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A meta-analysis of global stillbirth rates during the COVID-19 pandemic.
Manoj Mohan
Kwabena Appiah-Sakyi

Manoj Mohan

and 5 more

June 23, 2021
Background The global effect of the COVID-19 pandemic has had an impact on pregnancy and outcomes. There has been recently some conflicting evidence on the stillbirths during the COVID-19 pandemic. This meta-analysis attempts to resolve this through a systematic approach. Objectives To analyse and determine the impact of COVID-19 on the stillbirth rate. Search strategy We searched PubMed, Embase, Cochrane library, ClinicalTrials.gov and Web of Science from inception to 05 March 2021 with no language restriction for this meta-analysis. Selection criteria Publications (a) with stillbirth data on pregnant women with COVID-19 (b) comparing stillbirth rates in pregnant women with and without COVID-19 and (c), comparing stillbirth rates before and during the pandemic. Data collection and Analysis The included studies were all observational studies, and we used the Newcastle Ottawa score for risk of bias. We performed the meta-analysis using Comprehensive meta-analysis software, version 3. Main results A total of 29 studies were included in the meta-analysis; from 17 of these, the SB rate was 7 per 1000 in pregnant women with COVID-19. This rate was much higher (34/1000) in low- and middle-income countries. The odds ratio of stillbirth in pregnant women with COVID-19 compared to those without was 1.89. However, there was no significant difference in population SB rates before and during the pandemic. Conclusions There is some evidence that the stillbirth rate has increased during the COVID-19 pandemic, but this is mainly in low- and middle-income countries. Inadequate access to healthcare during the pandemic could be a contributing factor.
Trends of lymph node sampling and metastasis in pediatric patients with clear cell, e...
Jennine Weller
Carly Westermann

Jennine Weller

and 6 more

June 23, 2021
Background: Clear cell sarcoma (CCS), epithelioid sarcoma, and synovial sarcoma are rare tumors historically identified as high risk for lymph node metastasis. Nodal metastasis in adults with these subtypes has been described. This study investigates incident nodal metastasis and associated survival in children with these subtypes. Procedure: Using the National Cancer Database (2004-2015), we created a retrospective cohort of 1303 patients (aged ≤25 years) who underwent local control therapy for CCS, epithelioid sarcoma, and synovial sarcoma. Kaplan-Meier curves estimated overall survival (OS) by subtype. Stratifying on subtype, Cox regressions assessed OS by lymph node sampling status and nodal metastasis. Results: There were 103 (7.9%) patients with CCS, 221 (17.0%) with epithelioid sarcoma, and 979 (75.1%) with synovial sarcoma. Lymph node sampling was more frequent in patients with CCS (56.3%) and epithelioid sarcoma (52.5%) versus synovial sarcoma (20.5%, p<0.001). Synovial sarcoma metastasized to lymph nodes less frequently than CCS or epithelioid sarcoma (2.2% vs. 14.6% and 15.0%, p<0.001). Across all subtypes, lymph node metastasis was associated with inferior OS (HR 2.10, CI 1.44-3.07, p<0.001). Lymph node sampling was associated with improved OS in CCS (HR 0.35, CI 0.15-0.78, p=0.010), inferior OS in synovial sarcoma (HR 1.60, CI 1.13- 2.25, p=0.007), and no statistical association with OS in epithelioid sarcoma. Conclusions: Lymph node metastasis is rare in children with synovial sarcoma. Lymph node sampling procedures were not consistently performed for patients with CCS or epithelioid sarcoma, but improved OS supports routine lymph node sampling in children with CCS.
Fluorescent guided lymph node harvest in laparoscopic Wilms nephroureterectomy - a ne...
Max Pachl

Maximilian Pachl

June 23, 2021
Lymph node harvest is an integral part of Wilms tumor surgery with both SIOP and COG protocols asking for more than 6 lymph nodes to best evaluate for nodal spread and a subsequent need for intensification of treatment. The majority of studies show that in both open and minimally invasive resections the median number of nodes removed is 4. Indocyanine green and near infrared fluorescence may be the key to solving this problem. In adult gynaecology, colorectal and breast cancers, ICG is used to identify sentinel nodes and facilitate nodal harvest. This report describes its use in Wilms tumor
Interventions to Enhance Medication Safety in Residential Aged Care Settings: An Umbr...
Shadi Alruthea
Paula Bowman

Shadi Alruthea

and 3 more

June 23, 2021
Aim: To conduct the first systematic synthesis of existing evidence reviews on interventions to enhance medication safety in RACS, to establish and compare their effectiveness. Method: This umbrella review included examination of meta-analyses, scoping and systematic reviews. Four electronic databases (MEDLINE, EMBASE, CINAHL, and The Cochrane library database of Systematic Reviews) were explored for eligible reviews. Those meeting the inclusion criteria were critically appraised using the JBI Critical Appraisal Instrument for Systematic reviews and Research Syntheses by two authors. Results: Fourteen reviews covering 166 unique, primary studies were included. Interventions were grouped according to type: medication review (n= 12); staff education (n= 8); multidisciplinary team meetings (n= 6); computerised clinical decision support systems (n= 5); and transferring medicines information between health care settings (n= 1). Most reviews showed mixed evidence to support interventions’ effectiveness, due to the significant heterogeneity between original research studies in respect to sites, samples sizes and intervention periods. However, in all intervention categories, pharmacists’ collaboration with other health care professionals was most beneficial, showing definitive evidence for improving medication safety and quality of prescribing in RACS. The evidence suggests that combining two or more interventions is the most promising approach, despite this presenting implementation barriers in the resource-limited environments of many RACS, and methodological challenges in identifying the precise contribution of individual interventions, when implemented concurrently. Conclusion: Health stakeholders should explore a combination of at least two interventions, such as medication review and staff education, to improve medication safety in RACS.
Pharmacokinetics, safety, and tolerability of a THC:CBD oil formulation in patients w...
Yvonne  Bonomo
Amanda Norman

Yvonne Bonomo

and 8 more

June 22, 2021
Aim This Phase I open label study examined pharmacokinetics, safety, and tolerability of escalating doses of a combination cannabinoid medication (1:1 ratio THC:CBD) in patients with chronic non-cancer pain (CNCP) on high dose opioid analgesia. Methods Nine people with CNCP and oral morphine equivalent daily dose of ≥60mg were recruited. Blood concentrations of THC, 11-hydroxytetrahydrocannabinol (OH-THC), 11-nor-9-carboxy-tetrahydrocannabinol (COOH-THC) and CBD were assayed weekly. Concentrations were measured after a single dose of 2.5mg THC/2.5mg CBD up to 12.5mg THC/12.5mg CBD on Day 29. Follow-up was on Day 36 after 7 day washout. Secondary outcome data encompassed pain, mood, and sleep parameters. Results The parent THC, CBD, OH-THC, COOH-THC were detected at most time points. In general, the concentration of all analytes increased until 2 hours post-administration, decreasing to approximately pre-dose concentrations by 8 hrs. There was considerable inter- and intra-individual variability. The study medication was well tolerated. Eight participants reported at least one Adverse Event (AE), with a total of 62 AEs; most common were euphoric mood, headache, and agitation, none classified as severe. There was no significant change to pain severity self-ratings, nor use of pain medications. Improvements in pain interference scores, mood, and some sleep parameters were observed. Conclusion The THC:CBD formulation was tolerated well in a CNCP patient group. Between-participant variability supports personalized dosing and “start low-go slow” titration. Improvements in pain, mood, and sleep parameters suggest that on relatively low dosages clinical effects are apparent. To validate and quantify findings a comparison placebo group study is needed.
Public Theology in the Secular Age: Editor’s Introduction
Michael A. Milton, PhD

Michael A. Milton, PhD

June 13, 2022
Lost and Found: Public Theology in the Secular Age is an anthology of monographs offered to the general public as a contribution of distinctively Christian thinking about the personal and public implications for following Jesus Christ in “A Secular Age” (Charles Taylor, 2009). The monographs are written by subject matter experts—clergy, and laity; academics and practitioners; theologians representing a variety of traditions within the Church, as well as professionals from business, law, and medicine— with a common mission to leverage their expertise in the service of Christ and His Church. The work is a public theology initiative of the D. James Kennedy Institute of Reformed Leadership, a ministry, and program of Faith for Living, Inc., a North Carolina nonprofit corporation. The collection address twelve areas of Christian witness at work within the framework of the "Secular Age," and is grouped under four "areas:" Ideas, Daily Life, the Nation, and Triggers. Each area constitutes a division of the collection. Each of the four divisions contains three issues. The twelve issues represent the twelve chapter chapters in the book.
The clinical importance of microscopic hematuria and hydronephrosis in urolithiasis

June 22, 2021
Aim: The aim of this study was to investigate the relationship between the degree of hydronephrosis and the presence of microscopic hematuria in patients that presented to the emergency department (ED) with ureteral stones. Methods: The records of patients who presented to our ED due to urolithiasis between January 2017 and December 2020 were retrospectively analyzed. Patients aged 18 years or older who underwent non-contrast computed tomography (CT abdomen/pelvis) and urinalysis (UA) and were diagnosed with ureteral stones were included in the study. Radiology reports were reviewed for stone size, localization, and degree of hydronephrosis. Patients with and without microscopic hematuria and the degree of hydronephrosis were compared. Results: A total of 476 patients were included, which consisted of 391 with microscopic hematuria and 85 without microscopic hematuria. The median stone size was 4.1 mm in the presence of microscopic hematuria and 5.5 mm in the absence of microscopic hematuria. Logistic regression analysis was performed to determine the factors associated with the development of hydronephrosis. Stone size [odds ratio (OR):2.15, 95% confidence interval (CI):1.12-4.16, p<0.001), presence of pyuria (OR: 2.58, 95%CI: 1.78-3.48, p<0.001), and absence of microscopic hematuria (OR: 1.31, 95%CI 1.04-2.89, p=0.017) were identified as risk factors for moderate and severe hydronephrosis. Conclusion: We consider that non-contrast CT imaging is necessary for the diagnosis and treatment of emergency cases in which microscopic hematuria is not detected in urinalysis since their stone size may be larger and degree of hydronephrosis may be more severe.
Reframing Explanation as an Interactive Medium: The EQUAS (Explainable QUestion Answe...
Dhruv  Batra
William Ferguson

Dhruv Batra

and 15 more

June 22, 2021
This letter provides a retrospective analysis of our team’s research performed under the DARPA Explainable Artificial Intelligence (XAI) project. We began by exploring salience maps, English sentences, and lists of feature names for explaining the behavior of deep-learning-based discriminative systems, especially visual question answering systems. We demonstrated limited positive effects from statically presenting explanations along with system answers – for example when teaching people to identify bird species. Many XAI performers were getting better results when users interacted with explanations. This motivated us to evolve the notion of explanation as an interactive medium – usually, between humans and AI systems but sometimes within the software system. We realized that interacting via explanations could enable people to task and adapt ML agents. We added affordances for editing explanations and modified the ML system to act in accordance with the edits to produce an interpretable interface to the agent. Through this interface, editing an explanation can adapt a system’s performance to new, modified purposes. This deep tasking, wherein the agent knows its objective and the explanation for that objective will be critical to enable higher levels of autonomy.
Second virial coefficient for the exponent--spline-Morse-spline-van der Waals potenti...
E. Somuncu
B.A. Mamedov

E. Somuncu

and 1 more

June 22, 2021
An analytical expression for the second virial coefficient based on an exponent-spline-Morse-spline-van der Waals (ESMSV) potential is presented here for use in defining the thermodynamic properties of rare gases. Our method is established based on a series expansion of the exponential function, Meijer function, gamma function, binomial function, and hypergeometric function. Numerical approaches have commonly been used for the evaluation of the second virial coefficient with the ESMSV potential in the literature. The general formula obtained here can be applied to estimate the thermal properties of rare gases. Our results for the second virial coefficient based on the ESMSV potential of He-He, He-Ne, He-Ar, and He-Xe rare gases are compared with numerical calculations and experimental data, and it is shown that our analytical expression can be successfully used for other gases.
Incidence and outcome of rhabdomyolysis after type A Aortic Dissection surgery -a ret...
PRAVEEN SIVADASAN
Amr Omar

PRAVEEN SIVADASAN

and 9 more

June 22, 2021
Objectives: To study the incidence of rhabdomyolysis (RML) after ascending aortic dissection surgery and to correlate with the outcome especially in terms of renal function. The secondary objective was to pinpoint the perioperative risk factors associated with the development of Rhabdomyolysis and adverse renal outcome after Aortic dissection repair Design: Retrospective single-center study Settings: Tertiary cardiac center Participants: Patients who had undergone ascending aortic dissection repair from 2011-2017. Interventions: Two groups Group 1- with RML creatine kinase (CK) above cut-off levels 2500 U/Liter and Group 2 without RML. The potential determinants of RML and the impact of the same on the patient outcome; especially on postoperative renal function was studied. Measurements and main results: Out of 33 patients studied, 21 patients (64%) developed Rhabdomyolysis (Group RML) and 12 did not (Group non-RML). Demographic and intraoperative factors had no significant impact on the incidence of RML. There was a significantly higher incidence of AKI in the RML group (90%) than in the non-RML group (25%). All 4 patients who went into new post-operative dialysis belonged to the RML group. The peak troponin levels were significantly higher in RML group Conclusion: In this study, we found a high incidence of RML after aortic dissection surgery which paralleled with an adverse renal outcome and need for postoperative dialysis. Identification of risk factors and early intervention might help to mitigate the severity of renal failure. Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on outcome
Comparative analysis of phasic left atrial strain and left ventricular posterolateral...
David Frumkin
Isabel Mattig

David Frumkin

and 7 more

June 22, 2021
Background ‘Classical’ echocardiographic signs of Fabry cardiomyopathy (FC), such as left ventricular hypertrophy (LVH), posterolateral strain deficiency (PLSD) and papillary muscle hypertrophy may have a limited diagnostic accuracy in clinical practice. Our aim was to evaluate the diagnostic value of left atrial (LA) strain impairment compared to ‘classical’ echocardiographic findings to discriminate FC. Methods In standard echocardiographic assessments, we retrospectively analyzed the diagnostic value of the “classical” red flags of FC as well as LA strain in 20 FC patients and in 20 subjects with other causes of LVH. Receiver operating characteristic (ROC) curve analysis was performed to assess the respective diagnostic accuracy. Results FC was confirmed in 20 patients by genetic testing. In the LVH group, 12 patients were classified by biopsy to have hypertrophic cardiomyopathy, two had hypertensive heart disease, and six LVH combined with borderline myocarditis. Global and regional left ventricular (LV) strain was not significantly different between groups while LA strain was significantly impaired in FC (Left atrial reservoir strain (LASr) 19.1%±8.4 in FC and 25.6%±8.9 in LVH, p=0.009; left atrial conduction strain (LAScd) -8.4%±4.9 in FC and -15.9%±8.4 in LVH, p<0.01). LAScd, with an area under the curve (AUC) of 0.81 [95% confidence interval (CI) 0.66-0.96] showed the highest diagnostic accuracy to discriminate FC. The PLSD pattern showed an AUC of 0.49, quantification of papillary muscle hypertrophy an AUC of 0.47. Conclusion Adding LA strain analysis to a comprehensive echocardiographic work-up of unclear LVH may be helpful to identify FC as a possible cause.
Value of clinical research: Usefulness tool development and systematic review of 350...
Janneke van t Hooft
Charlotte van Dijk

Janneke van t Hooft

and 8 more

June 22, 2021
Objective: We developed a research usefulness tool collating published criteria and examined if randomised controlled trials (RCTs) addressing preterm birth were useful. Search Strategy: Cochrane library. Selection Criteria: Published RCTs within 56 preterm birth Cochrane reviews. Data Collection and Analysis: A usefulness tool was developed with eight criteria combining 13 items identified through literature searches and consensus. RCTs were evaluated for compliance with each item by multiple assessors (reviewer agreement 95-98%). Proportions with 95% confidence interval (CI) were calculated and compared for change over time using ≧ 2010 as a cut-off, with relative risks (RR). Main Results: Among 350 selected RCTs, only 38 (11%, 95% CI 8-15%) met half of the usefulness criteria. Compared to trials before 2010, recent trials used composite or surrogate (less informative) outcomes more often (13% vs 25%, RR 1.87, 95% CI 1.19-2.93). Only 17 trials reflected real life (pragmatism) in design (5%, 95% CI 3-8%), with no improvements over time. No trials reported involvement of mothers to reflect patients’ top priorities in question definition or outcomes selection. Recent trials were more transparent with prospective registration (0.5% vs 28%, RR 58, 95% CI 8-420%), availability of protocol (0.5% vs 15%, RR 32, 95% CI 4-237%) and data sharing statements (2% vs 8%, RR 3, 95% CI 1-10%). Conclusion: Clinical trials in preterm birth lacked many usefulness features, with one tenth of trials meeting half of the items evaluated. Use of informative outcomes, patient centeredness, pragmatism and transparency should be key targets for future research planning.
Effect of systolic dysfunction and elevated left ventricular end diastolic pressure o...
YU HYEYON
JIHUN AHN

YU HYEYON

and 1 more

June 22, 2021
Objectives: Systolic and diastolic dysfunctions are related to adverse clinical outcomes in patients with sinus rhythm. The aim of this study was to clarify the prognostic significance of systolic and diastolic dysfunctions in patients with chronic persistent atrial fibrillation (AF). Methods: We evaluated data for 114 consecutive patients with chronic AF who underwent measurement of LVEDP at our hospital between 1 March 2011 and 31 December 2014. In total, 114 consecutive patients with chronic AF were divided into two groups according to the left ventricular ejection fraction (LVEF): LVEF < 50 (reduced ejection fraction, REF group) and LVEF ≥50 (preserved EF, PEF group). The PEF group was further divided into two subgroups according to the left ventricular end-diastolic filling pressure (LVEDP): LVEDP >15 mmHg and LVEDP ≤ 15 mmHg. The 3-year clinical outcomes were compared between the PEF and REF groups and the LVEDP ≥15 mmHg and LVEDP <15 mmHg groups. Results: During the 3-year follow-up period, the rate of heart failure (HF) hospitalisation and incidence of AF with rapid ventricular rhythm (RVR) were higher in the REF group than in the PEF group. Multivariate analysis revealed that REF was the only significant predictor of HF hospitalisation (hazard ratio, 4.71; 95% confidence interval, 1.48–15.02; p=0.009). Conclusions: Our observations during a mid-term follow-up period revealed that systolic dysfunction could be an important predictor of HF hospitalisation in patients with AF. However, elevated LVEDP may not be associated with mid-term adverse clinical outcomes in patients without systolic dysfunction.
A new approach for the generalized fractional Casson fluid model with Newtonian heati...
RADHAKRISHNAN BHEEMAN
Tamilarasi Mathivanan

RADHAKRISHNAN BHEEMAN

and 1 more

June 22, 2021
This research is about the transfer of heat of a generalized fractional Casson fluid on an unsteady boundary layer which is passing through an infinite oscillating plate, in vertical direction combined with the Newtonian heating. The results are obtained by using modified Riemann-Liouville fractional derivative. The present fluid model, starts with the governing equations which are then converted to a system of partial differential equations(linear) by using some suitable non-dimensional variables. Using the method of integral balance and the Laplace transform technique, an analytical solution is obtained. The velocity and temperature expressions are derived and the effects of modelling parameters re shown in tables and graphs to validate the obtained theoretical results.
Kin discrimination in allelopathy and consequences for agriculture
Niels Anten
Bin Chen

Niels Anten

and 1 more

June 22, 2021
Recent research has shown that plants can distinguish genetically-related individuals from strangers (kin recognition) and exhibit more cooperative behaviours towards these more related individuals (kin discrimination). The first evidence for this was found when Cakile edentula plants growing with half-sibs allocated relatively less biomass to roots than plants growing with unrelated individuals, indicating that kin recognition can reduce the intensity of competition (Dudley & File, 2007). Since then, kin discrimination has been shown to result in reduced competition for soil resources (Semchenko, Saar, & Lepik, 2014), light (Crepy & Casal, 2015) and pollinators (Torices, Gómez, & Pannell, 2018). On the other hand, allelopathy, plants producing chemical compounds that negatively affect performance of neighbour plants, has also been widely documented (Inderjit & Duke, 2003) and shown to profoundly affect local species coexistence and plant community structure (Meiners, Kong, Ladwig, Pisula, & Lang, 2012). In crops allelopathy can also be beneficial in suppressing weeds (Macías, Mejías, & Molinillo, 2019). In the current issue, Xu, Cheng, Kong, and Meiners (2021) published the first study to show that kin discrimination can also affect the balance between direct competition for resources and allelopathy, and this together may lead to improved weed suppression in rice.
Usefulness of Age, Creatinine and Ejection Fraction - Modification of Diet in Renal D...
Rengin Çetin Güvenç
Tolga Guvenc

Rengin Cetin Guvenc

and 4 more

June 22, 2021
Background: While many risk models have been developed to predict prognosis in heart failure (HF), these models are rarely useful for the clinical practitioner as they include multiple variables that might be time-consuming to obtain, they are usually difficult to calculate and they may suffer from statistical overfitting. Present study aimed to investigate whether a simpler model, namely ACEF-MDRD score, could be used for predicting one-year mortality in HF patients. Methods: 748 cases within the SELFIE-HF registry had complete data to calculate ACEF-MDRD score. Patients were grouped into tertiles for analyses. Results: Significantly more patients within the ACEF-MDRDhigh tertile (30.0%) died within one year, as compared to other tertiles (10.8% and 16.1%, respectively, for ACEF-MDRDlow and ACEF-MDRDmed, p<0.001 for both comparisons). There was a stepwise decrease in one-year survival as ACEF-MDRD score increased (log-rank p<0.001). ACEF-MDRD was an independent predictor of survival after adjusting for other variables (OR: 1.14, 95%CI:1.04 – 1.24, p=0.006). ACEF-MDRD score offered similar accuracy to GWTG-HF score for prediction of one-year mortality (p=0.14). Conclusions: ACEF-MDRD is a predictor of mortality in patients with HF, and its usefulness is comparable to similar yet more complicated models.
Methodological quality of a meta-analysis precedes its clinical significance
Jinlin Wu
Tucheng Sun

Jinlin Wu

and 2 more

June 22, 2021
In this letter, we commented on several issues of the recent study entitled “Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta‐analysis” by Dr. Mousavizadeh et al. We hope to improve the clarity of this research and call attention to the methodological quality of performing a meta-analysis.
Decentralisation of Transcatheter Aortic Valve Implantation- a review of outcomes and...
Frazer Kirk
Lim Eng

Frazer Kirk

and 2 more

June 22, 2021
The introduction of Transcatheter Aortic Valve Implantation (TAVI) has transformed interventional cardiology and minimally invasive cardiac surgery. TAVI is a relatively new technique that is rapidly expanding in its indications and technology as well as places of practice. De-centralisation of this previous supra-specialised procedure can be done safely and efficaciously, to improve the health inequalities across regional and remote Australia. The purpose of this study is to detail the introduction of the TAVI program at a geographically isolated tertiary hospital in regional Australia. Illustrating the safe introduction of TAVI in this location may guide other isolated hospitals on the introduction of the service.
Monitoraggio delle emissioni odorigene in un piccolo impianto di depurazione attraver...
Federica Russo

Federica Russo

November 12, 2021
Le molestie olfattive indotte da impianti di trattamento di acque reflue costituiscono un vero e proprio problema ambientale. In particolare, le emissioni odorigene derivanti dall’esercizio di impianti in zone turistiche sono considerate la principale causa di disturbo notato dalla popolazione esposta. La valutazione dell’impatto indotto può essere effettuata attraverso la misurazione degli odori, utilizzando un metodo analitico, sensoriale o misto. Il sensoriale, legato al “sensore umano” è causa di notevole incertezza. L'analitico-strumentale è in grado di identificare e quantificare solo la concentrazione dei composti chimici singoli o multipli ma non l'odore complessivo di una miscela. Pertanto, integrando entrambi i metodi, nel presente articolo si vuole mostrare l’applicazione di una procedura di tipo senso-strumentale (GC/MS con porta ODP). I risultati ottenuti in uno SWWTP hanno dimostrato l’applicabilità di tale procedura nel monitoraggio delle emissioni odorigene ed hanno permesso l’identificazione di 39 sostanze diverse di cui quasi la metà responsabili di disturbi olfattivi.    
Enteral Ciprofloxacin or Levofloxacin for Ventilator-Associated Tracheobronchitis in...
Christina Smith
Caroline Sierra

Christina Smith

and 3 more

June 22, 2021
Introduction Pseudomonas aeruginosa is the most commonly isolated organism in children with ventilator-associated tracheobronchitis (VAT). Enteral treatment with ciprofloxacin or levofloxacin is sometimes employed, but supportive data are limited. The purpose of this study was to evaluate the effectiveness and safety of enteral ciprofloxacin and levofloxacin administration for VAT in children. Methods This was a retrospective review of electronic medical records for children less than 18 years of age who received enteral ciprofloxacin or levofloxacin for the treatment of VAT from January 2013 through January 2020 at an academic children’s hospital. Results Seventy-six children (median age 9.5, IQR 3.6-13.1 years), received ciprofloxacin or levofloxacin for VAT treatment during the study period. Median treatment duration was 8 (range 7-10) days. Most tracheostomy cultures (n=70/82, 85%) were polymicrobial, with P. aeruginosa most commonly isolated (n=67/224 organisms, 30%). Sixty-five children (86%) were successfully treated with an enteral fluoroquinolone. Antibiotics were changed or extended for two (3%) children. Ten (13%) children were prescribed antibiotics and eight (11%) required hospitalization for a lower respiratory tract infection within 30 days of completion of their fluoroquinolone course. Six (8%) patients received a seizure rescue medication, seven (9%) experienced emesis, and one (1%) had elevated transaminases. Tendonitis, tendon rupture and QTc prolongation were not observed. Conclusions The results of this study suggest enteral fluoroquinolones may be effective for the treatment of VAT in children. Further study is warranted to clarify the role of these agents in pediatric VAT.
Derived Storage Allocation Rules to Meet Shared Water Demands for Optimal Operation o...
Fang Wan
Yu Wang

Fang Wan

and 3 more

June 22, 2021
The priority principle of storage allocation rules of serial cascade reservoirs within an inter-basin water supply can reduce water loss and reduce water supply times. Reasonable balancing curves for reservoirs in parallel are proposed and the proportional distribution of water is determined to illustrate the optimal allocation rule for different scheduling periods of reservoirs. The mutation point and slope are used to describe the segmentation of reservoirs in parallel. In addition, the optimization model is established with the objective function to minimize times of water shortage while the particle swarm optimization algorithm based on the immune evolutionary algorithm is applied to calibrate the balancing curves. Finally, the relative optimal water supply rule is obtained, providing a larger water supply capacity and higher storage synchronization of member reservoirs. The reservoir groups downstream of Luan River are used as an example, with the results showing that the suggested method can effectively improve the operational performance and meet shared water demands in an inter-basin multi-reservoir. This article highlights the superior results obtained compared to the current storage allocation rules to meet shared water demands.
Fluvial Suspended Sediment Transfer and Lacustrine Sedimentation of Recent Flood Turb...
Erik Schiefer
Jason Geck

Erik Schiefer

and 6 more

June 22, 2021
Suspended sediment delivery and deposition in proglacial lakes is generally sensitive to a wide range of hydrometeorologic and geomorphic controls. High discharge conditions are of particular importance in many glaciolacustrine records, with individual floods potentially recorded as distinctive turbidites. We used an extensive network of surface sediment cores and hydroclimatic monitoring data to analyze recent flood turbidites and associated sediment transfer controls over instrumental periods at Eklutna Lake, western Chugach Mountains, Alaska. Close to a decade of fluvial data from primary catchment tributaries show a dominating influence of discharge on sediment delivery, with various interconnections with other related hydroclimatic controls. Multivariate fluvial models highlight and help quantify some complexities in sediment transfer, including intra-annual variations, meteorological controls, and the influence of subcatchment glacierization. Sediments deposited in Eklutna Lake during the last half century are discontinuously varved and contain multiple distinctive turbidites. Over a 30-year period of stratigraphic calibration, we correlate the four thickest flood turbidites (1989, 1995, 2006, 2012) to specific regional storms. The studied turbidites correlate with late-summer and early-autumn rainstorms with a magnitude of relatively instantaneous sedimentation 3 to 15 times greater than annual background accumulation. Our network of sediment core data captured the broad extent and sediment variability among the study turbidites and background sediment yield. Within-lake spatial modelling of deposition quantifies variable rates of downlake thinning and sediment focusing effects, and highlights especially large differences between the thickest flood turbidites and background sedimentation. This we primarily relate to strongly contrasting dispersion processes controlled by inflow current strength and turbidity. Sediment delivery is of interest for this catchment because of reservoir and water supply operations. Furthermore, although smaller floods may not be consistently represented, the lake likely contains a valuable proxy record of regional flooding proximal to major population centers of south-central Alaska including Anchorage.
Factors influencing the habitat choice of pangolins (Manis spp.) in low land of Nepal
Arati Shrestha
Santosh  Bhattarai

Arati Shrestha

and 3 more

June 22, 2021
Pangolins in the genus Manis are nocturnal, burrowing, insectivorous mammals listed as Critically Endangered or Endangered by the International Union for Conservation of Nature. Of the eight extant pangolin species worldwide, two species are found in Nepal: the Chinese pangolin (Manis pentadactyla) and the Indian pangolin (Manis crassicaudata). Despite having a great ecological role by controlling the ants or termite population, little attention has been given to the conservation interventions of both species of pangolins found in the Terai region (low land) of Nepal. The present study assesses habitat use and factors affecting the habitat choice of pangolins in low land (Terai), Nepal. The research was focused on Amritdharapani community forest of Chitwan district. Pangolin burrows were used as the indirect signs of pangolin presence. A total of thirty-nine burrows were observed at elevations ranging from 301 to 413 m asl. Burrows were frequently associated with north-west aspects, gentle slope (15º to 20º), moderate canopy cover (51 to 75%), red-colored soil, and acidic soils with pH 6.5 to 7. The burrows were most common in areas with weak human disturbance (i.e. 1500 to 1700 m from settlements), 800 to 1200 m from roads, and with-in 300 m from a water source and with-in 20 m from the nearest termitarium. This study revealed distance to settlement, distance to road, soil pH, and canopy cover as major factors affecting the habitat choice of pangolins in the study area.
A signature-based approach to quantify soil moisture dynamics under contrasting land-...
Ryoko Araki
Flora Branger

Ryoko Araki

and 3 more

December 21, 2021
Soil moisture signatures provide a promising solution to overcome the difficulty of evaluating soil moisture dynamics in hydrologic models. Soil moisture signatures are metrics that quantify the dynamic aspects of soil moisture timeseries and enable process-based model evaluations. To date, soil moisture signatures have been tested only under limited land-use types. In this study, we explore soil moisture signatures’ ability to discriminate different dynamics among contrasting land-uses. We applied a set of nine soil moisture signatures to datasets from six in-situ soil moisture networks worldwide. The dataset covered a range of land-use types, including forested and deforested areas, shallow groundwater areas, wetlands, urban areas, grazed areas, and cropland areas. Our set of signatures characterized soil moisture dynamics at three temporal scales: event, season, and a complete timeseries. Statistical assessment of extracted signatures showed that (1) event-based signatures can distinguish different dynamics for all the land-uses, (2) season-based signatures can distinguish different dynamics for some types of land-uses (deforested vs. forested, urban vs. greenspace, and cropped vs. grazed vs. grassland contrasts), (3) timeseries-based signatures can distinguish different dynamics for some types of land-uses (deforested vs. forested, urban vs. greenspace, shallow vs. deep groundwater, wetland vs. non-wetland, and cropped vs. grazed vs. grassland contrasts). Further, we compared signature-based process interpretations against literature knowledge; event-based and timeseries-based signatures generally matched well with previous process understandings from literature, but season-based signatures did not. This study will be a useful guideline for understanding how catchment-scale soil moisture dynamics in various land-uses can be described using a standardized set of hydrologically relevant metrics.
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