bluuebunny/crossref_metadata_2025 huggingface dataset:
2-GHz watt-level Kerr-lens mode-locked Yb:KGW laser
Authors: Zheng Li , Tian Wenlong , Liu Han , Wang Geyang , Bai Chuan , Xu Rui , Zhang Dacheng , Han Hainian , Zhu Jiangfeng , Wei Zhiyi
Published: March 2021

We report on a 2-GHz high-power Kerr-lens mode-locked Yb:KGW laser pumped by a single-mode fiber laser. The output performance for two different output coupling rates was investigated. Stable bidirectional mode-locking operation at the repetition rate of 2.157 GHz was obtained with a 0.6% output coupler. The average output powers of bidirectional operation are 741 mW and 746 mW, with 123-fs and 126-fs pulse durations, respectively. By using a 1.6% output coupler, unidirectional mode-locking is achieved with 145-fs pulse duration and 1.7-W average output power, which, to the best of our knowledge, is the highest average power from Kerr-lens mode-locked GHz femtosecond oscillators.
Poincaré sphere of electromagnetic spatial coherence
Authors: Laatikainen Jyrki , Friberg Ari T. , Korotkova Olga , Setälä Tero
Published: March 2021

We introduce a Poincaré sphere construction for geometrical representation of the state of two-point spatial coherence in random electromagnetic (vectorial) beams. To this end, a novel descriptor of coherence is invoked, which shares some important mathematical properties with the polarization matrix and spans a new type of Stokes parameter space. The coherence Poincaré sphere emerges as a geometric interpretation of this novel formalism, which is developed for uniformly and nonuniformly fully polarized beams. The construction is extended to partially polarized beams as well and is demonstrated with a field having separable spatial coherence and polarization characteristics. At a single point, the coherence Poincaré sphere reduces to the conventional polarization Poincaré sphere for any state of partial polarization.
Optical response of noble metal nanostructures: quantum surface effects in crystallographic facets
Authors: Rodríguez Echarri A. , Gonçalves P. A. D. , Tserkezis C. , García de Abajo F. Javier , Mortensen N. Asger , Cox Joel D.
Published: March 2021

Noble metal nanostructures are ubiquitous elements in nano-optics, supporting plasmon modes that can focus light down to length scales commensurate with nonlocal effects arising from quantum confinement and spatial dispersion in the underlying electron gas. Quantum and nonlocal effects can be more prominent in crystalline noble metals, due to their lower intrinsic loss (when compared with their polycrystalline counterparts), and because particular crystal facets give rise to distinct electronic surface states whose signatures can be imprinted in the optical response of a structure. Here, we employ an atomistic method to describe nonclassical effects impacting the optical response of crystalline noble metal surfaces and demonstrate that these effects can be well captured using a set of surface-response functions known as Feibelman

d

-parameters determined from such quantum-mechanical models. In particular, we characterize the

d

-parameters associated with the (111) and (100) crystal facets of gold, silver, and copper, emphasizing the importance of quantum surface effects associated with electron wave function spill-out/spill-in and with the surface-projected band gap emerging from the atomic-layer corrugation. Furthermore, we show that the extracted

d

-parameters can be straightforwardly applied to describe the optical response of various nanoscale metal morphologies of interest, including metallic ultrathin films, graphene–metal heterostructures hosting ultraconfined acoustic graphene plasmons, and crystallographic faceted metallic nanoparticles supporting localized surface plasmons. We envision that the

d

-parameters presented here, along with the prescription to extract and apply them, could help circumvent computationally expensive first-principles atomistic calculations to describe quantum nonlocal effects in the optical response of mesoscopic crystalline metal surfaces, which are becoming widely available with increasing control over morphology down to atomic length scales for state-of-the-art experiments in nano-optics.
A prediction tool for plaque progression based on patient-specific multi-physical modeling
Authors: Pan Jichao , Cai Yan , Wang Liang , Maehara Akiko , Mintz Gary S. , Tang Dalin , Li Zhiyong
Published: March 2021

Atherosclerotic plaque rupture is responsible for a majority of acute vascular syndromes and this study aims to develop a prediction tool for plaque progression and rupture. Based on the follow-up coronary intravascular ultrasound imaging data, we performed patient-specific multi-physical modeling study on four patients to obtain the evolutional processes of the microenvironment during plaque progression. Four main pathophysiological processes, i.e., lipid deposition, inflammatory response, migration and proliferation of smooth muscle cells (SMCs), and neovascularization were coupled based on the interactions demonstrated by experimental and clinical observations. A scoring table integrating the dynamic microenvironmental indicators with the classical risk index was proposed to differentiate their progression to stable and unstable plaques. The heterogeneity of plaque microenvironment for each patient was demonstrated by the growth curves of the main microenvironmental factors. The possible plaque developments were predicted by incorporating the systematic index with microenvironmental indicators. Five microenvironmental factors (LDL, ox-LDL, MCP-1, SMC, and foam cell) showed significant differences between stable and unstable group (p < 0.01). The inflammatory microenvironments (monocyte and macrophage) had negative correlations with the necrotic core (NC) expansion in the stable group, while very strong positive correlations in unstable group. The inflammatory microenvironment is strongly correlated to the NC expansion in unstable plaques, suggesting that the inflammatory factors may play an important role in the formation of a vulnerable plaque. This prediction tool will improve our understanding of the mechanism of plaque progression and provide a new strategy for early detection and prediction of high-risk plaques.
Tuned inhibition in perceptual decision-making circuits can explain seemingly suboptimal confidence behavior
Authors: Maniscalco Brian , Odegaard Brian , Grimaldi Piercesare , Cho Seong Hah , Basso Michele A. , Lau Hakwan , Peters Megan A. K.
Published: March 2021

Current dominant views hold that perceptual confidence reflects the probability that a decision is correct. Although these views have enjoyed some empirical support, recent behavioral results indicate that confidence and the probability of being correct can be dissociated. An alternative hypothesis suggests that confidence instead reflects the magnitude of evidence in favor of a decision while being relatively insensitive to the evidence opposing the decision. We considered how this alternative hypothesis might be biologically instantiated by developing a simple neural network model incorporating a known property of sensory neurons: tuned inhibition. The key idea of the model is that the level of inhibition that each accumulator unit receives from units with the opposite tuning preference, i.e. its inhibition ‘tuning’, dictates its contribution to perceptual decisions versus confidence judgments, such that units with higher tuned inhibition (computing relative evidence for different perceptual interpretations) determine perceptual discrimination decisions, and units with lower tuned inhibition (computing absolute evidence) determine confidence. We demonstrate that this biologically plausible model can account for several counterintuitive findings reported in the literature where confidence and decision accuracy dissociate. By comparing model fits, we further demonstrate that a full complement of behavioral data across several previously published experimental results—including accuracy, reaction time, mean confidence, and metacognitive sensitivity—is best accounted for when confidence is computed from units without, rather than units with, tuned inhibition. Finally, we discuss predictions of our results and model for future neurobiological studies. These findings suggest that the brain has developed and implements this alternative, heuristic theory of perceptual confidence computation by relying on the diversity of neural resources available.
Pandemic velocity: Forecasting COVID-19 in the US with a machine learning & Bayesian time series compartmental model
Authors: Watson Gregory L. , Xiong Di , Zhang Lu , Zoller Joseph A. , Shamshoian John , Sundin Phillip , Bufford Teresa , Rimoin Anne W. , Suchard Marc A. , Ramirez Christina M.
Published: March 2021

Predictions of COVID-19 case growth and mortality are critical to the decisions of political leaders, businesses, and individuals grappling with the pandemic. This predictive task is challenging due to the novelty of the virus, limited data, and dynamic political and societal responses. We embed a Bayesian time series model and a random forest algorithm within an epidemiological compartmental model for empirically grounded COVID-19 predictions. The Bayesian case model fits a location-specific curve to the velocity (first derivative) of the log transformed cumulative case count, borrowing strength across geographic locations and incorporating prior information to obtain a posterior distribution for case trajectories. The compartmental model uses this distribution and predicts deaths using a random forest algorithm trained on COVID-19 data and population-level characteristics, yielding daily projections and interval estimates for cases and deaths in U.S. states. We evaluated the model by training it on progressively longer periods of the pandemic and computing its predictive accuracy over 21-day forecasts. The substantial variation in predicted trajectories and associated uncertainty between states is illustrated by comparing three unique locations: New York, Colorado, and West Virginia. The sophistication and accuracy of this COVID-19 model offer reliable predictions and uncertainty estimates for the current trajectory of the pandemic in the U.S. and provide a platform for future predictions as shifting political and societal responses alter its course.
Predicting antimicrobial mechanism-of-action from transcriptomes: A generalizable explainable artificial intelligence approach
Authors: Espinoza Josh L. , Dupont Chris L. , O’Rourke Aubrie , Beyhan Sinem , Morales Pavel , Spoering Amy , Meyer Kirsten J. , Chan Agnes P. , Choi Yongwook , Nierman William C. , Lewis Kim , Nelson Karen E.
Published: March 2021

To better combat the expansion of antibiotic resistance in pathogens, new compounds, particularly those with novel mechanisms-of-action [MOA], represent a major research priority in biomedical science. However, rediscovery of known antibiotics demonstrates a need for approaches that accurately identify potential novelty with higher throughput and reduced labor. Here we describe an explainable artificial intelligence classification methodology that emphasizes prediction performance and human interpretability by using a Hierarchical Ensemble of Classifiers model optimized with a novel feature selection algorithm called Clairvoyance; collectively referred to as a CoHEC model. We evaluated our methods using whole transcriptome responses from Escherichia coli challenged with 41 known antibiotics and 9 crude extracts while depositing 122 transcriptomes unique to this study. Our CoHEC model can properly predict the primary MOA of previously unobserved compounds in both purified forms and crude extracts at an accuracy above 99%, while also correctly identifying darobactin, a newly discovered antibiotic, as having a novel MOA. In addition, we deploy our methods on a recent E. coli transcriptomics dataset from a different strain and a Mycobacterium smegmatis metabolomics timeseries dataset showcasing exceptionally high performance; improving upon the performance metrics of the original publications. We not only provide insight into the biological interpretation of our model but also that the concept of MOA is a non-discrete heuristic with diverse effects for different compounds within the same MOA, suggesting substantial antibiotic diversity awaiting discovery within existing MOA.
AMPK-dependent and -independent coordination of mitochondrial function and muscle fiber type by FNIP1
Authors: Xiao Liwei , Liu Jing , Sun Zongchao , Yin Yujing , Mao Yan , Xu Dengqiu , Liu Lin , Xu Zhisheng , Guo Qiqi , Ding Chenyun , Sun Wanping , Yang Likun , Zhou Zheng , Zhou Danxia , Fu Tingting , Zhou Wenjing , Zhu Yuangang , Chen Xiao-Wei , Li John Zhong , Chen Shuai , Xie Xiaoduo , Gan Zhenji
Published: March 2021

Mitochondria are essential for maintaining skeletal muscle metabolic homeostasis during adaptive response to a myriad of physiologic or pathophysiological stresses. The mechanisms by which mitochondrial function and contractile fiber type are concordantly regulated to ensure muscle function remain poorly understood. Evidence is emerging that the Folliculin interacting protein 1 (Fnip1) is involved in skeletal muscle fiber type specification, function, and disease. In this study,Fnip1was specifically expressed in skeletal muscle inFnip1-transgenic (Fnip1Tg) mice.Fnip1Tgmice were crossed withFnip1-knockout (Fnip1KO) mice to generateFnip1TgKOmice expressingFnip1only in skeletal muscle but not in other tissues. Our results indicate that, in addition to the known role in type I fiber program, FNIP1 exerts control upon muscle mitochondrial oxidative program through AMPK signaling. Indeed, basal levels of FNIP1 are sufficient to inhibit AMPK but not mTORC1 activity in skeletal muscle cells. Gain-of-function and loss-of-function strategies in mice, together with assessment of primary muscle cells, demonstrated that skeletal muscle mitochondrial program is suppressed via the inhibitory actions of FNIP1 on AMPK. Surprisingly, the FNIP1 actions on type I fiber program is independent of AMPK and its downstream PGC-1α. These studies provide a vital framework for understanding the intrinsic role of FNIP1 as a crucial factor in the concerted regulation of mitochondrial function and muscle fiber type that determine muscle fitness.
Modeling the spatial distribution of anthrax in southern Kenya
Authors: Otieno Fredrick Tom , Gachohi John , Gikuma-Njuru Peter , Kariuki Patrick , Oyas Harry , Canfield Samuel A. , Blackburn Jason K. , Njenga M. Kariuki , Bett Bernard
Published: March 2021

Background

Anthrax is an important zoonotic disease in Kenya associated with high animal and public health burden and widespread socio-economic impacts. The disease occurs in sporadic outbreaks that involve livestock, wildlife, and humans, but knowledge on factors that affect the geographic distribution of these outbreaks is limited, challenging public health intervention planning.

Methods

Anthrax surveillance data reported in southern Kenya from 2011 to 2017 were modeled using a boosted regression trees (BRT) framework. An ensemble of 100 BRT experiments was developed using a variable set of 18 environmental covariates and 69 unique anthrax locations. Model performance was evaluated using AUC (area under the curve) ROC (receiver operating characteristics) curves.

Results

Cattle density, rainfall of wettest month, soil clay content, soil pH, soil organic carbon, length of longest dry season, vegetation index, temperature seasonality, in order, were identified as key variables for predicting environmental suitability for anthrax in the region. BRTs performed well with a mean AUC of 0.8. Areas highly suitable for anthrax were predicted predominantly in the southwestern region around the shared Kenya-Tanzania border and a belt through the regions and highlands in central Kenya. These suitable regions extend westwards to cover large areas in western highlands and the western regions around Lake Victoria and bordering Uganda. The entire eastern and lower-eastern regions towards the coastal region were predicted to have lower suitability for anthrax.

Conclusion

These modeling efforts identified areas of anthrax suitability across southern Kenya, including high and medium agricultural potential regions and wildlife parks, important for tourism and foreign exchange. These predictions are useful for policy makers in designing targeted surveillance and/or control interventions in Kenya.

We thank the staff of Directorate of Veterinary Services under the Ministry of Agriculture, Livestock and Fisheries, for collecting and providing the anthrax historical occurrence data.
Serious adverse events following treatment of visceral leishmaniasis: A systematic review and meta-analysis
Authors: Singh-Phulgenda Sauman , Dahal Prabin , Ngu Roland , Maguire Brittany J. , Hawryszkiewycz Alice , Rashan Sumayyah , Brack Matthew , Halleux Christine M. , Alves Fabiana , Stepniewska Kasia , Olliaro Piero L , Guerin Philippe J.
Published: March 2021

Background

Despite a historical association with poor tolerability, a comprehensive review on safety of antileishmanial chemotherapies is lacking. We carried out an update of a previous systematic review of all published clinical trials in visceral leishmaniasis (VL) from 1980 to 2019 to document any reported serious adverse events (SAEs).

Methods

For this updated systematic review, we searched the following databases from 1st Jan 2016 through 2nd of May 2019: PUBMED, Embase, Scopus, Web of Science, Cochrane, clinicaltrials.gov, WHO ICTRP, and the Global Index Medicus. We included randomised and non-randomised interventional studies aimed at assessing therapeutic efficacy and extracted the number of SAEs reported within the first 30 days of treatment initiation. The incidence rate of death (IRD) from individual treatment arms were combined in a meta-analysis using random effects Poisson regression.

Results

We identified 157 published studies enrolling 35,376 patients in 347 treatment arms. Pentavalent antimony was administered in 74 (21.3%), multiple-dose liposomal amphotericin B (L-AmB) in 52 (15.0%), amphotericin b deoxycholate in 51 (14.7%), miltefosine in 33 (9.5%), amphotericin b fat/lipid/colloid/cholesterol in 31 (8.9%), and single-dose L-AmB in 17 (4.9%) arms. There was a total of 804 SAEs reported of which 793 (including 428 deaths) were extracted at study arm level (11 SAEs were reported at study level only). During the first 30 days, there were 285 (66.6%) deaths with the overall IRD estimated at 0.068 [95% confidence interval (CI): 0.041–0.114; I2 = 81.4%; 95% prediction interval (PI): 0.001–2.779] per 1,000 person-days at risk; the rate was 0.628 [95% CI: 0.368–1.021; I2 = 82.5%] in Eastern Africa, and 0.041 [95% CI: 0.021–0.081; I2 = 68.1%] in the Indian Subcontinent. In 21 study arms which clearly indicated allowing the inclusion of patients with HIV co-infections the IRD was 0.575 [95% CI: 0.244–1.355; I2 = 91.9%] compared to 0.043 [95% CI: 0.020–0.090; I2 = 62.5%] in 160 arms which excluded HIV co-infections.

Conclusion

Mortality within the first 30 days of VL treatment initiation was a rarely reported event in clinical trials with an overall estimated rate of 0.068 deaths per 1,000 person-days at risk, though it varied across regions and patient populations. These estimates may serve as a benchmark for future trials against which mortality data from prospective and pharmacovigilance studies can be compared. The methodological limitations exposed by our review support the need to assemble individual patient data (IPD) to conduct robust IPD meta-analyses and generate stronger evidence from existing trials to support treatment guidelines and guide future research.
A method for continuously monitoring the quality of Masson pine seedlings
Authors: Wang Li , Huang Zhuo , Gao Handong , Ni Chao
Published: March 2021

Root growth potential (RGP) is a popular physiological indicator used to evaluate seedling vigor. However, the time scale used in the RGP test is the order of days, which leads to poor performance of the RGP method. We propose an optical interference method, called statistical interferometry, to measure minute root elongation at a sub-nanometer scale, which can decrease the time used in measuring RGP. The time scale of this method is also 104 times less than that of the RGP method. Because we can measure the length of root elongation continuously, we can compute the root elongation rate (RER), which is the variety of the length of root elongation per second. Continuous monitoring can help determine the quality of Masson pine seedling as soon as possible. To show the effectiveness of our proposed method, we designed an experiment, in which we applied different water stresses to our collected Masson pine seedlings and acquired two groups of pines, representing two different qualities: one stressed by water and one not. After measuring the RER of the groups in our experiments, we found that RER is interrelated with the quality of seedlings.
Selection for feed efficiency elicits different postprandial plasma metabolite profiles in response to poor hygiene of housing conditions in growing pigs
Authors: Zem Fraga Alícia , Louveau Isabelle , Campos Paulo Henrique Reis Furtado , Hauschild Luciano , Le Floc’h Nathalie
Published: March 2021

This study was conducted to compare postprandial plasma concentrations of insulin, energy-related metabolites, and amino acids measured after a 6-week challenge consisting of exposure to good or poor hygiene of housing conditions of 24 growing pigs divergently selected for low-RFI (LRFI) and high-RFI (HRFI). Blood indicators of immune responses were assessed from samples collected before 0 (W0), and 3 (W3), and 6 weeks (W6) after pigs transfer to their respective hygiene of housing conditions. Plasma haptoglobin concentrations and blood neutrophil granulocyte numbers were greater in poor than in good hygiene of housing conditions at W3. Plasma concentrations of total immunoglobulin G were greater (p= 0.04) in poor than in good hygiene of housing conditions at W6. At W6, pigs were fitted with an intravenous catheter for serial blood samplings. Low-RFI pigs had greater insulin (p< 0.001) and lower triglyceride (p= 0.04) average plasma concentrations than HRFI pigs in both conditions. In poor hygiene of housing conditions, the peaks of insulin and glucose were observed earlier and that of insulin was greater in LRFI than in HRFI pigs. Irrespective of genetic line, average plasma concentrations of histidine, isoleucine, leucine, methionine, threonine, valine, and alanine were greater in poor compared with good hygiene of housing conditions. Only HRFI pigs had greater lysine, asparagine, proline, and tyrosine plasma concentrations in poor than in good hygiene of housing conditions. Conversely, arginine, tryptophan, proline, and tyrosine plasma concentrations were lower only for LRFI pigs housed in poor hygiene conditions. Our results suggest that, contrary to HRFI, LRFI pigs increase or maintain their utilization of tryptophan, arginine, and lysine when housed in poor hygiene conditions. This indicates that this difference may contribute to the better capacity of LRFI to cope with poor hygiene of housing conditions.
Feasibility of integrating survivors of stroke into cardiac rehabilitation: A mixed methods pilot study
Authors: Regan Elizabeth W. , Handlery Reed , Stewart Jill C. , Pearson Joseph L. , Wilcox Sara , Fritz Stacy
Published: March 2021

Background

Survivors of stroke are often deconditioned and have limited opportunities for exercise post-rehabilitation. Cardiac Rehabilitation (CR), a structured exercise program offered post-cardiac event in the United States (U.S.), may provide an opportunity for continued exercise.

The purpose of this study was to examine the feasibility of integrating survivors of stroke into an existing, hospital-based CR program through an assessment of (1) recruitment, uptake and retention, (2) adherence and fidelity, (3) acceptability and (4) safety.

Methods

A mixed methods design combined a single group, pre-post design, pilot feasibility study with an imbedded qualitative inquiry. Survivors of stroke were recruited into a standard 12-week, 36 visit CR program.

Results

Fifty-three survivors were referred, 29 started and 24 completed the program. Program uptake rate was 55% and completion rate was 83%. Eleven completers and one non-completer participated in the qualitative interviews. Program completers attended an average of 25.25 (SD 5.82) sessions with an average of 38.93 (SD 5.64) exercise minutes per session while reaching targeted rate of perceived exertion levels. Qualitative themes included perceived benefits of an individualized program in a group setting, positive interactions with qualified staff, opportunities for socialization, and regular monitoring and staff attentiveness promoting feelings of safety.

Conclusions

Survivors of stroke were able to meet Medicare standard dosage (frequency and session duration) and rate of perceived intensity goals, and perceived the program as needed regardless of their mobility limitations or previous exercise experience. Primary challenges included managing referrals and uptake. Results support feasibility and benefit for survivors to integrate into U.S. CR programs.
Composition and distribution of vegetation in the water level fluctuating zone of the Lantsang cascade reservoir system using UAV multispectral imagery
Authors: Jiang Weiwei , Liu Lun , Xiao Henglin , Zhu Song , Li Wentao , Liu Ying
Published: March 2021

With the development of a large number of tall dams and large cascade reservoir projects in the Lantsang River Basin, a large water level fluctuating zone (WLFZ) containing cascading reservoirs has formed. This newborn ecosystem is related to the sustainable development of hydropower projects, and has become a new problem to be studied urgently. Taking WLFZs in the Huangdeng, Xiaowan and Nuozhadu Reservoirs in the Lantsang River Basin as study areas, this study used multi-spectral remote-sensing field data obtained with unmanned aerial vehicles (UAVs) to ascertain the species types, coverage, distribution characteristics, dominant species and pioneer species of naturally restored vegetation. The considered data were subjected to UAV data processing, vegetation classification using multi-spectral images and a geographic information system (GIS) terrain-distribution analysis. Results show that: Polygonum Plebeium, Cynodon dactylon, Xanthium sibiricum, Ageratum conyzoides, Eleusine indica, Digitaria sanguinalis and Verbena officinalis are the dominant species of vegetation that could be naturally restored in the WLFZ; the vegetation coverage and the number of species are significantly positively correlated with the age and restoration periods of the WLFZ; the vegetation coverage of each study area increases at first, and then decreases, as a function of elevation; gentle slopes about 0–25°are more suitable for vegetation restoration. This study provides first-hand data on the natural restoration of vegetation in WLFZs, and gives a useful reference for its ecological restoration as a consequence of hydropower cascade development in the Lantsang River Basin. Finally, the study demonstrates that light UAV remote sensing is an attractive choice for investigating vegetation in reservoir WLFZs.
Oropharyngeal meningococcal carriage in children and adolescents, a single center study in Buenos Aires, Argentina
Authors: Gentile Angela , Della Latta Maria Paula , Bloch Mercedes , Martorelli Luisina , Wisner Barbara , Sorhouet Pereira Cecilia , Regueira Mabel , Juarez Maria del Valle , Umido Veronica , Efron Adriana
Published: March 2021

Background

Neisseria meningitidis (Nm) pharyngeal carriage is a necessary condition for invasive disease. We present the first carriage study in children in Buenos Aires, Argentina, considering 2017 as a transition year. Aims: to assess the rate of Nm carriage, to determine genogroup, clonal complex and outer membrane protein distribution, to determine carriage risk factors by age.

Methods

Cross-sectional study including children 1–17 yrs, at Ricardo Gutiérrez Children’s Hospital in Buenos Aires 2017. Oro-pharyngeal swabs were taken and cultured within a short time after collection. Genogroup was determined by PCR and clonal complex by MLST. Categorical variables were analyzed.

Results

A total of 1,751 children were included. Group 1: 943 children 1–9 yrs, 38 Nm were isolated; overall carriage 4.0%. Genogroup distribution: B 26.3%, W 5.3%, Y 2.6%, Z 5.3%, other groups 7.9% and capsule null (cnl) 52.6%. Participating in extracurricular activities was the only independent predictor of Nm carriage. Group 2: 808 children 10–17 yrs, 76 Nm were isolated; overall carriage 9.4%. Genogroup distribution: B 19.7%, C 5.3%, W 7.9%, Y 9.2%, Z 5.3%, other groups 7.9% and cnl 44.7%. Independent predictors of carriage: attending pubs/night clubs and passive smoking (adjusted OR: 0.55, 95%CI = 0.32–0.93; p = 0.025).

Conclusions

Overall carriage was higher in 10–17 yrs. The isolates presenting the cnl locus were prevalent in both age groups and genogroup B was the second most frequent.
Management and patient safety of complex elderly patients in primary care during the COVID-19 pandemic in the UK—Qualitative assessment
Authors: Alboksmaty Ahmed , Kumar Sonia , Parekh Ravi , Aylin Paul
Published: March 2021

Objectives

The study aims to investigate GPs’ experiences of how UK COVID-19 policies have affected the management and safety of complex elderly patients, who suffer from multimorbidity, at the primary care level in North West London (NWL).

Design

This is a service evaluation adopting a qualitative approach.

Setting

Individual semi-structured interviews were conducted between 6 and 22 May 2020, 2 months after the introduction of the UK COVID-19 Action Plan, allowing GPs to adapt to the new changes and reflect on their impact.

Participants

Fourteen GPs working in NWL were interviewed, until data saturation was reached.

Outcome measures

The impact of COVID-19 policies on the management and safety of complex elderly patients in primary care from the GPs’ perspective.

Results

Participants’ average experience was fourteen years working in primary care for the NHS. They stated that COVID-19 policies have affected primary care at three levels, patients’ behaviour, work conditions, and clinical practice. GPs reflected on the impact through five major themes; four of which have been adapted from the Safety Attitudes Questionnaire (SAQ) framework, changes in primary care (at the three levels mentioned above), involvement of GPs in policy making, communication and coordination (with patients and in between medical teams), stressors and worries; in addition to a fifth theme to conclude the GPs’ suggestions for improvement (either proposed mitigation strategies, or existing actions that showed relative success). A participant used an expression of “infodemic” to describe the GPs’ everyday pressure of receiving new policy updates with their subsequent changes in practice.

Conclusion

The COVID-19 pandemic has affected all levels of the health system in the UK, particularly primary care. Based on the GPs’ perspective in NWL, changes to practice have offered opportunities to maintain safe healthcare as well as possible drawbacks that should be of concern.
A protein structural study based on the centrality analysis of protein sequence feature networks
Authors: Wan Xiaogeng , Tan Xinying
Published: March 2021

In this paper, we use network approaches to analyze the relations between protein sequence features for the top hierarchical classes of CATH and SCOP. We use fundamental connectivity measures such as correlation (CR), normalized mutual information rate (nMIR), and transfer entropy (TE) to analyze the pairwise-relationships between the protein sequence features, and use centrality measures to analyze weighted networks constructed from the relationship matrices. In the centrality analysis, we find both commonalities and differences between the different protein 3D structural classes. Results show that all top hierarchical classes of CATH and SCOP present strong non-deterministic interactions for the composition and arrangement features of Cystine (C), Methionine (M), Tryptophan (W), and also for the arrangement features of Histidine (H). The different protein 3D structural classes present different preferences in terms of their centrality distributions and significant features.
Construction of a detachable artificial trachea model for three age groups for use in an endotracheal suctioning training environment simulator
Authors: Yoshimura Takaaki , Colley Noriyo , Komizunai Shunsuke , Ninomiya Shinji , Kanai Satoshi , Konno Atsushi , Yasuda Koichi , Taguchi Hiroshi , Hashimoto Takayuki , Shimizu Shinichi
Published: March 2021

Tracheal suctioning is an important procedure to maintain airway patency by removing secretions. Today, suctioning operators include not only medical staff, but also family caregivers. The use of a simulation system has been noted to be the most effective way to learn the tracheal suctioning technique for operators. While the size of the trachea varies across different age groups, the artificial trachea model in the simulation system has only one fixed model. Thus, this study aimed to construct multiple removable trachea models according to different age groups. We enrolled 20 patients who had previously received proton beam therapy in our institution and acquired the treatment planning computed tomography (CT) image data. To construct the artificial trachea model for three age groups (children, adolescents and young adults, and adults), we analyzed the three-dimensional coordinates of the entire trachea, tracheal carina, and the end of the main bronchus. We also analyzed the diameter of the trachea and main bronchus. Finally, we evaluated the accuracy of the model by analyzing the difference between the constructed model and actual measurements. The trachea model was 8 cm long for children and 12 cm for adolescents and young adults, and for adults. The angle between the trachea and bed was about 20 degrees, regardless of age. The mean model accuracy was less than 0.4 cm. We constructed detachable artificial trachea models for three age groups for implementation in the endotracheal suctioning training environment simulator (ESTE-SIM) based on the treatment planning CT image. Our constructed artificial trachea models will be able to provide a simulation environment for various age groups in the ESTE-SIM.
Sensations, symptoms, and then what? Early bodily experiences prior to diagnosis of lung cancer
Authors: Bernhardson Britt-Marie , Tishelman Carol , Rasmussen Birgit H. , Hajdarevic Senada , Malmström Marlene , Overgaard Hasle Trine Laura , Locock Louise , Eriksson Lars E.
Published: March 2021

Lung cancer (LC) generally lacks unique core symptoms or signs. However, there are a multitude of bodily sensations that are often non-specific, not easily understood, and many times initially not recognized as indicative of LC by the affected person, which often leads to late diagnosis. In this international qualitative study, we inductively analyzed retrospective accounts of 61 people diagnosed with LC in Denmark, England and Sweden. Using the bodily sensations they most commonly spoke about (tiredness, breathlessness, pain, and cough), we constructed four sensation-based cases to understand the pre-diagnostic processes of reasoning and practice triggered by these key indicators of LC. We thereafter critically applied Hay’s model of sensations to symptoms transformation, examining its central concepts of duration, disability and vulnerability, to support understanding of these processes. We found that while duration and disability are clearly relevant, vulnerability is more implicitly expressed in relation to perceived threat. Tiredness, even when of long duration and causing disability, was often related to normal aging, rather than a health threat. Regardless of duration, breathlessness was disturbing and threatening enough to lead to care-seeking. Pain varied by location, duration and degree of disability, and thus also varied in degree of threat perceived. Preconceived, but unmet expectations of what LC-related cough and pain would entail could cause delays by misleading participants; if cough lasted long enough, it could trigger health care contact. Duration, disability, and sense of threat, rather than vulnerability, were found to be relevant concepts for understanding the trajectory to diagnosis for LC among these participants. The process by which an individual, their family and health care providers legitimize sensations, allowing them to be seen as potential symptoms of disease, is also an essential, but varying part of the diagnostic processes described here.
Planned missing data in early literacy interventions: A replication study with an additional gold standard
Authors: Rippe Ralph C. A. , Merkelbach Inge
Published: March 2021

Introduction

In a digital early literacy intervention RCT, children born late preterm fell behind peers when in a control condition, but outperformed them when assigned to the intervention. Results did however not replicate previous findings. Replication is often complicated by resource quality. Gold Standard measures are generally time-intensive and costly, while they closely align with, and are more sensitive to changes in, early literacy and language performance. A planned missing data approach, leaving these gold standard measures incomplete, might aid in addressing the origin(s) of non-replication.

Methods

Participants after consent were 695 p Dutch primary school pupils of normal and late preterm birth. The high-quality measures, in additional to simpler but complete measures, were intentionally administered to a random subsample of children. Five definitions of gold standard alignment were evaluated.

Results

Two out of five gold standard levels improved precision compared to the original results. The lowest gold standard level did not lead to improvement: precision was actually diminished. In two gold standard definitions, an alphabetical factor and a writing-only factor the model estimates were comparable to the original results. Only the most precise definition of the gold standard level replicated the original results.

Conclusion

Gold standard measures could only be used to improve model efficiency in RCT-designs under sufficiently high convergent validity.
Serine protease inhibitors of the whirling disease parasite Myxobolus cerebralis (Cnidaria, Myxozoa): Expression profiling and functional predictions
Authors: Eszterbauer Edit , Szegő Dóra , Ursu Krisztina , Sipos Dóra , Gellért Ákos
Published: March 2021

Here, we studied the expression pattern and putative function of four, previously identified serine protease inhibitors (serpins) of Myxobolus cerebralis, a pathogenic myxozoan species (Cnidaria: Myxozoa) causing whirling disease of salmonid fishes. The relative expression profiles of serpins were determined at different developmental stages both in fish and in annelid hosts using serpin-specific qPCR assays. The expression of serpin Mc-S1 was similar throughout the life cycle, whereas a significant decrease was detected in the relative expression of Mc-S3 and Mc-S5 during the development in fish, and then in the sporogonic stage in the worm host. A decreasing tendency could also be observed in the expression of Mc-S4 in fish, which was, however, upregulated in the worm host. For the first time, we predicted the function of M. cerebralis serpins by the use of several bioinformatics-based applications. Mc-S1 is putatively a chymotrypsin-like inhibitor that locates extracellularly and is capable of heparin binding. The other three serpins are caspase-like inhibitors, and they are probably involved in protease and cell degradation processes during the early stage of fish invasion.
Co-similar malware infection patterns as a predictor of future risk
Authors: Yavneh Amir , Lothan Roy , Yamin Dan
Published: March 2021

The internet is flooded with malicious content that can come in various forms and lead to information theft and monetary losses. From the ISP to the browser itself, many security systems act to defend the user from such content. However, most systems have at least one of three major limitations: 1) they are not personalized and do not account for the differences between users, 2) their defense mechanism is reactive and unable to predict upcoming attacks, and 3) they extensively track and use the user’s activity, thereby invading her privacy in the process. We developed a methodological framework to predict future exposure to malicious content. Our framework accounts for three factors–the user’s previous exposure history, her co-similarity to other users based on their previous exposures in a conceptual network, and how the network evolves. Utilizing over 20,000 users’ browsing data, our approach succeeds in achieving accurate results on the infection-prone portion of the population, surpassing common methods, and doing so with as little as 1/1000 of the personal information it requires.
Multilevel analysis of unhealthy bodyweight among women in Malawi: Does urbanisation matter?
Authors: Afolabi Rotimi Felix , Palamuleni Martin Enock
Published: March 2021

Background

Underweight and overweight constitute unhealthy bodyweight and their coexistence is symptomatic of the dual burden of malnutrition (DBM) of high public health concern in many sub-Saharan Africa countries. Little is known about DBM and its correlates in Malawi, a country undergoing urbanisation. The study examined net effects of urban residence on unhealthy weights amidst individual- and community-level factors among women in Malawi.

Methods

Data on 7231 women aged 15–49 years nested within 850 communities extracted from 2015–16 Malawi Demographic and Health Survey were analysed. Women’s weight status measured by body mass index, operationally categorised as underweight, normal and overweight, was the outcome variable while urban-rural residence was the main explanatory variable. Multilevel multinomial logistic regression analysis was employed at 5% significant level; the relative-risk ratio (RR) and its 95% confidence interval (CI) were presented.

Results

Urban residents had a significantly higher prevalence of overweight than rural (36.4% vs. 17.2%; p< 0.001) but a -non-significant lower prevalence of underweight (6.2% vs. 7.4%; p = 0.423). Having adjusted for both individual- and community-level covariates, compared to rural, living in urban (aRR = 1.25; CI: 1.02–1.53) accounted for about 25% higher risk of being overweight relative to normal weight. Higher education attainment, being married and belonging to Chewa, Lomwe or Mang’anja ethnic group significantly reduced the risk of being underweight but heightened the risk of being overweight. Being older and living in wealthier households respectively accounted for about 3- and 2-times higher likelihood of being overweight, while breastfeeding (aRR = 0.65; CI: 0.55–0.76) was protective against overweight. Living in communities with higher poverty and higher education levels reduced and increased the risk of being overweight, respectively. Evidence of community’s variability in unhealthy weights was observed in that 11.1% and 3.0% respectively of the variance in the likelihood of being overweight and underweight occurred across communities.

Conclusions

The study demonstrated association between urban residence and women overweight. Other important associated factors of overweight included breastfeeding, community education- and poverty-level, while education attainment, marital status and ethnicity were associated with the dual unhealthy weight. Thus, both individual- and community-level characteristics are important considerations for policy makers in designing interventions to address DBM in Malawi.
What do patients and dermatologists prefer regarding low-risk basal cell carcinoma follow-up care? A discrete choice experiment
Authors: van Egmond Sven , de Vries Esther , Hollestein Loes , Bastiaens Maarten , de Roos Kees-Peter , Kuijpers Daniëlle , Steyerberg Ewout , Wakkee Marlies , Mosterd Klara , Nijsten Tamar , de Bekker-Grob Esther W.
Published: March 2021

Background

Follow-up after low-risk basal cell carcinoma (BCC) is being provided more frequently than recommended by guidelines. To design an acceptable strategy to successfully reduce this ‘low-value’ care, it is important to obtain insights into the preferences of patients and dermatologists.

Objective

To determine the preferences and needs of patients and dermatologists to reduce low-risk BCC follow-up care, and the trade-offs they are willing to make.

Methods

A questionnaire including a discrete choice experiment was created, containing attributes regarding amount of follow-up, continuity of care, method of providing addition information, type of healthcare provider, duration of follow-up visits and skin examination. In total, 371 BCC patients and all Dutch dermatologists and dermatology residents (n = 620) were invited to complete the questionnaire. A panel latent class model was used for analysis.

Results

Eighty-four dermatologists and 266 BCC patients (21% and 72% response rates respectively) completed the discrete choice experiment. If the post-treatment visit was performed by the same person as treatment provider and a hand-out was provided to patients containing personalised information, the acceptance of having no additional follow-up visits (i.e. following the guidelines) would increase from 55% to 77% by patients. Female patients and older dermatologists, however, are less willing to accept the guidelines and prefer additional follow-up visits.

Limitations

The low response rate of dermatologists.

Conclusion

This discrete choice experiment revealed a feasible strategy to substantially reduce costs, while maintaining quality of care, based on the preferences and needs of BCC patients, which is supported by dermatologists.
Faculty development program assists the new faculty in constructing high-quality short answer questions; a quasi-experimental study
Authors: Abdulghani Hamza Mohammad , Sattar Kamran , Ahmad Tauseef , Akram Ashfaq , Khalil Mahmoud Salah
Published: March 2021

Faculty development programs (FD) prepare the faculty for their educational role and career tasks. We aimed to evaluate the effectiveness of FDP in advancing the quality of short-answer questions (SAQs). This was a quasi-experimental study, comprising 37 new faculty. The SAQs were examined on psychometric analysis and Bloom’s cognitive levels for the two educational blocks of 1st medical year (i.e. Musculoskeletal (MSK) and Renal blocks). We found substantial improvement in the discrimination index values of SAQs prepared after the workshop (p = 0.04). A higher number of SAQs with moderate difficulty and higher discrimination were also observed. Flaws within the post-workshop questions were reduced (3.0%) when compared with pre-workshop (12.5%). The major incline was also reported within Bloom’s cognitive levels when pre-workshop K2 questions (30%) were compared with post-workshop (45.5%) with a p-value = 0.05. The SAQs constructed by the faculty member without participating in FDP are generally of unsatisfactory quality. After the FDP the assessment items of two blocks improved for various parameters of student assessment. The current study advocates that newly joined faculty shall be provided with the FDP to be guided, trained and supported for improving the quality of assessment through SAQs items writing.