bluuebunny/crossref_metadata_2025 huggingface dataset:
The Influence of Zinc Oxide with Carbon Nanotube Composite NanoMaterials on Antibacterial Activity
Authors: Alias M. F. A. , Abd – Alsada A.S.
Published: December 2021

A novel hybrid substance, ZnO: MWCNT, are fabricated from prepared pellets using a pulsed laser ablation liquid technique at varied MWCNT concentrations (0, 3, 5, 10, and 15) wt%. The study cast at the effect of MWCNT concentration on the structure of prepared samples using FTIR and tested for different types of antimicrobial activity. From FTIR examination, one can observe that all the prepared ZnO: MWCNT samples with different concentrations have different types of band (stretching and bending). All the prepared composite samples with various concentrations have showed influence on different types of bacterial, however in general the annealing ZnO, MWCNT and the composite nanomaterial with 15%MWCNT have higher zone of antibacterial activity for studying types of bacterial inhibition.
Determining the features on the image of Satellite Sentinel-2 with different resolution and comparing them with images of Satellite Sentinel-1
Authors: ameer Ghufran , Gazal Nawal Kh.
Published: December 2021

Land cover-land use (LCLU) classification tasks can take advantage of the fusion of radar and optical remote sensing data, leading generally to increase mapping accuracy. Here we propose a methodological approach to fuse information from the new European Space Sentinel-2 imagery for accurate land cover mapping of a portion of the region, Baghdad. I First step Download the Sentinel 2 image in its correct geographic location, then take a 10-meter, 20 meter and 60 meter resolution images then drawn point, line and polygon feature of each resolution image the discuss the difference between them The aim of this study was to discuss which resolution gives better accuracy.

as the difference between the features, by redusing the resolution, it will be made difficulty in identifying the features.

The landmarks appear clearly as the image resolution increases, so the features are clearer in the image with a resolution of 10 meters than the image with a resolution of 20 meters and 60 meters. Also, the images of the Sentinel-2 are clearer, and dealing with them is much easier than the images of the Sentinel-1.
Sustainability challenges for the social-environmental systems across the Asian Drylands Belt
Authors: Chen Jiquan , John Ranjeet , Yuan Jing , Mack Elizabeth A , Groisman Pavel , Allington Ginger , Wu Jianguo , Fan Peilei , de Beurs Kirsten M , Karnieli Arnon , Gutman Garik , Kappas Martin , Dong Gang , Zhao Fangyuan , Ouyang Zutao , Pearson Amber L , Şat Beyza , Graham Norman A , Shao Changliang , Graham Anna K , Henebry Geoffrey M , Xue Zhichao , Amartuvshin Amarjargal , Qu Luping , Park Hogeun , Xin Xiaoping , Chen Jingyan , Tian Li , Knight Colt , Kussainova Maira , Li Fei , Fürst Christine , Qi Jiaguo
Published: December 2021

This paper synthesizes the contemporary challenges for the sustainability of the social-environmental system (SES) across a geographically, environmentally, and geopolitically diverse region—the Asian Drylands Belt (ADB). This region includes 18 political entities, covering 10.3% of global land area and 30% of total global drylands. At the present time, the ADB is confronted with a unique set of environmental and socioeconomic changes including water shortage-related environmental challenges and dramatic institutional changes since the collapse of the Union of Soviet Socialist Republics. The SES of the ADB is assessed using a conceptual framework rooted in the three pillars of sustainability science: social, economic, and ecological systems. The complex dynamics are explored with biophysical, socioeconomic, institutional, and local context-dependent mechanisms with a focus on institutions and land use and land cover change (LULCC) as important drivers of SES dynamics. This paper also discusses the following five pressing, practical challenges for the sustainability of the ADB SES: (a) reduced water quantity and quality under warming, drying, and escalating extreme events, (b) continued, if not intensifying, geopolitical conflicts, (c) volatile, uncertain, and shifting socioeconomic structures, (d) globalization and cross-country influences, and (e) intensification and shifts in LULCC. To meet the varied challenges across the region, place-based, context-dependent transdisciplinary approaches are needed to focus on the human-environment interactions within and between regional landscapes with explicit consideration of specific forcings and regulatory mechanisms. Future work focused on this region should also assess the role of the following mechanisms that may moderate SES dynamics: socioeconomic regulating mechanisms, biophysical regulating mechanisms, regional and national institutional regulating mechanisms, and localized institutional regulating mechanisms.
Transthoracic esophagectomy compared to transhiatal extended gastrectomy for adenocarcinoma of the esophagogastric junction: a multicenter retrospective cohort study
Authors: De Pasqual Carlo Alberto , van der Sluis Pieter C , Weindelmayer Jacopo , Lagarde Sjoerd M , Giacopuzzi Simone , De Manzoni Giovanni , Wijnhoven Bas P L
Published: December 2021

Optimal surgical treatment for Siewert type II esophagogastric junction adenocarcinoma is debated. The aim of this study was to compare transhiatal extended gastrectomy (TEG) and transthoracic esophagectomy (TTE). Patients with Siewert type II tumors who underwent a resection by TEG or TTE in two centers (Erasmus University Medical Center, Rotterdam, and University of Verona) between 2014 and 2019 were identified. To limit selection bias, patients were matched for baseline characteristics and compared with a multivariable logistic regression model. Some 159 patients treated by TEG (60 patients, 37.7%) or TTE (99 patients, 62.3%) were included. Patients in the TEG group were older, had less tumor invasion of the esophagus, and were more often excluded from neoadjuvant therapy. Post-operative morbidity was comparable (P = 0.88), while 90-day mortality was higher after TEG (90-day mortality 10.0% in TEG group vs. 2.0% in TTE group P = 0.01). R0 resection was achieved in 83.3% of patients after TEG and in 97.9% after TTE (P < 0.01), with the proximal resection margin involved in 16.6% of patients after TEG versus 0 in TTE group (P < 0.01). The 3-year overall survival was comparable (TEG: 36.5%, TTE: 48.4%, P = 0.12). At multivariable analysis, (y)pT category was an independent risk factor for 3-year recurrence. After matching, TEG was still associated with an increased risk of incomplete tumor resection (P = 0.03) and proximal margin involvement (P < 0.01), while there were no differences in post-operative morbidity (P = 0.56) and mortality (P = 0.31). Our data suggest that patients with Siewert type II tumors treated by TEG are exposed to a higher risk of positive proximal resection margin compared to TTE.
Permanent-Transitory decomposition of cointegrated time series via dynamic factor models, with an application to commodity prices
Authors: Casoli Chiara , Lucchetti Riccardo (Jack)
Published: December 2021

We propose a cointegration-based Permanent-Transitory decomposition for nonstationary dynamic factor models (DFMs). Our methodology exploits the cointegration relations among the observable variables and assumes they are driven by a common and an idiosyncratic component. The common component is further split into a long-term nonstationary and a short-term stationary part. A Monte Carlo experiment shows that incorporating the cointegration structure into the DFM leads to a better reconstruction of the space spanned by the factors, compared to the most standard technique of applying a factor model in differenced systems. We apply our procedure to a set of commodity prices to analyse the co-movement among different markets and find that commodity prices move together mostly due to long-term common forces; while the trend for the prices of most primary goods is declining, metals and energy exhibit an upward or at least stable pattern since the 2000s.
Prevalent migraine as a predictor of incident hypertension
Authors: Entonen Anitta H , Suominen Sakari B , Sillanmäki Lauri H , Rautava Päivi T , Kauniskangas Katariina , Mäntyselkä Pekka T , Sumanen Markku , Koskenvuo Markku J
Published: December 2021

Background

Migraine has been associated with several diseases. This population-based prospective Finnish postal survey Health and Social Support Study explored whether self-reported migraine predicted incident hypertension independently in a working-age population by utilizing two data sources: the baseline survey from the year 1998 in combination with the follow-up survey data from the years 2003 and 2012 with linkage to the national Social Insurance Institution registry data of the special reimbursement medication for hypertension from 1999 to 2013. The survey follow-up reached until the second follow-up in the year 2012. The register follow-up also included the year 2013.

Methods

The present population-based prospective cohort study, utilizing two different data sources, included 8593 respondents (22.7% response rate) who participated in 1998, 2003, and 2012 but who did not report hypertension at the baseline in 1998, and whose responses could be linked with the Social Insurance Institution registry data from the beginning of 1999 to the end of 2013. The multivariable logistic regression analysis was based on the combined two data sets.

Results

A significant association of self-reported migraine and incident hypertension (odds ratio 1.37; 95% confidence interval 1.20–1.57) prevailed in the multiple logistic regression analysis adjusted for central socio-demographic and health behaviour variables.

Conclusion

Extra attention should be paid to prevention and control of hypertension in working-age migraine patients.
Decision Support Tool Identifies Ulcerative Colitis Patients Most Likely to Achieve Remission With Vedolizumab vs Adalimumab
Authors: Dulai Parambir S , Wong Emily C L , Reinisch Walter , Colombel Jean-Frederic , Marshall John K , Narula Neeraj
Published: December 2021

Background & Aims

We have previously validated a clinical decision support tool (CDST) (vedolizumab CDST [VDZ-CDST]) for clinical and endoscopic remission with VDZ in ulcerative colitis (UC). We aim to expand the validation for predicting histoendoscopic mucosal improvement (HEMI) with VDZ vs adalimumab (ADA).

Methods

In a post hoc analysis of a clinical trial for VDZ vs ADA in moderate to severe UC (VARSITY trial; NCT02497469), comparative accuracy was evaluated for the VDZ-CDST among an external validation cohort of VDZ- and ADA-treated patients for week 52 HEMI (Mayo endoscopic subscore 0-1 and Geboes score <3.2). Comparative effectiveness of VDZ and ADA was assessed after stratifying the cohort by baseline probability of response to VDZ using the VDZ-CDST.

Results

A total of 419 patients were included. The majority of patients enrolled in the VARSITY trial had a high (61%) or intermediate (29%) baseline predicted probability of response to VDZ. The baseline VDZ-CDST score was significantly more likely to predict week 52 HEMI for VDZ (area under the curve , 0.712; 95% confidence interval, 0.636-0.787) relative to ADA-treated patients (area under the curve, 0.538; 95% confidence interval, 0.377-0.700; P < .001 for AUC comparison). A significant (P < .001) association was observed between the VDZ-CDST and measured VDZ drug exposure over 52 weeks. Superiority of VDZ to ADA was only observed in patients with a high baseline predicted probability of response to VDZ.

Conclusions

Superiority of VDZ to ADA is dependent on baseline probability of response, and a VDZ-CDST is capable of identifying UC patients most appropriate for VDZ vs ADA.
Effect of High Temperature and Natural Enemies on the Interspecies Competition Between Two Wheat Aphid Species, Rhopalosiphum padi and Sitobion miscanthi
Authors: Miao Jin , Guo Pei , Zhang Yunhui , Tan Xiaoling , Chen Julian , Li Yaofa , Wu Yuqing
Published: December 2021

Interspecies competition affects the distribution, quantity, and community structure of insects, especially among closely-related (congeners) species. Some ecological factors differentially affect the fitness of co-existing species, thus conferring an advantage on one competitor, and then the structure of communities. The present work evaluated the effects of high temperature and natural enemies on the interspecific competition between the grain aphid Sitobion miscanthi (Takahashi) (Aphididae: Hemiptera) and bird cherry-oat aphid Rhopalosiphum padi (L.) (Hemiptera: Aphididae), two key pests of wheat in China. Results showed that the population growth of R. padi was faster at 30°C, and the intrinsic rate of natural increase (rm) value was 5 times that of S. miscanthi, indicating that R. padi was more high-temperature resistant and has advantages in interspecific competition at high temperature. Moreover, compared to S. miscanthi, the population of R. padi was less affected by their predator, larvae of the multicolored Asian lady beetle, Harmonia axyridis (Pallas) (Coleoptera: Coccinellidae), and aphid parasitoids, Aphidius avenae (Haliday) or Aphidius gifuensis (Ashmead) (Hymenoptera: Aphidiidae), which made them gain an advantage in the interspecific competition. Our results enrich the knowledge of phytophagous insect interspecific completion and implicate the ecological mechanism of R. padi may become the dominant species in wheat fields in China.
Risk factors for recurrence after operation in patients with pT1a renal cell carcinoma: sub-analysis of the multi-institutional national database of the Japanese Urological Association
Authors: Nakajima Nobuyuki , Miyajima Akira , Shinohara Nobuo , Obara Wataru , Kondo Tsunenori , Kimura Go , Kume Haruki , Fujimoto Hiroyuki , Sugiyama Takayuki , Nonomura Norio , Hongo Fumiya , Fukumori Tomoharu , Takahashi Masayuki , Kanayama Hiro-omi , Eto Masatoshi
Published: December 2021

Background

More patients with renal cell carcinoma are now diagnosed with the disease in its early stages. Although patients with pT1a renal cell carcinoma have a good prognosis and low recurrence rate, a few patients still experience recurrence. Herein, we evaluated the clinicopathological risk factors for postoperative recurrence of pT1aN0M0 renal cell carcinoma.

Methods

An renal cell carcinoma survey was conducted by the Japanese Urological Association to register newly diagnosed cases of renal cell carcinoma. A total of 1418 patients diagnosed with pT1aN0M0 renal cell carcinoma who underwent surgery as the primary surgical treatment were included. We analyzed the recurrence-free survival using the Kaplan–Meier method and clinicopathological factors for recurrence using Cox proportional hazards models.

Results

Among 1418 patients, 58 (4.1%) had recurrences after a median follow-up of 62.8 months. The median time to recurrence was 31.0 months. Metastases to the lungs and the bone were observed in 20 and 10 cases, respectively. Significant differences in sex, tumor size, Eastern Cooperative Oncology Group performance status, and dialysis history, preoperative hemoglobin levels, C-reactive protein levels and creatinine levels were observed between the recurrence and non-recurrence groups. Multivariate analysis identified male sex, high C-reactive protein level and tumor size ≥3 cm as independent risk factors. The 5-year recurrence-free survival of patients with 0, 1, 2 and 3 risk factors was 99.0, 97.2, 93.1 and 80.7%, respectively.

Conclusions

Male sex, tumor diameter and a high C-reactive protein level were independent recurrence risk factors for pT1a renal cell carcinoma; special attention should be paid to patients with these risk factors during postoperative follow-up.
Self-Reported Autonomic Dysregulation in Gulf War Illness
Authors: Avery Timothy J , Mathersul Danielle C , Schulz-Heik R Jay , Mahoney Louise , Bayley Peter J
Published: December 2021

Introduction

Autonomic nervous system dysregulation is commonly observed in Gulf War illness (GWI). Using a new sample, we sought to replicate and extend findings from a previous study that found autonomic symptoms predicted physical functioning in Veterans with GWI.

Materials and Methods

A linear regression model was used to predict physical functioning (36-item Short Form Health Survey (SF-36); n = 73, 75% male). First, we examined the predictive value of independent variables individually in the model including: the 31-item Composite Autonomic Symptom Score (COMPASS-31) total score, body mass index (BMI), mental health burden (i.e., post-traumatic stress disorder [PTSD] and/or depression), and COMPASS-31 subscales: orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor. Next, we estimated linear regression models containing the three variables (autonomic symptoms, BMI, and mental health burden) identified as predictors of physical functioning from the prior study.

Results

These linear regression models significantly predicted physical functioning and accounted for 15% of the variance with COMPASS-31, 36.6% of variance with COMPASS-31 and BMI, and 38.2% of variance with COMPASS-31, BMI, and mental health burden. Then, forward step-wise linear regressions were applied to explore new models including COMPASS-31 subscales. Two new models accounted for more of the variance in physical functioning: 39.3% with added gastrointestinal symptoms (β = −2.206, P = .001) and 43.4% of variance with both gastrointestinal (β = −1.592, P = .008) and secretomotor subscales (β = −1.533, P = .049). Unlike the previous study we intended to replicate, mental health burden was not a significant predictor in any of our models.

Conclusions

Treatments that address autonomic dysregulation should be prioritized for research and clinical recommendations for Veterans with GWI who experience chronic pain.
Dynamo activity of the K dwarf KOI-883 from transit photometry mapping
Authors: Zaleski S M , Valio A , Carter B D , Marsden S C
Published: December 2021

The Kepler mission target star KOI-883 is notable in being a low-mass K2V dwarf with moderately fast 8.99-d rotation and hosting a single transiting hot Jupiter in a 2.69-d orbit. This combination thus presents a particular opportunity to study star-spot activity by using the many deep planetary transits apparent in the light curve to map the stellar surface. The data have been analysed using spot modelling and temporal mapping methods we have used for other Kepler host stars, and a search for flares was conducted. Our results indicate a low-latitude region of the photosphere marked by distinct areas of individual or grouped star-spots with moderately high solar-type differential rotation of 0.102 ± 0.011 rad d−1, but with just two major flares observed across 400 d. These results imply a rotational shear significantly greater than that of our slower rotating Sun. The observed flares are more energetic than typical solar flares, but similar to those of other magnetically active cool dwarfs.
Binary AGNs simulations with radiation pressure reveal a new duty cycle, and a reduction of gravitational torque, through ‘minitori’ structures
Authors: Williamson David J , Bösch Lars H , Hönig Sebastian F
Published: December 2021

We produce the first set of radiation hydrodynamics simulations of binary active galactic nuclei (AGNs) at parsec-scale separation in scale-model simulations. We use SPH for hydrodynamics, and raytracing to calculate optical depths and radiation pressure from the two AGNs. We confirm that, without radiation pressure, the sign of gravitational torque is sensitive to the binary parameters, although in one of our two orbital configurations the binary should coalesce in a time-scale of <109 yr. However, radiation pressure quickly destroys the ‘minitori’ around each supermassive black hole (SMBH), drastically reducing gravitational torques and accretion, and greatly increasing the coalescence time-scale. Our simulations suggest a new ‘minitorus’ duty cycle with a time-scale of ∼10 binary periods (∼106 yr when scaling our models to a total binary mass of 2 × 107 M⊙). The growth and blow-out phases of the ‘minitori’ are of similar time-scales, and thus we expect about half of observed binary SMBHs to be active, in at least one component. The ‘minitorus’ structure provides asymmetries that could be observed by infrared interferometry.
Lithium abundances as a tracer of asymptotic giant branch star pollution in the globular cluster NGC 6752
Authors: Schiappacasse-Ulloa J , Lucatello Sara , Rain M J , Pietrinferni Adriano
Published: December 2021

This paper presents a chemical abundance analysis of 217 stars in the metal-poor globular cluster NGC 6752, distributed from the turn-off to the lower red giant branch. Al and Li abundances were derived through spectral synthesis applied to spectra collected with FLAMES, in both GIRAFFE and UVES modes. The work aims to gain insight into the nature of the polluter(s) responsible for the abundance variations and the C-N, Na-O, Al-Mg anticorrelations associated with the multiple-population phenomenon. We found a plateau at A(Li) = 2.33 ± 0.06 dex in unevolved stars, with the average Li content decreasing continuously down to ∼1.25 dex at the bottom of the red giant branch. As expected in the classic anticorrelation scenario, we found stars low in Al and high in Li abundance, and stars high in Al and low in Li. However, in addition, we also found evidence of Al-rich, second-generation stars with high Li content. This finding suggests the need for Li production, known to happen in intermediate-mass (∼4–8 M⊙) asymptotic giant branch stars through the Cameron–Fowler mechanism. It is worth noting that the Li abundance observed in Al-rich stars never exceeds that in Al-poor stars.
RNA-seq Analysis of Rhizoctonia solani AG-4HGI Strain BJ-1H Infected by a New Viral Strain of Rhizoctonia solani Partitivirus 2 Reveals a Potential Mechanism for Hypovirulence
Authors: Li Yuting , Li Siwei , Liang Zhijian , Cai Qingnian , Zhou Tao , Zhao Can , Wu Xuehong
Published: December 2021

Rhizoctonia solani partitivirus 2 (RsPV2), in the genus Alphapartitivirus, confers hypovirulence on R. solani AG-1-IA, the causal agent of rice sheath blight. In this study, a new strain of RsPV2 obtained from R. solani AG-4HGI strain BJ-1H, the causal agent of black scurf on potato, wasidentified and designated as Rhizoctonia solani partitivirus 2 strain BJ-1H (RsPV2-BJ). An RNA sequencing analysis of strain BJ-1H and the virus RsPV2-BJ-free strain BJ-1H-VF derived from strain BJ-1H was conducted to investigate the potential molecular mechanism of hypovirulence induced by RsPV2-BJ. In total, 14,319 unigenes were obtained, and 1,341 unigenes were identified as differentially expressed genes (DEGs), with 570 DEGs being down-regulated and 771 being up-regulated. Notably, several up-regulated DEGs were annotated to cell wall degrading enzymes, including β-1,3-glucanases. Strain BJ-1H exhibited increased expression of β-1,3-glucanase after RsPV2-BJ infection, suggesting that cell wall autolysis activity in R. solani AG-4HGI strain BJ-1H might be promoted by RsPV2-BJ, inducing hypovirulence in its host fungus R. solani AG-4HGI. To the best of our knowledge, this is the first report on the potential mechanism of hypovirulence induced by a mycovirus in R. solani.
Strengthening Critical Thinking Skills in Associate Degree Nursing Students Through Combined Pedagogies of Concept Mapping Using the Nursing Process and Simulation
Authors: O'Halloran Bernadette
Published: December 2021

Combining the utility of concept maps using the nursing process with simulation in associate degree nursing programs may help develop the critical thinking and reasoning skills of novice learners. This qualitative case study explored the learning experiences of students enrolled in the first nursing course. Although results showed initial feelings of uncertainty, confusion, and an overwhelming experience, students found the combined pedagogies beneficial in developing essential competencies of critical thinking when utilized consistently across the program. Integrating concept maps into the simulation design as a framework for immersive learning presented both challenges and opportunities.
Bringing Clinical Context to the Classroom in Nursing Pharmacology: A Case Study
Authors: Mauldin Betsy
Published: December 2021

Patient safety is part and parcel of nursing care and is taught throughout nursing education, particularly in core pharmacology, first-semester courses. This timing does not allow for clinical application and fosters a theory-practice gap. Transformational learning theory explains how teachers can engage students in active learning and introduce clinical context into a didactic classroom. To that end, an innovative pharmacology assignment, using a real-time nurse case study, was a structured, in-class activity. Post-class reflection focused on contextualizing learning for nursing students without clinical experience. Students reported transformed thinking regarding the importance of meaningful learning in nursing pharmacology.
Gamification of Primary Care in a Baccalaureate Nursing Education Program
Authors: Pollio E. Whitney , Patton Emily M. , Nichols Lynn S. , Bowers Deborah A.
Published: December 2021

A grant-funded undergraduate nursing elective was designed to increase the bachelor of science in nursing-prepared nursing workforce in primary care. We created a board game to engage students to address complex needs of clients in primary care. Using patient scenario game cards, students identify and discuss levels of prevention, social determinants of health, and resiliency principles as they move along the board. Gamification challenges students to think critically and make decisions about primary care patient scenarios in a safe learning environment. Potential uses for gamification to teach students management of complex patient scenarios are identified.
Operationalizing Programmatic Assessment: The CBME Programmatic Assessment Practice Guidelines
Authors: Rich Jessica V. , Luhanga Ulemu , Fostaty Young Sue , Wagner Natalie , Dagnone J. Damon , Chamberlain Sue , McEwen Laura A.
Published: December 2021

Problem

Assessing the development and achievement of competence requires multiple formative and summative assessment strategies and the coordinated efforts of trainees and faculty (who often serve in multiple roles, such as academic advisors, program directors, and competency committee members). Operationalizing programmatic assessment (PA) in competency-based medical education (CBME) requires comprehensive practice guidelines, written in accessible language with descriptions of stakeholder activities, to move assessment theory into practice and to help guide the trainees and faculty who enact PA.

Approach

Informed by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework, the authors used a multiphase, multimethod approach to develop the CBME Programmatic Assessment Practice Guidelines (PA Guidelines). The 9 guidelines are organized by phases of assessment and include descriptions of stakeholder activities. A user guide provides a glossary of key terms and summarizes how the guidelines can be used by different stakeholder groups across postgraduate medical education (PGME) contexts. The 4 phases of guideline development, including internal stakeholder consultations and external expert review, occurred between August 2016 and March 2020.

Outcomes

Local stakeholders and external experts agreed that the PA Guidelines hold potential for guiding initial operationalization and ongoing refinement of PA in CBME by individual stakeholders, residency programs, and PGME institutions. Since July 2020, the PA Guidelines have been used at Queen’s University to inform faculty and resident development initiatives, including online CBME modules for faculty, workshops for academic advisors/competence committee members, and a guide that supports incoming residents’ transition to CBME.

Next Steps

Research exploring the use of the PA Guidelines and user guide in multiple programs and institutions will gather further evidence of their acceptability and utility for guiding operationalization of PA in different contexts.
Association of Brain Injury Biomarkers and Circulatory Shock Following Moderate-Severe Traumatic Brain Injury: A TRACK-TBI Study
Authors: Toro Camilo , Jain Sonia , Sun Shelly , Temkin Nancy , Barber Jason , Manley Geoffrey , Komisarow Jordan M. , Ohnuma Tetsu , Foreman Brandon , Korley Frederick , James Michael L. , Laskowitz Daniel , Vavilala Monica S. , Hernandez Adrian , Mathew Joseph P. , Markowitz Amy J. , Krishnamoorthy Vijay ,   the TRACK-TBI Investigators
Published: December 2021

Introduction:

Early circulatory shock following traumatic brain injury (TBI) is a multifactorial process; however, the impact of brain injury biomarkers on the risk of shock has not been evaluated. We examined the association between neuronal injury biomarker levels and the development of circulatory shock following moderate-severe TBI.

Methods:

In this retrospective cohort study, we examined adults with moderate-severe TBI (Glasgow Coma Scale score <13) enrolled in the TRACK-TBI study, an 18-center prospective TBI cohort study. The exposures were day-1 levels of neuronal injury biomarkers (glial fibrillary acidic protein, ubiquitin C-terminal hydrolase-L1 [UCH-L1], S100 calcium-binding protein B [S100B], neuron-specific enolase), and of an inflammatory biomarker (high-sensitivity C-reactive protein). The primary outcome was the development of circulatory shock, defined as cardiovascular Sequential Organ Failure Assessment Score ≥2 within 72 hours of admission. Association between day-1 biomarker levels and the development of circulatory shock was assessed with regression analysis.

Results:

The study included 392 subjects, with a mean age of 40 years; 314 (80%) were male and 165 (42%) developed circulatory shock. Median (interquartile range) day-1 levels of UCH-L1 (994.8 [518.7 to 1988.2] pg/mL vs. 548.1 [280.2 to 1151.9] pg/mL; P<0.0001) and S100B (0.47 μg/mL [0.25 to 0.88] vs. 0.27 [0.16 to 0.46] μg/mL; P<0.0001) were elevated in those who developed early circulatory shock compared with those who did not. In multivariable regression, there were associations between levels of both UCH-L1 (odds ratio, 1.63 [95% confidence interval, 1.25-2.12]; P<0.0005) and S100B (odds ratio, 1.73 [95% confidence interval 1.27-2.36]; P<0.0005) with the development of circulatory shock.

Conclusion:

Neuronal injury biomarkers may provide the improved mechanistic understanding and possibly early identification of patients at risk for early circulatory shock following moderate-severe TBI.
Are the Arbeitsgemeinschaft Für Osteosynthesefragen (AO) Principles for Long Bone Fractures Applicable to 3-Column Osteotomy to Reduce Rod Fracture Rates?
Authors: Virk Sohrab , Lafage Renaud , Bess Shay , Shaffrey Christopher , Kim Han J. , Ames Christopher , Burton Doug , Gupta Munish , Smith Justin S. , Eastlack Robert , Klineberg Eric , Mundis Gregory , Schwab Frank , Lafage Virginie ,   the International Spine Study Group
Published: December 2021

Objective:

The aim was to determine whether applying Arbeitsgemeinschaft für Osteosynthesefragen (AO) principles for external fixation of long bone fracture to patients with a 3-column osteotomy (3CO) would be associated with reduced rod fracture (RF) rates.

Summary of Background Data:

AO dictate principles to follow when fixating long bone fractures: (1) decrease bone-rod distance; (2) increase the number of connecting rods; (3) increase the diameter of rods; (4) increase the working length of screws; (5) use multiaxial fixation. We hypothesized that applying these principles to patients undergoing a 3CO reduces the rate of RF.

Methods:

Patients were categorized as having RF versus no rod fracture (non-RF). Details on location and type of instrumentation were collected. Dedicated software was used to calculate the distance between osteotomy site and adjacent pedicle screws, angle between screws and the distance between the osteotomy site and rod. Classic sagittal spinopelvic parameters were evaluated.

Results:

The study included 170 patients (34=RF, 136=non-RF). There was no difference in age (P=0.224), sagittal vertical axis correction (P=0.287), or lumbar lordosis correction (P=0.36). There was no difference in number of screws cephalad (P=0.62) or caudal (P=0.31) to 3CO site. There was a lower rate of RF for patients with >2 rods versus 2 rods (P<0.001). Patients with multiplanar rod fixation had a lower rod fracture rate (P=0.01). For patients with only 2 rods (N=68), the non-RF cohort had adjacent screws that trended to have less angulation to each other (P=0.06) and adjacent screws that had a larger working length (P=0.03).

Conclusions:

A portion of AO principles can be applied to 3CO to reduce RF rates. Placing more rods around a 3CO site, placing rods in multiple planes, and placing adjacent screws with a larger working length around the 3CO site is associated with lower RF rates.
Impact of the Coronavirus Disease 2019 Pandemic on Moral Distress Among Nurses and Physicians in Spanish ICUs
Authors: Rodriguez-Ruiz Emilio , Campelo-Izquierdo Maitane , Boga Veiras Paula , Mansilla Rodríguez Montserrat , Estany-Gestal Ana , Blanco Hortas Andrés , Rodríguez-Calvo María Sol , Rodríguez-Núñez Antonio
Published: December 2021

OBJECTIVES:

To assess the impact of COVID-19 pandemic on moral distress (MD) among healthcare professionals (HCPs) (physicians and nurses) in Spanish ICUs.

DESIGN:

Cross-sectional, prospective study.

SETTING:

ICUs in Spain.

PARTICIPANTS:

HCPs currently working in Spanish ICUs.

INTERVENTIONS:

Data were collected via electronic survey with the use of a 50-item questionnaire in two different periods: prepandemic (October-December 2019) and during the second wave of COVID-19 (September-November 2020).

MEASUREMENTS AND MAIN RESULTS:

During the prepandemic and pandemic periods, 1,065 (57.1% nurses) and 1,115 (58.5% nurses) HCPs completed the questionnaire, respectively. Higher MD levels were reported during COVID-19 pandemic, particularly among ICU nurses, when compared with the prepandemic period. Before COVID-19, physicians reported significantly higher levels of MD than ICU nurses (80.0 [interquartile range {IQR}, 40.0–135.0] vs 61.0 [IQR, 35.0–133.0]; p = 0.026). These differences disappeared during the pandemic period (81.0 [IQR, 39.0–138.5] vs 74.0 [IQR, 41.0–143.0]; p = 0.837). During the pandemic, younger and less experienced HCPs working in hospital areas that were converted in ICU or in ICUs with multiple occupancy rooms reported higher MD levels. In addition, HCPs who were off work for psychologic burden reported higher MD levels (108.0 [IQR, 66.0–139.0] vs 76.0 [IQR, 40.0–141.0]; p < 0.05). In the prepandemic period, patient-level root causes were the most morally distressing for nurses, whereas physicians reported higher MD on system-level root causes. During the pandemic, both groups reported higher MD on system-level root causes. During COVID-19, significantly more HCPs considered leaving their job due to MD.

CONCLUSIONS:

MD has increased among ICU HCPs in Spain during COVID-19 pandemic. Physicians reported higher MD levels than nurses in the prepandemic period, whereas both HCPs groups reported similar MD levels in the pandemic period. Strategies are needed and should be implemented to mitigate MD among HCPs.
Prognostic value of high-frequency oscillations combined with multimodal imaging methods for epilepsy surgery
Authors: Yan Xiaoming , Yin Fangzhao , Xu Cuiping , Yu Tao , Li Xiaonan , Wang Wei , Zhang Xi , Ma Kai , Zhang Guojun
Published: December 2021

Background:

The combination of high-frequency oscillations (HFOs) with single-mode imaging methods has been proved useful in identifying epileptogenic zones, whereas few studies have examined HFOs combined with multimodal imaging methods. The aim of this study was to evaluate the prognostic value of ripples, an HFO subtype with a frequency of 80 to 200 Hz is combined with multimodal imaging methods in predicting epilepsy surgery outcome.

Methods:

HFOs were analyzed in 21 consecutive medically refractory epilepsy patients who underwent epilepsy surgery. All patients underwent positron emission tomography (PET) and deep electrode implantation for stereo-electroencephalography (SEEG); 11 patients underwent magnetoencephalography (MEG). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting surgical outcome were calculated for ripples combined with PET, MEG, both PET and MEG, and PET combined with MEG. Kaplan-Meier survival analyses were conducted in each group to estimate prognostic value.

Results:

The study included 13 men and 8 women. Accuracy for ripples, PET, and MEG alone in predicting surgical outcome was 42.9%, 42.9%, and 81.8%, respectively. Accuracy for ripples combined with PET and MEG was the highest. Resection of regions identified by ripples, MEG dipoles, and combined PET findings was significantly associated with better surgical outcome (P 
< 0.05).

Conclusions:

Intracranial electrodes are essential to detect regions which generate ripples and to remove these areas which indicate good surgical outcome for medically intractable epilepsy. With the assistance of presurgical noninvasive imaging examinations, PET and MEG, for example, the SEEG electrodes would identify epileptogenic regions more effectively.
Treatment and disease management patterns for bacillus Calmette-Guérin unresponsive nonmuscle invasive bladder cancer in North America, Europe and Asia: A real-world data analysis
Authors: Broughton Edward I. , Chun Danielle S. , Gooden Kyna M. , Mycock Katie L. , Rajkovic Ivana , Taylor-Stokes Gavin
Published: December 2021

Background

This study examined real-world treatment and management of bacillus Calmette-Guérin (BCG)-unresponsive patients across 3 continents, including patients unable or unwilling to undergo cystectomy.

Materials and methods

Physicians actively involved in managing patients with nonmuscle invasive bladder cancer completed online case report forms for their 5 consecutive patients from the broad BCG-unresponsive population and a further 5 consecutive BCG-unresponsive patients who did not undergo cystectomy (in Japan, physicians provided a total of 5 patients across both cohorts).

Results

Most patients had received 1 (37%) or 2 (24%) maintenance courses of BCG. Five or more maintenance BCG courses were received by patients in Japan (59%) and China (31%), while in Germany 76% of patients received only 1 course. Most patients became BCG-unresponsive during their first (44%) or second (22%) treatment course; in Germany, 77% became BCG-unresponsive during their first treatment course. Most countries did not provide another course of BCG after a patient first became unresponsive, whereas unresponsive patients in Japan and China were most likely to be retreated with BCG. “Untreated - on watch and wait” was the main treatment/management approach received post-BCG treatment for 42% or more of patients in most countries except China (39%) and the United States (36%). “Following treatment guidelines” was consistently the top reason for post-BCG treatment selection across all treatment options.

Conclusions

This study confirmed the global unmet need for patients with nonmuscle invasive bladder cancer, and found that many patients experienced periods of no treatment after not responding to BCG therapy.
Meningothelial Hamartoma of the Scalp in a Child With Gorlin Syndrome
Authors: Legaspi Christiana , Riesel Johanna N. , Putra Juan
Published: December 2021

Meningothelial hamartoma of the scalp is a rare entity characterized by a mix of meningothelial tissue and various connective tissue elements. To the best of the authors' knowledge, there has only been one reported case of meningothelial hamartoma of the scalp in the setting of Gorlin syndrome in the literature. In this report, we describe the case of a 3-year-old boy with Gorlin syndrome who presented with a congenital scalp lesion. Histologic examination revealed scattered islands of meningothelial cells in a background of dense fibrous and vascular tissue, in keeping with meningothelial hamartoma of the scalp. The differential diagnoses of congenital scalp lesions and the association between Gorlin syndrome and meningothelial hamartoma of the scalp are discussed.
Diagnosis of Lyme Borreliosis With a Novel, Seminested Real-Time Polymerase Chain Reaction Targeting the 5S-23S Intergenic Spacer Region: Clinical Features, Histopathology, and Immunophenotype in 44 Patients
Authors: Podbićanin-Ziburt Adna , Falk Thomas M. , Metze Dieter , Böer-Auer Almut
Published: December 2021

Lyme borreliosis (LB) is the most common tick-borne infection in Europe and North America. Polymerase chain reaction (PCR) is an important tool to confirm the diagnosis, but not always successful, especially when organisms are sparse. We developed a novel, seminested real-time PCR assay [target: 5S-23S intergenic spacer region (IGS)] and compared it with 3 well-established conventional PCR assays (IGS/OspA/real-time IGS) on 596 formalin-fixed, paraffin-embedded routine skin biopsies. The seminested real-time assay identified 46 cases of borreliosis while 25, 27, and 38 were identified by the 3 other assays, respectively (P 0.01, P 0.02, and P 0.42; significance P < 0.05). Clinicopathologic and immunophenotypic analysis of PCR-positive cases revealed 38 erythema migrans (EM), 6 Borrelia lymphocytomas, and 2 acrodermatitis chronica atrophicans (ACA). In the 44 PCR-confirmed cases, plasma cells were present in only a third of EM cases. By contrast, CD123-positive plasmacytoid dendritic cells were common (74%) and therefore are unlikely to be helpful in the differential diagnosis between EM and tumid lupus erythematosus. A loss of CD34 in a third of all LB specimens limits its diagnostic value in the differential diagnosis with morphea. Interstitial macrophages were common in cutaneous LB (42/43) forming interstitial granulomas in a third of all cases, and 3/38 EM, 3/6 Borrelia lymphocytomas, and 1/2 ACA were only identified by the new seminested real-time assay, suggesting that it is especially helpful in confirming the diagnosis of Borrelia lymphocytoma.
A Simple, Rapid, Comparative Evaluation of Multiple Products for Decontamination of Actinide-contaminated Rat Skin Ex Vivo
Authors: Griffiths Nina M. , Devilliers Karine , Laroche Pierre , Van der Meeren Anne
Published: December 2021

Decontamination of skin is an important medical countermeasure in order to limit potential internal contamination by radionuclides such as actinides. Minimizing skin surface contamination will ultimately prevent internal contamination and subsequent committed effective dose as well as contamination spreading. The decontamination agents tested on a rat skin ex vivo model ranged from water to hydrogel wound dressings. A surfactant-containing cleansing gel and calixarene nanoemulsion with chelation properties demonstrated marked decontamination efficacies as compared with water or the chelator DTPA. Based on efficacy to remove different actinide physicochemical forms from skin, the results demonstrate that all products can remove the more soluble forms, but a further component of emulsifying or tensioactive action is required for less soluble forms. This indicates that for practical purposes, successful decontamination will depend on identification of the actinide element, the physicochemical form, and possibly the solvent. This study offers a simple, quick, cheap, reproducible screening method for efficacy evaluation of multiple products for removal of a variety of contaminants.
Treatment of Cutaneous Leishmaniasis in a Nonendemic Country: A Case Series of Children in Australia
Authors: Hill Nicholas , Irwin Adam , Graham Nicolette , Leung Clare , Francis Joshua R. , Wall Nerilee , Nourse Clare
Published: December 2021

We describe 4 cases of cutaneous leishmaniasis in children in Australia. Treatment is challenging given lack of firm guidelines and limited access to conventional modalities used in endemic countries. Topical paromomycin or oral fluconazole were effective outpatient-based first-line treatments, however, topical paromomycin use was limited by expense to import or compound locally.
Risk factors and predictive markers for early and late-onset neonatal bacteremic sepsis in preterm and term infants
Authors: Tang Yi-Hsuan , Jeng Mei-Jy , Wang Hsin-Hui , Tsao Pei-Chen , Chen Wei-Yu , Lee Yu-Sheng
Published: December 2021

Background:

The early detection and prediction of bacteremic sepsis in preterm and term neonates remains a challenging task because of their nonspecific clinical presentations. We aimed to investigate the risk factors associated with bacteremia and find the cutoff values of predictive markers to achieve accurate diagnosis of neonatal bacteremic sepsis.

Methods:

Not-doing-well preterm and term neonates with suspected sepsis were retrospectively enrolled between January 2015 and December 2017 in Taipei Veterans General Hospital. Blood culture, hemogram, serum procalcitonin (PCT), and C-reactive protein (CRP) were drawn at the onset of clinical signs and symptoms. All cases were divided to either early-onset or late-onset groups according to postpartum age. Nonparametric statistic, logistic regression, and receiver operating characteristic analysis were performed to evaluate the risk factors and cutoff values for predicting bacteremia.

Results:

A total of 169 suspected sepsis episodes were analyzed, 68.0% of which had cardiopulmonary dysfunction and 19.5% had perinatal stress. The early-onset group had 123 (72.8%) patients, 4 of which had bacteremia and 119 had nonbacteremia conditions. The late-onset group had 46 (27.2%) patients, 8 of which had bacteremia and 38 had nonbacteremia conditions. Gestational age, birth body weight, Apgar score at 5 minutes, serum PCT, CRP, and platelet (PLT) count in the early-onset group and white blood cell (WBC) count in the late-onset group were substantially different between the patients with bacteremia and nonbacteremia conditions. PCT greater than 27 µg/L (adjusted odd ratio [aOR], 21.6; 95% CI, 1.1–435.1) and thrombocytopenia less than 100 × 109/L (aOR, 38.6; 95% CI, 1.4–1030.3) were predictive markers for bacteremia in the early-onset group.

Conclusion:

Early- and late-onset neonatal sepsis had different risk factors and predictive markers of bacteremia. PCT and PLT count in the early-onset group and WBC count in the late-onset group were accurate diagnostic serum markers for neonatal bacteremic sepsis.
Health Insurances and the Health-Related Work Capacity of Retirement-Aged Workers
Authors: Li Jiannan , Yuan Bocong
Published: December 2021

Objective:

This study is to investigate the health-related work capacity of retirement-aged workers under the beneficiary status of different health insurance schemes in China.

Method:

Using the data from CHARLS program, we investigate the health-related work capacity of retirement-aged workers in China (more than 60/55 years-old for men/women respectively). Multivariate regressions and robustness checks (Heckman two-stage procedures, chronological design, etc) are conducted.

Results:

(1) Late-life career participation could reduce the risk of declining work capacity due to health problems; (2) different social health insurances affect health-related work capacity among retirement-aged workers differently; (3) social health insurances influence the role of late-life career participation in reducing the risk of health-related work capacity, with different schemes displaying different effects (mitigate or strengthen).

Conclusions:

Systematic inequity in benefit across health insurances may result in contrasting health outcomes of retirement-aged workers.