bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards reflectivity profile inversion through artificial neural networks
Authors: Carmona Loaiza Juan Manuel , Raza Zamaan
Published: February 2021

The goal of specular neutron and x-ray reflectometry is to infer a material’s scattering length density (SLD) profile from its experimental reflectivity curves. This paper focuses on the investigation of an original approach to the ill-posed non-invertible problem which involves the use of artificial neural networks (ANNs). In particular, the numerical experiments described here deal with large data sets of simulated reflectivity curves and SLD profiles, and aim to assess the applicability of data science and machine learning technology to the analysis of data generated at large-scale neutron scattering facilities. It is demonstrated that, under certain circumstances, properly trained deep neural networks are capable of correctly recovering plausible SLD profiles when presented with previously unseen simulated reflectivity curves. When the necessary conditions are met, a proper implementation of the described approach would offer two main advantages over traditional fitting methods when dealing with real experiments, namely (1) sample physical models are described under a new paradigm: detailed layer-by-layer descriptions (SLDs, thicknesses, roughnesses) are replaced by parameter-free curves ρ(z), allowing a priori assumptions to be used in terms of the sample family to which a given sample belongs (e.g. ‘thin film,’ ‘lamellar structure’,etc.); (2) the time required to reach a solution is shrunk by orders of magnitude, enabling faster batch analysis for large datasets.
A Koopman-von Neumann type theorem on the convergence of Cesàro means in Riesz spaces
Authors: Homann Jonathan , Kuo Wen-Chi , Watson Bruce
Published: February 2021

We extend the Koopman-von Neumann convergence condition on the Cesàro mean to the context of a Dedekind complete Riesz space with weak order unit. As a consequence, a characterisation of conditional weak mixing is given in the Riesz space setting. The results are applied to convergence in

L
1

L^1

.
Clinical and Pathologic Spectrum ofDDX41-Mutated Hematolymphoid Neoplasms
Authors: Goyal Tanu , Tu Zheng Jin , Wang Zhen , Cook James R
Published: February 2021

Objectives

This study seeks to further characterize the clinicopathologic spectrum of DDX41-mutated hematolymphoid malignancies.

Methods

We identified DDX41 mutations from a cohort of known or suspected hematologic disorders and reviewed the corresponding clinical, genetic, phenotypic, and morphologic findings.

Results

DDX41 mutations were identified in 20 (1.4%) of 1,371 cases, including 8 cases of acute myeloid leukemia (AML), 5 cases of myelodysplastic syndrome (MDS), 2 cases of therapy-related MDS/AML, 1 case of primary myelofibrosis, 1 case of chronic myeloid leukemia, 1 case of clonal cytopenia of uncertain significance (CCUS), 1 case of T-cell large granular lymphocytic leukemia (T-LGL), and 1 case of multiple myeloma. DDX41-mutated neoplasms were morphologically heterogeneous with a median cellularity of 20% (range, 10%-100%). Megakaryocyte dysplasia occurred in 7 (35%) of 20 cases and trilineage dysplasia in 1 (5%). Frequently comutated genes include a second, somatic DDX41 mutation (8/19, 42%) followed by mutations in TET2 (20%), DNMT3A (20%), ASXL1 (20%), and CUX1 (20%). Karyotypes were noncomplex in 17 (89%) of 19.

Conclusions

This report extends the spectrum of DDX41-mutated disorders to include CCUS, T-LGL, and plasma cell disorders. The morphologic features are heterogeneous and nonspecific, highlighting the importance of DDX41 testing during routine workup of hematolymphoid neoplasms.
Facial Hair Transplantation for Transgender Patients: A Literature Review and Guidelines for Practice
Authors: Patel Viren , Nolan Ian T , Card Elizabeth , Morrison Shane D , Bared Anthony
Published: February 2021

Background

Facial hair transplantation has become an increasingly popular modality to create a more masculine appearance for transmasculine patients.

Objectives

This aim of this study was to review the current literature regarding facial hair transplantation and provide recommendations and best practices for transgender patients.

Methods

A comprehensive literature search of the PubMed, MEDLINE, and Embase databases was conducted for studies published through April 2020 for publications discussing facial hair transplant in transmasculine patients, in addition to the nontransgender population. Data extracted include patient demographics, techniques, outcomes, complications, and patient satisfaction.

Results

We identified 2 articles discussing facial hair transplantation in transmasculine patients. Due to the paucity of publications describing facial hair transplantation in transmasculine patients, data regarding facial hair transplant from the cisgender population were utilized to augment our review and recommendations.

Conclusions

Facial hair transplant is a safe and effective means of promoting a masculine appearance for transgender patients. Nevertheless, facial hair transplantation should be deferred until at least 1 year after the initiation of testosterone therapy to allow surgeons to more accurately identify regions that would benefit the most from transplantation. Additionally, providers should engage patients in discussions about any plans to undergo facial masculinization surgery because this can alter the position of transplanted hairs. Currently, follicular unit extraction from the occipital scalp is the preferred technique, with use of the temporal scalp if additional grafts are needed. Patients should be advised that a secondary grafting procedure may be needed a year after initial transplant to achieve desired density.

Level of Evidence: 4
Social construction of migrant identities: everyday life of Bangladeshi migrants in West Bengal
Authors: Chakrabarty Anindita , Jha Manish K
Published: February 2021

The construction of migrant population across India–Bangladesh borders is premised on cultural affiliation, religious sentiments and the contingent political economy. With a history of partition in different phases, the subjective conceptions of identity of migrants are layered and complex. The article unravels how identities of migrants are shaped in everyday life through the frame of legality–illegality, religious–political and economic–social aspects. Drawing on previous research and empirical engagement, the article engages with the questions on citizenship, residency, identity, belonging, exclusion and inclusion. The field work in the borderland district of North 24 Parganas provides rich description about the life and circumstances of migrants at the threshold of security and insecurity, belonging and unbelonging around layers of caste and communal tangle. The article presents a grounded understanding on the politics of documenting and phenomenon of maintaining undocumentedness. To explain the social construction of identity, the article explores the role of Hindu nationalist ideas that influences the negotiation of migrant populations around religious lines; either accepted, ignored, patronized or kept insecure, susceptible to fear and exclusion.
Analysis of Main Components in Jujube and Mulberry Extracts by High-Sensitive HPLC-ESI-Q-TOF-MS/MS
Authors: Li Ran , Wei Min , Guo Guoning , Li Yi , Pan Xi , Song Xuyan , Rong Lin , Chen Yi , Chen Beibei
Published: February 2021

In order to comprehensively reflect the cigarette quality, a method combining direct injection of diluted sample with high sensitive high-performance liquid chromatography (HPLC)- electrospray (ESI)- quadrupole (Q)- time of flight (TOF)- tandem mass spectrometry (MS/MS) was developed for the identification of major components of cigarette essences (jujube and mulberry extracts). Based on the observed relative molecular mass, MS/MS fragmentation behavior, MS/MS database and related literatures, the components of the jujube extract and mulberry extract were identified. The result shows that the composition of jujube extract and mulberry extract has some similarity. They all mainly contain amino acids, free amino compounds and Maillard reaction products, which are the main constituents of a cigarette essence.
Sustained Transmission ofNeisseria gonorrhoeaewith High-Level Resistance to Azithromycin, in Indianapolis, Indiana, 2017–2018
Authors: Holderman Justin L , Thomas Jesse C , Schlanger Karen , Black Jamie M , Town Katy , St. Cyr Sancta B , Pham Cau D , Kirkcaldy Robert D
Published: February 2021

Background

Since 2014, Neisseria gonorrhoeae azithromycin (AZM) susceptibility has declined in the United States, but high-level AZM resistance (HL-AZMR) has been infrequent and sporadic. We describe a cluster of 14 N. gonorrhoeae isolates with HL-AZMR identified in Indianapolis over 13 months.

Methods

N. gonorrhoeae culture specimens (genital and extragenital) were collected from attendees of the Bell Flower Clinic. Isolates underwent antimicrobial susceptibility testing (AST) using Etest. AZM minimum inhibitory concentrations ≥256 µg/mL were classified as HL-AZMR. Local disease intervention specialists interviewed patients whose isolates demonstrated HL-AZMR and conducted partner services. Relatedness of isolates was investigated by genomic analyses.

Results

During 2017–2018, AST was performed in 1016 N. gonorrhoeae isolates collected at the Bell Flower Clinic. Fourteen isolates (1.4%) from 12 men collected over 13 months demonstrated HL-AZMR; all were cephalosporin susceptible. Of the 12 men, 9 were white and reported male sex partners. Nine of the men were able to be retested; all were cured with 250-mg ceftriaxone plus 1-g AZM. Two men named each other as partners; no other partners in common were reported. Genomic analysis demonstrated close relatedness of the HL-AZMR isolates and a novel combination of a mosaic-mtrR promoter along with 23S ribosomal RNA mutations that appear to have emerged from circulating strains.

Conclusions

The close genetic relatedness with limited epidemiologic linkages between patients highlights the challenges of gonorrhea partner investigations and suggests undetected local transmission. Local AST, rapid public health action, and epidemiologic investigations combined with genomic analysis provides a multipronged approach to understanding an outbreak of sexually transmitted disease.
Why Is There Low Utilization of Biosimilars in Inflammatory Bowel Disease Patients by Gastroenterology Advanced Practice Providers?
Authors: Bernasko Nana , Clarke Kofi
Published: February 2021

Aim

To assess knowledge, practice patterns and attitudes toward the use of biosimilars by Advanced Practice Providers (APPs) treating patients with inflammatory bowel disease (IBD).

Background

APPs provide care in a variety of healthcare settings including medical specialties. In Gastroenterology, they are an integral part of providing care to a complex group of patients with IBD. There has been an increase in options of medical therapies for treating IBD. These include small molecules, biologics, and biosimilars. Adoption of biosimilars for treatment of IBD patients by gastroenterologists in the United States compared to Europe has been slow for several reasons. There is lack of data on their use by APPs who provide frontline IBD clinical care in the United States.

Methods

Questionnaire-based survey of APPs attending Gastroenterology conferences with a focus on IBD.

Results

APPs in gastroenterology do not routinely consider the use of biosimilars in their practice.

Conclusions

There is low utilization of biosimilars in treating IBD patients by APPs. In addition, there are significant concerns about risk of side effects as well as perceived lack of APP targeted educational resources.
Dynamics in myocardial deformation as an indirect marker of myocardial involvement in acute myocarditis due to HIV infection: a case report
Authors: Stöbe Stephan , Tayal Bhupendar , Tünnemann-Tarr Adrienn , Hagendorff Andreas
Published: February 2021

Background

The diagnosis of acute myocarditis (AM) is often challenging and mainly performed by cardiac magnetic resonance (CMR).

Case summary

The present case describes echocardiographic findings of a 38-year-old male patient with exertional dyspnoea probably due to myocardial involvement of previously undiagnosed acute human immunodeficiency virus (HIV) infection. Myocardial deformation imaging might be helpful to detect early stages of myocardial dysfunction in patients with AM and/or systemic infectious diseases by documentation of patchy abnormalities of longitudinal, circumferential and rotational left ventricular (LV) deformation.

Discussion

CMR still represents the gold standard to diagnose AM, which has been confirmed by myocardial oedema and hyperaemia in the present case. However, speckle tracking echocardiography seems to be useful to detect myocardial involvement in HIV infection by dynamic alterations of different components of LV deformation. This was documented by comparing echocardiographic findings at the acute stage of HIV infection to findings at follow-ups during antiviral treatment. The diagnostic option to detect myocardial involvement by deformation imaging in a patient with HIV infection is described for the first time.
A rare pheochromocytoma complicated by cardiogenic shock and posterior reversible encephalopathy syndrome: case report
Authors: Dominedò Cristina , D’Avino Emilio , Martinotti Alessandra , Cingolani Emiliano
Published: February 2021

Background

Pheochromocytoma is a rare catecholamine-producing tumour that classically displays clinical manifestations related to alpha-adrenergic stimulation, including paroxysmal or sustained hypertension. However, it may occasionally be complicated by life-threatening crisis, leading to refractory acute heart dysfunction in the most severe cases.

Case summary

A 28-year-old woman was admitted to intensive care unit due to hypertensive crisis causing pulmonary oedema, Takotsubo cardiomyopathy, and metabolic acidosis. Due to cardiogenic shock, she required venoarterial extracorporeal membrane oxygenation and IMPELLA implantation. A computed tomography scan revealed a 5 cm tumour of the left adrenal gland compatible with pheochromocytoma The clinical course was complicated by acute kidney injury requiring renal replacement therapy and posterior reversible encephalopathy syndrome (PRES). Pharmacological treatment with alpha lityc agents (including urapidil, dexmedetomidine, and doxazosin at maximum daily dose) and beta blockers, together with left videolaparoscopic adrenalectomy, led to progressive blood pressure control and resolution of the neurological symptoms.

Discussion

Pheochromocytoma crisis turned into a potential catastrophic scenario, characterized by refractory cardiogenic shock requiring circulatory supportive devices and PRES. Alpha-antagonists and beta-blockers were the gold standard pharmacological treatment. A multidisciplinary decision-algorithm was necessary to successfully manage this complex clinical setting.
Focal ST-segment elevation without coronary occlusion: myocardial infarction with no obstructive coronary atherosclerosis associated with COVID-19—a case report
Authors: Meizinger Casey , Klugherz Bruce
Published: February 2021

Background

While it is understood that coronavirus disease 2019 (COVID-19) is primarily complicated by respiratory failure, more data are emerging on the cardiovascular complications of this disease. A subset of COVID-19 patients present with ST-elevations on electrocardiogram (ECG) yet normal coronary angiography, a presentation that can fit criteria for myocardial infarction with no obstructive coronary atherosclerosis (MINOCA). There is little known about non-coronary myocardial injury observed in patients with COVID-19, and we present a case that should encourage further conversation and study of this clinical challenge.

Case summary

An 86-year-old man presented to our institution with acute hypoxic respiratory failure and an ECG showing anteroseptal ST-segment elevation concerning for myocardial infarction. Mechanic ventilation was initiated prior to presentation, and emergent transthoracic echocardiography reported an ejection fraction of 50–55%, with no significant regional wall motion abnormalities. Next, emergent coronary angiography was performed, and no significant coronary artery disease was detected. The patient tested positive for COVID-19. Despite supportive management in the intensive care unit, the patient passed away.

Discussion

We present a case of COVID-19 that is likely associated with MINOCA. It is crucial to understand that in COVID-19 patients with signs of myocardial infarction, not all myocardial injury is due to obstructive coronary artery disease. In the case of COVID-19 pathophysiology, it is important to consider the cardiovascular effects of hypoxic respiratory failure, potential myocarditis, and significant systemic inflammation. Continued surveillance and research on the cardiovascular complications of COVID-19 is essential to further elucidate management and prognosis.
The Gerbode defect: a case series
Authors: Sunderland Nicholas , El-Medany Ahmed , Temporal Justin , Pannell Laura , Doolub Gemina , Nelson Martin , Vohra Hunaid
Published: February 2021

Background 

The Gerbode defect is a rare abnormal communication between the left ventricle (LV) and right atrium (RA). The lesion is either congenital or acquired. Acquired defects are largely iatrogenic or infective in origin. We present two cases of acquired Gerbode defects with similar clinical presentations but very different outcomes.

Case summaries

Patient 1 A 64-year-old male presented with features of decompensated cardiac failure and a low-grade temperature. Dehiscence of a recently implanted bioprosthetic aortic valve and high-velocity LV to RA jet (Gerbode defect) was found on echocardiography. Blood cultures grew Staphylococcus warneri and the diagnosis of infective endocarditis was established. The patient was treated with intravenous antibiotics and the aortic valve and Gerbode defect were successfully surgically repaired.

Patient 2 An 81-year-old male presented after being found on the floor at home. On admission, he was clinically septic with evidence of decompensated heart failure. No clear infective focus was initially found. Transthoracic echocardiography revealed severe left ventricular impairment, with a normal bioprosthetic aortic valve. He was treated with intravenous antibiotics, but later deteriorated with evidence of embolic phenomena. Repeat echocardiography revealed a complex infective aortic root lesion with bioprosthetic valve dehiscence and flow demonstrated from the LV to RA. Unfortunately, the patient succumbed to the infection and cardiac complications.

Discussion 

The Gerbode defect is a rare but important complication of infective endocarditis and valve surgery. Care needs to be taken to assess for Gerbode defect shunts on echocardiogram, especially in the context of previous cardiac surgery.
Apical hypertrophic cardiomyopathy associated with circumflex to left ventricular fistulae: a case report of two rare subtypes of rare conditions occurring together
Authors: Conway Samuel , Herrey Anna S , Rakhit Roby D
Published: February 2021

Background 

Coronary arterial fistulae are rare yet have been associated with hypertrophic cardiomyopathy (HCM). We present a patient who was found to have a left circumflex (LCx) to left ventricular (LV) fistula in combination with apical HCM.

Case summary 

A 72-year-old female presented with syncope after exercise. She sustained facial injuries including fracture of her nasal bones. There were no previous episodes, no cardiac history, and she denied chest pain or anginal symptoms. Electrocardiogram showed sinus rhythm with T-wave inversion throughout the chest leads. Echocardiography suggested apical HCM with hypertrophy of the LV apex but good systolic function. This was confirmed on cardiac magnetic resonance imaging with a characteristically spade-shaped LV cavity. Coronary angiography demonstrated a distal LCx to LV fistula from the apical hypertrophy but no coronary artery disease. She was started on beta-blockers and has had no further episodes, remaining well.

Discussion 

Coronary fistulae are present in 0.002% of the population but clinical outcomes are poorly understood. The majority are asymptomatic but anginal chest pains can occur through the ‘coronary steal’ phenomenon. Apical HCM is a subtype of HCM characterized by spade-shaped LV cavity obliteration. It is unclear whether the association between fistulae and HCM occur because of the increased vascularization and fibrosis associated with HCM or whether congenital malformation leads to hypertrophy. Both can produce a constellation of cardiac symptoms. Our patient has the previously unreported combination of apical HCM and an LCx fistula; two rarer subtypes of rare conditions appearing together.
Transcatheter aortic valve replacement same-day discharge for selected patients: a case series
Authors: Rai Devesh , Tahir Muhammad Waqas , Chowdhury Medhat , Ali Hammad , Buttar Rupinder , Abtahian Farhad , Bhatt Deepak L , Depta Jeremiah P
Published: February 2021

Background

The coronavirus disease 2019 (COVID-19) pandemic has resulted in drastic changes to the practice of medicine, requiring healthcare systems to find solutions to reduce the risk of infection. Using a case series, we propose a protocol for same-day discharge (SDD) for selected patients undergoing transcatheter aortic valve replacement (TAVR) using real-time remote cardiac monitoring. Six patients with severe symptomatic aortic stenosis underwent TAVR and were discharged on the same day.

Case summary

Six patients with symptomatic severe native or bioprosthetic aortic valve stenosis underwent a successful transfemoral TAVR using standard procedures, including the use of rapid atrial pacing to assess the need for permanent pacemaker implantation. Following TAVR, patients were monitored on telemetry in the recovery area for 3 h, ambulated to assess vascular access stability, and discharged with real-time remote cardiac monitoring if no new conduction abnormality was observed. The patients were seen by tele-visits within 2 days and 2 weeks after discharge.

Discussion

Amidst the COVID-19 pandemic, SDD following successful transfemoral TAVR may be feasible for selected patients and reduce potential COVID-19 exposure.
Incorporating reading circles into a task-based EAP reading scheme
Authors: Xu Qi
Published: February 2021

This study explored how reading circles (RCs) can be incorporated into a task-based reading curriculum in academic classroom settings. It investigated students’ perceptions of academic RC tasks and examined their effectiveness in improving students’ reading abilities and critical thinking skills. Twenty-six EFL university students majoring in Business English participated in the study. They were asked to read English business journal articles weekly, assigned different roles and tasks to complete, and given opportunities to share interpretations in class. Data were collected from questionnaires, interviews, students’ reflective journals, reading proficiency tests, and weekly homework. The results show that students held quite positive attitudes toward RC tasks in academic contexts and confirmed their effectiveness in enhancing their reading abilities and critical thinking skills through a collaborative learning process. Such a reading scheme has been proved to be a pedagogically appropriate approach for language development in academic contexts.
Exercise capacity improvement after cardiac rehabilitation following myocardial infarction and its association with long-term cardiovascular events
Authors: Novaković Marko , Novak Tjaša , Vižintin Cuderman Tjaša , Krevel Barbara , Tasič Jerneja , Rajkovič Uroš , Fras Zlatko , Jug Borut
Published: February 2021

Aims 

Cardiovascular rehabilitation (CR) improves aerobic capacity and quality of life in patients after myocardial infarction (MI). The aim was to examine the associations between exercise capacity improvement and different clinically relevant cardiovascular events.

Methods and results 

This was a registry-based study of post-MI patients, referred to CR. All patients were submitted to exercise testing before and after CR (36 sessions, 2–3 times/week, and combined exercise). Patients were divided into two groups, based on the difference in exercise capacity before and after the CR programme with the cut-off of two metabolic equivalents (METs) improvement. We assessed the correlation between the extent of exercise capacity improvement and the following cardiovascular events: major adverse cardiac events (MACE), cardiovascular-related hospitalizations, and unplanned coronary angiography. A total of 499 patients were included (mean age 56 ± 10 years, 20% women). Both groups significantly improved in terms of exercise capacity, natriuretic peptide levels, resting heart rate, and resting diastolic pressure; however, lipid status significantly improved only in patients with ≥2 METs difference in exercise capacity. A total of 13.4% patients suffered MACE (median follow-up 858 days); 21.8% were hospitalized for cardiovascular reasons (median follow-up 791 days); and 19.8% had at least one unplanned coronary angiography (median follow-up 791 days). Exercise capacity improvement of ≥2 METs was associated with lower rates of MACE, cardiovascular hospitalizations, and unplanned coronary angiography in all examined univariate and multivariate models.

Conclusion 

This study has shown that exercise improvement of ≥2 METs is associated with a significant decrease in MACE, cardiac hospitalizations, and unplanned coronary angiography.
The Zn-finger of Saccharomyces cerevisiae Rad18 and its adjacent region mediate interaction with Rad5
Authors: Frittmann Orsolya , Gali Vamsi K , Halmai Miklos , Toth Robert , Gyorfy Zsuzsanna , Balint Eva , Unk Ildiko
Published: February 2021

DNA damages that hinder the movement of the replication complex can ultimately lead to cell death. To avoid that, cells possess several DNA damage bypass mechanisms. The Rad18 ubiquitin ligase controls error-free and mutagenic pathways that help the replication complex to bypass DNA lesions by monoubiquitylating PCNA at stalled replication forks. In Saccharomyces cerevisiae, two of the Rad18 governed pathways are activated by monoubiquitylated PCNA and they involve translesion synthesis polymerases, whereas a third pathway needs subsequent polyubiquitylation of the same PCNA residue by another ubiquitin ligase the Rad5 protein, and it employs template switching. The goal of this study was to dissect the regulatory role of the multidomain Rad18 in DNA damage bypass using a structure-function based approach. Investigating deletion and point mutant RAD18 variants in yeast genetic and yeast two-hybrid assays we show that the Zn-finger of Rad18 mediates its interaction with Rad5, and the N-terminal adjacent region is also necessary for Rad5 binding. Moreover, results of the yeast two-hybrid and in vivo ubiquitylation experiments raise the possibility that direct interaction between Rad18 and Rad5 might not be necessary for the function of the Rad5 dependent pathway. The presented data also reveal that yeast Rad18 uses different domains to mediate its association with itself and with Rad5. Our results contribute to better understanding of the complex machinery of DNA damage bypass pathways.
Health promotion innovations scale up: combining insights from framing and actor-network to foster reflexivity
Authors: Larouche Annie , Bilodeau Angèle , Laurin Isabelle , Potvin Louise
Published: February 2021

There are numerous hurdles down the road for successfully scaling up health promotion innovations into formal programmes. The challenges of the scaling-up process have mainly been conceived in terms of available resources and technical or management problems. However, aiming for greater impact and sustainability involves addressing new contexts and often adding actors whose perspectives may challenge established orientations. The social dimension of the scaling-up process is thus critical. Building on existing conceptualizations of interventions as dynamic networks and of evolving framing of health issues, this paper elaborates a social view of scaling up that accounts for the transformations of innovations, using framing analysis and the notion of ‘expanding scaling-up networks’. First, we discuss interventions as dynamic networks. Second, we conceptualize scaling-up processes as networks in expansion within which social learning and change occur. Third, we propose combining a ‘representational approach’ to frame analysis and an ‘interactional approach’ that illustrates framing processes related to the micro-practices of leading public health actors within expanding networks. Using an example concerning equity in early childhood development, we show that this latter approach allows documenting how frames evolve in the process. Considering the process in continuity with existing conceptualizations of interventions as actor-networks and transformation of meanings enriches our conceptualization of scaling up, improves our capacity to anticipate its outcomes, and promotes reflexivity about health promotion goals and means.
Combination of slide tracheoplasty and side-to-side bronchoplasty for complex congenital tracheobronchial stenosis
Authors: Chan Jasmine Lijuan , Yap Kok Hooi , Teoh Oon Hoe , Nakao Masakazu
Published: February 2021

Congenital tracheal stenosis is a rare but serious condition with high mortality and morbidity. We present a 6-month-old patient with complex congenital tracheal stenosis involving the trachea, carina and right bronchus intermedius, which was corrected with a combination of slide tracheoplasty and side-to-side bronchoplasty.
Cerebrospinal Fluid Pterins, Pterin-Dependent Neurotransmitters, and Mortality in Pediatric Cerebral Malaria
Authors: Rubach Matthew P , Mukemba Jackson P , Florence Salvatore M , Lopansri Bert K , Hyland Keith , Simmons Ryan A , Langelier Charles , Nakielny Sara , DeRisi Joseph L , Yeo Tsin W , Anstey Nicholas M , Weinberg J Brice , Mwaikambo Esther D , Granger Donald L
Published: February 2021

Background

Cerebral malaria (CM) pathogenesis remains incompletely understood. Having shown low systemic levels of tetrahydrobiopterin (BH4), an enzymatic cofactor for neurotransmitter synthesis, we hypothesized that BH4 and BH4-dependent neurotransmitters would likewise be low in cerebrospinal fluid (CSF) in CM.

Methods

We prospectively enrolled Tanzanian children with CM and children with nonmalaria central nervous system conditions (NMCs). We measured CSF levels of BH4, neopterin, and BH4-dependent neurotransmitter metabolites, 3-O-methyldopa, homovanillic acid, and 5-hydroxyindoleacetate, and we derived age-adjusted z-scores using published reference ranges.

Results

Cerebrospinal fluid BH4 was elevated in CM (n = 49) compared with NMC (n = 51) (z-score 0.75 vs −0.08; P < .001). Neopterin was increased in CM (z-score 4.05 vs 0.09; P < .001), and a cutoff at the upper limit of normal (60 nmol/L) was 100% sensitive for CM. Neurotransmitter metabolite levels were overall preserved. A higher CSF BH4/BH2 ratio was associated with increased odds of survival (odds ratio, 2.94; 95% confidence interval, 1.03–8.33; P = .043).

Conclusion

Despite low systemic BH4, CSF BH4 was elevated and associated with increased odds of survival in CM. Coma in malaria is not explained by deficiency of BH4-dependent neurotransmitters. Elevated CSF neopterin was 100% sensitive for CM diagnosis and warrants further assessment of its clinical utility for ruling out CM in malaria-endemic areas.
High Amounts of SARS-CoV-2 Precede Sickness Among Asymptomatic Health Care Workers
Authors: Dillner Joakim , Elfström K Miriam , Blomqvist Jonas , Engstrand Lars , Uhlén Mathias , Eklund Carina , Boulund Fredrik , Lagheden Camilla , Hamsten Marica , Nordqvist-Kleppe Sara , Seifert Maike , Hellström Cecilia , Olofsson Jennie , Andersson Eni , Falk August Jernbom , Bergström Sofia , Hultin Emilie , Pin Elisa , Pimenoff Ville N , Hassan Sadaf , Månberg Anna , Nilsson Peter , Hedhammar My , Hober Sophia , Mattsson Johan , Arroyo Mühr Laila Sara , Lundgren Kalle Conneryd
Published: February 2021

Background

Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity among asymptomatic subjects reflects past or future disease may be difficult to ascertain.

Methods

We tested 9449 employees at Karolinska University Hospital, Stockholm, Sweden for SARS-CoV-2 RNA and antibodies, linked the results to sick leave records, and determined associations with past or future sick leave using multinomial logistic regression.

Results

Subjects with high amounts of SARS-CoV-2 virus, indicated by polymerase chain reaction (PCR) cycle threshold (Ct) value, had the highest risk for sick leave in the 2 weeks after testing (odds ratio [OR], 11.97; 95% confidence interval [CI], 6.29–22.80) whereas subjects with low amounts of virus had the highest risk for sick leave in the 3 weeks before testing (OR, 6.31; 95% CI, 4.38–9.08). Only 2.5% of employees were SARS-CoV-2 positive while 10.5% were positive by serology and 1.2% were positive in both tests. Serology-positive subjects were not at excess risk for future sick leave (OR, 1.06; 95% CI, .71–1.57).

Conclusions

High amounts of SARS-CoV-2 virus, as determined using PCR Ct values, was associated with development of sickness in the next few weeks. Results support the concept that PCR Ct may be informative when testing for SARS-CoV-2.

Clinical Trials Registration. NCT04411576.
Training Radiologists to Interpret Contrast-enhanced Mammography: Toward a Standardized Lexicon
Authors: Berg Wendie A , Bandos Andriy I , Zuley Margarita L , Waheed Uzma X
Published: February 2021

Objective

Using terms adapted from the BI-RADS Mammography and MRI lexicons, we trained radiologists to interpret contrast-enhanced mammography (CEM) and assessed reliability of their description and assessment.

Methods

A 60-minute presentation on CEM and terminology was reviewed independently by 21 breast imaging radiologist observers. For 21 CEM exams with 31 marked findings, observers recorded background parenchymal enhancement (BPE) (minimal, mild, moderate, marked), lesion type (oval/round or irregular mass, or non-mass enhancement), intensity of enhancement (none, weak, medium, strong), enhancement quality (none, homogeneous, heterogeneous, rim), and BI-RADS assessment category (2, 3, 4A, 4B, 4C, 5). “Expert” consensus of 3 other radiologists experienced in CEM was developed. Kappa statistic was used to assess agreement between radiologists and expert consensus, and between radiologists themselves, on imaging feature categories and final assessments. Reproducibility of specific feature descriptors was assessed as fraction of consensus-concordant responses.

Results

Radiologists demonstrated moderate agreement for BPE, (mean kappa, 0.43; range, 0.05–0.69), and lowest reproducibility for “minimal.” Agreement was substantial for lesion type (mean kappa, 0.70; range, 0.47–0.93), moderate for intensity of enhancement (mean kappa, 0.57; range, 0.44–0.76), and moderate for enhancement quality (mean kappa, 0.59; range, 0.20–0.78). Agreement on final assessment was fair (mean kappa, 0.26; range, 0.09–0.44), with BI-RADS category 3 the least reproducible. Decision to biopsy (BI-RADS 2–3 vs 4–5) showed moderate agreement with consensus (mean kappa, 0.54; range, −0.06–0.87).

Conclusion

With minimal training, agreement for description of CEM findings by breast imaging radiologists was comparable to other BI-RADS lexicons.
Flow cytometry with cell sorting and sequencing as a tool for the study of the stomach microbiota of the Humboldt Current krill (Euphausiacea)
Authors: Henríquez-Castillo Carlos , Franco-Cisterna Belén , Murillo Alejandro A , Ulloa Osvaldo , Riquelme-Bugueño Ramiro
Published: February 2021

Euphausiids (krill) are important contributors to marine biomass and key players in marine pelagic trophic webs. Euphausiid stomachs represent a speciﬁc niche for microbes that participate in the digestion of the host’s dietary components. Methods for the study of the diversity and function of these microorganisms remain complex. Bacterial ribosomal sequences obtained from lysates of stomachs are often overrepresented by organisms from the surrounding environment. Flow cytometry with cell sorting (FC-CS) have become a powerful technique to study microbial community structure but also for the study of population genomics of gut-associated bacteria. We compared the performance of the FC-CS-sequencing and total DNA extraction-sequencing to study the stomach microbiota of the Humboldt Current krill. Non-specific amplification was not retrieved in the polymerase chain reaction (PCR) from cells sorted, opposite to the observed using the DNA from the whole lysate. Sequences obtained from the whole stomach DNA were enriched in picocyanobacteria, whereas sequences retrieved from cells sorted belonged almost exclusively to Balneola sp. of the new phylum Balneolaeota. Our results suggest that the stomach-associated microbiota can be successfully characterized by FC-CS and sequencing by manual scraping of the stomach. The implementation of this technique might complement future studies on host-microbes interaction and their implications on the marine pelagic food web.
Long-term outcomes of salvage endoscopic submucosal dissection for local failure after chemoradiotherapy for esophageal squamous cell carcinoma
Authors: Kimura Hidenori , Yoshida Masao , Yabuuchi Yohei , Kakushima Naomi , Yamamoto Yoichi , Kawata Noboru , Takizawa Kohei , Kishida Yoshihiro , Imai Kenichiro , Ito Sayo , Hotta Kinichi , Ishiwatari Hirotoshi , Matsubayashi Hiroyuki , Ono Hiroyuki
Published: February 2021

Background

Salvage endoscopic submucosal dissection is considered a minimally invasive treatment for local failure after chemoradiotherapy for esophageal squamous cell carcinoma. However, the long-term outcomes have not been fully evaluated. This study investigated the short-term and long-term outcomes of salvage endoscopic submucosal dissection.

Methods

Patients who underwent endoscopic submucosal dissection for local recurrence or residual tumor after chemoradiotherapy from January 2006 to December 2017 were retrospectively investigated. Follow-up included endoscopic examination and computed tomography at least once every 6 months after salvage endoscopic submucosal dissection. Risk factors for disease recurrence after salvage endoscopic submucosal dissection were assessed using the Cox hazards model.

Results

A total of 30 patients (33 cases of esophageal squamous cell carcinoma: local recurrence, n = 27; residual tumor, n = 6) were included. The median endoscopic submucosal dissection procedure time was 40 min (interquartile range [IQR], 33–58.5 min). En bloc resection was achieved in 31 (94%) of 33 esophageal squamous cell carcinoma cases. One patient with intraoperative perforation did not require surgical intervention and recovered with conservative treatment. A total of 16 patients (53%) had disease recurrence at a median follow-up of 51 months (IQR, 33–81 months). The 3-year overall, disease-specific, recurrence-free and local recurrence-free survival rates were 75%, 82%, 58% and 90%, respectively. The positive vertical margin, submucosal invasion in the endoscopic submucosal dissection specimen and piecemeal resection were significantly associated with disease recurrence after salvage endoscopic submucosal dissection.

Conclusions

Salvage endoscopic submucosal dissection is a feasible treatment for local failure after chemoradiotherapy for esophageal squamous cell carcinoma with acceptable long-term outcomes. However, for cases with positive vertical margins and submucosal invasion in the endoscopic submucosal dissection specimen, salvage endoscopic submucosal dissection outcomes were insufficient and additional treatment might be required.
Multisystem Inflammatory Syndrome Associated With Severe Acute Respiratory Syndrome Coronavirus 2 in Children: A Case Series From Mayotte Island
Authors: Cattaneo Chiara , Drean Maureen , Subiros Marion , Combe Patrice , Abasse Soumeth , Chamouine Abdourahim , Simon Thomas
Published: February 2021

During the COVID-19 outbreak in the French overseas department Mayotte, 11 children developed multisystem inflammatory syndrome (MIS-C). They all had a fever and gastrointestinal symptoms. Six patients were admitted to intensive care unit; management included intravenous immunoglobulin and corticosteroid. Severe acute respiratory syndrome coronavirus 2 was documented in all patients. The risk of developing MIS-C was much higher than in all of France.
A cut above the rest: oxidative stress in chronic wounds and the potential role of polyphenols as therapeutics
Authors: Johnson Joel B , Broszczak Daniel A , Mani Janice S , Anesi Jack , Naiker Mani
Published: February 2021

Objectives

The pathophysiology of chronic wounds typically involves redox imbalance and inflammation pathway dysregulation, often with concomitant microbial infection. Endogenous antioxidants such as glutathione and tocopherols are notably reduced or absent, indicative of significant oxidative imbalance. However, emerging evidence suggests that polyphenols could be effective agents for the amelioration of this condition. This review aims to summarise the current state of knowledge surrounding redox imbalance in the chronic wound environment and the potential use of polyphenols for the treatment of chronic wounds.

Key findings

Polyphenols provide a multi-faceted approach towards the treatment of chronic wounds. Firstly, their antioxidant activity allows direct neutralisation of harmful free radicals and reactive oxygen species, assisting in restoring redox balance. Upregulation of pro-healing and anti-inflammatory gene pathways and enzymes by specific polyphenols further acts to reduce redox imbalance and promote wound healing actions, such as proliferation, extracellular matrix deposition and tissue remodelling. Finally, many polyphenols possess antimicrobial activity, which can be beneficial for preventing or resolving infection of the wound site.

Exploration of this diverse group of natural compounds may yield effective and economical options for the prevention or treatment of chronic wounds.
Air Force Executive Nurse Leadership Impact: Brigadier General Diann Hale O’Connor, Air Force Nurse Corps Chief From 1982 to 1985
Authors: Hughes Vickie , Chow Sotera , Flanagan Eleni Doukakis
Published: February 2021

Introduction

In the 1980s, nurses became more recognized as interprofessional healthcare partners who actively participated in the advancement of patient care and the nursing profession. There is a significant gap in the nursing literature about the significant contributions of executive military nurse leaders. The purpose of the interview with Brigadier General (Brig Gen) Hale O’Connor was to explore the personal stories, experiences, leadership strategies, lessons learned, and impact of her leadership on the future development of nursing as a profession.

Methods

The oral history method provided a framework for the interview and the analysis. In compliance with the Oral History Association guidelines, the primary investigator obtained Institutional Review Board permission, participant informed consent, and an audiotaped interview. A graduate research assistant transcribed the 3-hour audiotaped interview verbatim. The participant reviewed the transcription, provided clarification, and validated accuracy. Three independent coders extracted prevalent themes and subthemes during analysis. Researchers compared findings and reached a consensus when resolving minor discrepancies.

Results

Two broad thematic qualities, commitment to duty and fairness, emerged from the data with their respective subthemes. Subthemes of trust, patriotism, loyalty, and assiduousness supported the main theme of commitment to duty. Pillars of alignment, equality, and advocacy supported the broad theme of fairness.

Conclusion

Although the team did not use the Reina Trust Model as a framework, the trust-building behaviors emerged from the transcribed interview during the analysis. Surprisingly, many of the leadership strategies utilized by Brig Gen Hale O’Connor fit well into the Reina Trust Model, published 25 years following O’Connor’s tenure as Chief, Air Force Nurse Corps. In addition, several of Brig Gen Hale O’Connor’s leadership accomplishments are still relevant today, solidifying the observation that the foresight of Brig Gen Hale O’Connor was fundamental to the advancement of nursing during her tenure and for those who followed.
A systematic survey for z< 0.04 CLAGNs
Authors: Senarath Madhooshi R , Brown Michael J I , Cluver Michelle E , Jarrett Thomas H , Wolf Christian , Ross Nicholas P , Lucey John R , Parkash Vaishali , Hon Wei J
Published: February 2021

We have conducted a systematic survey for z < 0.04 active Galactic nuclei (AGNs) that may have changed spectral class over the past decade. We use SkyMapper, Pan-STARRS and the Véron-Cetty & Véron catalogue to search the entire sky for these ‘changing-look’ AGNs (CLAGNs) using a variety of selection methods, where Pan-STARRS has a coverage of 3$\pi$ steradians (sky north of Declination −30○) and SkyMapper has coverage of ∼21000 $~\rm {deg^2}$ (sky south of Declination 0○). We use small aperture photometry to measure how colour and flux have changed over time, where a change may indicate a change in spectral type. Optical colour and flux are used as a proxy for changing Hα equivalent width, while WISE 3.4 μm flux is used to look for changes in the hot dust component. We have identified four AGNs with varying spectra selected using our optical colour selection method. Three AGNs were confirmed from recent observations with WiFeS on the 2.3 m telescope at Siding Spring and the other was identified from archival spectra alone. From this, we identify two new CLAGNs; NGC 1346 and 2MASX J20075129–1108346. We also recover Mrk 915 and Mrk 609, which are known to have varying spectra in the literature, but they do not meet our specific criteria for CLAGNs.
Using Gaia DR2 to make a systematic comparison between two geometric distortion solutions
Authors: Zheng Z J , Peng Q Y , Lin F R
Published: February 2021

Gaia Data Release 2 (Gaia DR2) provides high accuracy and precision astrometric parameters (position, parallax, and proper motion) for more than 1 billion sources and is revolutionizing astrometry. For a fast-moving target such as an asteroid, with many stars in the field of view that are brighter than the faint limit magnitude of Gaia (21 Gmag), its measurement accuracy and precision can be greatly improved by taking advantage of Gaia reference stars. However, if we want to study the relative motions of cluster members, we could cross-match them in different epochs based on pixel positions. For both types of targets, the determination of optical field-angle distortion or called geometric distortion (GD) in this paper is important for image calibration especially when there are few reference stars to build a high-order plate model. For the former, the GD solution can be derived based on the astrometric catalogue’s position, while for the latter, a reference system called ‘master frame’ is constructed from these observations in pixel coordinates, and then the GD solution is derived. But, are the two GD solutions in agreement with each other? In this paper, two types of GD solutions, which are derived either from the Gaia DR2 catalogue or from the self-constructed master frame, are applied respectively for the observations taken by 1-m telescope at Yunnan Observatory. It is found that two GD solutions enable the precision to achieve a comparable level (∼10 mas) but their GD patterns are different. Synthetic distorted positions are generated for further investigation into the discrepancy between the two GD solutions. We aim to find the correlation and distinction between the two types of GD solutions and their applicability in high precision astrometry.