bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Two-Step Testing Algorithm on Reducing Hospital-Onset Clostridioides difficile Infections
Authors: Navalkele Bhagyashri , Winn Wendy , Fletcher Sheila , Galloway Regina , Parham Jason , Daley William , Kyle Patrick , Clack Vonda , Sheilds Kathy
Published: November 2021

Clostridioides difficile infection (CDI) is one of the leading causes of hospital–onset infections. Clinically distinguishing true CDI versus colonization with C. difficile is challenging and often requires reliable and rapid molecular testing methods. At our academic center, we implemented a 2-step testing algorithm to help identify true CDI cases. The University of Mississippi Medical Center is a 700+ bed academic facility located in Jackson, Mississippi. Hospital-onset (HO) CDI was defined based on NHSN Laboratory Identified (LabID) event as the last positive C. difficile test result performed on a specimen using a multistep testing algorithm collected >3 calendar days after admission to the facility. HO-CDI data were collected from all inpatient units except the NICU and newborn nursery. HO-CDI outcomes were assessed based on standardized infection ratio (SIR) data. In May 2020, we implemented a 2-step testing algorithm (Figure 1). All patients with diarrhea underwent C. difficile PCR testing. Those with positive C. difficile PCR test were reflexed to undergo enzyme immunoassay (EIA) glutamate dehydrogenase antigen (Ag) testing and toxin A and B testing. The final results were reported as colonization (C. difficile PCR+/EIA Ag+/Toxin A/B−) or true CDI case (C. difficile PCR+/EIA +/Toxin A/B +) or negative (C. difficile PCR−). All patients with colonization or true infection were placed under contact isolation precautions until diarrhea resolution for 48 hours. During the preintervention period (October 2019–April 2020), 25 HO-CDI cases were reported compared to 8 cases in the postintervention period (June 2020–December 2020). A reduction in CDI SIR occurred in the postintervention period (Q3 2020–Q4 2020, SIR 0.265) compared to preintervention period (Q4 2019–Q1 2020, SIR 0.338) (Figure 2). We successfully reduced our NHSN HO-CDI SIR below the national average after implementing a 2-step testing algorithm for CDI. The 2-step testing algorithm was useful for antimicrobial stewardship to guide appropriate CDI treatment for true cases and for infection prevention to continue isolation of infected and colonized cases to reduce the spread of C. difficile spores.

Funding: No

Disclosures: None
Use of COVID-19 Serologic Testing in Healthcare Workers with Acute Respiratory Tract Infection
Authors: Ray Amy
Published: November 2021

Background: Diagnostic tests for COVID-19 are in high demand. Serologic assays are of interest as diagnostic adjuncts to SARS-CoV-2 quantitative polymerase chain reaction (PCR); however, many of the commercially available assays have limited validation data and clinical utility is unknown. We describe the utilization of SARS-CoV-2 IgG enzyme-linked immunosorbent assay (ELISA) for healthcare workers with acute respiratory tract infection (ARTI) who underwent SARS-CoV-2 PCR testing. Methods: The MetroHealth System is the largest public hospital system in Ohio, employing ~8,000 staff. COVID-19 detection began in early March 2020. EDI novel coronavirus COVID-19 IgG ELISA (KT-1032) targeting antibody response to viral nucleocapsid was obtained for diagnostic and seroprevalence analyses. Manufacturer reports of sensitivity and specificity of the assay are 100% and 99%, respectively. A 2-part test strategy for employees with symptoms of ARTI was implemented. Qualifying symptoms for SARS-CoV-2 PCR testing included fever and either cough or shortness of breath. Additional symptoms were included to reflect expanding knowledge of COVID-19. Employees who underwent SARS-CoV-2 PCR testing (Luminex ARIES) were offered serologic testing on day 14 following PCR result. Education accompanied the offer for serologic testing as well as the receipt of test result to aide interpretation. Results: From April 16, 2020, through July 6, 2020, 588 employees underwent PCR testing. Overall, 70 cases of COVID-19 were detected. Of the 197 employees who opted for serologic testing, IgG positivity was 12.6%. The mean time to IgG collection following PCR result was 30 days (range, 10–79). Using PCR results obtained in the clinical setting of ARTI as the diagnostic gold standard, IgG was 84.6% sensitive and 98.2% specific (Figure 1). Conclusions: In a population of symptomatic healthcare workers, SARS-CoV2 IgG testing was specific for COVID-19 diagnosis. Sensitivity was inadequate compared to the positive predictive agreement of 90% or greater required for US Food and Drug Administration emergency use authorization. In a low-prevalence environment for COVID-19 (<5%), a positive SARS-CoV-2 IgG has a low positive predictive value, which may falsely imply immunity and may negatively affect infection prevention practices.

Funding: No

Disclosures: None
Stewardship of Remdesivir Use in a Rural Community Hospital During the COVID-19 Pandemic
Authors: Tirupathi Raghavendra , Gross Melissa
Published: November 2021

Background: Remdesivir was granted EUA followed by full FDA approval for treatment of hospitalized COVID-19 patients on October 22, 2020, based on the results from the ACTT1 trial. Remdesivir use was initially restricted to infectious disease (ID) physicians in our hospital with prescription needing formal ID consultation until complete approval. Due to increasing case counts in our hospital, a decision was made to allow intensivists and hospitalists the authorization to prescribe remdesivir in a phased manner. In this retrospective study, we assessed the impact of phased-in prescribing on remdesivir utilization and days of therapy of antimicrobials. Methods: Remdesivir prescribing was streamlined by real-time institutional guidelines developed by a COVID-19 treatment committee constituting ID and other clinicians. Eligibility for remdesivir included positive SARS-CoV-2 PCR test, severe disease defined as persistent hypoxia (<94% oxygen saturation on room air), requiring supplemental oxygen and/or on mechanical ventilation (MV) for <72 hours, and symptom onset of <10 days. We retrospectively reviewed cohorts of 3 periods during which remdesivir was prescribed. In the first cohort A, between October 23, 2020, and November 12, 2020, remdesivir was restricted to ID physicians with formal ID consultation. Cohort B comprised inpatients between November 13, 2020, and December 6, 2020, when hospitalists and intensivists were allowed to prescribe remdesivir through an EMR order set after prior authorization by an ID physician via curbside or telephonic consultation. Cohort C, from December 7, 2020, to December 26, 2020, comprised inpatients with unrestricted prescribing of remdesivir by hospitalists and intensivists. We also evaluated antibiotic use. Results: In cohort A, SARS CoV-2 positivity was 20.3%; 64 inpatients tested positive and 35 patients (54.7%) who met the criteria were prescribed remdesivir after a formal consultation with an ID physician. In cohort B, requiring prior authorization by an ID physician, SARS-CoV-2 positivity rapidly increased to 34%; 193 patients tested positive and 97 patients (50.3%) received remdesivir. In cohort C, during unrestricted access, positivity further increased to 38%; 235 inpatients tested positive and 123 (52.5%) received remdesivir. Remdesivir use remained steady during the 3 phases of gradual de-escalation of restricted prescribing and safe handoff in the context of clear guidelines, as well as ongoing curbside education provided by ID physicians during the second phase. Cohort B demonstrated the best prescribing rates. Antimicrobial prescribing data were also collected during the 3 cohort phases (Figures 1–3). Conclusions: Remdesivir is an expensive antiviral with limited utility and maximum benefit in COVID-19 inpatients who are hypoxic but do not require mechanical ventilation. Stewardship of remdesivir with safe, gradual handoff to inpatient can be achieved without overuse.

Funding: No

Disclosures: None
Comparing Hospital Healthcare-Associated Infection Incidence During Pre-COVID-19 Pandemic and Pandemic Eras
Authors: Parriott Andrea , Kazerouni N. Neely , Epson Erin
Published: November 2021

Background: Diversion of resources from infection prevention activities, personal protective equipment supply shortages, conservation (extended use and reuse) or overuse with multiple gown and glove layers, and antimicrobial prescribing changes during the COVID-19 pandemic might increase healthcare-associated infection (HAI) incidence and antimicrobial resistance. We compared the incidences of Clostridioides difficile infection (CDI), methicillin-resistant Staphyloccocus aureus bloodstream infection (MRSA BSI), and vancomycin-resistant enterococci bloodstream infection (VRE BSI) reported by California hospitals during the COVID-19 pandemic with incidence data collected prior to the pandemic. Methods: Using data reported by hospitals to the California Department of Health via the NHSN, we compared incidences in the second and third quarters of 2020 (pandemic) to the second and third quarters of 2019 (before the pandemic). For CDI and MRSA BSI, we compared the standardized infection ratios (SIRs, based on the 2015 national baseline), and we calculated the P values. No adjustment model is available for VRE BSI; thus, we measured incidence via crude incidence rates (infections per 100,000 patient days). We calculated incidence rate ratio (IRR) with 95% CI for VRE BSI. To examine the possible effect of missing data during the pandemic, we performed a sensitivity analysis by excluding all facilities that had incomplete data reporting at any time during either analysis period. Results: Incidence measures and numbers of facilities contributing data in prepandemic and pandemic periods are shown in Table 1. There were no statistically significant changes in SIRs at P = .05 for either MRSA BSI or CDI between the prepandemic and pandemic periods (MRSA BSI P = .17; CDI P = .08). Crude VRE BSI incidence increased during the pandemic compared to the prepandemic period (IRR, 1.40; 95% CI, 1.16–1.70). Excluding facilities with incomplete data had minimal effect. Conclusions: We found insufficient evidence that MRSA BSI or CDI incidence changed in California hospitals during the pandemic relative to the prepandemic period; however, there was a significant increase in the crude incidence of VRE BSI. Next, we will include interrupted time series analyses to assess departure from long-term trends, including a risk-adjusted model for VRE BSI. Additionally, we will evaluate for changes in central-line–associated bloodstream infection incidence and antimicrobial resistance among HAI pathogens.

Funding: No

Disclosures: None
Linking Staff Cases in a Hospital COVID-19 Outbreak Using Electronic Tracking Data
Authors: Dhaubhadel Pragya , Pace Margie , Augustine Trina , Hostetler Seth , Shelly Mark
Published: November 2021

Background: Significant outbreaks of SARS-CoV-2 infections have occurred in healthcare personnel (HCP). We used an electronic tracking system (ETS) as a tool to link staff cases of COVID-19 in place and time during a COVID-19 outbreak in a community hospital. Methods: We identified SARS-CoV-2 infection cases through surveillance, case investigation and contact tracing, and voluntary testing. For those wearing ETS badges (Centrak), data were reviewed for places occupied by the personnel during their incubation and infectious windows. Contacts beyond 15 minutes in the same location were considered close contacts. Results: Over 6 weeks (August 10–September 14, 2020), 35 HCPs tested positive for SARS-CoV-2 by NAAT testing. In total, 18 nurses and aides were clustered on 1 hospital unit, 7 cases occurred among respiratory therapists that visited that unit, and 10 occurred in other departments. Overall, 17 individuals wore ETS badges as part of hand hygiene monitoring. ETS data established potential transmission opportunities in 17 instances, all but 2 before symptom onset or positive test result. Contacts were most often (10 of 17) in common work areas (nursing stations), with a median time of 45 minutes (IQR, 21–137). Contacts occurred within and between departments. A few COVID-19 patients were cared for in this location at the time of the outbreak. However, we did not detect HCP-to-patient nor patient-to-HCP transmission. Conclusions: Significant HCP-to-HCP transmission occurred during this outbreak based on ETS location. These events often occurred in shared work areas such as the nursing station in addition to break areas noted in other reports. ETS systems, installed for other purposes, can serve to reinforce standard epidemiology.

Funding: No

Disclosures: None
Constituting and Regulating Democracy: Kenya's Electoral Commission and the Courts in the 2010s
Authors: Stacey Richard , Miyandazi Victoria
Published: November 2021

In August 2017, responding to a petition from the losing candidate in the presidential election held days before, the Supreme Court of Kenya declared the results of the election null and void. Dramatic in itself, the decision stands in surprising contrast to the same Court's decision to uphold the 2013 election results following a similar petition. Beyond the different outcomes in 2013 and 2017, the Court's jurisprudential approach to the two petitions was markedly different. The Court showed significant deference to the Independent Elections and Boundaries Commission (IEBC) in 2013, and did not seriously interrogate its conclusion that the election had been free and fair. In 2017, however, the Court scrutinised the IEBC's process and paid close attention to the reasons it gave for declaring the result free and fair. This article considers the difference in the Court's approach in two ways. First, from a prescriptive perspective, it suggests when it is appropriate for courts to closely scrutinise the work of elections management boards and other ‘fourth branch’ institutions protecting democracy (IPDs). The article argues that where an IPD performs a function that is constitutive of rights, courts should be prepared to intervene. By contrast, where an IPD performs a function that is regulative of already constituted rights, courts of review should act with deference. On this basis, the article concludes that the Court should have engaged in a deeper review of the IEBC's 2013 decision. Second, from a descriptive perspective, the article suggests that the difference between the Court's 2013 and 2017 approaches can be explained by waning levels of public trust in the IEBC alongside growing levels of public confidence in the judiciary.
The Making of Everyman’s Capitalism in Sweden: Micro-Infrastructures, Unlearning, and Moral Boundary Work
Authors: Husz Orsi , Larsson Heidenblad David
Published: November 2021

This article analyzes the so-called turn to the market in Sweden, with an emphasis on aspects that are typically absent from large-scale narratives. How did the changes known as neoliberalization and financialization enter everyday life and mundane financial practices? And which analytical tools can historians use to meaningfully connect the experience of changes on the micro level to those on the macro level? Zooming in on the the year 1979 and focusing on two empirical cases—the popularization of stock saving and the domestication of consumer credit—allows us to elaborate and apply a set of analytical entry points about (1) mundane micro-infrastructures, (2) financial knowledge as learning and unlearning, and (3) moral boundary work. This framework offers a way of exploring when and in what ways new financial practices were experienced and eventually embraced by those who had previously been skeptical or even hostile. It also reveals the role played by actors and institutions not typically seen as agents of marketization.
Topology of random -dimensional cubical complexes
Authors: Kahle Matthew , Paquette Elliot , Roldán Érika
Published: November 2021

We study a natural model of a random

$2$

-dimensional cubical complex which is a subcomplex of an n-dimensional cube, and where every possible square

$2$

-face is included independently with probability p. Our main result exhibits a sharp threshold

$p=1/2$

for homology vanishing as

$n \to \infty $

. This is a

$2$

-dimensional analogue of the Burtin and Erdoős–Spencer theorems characterising the connectivity threshold for random graphs on the

$1$

-skeleton of the n-dimensional cube.

Our main result can also be seen as a cubical counterpart to the Linial–Meshulam theorem for random

$2$

-dimensional simplicial complexes. However, the models exhibit strikingly different behaviours. We show that if

$p> 1 - \sqrt {1/2} \approx 0.2929$

, then with high probability the fundamental group is a free group with one generator for every maximal

$1$

-dimensional face. As a corollary, homology vanishing and simple connectivity have the same threshold, even in the strong ‘hitting time’ sense. This is in contrast with the simplicial case, where the thresholds are far apart. The proof depends on an iterative algorithm for contracting cycles – we show that with high probability, the algorithm rapidly and dramatically simplifies the fundamental group, converging after only a few steps.
Mapping non-laminar proton acceleration in laser-driven target normal sheath field
Authors: Qin C. Y. , Zhang H. , Li S. , Zhai S. H. , Li A. X. , Qian J. Y. , Gui J. Y. , Wu F. X. , Zhang Z. X. , Xu Y. , Liang X. Y. , Leng Y. X. , Shen B. F. , Ji L. L. , Li R. X.
Published: November 2021

We report on experimental observation of non-laminar proton acceleration modulated by a strong magnetic field in laser irradiating micrometer aluminum targets. The results illustrate the coexistence of ring-like and filamentation structures. We implement the knife edge method into the radiochromic film detector to map the accelerated beams, measuring a source size of 30–110 μm for protons of more than 5 MeV. The diagnosis reveals that the ring-like profile originates from low-energy protons far off the axis whereas the filamentation is from the near-axis high-energy protons, exhibiting non-laminar features. Particle-in-cell simulations reproduced the experimental results, showing that the short-term magnetic turbulence via Weibel instability and the long-term quasi-static annular magnetic field by the streaming electric current account for the measured beam profile. Our work provides direct mapping of laser-driven proton sources in the space-energy domain and reveals the non-laminar beam evolution at featured time scales.
On state instability of the bi-stable flow past a notchback bluff body
Authors: He Kan , Minelli Guglielmo , Su Xinchao , Gao Guangjun , Krajnović Siniša
Published: November 2021

The wake of a notchback Ahmed body presenting a bi-stable nature is investigated by performing wind tunnel experiments and large-eddy simulations. Attention is confined to the Reynolds number (

$Re$

) influence on the wake state instability within

$5\times 10^{4}\leq Re \leq 25\times 10^{4}$

. Experimental observations suggest a wake bi-stability with low-frequency switches under low

$Re$

. The wake becomes ‘tri-stable’ with the increase of

$Re$

with the introduction of a new symmetric state. The higher presence of the symmetric state can be considered as a symmetrization of the wake bi-stability with an increasing

$Re$

. The wake symmetry under high

$Re$

attributed to the highly frequent switches of the wake is extremely sensitive to small yaw angles, showing the feature of bi-stable flows. The wake asymmetry is confirmed in numerical simulations with both low and high

$Re$

. The wake asymmetries are indicated by the wake separation, the reattachment and the wake dynamics identified by the proper orthogonal decomposition. However, the turbulence level is found to be significantly higher with a higher

$Re$

. This leads to a higher possibility to break the asymmetric state, resulting in highly frequent switches showing symmetry.
Pressure fluctuations due to ‘trapped waves’ in the initial region of compressible jets
Authors: Zaman K.B.M.Q. , Fagan A.F. , Upadhyay P.
Published: November 2021

An experimental study is conducted on unsteady pressure fluctuations occurring near the nozzle exit and just outside the shear layer of compressible jets. These fluctuations are related to ‘trapped waves’ within the jet's potential core, as investigated and reported recently by other researchers. Round nozzles of three different diameters and rectangular nozzles of various aspect ratios are studied. The fluctuations manifest as a series of peaks in the spectra of the fluctuating pressure. Usually the first peak at the lowest frequency (fundamental) has the highest amplitude and the amplitude decreases progressively for successive peaks at higher frequencies. These ‘trapped wave spectral peaks’ are found to occur with all jets at high subsonic conditions and persist into the supersonic regime. Their characteristics and variations with axial and radial distances, jet Mach number and aspect ratio of the nozzle are documented. For round nozzles, the frequency of the fundamental is found to be independent of the jet's exit boundary layer characteristics and scales with the nozzle diameter. On a Strouhal number (based on diameter) versus jet Mach number plot it is represented by a unique curve. Relative to the fundamental the frequencies of the successive peaks are found to bear the ratios of 5/3, 7/3, 9/3 and so on, at a given Mach number. For rectangular nozzles, the number of peaks observed on the major axis is found to be greater than that observed on the minor axis by a factor approximately equal to the nozzle's aspect ratio; the fundamental is the same on either edge. For all nozzles the onset of screech tones appears as a continuation of the evolution of these peaks; it is as if one of these peaks abruptly increases in amplitude and turns into a screech tone as the jet Mach number is increased.
Examination of dietary intake of UK preschool children by varying carers: evidence from the 2008–2016 UK National Diet and Nutrition Survey
Authors: Marr Colette , Breeze Penny , Caton Samantha J.
Published: November 2021

Early years caregivers can play a key role in young children’s eating and the prevention of childhood obesity. The UK National Diet and Nutrition Survey (NDNS) is a large representative survey collecting detailed food and nutrition consumption data. Using these data, the aim of this study was to investigate the relationship between dietary intake of preschool children in the UK aged 2 to 4 years and accompanying adult/s. Nutrition consumption data from 1218 preschool children from years 1 to 8 of the 2008–2016 NDNS were accessed. Dietary data were captured using 3 or 4 day estimated food diaries. Regression analyses revealed significant differences in consumption when children were not accompanied by their parents. Compared with when children were with parents, children consumed significantly more energy dense meals (0·32 kJ/g, 95% CI 0·1–0·6 kJ/g), energy (62 kJ/g, (95% CI 27–97 kJ)) Na (19 mg, (95 % CI 6, 32)), added sugars (0·6 g, (95 % CI 0·1, 1·1)), vegetables (3 g, (95 % CI 1, 4)), total grams (12 g, (95 % CI 3, 21)) and saturated fat (0·2 g, (95 % CI 0·1, 0·4)) per eating occasion when accompanied by wider family. When children were accompanied by a formal childcare provider, they consumed significantly lower energy dense meals (−0·9 kJ/g, (95% CI −1·4 – −0·3 kJ/g)), less added sugars (−1·6 g, (95 % CI −2·4, −0·8)) and more fruit (12 g, (95 % CI 3, 21)) per eating occasion than when they were with their parents. The results demonstrate that non-parental caregivers might be an important target to promote healthy eating in young children. Further research is needed to establish which caregivers would benefit most.
The Frucht property in the quantum group setting
Authors: Banica T. , McCarthy J.P.
Published: November 2021

A classical theorem of Frucht states that any finite group appears as the automorphism group of a finite graph. In the quantum setting, the problem is to understand the structure of the compact quantum groups which can appear as quantum automorphism groups of finite graphs. We discuss here this question, notably with a number of negative results.
Management of obstructive pathology of the salivary glands in elderly patients: a preliminary study
Authors: Familiari M , Ferrario F , Giordano L , Di Santo D , Indelicato P , Battista R A , Bussi M
Published: November 2021

Background

Obstructive pathology is a benign condition of the salivary glands that can affect elderly and co-morbid people. Sialoendoscopy is a minimally invasive surgical procedure with a success rate comparable to standard sialoadenectomy and has the advantage that it can be performed under local anaesthesia.

Methods

This study aimed to assess sialoendoscopy benefits in elderly patients unfit for general anaesthesia. A group of elderly patients (aged 65 years or more) undergoing sialoendoscopy under local anaesthesia were evaluated. Age, co-morbidities, surgical time, hospital stay, and complication and recurrence rates were assessed.

Results

Nineteen sialoendoscopies were performed in 18 elderly patients with a mean age of 69.7 ± 5.6 years, with some of them suffering from multiple co-morbidities. Surgery was successful in 16 patients, while surgery was unsuccessful in 2 patients because of intraglandular stones. The average surgical duration was 54.5 ± 30.1 minutes, and all patients were discharged 2–3 hours after surgery. No post-operative complications were found and only one patient had recurrence during follow up.

Conclusion

Sialoendoscopy under local anaesthesia is a safe and effective procedure in elderly patients who are more prone to complications.
Changes in the provision of undergraduate ENT clinical placements across the UK in response to the coronavirus disease 2019 pandemic
Authors: Patel B , Parmar D , Gera R , Hannan S A , Saeed S R
Published: November 2021

Objective

This study aimed to report the changes made to ENT placements across the UK in response to the pandemic and their impact on student experience.

Methods

A questionnaire eliciting how ENT placements were provided before and after coronavirus disease 2019 was disseminated amongst Student and Foundation Doctors in Otolaryngology representatives.

Results

Thirty-eight respondents from 27 medical schools across the UK completed the survey (response rate of 90 per cent). Twenty-nine of the 38 respondents (76 per cent) reported a change in ENT placements in response to the pandemic. Six of the 38 students (16 per cent) remained satisfied with their ENT placements, as compared to 12 students prior to the pandemic (32 per cent).

Conclusion

There is considerable variability in how medical schools responded to the pandemic. Most medical schools placed students into smaller groups, with less direct contact in the hospital. These changes resulted in lower student satisfaction. The increased emphasis on e-learning underscores the need for high quality e-learning materials to promote learning throughout the pandemic and in the future.
Can we improve our day-case rate in functional endoscopic sinus surgery?
Authors: Edafe O , Sargeant T , Morsy M , Oluwole M K , Mirza S
Published: November 2021

Objective

Day-case functional endoscopic sinus surgery is associated with increased patient satisfaction and reduced costs. This study aimed to identify reasons for overnight admission with a view to improving same-day discharge.

Methods

This was a retrospective observation study over a one-year period. All consecutive patients who underwent elective functional endoscopic sinus surgery were included.

Results

A total of 172 patients were included in this study. Functional endoscopic sinus surgery was planned as a day-case procedure in 152 patients (88 per cent), with a planned overnight stay in 20 (12 per cent). The rate of same-day discharge in patients who underwent elective functional endoscopic sinus surgery was 80.2 per cent (n = 138). Reasons for an unplanned overnight admission were: bleeding (n = 8), urinary retention (n = 3), medical co-morbidities (n = 1), post-operative pain (n = 1) and social reasons (n = 1).

Conclusion

There is scope to further improve the functional endoscopic sinus surgery day-case rate by utilising techniques to minimise post-operative bleeding. This has the potential to improve both patient satisfaction and service efficiency.
Effect of shaping on turbulent dynamics in reversed-field pinch simulations
Authors: Chahine Robert , Schneider Kai , Bos Wouter J.T.
Published: November 2021

We study the influence of the shape of the plasma container on the dynamics of the reversed-field pinch (RFP). The geometries we consider are periodic cylinders with elliptical and circular-shaped cross-sections. Numerical simulations of fully nonlinear viscoresistive magnetohydrodynamics are carried out to illustrate how the plasma dynamics is affected by shaping. It is shown that independent of the plasma shape, the quantity

$\beta$

, comparing the hydrodynamic pressure to the magnetic pressure, decreases for increasing values of the Lundquist number, but the pressure gradient fluctuations remain roughly constant, when compared to the Lorentz force. Different elliptical shapes of the cross-section of the domain lead to the excitation of different toroidal (or axial) magnetic and dynamic modes. Furthermore, it is found that in a geometry with circular cross-section, a significant local poloidal angular momentum is observed, absent in the geometries with elliptical cross-section. Because the confinement is dominantly determined by plasma movement, and the dynamics of the velocity and magnetic field are modified by the modification of the geometry, shaping can thus affect the performance of RFP devices.
School Teachers and Soft Decolonisation in Dutch–Indonesian Relations, 1945–1949
Authors: Suwignyo Agus
Published: November 2021

The emergence of two states in Indonesia in the aftermath of the Second World War, namely the Republic of Indonesia and the Netherlands Indies Civil Administration, instigated a war that imposed citizenship, which schoolteachers had to choose carefully. By examining the quest for professional trajectories of Dutch and Indonesian schoolteachers during the 1945–1949 period, this paper argues that expanding citizenship fostered decolonisation through the teachers’ detachment from a shared dream of social mobility. The post–World War II reconstruction project, which is largely depicted as narratives of state building in many of the existing bibliographies, reflected a growing discontent in teachers’ expectations for economic reestablishment at the personal levels. The teachers’ detachment from a shared dream of social mobility reflected the dissolution of an imagined community where transnational cultural identities had met and melded in the early twentieth century. In contrast to the emerging historiography that emphasises atrocities and violence, this paper offers a perspective on the soft process of decolonisation.
The Portable Coup: The Jurisprudence of ‘Revolution’ in Uganda and Nigeria
Authors: Daly Samuel Fury Childs
Published: November 2021

In the years after independence, former British colonies in eastern and southern Africa struggled to fill the ranks of their judiciaries with African judges. Beginning in the mid-1960s, states including Uganda, Tanzania, and Botswana solved this problem by retaining judges from the Caribbean and West Africa, especially Nigeria. In this same period, a wave of coups brought many independent states under the rule of their militaries (or authoritarian civilian regimes). Foreign judges who had been appointed in the name of pan-African cooperation were tasked with interpreting the laws that soldiers imposed, and assessing the legitimacy of regimes born of coups. The decisions they rendered usually accommodated authoritarianism, but they could also be turned against it. To understand how colonial law and postcolonial solidarities shaped Africa's military dictatorships, this article focuses on one judge, Sir Egbert Udo Udoma of Nigeria, who served as Uganda's first African chief justice and was an influential member of the Nigerian Supreme Court. Udoma and other judges like him traversed the continent in the name of African cooperation, making a new body of jurisprudence as they did so. Their rulings were portable, and they came to underpin military rule in many states, both in Africa and in the wider Commonwealth.
Recent change in modality in informal spoken British English: 1990s–2010s
Authors: LOVE ROBBIE , CURRY NIALL
Published: November 2021

Studies in modality comprise a complex canon of functional, formal, sociological and diachronic analyses of language. The current understanding of how English language speakers use modality is unclear; while some research argues that core modal auxiliaries are in decline, they are reported as increasing elsewhere. A lack of contemporary and representative spoken language data has rendered it difficult to reconcile such differing perspectives. To address this issue, this article presents a diachronic study of modality using the Spoken BNC2014 and the spoken component of the BNC1994. We investigate the frequency of core modal auxiliaries, semi-modals, and lexical modality-indicating devices (MIDs), as well as the modal functions of the core modal auxiliaries, in informal spoken British English, between the 1990s and 2010s. The results of the analysis are manifold. We find that core modal auxiliaries appear to be in decline, while semi-modals and lexical MIDs appear relatively stable. However, on a form-by-form basis, there is significant evidence of both increases and decreases in the use of individual expressions within each modal set. As a result, this study problematises form-based studies of change, and illustrates the value and coherence that functional analyses of modality can afford future work.
Qualitative exploration of the dynamics of women’s dietary diversity. How much does economic empowerment matter?
Authors: Onah Michael Nnachebe , Hoddinott John , Horton Susan
Published: November 2021

Objective:

This study qualitatively examined dietary diversity among married women of reproductive age who engaged in two socio-economic activities to explore the dynamics of food availability, access, costs and consumption.

Design:

Qualitative in-depth interviews. The food groups in the Minimum Dietary Diversity for women were used to explore women’s dietary diversity. IDI were used to develop a roster of daily food consumption over a week. We explored food items that were considered expensive and frequency of consumption, food items that women require permission to consume and frequency of permission sought and the role of economic empowerment. Data analysis followed an inductive–deductive approach to thematic analysis.

Setting:

Rural and peri-urban setting in Enugu State, Nigeria.

Participants:

Thirty-eight married women of reproductive age across two socio-economic groupings (women who work only at home and those who worked outside their homes) were recruited in April 2019.

Results:

Economic empowerment improved women’s autonomy in food purchase and consumption. However, limited income restricted women from full autonomy in consumption decisions and access. Consumption of non-staple food items, especially flesh proteins, would benefit from women’s economic empowerment, whereas staple food items would not benefit so much. Dietary diversity is influenced by food production and purchase where factors including seasonal variation in food availability, prices, contextual factors that influence women’s autonomy and income are important determinants.

Conclusion:

With limited income, agency and access to household financial resources coupled with norms that restrict women’s income earning, women continue to be at risk for not achieving adequate dietary diversity.
The Other Otto Dresel: Public and Private Musical Identities in a German-American ‘Forty-Eighter’ and his Family, c. 1860–1880
Authors: Barnes Molly
Published: November 2021

This essay explores the musical life of a German-American ‘Forty-Eighter’ and his family, with particular attention to their domestic musical preferences as reflected in five surviving sheet-music albums. Otto Dresel, easily confused with the far more prominent German musician of the same name who settled in Boston, was a gifted amateur whose public musical activities, both choral and instrumental, typified those of many German arrivals of that generation. This was a largely male realm of affirmative, expansive ideals; here the stress was on civic virtues, happy fraternal bonds, and the celebration of German musical culture as an elevating force in America. The family albums suggests that the music he shared with his wife and children at home in Columbus, Ohio, served quite different purposes. It was performed intimately, in an often melancholy and even mournful mode that reflected the need for personal consolation and was thus more in keeping with typical Victorian attitudes toward the domestic, womanly sphere. Evidence about the troubled course of Dresel's life helps us understand his growing need to take refuge in his home and family as well as in music that helped him and his loved ones deal – for a time, at least – with deepening feelings of regret, failure and loss. This marked contrast between the public and private sides of the Dresels’ musical lives points to a need for greater attention to the distinctive character and functions of intimate family music-making in nineteenth-century America, especially during the years of widespread disillusionment and cultural reorientation that followed the Civil War.
Gas hydrate stability zone in Muri coalfield, Qinghai Province, China
Authors: LI Jing , YAO Zheng , ZHAO Hongbo , WANG Zewei
Published: November 2021

The gas hydrate stability zone (GHSZ) is the essential condition for gas hydrate accumulation, which is controlled by three main factors: gas component, geothermal gradient and permafrost thickness. Based on the gas component of hydrate samples from drilling in Muri coalfield, the gas hydrate phase equilibrium curve was calculated using Sloan's natural gas hydrate phase equilibrium procedure (CSMHYD) program. Through temperature data processing of coalfield boreholes, some important data such as thickness of permafrost and geothermal gradient were obtained. The GHSZ parameters of a single borehole were calculated by programming based on the above basic data. The average thickness of GHSZ of 85 boreholes in Muri coalfield amounted to approximately 1000 m, indicating very broad space for gas hydrate occurrence. The isogram of GHSZ bottom depth drawn from single borehole data in Muri coalfield demonstrated the regional distribution characteristics of GHSZ, and identified three favourable areas of gas hydrate occurrence where the bottom of GHSZ had a burial depth >1500 m – namely, the southern part of Juhugeng Mining Area, the middle part of Duosuogongma Mining Area and the eastern part of Xuehuoli Mining Area.
Targeted Neuropsychological Screening in the Context of a Pediatric Psychiatry Consultation/Liaison Service
Authors: Bush Lauren , Ohanian Diana M. , Drossos Tina , Afzal Khalid I. , Lichtor Stephanie
Published: November 2021

Objective: Inpatient neuropsychological screening represents a promising direction for addressing consultation questions directed to pediatric psychiatry consultation/liaison (C/L) providers. Despite the potential of such a service, few studies have directly examined the role of targeted neuropsychological screening on a pediatric psychiatry C/L team. Thus, the primary goals of this paper were to explore the feasibility and utility of brief neuropsychological assessment in the context of a C/L service. Method: We review the literature related to neuropsychological consultation in pediatric medical settings. We provide a clinical case example to illustrate our experience incorporating targeted neuropsychological screening on our pediatric psychiatry C/L service. Results: Targeted screening as part of a psychiatry consultation service has the potential to be informative in patient care. Several existing preventive pediatric care models that include brief assessment are already being used in other pediatric medical settings. Conclusions: Inpatient neuropsychological screening can play a role in integrated care teams when both its strengths and limitations are understood. The incorporation of brief neuropsychological assessment into clinical practice within C/L services represents an important and potentially impactful future direction in both research and clinical care.

Implications for Impact Statement

Neuropsychological screening as part of a psychiatry consultation service has the potential to be informative for patient care. There are many existing preventive pediatric care models that include brief assessment in other medical settings. This paper reviews the relevant literature and provides a clinical case example to illustrate this.
CircRNA circ-NNT mediates myocardial ischemia/reperfusion injury through activating pyroptosis by sponging miR-33a-5p and regulating USP46 expression
Authors: Ye Xiaomiao , Hang Yanwen , Lu Yi , Li Dandan , Shen Fangfang , Guan Ping , Dong Jian , Shi Ludong , Hu Wei
Published: November 2021

Pyroptosis has been implicated in the pathophysiology of myocardial infarction (MI) in rodents, but its contribution to reperfusion injury in MI patients is unclear. Here, we evaluated pyroptosis in MI patients in vitro and in vivo models of myocardial ischemia/reperfusion (I/R) injury. We also investigated the molecular mechanisms that regulate pyroptosis and myocardial I/R injury in these in vitro and in vivo models. The study showed that MI patients exhibited elevated serum concentrations of the pyroptosis-related pro-inflammatory cytokines IL-1β and IL-18. Increased levels of IL-1β and IL-18 as well as the pyroptosis-related inflammatory caspases (caspase-1 and 11) were detected in cultured cardiomyocytes after anoxia/reoxygenation (A/R) and in cardiac tissues after I/R. Circ-NNT and USP46 were upregulated while miR-33a-5p was downregulated in MI patients, as well as in cultured cardiomyocytes after A/R and cardiac tissues after I/R. Circ-NNT or USP46 knockdown or miR-33a-5p overexpression inhibited the expression of pro-caspase-1, cleaved caspase-1, pro-caspase-11, cleaved caspase-11, IL-1β, and IL-18 in A/R cardiomyocytes and attenuated myocardial infarction in I/R mice. The results from luciferase reporter assays and gene overexpression/knockdown studies indicated that miR-33a-5p directly targets USP46, and circ-NNT regulates USP46 by acting as a miR-33a-5p sponge. Direct association between circ-NNT and miR-33a-5p in cardiomyocytes was confirmed by pull-down assays. In summary, pyroptosis is activated during myocardial I/R and contributes to reperfusion injury. Circ-NNT promotes pyroptosis and myocardial I/R injury by acting as a miR-33a-5p sponge to regulate USP46. This circ-NNT→miR-33a-5p→USP46 signaling axis may serve as a potential target for the development of cardio-protective agents to improve the clinical outcome of reperfusion therapy.
Real-time alerting system for COVID-19 and other stress events using wearable data
Authors: Alavi Arash , Bogu Gireesh K. , Wang Meng , Rangan Ekanath Srihari , Brooks Andrew W. , Wang Qiwen , Higgs Emily , Celli Alessandra , Mishra Tejaswini , Metwally Ahmed A. , Cha Kexin , Knowles Peter , Alavi Amir A. , Bhasin Rajat , Panchamukhi Shrinivas , Celis Diego , Aditya Tagore , Honkala Alexander , Rolnik Benjamin , Hunting Erika , Dagan-Rosenfeld Orit , Chauhan Arshdeep , Li Jessi W. , Bejikian Caroline , Krishnan Vandhana , McGuire Lettie , Li Xiao , Bahmani Amir , Snyder Michael P.
Published: November 2021

Early detection of infectious diseases is crucial for reducing transmission and facilitating early intervention. In this study, we built a real-time smartwatch-based alerting system that detects aberrant physiological and activity signals (heart rates and steps) associated with the onset of early infection and implemented this system in a prospective study. In a cohort of 3,318 participants, of whom 84 were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this system generated alerts for pre-symptomatic and asymptomatic SARS-CoV-2 infection in 67 (80%) of the infected individuals. Pre-symptomatic signals were observed at a median of 3 days before symptom onset. Examination of detailed survey responses provided by the participants revealed that other respiratory infections as well as events not associated with infection, such as stress, alcohol consumption and travel, could also trigger alerts, albeit at a much lower mean frequency (1.15 alert days per person compared to 3.42 alert days per person for coronavirus disease 2019 cases). Thus, analysis of smartwatch signals by an online detection algorithm provides advance warning of SARS-CoV-2 infection in a high percentage of cases. This study shows that a real-time alerting system can be used for early detection of infection and other stressors and employed on an open-source platform that is scalable to millions of users.
Exposure to airborne cadmium and breast cancer stage, grade and histology at diagnosis: findings from the E3N cohort study
Authors: Amadou Amina , Praud Delphine , Coudon Thomas , Danjou Aurélie M. N. , Faure Elodie , Deygas Floriane , Grassot Lény , Leffondré Karen , Severi Gianluca , Salizzoni Pietro , Mancini Francesca Romana , Fervers Béatrice
Published: November 2021

Molecular studies suggest that cadmium due to its estrogenic properties, might play a role in breast cancer (BC) progression. However epidemiological evidence is limited. This study explored the association between long-term exposure to airborne cadmium and risk of BC by stage, grade of differentiation, and histological types at diagnosis. A nested case–control study of 4401 cases and 4401 matched controls was conducted within the French E3N cohort. A Geographic Information System (GIS)-based metric demonstrated to reliably characterize long-term environmental exposures was employed to evaluate airborne exposure to cadmium. Multivariable adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression models. There was no relationship between cadmium exposure and stage of BC. Also, no association between cadmium exposure and grade of differentiation of BC was observed. However, further analyses by histological type suggested a positive association between cadmium and risk of invasive tubular carcinoma (ITC) BC [ORQ5 vs Q1 = 3.4 (95% CI 1.1–10.7)]. The restricted cubic spline assessment suggested a dose–response relationship between cadmium and ITC BC subtype. Our results do not support the hypothesis that airborne cadmium exposure may play a role in advanced BC risk, but suggest that cadmium may be associated with an increased risk of ITC.