bluuebunny/crossref_metadata_2025 huggingface dataset:
The contagion externality of a superspreading event: The Sturgis Motorcycle Rally and COVID‐19
Authors: Dave Dhaval , McNichols Drew , Sabia Joseph J.
Published: December 2020

Large in‐person gatherings of travelers who do not socially distance are classified as the “highest risk” for COVID‐19 spread by the Centers for Disease Control and Prevention (CDC). From August 7–16, 2020, nearly 500,000 motorcycle enthusiasts converged on Sturgis, South Dakota for its annual rally in an environment without mask‐wearing requirements or other mitigating policies. This study is the first to explore this event's public health impacts. First, using anonymized cell phone data, we document that foot traffic at restaurants/bars, retail establishments, and entertainment venues rose substantially at event locations. Stay‐at‐home behavior among local residents fell. Second, using a synthetic control approach, we find that the COVID‐19 case rate increased substantially in Meade County and in the state of South Dakota in the month following the Rally. Finally, using a difference‐in‐differences model to assess nationwide spread, we find that following the Sturgis event, counties outside of South Dakota that contributed the highest inflows of rally attendees experienced a 6.4–12.5% increase in COVID‐19 cases relative to counties without inflows. Our findings highlight that local policy decisions assessing the tradeoff between local economic benefits and COVID‐19 health costs will not be socially optimal in the presence of large contagion externalities.
Enhancing Built‐In Electric Field and Defect Passivation through Gradient Doping in Inverted CsPbI2Br Perovskite Solar Cells
Authors: Han Dongwei , Yuan Quan , Slanina Zdenek , Tang Xiaoxuan , Yi Siwei , Zhou Dong-Ying , Uhlik Filip , Feng Lai
Published: December 2020

Cesium‐based all‐inorganic perovskites (PVKs) are prized for their high thermal stability and wide bandgap suitable for the top layer of tandem solar cells. To further boost the photovoltaic performance of inorganic PVK solar cells (PeSCs), a variety of strategies aiming to either passivate defects or enhance the electric field are developed. Nevertheless, a double‐aim strategy is less explored. Herein, a facile strategy of gradient doping is adopted for optimizing the inverted CsPbI2Br PeSCs. Particularly, a bicationic iodine salt, namely 2,2′‐bis(trifluoromethyl)‐[1,1′‐biphenyl]‐4,4′‐diamine iodine (BFBAI2), is used to realize gradient doping in PVK and ZnO layers, respectively. As a result, the inverted PeSCs with the doped PVK/ZnO bilayer deliver improves power conversion efficiency (PCE) up to 14.38% along with enhanced device stability under ambient or thermal aging conditions, greatly surpassing the pristine devices. The improvements are attributed principally to the low‐defect PVK layer as well as enhanced electric field across the inverted PeSCs upon gradient doping. This work thus demonstrates an efficient bifunctional strategy toward highly efficient and stable CsPbI2Br PeSCs with inverted configuration.
Folding Stability and Self‐Association of a Triplet‐Repeat (CAG)20 RNA Hairpin in Cytomimetic Media
Authors: Hautke Alexander Christoph , Ebbinghaus Simon
Published: December 2020

RNA molecules with trinucleotide repeat expansions are involved in the pathology of various neurodegenerative diseases, such as Huntington's disease. A central research objective is to understand how trinucleotide repeat RNAs fold and function in disease progression. Studies that investigate the sequence structure, stability and self‐assembly of such RNAs mainly focused on in vitro methods in dilute aqueous solution. Functional studies in cells reveal further aspects of transport, protein association or assembly in phase separated compartments. Our study aims to understand governing factors for folding stability of trinucleotide repeats on the cellular level by assessing the influence of key components of the cellular medium in vitro. We investigate (CAG)20 RNA in complex and cytomimetic media using Fast Relaxation Imaging. Using distinct cosolutes we analyze the different enthalpic and entropic contributions that determine folding stability. We find a remarkable destabilization and aggregation of the RNA in cellular lysate that can be attributed to specific and non‐specific interactions with the unfolded state.
Domestic wastewater treatment in a coupled sequential batch reactor‐electrochemical reactor process
Authors: Akula Lokesh Kumar , Gaddam Vidyasagar Babu , Damaraju Madhuri , Bhattacharyya Debraj , Kurilla Kiran Kumar
Published: December 2020

The effectiveness of a sequenced biological–physicochemical reactor system for treating sewage was studied. The biological degradation was conducted in a Sequential Batch Reactor, which had innovative features for simplifying the operation and maintenance of the reactor. The reactor was operated at 4, 6, 8, and 12 hr cycle. Up to 82% removal of Chemical Oxygen Demand (COD), 50% removal of Dissolved Organic Carbon (DOC), 45% removal of Total Nitrogen (TN), and 45% removal of Total Phosphorus (TP) were achieved. The treated effluent was further polished in a continuous‐flow bipolar‐mode electrochemical reactor to remove additional recalcitrant organic matter from the wastewater. The process parameters were optimized using Response Surface Methodology. At the optimum condition (pH = 8.7; Current = 1.0; reaction time = 9.0), up to 90% removal of COD, 67% removal of DOC, 61% removal of TN, and 99.9% removal of TP were achieved in the coupled system. Micropollutants belonging to Pharmaceutically Active Compounds, pesticides, etc., were significantly removed. The coupled system completely removed Salmonella, Pseudomonas, and Staphylococcus. However, coliforms were detected at the outlet samples. A UV or ozone disinfection treatment is recommended for the safe reuse of the treated water for nonpotable purposes.

Practioner points

Sequential sequential batch reactor‐electrochemical reactor process (SBR‐ECR) technology is effective for micropollutant removal from sewage.

The coupled SBR‐ECR system requires less footprint compared to conventional biological systems for wastewater treatment.

Carbon material balance study revealed that more than 60% of carbon escapes from wastewater in the form of CO2
Introduction to the special issue on the Flatreef PGE-Ni-Cu deposit, northern limb of the Bushveld Igneous Complex
Authors: Maier Wolfgang D. , Yudovskaya Marina , Jugo Pedro
Published: December 2020

More than 30 years ago, Cox and Singer (1986) suggested that magmatic platinum-group element (PGE)-Ni-Cu deposits are amongst the best understood of ore deposits, yet the origin of PGE mineralization in the Bushveld Igneous Complex (BIC) remains controversial after a century of study. In the northern limb of the BIC, the unravelling of ore formation proved particularly difficult due to relatively poor outcrop, which is typically affected by contamination of the intruding magmas with the host rocks and expressed in the form of abundant xenoliths, footwall rafts and disturbance of magmatic stratigraphy. In this thematic issue, we present contributions on the Flatreef, a recently discovered world-class PGE-Ni-Cu deposit constituting a downdip extension of the mineralized unit of the Platreef of the northern limb. Two deep shafts are currently being sunk, making the Flatreef one of the most significant new mine development on the Bushveld in several decades.
Effect of a subsequent pregnancy on anal sphincter integrity and function after obstetric anal sphincter injury (OASI)
Authors: Okeahialam Nicola Adanna , Thakar Ranee , Sultan Abdul H.
Published: December 2020

Introduction and hypothesis

Endoanal ultrasound (EAUS) and anal manometry are used in the assessment women with a history of obstetric anal sphincter injury (OASI), both postpartum and in a subsequent pregnancy, to aid counselling regarding mode of delivery (MOD).

Methods

A prospective observational study between 2012 to 2020 was completed. Women were reviewed 3 months postpartum following OASI and in the second half of a subsequent pregnancy. Anorectal symptoms were measured using the validated St Mark’s Incontinence Score (SMIS: asymptomatic to mild symptoms = ≤ 4). Anal manometry (incremental maximum squeeze pressure [iMSP: normal = > 20 mmHg]) and EAUS (abnormal = sphincter defect > 1 h in size) were performed.

Results

One hundred forty-six women were identified and 67.8% had an anal sphincter defect ≤ 1 h in size postnatally. In those with a defect ≤ 1 h, postpartum mean iMSP and SMIS significantly improved in a subsequent pregnancy (p = 0.04 andp = 0.01, respectively). In women with a defect > 1 h, there was no significant difference between the mean iMSP or SMIS score postnatally compared to a subsequent pregnancy. At both time points, significantly more women had an anal sphincter defect ≤ 1 h and SMIS of ≤ 4 (p = 0.001 and p < 0.001 respectively) compared to those with a defect < 1 h. In addition, significantly more women had an anal sphincter defect ≤ 1 h and iMSP ≥ 20 mmHg (p < 0.001). Overall, out of the 146 women included in this study, 76 (52.1%) with a defect ≤ 1 h also had an iMSP ≥ 20 mmHg and SMIS ≤ 4 at 3 months postpartum.

Conclusions

Women who remain asymptomatic with normal anal manometry and no abnormal sphincter defects on EAUS postnatally do not need to have these investigations repeated in a subsequent pregnancy and can be recommended to have a vaginal delivery. If our protocol was modified, over half of the women in this study could have had their MOD recommendation made in the postnatal period alone.
Suturing methods in prolapse surgery: a biomechanical analysis
Authors: Hachenberg J. , Sauerwald A. , Brunke H. , Ludwig S. , Scaal M. , Prescher A. , Eichler C.
Published: December 2020

Introduction

Pelvic organ prolapse is a common problem in urogynecological surgery. Abdominal and laparoscopic sacrocolpopexy is currently considered to be the gold standard of treatment. The main problem remains the anatomical point of fixation as well as how sutures are placed. We evaluated the biomechanical difference between an in-line ligament suture versus an orthogonal ligament suture and a single suture versus a continuous suture at the anterior longitudinal ligament in an in-vitro, sacrocolpopexy model.

Methods

Biomechanical in-vitro testing was performed on human, non-embalmed, female cadaver pelvises. An Instron test frame (tensinometer) was used for load/ displacement analysis. The average patient age was 75 years. Ligament preparation yielded 15 ligaments available for testing. Recorded parameters were the ultimate load, failure displacement, and stiffness.

Results

This in-vitro analysis of different suturing methods showed the difference between an orthogonal and an in-line approach to be the ultimate load. Orthogonal sutures displayed an ultimate load of 80 N while in-line suturing yielded only 57 N (p < 0.05). For the anterior longitudinal ligament, this study demonstrated that continuous suture is significantly superior to a single suture regarding failure displacement (p < 0.05).

Conclusion

We established baseline biomechanical parameters for the sacrospinous ligament and anterior longitudinal ligament. An orthogonal suture is superior to an in-line suture in an in-vitro model. A continuous suture is superior to a single suture at the anterior longitudinal ligament. Clinical trials might be able to evaluate whether any clinical significance can be established from these findings.
Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: a longitudinal study
Authors: Damoiseaux-Volman Birgit A. , Medlock Stephanie , Raven Kimmy , Sent Danielle , Romijn Johannes A. , van der Velde Nathalie , Abu-Hanna Ameen
Published: December 2020

Purpose

To investigate prevalence, independent associations, and variation over time of potentially inappropriate prescriptions in a population of older hospitalized patients.

Methods

A longitudinal study using a large dataset of hospital admissions of older patients (≥ 70 years) based on an electronic health records cohort including data from 2015 to 2019. Potentially inappropriate medication (PIM) and potential prescribing omission (PPO) prevalence during hospital stay were identified based on the Dutch STOPP/START criteria v2. Univariate and multivariate logistic regression were used for analyzing associations and trends over time.

Results

The data included 16,687 admissions. Of all admissions, 56% had ≥ 1 PIM and 58% had ≥ 1 PPO. Gender, age, number of medications, number of diagnoses, Charlson score, and length of stay were independently associated with both PIMs and PPOs. Additionally, number of departments and number of prescribing specialties were independently associated with PIMs. Over the years, the PIM prevalence did not change (OR = 1.00, p = .95), whereas PPO prevalence increased (OR = 1.08, p < .001). However, when corrected for changes in patient characteristics such as number of diagnoses, the PIM (aOR = 0.91, p < .001) and PPO prevalence (aOR = 0.94, p < .001) decreased over the years.

Conclusion

We found potentially inappropriate prescriptions in the majority of admissions of older patients. Prescribing relatively improved over time when considering complexity of the admissions. Nevertheless, the high prevalence shows a clear need to better address this issue in clinical practice. Studies seeking effective (re)prescribing interventions are warranted.
3D Dixon water-fat LGE imaging with image navigator and compressed sensing in cardiac MRI
Authors: Zeilinger Martin Georg , Wiesmüller Marco , Forman Christoph , Schmidt Michaela , Munoz Camila , Piccini Davide , Kunze Karl-Philipp , Neji Radhouene , Botnar René Michael , Prieto Claudia , Uder Michael , May Matthias , Wuest Wolfgang
Published: December 2020

Objectives

To evaluate an image-navigated isotropic high-resolution 3D late gadolinium enhancement (LGE) prototype sequence with compressed sensing and Dixon water-fat separation in a clinical routine setting.

Material and methods

Forty consecutive patients scheduled for cardiac MRI were enrolled prospectively and examined with 1.5 T MRI. Overall subjective image quality, LGE pattern and extent, diagnostic confidence for detection of LGE, and scan time were evaluated and compared to standard 2D LGE imaging. Robustness of Dixon fat suppression was evaluated for 3D Dixon LGE imaging. For statistical analysis, the non-parametric Wilcoxon rank sum test was performed.

Results

LGE was rated as ischemic in 9 patients and non-ischemic in 11 patients while it was absent in 20 patients. Image quality and diagnostic confidence were comparable between both techniques (p = 0.67 and p = 0.66, respectively). LGE extent with respect to segmental or transmural myocardial enhancement was identical between 2D and 3D (water-only and in-phase). LGE size was comparable (3D 8.4 ± 7.2 g, 2D 8.7 ± 7.3 g, p = 0.19). Good or excellent fat suppression was achieved in 93% of the 3D LGE datasets. In 6 patients with pericarditis, the 3D sequence with Dixon fat suppression allowed for a better detection of pericardial LGE. Scan duration was significantly longer for 3D imaging (2D median 9:32 min vs. 3D median 10:46 min, p = 0.001).

Conclusion

The 3D LGE sequence provides comparable LGE detection compared to 2D imaging and seems to be superior in evaluating the extent of pericardial involvement in patients suspected with pericarditis due to the robust Dixon fat suppression.

Key Points

• Three-dimensional LGE imaging provides high-resolution detection of myocardial scarring.

• Robust Dixon water-fat separation aids in the assessment of pericardial disease.

• The 2D image navigator technique enables 100% respiratory scan efficacy and permits predictable scan times.
Mesenteric artery calcium scoring: a potential screening method for chronic mesenteric ischemia
Authors: Terlouw Luke G. , van Noord Desirée , van Walsum Theo , Bruno Marco J. , Moelker Adriaan
Published: December 2020

Objective

A practical screening tool for chronic mesenteric ischemia (CMI) could facilitate early recognition and reduce undertreatment and diagnostic delay. This study explored the ability to discriminate CMI from non-CMI patients with a mesenteric artery calcium score (MACS).

Methods

This retrospective study included CTAs of consecutive patients with suspected CMI in a tertiary referral center between April 2016 and October 2019. A custom-built software module, using the Agatston definition, was developed and used to calculate the MACS for the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery. Scoring was performed by two blinded observers. Interobserver agreement was determined using 39 CTAs scored independently by both observers. CMI was defined as sustained symptom improvement after treatment. Non-CMI patients were patients not diagnosed with CMI after a diagnostic workup and patients not responding to treatment.

Results

The MACS was obtained in 184 patients, 49 CMI and 135 non-CMI. Interobserver agreement was excellent (intraclass correlation coefficient 0.910). The MACS of all mesenteric arteries was significantly higher in CMI patients than in non-CMI patients. ROC analysis of the combined MACS of CA + SMA showed an acceptable AUC (0.767), high sensitivity (87.8%), and high NPV (92.1%), when using a ≥ 29.7 CA + SMA MACS cutoff. Comparison of two CTAs, obtained in the same patient at different points in time with different scan and reconstruction parameters, was performed in 29 patients and revealed significant differences in MACSs.

Conclusion

MACS seems a promising screening method for CMI, but correction for scan and reconstruction parameters is warranted.

Key Points

• A mesenteric artery calcium score obtained in celiac artery and superior mesenteric artery has a high negative predictive value for chronic mesenteric ischemia and could serve as a screening tool.

• Interobserver agreement of the mesenteric artery calcium score is excellent.

• Scan and reconstruction parameters influence the mesenteric artery calcium score and warrant the development of a method to correct for these parameters.
Spiral breast computed tomography (CT): signal-to-noise and dose optimization using 3D-printed phantoms
Authors: Germann Manon , Shim Sojin , Angst Florian , Saltybaeva Natalia , Boss Andreas
Published: December 2020

Objectives

To investigate the dependence of signal-to-noise ratio (SNR) and calculated average dose per volume of spiral breast-CT (B-CT) on breast size and breast density and to provide a guideline for choosing the optimal tube current for each B-CT examination.

Materials and methods

Three representative B-CT datasets (small, medium, large breast size) were chosen to create 3D-printed breast phantoms. The phantoms were filled with four different agarose-oil-emulsions mimicking differences in breast densities. Phantoms were scanned in a B-CT system with systematic variation of the tube current (6, 12.5, 25, 32, 40, 50, 64, 80, 100, 125 mA). Evaluation of SNR and the average dose per volume using Monte Carlo simulations were performed for high (HR) and standard (STD) spatial resolution.

Results

SNR and average dose per volume increased with increasing tube current. Artifacts had negligible influence on image evaluation. SNR values ≥ 35 (HR) and ≥ 100 (STD) offer sufficient image quality for clinical evaluation with SNR being more dependent on breast density than on breast size. For an average absorbed dose limit of 6.5 mGy for the medium and large phantoms and 7 mGy for the small phantom, optimal tube currents were either 25 or 32 mA.

Conclusions

B-CT offers the possibility to vary the X-ray tube current, allowing image quality optimization based on individual patient’s characteristics such as breast size and density. This study describes the optimal B-CT acquisition parameters, which provide diagnostic image quality for various breast sizes and densities, while keeping the average dose at a level similar to digital mammography.

Key Points

• Image quality optimization based on breast size and density varying the tube current using spiral B-CT.
Decadal variability of the Kuroshio Extension: the response of the jet to increased atmospheric resolution in a coupled ocean–atmosphere model
Authors: Fedele Giusy , Bellucci Alessio , Masina Simona , Pierini Stefano
Published: December 2020

The Kuroshio Extension (KE) shifts between elongated and convoluted states on interannual to decadal time scales. The nature of this low frequency variability (LFV) is still under debate since it is known to be driven by intrinsic oceanic mechanisms, but it is also synchronized with the Pacific Decadal Oscillation (PDO). In this analysis we present the results from two present-climate coupled simulations performed with the CMCC-CM2 model under the CMIP6 HighResMIP protocol and differing only by their atmospheric component resolution. The impact of increased atmospheric resolution on the KE LFV is assessed inspecting several aspects: the KE bimodality, the large-scale variability and the air–sea interactions. The KE LFV and the teleconnection mechanism that connects the KE and the PDO are well captured by both configurations. However, higher atmospheric resolution favors the occurrence of the elongated state and leads to a more realistic PDO representation. Moreover, both simulations qualitatively capture the signatures of atmosphere-driven and ocean-driven regimes over the North Pacific Ocean, even if the higher resolution induces an excessively strong ocean–atmosphere coupling that leads to an overestimation of the air–sea feedbacks. This work highlights that the small scale atmospheric variability (resolution lower than 1°) does not substantially contribute to improve the realism of the KE LFV, but causes significant differences in the air–sea interaction over the KE region likely related to the strengthening of the coupling. The eddy-permitting ocean resolution shared by both configurations is likely responsible for the degree of realism exhibited by the simulated KE LFV in the two analyzed simulations.
Post-weight loss changes in fasting appetite- and energy balance-related hormone concentrations and the effect of the macronutrient content of a weight maintenance diet: a randomised controlled trial
Authors: Näätänen Mari , Kolehmainen Marjukka , Laaksonen David E. , Herzig Karl-Heinz , Poutanen Kaisa , Karhunen Leila
Published: December 2020

Purpose

We investigated the effects of the macronutrient composition of diets with differing satiety values on fasting appetite-related hormone concentrations after weight loss and examined whether the hormone secretion adapted to changes in body fat mass (FM) and fat-free mass (FFM) during the weight maintenance period (WM).

Methods

Eighty-two men and women with obesity underwent a 7-week very-low-energy diet (VLED) and were then randomised to a higher-satiety food (HSF) group or a lower-satiety food (LSF) group during 24-weeks of the WM. The groups consumed isoenergetic foods with different satiety ratings and macronutrient compositions.

Results

During the WM, the HSF group consumed more protein and dietary fibre and less fat than the LSF group, but the groups showed similar changes in body weight and fasting appetite-related hormones. In the whole study sample, VLED induced 12 kg (p < 0.001) weight loss. At the end of the WM, weight regain was 1.3 kg (p = 0.004), ghrelin concentration increased, whereas leptin, insulin, and glucose concentrations decreased compared to pre-VLED levels (p < 0.001 for all). Peptide YY did not differ from pre-VLED levels. Changes in ghrelin levels were inversely associated with changes in FFM during weeks 0–12 of the WM (p = 0.002), while changes in leptin and insulin levels were positively associated with changes in FM during weeks 0–12 (p = 0.015 and p = 0.038, respectively) and weeks 12–24 (p < 0.001 and p = 0.022) of the WM.

Conclusions

The macronutrient composition of an isoenergetic WM diet did not affect fasting appetite-related hormone concentrations. Leptin and insulin adjusted to the reduced FM, whereas ghrelin reflected FFM during the first months of the WM.

Trial registration

isrctn.com, ID 67529475.
Borderline personality disorder classification based on brain network measures during emotion regulation
Authors: Cremers Henk , van Zutphen Linda , Duken Sascha , Domes Gregor , Sprenger Andreas , Waldorp Lourens , Arntz Arnoud
Published: December 2020

Borderline Personality Disorder (BPD) is characterized by an increased emotional sensitivity and dysfunctional capacity to regulate emotions. While amygdala and prefrontal cortex interactions are regarded as the critical neural mechanisms underlying these problems, the empirical evidence hereof is inconsistent. In the current study, we aimed to systematically test different properties of brain connectivity and evaluate the predictive power to detect borderline personality disorder. Patients with borderline personality disorder (n = 51), cluster C personality disorder (n = 26) and non-patient controls (n = 44), performed an fMRI emotion regulation task. Brain network analyses focused on two properties of task-related connectivity: phasic refers to task-event dependent changes in connectivity, while tonic was defined as task-stable background connectivity. Three different network measures were estimated (strength, local efficiency, and participation coefficient) and entered as separate models in a nested cross-validated linear support vector machine classification analysis. Borderline personality disorder vs. non-patient controls classification showed a balanced accuracy of 55%, which was not significant under a permutation null-model, p = 0.23. Exploratory analyses did indicate that the tonic strength model was the highest performing model (balanced accuracy 62%), and the amygdala was one of the most important features. Despite being one of the largest data-sets in the field of BPD fMRI research, the sample size may have been limited for this type of classification analysis. The results and analytic procedures do provide starting points for future research, focusing on network measures of tonic connectivity, and potentially focusing on subgroups of BPD.
Predictive factors for surgical treatment in preterm neonates with necrotizing enterocolitis: a multicenter case-control study
Authors: el Manouni el Hassani Sofia , Niemarkt Hendrik J. , Derikx Joep P. M. , Berkhout Daniel J. C. , Ballón Andrea E. , de Graaf Margot , de Boode Willem P. , Cossey Veerle , Hulzebos Christian V. , van Kaam Anton H. , Kramer Boris W. , van Lingen Richard A. , Vijlbrief Daniel C. , van Weissenbruch Mirjam M. , Benninga Marc A. , de Boer Nanne K. H. , de Meij Tim G. J.
Published: December 2020

Necrotizing enterocolitis (NEC) is one of the most common and lethal gastrointestinal diseases in preterm infants. Early recognition of infants in need for surgical intervention might enable early intervention. In this multicenter case-control study, performed in nine neonatal intensive care units, preterm born infants (< 30 weeks of gestation) diagnosed with NEC (stage ≥ IIA) between October 2014 and August 2017 were divided into two groups: (1) medical (conservative treatment) and (2) surgical NEC (sNEC). Perinatal, clinical, and laboratory parameters were collected daily up to clinical onset of NEC. Univariate and multivariate logistic regression analyses were applied to identify potential predictors for sNEC. In total, 73 preterm infants with NEC (41 surgical and 32 medical NEC) were included. A low gestational age (p value, adjusted odds ratio [95%CI]; 0.001, 0.91 [0.86–0.96]), no maternal corticosteroid administration (0.025, 0.19 [0.04–0.82]), early onset of NEC (0.003, 0.85 [0.77–0.95]), low serum bicarbonate (0.009, 0.85 [0.76–0.96]), and a hemodynamically significant patent ductus arteriosus for which ibuprofen was administered (0.003, 7.60 [2.03–28.47]) were identified as independent risk factors for sNEC.

Conclusions: Our findings may support the clinician to identify infants with increased risk for sNEC, which may facilitate early decisive management and consequently could result in improved prognosis.

What is Known:• In 27–52% of the infants with NEC, a surgical intervention is indicated during its disease course.• Absolute indication for surgical intervention is bowel perforation, whereas fixed bowel loop or clinical deterioration highly suggestive of bowel perforation or necrosi, is a relative indication.

What is New:• Lower gestational age, early clinical onset, and no maternal corticosteroids administration are predictors for surgical NEC.• Low serum bicarbonate in the 3 days prior clinical onset and patent ductus arteriosus for which ibuprofen was administered predict surgical NEC.
Treatment patterns and clinical outcomes in patients with advanced non-small cell lung cancer initiating first-line treatment in the US community oncology setting: a real-world retrospective observational study
Authors: Nadler Eric , Arondekar Bhakti , Aguilar Kathleen Marie , Zhou Jie , Chang Jane , Zhang Xinke , Pawar Vivek
Published: December 2020

Purpose

Treatments for advanced non-small cell lung cancer (NSCLC) have evolved to include targeted and immuno-oncology therapies, which have demonstrated clinical benefits in clinical trials. However, few real-world studies have evaluated these treatments in the first-line setting.

Methods

Adult patients with advanced NSCLC who initiated first-line treatment with chemotherapy, targeted therapies (TT), or immuno-oncology–based regimens in the US Oncology Network (USON) between March 1, 2015, and August 1, 2018, were included and followed up through February 1, 2019. Data were sourced from structured fields of USON electronic health records. Patient and treatment characteristics were assessed descriptively, with Kaplan-Meier methods used to evaluate time-to-event outcomes, including time to treatment discontinuation (TTD) and overall survival (OS). Adjusted Cox regression analyses and inverse probability of treatment weighting (IPTW) were performed to control for covariates that may have affected treatment selection and outcomes.

Results

Of 7746 patients, 75.6% received first-line systemic chemotherapy, 11.7% received immuno-oncology monotherapies, 8.5% received TT, and 4.2% received immuno-oncology combination regimens. Patients who received immuno-oncology monotherapies had the longest median TTD (3.5 months; 95% confidence interval [CI], 2.8–4.2) and OS (19.9 months; 95% CI, 16.6–24.1). On the basis of multivariable Cox regression and IPTW, immuno-oncology monotherapy was associated with reduced risk of death and treatment discontinuation relative to other treatments.

Conclusion

These results suggest that real-world outcomes in this community oncology setting improved with the introduction of immuno-oncology therapies. However, clinical benefits are limited in certain subgroups and tend to be reduced compared with clinical trial observations.
Applying the electronic nose for pre-operative SARS-CoV-2 screening
Authors: Wintjens Anne G. W. E. , Hintzen Kim F. H. , Engelen Sanne M. E. , Lubbers Tim , Savelkoul Paul H. M. , Wesseling Geertjan , van der Palen Job A. M. , Bouvy Nicole D.
Published: December 2020

Background

Infection with SARS-CoV-2 causes corona virus disease (COVID-19). The most standard diagnostic method is reverse transcription-polymerase chain reaction (RT-PCR) on a nasopharyngeal and/or an oropharyngeal swab. The high occurrence of false-negative results due to the non-presence of SARS-CoV-2 in the oropharyngeal environment renders this sampling method not ideal. Therefore, a new sampling device is desirable. This proof-of-principle study investigated the possibility to train machine-learning classifiers with an electronic nose (Aeonose) to differentiate between COVID-19-positive and negative persons based on volatile organic compounds (VOCs) analysis.

Methods

Between April and June 2020, participants were invited for breath analysis when a swab for RT-PCR was collected. If the RT-PCR resulted negative, the presence of SARS-CoV-2-specific antibodies was checked to confirm the negative result. All participants breathed through the Aeonose for five minutes. This device contains metal-oxide sensors that change in conductivity upon reaction with VOCs in exhaled breath. These conductivity changes are input data for machine learning and used for pattern recognition. The result is a value between − 1 and + 1, indicating the infection probability.

Results

219 participants were included, 57 of which COVID-19 positive. A sensitivity of 0.86 and a negative predictive value (NPV) of 0.92 were found. Adding clinical variables to machine-learning classifier via multivariate logistic regression analysis, the NPV improved to 0.96.

Conclusions

The Aeonose can distinguish COVID-19 positive from negative participants based on VOC patterns in exhaled breath with a high NPV. The Aeonose might be a promising, non-invasive, and low-cost triage tool for excluding SARS-CoV-2 infection in patients elected for surgery.
Evaluation of reflux following sleeve gastrectomy and one anastomosis gastric bypass: 1-year results from a randomized open-label controlled trial
Authors: Musella Mario , Vitiello Antonio , Berardi Giovanna , Velotti Nunzio , Pesce Marcella , Sarnelli Giovanni
Published: December 2020

Background

Recent reports have demonstrated that de novo reflux and worsening of pre-existing symptoms occur after SG; concerns are still expressed about the risk of symptomatic biliary reflux gastritis and oesophagitis. The aim of our study was to investigate and compare the rate of postoperative acid and non-acid reflux following Mini-/One anastomosis gastric bypass (MGB/OAGB) and laparoscopic sleeve gastrectomy (LSG).

Study design

A prospective randomized open-label, controlled trial registered on clinicaltrial.gov (NCT number: NCT02987673) has been carried out to evaluate esophagogastric junction exposure to reflux in the first year after MGB/OAGB and LSG using high impedance manometry, endoscopy, and a validated questionnaire.

Results

A total of 58 individuals were eventually enrolled in this trial and represented the per-protocol population (n = 28 MGB/OAGB, n = 30 LSG). No difference was found between the two groups in terms of demographic characteristics, PAGI-SYM score, acid exposure time percent of the esophagus (AET%), esophagitis, and other HRiM and MII-pH data at baseline. Comparing MII-pH outcomes of the two groups, AET% resulted significantly higher after LSG at 12 months. Endoscopic findings showed a significant increase of esophagitis ≥ B in the LSG group after 1 year; postoperative esophagitis ≥ B resulted also significantly worsened after LSG when compared to MGB/OAGB.

Conclusion

Since AET% and rate of esophagitis are significantly higher after LSG when compared to MGB/OAGB, this procedure should be preferred in case of preoperative subclinical reflux or low grade (A) esophagitis.
Frequency of Self-reported Unpleasant Events and Harm in a Mindfulness-Based Program in Two General Population Samples
Authors:   The MYRIAD team, Baer Ruth , Crane Catherine , Montero-Marin Jesus , Phillips Alice , Taylor Laura , Tickell Alice , Kuyken Willem
Published: December 2020

Objectives

Evidence-based mindfulness programs have well-established benefits, but the potential for harmful effects is understudied. We explored the frequency and severity of unpleasant experiences and harm in two nonclinical samples participating in an adaptation of mindfulness-based cognitive therapy (MBCT) for the general population.

Methods

Study 1 included 84 schoolteachers; study 2 included 74 university students. Both studies were uncontrolled. Participants completed self-report questionnaires about psychological symptoms before and after the 8-week mindfulness course. After the course, they responded to a survey designed for this study that included Likert ratings and free-text questions about unpleasant experiences and harm. All data were collected online.

Results

In both samples, about two-thirds of participants reported unpleasant experiences associated with mindfulness practice during the course. Most participants (85–92%) rated these experiences as not at all or somewhat upsetting; some indicated that difficult experiences led to important learning or were beneficial in some way. The proportion of participants reporting harm from the mindfulness course ranged from 3 to 7%. The proportion showing reliable deterioration on symptom questionnaires ranged from 2 to 7%. Those reporting harm and those showing reliable deterioration on questionnaires were largely separate subgroups; only one participant fell in both.

Conclusions

Findings highlight the need for mindfulness teachers to manage expectations about benefits and difficulties that may occur in mindfulness-based programs and to work skilfully with participants experiencing difficulties. Experiences of harm may not be captured by symptom questionnaires and should be explicitly assessed in other ways.
Estimation of spatial and temporal overlap in three ungulate species in a Mediterranean environment
Authors: Zanni Michele , Brivio Francesca , Grignolio Stefano , Apollonio Marco
Published: December 2020

Interspecific interactions are key drivers in structuring animal communities. Sympatric animals may show such behavioural patterns as the differential use of space and/or time to avoid competitive encounters. We took advantage of the ecological conditions of our study area, inhabited by different ungulate species, to investigate the spatial and temporal distribution ofCapreolus capreolus,Dama damaandSus scrofa. We estimated intraspecific interaction arising from the concomitant use of resources by using camera trapping. We collected 2741 videos with the three ungulates, which showed peculiar activity patterns. The three species were observed in all the habitat types of the study area over the four seasons, thus highlighting an evident spatial overlap. Moreover, our analysis demonstrated that the three species did not avoid each other through temporal segregation of their activities, rather showing a high overlap of daily activity rhythms, though with differences among the species and the seasons. Despite the high spatial and temporal overlap, the three species seemed to adopt segregation through fine-scale spatial avoidance: at an hourly level, the proportion of sites where the species were observed together was relatively low. This spatio-temporal segregation revealed complex and alternative behavioural strategies, which likely facilitated intra-guild sympatry among the studied species. Both temporal and spatio-temporal overlap reached the highest values in summer, when environmental conditions were more demanding. Given these results, we may presume that different drivers (e.g. temperature, human disturbance), which are likely stronger than interspecific interactions, affected activity rhythms and fine-scale spatial use of the studied species.
Inferring ethylene temporal and spatial distribution in an apple orchard (Malus domestica Borkh): a pilot study for optimal sampling with a gas sensor
Authors: Valente João , Almeida Rodrigo , Kooistra Lammert
Published: December 2020

Apples emit a volatile organic compounds during the ripening process named ethylene, which can be used to infer the optimal harvest time. Currently, the fruit ethylene emission is assessed in controlled facilities, thus laborious and expensive. This article pioneers the study of assessing ethylene emissions in uncontrolled environments. However, understanding how the ethylene spatial temporal dynamics in an open field, its still elusive. Therefore, this paper provides a model from an (Malus domesticaBorkh) apple orchard for simulation and analysis of ethylene behaviour. We demonstrate that the model is able to explain the ethylene emissions behaviour in an orchard field when subject to different wind speeds, directions and ripeness stages. Based on that we have investigated different sampling schemes—regular and random—for capturing the variability of ethylene in an orchard using an electrochemical gas sensor. These results show that a random sampling scheme performs 25% better than an equivalent regular-defined grid. Moreover, the measurements acquired locally in the rows tend to be 10% more reliable than in other locations from the orchard. Finally, the ethylene variability can be assessed with a confidence of 75% using 4 and 16 sampling points.
“It is you, me on the team together, and my child”: Attending, resident, and patient family perspectives on patient ownership
Authors: Kiger Michelle E. , Meyer Holly S. , Varpio Lara
Published: December 2020

Introduction Patient ownership is an important element of physicians’ professional responsibility, but important gaps remain in our understanding of this concept. We sought to develop a theory of patient ownership by studying it in continuity clinics from the perspective of residents, attending physicians, and patients.

Methods Using constructivist grounded theory, we conducted 27 semi-structured interviews of attending physicians, residents, and patient families within two pediatric continuity clinics to examine definitions, expectations, and experiences of patient ownership from March–August 2019. We constructed themes using constant comparative analysis and developed a theory describing patient ownership that takes into account a diversity of perspectives.

Results Patient ownership was described as a bi-directional, relational commitment between patient/family and physician that includes affective and behavioral components. The experience of patient ownership was promoted by continuity of care and constrained by logistical and other systems-based factors. The physician was seen as part of a medical care team that included clinic staff and patient families. Physicians adjusted expectations surrounding patient ownership for residents based on scheduling limitations.

Discussion Our theory of patient ownership portrays the patient/family as an active participant in the patient–physician relationship, rather than a passive recipient of care. While specific expectations and tasks will vary based on the practice setting, our findings reframe the way in which patient ownership can be viewed and studied in the future by attending to a diversity of perspectives.
Simulation of the fatigue-wear coupling mechanism of an aviation gear
Authors: Zhang Boyu , Liu Huaiju , Zhu Caichao , Ge Yibo
Published: December 2020

The contact fatigue of aviation gears has become more prominent with greater demands for heavy-duty and high-power density gears. Meanwhile, the coexistence of tooth contact fatigue damage and tooth profile wear leads to a complicated competitive mechanism between surface-initiated failure and subsurface-initiated contact fatigue failures. To address this issue, a fatigue-wear coupling model of an aviation gear pair was developed based on the elastic-plastic finite element method. The tooth profile surface roughness was considered, and its evolution during repeated meshing was simulated using the Archard wear formula. The fatigue damage accumulation of material points on and underneath the contact surface was captured using the Brown-Miller-Morrow multiaxial fatigue criterion. The elastic-plastic constitutive behavior of damaged material points was updated by incorporating the damage variable. Variations in the wear depth and fatigue damage around the pitch point are described, and the effect of surface roughness on the fatigue life is addressed. The results reveal that whether fatigue failure occurs initially on the surface or sub-surface depends on the level of surface roughness. Mild wear on the asperity level alleviates the local stress concentration and leads to a longer surface fatigue life compared with the result without wear.
Limits of drag augmentation at spacecraft end-of-mission and a mitigation strategy
Authors: Kerr Emma , Macdonald Malcolm
Published: December 2020

An increasing number of objects are being launched into low-Earth orbit. Consequently, to avoid the possibility of future in-orbit collisions space object removal techniques are receiving attention. As one of the most developed techniques, drag augmentation is increasingly being considered as an option for end-of-mission removal of objects from low-Earth orbit. This paper highlights a common misconception around drag augmentation: although it can be used to reduce de-orbit time, when used inappropriately it can increase the volume swept by an object and, thus, increase the occurrence risk of collision with another space object. Knowingly ignoring this increased risk of collisions could leave spacecraft operators, and consequently their responsible state party, open to liability risk. By investigating the volume swept and de-orbit lifetime, a strategy of delayed deployment is proposed as a compromise between reducing volume swept and time to de-orbit. However, this increases system complexity and, likely, cost.
Thermal Management of Electrified Propulsion System for Low-Carbon Vehicles
Authors: Li Bo , Kuo Huang , Wang Xuehui , Chen Yiyi , Wang Yangang , Gerada David , Worall Sean , Stone Ian , Yan Yuying
Published: December 2020

An overview of current thermal challenges in transport electrification is introduced in order to underpin the research developments and trends of recent thermal management techniques. Currently, explorations of intelligent thermal management and control strategies prevail among car manufacturers in the context of climate change and global warming impacts. Therefore, major cutting-edge systematic approaches in electrified powertrain are summarized in the first place. In particular, the important role of heating, ventilation and air-condition system (HVAC) is emphasised. The trends in developing efficient HVAC system for future electrified powertrain are analysed. Then electric machine efficiency is under spotlight which could be improved by introducing new thermal management techniques and strengthening the efforts of driveline integrations. The demanded integration efforts are expected to provide better value per volume, or more power output/torque per unit with smaller form factor. Driven by demands, major thermal issues of high-power density machines are raised including the comprehensive understanding of thermal path, and multiphysics challenges are addressed whilst embedding power electronic semiconductors, non-isotropic electromagnetic materials and thermal insulation materials. Last but not least, the present review has listed several typical cooling techniques such as liquid cooling jacket, impingement/spray cooling and immersion cooling that could be applied to facilitate the development of integrated electric machine, and a mechanic-electric-thermal holistic approach is suggested at early design phase. Conclusively, a brief summary of the emerging new cooling techniques is presented and the keys to a successful integration are concluded.
Non-singular
-actions: an ergodic theorem over rectangles with application to the critical dimensions
Authors: DOOLEY ANTHONY H. , JARRETT KIERAN
Published: December 2020

We adapt techniques developed by Hochman to prove a non-singular ergodic theorem for

$\mathbb {Z}^d$
-actions where the sums are over rectangles with side lengths increasing at arbitrary rates, and in particular are not necessarily balls of a norm. This result is applied to show that the critical dimensions with respect to sequences of such rectangles are invariants of metric isomorphism. These invariants are calculated for the natural action of

$\mathbb {Z}^d$
on a product of d measure spaces.