axial symmetry. Eccentric and inclined Laplace equilibria, which had been presaged in systems of large enough mutual inclination, are here delineated over a broad range of mutually inclined perturbations. We recover them for test particles in the field of a hot Jupiter and a wide eccentric stellar binary, highlighting their relevance for the architecture of multi-planet systems in binaries. We then extend and deploy our machinery closer to home, as we consider the secular dynamics of trans-Neptunian objects (TNOs) in the presence of a putative ninth planet. We show how generalized Laplace equilibria seed islands for trans-Neptunian objects to be sheltered around, islands within chaotic seas that we capture via Poincaré sections, while highlighting a beautiful interplay between Laplace and Kozai–Lidov secular dynamical structures. An eminently classical tale revived for the exoplanetary 21st century!
Kidney tubule health, mineral metabolism and adverse events in persons with CKD in SPRINT
Authors: Ascher Simon B , Scherzer Rebecca , Estrella Michelle M , Berry Jarett D , de Lemos James A , Jotwani Vasantha K , Garimella Pranav S , Malhotra Rakesh , Bullen Alexander L , Katz Ronit , Ambrosius Walter T , Cheung Alfred K , Chonchol Michel , Killeen Anthony A , Ix Joachim H , Shlipak Michael G ,   for the SPRINT Research Group
Published: September 2021

Background

Measures of kidney tubule health are risk markers for acute kidney injury (AKI) in persons with chronic kidney disease (CKD) during hypertension treatment, but their associations with other adverse events (AEs) are unknown.

Methods

Among 2377 Systolic Blood Pressure Intervention Trial (SPRINT) participants with CKD, we measured at baseline eight urine biomarkers of kidney tubule health and two serum biomarkers of mineral metabolism pathways that act on the kidney tubules. Cox proportional hazards models were used to evaluate biomarker associations with risk of a composite of pre-specified serious AEs (hypotension, syncope, electrolyte abnormalities, AKI, bradycardia and injurious falls) and outpatient AEs (hyperkalemia and hypokalemia).

Results

At baseline, the mean age was 73 ± 9 years and mean estimated glomerular filtration rate (eGFR) was 46 ± 11 mL/min/1.73 m2. During a median follow-up of 3.8 years, 716 (30%) participants experienced the composite AE. Higher urine interleukin-18, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin (NGAL) and monocyte chemoattractant protein-1 (MCP-1), lower urine uromodulin (UMOD) and higher serum fibroblast growth factor-23 were individually associated with higher risk of the composite AE outcome in multivariable-adjusted models including eGFR and albuminuria. When modeling biomarkers in combination, higher NGAL [hazard ratio (HR) = 1.08 per 2-fold higher biomarker level, 95% confidence interval (CI) 1.03–1.13], higher MCP-1 (HR = 1.11, 95% CI 1.03–1.19) and lower UMOD (HR = 0.91, 95% CI 0.85–0.97) were each associated with higher composite AE risk. Biomarker associations did not vary by intervention arm (P > 0.10 for all interactions).

Conclusions

Among persons with CKD, several kidney tubule biomarkers are associated with higher risk of AEs during hypertension treatment, independent of eGFR and albuminuria.
Sulfation modification of dopamine in brain regulates aggregative behavior of animals
Authors: Chen Bing , Tong Xiwen , Zhang Xia , Gui Wanying , Ai Guoming , Huang Lihua , Ding Ding , Zhang Jiangxu , Kang Le
Published: September 2021

Behavioral plasticity and the underlying neuronal plasticity represent a fundamental capacity of animals to cope with environmental stimuli. Behavioral plasticity is controlled by complex molecular networks that act under different layers of regulation. While various molecules have been found to be involved in the regulation of plastic behaviors across species, less is known about how organisms orchestrate the activity of these molecules as part of a coherent behavioral response to varying environments. Here we discover a mechanism for the regulation of animal behavioral plasticity involving molecular sulfation in the brain, a modification of substrate molecules by sulfotransferase (ST)-catalyzed addition of a sulfonate group (SO3) from an obligate donor, 3′-phosphoadenosine 5′-phosphosulfate (PAPS) to the substrates. We investigated aggregation behaviors of migratory locusts, which are well-known for extreme phase change plasticity triggered by population density. The processes of PAPS biosynthesis acted efficiently on induction of locust behavioral transition: Inhibition of PAPS synthesis solicited a behavioral shift from gregarious to solitarious states; external PAPS dosage, by contrast, promoted aggregation in solitarious locusts. Genetic or pharmacological intervention in the sulfation catalyzation resulted into pronounced solitarizing effects. Analysis of substrate-specific STs suggests a widespread involvement of sulfated neurotransmitters in the behavioral response. Dopamine in the brain was finally identified to be actively sulfate conjugated, and the sulfate conjugation enhanced the free DA-mediated behavioral aggregation. Similar results in Caenorhabditis elegans and mice indicate that sulfation may be involved more broadly in the modulation of animal aggregation. These findings reveal a general mechanism that effectively regulates animal social-like behavioral plasticity, possibly through sulfation-mediated modification of neural networks.
Claims of Reduced Odor on Tobacco Packs in Low- and Middle-Income Countries
Authors: Erinoso Olufemi , Welding Kevin , Smith Katherine Clegg , Cohen Joanna E
Published: September 2021

Introduction

Cigarettes designed to have less smoke smell were developed by the tobacco industry to supposedly reduce negative qualities. Cigarettes with marketing claims communicating these designs have been sold in high-income countries and marketing of “less smoke smell” terms on cigarette packaging can promote cigarette use. It is unclear to what extent they have been marketed in low- and middle-income countries (LMICs).

Aims and Methods

The Tobacco Pack Surveillance System (TPackSS) systemically collected tobacco packs available in 14 LMICs with high tobacco use between 2013 and 2017. We coded 4354 packs for marketing appeals, including claims related to smoke smell. We describe “less smoke smell” and similar claims found on these packs and compare across country and tobacco manufacturers.

Results

Phrases communicating less smoke smell were present on packs purchased in nine of 14 LMICs, including Bangladesh, Brazil, China, India, Mexico, Philippines, Russia, Ukraine, and Vietnam. The most commonly (74.1%) used terminology was “less smoke smell,” “LSS,” or a combination of the two. Packs from Russia had the most prevalent use (11.8%) of such claims. Companies using these terms across 21 brands included Japan Tobacco International (JTI), British American Tobacco (BAT), Philip Morris International (PMI), and other smaller companies. JTI accounted for 70.9% of packs with such terms.

Conclusions

Some of the world’s largest tobacco companies are communicating less smoke smell on packs in LMICs. Less smoke smell and similar phrases on packaging should be prohibited because they can enhance the appeal of cigarettes.

Implications

Tobacco companies are using “less smoke smell” and similar phrases on cigarette packs in LMICs. These claims have the potential to increase the appeal of smoking and promote cigarette use. Countries should consider policies to restrict attractive labeling claims, in accordance with the WHO Framework Convention on Tobacco Control (FCTC) Article 13 guidelines, which recommends restrictions on attractive design elements on tobacco packaging.
Exertional and CrossFit-Induced Rhabdomyolysis
Authors: Meyer Michelle , Sundaram Sneha , Schafhalter-Zoppoth Ingeborg
Published: September 2021

Few publications of exercise-induced rhabomyolysis currently exist in the medical literature besides case reports. However, this condition can be severe, resulting in hospitalization and IV fluid administration to prevent serious sequelae. This report describes a case of exercise-induced rhabdomyolysis caused by a CrossFit workout. A 31-year-old female presented with 2 days of bilateral upper extremity pain and soreness, which began 2 days after she completed a CrossFit workout. Workup revealed an elevated creatine phosphokinase (CPK) of 18 441 U/L, consistent with exercise-induced rhabdomyolysis, and elevated liver function tests and elevated D-dimer, although her renal function was normal. She was hospitalized for 2 days and treated with IV fluids. This case report demonstrates that CrossFit exercises can lead to rhabdomyolysis, highlighting a condition that may be underdiagnosed and underreported.
Racial Disparities and Upward Trend in Bowel Preparation for Elective Colectomy in the National Surgical Quality Improvement Program Procedure Targeted Dataset: 2012 to 2018
Authors: Stroever Stephanie J. , Ostapenko Alexander D. , Casasanta Marc J.
Published: September 2021

Objective:

The primary objective of this study was to assess trends in bowel preparation among patients who had elective colectomy between 2012 and 2018. The secondary objective was to assess patient and procedure-related factors predictive of bowel preparation use or lack thereof.

Background:

Numerous studies have demonstrated that bowel preparation before elective colorectal surgery can reduce the risk of postoperative complications. Studies of surgeon practices found 75% to 98% prescribe bowel preparation to their patients, although biases in the study design may lead to overestimation of bowel preparation practice.

Methods:

Cross-sectional study of the National Surgical Quality Improvement Program colectomy procedure targeted dataset. We included patients from 18 to 90 years old who underwent elective colectomy (n = 101,096). The primary outcomes were bowel preparation before elective colectomy, including oral antibiotic only, mechanical only, both oral and mechanical, or none.

Results:

Twenty percent of patients did not do any bowel preparation before elective colectomy. Almost all covariates were independently associated with any bowel preparation, although some were not clinically relevant. The odds that Black/African American or Hispanic patients had any bowel preparation were lower than that of White patients. Additionally, the odds minimally invasive colectomy patients completed any bowel preparation was 1.46 times that of open surgery patients.

Conclusions:

This study is the first of its kind to assess trends in bowel preparation using an objective dataset. Our study highlights disparities in bowel preparation. Further studies should focus on delineating the root cause of this disparity, identifying the barriers, and finding solutions.
The Impact of Unilateral 90Y-radioembolization on Functional Changes in the Contralateral Hepatic Lobe
Authors: Garlipp Benjamin , Amthauer Holger , Kupitz Dennis , Grosser Oliver S. , Jürgens Julian , Damm Robert , Powerski Maciej , Fabritius Matthias , Oecal Osman , Stuebs Patrick , Benckert Christoph , Seidensticker Ricarda , Ricke Jens , Pech Maciej , Seidensticker Max
Published: September 2021

Objectives:

To investigate how metabolic function of the contralateral liver lobe is affected by unilateral radioembolization (RE), and to compare the changes in volume and metabolic function.

Background:

Unilateral RE induces contralateral liver hypertrophy, but it is unknown if metabolic liver function improves in line with volume increases.

Methods:

This prospective open-label, nonrandomized, therapy-optimizing study included all consecutive patients undergoing right-sided or sequential 90Y-RE for liver malignancies without underlying liver disease or biliary obstruction at a single center in Germany. Magnetic resonance imaging volumetry and hepatobiliary scintigraphy were performed immediately before RE and approximately 6 weeks after RE.

Results:

Twenty-three patients were evaluated (11 metastatic colorectal cancer, 4 cholangiocellular carcinoma, 3 metastatic breast cancer, 1 each of metastatic neuroendocrine tumor, hepatocellular carcinoma, renal cell carcinoma, oesophageal cancer, pancreatic ductal adenocarcinoma). In the untreated contralateral left liver lobe, mean (SD) metabolic function significantly increased from 1.34 (0.76) %/min/m2 at baseline to 1.56 (0.75) %/min/m2 6 weeks after RE (P = 0.024). The mean (SD) functional volume (liver volume minus tumor volume) of the left liver lobe significantly increased from baseline (407.3 [170.3] mL) to follow-up (499.1 [209.8] mL; P < 0.01), with an equivalent magnitude to the metabolic function increase. There were no reports of grade ≥3 adverse events.

Conclusion:

This study indicates that unilobar RE produces a significant increase in the metabolic function, and equivalent volume increase, of the contralateral lobe. RE may be a useful option to induce hypertrophy of the future liver remnant before surgical resection of primary or secondary liver malignancies.
Differences in Blood Pressure and Workload Intensity During Arm and Leg Ergometry at Submaximal Target Heart Rates in College-Aged Individuals
Authors: Dias Konrad J. , DuClos Ethan , Heath James , Nelson Shelbi , Coffey Bethany , Schahl Steven , Giacalone Nicholas , Collins Sean M.
Published: September 2021

Purpose:

Blood pressure (BP) during arm (AE) and leg ergometry (LE) have traditionally been compared at submaximal intensities of the peak oxygen uptake, which is often challenging to interpret in clinical practice. The purpose of this investigation was to evaluate the relationship of the heart rate with systolic blood pressure (SBP), diastolic blood pressure (DBP), and workload (WL) during AE and LE exercise.

Methods:

A prospective, observational, cross-sectional design with 35 healthy subjects compared BP and WL during AE and LE at specific submaximal target heart rates (HRs) of 110, 120, 130, 140, and 150 beats per minute. A linear mixed model tested for differences in SBP, DBP, and WL between AE and LE.

Results:

There was a larger increase in SBP {0.55 mm Hg (95% CI [0.38, 0.73])} per heart beat during LE. There was a larger increase in WL {0.62 watts (95% CI [0.38, 0.85])} and WL relative to body mass {0.01 watts/kg (95% CI [0.006, 0.011])} per heart beat during LE. Statistical models were developed that estimated SBP, DBP, and WL based on the submaximal heart rate.

Conclusion:

The findings from this investigation informs physical therapists that lower SBP, higher DBP, and lower WL is achieved at any given submaximal HR during AE compared with LE. Furthermore, prediction equations derived from the statistical models can be used to compare actual against predicted SBP and DBP responses to determine tolerance to exercise. Finally, differences in WL per beat increase in HR are valuable in dosing exercise on the AE or LE.
Effects of Rehabilitation Before Lung Transplantation on Balance
Authors: Byrd Rebecca , Vallabhajosula Srikant , Bailey Stephen , Champion Tiffany
Published: September 2021

Purpose:

This study examined the effects of prelung transplant rehabilitation on balance and examined the relationship between clinical balance tests, instrumented balance assessments, and functional measures of strength and exercise capacity.

Methods:

Participants completed 1-month of 5 d/wk, multimodal, outpatient rehabilitation. They performed the Short Physical Performance Battery (SPPB), Four Square Step Test, Fullerton Advanced Balance (FAB) Scale, Short-Form FAB, Modified Clinical Test of Sensory Interaction with Balance (mCTSIB), Limits of Stability Test (LOS), 6-minute walk distance (6MWD), and clinical strength assessments. Changes prerehabilitation to postrehabilitation were assessed using t tests. Pearson correlation coefficient assessed the relationship between baseline tests. Effect size was calculated using Cohen d.

Results:

Thirty-nine participants (age = 50 [16] years) completed pretransplant rehabilitation. Participants showed impaired dynamic balance measured through clinical balance tests and LOS which significantly improved with moderate change postrehabilitation. Most mCTSIB components had a small, nonsignificant change. Functional strength and 6MWD improved significantly prerehabilitation to postrehabilitation. Changes in clinical balance were correlated with changes in LOS, SPPB, 5 times sit-to-stand, and arm strength.

Conclusions:

Balance improvements in candidates for lung transplant, after a multimodal rehabilitation program, seem to be most closely associated with improvement in dynamic balance and lower extremity functional strength.
Activated Charcoal and Poisoning: Is It Really Effective?
Authors: Aksay Erdem , Kaya Adem , Gulen Muge , Acehan Selen , Isıkber Cem , Sahin Gonca , Satar Salim
Published: September 2021

Background:

This study aims to compare the poisoned patients who could not be administered activated charcoal because of its unavailability with the poisoned patients who were administered charcoal in the later period and to reveal the results about its effectiveness.

Study Question:

Is the use of activated charcoal effective against poisoning caused by oral medication?

Study Design:

This retrospective cohort study with historical control was planned at a tertiary hospital. Patients older than 18 years were admitted to the emergency department because of oral drug poisoning during the study periods. A total of 1159 patients who were not given activated charcoal and 877 patients who were given activated charcoal were included in this study.

Measures and Outcomes:

The frequency of clinical findings secondary to the drug taken, the frequency of antidote use, the frequency of intubation, and the hospitalization length were determined as clinical outcome parameters.

Results:

There was no statistically significant difference in the development of central nervous system findings, cardiovascular system findings, frequency of intubation, and blood gas disorders, as well as the length of hospitalization periods according to the activated charcoal application. Hepatobiliary system findings and electrolyte disturbances were found to be less common in patients given activated charcoal. The frequency of tachycardia, speech impairment, coma, and respiratory acidosis was found to be statistically higher in patients who were administered activated charcoal. The hospitalization period of the patients who were given activated charcoal was longer in patients with drug findings; however, there was no difference in the hospitalization periods of the patients who were given an antidote.

Conclusions:

The use of activated charcoal in poisoned patients may not provide sufficient clinical benefits. However, clinical studies with strong evidence levels are needed to determine activated charcoal's clinical efficacy, which is still used as a universal antidote.
Pharmacological Management of Peptic Ulcer: A Century of Expert Opinions in Cecil Textbook of Medicine
Authors: Manu Peter , Rogozea Liliana M. , Sandor Vlaicu , Dumitraşcu Dan L.
Published: September 2021

Background:

Advances in drug therapy for peptic ulcer have had a significant impact on quality of life and work potential of many millions of affected persons and have contributed to a remarkable decrease in the prevalence of the disease, frequency and severity of complications, hospitalizations, and mortality.

Study Question:

What are the milestones of the changes in the expert approach to the pharmacological management of peptic ulcer in the past century?

Study Design:

To determine the changes in the experts' approach to the management of peptic ulcer, as presented in a widely used textbook in the United States.

Data Sources:

The chapters presenting the management of peptic ulcer in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020.

Results:

Acid neutralization with alkalies was the only pharmacological intervention recommended in the textbooks published from 1927 to 1975. Atropine and other antimuscarinic agents were mainly used to relieve pain and acid secretion according to the paradigm “no acid no ulcer.” The shift to the acid suppression paradigm started with the introduction of the histamine-2 receptor antagonist cimetidine in 1979, the proton-pump inhibitor omeprazole in 1988, and the prostaglandin agonist misoprostol in 1992. Finally, the eradication of Helicobacter pylori was codified in 1996.

Conclusions:

The pharmacological management of peptic ulcer has remained archaic well into the 20th century. Fundamental progress occurred in a very short period (1979–1996) and was due to paradigm shifts from acid neutralization to acid suppression and later the recognition of the role of H. pylori infection.
Magnetic Resonance Imaging Evaluation of Distance Between Adenoid Tissue and Internal Carotid Artery in Children With Adenoid Hypertrophy
Authors: Şahan Mehmet Hamdi , Bayar Muluk Nuray
Published: September 2021

Objectives

In the present study, we investigated the distance between adenoid tissue and internal carotid artery (ICA) in children with adenoid hypertrophy by magnetic resonance imaging.

Methods

Cranial magnetic resonance images of 200 children with adenoid hypertrophy between the ages of 5 and 15 were included. In group 1 (5–9 years of age), there were 100 children, and in group 2 (10–15 years of age), there were 100 children. In both groups, adenoid thickness, adenoid/nasopharynx) ratio, and superior, middle, and inferior adenoid-ICA distances were measured.

Results

Adenoid thickness is significantly higher in the 10-to-15 years age group than in the 5-to-9 years age group (P < 0.05). Adenoid-ICA distance got lower from the superior to the inferior part in both age groups and in both sexes: inferior < middle < superior adenoid-ICA distance. In the 5-to-9 years age group, the minimum adenoid-ICA distances were 2.40 mmsuperior, 0.90 mmmiddle, and 1.20 mminferior. In 10-to-15 years age group, the minimum adenoid-ICA distances were 2.50 mmsuperior, 1.00 mmmiddle, and 0.90 mminferior. As adenoid thickness increased, the inferior adenoid-ICA distance decreased bilaterally (P < 0.05). As the age got older, adenoid thickness increased, and the left superior and middle adenoid ICA distances and bilateral inferior adenoid-ICA distances decreased (P < 0.05).

Conclusion

The distance between adenoid and ICA decreased from superior to inferior. In 10- to 15-year-old children, the distance between adenoid and ICA was determined as lower than in the 5- to 9-year-old children. The minimum distances between adenoid and ICA were found to be between 0.9 and 2.5 mm in the 10-to-15 age group and between 0.9 and 2.4 mm in the 5-to-9 age group. It should be remembered that ICA can be very close to the adenoid tissue. In addition, because thermal injury can cause deeper damage to the tissue, bipolar cautery should be used with caution in this area and unipolar cautery should not be used.
Brain F-18 FDG and F-18 FP-CIT PET/CT Findings of c.856_860delCTCTA Mutation McLeod Syndrome
Authors: Ryu Ho-Sung , Hong Chae Moon
Published: September 2021

McLeod syndrome is a rare X-linked recessive genetic disorder that is caused by mutations of the XK gene. It is one of the core neuroacanthocytosis syndromes. We report the case of a 67-year-old man who presented to Kyungpook National University Hospital in the Republic of Korea with progressive worsening of generalized chorea and dystonia. He had no recognized family history of neurologic illness. A peripheral blood smear showed increased acanthocytes. His serum creatine kinase levels were 894 U/L. A brain MRI showed atrophy of the bilateral striatal nuclei. An F-18 F-N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane PET/CT showed moderately decreased dopamine transporter uptake in the putamen and severely decreased uptake in the caudate nucleus. An F-18 fludeoxyglucose PET/CT demonstrated markedly decreased metabolism at the caudate nucleus and the putamen. Whole exome sequencing revealed hemizygous pathogenic mutations of the XK gene (c.856_860delCTCTA;p.Leu286TyrfsTer16). We believe that these findings provide useful information regarding the clinical features of individuals with McLeod syndrome.
Preliminary Validation of the Learning Ratio for the HVLT–R and BVMT–R in Older Adults
Authors: Hammers Dustin B. , Gradwohl Brian D. , Kucera Amanda , Abildskov Tracy J. , Wilde Elisabeth A. , Spencer Robert J.
Published: September 2021

Background:

The learning slope is typically represented as the raw difference between the final score and the score of the first learning trial. A new method for calculating the learning slope, the learning ratio (LR), was recently developed; it is typically represented as the number of items that are learned after the first trial divided by the number of items that are yet to be learned.

Objective:

To evaluate the convergent and criterion validity of the LR in order to understand its sensitivity to Alzheimer disease (AD) pathology.

Method:

Fifty-six patients from a memory clinic underwent standard neuropsychological assessment and quantitative brain imaging. LR scores were calculated from the Hopkins Verbal Learning Test—Revised and the Brief Visuospatial Memory Test—Revised and were compared with both standard memory measures and total hippocampal volumes, as well as between individuals with AD and those with mild cognitive impairment.

Results:

Lower LR scores were consistently associated with poorer performances on standard memory measures and smaller total hippocampal volumes, generally more so than traditional learning slope scores. The LR scores of the AD group were smaller than those of the group with mild cognitive impairment. Furthermore, the aggregation of LR scores into a single metric was partially supported.

Conclusion:

The LR is sensitive to AD pathology along the AD continuum. This result supports previous claims that the LR score can reflect learning capacity better than traditional learning calculations can by considering the amount of information that is learned at trial 1.
The Effect of Donepezil on Problem-solving Ability in Individuals With Amnestic Mild Cognitive Impairment: A Pilot Study
Authors: Beversdorf David Q. , Nagaraja Haikady N. , Bornstein Robert A. , Scharre Douglas W.
Published: September 2021

Background:

Clinical trials involving individuals with mild cognitive impairment (MCI) have reported mixed results for the effects of cholinesterase inhibitors on cognitive outcomes. Our previous work demonstrated that a visuospatial problem-solving task was sensitive to non-memory impairments in individuals with MCI.

Objective:

To determine whether the same task is also sensitive to the effects of cholinesterase inhibitors in individuals with amnestic MCI (aMCI).

Method:

We gave 22 individuals with aMCI (clinical dementia rating of 0.5) and Mini-Mental State Examination (MMSE) scores of at least 24 the following measures at baseline and at follow-up 1 year later: Hopkins Verbal Learning Test, Boston Naming Test, Rey Complex Figures Test copying task, anagrams task, and visuospatial problem-solving task. The MMSE was also given at the 1-year follow-up. Twelve of the individuals were drug naïve, having never taken cholinesterase inhibitors before, and donepezil was initiated and titrated to 10 mg daily after baseline in an open-label manner. Ten of the individuals had already been taking donepezil, and there was no change in treatment. We compared the two groups for amount of performance change over 1 year.

Results:

Individuals for whom donepezil was initiated performed significantly better on the visuospatial problem-solving task after 1 year compared with individuals who had already been taking donepezil. No difference was observed for any of the other variables.

Conclusion:

The visuospatial problem-solving task appeared to be more sensitive than memory measures to the effects of cholinesterase inhibitors in individuals with aMCI, perhaps due to the high attentional demand of the task.
Pandemic-response adenoviral vector and RNA vaccine manufacturing
Authors: Kis Zoltán , Tak Kyungjae , Ibrahim Dauda , Papathanasiou Maria M , Chachuat Benoît , Shah Nilay , Kontoravdi Cleo
Published: September 2021

Rapid global COVID-19 pandemic response by mass vaccination is currently limited by the rate of vaccine manufacturing. This study presents a techno-economic feasibility assessment and comparison of three vaccine production platform technologies deployed during the COVID-19 pandemic: (1) adenovirus-vectored (AVV) vaccines, (2) messenger RNA (mRNA) vaccines, and (3) the newer self-amplifying RNA (saRNA) vaccines. Besides assessing the baseline performance of the production process, the impact of key design and operational uncertainties on the productivity and cost performance of these vaccine platforms were also evaluated using variance-based global sensitivity analysis. Cost and resource requirement projections were also computed for manufacturing multi-billion vaccine doses for covering the current global demand shortage and for providing annual booster immunizations. This model-based assessment provides key insights to policymakers and vaccine manufacturers for risk analysis, asset utilisation, directions for future technology improvements and future epidemic/pandemic preparedness, given the disease-agnostic nature of these vaccine production platforms.
Pharmacokinetic /Pharmacodynamic Considerations of Alternate Dosing Strategies of Tocilizumab in COVID-19
Authors: Leung Elizabeth , Jorgensen Sarah C.J. , Crass Ryan L. , Raybardhan Sumit , Langford Bradley , Moore W. Justin , Rhodes Nathaniel J.
Published: September 2021

Tocilizumab is one of few treatments that have been shown to improve mortality in patients with COVID-19, but increased demand has led to relative global shortages. Recently, it has been suggested that lower doses, or fixed doses, of tocilizumab could be a potential solution to conserve the limited global supply while conferring equivalent therapeutic benefit to the dosing regimens studied in major trials. The relationship between tocilizumab dose, exposure, and response in COVID-19 has not been adequately characterized. There are a number of pharmacokinetic (PK) parameters which likely differ between patients with severe COVID-19 and patients in whom tocilizumab was studied during the FDA approval process. Likewise, it is unclear whether a threshold exposure is necessary for tocilizumab efficacy. The safety and efficacy of fixed versus weight-based dosing of tocilizumab has been evaluated outside of COVID-19, but it is uncertain if these observations are generalizable to severe or critical COVID-19. In the current review, we consider the potential advantages and limitations of alternative tocilizumab dosing strategies. Leveraging PK models and simulation analyses, we demonstrate that a fixed single dose of tocilizumab 400 mg is unlikely to produce PK exposures equivalent to those achieved in the REMAP-CAP trial, though weight-stratified dosing appears to produce more uniform exposure distribution. Data from current and future trials could provide PK/PD insight to better inform dosing strategies at the bedside. Ultimately, rational dosing strategies that balance available limited supply with patient needs are required.
Computational methods for the discovery and annotation of viral integrations
Authors: Palatini Umberto , Pischedda Elisa , Bonizzoni Mariangela
Published: September 2021

The transfer of genetic material between viruses and eukaryotic cells is pervasive. Somatic integrations of DNA viruses and retroviruses have been linked to persistent viral infection and genotoxic effects. Integrations into germline cells, referred to as Endogenous Viral Elements (EVEs), can be co-opted for host functions. Besides DNA viruses and retroviruses, EVEs can also derive from nonretroviral RNA viruses, which have often been observed in piRNA clusters. Here, we describe a bioinformatic framework to annotate EVEs in a genome assembly, study their widespread occurrence and polymorphism and identify sample-specific viral integrations using whole-genome sequencing data.