ATS Core Curriculum 2021. Pediatric Pulmonary Medicine: Pulmonary Infections

The following is a concise review of the Pediatric Pulmonary Medicine Core reviewing pediatric pulmonary infections, diagnostic assays, and imaging techniques presented at the 2021 American Thoracic Society Core Curriculum. Molecular methods have revolutionized microbiology. We highlight the need to collect appropriate samples for detection of specific pathogens or for panels and understand the limitations of the assays. Considerable progress has been made in imaging modalities for detecting pediatric pulmonary infections. Specifically, lung ultrasound and lung magnetic resonance imaging are promising radiation-free diagnostic tools, with results comparable with their radiation-exposing counterparts, for the evaluation and management of pulmonary infections. Clinicians caring for children with pulmonary disease should ensure that patients at risk for nontuberculous mycobacteria disease are identified and receive appropriate nontuberculous mycobacteria screening, monitoring, and treatment. Children with coronavirus disease (COVID-19) typically present with mild symptoms, but some may develop severe disease. Treatment is mainly supportive care, and most patients make a full recovery. Anticipatory guidance and appropriate counseling from pediatricians on social distancing and diagnostic testing remain vital to curbing the pandemic. The pediatric immunocompromised patient is at risk for invasive and opportunistic pulmonary infections. Prompt recognition of predisposing risk factors, combined with knowledge of clinical characteristics of microbial pathogens, can assist in the diagnosis and treatment of specific bacterial, viral, or fungal diseases

Retraction Note: An apoptosis-enhancing drug overcomes platinum resistance in a tumour-initiating subpopulation of ovarian cancer.

This Article has been retracted; see accompanying Retraction Note

All-Solid-State Batteries Using Rationally Designed Garnet Electrolyte Frameworks

Functioning bulk-type all-solid-state batteries in a practical form factor with composite positive electrodes, using Al-substituted Li7La3Zr2O12 (LLZO) as the solid electrolyte, have been demonstrated for the first time. The devices incorporate bilayers composed of dense LLZO membranes and porous LLZO scaffolds infiltrated with LiNi0.6Mn0.2Co0.2O2 and other components as positive electrodes, combined with lithium anodes. The porous scaffolds are prepared using an easily scaled freeze-tape-casting method. The unidirectional pores of the scaffold facilitate infiltration of cathode components and shorten lithium ion diffusion path lengths, while the addition of a soft ionically conductive solid to the scaffold ensures good contact among the components

Rabbit Production in Selected Urban Areas of Southern Ghana: Status and Implications for Policy and Research

A survey was conducted to elicit information on rabbit keeping in 26 urban areas of southern Ghana. The average age of the rabbit keepers was 44.3 years, and 95.5% of the keepers had formal education. Most of the producers got into rabbit keeping for money to meet urgent family needs, while household consumption was a major factor influencing the decision for rearing rabbits. Personal savings was the main source of income for the establishment of the rabbit enterprises. The major breeds of rabbits kept were the California White, New Zealand White and crossbreds of varied genetic variations. Backyard, small-scale and medium-scale commercial rabbit holdings were held by 18.2, 51.7 and 30.2% of the keepers respectively. The average rabbit population per farm was 77.8, with an average of 8.4 bucks, 21.6 does. Young rabbits formed 70.0% of the rabbit population. Owners of rabbitries usually cared for their animals as hired labour was expensive and often not available. High cost of feed was the most significant constraint to rabbit keeping, and mange was the most common disease affecting the rabbits. Marketing of rabbits was not organized, and this served as a disincentive to expanding the holdings. The rabbits were mostly sold either life or as fresh carcasses at the farm gate. To ensure a rapid growth of the rabbit industry, research should be undertaken to address the identified constraints to production while appropriate policies are put in place to enhance the growth of the industry

Quantifying the behavior of stock correlations under market stress

Understanding correlations in complex systems is crucial in the face of turbulence, such as the ongoing financial crisis. However, in complex systems, such as financial systems, correlations are not constant but instead vary in time. Here we address the question of quantifying state-dependent correlations in stock markets. Reliable estimates of correlations are absolutely necessary to protect a portfolio. We analyze 72 years of daily closing prices of the 30 stocks forming the Dow Jones Industrial Average (DJIA). We find the striking result that the average correlation among these stocks scales linearly with market stress reflected by normalized DJIA index returns on various time scales. Consequently, the diversification effect which should protect a portfolio melts away in times of market losses, just when it would most urgently be needed. Our empirical analysis is consistent with the interesting possibility that one could anticipate diversification breakdowns, guiding the design of protected portfolios

Inertia based microfluidic capture and characterisation of circulating tumour cells for the diagnosis of lung cancer

Background: Routine clinical application of circulating tumour cells (CTCs) for blood based diagnostics is yet to be established. Despite growing evidence of their clinical utility for diagnosis, prognosis and treatment monitoring, the efficacy of a robust platform and universally accepted diagnostic criteria remain uncertain. We evaluate the diagnostic performance of a microfluidic CTC isolation platform using cytomorphologic criteria in patients undergoing lung cancer surgery. Methods: Blood was processed from 51 patients undergoing surgery for known or suspected lung cancer using the ClearBridge ClearCell FX systemTM (ClearBridge Biomedics, Singapore). Captured cells were stained on slides with haematoxylin and eosin (H&E) and independently assessed by two pathologist teams. Diagnostic performance was evaluated against the pathologists reported diagnosis of cancer from surgically obtained specimens. Results: Cancer was diagnosed in 43.1% and 54.9% of all cases. In early stage primary lung cancer, between the two reporting teams, a positive diagnosis of CTCs was made for 50% and 66.7% of patients. The agreement between the reporting teams was 80.4%, corresponding to a kappa-statistic of 0.61±0.11 (P<0.001), indicating substantial agreement. Sensitivity levels for the two teams were calculated as 59% (95% CI, 41–76%) and 41% (95% CI, 24–59%), with a specificity of 53% for both. Conclusions: The performance of the tested microfluidic antibody independent device to capture CTCs using standard cytomorphological criteria provides the potential of a diagnostic blood test for lung cancer

The Relationship of Corporate Financial Performance and Innovation among Manufacturing Industries

Innovation is becoming a critical determinant of the survival and advancement of firms. Despite this realization, there is a dearth of literature that tackles the subject matter and its specific role in corporate settings remains vague. Using corporate data on East and Southeast Asian manufacturing firms from 2008 to 2013, this study aims to identify the impact of corporate financial performance on research and development (R&D) expenditure as a measure of innovation. On the whole, the researchers utilized random effects (REM) and fixed effects (FEM) models to establish the relationship between R&D and corporate performance. The researchers, then, identified the factors that affected R&D. The researchers found that sales, profitability, and cash flow have positive relationships with R&D. Moreover, when firm size is considered, the researchers discovered that R&D determinants for large manufacturing firms were different - total profitability and liabilities and debt - from those of SMEs - number of employees and sales for SMEs

Combining Fine- and Coarse-Grained Classifiers for Diabetic Retinopathy Detection

Visual artefacts of early diabetic retinopathy in retinal fundus images are usually small in size, inconspicuous, and scattered all over retina. Detecting diabetic retinopathy requires physicians to look at the whole image and fixate on some specific regions to locate potential biomarkers of the disease. Therefore, getting inspiration from ophthalmologist, we propose to combine coarse-grained classifiers that detect discriminating features from the whole images, with a recent breed of fine-grained classifiers that discover and pay particular attention to pathologically significant regions. To evaluate the performance of this proposed ensemble, we used publicly available EyePACS and Messidor datasets. Extensive experimentation for binary, ternary and quaternary classification shows that this ensemble largely outperforms individual image classifiers as well as most of the published works in most training setups for diabetic retinopathy detection. Furthermore, the performance of fine-grained classifiers is found notably superior than coarse-grained image classifiers encouraging the development of task-oriented fine-grained classifiers modelled after specialist ophthalmologists.Comment: Pages 12, Figures

Parametric optimization for improving the machining process of Cu/Mo-SiCP composites produced by powder metallurgy

The features of composite materials such as production flexibility, lightness, and excellent strength put them in the class of materials that attract attention in various critical areas, i.e., aerospace, defense, automotive, and shipbuilding. However, the machining of composite materials displays challenges due to the difficulty in obtaining structural integrity. In this study, Cu/Mo-SiCP composite materials were produced by powder metallurgy with varied reinforcement ratios and then their machinability was investigated. In machinability experiments, the process parameters were selected as cutting speed (vC), feed rate (f), depth of cut (aP), and reinforcement ratio (RR). Two levels of these parameters were taken as per the Taguchi’s L8 orthogonal array, and response surface methodology (RSM) is employed for parametric optimization. As a result, the outcomes demonstrated that RR = 5%, f = 0.25 mm/rev, aP = 0.25 mm, vC = 200 m/min for surface roughness, RR = 0%, f = 0.25 mm/rev and aP = 0.25 mm and vC = 200 m/min for flank wear and RR = 0%, f = 0.25 mm/rev, aP = 0.25 mm, vC = 150 m/min for cutting temperature for cutting temperature and flank wear should be selected for the desired results. In addition, ANOVA results indicate that reinforcement ratio is the dominant factor on all response parameters. Microscope images showed that the prominent failure modes on the cutting tool are flank wear, built up edge, and crater wear depending on reinforcement ratio

Moving the needle: Directed intervention by the American Society for Surgery of the Hand is effective in encouraging diversity in expert panel composition

PURPOSE: Recent efforts have been made by the American Society for Surgery of the Hand to encourage female inclusion in expert panels. We hypothesized that female representation on expert panels has increased over the past decade and that a directed intervention by the American Society for Surgery of the Hand would be associated with an increased percentage of submissions with female panelists. METHODS: We performed a retrospective analysis of Instructional Course Lecture and Symposium submissions for the 2011 through 2021 American Society for Surgery of the Hand Annual Meetings. Authorship was reviewed, and the gender of the proposed authors was recorded. Additionally, the status of all-male panel was attributed to panels with no proposed female authors. Submissions were reviewed and compared with meeting programs to determine the status of accepted or rejected. Longitudinal analysis was performed to determine trends in the gender composition of expert panels. RESULTS: In total, 1,687 submissions were reviewed, including 1,323 Instructional Course Lectures and 364 Symposia. Female authorship constituted 18% of authorship (1,170/6,663), and lead authorship was similarly distributed, with 18% being female (296/1,687). Overall, female representation has increased steadily over the past decade, with females constituting 13% (43/332) and 20% (163/818) of the submitted authors in 2011 and 2020, respectively. Similarly, all-male panels declined from 74% (76/103) to 46% (85/185) of panels over the same timeframe. Most strikingly, a sharp increase in gender representation was observed with the directed intervention noted in the 2021 Call for Abstracts, resulting in an increase in female authorship to 26% (295/1,124) and a decline in all-male panels to 29% (70/241). CONCLUSIONS: Gender representation among hand surgery expert panels moved toward increased equity over the past decade, which has been aided by directed interventions. CLINICAL RELEVANCE: Career development and trainee decision making are impacted by gender representation; directed and intentional interventions by professional organizations are effective in encouraging greater equity and diversity within the field