bluuebunny/crossref_metadata_2025 huggingface dataset:
Mitigating Climate Biases in the Midlatitude North Atlantic by Increasing Model Resolution: SST Gradients and Their Relation to Blocking and the Jet
Authors: Athanasiadis Panos J. , Ogawa Fumiaki , Omrani Nour-Eddine , Keenlyside Noel , Schiemann Reinhard , Baker Alexander J. , Vidale Pier Luigi , Bellucci Alessio , Ruggieri Paolo , Haarsma Rein , Roberts Malcolm , Roberts Chris , Novak Lenka , Gualdi Silvio
Published: July 2022

Starting to resolve the oceanic mesoscale in climate models is a step change in model fidelity. This study examines how certain obstinate biases in the midlatitude North Atlantic respond to increasing resolution (from 1° to 0.25° in the ocean) and how such biases in sea surface temperature (SST) affect the atmosphere. Using a multimodel ensemble of historical climate simulations run at different horizontal resolutions, it is shown that a severe cold SST bias in the central North Atlantic, common to many ocean models, is significantly reduced with increasing resolution. The associated bias in the time-mean meridional SST gradient is shown to relate to a positive bias in low-level baroclinicity, while the cold SST bias causes biases also in static stability and diabatic heating in the interior of the atmosphere. The changes in baroclinicity and diabatic heating brought by increasing resolution lead to improvements in European blocking and eddy-driven jet variability. Across the multimodel ensemble a clear relationship is found between the climatological meridional SST gradients in the broader Gulf Stream Extension area and two aspects of the atmospheric circulation: the frequency of high-latitude blocking and the southern-jet regime. This relationship is thought to reflect the two-way interaction (with a positive feedback) between the respective oceanic and atmospheric anomalies. These North Atlantic SST anomalies are shown to be important in forcing significant responses in the midlatitude atmospheric circulation, including jet variability and the storm track. Further increases in oceanic and atmospheric resolution are expected to lead to additional improvements in the representation of Euro-Atlantic climate.
Soil Moisture and Streamflow Data Assimilation for Streamflow Prediction in the Narmada River Basin
Authors: Prakash Ved , Mishra Vimal
Published: July 2022

An accurate streamflow forecast is vital for flood prediction and early warning systems. Notwithstanding the rising frequency and intensity of floods during the summer monsoon season in India, efforts to examine the utility of data assimilation (DA) for streamflow prediction remain limited. We examine soil moisture and streamflow DA to improve streamflow simulations in the Narmada River basin, considered a testbed. Data assimilation was performed using the Variable Infiltration Capacity (VIC) model at four gauge stations in the basin. First, we used the ensemble Kalman filter (EnKF) to assimilate the satellite soil moisture from the European Space Agency Climate Change Initiative (ESA-CCI) to the initial state of the VIC model. We examined the usefulness of observed streamflow from the India Water Resources Information System (India-WRIS) to improve the initial hydrological conditions of the VIC model in the streamflow DA during the summer monsoon (June–September) season from 1980 to 2018. The assimilation of ESA-CCI soil moisture showed less improvement in percent error reduction (PER) and efficiency index (EFF) (less than 2%) than the streamflow DA at all of the four gauge locations in the Narmada basin. On the other hand, the streamflow DA showed a significant improvement in PER and EFF (more than 10%) at all the gauge stations for both mean and high-flow conditions. Streamflow data assimilation improved errors in the magnitude and timing for the major floods in 1994 and 2013.

Significance Statement

India is considerably affected by floods during the summer monsoon. Floods have increased and are projected to become more frequent under the warming climate. Flood prediction and early warning systems are essential in reducing their impacts and exposure. In the present study, we are interested in examining the role of soil moisture and streamflow data assimilation on flood prediction in the Narmada River basin. Our results show that streamflow data assimilation is more effective in reducing errors and bias in streamflow prediction than soil moisture data assimilation. The hydrologic framework used for the Narmada basin can be extended and evaluated to other flood-prone basins in India.
Variability of Heat Content and Eddy Kinetic Energy in the Southeast Indian Ocean: Roles of the Indonesian Throughflow and Local Wind Forcing
Authors: Li Yuanlong , Guo Yaru , Zhu Yanan , Kido Shoichiro , Zhang Lei , Wang Fan
Published: July 2022

Prominent interannual-to-decadal variations were observed in both heat content and mesoscale eddy activity in the southeast Indian Ocean (SEIO) during 1993–2020. The 2000–01 and 2008–14 periods stand out with increased 0–700-m ocean heat content (OHC) by ∼4.0 × 1021 J and enhanced surface eddy kinetic energy (EKE) by 12.5% over 85°–115°E, 35°–12°S. This study provides insights into the key dynamical processes conducive to these variations by analyzing observational datasets and high-resolution regional ocean model simulations. The strengthening of the Indonesian Throughflow (ITF) and anomalous cyclonic winds over the SEIO region during the two periods are demonstrated to be the most influential. While the ITF caused prevailing warming of the upper SEIO, the cyclonic winds cooled the South Equatorial Current and attenuated the warming in the subtropical SEIO by evoking upwelling Rossby waves. The EKE increase exerts significant influence on OHC only in the Leeuwin Current system. Dynamical instabilities of the Leeuwin Current give rise to high EKEs and westward eddy heat transport in climatology. As the Leeuwin Current was enhanced by both the ITF and local winds, the elevated EKEs drove anomalous heat convergence on its offshore flank. This process considerably contributes to the OHC increase in the subtropical SEIO and erases the wind-driven cooling during the two warm periods. This work highlights the vital role of eddies in regional heat redistribution, with implications for understanding time-varying ocean heat storage in a changing climate.
Performance Modeling of a Diode-Laser-Based Direct-Detection Doppler Lidar for Vertical Wind Profiling
Authors: Repasky Kevin S. , Cruikshank Owen , Colberg Luke
Published: July 2022

Micropulse differential absorption lidars (MPD) for water vapor, temperature, and aerosol profiling have been developed, demonstrated, and are addressing the needs of the atmospheric science community for low-cost ground-based networkable instruments capable of long-term monitoring of the lower troposphere. The MPD instruments use a diode-laser-based (DLB) architecture that can easily be adapted for a wide range of applications. In this study, a DLB direct-detection Doppler lidar based on the current MPD architecture is modeled to better understand the efficacy of the instrument for vertical wind velocity measurements, with the long-term goal of incorporating these measurements into the current network of MPD instruments. The direct-detection Doppler lidar is based on a double-edge receiver that utilizes two Fabry–Pérot interferometers and a vertical velocity retrieval that requires the ancillary measurement of the backscatter ratio, which is the ratio of the total backscatter coefficient to the molecular backscatter coefficient. The modeling in this paper accounts for the major sources of error. It indicates that the vertical velocity can be retrieved with an error of less than 0.56 m s−1 below 4 km with a 150-m range resolution and an averaging time of 5 min.

Significance Statement

Monitoring the temperature, relative humidity, and winds in the lower atmosphere is important for improving weather forecasting, particularly for severe weather such as thunderstorms. Cost-effective micropulse differential absorption lidar (MPD) instrumentation for continuous temperature and humidity monitoring has been developed and demonstrated, and its effects on weather forecasting are currently being evaluated. The modeling study described in this paper studies the feasibility of using a similar cost-effective MPD instrument architecture for monitoring vertical wind velocity in the lower atmosphere. Modeling indicates that wind velocities can be measured with less than 0.56 m s−1 accuracy and demonstrates the feasibility of adding vertical wind velocity measurements to the MPD instruments.
Doppler Lidar and Mobile Radiosonde Observation-Based Evaluation of Warn-on-Forecast System Predicted Near-Supercell Environments during TORUS 2019
Authors: Laser Jordan J. , Coniglio Michael C. , Skinner Patrick S. , Smith Elizabeth N.
Published: July 2022

Observational data collection is extremely hazardous in supercell storm environments, which makes for a scarcity of data used for evaluating the storm-scale guidance from convection allowing models (CAMs) like the National Oceanic and Atmospheric Administration (NOAA) Warn-on-Forecast System (WoFS). The Targeted Observations with UAS and Radar of Supercells (TORUS) 2019 field mission provided a rare opportunity to not only collect these observations, but to do so with advanced technology: vertically pointing Doppler lidar. One standing question for WoFS is how the system forecasts the feedback between supercells and their near-storm environment. The lidar can observe vertical profiles of wind over time, creating unique datasets to compare to WoFS kinematic predictions in rapidly evolving severe weather environments. Mobile radiosonde data are also presented to provide a thermodynamic comparison. The five lidar deployments (three of which observed tornadic supercells) analyzed show WoFS accurately predicted general kinematic trends in the inflow environment; however, the predicted feedback between the supercell and its environment, which resulted in enhanced inflow and larger storm-relative helicity (SRH), were muted relative to observations. The radiosonde observations reveal an overprediction of CAPE in WoFS forecasts, both in the near and far field, with an inverse relationship between the CAPE errors and distance from the storm.

Significance Statement

It is difficult to evaluate the accuracy of weather prediction model forecasts of severe thunderstorms because observations are rarely available near the storms. However, the TORUS 2019 field experiment collected multiple specialized observations in the near-storm environment of supercells, which are compared to the same near-storm environments predicted by the National Oceanic and Atmospheric Administration (NOAA) Warn-on-Forecast System (WoFS) to gauge its performance. Unique to this study is the use of mobile Doppler lidar observations in the evaluation; lidar can retrieve the horizontal winds in the few kilometers above ground on time scales of a few minutes. Using lidar and radiosonde observations in the near-storm environment of three tornadic supercells, we find that WoFS generally predicts the expected trends in the evolution of the near-storm wind profile, but the response is muted compared to observations. We also find an inverse relationship of errors in instability to distance from the storm. These results can aid model developers in refining model physics to better predict severe storms.
The Great Amen in First Corinthians
Authors: Coleman Ian G.
Published: July 2022

The late John A.T. Robinson claimed to have identified in St. Paul's First Letter to the Corinthians (16:22) “the remains of the earliest Christian liturgical sequence we possess”. While assessing his thesis, I also continue with my own parallel investigation into another possible liturgical sequence in chapter fourteen of First Corinthians. This second sequence has previously been overlooked for two reasons: first, because of the ambiguity in the meaning of the word eucharistia, and, second, because Paul's focus in the passage is on glossolalia, leaving the liturgical import of it somewhat opaque.
Differentiating Instruction for Students Who Are Blind and With Low Vision
Authors: Vaughn Sharon , Alsolami Abdulaziz , Swanson Elizabeth
Published: July 2022

To best support students with low vision in the general education classroom, special education teachers can facilitate use of several adaptations including: (a) attention to curriculum access (e.g. text magnifiers), (b) mechanisms for promoting social connectedness, (c) managing physical space, and (d) effective instructional techniques. This article provides an overview for special educators on how they can support general education teachers in providing research-based practices for students with low vision in their classroom. Description of effective practices along with resources helpful for continuing professional development are provided.
Outlier-resilient iterative-extended Kalman filter based on maximum correntropy criterion
Authors: Li Wenshuo , Guo Lei
Published: July 2022

The extended Kalman filter (EKF) is the most popular tool for state estimation of nonlinear stochastic systems. The conventional EKF can be refined via iterative re-linearization, leading to the so-called iterative EKF (IEKF). The performance of either EKF or IEKF will deteriorate in the presence of outliers. In this article, an outlier-resilient IEKF method is proposed using a more robust cost function, the correntropy, to replace the traditional mean squared error criterion. An iterative procedure is derived to maximize the correntropy criterion in a similar way to the Gauss–Newton optimization. Simulation results demonstrate the superiority of the proposed method as compared to the existing methods.
Automation Preferences by Traffic Climate and Driver Skills in Two Samples From Countries with Different Levels of Traffic Safety
Authors: Öztürk İbrahim , Wallén Warner Henriette , Özkan Türker
Published: July 2022

Automated systems present great capabilities with a wide range of options. In this respect, vehicle preferences and factors affecting these preferences are important for the future of automated systems. While automated systems offer varied features and improvements for drivers and general traffic safety, the relationship between drivers’ perceptions of traffic systems and driver skills have not been studied. The present study, therefore, focuses on country differences and the relationships between traffic climate and driver skills and their impact on the preferred level of vehicle automation for drivers in Turkey and Sweden. The study was conducted with 318 drivers (age: mean [M] = 22.41, standard deviation [SD] = 2.77) from Turkey and 312 drivers (age: M = 28.80, SD = 8.53) from Sweden in 2020. A questionnaire package asking for demographic information and preferred levels of vehicle automation—Traffic Climate Scale (TCS) and the Driver Skill Inventory (DSI)—was completed. A series of analyses of covariance (ANCOVA), hierarchical regression, and moderated moderation analyses were conducted. Drivers from Turkey preferred higher automation levels than drivers from Sweden. Drivers with higher perceived safety skills, with lower perceived perceptual-motor skills or perceiving the traffic system as more externally demanding preferred higher automation levels. Drivers’ automation preferences were affected by various individual and country-level factors. For the first time, drivers’ automation preferences were elaborated in relation to traffic climate and driver skills in two countries with different levels of traffic safety. Theoretical and practical implications of the findings are discussed in the light of the literature.
Saudi Women's Attitudes Toward Advocacy for Women's Rights
Authors: Alhajri Wafa , Pierce Barbara J.
Published: July 2022

There is a growing women's rights advocacy movement in Saudi Arabia—much of which explicitly targets the male guardianship system. In this system, Saudi women are restricted by the male-dominated culture and face obstacles that hold them accountable to their male guardians. Recent changes in this system have become crucially important to women's lives, but still, leave women lacking full freedom. This exploratory study provides a thematic analysis of 16 Saudi women's advocacy perspectives by focusing on the deeper meanings of their expressed attitudes toward the male guardianship system in Saudi Arabia. Analysis revealed conflicting attitudes toward women's advocacy for women's rights. Women who were hurt by the system raised concerns about being labeled as advocates. They feared being socially judged and having their families shamed for advocating against social norms and principles of Islam. These concerns led them to use fake social media accounts to support advocates. Those who supported the male guardianship system expressed their worries about the next generation being influenced by outside ideologies and abandoning their Islamic values. This paper concludes with recommendations for future social work practice and scholarship.
Sexual, Physical, and Emotional Maltreatment in Childhood Are Differentially Associated With Sexual and Physical Revictimization in Adulthood
Authors: Rowe Jessica , Chananna Jasmine , Cunningham Simone , Harkness Kate L.
Published: July 2022

Childhood maltreatment increases risk for sexual and physical revictimization in adulthood. The goal of the current study was to examine whether this risk is associated with specific maltreatment types (i.e., sexual vs. physical vs. emotional maltreatment vs. neglect) and perpetrators (i.e., mother vs. father). Participants included 720 adult women from North America and the United Kingdom, recruited through the online platform Prolific Academic. The severity of childhood maltreatment and adult physical and sexual victimization were assessed in two separate sessions through self-report questionnaires. All maltreatment types were modeled together to account for their co-occurrence. Greater severity of sexual maltreatment was significantly and independently associated with greater risk for sexual, physical, and sexual + physical revictimization. Further, in the full sample, risk of revictimization was predicted by greater severity of father-perpetrated emotional and physical maltreatment. In contrast, in subgroup analyses focusing on plurisexual (i.e., bi/pansexual) women, risk of revictimization was predicted by greater severity of mother-perpetrated emotional and physical maltreatment. These results suggest that girls with sexual and emotional maltreatment histories are at highest risk for revictimization. Future research identifying the biological, psychological, and social sequelae of these specific exposures may enable the development of specific intervention programs that have the potential for maximum efficacy in preventing further violence against women most at risk.
Language-Specific Non-Words for the Assessment of Working Memory: Dealing With Bilingual Children
Authors: Zaretsky Eugen , Lange Benjamin P.
Published: July 2022

Bilingual children with a limited command of the second language (L2) often yield unsatisfactory results in L2-based non-word repetition tasks (NWRT) for the assessment of working memory. In this study, monolinguals (MO) and bilinguals (BI) of preschool age acquiring German were compared in regard to their performance on German-based NWRT to choose test items that do not put BI at a disadvantage. Four-year-old children ( N = 876) were tested with the German language screenings Sprachscreening für das Vorschulalter (SSV) and Kindersprachscreening (KiSS), including 38 non-words. BI scored significantly lower in NWRT than MO due to a limited command of German as well as a limited language input (e.g., length of kindergarten attendance). After the statistical deletion of children who did not speak German age-appropriately, BI outperformed MO on the SSV, without significant differences on the KiSS. Performance on NWRT depended on the children’s command of the German vocabulary and phonotactics. Several relatively “culture-fair” NWRT items were identified.
Development of the Extended Infusion Set and Its Mechanism of Action
Authors: Zhang Gina , Cohen Ohad , Chattaraj Sarnath
Published: July 2022

Continuous subcutaneous insulin infusion (CSII, or insulin pump) and continuous glucose monitoring (CGM) sensors have been increasingly used and associated with improved glycemic control by people with type 1 diabetes and insulin-requiring type 2 diabetes. Commonly used infusion sets in most CSII systems are limited to a wear time of 3 days. In contradistinction, CGM sensors are currently approved for seven and more days of wear. With the motivation to provide a 7-day infusion set that matches the CGM wear time and to improve patient experience, the recently CE-marked and FDA 510k–cleared Medtronic extended infusion set (EIS) was designed.s The EIS offers enhanced new features that include use for up to 7 days, improved convenience, comfort, and better quality of life for insulin pump users.
Prediction of intensive care unit admission (>24h) after surgery in elective noncardiac surgical patients using machine learning algorithms
Authors: Lan Lan , Chen Fangwei , Luo Jiawei , Li Mengjiao , Hao Xuechao , Hu Yao , Yin Jin , Zhu Tao , Zhou Xiaobo
Published: July 2022

Background

To develop a highly discriminative machine learning model for the prediction of intensive care unit admission (>24h) using the easily available preoperative information from electronic health records. An accurate prediction model for ICU admission after surgery is of great importance for surgical risk assessment and appropriate utilization of ICU resources.

Method

Data were collected retrospectively from a large hospital, comprising 135,442 adult patients who underwent surgery except for cardiac surgery between 1 January 2014, and 31 July 2018 in China. Multiple existing predictive machine learning algorithms were explored to construct the prediction model, including logistic regression, random forest, adaptive boosting, and gradient boosting machine. Four secondary analyses were conducted to improve the interpretability of the results.

Results

A total of 2702 (2.0%) patients were admitted to the intensive care unit postoperatively. The gradient boosting machine model attained the highest area under the receiver operating characteristic curve of 0.90. The machine learning models predicted intensive care unit admission better than the American Society of Anesthesiologists Physical Status (area under the receiver operating characteristic curve: 0.68). The gradient boosting machine recognized several features as highly significant predictors for postoperatively intensive care unit admission. By applying subgroup analysis and secondary analysis, we found that patients with operations on the digestive, respiratory, and vascular systems had higher probabilities for intensive care unit admission.

Conclusion

Compared with conventional American Society of Anesthesiologists Physical Status and logistic regression model, the gradient boosting machine could improve the performance in the prediction of intensive care unit admission. Machine learning models could be used to improve the discrimination and identify the need for intensive care unit admission after surgery in elective noncardiac surgical patients, which could help manage the surgical risk.
Deserts and Oases: Geospatial Analytics of Higher Education Access
Authors: Ram Manulal P. , Lakshman Deepika , Manoharan A.N. , Varghese Resmi
Published: July 2022

Despite the high level of literacy, near universal enrolment in elementary education, and higher indices of social and human development among Indian States, Kerala has not made an impressive headway in higher education. Several studies show that there is ubiquitous relationship between ‘place’ and educational opportunities. Learners’ choice in enrolling to a programme and or an institution of study is largely driven by the geography and physical access to these institutions. This aspect has been widely covered in the Western context, but there are not many studies in the Indian context, especially so in Kerala. In this article, we propose a spatial-metric tool to assess disparity in educational opportunities by assigning a fixed dimension to define the ‘catchment’ area of an institution. We integrated our results with a model of higher education opportunity markets proposed in earlier studies for better understanding. This provides information about the graded nature in the choice of opportunities available in a region and its spatial distribution. Such regions are further classified as regions of negligible opportunities (education deserts) and abundant opportunities (education oases). The spatial-analytical tool proposed here can be recreated and applied across different regions employing various socio-economic and other relevant components of interest. This can have significant implications in educational planning and administration of a region.
Avapritinib for advanced systemic mastocytosis
Authors: Gotlib Jason , Reiter Andreas , DeAngelo Daniel J.
Published: July 2022

Avapritinib, a highly selective inhibitor of KIT D816V, was approved by the Food and Drug Administration in 2021 for treatment of advanced systemic mastocytosis (AdvSM) and by the European Medicines Agency in 2022 for AdvSM after prior systemic therapy. The phase 1 EXPLORER and phase 2 PATHFINDER trials demonstrated that avapritinib can elicit complete and durable clinical responses and molecular remission of KIT D816V. Key management challenges relate to the complex mutational landscape of AdvSM, often found with an associated hematologic neoplasm.
Developing disruptive mobility scenarios for rural areas. Participatory mobility scenario building in a Belgian village for the year 2050
Authors: Tori Sara , Pappers Jesse , Keserü Imre
Published: July 2022

Background

Historically, quantitative forecasting methods have been used in transport planning. As forecasts can be unreliable to plan for the medium- and long-term, scenario building has recently been increasingly used. However, scenario building methods often fail to take disruptions and wild cards into account, i.e., low probability but high impact events. When unaccounted for, wild card events, like the COVID-19 pandemic, lower the efficacy of scenario building in policy making, as these events may completely disturb the developed scenarios of the future.

Methods

In this paper, we develop and apply a creative and participatory methodology to develop visions and disrupted scenarios for rural mobility. Our research was carried out in the Belgian village of Oetingen, where inhabitants developed more resilient views of the future by creating disrupted mobility scenarios and a preferred mobility vision for their village for the year 2050 in a participatory scenario building exercise. Wild cards related to mobility were collected from mobility experts and inhabitants in three workshops. Inhabitants were engaged to define their mobility vision on a postcard that was distributed to all houses in the village as well as on a project website. Respondents were invited for a follow-up interview in which their preferred mobility vision was subjected to the wild cards, and participants described how these wild cards would change their preferred vision. As children tend to have more creative ideas, they were engaged via workshops at school.

Results

This process resulted in mobility scenarios for the village for the year 2050 based on the different wild cards, as well as an overall desired vision. We found that the use of wild cards did not significantly change the scenarios when compared to the vision, although it did make the interviewees step outside of their comfort zones. We also found that the citizens did not have more original and less path-dependent ideas in developing wild cards when compared to experts. Lastly, we found that children have many outside-of-the-box suggestions when it comes to the future. Although some of their ideas can be judged as impractical by today’s standards, many ideas had an indirect implication for mobility in the village and gave insights into children’s priorities, as potential future residents of the village.
SparkGC: Spark based genome compression for large collections of genomes
Authors: Yao Haichang , Hu Guangyong , Liu Shangdong , Fang Houzhi , Ji Yimu
Published: July 2022

Since the completion of the Human Genome Project at the turn of the century, there has been an unprecedented proliferation of sequencing data. One of the consequences is that it becomes extremely difficult to store, backup, and migrate enormous amount of genomic datasets, not to mention they continue to expand as the cost of sequencing decreases. Herein, a much more efficient and scalable program to perform genome compression is required urgently. In this manuscript, we propose a new Apache Spark based Genome Compression method called SparkGC that can run efficiently and cost-effectively on a scalable computational cluster to compress large collections of genomes. SparkGC uses Spark’s in-memory computation capabilities to reduce compression time by keeping data active in memory between the first-order and second-order compression. The evaluation shows that the compression ratio of SparkGC is better than the best state-of-the-art methods, at least better by 30%. The compression speed is also at least 3.8 times that of the best state-of-the-art methods on only one worker node and scales quite well with the number of nodes. SparkGC is of significant benefit to genomic data storage and transmission. The source code of SparkGC is publicly available athttps://github.com/haichangyao/SparkGC.
Genome-wide characterization of Salmonella Typhimurium genes required for the fitness under iron restriction
Authors: Karash Sardar , Jiang Tieshan , Kwon Young Min
Published: July 2022

Background

Iron is a crucial element for bacterial survival and virulence. During Salmonella infection, the host utilizes a variety of mechanisms to starve the pathogen from iron. However, Salmonella activates distinctive defense mechanisms to acquire iron and survive in iron-restricted host environments. Yet, the comprehensive set of the conditionally essential genes that underpin Salmonella survival under iron-restricted niches has not been fully explored.

Results

Here, we employed transposon sequencing (Tn-seq) method for high-resolution elucidation of the genes in Salmonella Typhimurium (S. Typhimurium) 14028S strain required for the growth under the in vitro conditions with four different levels of iron restriction achieved by iron chelator 2,2′-dipyridyl (Dip): mild (100 and 150 μM), moderate (250 μM) and severe iron restriction (400 μM). We found that the fitness of the mutants reduced significantly for 28 genes, suggesting the importance of these genes for the growth under iron restriction. These genes include sufABCDSE, iron transport fepD, siderophore tonB, sigma factor E ropE, phosphate transport pstAB, and zinc exporter zntA. The siderophore gene tonB was required in mild and moderate iron-restricted conditions, but it became dispensable in severe iron-restricted conditions. Remarkably, rpoE was required in moderate and severe iron restrictions, leading to complete attenuation of the mutant under these conditions. We also identified 30 genes for which the deletion of the genes resulted in increased fitness under iron-restricted conditions.

Conclusions

The findings broaden our knowledge of how S. Typhimurium survives in iron-deficient environments, which could be utilized for the development of new therapeutic strategies targeting the pathways vital for iron metabolism, trafficking, and scavenging.
Sample size recalculation based on the prevalence in a randomized test-treatment study
Authors: Hot Amra , Benda Norbert , Bossuyt Patrick M. , Gerke Oke , Vach Werner , Zapf Antonia
Published: July 2022

Background

Randomized test-treatment studies aim to evaluate the clinical utility of diagnostic tests by providing evidence on their impact on patient health. However, the sample size calculation is affected by several factors involved in the test-treatment pathway, including the prevalence of the disease. Sample size planning is exposed to strong uncertainties in terms of the necessary assumptions, which have to be compensated for accordingly by adjusting prospectively determined study parameters during the course of the study.

Method

An adaptive design with a blinded sample size recalculation in a randomized test-treatment study based on the prevalence is proposed and evaluated by a simulation study. The results of the adaptive design are compared to those of the fixed design.

Results

The adaptive design achieves the desired theoretical power, under the assumption that all other nuisance parameters have been specified correctly, while wrong assumptions regarding the prevalence may lead to an over- or underpowered study in the fixed design. The empirical type I error rate is sufficiently controlled in the adaptive design as well as in the fixed design.

Conclusion

The consideration of a blinded recalculation of the sample size already during the planning of the study may be advisable in order to increase the possibility of success as well as an enhanced process of the study. However, the application of the method is subject to a number of limitations associated with the study design in terms of feasibility, sample sizes needed to be achieved, and fulfillment of necessary prerequisites.
Comparison of risk scoring systems for upper gastrointestinal bleeding in patients after renal transplantation: a retrospective observational study in Hunan, China
Authors: Wang Rui , Wang Qiang
Published: July 2022

Background

Upper gastrointestinal bleeding (UGIB) is a common complication in renal transplant recipients. However, the risk stratification value of bleeding scoring systems in these patients is unclear, and data regarding risk factors are limited.

Methods

Clinical data of renal transplant recipients in The Third Xiangya hospital were collected. The predictive ability of Glasgow Blatchford score (GBS), pre-endoscopy Rockall score (pRS), and AIMS65 score were assessed by the area under the receiver operating characteristic curve (AUROC). Risk factors of UGIB were analyzed using binary logistic regression analysis.

Results

A total of 220 patients were enrolled, of which 55 with UGIB. Endoscopy improved the overall survival rate of patients. Glasgow Blatchford score (AUROC 0.868) performed best at predicting UGIB patients who need intervention or death, with a threshold of 10, sensitivity and specificity were 82.4% and 70%, respectively. In terms of predicting mortality, the GBS score was comparable with AIMS65 score (p = 0.30) and pRS score (p = 0.42). Viral hepatitis, intravenous hormone usage, low platelet count, and low albumin level were significant factors associated with UGIB.

Conclusions

The Glasgow Blatchford score (AUROC 0.868) was best at predicting the need for intervention or death. However, their ability to predict mortality was limited, with AUROC less than 0.8. Our study also identified four independent risk factors for renal transplant recipients with UGIB.
Exploring the difference between men and women in physical functioning: How do sociodemographic, lifestyle- and health-related determinants contribute?
Authors: Sialino Lena Dirkje , Picavet H. Susan J. , Wijnhoven Hanneke A. H. , Loyen Anne , Verschuren W. M. Monique , Visser Marjolein , Schaap Laura S. , van Oostrom Sandra H.
Published: July 2022

Background

To explore whether differences between men and women in the sensitivity to (strength of the association) and/or in the exposure to determinants (prevalence) contribute to the difference in physical functioning, with women reporting more limitations.

Methods

Data of the Doetinchem Cohort Study was used (n = 5856, initial ages 26–70 years), with follow-up measurements every 5 years (up to 20). Physical functioning (subscale SF-36, range:0–100), sex (men or women) and a number of socio-demographic, lifestyle- and health-related determinants were assessed. Mixed-model multivariable analysis was used to investigate differences between men and women in sensitivity (interaction term with sex) and in exposure (change of the sex difference when adjusting) to determinants of physical functioning.

Results

The physical functioning score among women was 6.55 (95%CI:5.48,7.61) points lower than among men. In general, men and women had similar determinants, but pain was more strongly associated with physical functioning (higher sensitivity), and also more prevalent among women (higher exposure). The higher exposure to low educational level and not having a paid job also contributed to the lower physical functioning score among women. In contrast, current smoking, mental health problems and a low educational level were more strongly associated with a lower physical functioning score among men and lower physical activity and higher BMI were more prevalent among men.

Conclusions

Although important for physical functioning among both men and women, our findings provide no indications for reducing the difference in physical functioning by promoting a healthy lifestyle but stress the importance of differences in pain, work and education.
Amphotericin B plus fluorocytosine combined with voriconazole for the treatment of non-HIV and non-transplant-associated cryptococcal meningitis: a retrospective study
Authors: Liu Junyu , Liu Jia , Su Xiaohong , Yang Lu , Wang Yijie , Wang Anni , Xu Xiaofeng , Li Min , Jiang Ying , Peng Fuhua
Published: July 2022

Background

Our previous study explored Amphotericin B (AMB) plus 5-flucytosine (5-FC) combined with fluconazole (FLU) therapy in the induction period, which seemed to be better than the previous AMB + 5-FC antifungal therapy in non-HIV and non-transplant-associated CM. However, based on our clinical finding, the outcomes of some CM patients who received AMB plus 5-FC combined with FLU antifungal therapy were still poor. Therefore, we need to explore new antifungal methods in non-HIV and non-transplant-associated CM during the induction period.

Methods

Clinical data from 148 patients admitted to the Third Affiliated Hospital of Sun Yat Sen University from January 2011 to December 2020 were collected. These patients were stratified based on antifungal treatment methods in the induction period (group I with AMB + 5-FC + VOR, group II with AMB + 5-FC + FLU, group III with AMB + 5-FC).

Results

The first hospitalization time of Group I (median: 25 days, IQR: 20–34.5) was significantly shorter than that of Group II (median: 43 days, IQR: 29–62) (p < 0.001) and Group III (median: 50.5 days, IQR: 43–77.5) (p < 0.001). After 2 weeks of follow-up, Group I (26/49) had more patients reaching CSF clearance (p = 0.004) than Group II (18/71) and Group III (7/28). In multivariable analysis, Group II (OR: 3.35, 95%CI 1.43–7.82, p = 0.005) and Group III (OR: 3.8, 95%CI 1.23–11.81, p = 0.021) were associated with higher risk about CSF clearance failure at 2 weeks follow-up than Group I. After 10 weeks of follow-up, the incidence of hypokalemia in Group I was significantly lower than that in Group II (p = 0.003) and Group III (p = 0.004), and the incidence of gastrointestinal discomfort in Group I was significantly lower than that in Group II (p = 0.004).

Conclusion

AMB plus 5-FC combined with VOR may rapidly improve clinical manifestation, decrease CSF OP and clear the cryptococci in CSF during the early phase, substantially shorten the hospitalization time, and reduce the incidences of hypokalemia and gastrointestinal discomfort.
Reduced brain subcortical volumes in patients with glaucoma: a pilot neuroimaging study using the region-of-interest-based approach
Authors: Ha Yae Won , Jang Heeseon , Koh Sang-Baek , Noh Young , Lee Seung-Koo , Seo Sang Won , Cho Jaelim , Kim Changsoo
Published: July 2022

Background

While numerous neuroimaging studies have demonstrated that glaucoma is associated with smaller volumes of the visual cortices in the brain, only a few studies have linked glaucoma with brain structures beyond the visual cortices. Therefore, the objective of this study was to compare brain imaging markers and neuropsychological performance between individuals with and without glaucoma.

Methods

We identified 64 individuals with glaucoma and randomly selected 128 age-, sex-, and education level-matched individuals without glaucoma from a community-based cohort. The study participants underwent 3 T brain magnetic resonance imaging and neuropsychological assessment battery. Regional cortical thickness and subcortical volume were estimated from the brain images of the participants. We used a linear mixed model after adjusting for potential confounding variables.

Results

Cortical thickness in the occipital lobe was significantly smaller in individuals with glaucoma than in the matched individuals (β = − 0.04 mm,P = 0.014). This did not remain significant after adjusting for cardiovascular risk factors (β = − 0.02 mm,P = 0.67). Individuals with glaucoma had smaller volumes of the thalamus (β = − 212.8 mm3,P = 0.028), caudate (β = − 170.0 mm3,P = 0.029), putamen (β = − 151.4 mm3,P = 0.051), pallidum (β = − 103.6 mm3,P = 0.007), hippocampus (β = − 141.4 mm3,P = 0.026), and amygdala (β = − 87.9 mm3,P = 0.018) compared with those without glaucoma. Among neuropsychological battery tests, only the Stroop color reading test  score was significantly lower in individuals with glaucoma compared with those without glaucoma (β = − 0.44,P = 0.038).

Conclusions

We found that glaucoma was associated with smaller volumes of the thalamus, caudate, putamen, pallidum, amygdala, and hippocampus.
Predictors and outcome of time to presentation among critically ill paediatric patients at Emergency Department of Muhimbili National Hospital, Dar es Salaam, Tanzania
Authors: Simbila Alphonce N. , Kilindimo Said S. , Sawe Hendry R. , Kalezi Zawadi E. , Yussuf Amne O. , Manji Hussein K. , Leyna Germana , Mfinanga Juma A. , Weber Ellen J.
Published: July 2022

Background

Mortality among under-five children in Tanzania remains high. While early presentation for treatment increases likelihood of survival, delays to care are common and factors causing delay to presentation among critically ill children are unknown. In this study delay was defined as presentation to the emergency department of tertially hospital i.e. Muhimbili National Hospital, more than 48 h from the onset of the index illness.

Methodology

This was a prospective cohort study of critically ill children aged 28 days to 14 years attending emergency department at Muhimbili National Hospital in Tanzania from September 2019 to January 2020. We documented demographics, time to ED presentation, ED interventions and 30-day outcome. The primary outcome was the association of delay with mortality and secondary outcomes were predictors of delay among critically ill paediatric patients.

Logistic regression and relative risk were calculated to measure the strength of the predictor and the relationship between delay and mortality respectively.

Results

We enrolled 440 (59.1%) critically ill children, their median age was 12 [IQR = 9–60] months and 63.9% were males. The median time to Emergency Department arrival was 3 days [IQR = 1–5] and more than half (56.6%) of critically ill children presented to Emergency Department in > 48 h whereby being an infant, self-referral and belonging to poor family were independent predictors of delay. Infants and those referred from other facilities had 2.4(95% CI 1.4–4.0) and 1.8(95% CI 1.1–2.8) times increased odds of presenting late to the Emergency Department respectively. The overall 30-day in-hospital mortality was 26.5% in which those who presented late were 1.3 more likely to die than those who presented early (RR = 1.3, CI: 0.9–1.9). Majority died > 24 h of Emergency Department arrival (P-value = 0.021).

Conclusion

The risk of in-hospital mortality among children who presented to the ED later than 48 h after onset of illness was 1.3 times higher than for children who presented earlier than 48 h. It could be anywhere from 10% lower to 90% higher than the point estimate. However, the effect size was statistically not significant since the confidence interval included the null value Qualitative and time-motion studies are needed to evaluate the care pathway of critically ill pediatric patients to identify preventable delays in care.
Factors associated with hypothermia within the first 6 hours of life in infants born at ≥340 weeks’ gestation: a multivariable analysis
Authors: Nguyen Laura , Mitsakakis Nicholas , Sucha Ewa , Lemyre Brigitte , Lawrence Sarah Linda
Published: July 2022

Background

Lack of appropriate temperature management has been associated with significant adverse outcomes in preterm and low birthweight neonates. There is a lack of similar investigations in the late preterm (340–366) and term (≥370) neonate population. Our aim was to identify key risk factors as well as clinical outcomes associated with hypothermia in this population.

Methods

A retrospective chart review was conducted at the Ottawa Hospital including all eligible infants ≥340 weeks’ gestation over a one-month period in November 2020. Infant, maternal, and delivery room variables were collected, including prematurity, maternal temperature, delivery mode, birthweight, and premature rupture of membranes, as well as clinical outcomes such as NICU/SCN admission and length of stay. Regression models were generated, adjusted for covariates, and stepwise regression was performed.

Results

Four hundred forty infants were included in the analysis; 26.8% (118/440) were hypothermic within 6 hours of delivery. In the multivariable analysis, prematurity, low 5 minute Apgar score (< 7) or need for resuscitation, maternal hypertension, and absence of premature rupture of membranes > 18 hours or suspected maternal infection were significantly associated with hypothermia within 6 hours of delivery (p < 0.05). Multivariable analysis of clinical outcomes demonstrated a significant association between hypothermia within 6 hours of delivery and NICU/SCN admission (OR = 2.87; 95% CI 1.36, 6.04), need for respiratory support or diagnosis of respiratory distress syndrome (OR = 3.94; 95% CI 1.55, 10.50), and length of stay (exp(β) = 1.20; 95% bootstrap CI 1.04, 1.37).

Conclusions

Our results suggest there are similar factors associated with hypothermia in our study population of infants born at ≥340 weeks’ gestation compared to prior studies in preterm and low-birthweight infants. Furthermore, hypothermia is associated with higher risk of adverse outcomes, which highlights the need to prevent hypothermia in all newborns.